1
|
Bulut M, Celik FB, Guvenc TS, Yilmaz Y, Celik M, Ozyildirim S, Gocer K, Asik M, Kul S, Caliskan M. Usefulness of triglyceride-glucose index and homeostatic model assessment for predicting coronary microvascular dysfunction. J Clin Lipidol 2024:S1933-2874(24)00183-1. [PMID: 38955587 DOI: 10.1016/j.jacl.2024.04.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/21/2024] [Accepted: 04/25/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) is a common occurrence in individuals with insulin resistance (IR). Homeostatic model assessment for insulin resistance (HOMA-IR) is a widely used surrogate marker of IR, although recent studies suggest Triglyceride-Glucose (TyG) index is a superior marker of IR that had a better accuracy to predict Type 2 Diabetes or cardiovascular outcomes than HOMA-IR. OBJECTIVES We aimed to assess the accuracy and usefulness of TyG index and HOMA-IR for predicting CMD as assessed with echocardiographic coronary flow reserve (CFR) measurement. METHODS All cases included in the institutional CFR registry were retrospectively reviewed, and 656 cases without epicardial coronary artery disease and without major risk factors for atherosclerosis were included. A CFR ≤2.0 was defined as CMD. RESULTS TyG index was available in all cases, while HOMA-IR was available in 398 cases. Both TyG index and HOMA-IR were associated with CMD on univariate analyses, while after adjustment for potential confounders HOMA-IR (OR:1.38, 95 %CI:1.14-1.67, p = 0.001) but not TyG index(OR:1.48, 95 %CI:0.82-2.67, p = 0.19) was associated with CMD. The predictive accuracy of HOMA-IR (c-statistic:0.63, 95 %CI:0.54-0.72, p = 0.003) was higher than TyG index(c-statistic:0.55, 95 %CI:0.47-0.63, p = 0.13), although the difference was not statistically significant (DeLong p = 0.23). There was strong evidence favoring a true difference between CMD vs. non-CMD groups for HOMA-IR (BF10:3507) but not for TyG index(BF10:0.66). CONCLUSIONS HOMA-IR, but not TyG index, is closely associated with CMD.
Collapse
Affiliation(s)
- Mustafa Bulut
- Sultanbeyli State Hospital, Department of Cardiology, Istanbul, Turkey (Dr Bulut)
| | - Fatma Betul Celik
- Istanbul Medeniyet University School of Medicine, Department of Cardiology, Istanbul, Turkey (Drs Celik, Yilmaz, Kul and Caliskan)
| | - Tolga Sinan Guvenc
- Istinye University School of Medicine, Department of Cardiology, Istanbul, Turkey (Dr Guvenc)
| | - Yusuf Yilmaz
- Istanbul Medeniyet University School of Medicine, Department of Cardiology, Istanbul, Turkey (Drs Celik, Yilmaz, Kul and Caliskan).
| | - Mehmet Celik
- Kartal Kosuyolu Heart and Research Hospital, Department of Cardiology, Istanbul, Turkey (Dr Celik)
| | - Serhan Ozyildirim
- Istanbul University-Cerrahpasa, Department of Cardiology, Cardiology Institute, Istanbul, Turkey (Dr Ozyildirim)
| | - Kemal Gocer
- Necip Fazil State Hospital, Department of Cardiology, Kahramanmaras, Turkey
| | - Murat Asik
- Istanbul Medeniyet University School of Medicine (Dr Asik), Department of Radiology, Istanbul, Turkey
| | - Seref Kul
- Istanbul Medeniyet University School of Medicine, Department of Cardiology, Istanbul, Turkey (Drs Celik, Yilmaz, Kul and Caliskan)
| | - Mustafa Caliskan
- Istanbul Medeniyet University School of Medicine, Department of Cardiology, Istanbul, Turkey (Drs Celik, Yilmaz, Kul and Caliskan)
| |
Collapse
|
2
|
İrgi T, Baycan ÖF, Güvenç TS, Özcan FB, Atıcı A, Yılmaz Y, Çalişkan M. Concomitant amyloidosis is the primary cause of endothelial and coronary microvascular dysfunction in carpal tunnel syndrome. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 41:100393. [PMID: 38655035 PMCID: PMC11035090 DOI: 10.1016/j.ahjo.2024.100393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
Study objectives Patients with carpal tunnel syndrome (CTS) show manifestations of arterial abnormalities, including carotid intimal thickening and increased vascular stiffness. As carpal tunnel syndrome is associated with amyloidosis, we hypothesized that previously observed abnormalities can largely be related with concomitant amyloidosis rather than CTS itself. Design Prospective observational study. Setting Medeniyet University Goztepe Hospital. Participants 61 patients with CTS (of whom 32 had biopsy-proven amyloidosis) and 36 healthy controls. Interventions Subjects underwent ultrasound examinations for the measurement of coronary flow velocity reserve (CFVR), flow-mediated vasodilatation (FMD) and carotid intimal-media thickness (CIMT). Main outcome measures Comparison of CFVR, FMD and CIMT in CTS patients with or without amyloidosis. Results Patients with either CTS or CTS with concomitant amyloidosis (CTS-A) had significantly lower FMD (9.7 % ± 4.0 % in CTS and 10.3 % ± 4.6 % in CTS-A groups, p < 0.05 for both) and CFVR (2.4 (2.1-2.8) in CTS and 1.8 (1.6-2.1) in CTS-A groups, p < 0.001 for both) as compared to controls, while CIMT was only increased in CTS-A group (0.70 (0.60-0.80), p < 0.001). The reduction in CFVR was solely related to an increased basal flow velocity in CTS patients while there was also a reduced hyperemic flow velocity in patients with CTS-A. Conclusion Most arterial phenomena in CTS patients could be attributable to concomitant amyloidosis, although endothelial dysfunction was present even in patients with CTS without amyloidosis.
Collapse
Affiliation(s)
- Tuğçe İrgi
- Istanbul Medeniyet University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Ömer Faruk Baycan
- Istanbul Medeniyet University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Tolga Sinan Güvenç
- Istinye University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Fatma Betül Özcan
- Istanbul Medeniyet University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Adem Atıcı
- Istanbul Medeniyet University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Yusuf Yılmaz
- Istanbul Medeniyet University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Mustafa Çalişkan
- Istanbul Medeniyet University School of Medicine, Department of Cardiology, Istanbul, Turkey
| |
Collapse
|
3
|
Ozyildirim S, Barman HA, Dogan O, Ersanli MK, Dogan SM. The Relationship between Coronary Flow Reserve and the TyG Index in Patients with Gestational Diabetes Mellitus. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1811. [PMID: 37893529 PMCID: PMC10608421 DOI: 10.3390/medicina59101811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Gestational diabetes mellitus (GDM) is a prevalent metabolic disorder characterized by glucose intolerance during pregnancy. The triglyceride glucose (TyG) index, a marker of insulin resistance, and coronary flow reserve (CFR), a measure of coronary microvascular function, are emerging as potential indicators of cardiovascular risk. This study aims to investigate the association between CFR and the TyG index in GDM patients. Materials and Methods: This cross-sectional study of 87 GDM patients and 36 healthy controls was conducted. The participants underwent clinical assessments, blood tests, and echocardiographic evaluations. The TyG index was calculated as ln(triglycerides × fasting glucose/2). CFR was measured using Doppler echocardiography during rest and hyperemia induced by dipyridamole. Results: The study included 87 individuals in the GDM group and 36 individuals in the control group. There was no significant difference in age between the two groups (34.1 ± 5.3 years for GDM vs. 33.1 ± 4.9 years for the control, p = 0.364). The TyG index was significantly higher in the GDM group compared to the controls (p < 0.001). CFR was lower in the GDM group (p < 0.001). A negative correlation between the TyG index and CFR was observed (r = -0.624, p < 0.001). Linear regression revealed the TyG index as an independent predictor of reduced CFR. Conclusions: The study findings reveal a significant association between the TyG index and CFR in GDM patients, suggesting their potential role in assessing cardiovascular risk.
Collapse
Affiliation(s)
| | - Hasan Ali Barman
- Institute of Cardiology, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul 34320, Turkey; (S.O.); (O.D.); (M.K.E.); (S.M.D.)
| | | | | | | |
Collapse
|
4
|
Kul S, Caliskan Z, Guvenc TS, Celik FB, Sarmis A, Atici A, Konal O, Akıl M, Cumen AS, Bilgic NM, Yilmaz Y, Caliskan M. Gut microbiota-derived metabolite trimethylamine N-oxide and biomarkers of inflammation are linked to endothelial and coronary microvascular function in patients with inflammatory bowel disease. Microvasc Res 2023; 146:104458. [PMID: 36471530 DOI: 10.1016/j.mvr.2022.104458] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/31/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD), which is an umbrella term used for ulcerative colitis (UC) and Crohn's disease (CD), is associated with an increased risk for atherosclerotic cardiovascular disease (CVD). We aimed to investigate the association of local and systemic biomarkers of inflammation and gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) with endothelial and coronary microvascular dysfunction in IBD. METHODS A total of 56 patients with IBD (20 with UC and 36 with CD) and 34 age and gender matched controls were included. For all participants, samples were collected to analyze faecal calprotectin, and TMAO concentrations. Ultrasound-based examinations were done to measure flow-mediated vasodilatation (FMD) and coronary flow velocity reserve (CFVR). RESULTS Patients with IBD had lower CFVR (2.07 (1.82-2.40)) and FMD (8.7 ± 3.7) as compared to controls (2.30 (2.07-2.74), p = 0.005 and 11.9 ± 6.8, p = 0.03). In patients with IBD, TMAO concentration (r = -0.30, p = 0.03), C-reactive protein (r = -0.29, p = 0.03) and WBC count (r = -0.37, p = 0.006) had a significant negative correlation with CFVR, and TMAO (β = -0.27, 95 % CI: -0.23 to -0.02) and WBC count (β = -0.31, 95 % CI: -0.56 to -0.06) were significant predictors of CFVR after multivariate adjustment. None of the biomarkers of inflammation or TMAO showed significant correlations with FMD. In patients with UC, TMAO showed a significant correlation with both CFVR (r = -0.55, p = 0.01) and FMD (r = -0.60, p = 0.005) while only WBC count had a statistically significant correlation with CFVR (r = -0.49, p = 0.004) in patients with CD. CONCLUSIONS Gut microbiota-derived metabolite TMAO and biomarkers of systemic inflammation are associated with measures of endothelial/coronary microvascular dysfunction in patients with IBD.
Collapse
Affiliation(s)
- Seref Kul
- Cardiology Department, Istanbul Medeniyet University, Faculty of Medicine, Prof Dr Suleyman Yalcin City Hospital, Dr. Erkin street, 34722 Istanbul, Turkey
| | - Zuhal Caliskan
- Gastroenterology Department, Istanbul Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Tolga Sinan Guvenc
- Department of Cardiology, Istinye University Faculty of Medicine, Istanbul, Turkey
| | - Fatma Betul Celik
- Cardiology Department, Istanbul Medeniyet University, Faculty of Medicine, Prof Dr Suleyman Yalcin City Hospital, Dr. Erkin street, 34722 Istanbul, Turkey
| | - Abdurrahman Sarmis
- Department of Medical Microbiology Laboratory, Prof Dr Suleyman Yalcin City Hospital, Dr. Erkin street, 34722 Istanbul, Turkey
| | - Adem Atici
- Cardiology Department, Istanbul Medeniyet University, Faculty of Medicine, Prof Dr Suleyman Yalcin City Hospital, Dr. Erkin street, 34722 Istanbul, Turkey
| | - Oguz Konal
- Cardiology Department, Istanbul Medeniyet University, Faculty of Medicine, Prof Dr Suleyman Yalcin City Hospital, Dr. Erkin street, 34722 Istanbul, Turkey
| | - Mesut Akıl
- Department of Parasitology, Faculty of Medicine, Istanbul Medeniyet University, Prof Dr Suleyman Yalcin City Hospital, Dr. Erkin street, 34722 Istanbul, Turkey
| | - Ahmet Selin Cumen
- Cardiology Department, Istanbul Medeniyet University, Faculty of Medicine, Prof Dr Suleyman Yalcin City Hospital, Dr. Erkin street, 34722 Istanbul, Turkey
| | - Nermin Mutlu Bilgic
- Gastroenterology Department, Istanbul Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Yilmaz
- Cardiology Department, Istanbul Medeniyet University, Faculty of Medicine, Prof Dr Suleyman Yalcin City Hospital, Dr. Erkin street, 34722 Istanbul, Turkey
| | - Mustafa Caliskan
- Cardiology Department, Istanbul Medeniyet University, Faculty of Medicine, Prof Dr Suleyman Yalcin City Hospital, Dr. Erkin street, 34722 Istanbul, Turkey.
| |
Collapse
|
5
|
Civieri G, Montisci R, Kerkhof PLM, Iliceto S, Tona F. Coronary Flow Velocity Reserve by Echocardiography: Beyond Atherosclerotic Disease. Diagnostics (Basel) 2023; 13:diagnostics13020193. [PMID: 36673004 PMCID: PMC9858233 DOI: 10.3390/diagnostics13020193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
Coronary flow velocity reserve (CFVR) is defined as the ratio between coronary flow velocity during maximal hyperemia and coronary flow at rest. Gold-standard techniques to measure CFVR are either invasive or require radiation and are therefore inappropriate for large-scale adoption. More than 30 years ago, echocardiography was demonstrated to be a reliable tool to assess CFVR, and its field of application rapidly expanded. Although initially validated to assess the hemodynamic relevance of a coronary stenosis, CFVR by echocardiography was later used to investigate coronary microcirculation. Microvascular dysfunction was detected in many different conditions, ranging from organ transplantation to inflammatory disorders and from metabolic diseases to cardiomyopathies. Moreover, it has been proven that CFVR by echocardiography not only detects coronary microvascular involvement but is also an effective prognostic factor that allows a precise risk stratification of the patients. In this review, we will summarize the many applications of CFVR by echocardiography, focusing on the coronary involvement of systemic diseases.
Collapse
Affiliation(s)
- Giovanni Civieri
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
| | - Roberta Montisci
- Clinical Cardiology, AOU Cagliari, Department of Medical Science and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Peter L. M. Kerkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VUmc, 1081 HV Amsterdam, The Netherlands
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
| | - Francesco Tona
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
- Correspondence: ; Tel.: +39-049-8211844
| |
Collapse
|
6
|
Coronary flow velocity reserve is reduced in patients with an exaggerated blood pressure response to exercise. Hypertens Res 2022; 45:1653-1663. [DOI: 10.1038/s41440-022-00995-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/18/2022] [Accepted: 06/23/2022] [Indexed: 11/09/2022]
|
7
|
Stanhewicz AE, Schlarmann RL, Brustkern KM, Jalal D. Oxidative stress contributes to reductions in microvascular endothelial- and nitric oxide-dependent dilation in women with a history of gestational diabetes. J Appl Physiol (1985) 2022; 133:361-370. [PMID: 35796611 PMCID: PMC9359638 DOI: 10.1152/japplphysiol.00189.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Women with a history of gestational diabetes mellitus (GDM) are twice as likely to develop cardiovascular disease and ~7x as likely to develop type II diabetes as their age-matched counterparts. However, the mechanism(s) mediating these associations remain unclear. We hypothesized that endothelium- and NO-dependent dilation would be attenuated through oxidant stress mechanisms in the microvasculature of women with a history of GDM compared to control women with a history of uncomplicated pregnancy (HC). Ten HC (35±4yrs) and 10 GDM (34±4yrs) underwent a standard local heating protocol (42°C; 0.1°C·s-1). Two intradermal microdialysis fibers were placed in the ventral forearm for local delivery of lactated Ringer's (control), or 5mM L-ascorbate. After full expression of the local heating response, 15mM NG-nitro-L-arginine methyl ester NO synthase-inhibition) was perfused. Red cell flux was measured continuously by laser-Doppler flowmetry and cutaneous vascular conductance (CVC=flux/MAP) was standardized to maximum (%CVCmax; 28mM SNP + 43°C). Urine albumin:creatinine ratio (ACR) was measured. GDM had attenuated endothelium-dependent (GDM: 67±7 vs. HC: 90±4%CVCmax; p<0.001) and NO-dependent (GDM: 54±7 vs. HC: 71±3%; p=0.001) dilation at the control site and tended to have higher urine ACR (p=0.06). Both endothelium-dependent (r2=0.53, p=0.02) and NO-dependent (r2=0.56, p=0.01) dilation were related to urine ACR in GDM. L-ascorbate perfusion improved endothelium-dependent (82±5%CVCmax; p=0.03 vs. control) and NO-dependent (68±5%; p=0.02 vs. control) dilation in GDM but had no effect in HC (p>0.05). Otherwise healthy women with a history of GDM have attenuated microvascular endothelial function and this dysfunction is mediated, in part, by oxidative stress.
Collapse
Affiliation(s)
- Anna E Stanhewicz
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa, United States
| | - Rowan L Schlarmann
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa, United States
| | - Kaila M Brustkern
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa, United States
| | - Diana Jalal
- The Iowa City VA HCS, Iowa City, IA, United States.,Department of Internal Medicine, Carver College of Medicine, Iowa City, IA, United States
| |
Collapse
|
8
|
Çalışkan M, Baycan ÖF, Çelik FB, Güvenç TS, Atıcı A, Çağ Y, Konal O, İrgi T, Bilgili ÜZ, Ağırbaşlı MA. Coronary Microvascular Dysfunction is Common in Patients Hospitalized with COVID-19 Infection. Microcirculation 2022; 29:e12757. [PMID: 35437863 PMCID: PMC9115225 DOI: 10.1111/micc.12757] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 03/15/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022]
Abstract
Background and Aims Microvascular disease is considered as one of the main drivers of morbidity and mortality in severe COVID‐19, and microvascular dysfunction has been demonstrated in the subcutaneous and sublingual tissues in COVID‐19 patients. The presence of coronary microvascular dysfunction (CMD) has also been hypothesized, but direct evidence demonstrating CMD in COVID‐19 patients is missing. In the present study, we aimed to investigate CMD in patients hospitalized with COVID‐19, and to understand whether there is a relationship between biomarkers of myocardial injury, myocardial strain and inflammation and CMD. Methods 39 patients that were hospitalized with COVID‐19 and 40 control subjects were included to the present study. Biomarkers for myocardial injury, myocardial strain, inflammation, and fibrin turnover were obtained at admission. A comprehensive echocardiographic examination, including measurement of coronary flow velocity reserve (CFVR), was done after the patient was stabilized. Results Patients with COVID‐19 infection had a significantly lower hyperemic coronary flow velocity, resulting in a significantly lower CFVR (2.0 ± 0.3 vs. 2.4 ± 0.5, p < .001). Patients with severe COVID‐19 had a lower CFVR compared to those with moderate COVID‐19 (1.8 ± 0.2 vs. 2.2 ± 0.2, p < .001) driven by a trend toward higher basal flow velocity. CFVR correlated with troponin (p = .003, r: −.470), B‐type natriuretic peptide (p < .001, r: −.580), C‐reactive protein (p < .001, r: −.369), interleukin‐6 (p < .001, r: −.597), and d‐dimer (p < .001, r: −.561), with the three latter biomarkers having the highest areas‐under‐curve for predicting CMD. Conclusions Coronary microvascular dysfunction is common in patients with COVID‐19 and is related to the severity of the infection. CMD may also explain the “cryptic” myocardial injury seen in patients with severe COVID‐19 infection.
Collapse
Affiliation(s)
- Mustafa Çalışkan
- Medeniyet University, Faculty of Medicine, Department of Internal Medical Sciences, Division of Cardiology, Istanbul, Turkey
| | - Ömer Faruk Baycan
- Medeniyet University, Faculty of Medicine, Department of Internal Medical Sciences, Division of Cardiology, Istanbul, Turkey
| | - Fatma Betül Çelik
- Medeniyet University, Faculty of Medicine, Department of Internal Medical Sciences, Division of Cardiology, Istanbul, Turkey
| | - Tolga Sinan Güvenç
- Istinye University School of Medicine, Department of Internal Medical Sciences, Division of Cardiology, Istanbul, Turkey
| | - Adem Atıcı
- Medeniyet University, Faculty of Medicine, Department of Internal Medical Sciences, Division of Cardiology, Istanbul, Turkey
| | - Yasemin Çağ
- Medeniyet University, Faculty of Medicine, Department of Internal Medical Sciences, Division of Cardiology, Istanbul, Turkey
| | - Oğuz Konal
- Medeniyet University, Faculty of Medicine, Department of Internal Medical Sciences, Division of Cardiology, Istanbul, Turkey
| | - Tuğçe İrgi
- Medeniyet University, Faculty of Medicine, Department of Internal Medical Sciences, Division of Cardiology, Istanbul, Turkey
| | - Ümmühan Zeynep Bilgili
- Medeniyet University, Faculty of Medicine, Department of Internal Medical Sciences, Division of Cardiology, Istanbul, Turkey
| | - Mehmet Ali Ağırbaşlı
- Medeniyet University, Faculty of Medicine, Department of Internal Medical Sciences, Division of Cardiology, Istanbul, Turkey
| |
Collapse
|
9
|
Kul Ş, Güvenç TS, Baycan ÖF, Çelik FB, Çalışkan Z, Çetin Güvenç R, Çiftçi FC, Caliskan M. Combined past preeclampsia and gestational diabetes is associated with a very high frequency of coronary microvascular dysfunction. Microvasc Res 2020; 134:104104. [PMID: 33189732 DOI: 10.1016/j.mvr.2020.104104] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/16/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND A history of preeclampsia (pPE) and gestational diabetes (pGDM) are female-specific risk markers for atherosclerosis and future cardiovascular risk. In addition to increasing the risk of established risk factors for atherosclerosis, such as hypertension or diabetes, evidence suggests that pregnancy-related complications can also directly accelerate atherosclerosis by inducing endothelial dysfunction. A combination of both conditions is seen in a subset of patients with pregnancy, though it is not known whether this combination increases the overall risk for cardiovascular events. AIMS Present study aimed to find the impact of combined pPE/pGDM on the prevalence of coronary microvascular dysfunction (CMD). METHODS A total of 24 patients with combined pPE/pGDM, 19 patients with isolated pPE and 63 patients with pGDM were included to the present study and a further 36 healthy women with no previous pregnancy-related complications served as controls. Coronary flow reserve was measured using echocardiography and CMD was defined as a coronary flow reserve ≤2.5. RESULTS Patients with combined pPE/pGDM had a high prevalence of CMD (91%), which was significantly higher than controls (5.6%, p < 0.001) and patients with pGDM (55%, p = 0.01). A history of pPE on top of pGDM was associated with an increased risk of CMD (HR:6.28, 95%CI:1.69-23.37, p = 0.006) after multivariate adjustment, but pGDM did not increase the odds for CMD in those with pPE. CONCLUSIONS Combined pPE/pDM is associated with a very high prevalence of CMD, which may indicate an increased risk for future cardiovascular events.
Collapse
Affiliation(s)
- Şeref Kul
- Istanbul Medeniyet University, Faculty of Medicine, Division of Cardiology, Istanbul, Turkey.
| | - Tolga Sinan Güvenç
- Kirklareli University, Faculty of Medicine, Department of Cardiology, Kirklareli, Turkey
| | - Ömer Faruk Baycan
- Istanbul Medeniyet University, Faculty of Medicine, Division of Cardiology, Istanbul, Turkey
| | - Fatma Betül Çelik
- Istanbul Medeniyet University, Faculty of Medicine, Division of Cardiology, Istanbul, Turkey
| | - Zuhal Çalışkan
- Umraniye Research and Training Hospital, Department of Gastroenterology, Istanbul, Turkey
| | - Rengin Çetin Güvenç
- Kirklareli University, Faculty of Medicine, Department of Cardiology, Kirklareli, Turkey
| | - Faika Ceylan Çiftçi
- Başkent University Faculty of Medicine, Konya Training and Practice Center, Konya, Turkey
| | - Mustafa Caliskan
- Istanbul Medeniyet University, Faculty of Medicine, Division of Cardiology, Istanbul, Turkey
| |
Collapse
|
10
|
Caliskan Z, Telci Caklili O, Kahraman R, Ozcan FB, Sayar S, Kostek O, Demircioglu K, Yilmaz Y, Kul S, Caliskan M. Does celiac disease impair coronary microvascular circulation: Coronary flow velocity reserve of patients with celiac disease. Echocardiography 2019; 37:34-40. [PMID: 31816123 DOI: 10.1111/echo.14554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/12/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Celiac disease (CD) is an enteropathy characterized with immune reaction to gliadin protein. AIM In this study, we aimed to assess effect of CD on coronary microvascular circulation and the association between coronary flow velocity reserve (CFVR) and hs-CRP/Albumin ratio. MATERIAL AND METHODS Study was conducted between March 2017 and November 2018 with CD at Umraniye Training and Research Hospital Gastroenterology Clinic. CFVR was defined as the ratio of hyperemic to baseline diastolic peak velocities. CFVR ≥ 2.0 was considered normal. C-reactive protein/albumin ratio (CAR) was calculated as hs-CRP/albumin. RESULTS Serum albumin (4.27 ± 0.56 vs 4.50 ± 0.34; P value: .04) level was significantly lower in celiac group but higher Hs-CRP (2.44 ± 1.24 vs 1.82 ± 1.29; P value < .01), hs-CRP/albumin ratio (0.57 ± 0.30 vs 0.41 ± 0.31; P value: .03) were recorded in celiac group. Both hyperemic flow and CFVR substantially lower in the celiac group compared to controls. In univariate analysis; age, hs-CRP, and hs-CRP/albumin ratio were associated with low CFVR and hs-CRP/albumin level was an accurate predictor of low CFVR at the ROC curve. CONCLUSION In this study, we found that in patients with CD, coronary flow reserve is impaired.
Collapse
Affiliation(s)
- Zuhal Caliskan
- Gastroenterology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ozge Telci Caklili
- Department of Endocrinology and Metabolism, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Resul Kahraman
- Gastroenterology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Fatma Betul Ozcan
- Cardiology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Suleyman Sayar
- Gastroenterology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | | | - Kenan Demircioglu
- Cardiology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Yilmaz
- Cardiology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Seref Kul
- Cardiology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Caliskan
- Cardiology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
11
|
Young L, Cho L. Unique cardiovascular risk factors in women. Heart 2019; 105:1656-1660. [PMID: 31315936 DOI: 10.1136/heartjnl-2018-314268] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/30/2019] [Accepted: 06/08/2019] [Indexed: 01/16/2023] Open
Abstract
Despite an overall reduction in cardiovascular disease (CVD) mortality in the USA, the rate of coronary heart disease and CVD mortality is on the rise in younger women aged 35 to 54 years. This has been attributed to an increasing prevalence of CVD risk factors, which can portend disparate outcomes in women versus men. Women with diabetes and those who smoke have an excess relative risk of CVD when compared with their male counterparts. In addition to these discrepancies in traditional risk factors, a number of clinical conditions unique to women have been shown to increase CVD risks such as pre-eclampsia, gestational diabetes, polycystic ovary syndrome, early menopause and autoimmune diseases. The majority of these sex-specific risk factors can be identified at an early age, allowing for aggressive risk factor modification through lifestyle changes and, in certain patients, medications. The recently published 2018 American College of Cardiology and American Heart Association (ACC/AHA) hypercholesterolaemia and 2019 ACC/AHA primary prevention guidelines reflect this, citing pre-eclampsia, early menopause and autoimmune diseases as 'risk enhancers' that if present may favour initiation of statin therapy in borderline or intermediate risk patients. This comprehensive review addresses both traditional and unique risk factors of CVD in women, as well as sex-specific risk stratification and management options.
Collapse
Affiliation(s)
- Laura Young
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Leslie Cho
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| |
Collapse
|
12
|
Tuzun D, Oguz A, Aydin MN, Kurutas EB, Ercan O, Sahin M, Ünsal V, Ceren I, Akçay A, Gul K. Is FGF-23 an early indicator of atherosclerosis and cardiac dysfunction in patients with gestational diabetes? ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:506-513. [PMID: 30462803 PMCID: PMC10118658 DOI: 10.20945/2359-3997000000070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/10/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Fibroblast growth factor 23 (FGF-23) is a phosphorus-regulating hormone and plays a role in the pathogenesis of myocardial hypertrophy. The aim of this study was to evaluate the association of FGF-23 levels with echocardiographic parameters and insulin resistance (IR) in patients with gestational diabetes. SUBJECTS AND METHODS Fifty-four pregnant patients with gestational diabetes mellitus (GDM) (age, 31.12 ± 5.72 years) and 33 healthy pregnant women (age, 29.51 ± 4.92 years) were involved in the study. Fasting insulin, fasting plasma glucose (FPG), lipid profile, oral glucose tolerance test (OGTT), FGF23, echocardiographic parameters, and carotid artery intima-media thickness (CIMT) were evaluated in the two groups. RESULTS The two groups were not significantly different in age, sex, body mass index, lipid profile, or blood pressure. Insulin, homeostatic model assessment-insulin resistance (HOMA-IR), FGF-23 levels, CIMT, left ventricular (LV) mass, LV mass index and myocardial performance index (MPI) were significantly higher in the GDM group. HOMA-IR was positively correlated with FGF-23, and insulin was positively correlated with FGF-23. Additionally, FGF-23 was positively correlated with CIMT, LV mass index, and MPI. CONCLUSION Our findings suggest that monitoring serum FGF-23 may be useful as a non-invasive indicator of subclinical atherosclerosis in patients with GDM.
Collapse
Affiliation(s)
- Dilek Tuzun
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Endocrinology and Metabolism, Kahramanmaras, Turkey
| | - Ayten Oguz
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Endocrinology and Metabolism, Kahramanmaras, Turkey
| | - Muhammet Naci Aydin
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Cardiology, Kahramanmaras, Turkey
| | - Ergul Belge Kurutas
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Biochemistry, Kahramanmaras, Turkey
| | - Onder Ercan
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Obstetric and Gynecology, Kahramanmaras, Turkey
| | - Murat Sahin
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Endocrinology and Metabolism, Kahramanmaras, Turkey
| | - Velid Ünsal
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Biochemistry, Kahramanmaras, Turkey
| | - Imran Ceren
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Cardiology, Kahramanmaras, Turkey
| | - Ahmet Akçay
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Cardiology, Kahramanmaras, Turkey
| | - Kamile Gul
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Endocrinology and Metabolism, Kahramanmaras, Turkey
| |
Collapse
|
13
|
Di Cianni G, Lacaria E, Lencioni C, Resi V. Preventing type 2 diabetes and cardiovascular disease in women with gestational diabetes - The evidence and potential strategies. Diabetes Res Clin Pract 2018; 145:184-192. [PMID: 29684619 DOI: 10.1016/j.diabres.2018.04.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/10/2018] [Indexed: 02/01/2023]
Abstract
Gestational Diabetes Mellitus is a condition strongly related to the development of type 2 diabetes later in life, although the risk and the onset have not been fully identified yet. Although glucose tolerance returns to normal levels after delivery in the majority of women with GDM, this condition represents an early stage in the natural history of T2DM. In addition, women with previous GDM exhibit an increased cardiovascular risk profile and a raised incidence of cardiovascular diseases. Lifestyle changes and pharmacological interventions might be able to reduce the incidence of type 2 diabetes in pGDM women, although results are still not conclusive. Long term continuous programs specifically addressed to women with pGDM should be implemented, with the ambitious target to encourage them to regularly check glucose tolerance, lipid profile and other parameters related to cardiovascular diseases, aimed at improving women's health. In this paper, we review the relationship between type 2 diabetes, cardiovascular diseases and a history of GDM.
Collapse
Affiliation(s)
- Graziano Di Cianni
- Diabetes and Metabolic Diseases Unit, Health Local Unit Nord-West Tuscany, Livorno Hospital, Livorno, Italy.
| | - Emilia Lacaria
- Diabetes and Metabolic Diseases Unit, Health Local Unit Nord-West Tuscany, Livorno Hospital, Livorno, Italy
| | - Cristina Lencioni
- Diabetes and Metabolic Diseases Unit, Health Local Unit Nord-West Tuscany, Lucca Hospital, Lucca, Italy
| | - Veronica Resi
- Diabetes Service, Unit of Endocrinology, IRCCS Cà Granda-Ospedale Maggiore Policlinico Foundation and Department of Medical Sciences, University of Milan, Milan, Italy
| |
Collapse
|
14
|
Mecacci F, Ottanelli S, Petraglia F. Mothers with HIP - The short term and long-term impact, what is new? Diabetes Res Clin Pract 2018; 145:146-154. [PMID: 29730389 DOI: 10.1016/j.diabres.2018.04.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 04/26/2018] [Indexed: 01/13/2023]
Abstract
Hyperglycemia is one of the most common medical conditions that women encounter during pregnancy and it is due to gestational diabetes (GDM) in the majority of cases (International Diabetes Federation, 2015) [1]. GDM is associated with a higher incidence of maternal morbidity in pregnancy in term of hypertensive disorders/preclampsia and higher rate of cesarean delivery but also with long-term risk of type 2 diabetes and cardiovascular disease. Pregnancy can therefore be considered a stress test; diagnosis of HIP can unmask a preexisting susceptibility and consequently a future risk for type 2 diabetes and can be a useful marker of future cardiovascular risk. Postpartum follow up provides an excellent opportunity to implement healthy lifestyle behaviors to prevent or delay the development of diabetes or cardiovascular disease. The aim of the current review is to focus on short and long term maternal morbidity of HIP.
Collapse
Affiliation(s)
- Federico Mecacci
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - Serena Ottanelli
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy.
| | - Felice Petraglia
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| |
Collapse
|
15
|
McKenzie-Sampson S, Paradis G, Healy-Profitós J, St-Pierre F, Auger N. Gestational diabetes and risk of cardiovascular disease up to 25 years after pregnancy: a retrospective cohort study. Acta Diabetol 2018; 55:315-322. [PMID: 29327149 DOI: 10.1007/s00592-017-1099-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/29/2017] [Indexed: 12/11/2022]
Abstract
AIMS The risk of cardiovascular disease in women with gestational diabetes is poorly understood. We sought to determine whether gestational diabetes increases the risk of cardiovascular disease more than two decades after pregnancy. METHODS We carried out a retrospective cohort study of 1,070,667 women who delivered infants in hospitals within Quebec, Canada, between 1989 and 2013. We followed 67,356 women with gestational diabetes and 1,003,311 without gestational diabetes for a maximum of 25.2 years after the index delivery. The main outcome measures were hospitalization for ischemic heart disease, myocardial infarction, coronary angioplasty, coronary artery bypass graft, and other cardiovascular disorders. We used Cox regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) comparing women with gestational diabetes to no gestational diabetes, adjusted for age, parity, socioeconomic deprivation, time period, and preeclampsia. RESULTS Women with gestational diabetes had a higher cumulative incidence of hospitalization for cardiovascular disease 25 years after delivery (190.8 per 1000 women) compared with no gestational diabetes (117.8 per 1000 women). Gestational diabetes was associated with a higher risk of ischemic heart disease (HR 1.23, 95% CI 1.12-1.36), myocardial infarction (HR 2.14, 95% CI 1.15-2.47), coronary angioplasty (HR 2.23, 95% CI 1.87-2.65), and coronary artery bypass graft (HR 3.16, 95% CI 2.24-4.47). CONCLUSIONS In this population of pregnant women, gestational diabetes was associated with an increased risk of heart disease 25 years after delivery. Women with gestational diabetes may merit closer monitoring for cardiovascular disease prevention after pregnancy.
Collapse
Affiliation(s)
- Safyer McKenzie-Sampson
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Institut national de santé publique du Québec, 190 Cremazie Blvd E, Montreal, QC, H2P 1E2, Canada
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Institut national de santé publique du Québec, 190 Cremazie Blvd E, Montreal, QC, H2P 1E2, Canada
| | - Jessica Healy-Profitós
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Institut national de santé publique du Québec, 190 Cremazie Blvd E, Montreal, QC, H2P 1E2, Canada
| | | | - Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, QC, Canada.
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
- Institut national de santé publique du Québec, 190 Cremazie Blvd E, Montreal, QC, H2P 1E2, Canada.
| |
Collapse
|
16
|
Kul S, Kutlu GA, Guvenc TS, Kavas M, Demircioglu K, Yilmaz Y, Yakar HI, Kanbay A, Boga S, Caliskan M. Coronary flow reserve is reduced in sarcoidosis. Atherosclerosis 2017; 264:115-121. [DOI: 10.1016/j.atherosclerosis.2017.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 04/28/2017] [Accepted: 05/04/2017] [Indexed: 11/16/2022]
|
17
|
Suhrs HE, Kristensen AM, Rask AB, Michelsen MM, Frestad D, Mygind ND, Bové K, Prescott E. Coronary microvascular dysfunction is not associated with a history of reproductive risk factors in women with angina pectoris-An iPOWER substudy. Maturitas 2017; 107:110-115. [PMID: 28807722 DOI: 10.1016/j.maturitas.2017.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/28/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Reproductive risk factors such as preeclampsia and recurrent miscarriages have been associated with adverse cardiovascular (CV) events. Underlying coronary microvascular dysfunction (CMD) may be a common denominator. PURPOSE We investigated whether a history of reproductive risk factors was associated with CMD in women with angina pectoris and no obstructive coronary artery disease (CAD). METHODS Participants from the iPOWER study, including women with angina pectoris and no obstructive CAD (<50% stenosis), were invited to complete an electronic survey regarding reproductive risk factors: recurrent miscarriages, gestational diabetes, preeclampsia, rhesus immunity, polycystic ovary syndrome and menopausal status as well as migraine and Raynaud phenomenon. CMD was assessed by transthoracic Doppler echocardiography with measurement of coronary flow velocity reserve (CFVR) during high-dose dipyridamole infusion, and analyzed in three categories with cut-off points at 2.0 and 2.5. Associations between CFVR and a history of reproductive risk factors were examined by age-adjusted trend test. RESULTS The questionnaire was completed by 613 women (73% of those invited), of whom 550 had a successful CFVR measurement. There was no significant difference in baseline characteristics between participants and non-participants. Median (interquartile range (IQR)) age was 62.8 (54.8; 68.7) years, median (IQR) BMI 26.2 (23.2; 29.8) kg/m2, and 81.5% were postmenopausal. We did not find any significant associations between any of the reproductive risk factors, Raynaud's phenomenon or migraine and CFVR. CONCLUSION The lack of association between coronary microvascular function and a history of reproductive risk factors, migraine and Raynaud's phenomenon suggests that a common vascular pathophysiological mechanism underlying these conditions is unlikely.
Collapse
Affiliation(s)
- Hannah Elena Suhrs
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark.
| | - Anna Meta Kristensen
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark
| | - Anna Bay Rask
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark
| | - Marie Mide Michelsen
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark
| | - Daria Frestad
- Department of Cardiology, Hvidovre Hospital, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Naja Dam Mygind
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Kira Bové
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark
| |
Collapse
|
18
|
Burlina S, Dalfrà MG, Chilelli NC, Lapolla A. Gestational Diabetes Mellitus and Future Cardiovascular Risk: An Update. Int J Endocrinol 2016; 2016:2070926. [PMID: 27956897 PMCID: PMC5124460 DOI: 10.1155/2016/2070926] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 12/13/2022] Open
Abstract
The prevalence of gestational diabetes mellitus is increasing in parallel with the rising prevalence of type 2 diabetes and obesity around the world. Current evidence strongly suggests that women who have had gestational diabetes mellitus are at greater risk of cardiovascular disease later in life. Given the growing prevalence of gestational diabetes mellitus, it is important to identify appropriate reliable markers of cardiovascular disease and specific treatment strategies capable of containing obesity, diabetes, and metabolic syndrome in order to reduce the burden of cardiovascular disease in the women affected.
Collapse
Affiliation(s)
- S. Burlina
- Department of Medicine (DIMED), University of Padova, Via Giustiniani, No. 2, 35128 Padova, Italy
| | - M. G. Dalfrà
- Department of Medicine (DIMED), University of Padova, Via Giustiniani, No. 2, 35128 Padova, Italy
| | - N. C. Chilelli
- Department of Medicine (DIMED), University of Padova, Via Giustiniani, No. 2, 35128 Padova, Italy
| | - A. Lapolla
- Department of Medicine (DIMED), University of Padova, Via Giustiniani, No. 2, 35128 Padova, Italy
| |
Collapse
|
19
|
Caliskan Z, Keles N, Gokturk HS, Ozdil K, Aksu F, Ozturk O, Kahraman R, Kostek O, Tekin AS, Ozgur GT, Caliskan M. Is activation in inflammatory bowel diseases associated with further impairment of coronary microcirculation? Int J Cardiol 2016; 223:176-181. [PMID: 27541650 DOI: 10.1016/j.ijcard.2016.08.141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 08/05/2016] [Accepted: 08/06/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Inflammatory bowel disease [IBD] includes a number of chronic relapsing diseases. In IBD intestinal microvascular endothelial cells are damaged by an abnormal immune response. Several studies have shown that IBD may cause increment in risk of developing atherosclerosis. IBD in activation was related to enhanced risks of worse cardiovascular [CV] outcome, on the other hand no risk increment was seen in remission comparing to control group in those studies. Coronary Flow Reserve [CFR] reflects coronary microvascular circulation. Coronary microvascular dysfunction may be defined as a predictor of CV outcome combined with previous described atherosclerotic risk factors. The present study was purposed to further evaluate whether or not CFR in the left anterior descending artery [LAD] is disturbed in IBD patients with activation in comparison to remission and healthy subjects. METHODS 62 patients with IBD and 39 healthy volunteers were enrolled into the study. Patients' demographics were recorded. CFR evaluation of patients with IBD in both activation and remission period and control group were performed with transthoracic echocardiography. RESULTS CFR was significantly lowest in the active period of the IBD [2.26 [2.08-2.55] vs. 2.55 [2.18-3.00] and 3.10 [2.85-3.29] p<0.001]. CFR is negatively correlated with disease activity scores of IBD. CONCLUSION This study showed that CFR is more prominently disturbed in patients with IBD in activation. The activation of disease may have a major role in the progression of coronary microcirculatory dysfunction and future cardiovascular events.
Collapse
Affiliation(s)
- Zuhal Caliskan
- Baskent University Department of Gastroenterology, Konya, Turkey
| | - Nursen Keles
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | | | - Kamil Ozdil
- Umraniye Training and Research Hospital Department of Gastroenterology, Istanbul,Turkey
| | - Feyza Aksu
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Oguzhan Ozturk
- Umraniye Training and Research Hospital Department of Gastroenterology, Istanbul,Turkey
| | - Resul Kahraman
- Umraniye Training and Research Hospital Department of Gastroenterology, Istanbul,Turkey
| | - Osman Kostek
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Internal Medicine, Istanbul, Turkey
| | - Ahmet S Tekin
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | | | - Mustafa Caliskan
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| |
Collapse
|