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Binou P, Stergiou A, Kosta O, Tentolouris N, Karathanos V. Positive effects of bread enriched with a-cyclodextrin or a compound of hydroxytyrosol encapsulated in a-cyclodextrin on postprandial glucose, insulin and appetite responses of healthy subjects. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Stampouloglou PK, Bletsa E, Siasos G, Oikonomou E, Paschou SA, Gouliopoulos N, Katsianos E, Tsigou V, Kassi E, Tentolouris N, Tsioufis K, Tousoulis D. Differential effect of novel antidiabetic agents on the arterial stiffness and endothelial function in patients with type 2 diabetes mellitus. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Arterial stiffness and endothelial function markers flag increased cardiovascular disease risk in patients with type 2 Diabetes Mellitus (T2DM).
Purpose
To investigate the effects of novel antidiabaetic agents on arterial stiffness and endothelial function in T2DM patients.
Patients and methods
We enrolled 80 consecutive patients under stable antidiabetic therapy who did not reach therapeutic targets. Subjects were assessed to receive an additional antidiabetic agent to optimize glucose control; dipeptidyl peptidase-4 inhibitor (DPP-4i, n=24), glucagon like peptide-1 receptor agonist (GLP-1RA, n=26), sodium/glucose cotransporter-2 inhibitor (SGLT-2i, n=21) or long lasting insulin (n=9). Glycosylated hemoglobin (Hba1c) along with carotid-femoral pulse wave velocity (PWV), augmentation index (Alx) and flow-mediated dialatation (FMD), as biomarkers of arterial stiffness and endothelial function accordingly, were measured at baseline and 3 months after treatment intensification.
Results
There were no differences between the study groups in traditional risk factors, or baseline HbA1c, PWV, Alx and FMD levels (ps=NS for all). All groups achieved better glycemic control in terms of HbA1c values between baseline and follow-up, as seen in the paired differences of these values (for DPP4i: 0.7±0.3%, for GLP-1RA: 1.3±0.7%, for SGLT-2i: 0.8±0.5% and for insulin 2.0±0.8%, p<0.001 for all). PWV showed a decrease from 10.0±0.84 to 9.1±0.43 m/sec (p=0.092) in the DPP4-i group, from 11.7±0.72 to 10.2±0.74 m/sec (p<0.001) in the GLP-1RA group, from 10.3±0.54 to 9.6±0.59 m/sec (p=0.001) in the SGLT-2i group and from 11.6±1.04 to 11.1±1.02 m/sec (p=0.219) in the insoulin group, as presented in Figure 1. Alx was also decreased from 34.2±1.89 to 31.5±2.7% (p=0.023) in the DPP-4i group, from 29.1±1.52 to 25.6±2.09% (p<0.001) in the GLP-1RA group, from 29.9±1.44 to 24.2±1.48% (p<0.001) in the SGLT-2i group and from 28.2±2.33 to 26.2±1.64% (p=0.153) in the insulin group, as presented in Figure 1, as well. Regarding FMD, a reduction in the values between groups from baseline to follow-up was also observed; from 5.33±1.3 to 5.50±1.1% (p=0.004) for the DPP-4i group, from 5.54±0.8 to 5.99±0.8% (p=0,001) for the GLP-1RA group, from 5.59±0.9 to 5.77±1.2% (p=0.005) for the SGLT-2i group and from 5.76±0.8 to 5.83±0.9% for the insulin group, as demonstrated in Figure 2.
Limitations: Our results should be examined under the scope of limited data pool and its subsequent restrictions.
Conclusion
These preliminary data provide evidence that treatment intesification- particularly with GLP1-RA and SGLT-2i, benefits vascular properties, a finding which could partly explain the positive cardiovascular outcomes of recent randomized clinical trials in this field.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P K Stampouloglou
- Hippokration General Hospital, Heart and Diabetes Center, 1st Cardiology Department, Athens, Greece
| | - E Bletsa
- Hippokration General Hospital, Heart and Diabetes Center, 1st Cardiology Department, Athens, Greece
| | - G Siasos
- Hippokration General Hospital, Heart and Diabetes Center, 1st Cardiology Department, Athens, Greece
| | - E Oikonomou
- Hippokration General Hospital, Heart and Diabetes Center, 1st Cardiology Department, Athens, Greece
| | - S A Paschou
- Hippokration General Hospital, Heart and Diabetes Center, 1st Cardiology Department, Athens, Greece
| | - N Gouliopoulos
- Hippokration General Hospital, Heart and Diabetes Center, 1st Cardiology Department, Athens, Greece
| | - E Katsianos
- Hippokration General Hospital, Heart and Diabetes Center, 1st Cardiology Department, Athens, Greece
| | - V Tsigou
- Hippokration General Hospital, Heart and Diabetes Center, 1st Cardiology Department, Athens, Greece
| | - E Kassi
- Hippokration General Hospital, Heart and Diabetes Center, 1st Cardiology Department, Athens, Greece
| | - N Tentolouris
- Hippokration General Hospital, Heart and Diabetes Center, 1st Cardiology Department, Athens, Greece
| | - K Tsioufis
- Hippokration General Hospital, Heart and Diabetes Center, 1st Cardiology Department, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, Heart and Diabetes Center, 1st Cardiology Department, Athens, Greece
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Argyropoulou O, Aissopou E, Argyris A, Goules A, Mavragani C, Tentolouris N, Sfikakis P, Vlachoyiannopoulos P, Tzioufas A, Protogerou A. POS0807 RETINAL VESSEL CALIBERS AS A NON-INVASIVE BIOMARKER OF INFLAMMATORY BURDEN IN PRIMARY SYSTEMIC VASCULITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Primary Systemic Vasculitides (PSV) constitute a heterogeneous group of rare and potentially life-threatening autoimmune diseases, characterized by a varying degree of inflammatory response, leading to local or generalized vascular disease. Vessel involvement accounts for the micro- and macrovascular complications of the disease, along with the classic risk factors including, among others age and chronic use of steroids (1). Early identification of high-risk patients for cardiovascular disease (CVD) development and the contribution of inflammation towards this adverse outcome are still unmet needs. Alterations of retinal microcirculation have been independently associated with increased CVD risk in the general population (2). The potential changes of retinal vasculature and their association with disease activity and the magnitude of inflammation have not been studied in PSV so far.Objectives:To explore the effect of disease activity and inflammation on retinal microcirculation in PSV, classified according to vessel size as large, medium or small vessel vasculitides (LVV, MVV or SVV respectively), and polymyalgia rheumatica (PMR) without vasculitis.Methods:Fifty-nine patients, 43 with active disease [30 active vasculitis (12 LVV, 4 MVV, 14 SVV) and 13 PMR] and 16 with chronic inactive disease (13 vasculitis, 3 PMR) were studied. All patients were matched at 1:1 ratio with 59 controls, without underlying autoimmune/autoinflammatory disorder, neoplasia or infection, according to age, gender, CVD history, BMI, smoking, arterial hypertension, dyslipidemia, diabetes mellitus and treatment related to comorbidities. A total of 32 rheumatoid arthritis (RA) patients with mild to moderate inflammatory component as defined by standard of care acute phase reactants (ESR and CRP) and 16 chronic RA patients with normal ESR and CRP levels, matched 1:1 according to all the above parameters with 32 active and 16 inactive vasculitis/PMR patients respectively, served as disease controls. Digital retinal images were obtained and retinal vessel calibers were measured with a validated software to determine central retinal arteriolar and venular equivalents ratio (CRAE and CRVE respectively). For 16 patients with active vasculitis/PMR, retinal examination was performed in two time points (baseline and ≤ 6 months later).Results:In the overall population, patients with active Vasculitis/PMR had increased CRVE (213.8±21.7 vs 201.3±17.1, p<0.001) and CRAE (180.0±19.2 vs 164.1±17.5 p<0.001) compared to healthy controls. Separating patients according to disease type, we found that in LVV, MVV and PMR, CRAE (p≤0.05) and CRVE (p<0.05) were increased compared to control group, while in SVV only CRAE was increased (p<0.001). Interestingly, chronic patients with disease in remission displayed higher CRAE compared to matched controls (179.8±17.2 vs 169.1±11.1, p=0.006). After immunosuppressive treatment for ≤ 6 months CRVE and to a lesser extent CRAE were reduced (p=0.048 and 0.149 respectively) with a stronger statistical significance found in the Vasculitis group (p=0.026 and 0.069 respectively). Pearson’s linear correlation coefficient in active disease state (at baseline examination) revealed positive bivariate correlation only between CRVE with ESR and CRP. Patients with Vasculitis/PMR had also increased CRAE when compared to RA patients in both active and inactive disease status (182.8±19.4 vs 170.1±18.4, p<0.001 and 179.8±17.2 vs 166.3±17.9, p=0.005 respectively).Conclusion:Systemic inflammation alters retinal microcirculation in both a reversible (venules) and irreversible (arterioles) way, independently of PSV form. Thus, common disease specific pathogenetic mechanisms related to inflammation may be implicated in vascular remodeling. Sequential follow-up of PSV patients will address whether retinal vessel calibers may serve as a biomarker of disease activity and CVD development.References:[1]Argyropoulou OD et al. Curr Opin Rheumatol 2017.[2]Shaohua G et al. Current Atherosclerosis reports 2020.Disclosure of Interests:None declared
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Kokkinos A, Liaskos C, Alexiadou K, Papassotiriou I, Margeli A, Argyrakopoulou G, Perrea D, Alexandrou A, Katsilambros N, Diamantis T, Tentolouris N. Plasma levels of soluble urokinase plasminogen activator receptor (suPAR) and high-sensitivity C-reactive protein after Roux-en-Y gastric bypass or sleeve gastrectomy: a 1-year prospective observational study. J Endocrinol Invest 2021; 44:599-608. [PMID: 32681464 DOI: 10.1007/s40618-020-01358-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Low-grade inflammation in obesity contributes to the development of cardiovascular disease, diabetes mellitus and cancer, and is associated with increased mortality. The purpose of this 1-year prospective observational study was to examine the weight loss effect of bariatric surgery on plasma concentrations of two inflammatory markers, namely high-sensitivity C-reactive protein (hsCRP) and soluble urokinase-type plasminogen activator receptor (suPAR), in patients with obesity. METHODS Sixteen subjects without obesity and 32 patients with obesity class III, who had already settled upon Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) were included in the study. Subjects without obesity were examined once, at baseline; patients with obesity were examined preoperatively (baseline) and 3, 6 and 12 months postoperatively. RESULTS Plasma suPAR and hsCRP concentrations at baseline were higher in patients with obesity than in lean participants (2.68 ± 0.86 vs 1.86 ± 0.34 ng/mL, p < 0.001 and 9.83 ± 9.55 vs 1.36 ± 1.95 mg/dL, p < 0.001). Levels of suPAR following bariatric surgery increased significantly 3 months after either RYGB or SG (3.58 ± 1.58 vs 3.26 ± 0.7 ng/mL, respectively) and declined at 6 (3.19 ± 1.75 vs 2.8 ± 0.84 ng/mL, respectively) and 12 months (2.6 ± 1.5 vs 2.22 ± 0.49 ng/mL, respectively; p < 0.05 for the effect of time on suPAR levels during the study), whereas those of hsCRP declined consistently after bariatric surgery (3 months: 5.44 ± 3.99 vs 9.47 ± 11.98 mg/dL, respectively; 6 months; 5.39 ± 5.6 vs 10.25 ± 17.22 mg/dL, respectively; and 12 months: 2.23 ± 2.5 vs 3.07 ± 3.63 mg/dL, respectively; p < 0.001 for the effect of time on hsCRP levels during the study). 1-year change in BMI was negatively associated with suPAR levels at 12 months. CONCLUSION Our findings support an association between obesity and low-grade inflammation. Weight loss following bariatric surgery is associated with a consistent decline in plasma hsCRP, while plasma suPAR levels increase at 3 months and decline by 12 months.
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Affiliation(s)
- A Kokkinos
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - C Liaskos
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - K Alexiadou
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - I Papassotiriou
- Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou Street, 11527, Athens, Greece
| | - A Margeli
- Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou Street, 11527, Athens, Greece
| | - G Argyrakopoulou
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - D Perrea
- Laboratory of Experimental Surgery and Surgical Research "NS Christeas", Medical School, National and Kapodistrian University of Athens, 15Β Agiou Thoma Street, 11527, Athens, Greece
| | - A Alexandrou
- First Department of Surgery, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - N Katsilambros
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - T Diamantis
- First Department of Surgery, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - N Tentolouris
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Street, 11527, Athens, Greece.
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Kefala V, Dimosthenopoulos C, Katsilambros N, Tentolouris N. Change in weight and glycemic control over time in type 2 diabetic patients. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fragoulis GE, Evangelatos G, Tentolouris N, Fragkiadaki K, Panopoulos S, Konstantonis G, Iliopoulos A, Chatzidionysiou K, Sfikakis P, Tektonidou M. FRI0338 SIMILAR CARDIOVASCULAR COMORBIDITY AND HIGHER DEPRESSION RATES IN PSORIATIC ARTHRITIS COMPARED TO AGE- AND SEX-MATCHED RHEUMATOID ARTHRITIS AND DIABETES MELLITUS PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Comorbidities are frequent in psoriatic arthritis (PsA) but it is not known how they differ from other high comorbidity burden diseases like rheumatoid arthritis (RA) and diabetes mellitus (DM).Objectives:To compare the prevalence of comorbidities in PsA vs. RA and DM patients.Methods:215 PsA patients were age/gender-matched with 215 RA and 215 DM patients from two tertiary hospitals. Prevalence of comorbidities (hypertension, current smoking, hyperlipidemia, obesity (BMI≥30), coronary disease [CD], stroke, MACE [combined CD and stroke], depression, osteoporosis, history of malignancies) were compared across the three groups. Within PsA group, associations between comorbidities and demographic and clinical features (e.g entheitis), including PsA phenotypes (RA-like vs oligoarthritis pattern and Axial-involvment vs Non-Axial-involvement) were assessed.Results:Hyperlipidaemia, obesity and depression were more frequent in PsA vs. RA. Depression and osteoporosis were more common in PsA vs DM. In contrast, hypertension was more frequent in DM. All other comorbidities, including frequency of stroke, CD and major adverse cardiovascular events did not differ between groups. Results remain unchanged after adjustments (Table 1).Table 1.Comparison of comorbidities between psoriatic arthritis (PsA), rheumatoid (RA) arthritis and Diabetes mellitus (DM) patients. OR: odds ratio, MACE: major adverse cardiovascular events. CI: Confidence IntervalsPsA vs RAPsA vs DMComorbidityPsAn=215n (%)RAn=215n (%)DMN=215n (%)Crude OR(95% CI)Adjusted OR(95% CI)Crude OR(95% CI)Adjusted OR(95% CI)Smoking76 (35.4)62 (28.8)85 (39.5)1.35(0.90-2.03)0.84(0.57-1.24)Obesity50 (29.4)24 (12.8)79 (36.7)2.83(1.65-4.86)0.72(0.47-1.10)Hyperlipidemia101 (47.0)67 (31.2)101 (47.0)1.96(1.32-2.90)-1-Hypertension62 (28.8)51 (23.8)97 (45.1)1.30(0.84-1.99)-0.49(0.33-0.74)-Coronary disease10 (4.7)10 (4.7)16 (7.4)1(0.41-2.45)0.97(0.34-2.79)*0.61(0.27-1.37)0.66(0.23-1.91)*Stroke8 (3.7)2 (0.9)7 (3.3)4.12(0.86-19.6)3.74(0.73-19.3)*1.15(0.41-3.22)1.20(0.35-4.12)*MACE12 (5.6)12 (5.6)22 (10.2)1(0.44-2.28)0.94(0.36-2.46)*0.52(0.25-1.08)0.42(0.16-1.10)*Osteoporosis9 (5.5)24 (11.2)2 (0.9)0.46(0.21-1.03)0.67(0.28-1.64)**6.22(1.33-29.2)-Depression42 (19.5)15 (7.0)12 (5.6)3.24(1.74-6.04)3.02(1.57-5.81)***4.11(2.10-8.05)4.85(2.37-9.93)***Malignancy12 (5.6)7 (3.3)-1.76(0.68-4.55)1.60(0.60-4.26)****--* adjusted for age, gender, smoking, hypertension, dyslipidemia, body mass index, ** adjusted for steroids, *** adjusted for age, gender, disease duration, smoking, **** adjusted for age, disease durationWithin PsA group, depression was associated with female gender (p=0.02), older age (p=0.03), higher disease duration (p=0.04) and current smoking (p=0.04). MACEs in PsA, were associated with male gender (p=0.03), older age (p=0.0002), dyslipidaemia (p=0.003) and hypertension (p<0.0001). No differences were found between different phenotypes of PsA.Conclusion:PsA patients had higher BMI and hyperlipidaemia compared to RA but not to DM. MACE is comparable between PsA and RA or DM, while depression is more common in PsA. Taking into account certain risk factors, screening for and management of comorbidities in PsA is important in the clinical setting.Disclosure of Interests:George E. Fragoulis: None declared, Gerasimos Evangelatos: None declared, Nikolaos Tentolouris: None declared, Kalliopi Fragkiadaki: None declared, Stylianos Panopoulos: None declared, George Konstantonis: None declared, Alexios Iliopoulos: None declared, Katerina Chatzidionysiou Consultant of: AbbVie, Pfizer, Lilly., Petros Sfikakis Grant/research support from: Grant/research support from Abvie, Novartis, MSD, Actelion, Amgen, Pfizer, Janssen Pharmaceutical, UCB, Maria Tektonidou Grant/research support from: AbbVie, MSD, Novartis and Pfizer, Consultant of: AbbVie, MSD, Novartis and Pfizer
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Bletsa E, Antonopoulos A, Siasos G, Stampouloglou PK, Batzias K, Paschou SA, Oikonomou E, Gouliopoulos N, Tsigkou V, Kassi E, Thanopoulou A, Vryonidou A, Tentolouris N, Pallantza Z, Tousoulis D. P2483Differential effects of novel antidiabetics on arterial stiffness in patients with type 2 diabetes mellitus. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Arterial stiffness flags increased cardiovascular disease risk in type 2 diabetes mellitus (T2DM) patients. There is limited data on how novel anti-diabetic agents affect arterial stiffness.
Purpose
To investigate the effects of novel anti-diabetic agents on arterial stiffness in T2DM patients.
Patients and methods
We enrolled 64 consecutive patients under stable antidiabetic therapy who did not achieve therapeutic targets. Subjects were assessed to receive an additional antidiabetic agent to optimize glucose control; dipeptidyl peptidase-4 inhibitor (DPP4i, n=14), glucagon like peptide-1 receptor agonist (GLP1RA, n=21), sodium/glucose cotransporter-2 inhibitor (SGLT2i, n=21) or long-acting insulin (n=8). Glycosylated hemoglobin (HbA1c) as well as carotid-femoral pulse wave velocity (PWV) and augmentation index (Alx) were measured (as indices of arterial stiffness) were measured at baseline and 3 months after treatment intensification.
Results
There were no differences between the study groups in traditional risk factors, or baseline HbA1c, PWV and Alx levels (p=NS for all). All groups achieved better glycemic control in terms of HbA1c values between baseline and follow-up (for DPP4i: 7.4±0.2% vs 6.7±0.2%, for GLP1RA: 8.3±0.2% vs 6.9±0.1%, for SGLT2i: 7.5±0.1% vs 6.7±0.1% and for insulin 9.8±0.5% vs 7.7±0.4%, p<0.001 for all). PWV decreased from 10.0±0.84 to 9.1±0.43 m/sec (p=0.092) in the DPP4i group, from 11.7±0.72 to 10.2±0.74 m/sec (p<0.001) in the GLP1RA group, from 1.3±0.54 to 9.6±0.59 m/sec (p=0.001) in the SGLT2i group and from 11.6±1.04 to 11.1±1.02 m/sec (p=0.219) in the insulin group. Alx was also decreased from 34.2±1.89 to 31.5±2.17% (p=0.023) in the DPP4i group, from 29.1±1.52 to 25.6±2.09% (p<0.001) in the GLP1RA group, from 29.9±1.44 to 24.2±1.48% (p<0.001) in SGLT2i group, and from 28.2±2.33 to 26.2±1.64% (p=0.153) in insulin group.
Conclusions
These preliminary data provide evidence that treatment intensification -particularly with GLP1RA, and SGLT2i- benefits vascular properties, a finding which could partly explain the positive findings of recent randomized clinical trails in this field.
Acknowledgement/Funding
None
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Affiliation(s)
- E Bletsa
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - A Antonopoulos
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - G Siasos
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - P K Stampouloglou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - K Batzias
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - S A Paschou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - E Oikonomou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - N Gouliopoulos
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - V Tsigkou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - E Kassi
- Laiko University General Hospital, 1st Department of Internal Medicine, Athens Medical School, Athens, Greece
| | - A Thanopoulou
- Hippokration General Hospital, 2nd Department of Internal Medicine, Athens Medical School, Athens, Greece
| | - A Vryonidou
- Hellenic Red Cross Hospital, Department of Endocrinology and Diabetes, Athens, Greece
| | - N Tentolouris
- Laiko University General Hospital, Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Athens Medical School, Athens, Greece
| | - Z Pallantza
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
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Stampouloglou PK, Antonopoulos A, Siasos G, Bletsa E, Batzias K, Paschou SA, Oikonomou E, Gouliopoulos N, Tsigkou V, Kassi E, Thanopoulou A, Vryonidou A, Tentolouris N, Pallantza Z, Tousoulis D. P2481The effect of DPP-4i, GLP-1RA, SGLT-2i and long-acting insulin on platelet function in patients with type 2 diabetes mellitus. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Patients with type 2 diabetes mellitus (T2DM) are at higher risk for thrombotic events. Platelet function may be used to assess prothrombotic state in patients with cardiovascular disease.
Purpose
We aimed to investigate whether the administration of novel antidiabetic agents influence platelet function in TDM2 patients.
Patients and methods
We 60 enrolled consecutive patients with T2DM, on stable antidiabetic therapy, who did not achieve therapeutic targets. Subjects were assessed to receive an additional anti-diabetic agent; dipeptidyl peptidase-4 inhibitor (DPP4i, n=14), glucagon like peptide-1 receptor agonist (GLP1RA, n=24), sodium/glucose cotransporter-2 inhibitor (SGLT2i, n=22). Platelet reactivity was measured with PFA-200 collagen/epinephrine (c-EPI) and PFA-200 collagen/ADP (c-ADP) closure time. Glycosylated hemoglobin (HbA1c), c-EPI and c-ADP were assessed at baseline and 3 months after treatment intensification.
Results
There was no difference between the study groups regarding gender, age, hypertension, dyslipidemia, smoking, Hba1c and CADP or CEPI (p=NS for all) at baseline. All groups achieved better glycemic control in terms of HbA1c values between baseline and follow-up (for DPP4i: 7.4±0.2% vs 6.7±0.2%, for GLP1RA: 8.3±0.2% vs 6.9±0.1%, for SGLT2i: 7.5±0.1% vs 6.7±0.1% and for insulin 9.8±0.5% vs 7.7±0.4%, p<0.001 for all). After a 3 month-period, treatment intensification with these novel agents did not influence c-EPI and c-ADP values [155.4±6.64 sec vs 152.9±8.28 sec (p=0.678) and 106.6±4.30 sec vs 106.8±3.93 sec (p=0.955) respectively] in whole population. In subgroup analysis, for patients off antiplatelet treatment (n=31), c-EPI was significantly decreased from 148.4±8.5 to 129.8±13.9 sec (p=0.036), but not c-ADP (from 105.4±5.3 to 99.3±4.9 sec, p=0.094). In patients who did receive antiplatelets (n=37), c-EPI and c-ADP were not significantly changed (c-EPI 163.1±10.9 to 179.6±13.9 sec p=0.201 and c-ADP from 106.6±8.2 sec to 114.6±7.3 sec, p=0.318) respectively.
Conclusion
Antiplatelet treatment prevents thrombotic risk in T2DM patients receiving novel antidiabetics. The effects of novel antidiabetics on platelet reactivity -as well as any distinct class properties- merits further investigation.
Acknowledgement/Funding
None
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Affiliation(s)
- P K Stampouloglou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - A Antonopoulos
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - G Siasos
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - E Bletsa
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - K Batzias
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - S A Paschou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - E Oikonomou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - N Gouliopoulos
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - V Tsigkou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - E Kassi
- Laiko University General Hospital, 1st Department of Internal Medicine, Athens Medical School, Athens, Greece
| | - A Thanopoulou
- Hippokration General Hospital, 2nd Department of Internal Medicine, Athens Medical School, Athens, Greece
| | - A Vryonidou
- Hellenic Red Cross Hospital, Department of Endocrinology and Diabetes, Athens, Greece
| | - N Tentolouris
- Laiko University General Hospital, Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Athens Medical School, Athens, Greece
| | - Z Pallantza
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
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9
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Binou P, Yanni A, Karathanos V, Kartsioti K, Chatzigeorgiou A, Perrea D, Konstantopoulos P, Tentolouris N, Kokkinos A. MON-PO444: Effects of Daily Consumption of Yoghurt Enriched with Vitamins B in Comparison to Plain Yoghurt on Type 2 Diabetic Patients: A Randomized Clinical Trial. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32277-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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10
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Knudsen ST, Lapolla A, Schultes B, Tentolouris N, Catarig A, Wolden ML, Siegmund T. Clinical benefits of switching to insulin degludec irrespective of previous basal insulin therapy in people with Type 1 or Type 2 diabetes: evidence from a European, multicentre, retrospective, non-interventional study (EU-TREAT). Diabet Med 2019; 36:868-877. [PMID: 31001865 PMCID: PMC6618263 DOI: 10.1111/dme.13976] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2019] [Indexed: 11/26/2022]
Abstract
AIMS To investigate whether the benefits of switching to insulin degludec observed in the European retrospective chart review study EU-TREAT were dependent on the previous basal insulin used. METHODS People with Type 1 or Type 2 diabetes were switched to insulin degludec from other basal insulins ≥6 months before data collection. Participants were stratified into three groups based on their previous basal insulin: insulin glargine 100 units/ml (Type 1: n=888; Type 2: n=259); insulin detemir (Type 1: n=726; Type 2: n=415); and neutral protamine Hagedorn (Type 1: n=53; Type 2: n=95). Their glycaemic control and hypoglycaemia incidence at 6 and 12 months post-switch vs pre-switch was then evaluated. RESULTS Significant HbA1c reductions were achieved in all previous basal insulin groups for participants with Type 1 diabetes [insulin glargine 100 units/ml: -2.08 mmol/mol (-0.19%); insulin detemir: -2.40 mmol/mol (-0.22%)] and those with Type 2 diabetes [insulin glargine 100 units/ml: -5.90 mmol/mol (-0.54%); insulin detemir: -6.01 mmol/mol (-0.55%); neutral protamine Hagedorn: -2.73 mmol/mol (-0.25%)] at 6 months, except for the relatively small neutral protamine Hagedorn group in those with Type 1 diabetes [-1.75 mmol/mol (-0.16%)], where statistical significance was not reached. At 6 months in the Type 1 diabetes group, switching to insulin degludec from insulin glargine 100 units/ml resulted in significantly lower hypoglycaemia rates across all hypoglycaemia categories; for the insulin detemir group, this significance was also observed for severe and nocturnal non-severe hypoglycaemia, while the low number of people in the neutral protamine Hagedorn group resulted in nonsignificant reductions in hypoglycaemia rates. At 6 months in the people with Type 2 diabetes, switching to insulin degludec resulted in significantly lower rates of hypoglycaemia across all categories for all groups. Similar outcomes were observed at 12 months. CONCLUSIONS Switching to insulin degludec from other basal insulins can improve glycaemic control and/or reduce hypoglycaemia risk in people with diabetes (although there was a nonsignificant reduction in HbA1c and hypoglycaemia rates for the neutral protamine Hagedorn group in Type 1 diabetes) under routine care.
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Affiliation(s)
- S. T. Knudsen
- Steno Diabetes Centre AarhusAarhus University HospitalAarhusDenmark
| | - A. Lapolla
- Department of MedicinePadova UniversityPadovaItaly
| | - B. Schultes
- eSwiss Medical and Surgical CentreSt GallenSwitzerland
| | - N. Tentolouris
- First Department of Propaedeutic Internal MedicineMedical SchoolNational and Kapodistrian University of AthensAthensGreece
| | | | | | - T. Siegmund
- Department of Endocrinology, Diabetes and MetabolismISAR Klinikum München GmbHMunichGermany
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11
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Abstract
Schizophrenia is associated with increased risk for type 2 diabetes mellitus, resulting in elevated cardiovascular risk and limited life expectancy, translated into a weighted average of 14.5 years of potential life lost and an overall weighted average life expectancy of 64.7 years. The exact prevalence of type 2 diabetes among people with schizophrenia varies across studies and ranges 2-5fold higher than in the general population, whereas the aetiology is complex and multifactorial. Besides common diabetogenic factors, applied similarly in the general population, such as obesity, hyperlipidemia, smoking, hypertension, poor diet and limited physical activity, the co-occurrence of schizophrenia and diabetes is also attributed to unique conditions. Specifically, excessive sedentary lifestyle, social determinants, adverse effects of antipsychotic drugs and limited access to medical care are considered aggravating factors for diabetes onset and low quality of diabetes management. Schizophrenia itself is further proposed as causal factor for diabetes, given the observed higher prevalence of diabetes in young patients, newly diagnosed with schizophrenia and unexposed to antipsychotics. Furthermore, studies support genetic predisposition to diabetes among people with schizophrenia, suggesting shared genetic risk and disclosing a number of overlapped risk loci. Therefore, special attention should be paid in preventing diabetes in people with schizophrenia, through intervention in all possible modifiable risk factors. Implementation of careful antipsychotic prescription, provision of adequate motivation for balanced diet and physical activity and facilitating access to primary health care, could serve in reducing diabetes prevalence. On the other hand, increasing calls are made for early diagnosis of diabetes, application of the appropriate anti-diabetic therapy and strict inspection of therapy adherence, to limit the excess mortality due to cardiovascular events in people with schizophrenia. Moreover, population health programs could help counseling and preventing diabetes risk, additionally to early screening and diagnosis set, aiming to reduce disparities in populations. Finally, mental health-care providers might greatly promote offered health services to patients with schizophrenia, through a holistic individualized approach, considering additionally the physical health of the patients and working closely, preventively and therapeutically, in collaboration with the physicians and diabetologists.
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Affiliation(s)
- V Mamakou
- Medical School, National and Kapodistrian University of Athens, Athens.,Dromokaiteio Psychiatric Hospital, Athens
| | - A Thanopoulou
- Diabetes Centre, 2nd Department of Internal Medicine, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, Athens
| | - F Gonidakis
- 1st Psychiatric Department, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens
| | - N Tentolouris
- First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Medical School, Laiko General Hospital, Athens, Greece
| | - V Kontaxakis
- 1st Psychiatric Department, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens
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12
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Xaplanteris PX, Vlachopoulos C, Protogerou A, Aznaouridis K, Terentes-Printzios D, Argyris A, Tentolouris N, Sfikakis P, Tousoulis D. P1274A clinical score to predict elevated arterial stiffness: derivation and validation in 3,943 hypertensive patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P X Xaplanteris
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C Vlachopoulos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Protogerou
- Laiko University General Hospital, Cardiovascular Prevention and Research Unit, Department of Pathophysiology, Athens, Greece
| | - K Aznaouridis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - D Terentes-Printzios
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Argyris
- Laiko University General Hospital, Cardiovascular Prevention and Research Unit, Department of Pathophysiology, Athens, Greece
| | - N Tentolouris
- Laiko University General Hospital, Cardiovascular Prevention and Research Unit, Department of Pathophysiology, Athens, Greece
| | - P Sfikakis
- Laiko University General Hospital, Cardiovascular Prevention and Research Unit, Department of Pathophysiology, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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13
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Antonopoulos A, Siasos G, Tentolouris N, Konsola T, Oikonomou E, Kollia C, Vogiatzi G, Tsalamandris S, Zacharia E, Tousoulis D. P1413Diabetic foot: the role of vascular function and inflammation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Protogerou AD, Fransen J, Zampeli E, Argyris AA, Aissopou E, Arida A, Konstantonis GD, Tentolouris N, Makrilakis K, Psichogiou M, Daikos G, Kitas GD, Sfikakis PP. The Additive Value of Femoral Ultrasound for Subclinical Atherosclerosis Assessment in a Single Center Cohort of 962 Adults, Including High Risk Patients with Rheumatoid Arthritis, Human Immunodeficiency Virus Infection and Type 2 Diabetes Mellitus. PLoS One 2015; 10:e0132307. [PMID: 26230728 PMCID: PMC4521696 DOI: 10.1371/journal.pone.0132307] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/11/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Presence of femoral atheromatic plaques, an emerging cardiovascular disease (CVD) biomarker additional to carotid plaques, is poorly investigated in conditions associating with accelerated atherosclerosis such as Rheumatoid Arthritis (RA), Human Immunodeficiency Virus (HIV) infection and Type 2 Diabetes Mellitus (T2DM). OBJECTIVE/METHODS To assess the frequency of femoral/carotid subclinical atheromatosis phenotypes in RA, HIV and T2DM and search for each disease-specific probability of either femoral and/or carotid subclinical atheromatosis, we examined by ultrasound a single-center cohort of CVD-free individuals comprised of consecutive non-diabetic patients with RA (n=226) and HIV (n=133), T2DM patients (n=109) and non-diabetic individuals with suspected/known hypertension (n=494) who served as reference group. RESULTS Subclinical atheromatosis--defined as local plaque presence in at least on arterial bed--was diagnosed in 50% of the overall population. Among them, femoral plaques only were found in 25% of either RA or HIV patients, as well as in 16% of T2DM patients and 35% of reference subjects. After adjusting for all classical CVD risk factors, RA and HIV patients had comparable probability to reference group of having femoral plaques, but higher probability (1.75; 1.17-2.63 (odds ratio; 95% confidence intervals), 2.04; 1.14-3.64, respectively) of having carotid plaques, whereas T2DM patients had higher probability to have femoral and carotid plaques, albeit, due to their pronounced dyslipidemic profile. CONCLUSION RA and HIV accelerate predominantly carotid than femoral. A "two windows" carotid/femoral, rather than carotid alone ultrasound, screening improves substantially subclinical atheromatosis detection in patients at high CVD risk.
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Affiliation(s)
- Athanasios D. Protogerou
- First Department of Propaedeutic & Internal Medicine, Laikon Hospital, Athens, Greece
- Joint Academic Rheumatology Program of the National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Jaap Fransen
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Evangelia Zampeli
- First Department of Propaedeutic & Internal Medicine, Laikon Hospital, Athens, Greece
- Joint Academic Rheumatology Program of the National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Antonis A. Argyris
- First Department of Propaedeutic & Internal Medicine, Laikon Hospital, Athens, Greece
| | - Evagelia Aissopou
- First Department of Propaedeutic & Internal Medicine, Laikon Hospital, Athens, Greece
| | - Aikaterini Arida
- First Department of Propaedeutic & Internal Medicine, Laikon Hospital, Athens, Greece
- Joint Academic Rheumatology Program of the National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - George D. Konstantonis
- First Department of Propaedeutic & Internal Medicine, Laikon Hospital, Athens, Greece
- Joint Academic Rheumatology Program of the National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Nikos Tentolouris
- First Department of Propaedeutic & Internal Medicine, Laikon Hospital, Athens, Greece
| | | | - Mina Psichogiou
- First Department of Propaedeutic & Internal Medicine, Laikon Hospital, Athens, Greece
| | - George Daikos
- First Department of Propaedeutic & Internal Medicine, Laikon Hospital, Athens, Greece
| | - George D. Kitas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, United Kingdom
- Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, United Kingdom
| | - Petros P. Sfikakis
- First Department of Propaedeutic & Internal Medicine, Laikon Hospital, Athens, Greece
- Joint Academic Rheumatology Program of the National and Kapodistrian University of Athens Medical School, Athens, Greece
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15
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Wessel J, Chu AY, Willems SM, Wang S, Yaghootkar H, Brody JA, Dauriz M, Hivert MF, Raghavan S, Lipovich L, Hidalgo B, Fox K, Huffman JE, An P, Lu Y, Rasmussen-Torvik LJ, Grarup N, Ehm MG, Li L, Baldridge AS, Stančáková A, Abrol R, Besse C, Boland A, Bork-Jensen J, Fornage M, Freitag DF, Garcia ME, Guo X, Hara K, Isaacs A, Jakobsdottir J, Lange LA, Layton JC, Li M, Hua Zhao J, Meidtner K, Morrison AC, Nalls MA, Peters MJ, Sabater-Lleal M, Schurmann C, Silveira A, Smith AV, Southam L, Stoiber MH, Strawbridge RJ, Taylor KD, Varga TV, Allin KH, Amin N, Aponte JL, Aung T, Barbieri C, Bihlmeyer NA, Boehnke M, Bombieri C, Bowden DW, Burns SM, Chen Y, Chen YD, Cheng CY, Correa A, Czajkowski J, Dehghan A, Ehret GB, Eiriksdottir G, Escher SA, Farmaki AE, Frånberg M, Gambaro G, Giulianini F, Goddard WA, Goel A, Gottesman O, Grove ML, Gustafsson S, Hai Y, Hallmans G, Heo J, Hoffmann P, Ikram MK, Jensen RA, Jørgensen ME, Jørgensen T, Karaleftheri M, Khor CC, Kirkpatrick A, Kraja AT, Kuusisto J, Lange EM, Lee IT, Lee WJ, Leong A, Liao J, Liu C, Liu Y, Lindgren CM, Linneberg A, Malerba G, Mamakou V, Marouli E, Maruthur NM, Matchan A, McKean-Cowdin R, McLeod O, Metcalf GA, Mohlke KL, Muzny DM, Ntalla I, Palmer ND, Pasko D, Peter A, Rayner NW, Renström F, Rice K, Sala CF, Sennblad B, Serafetinidis I, Smith JA, Soranzo N, Speliotes EK, Stahl EA, Stirrups K, Tentolouris N, Thanopoulou A, Torres M, Traglia M, Tsafantakis E, Javad S, Yanek LR, Zengini E, Becker DM, Bis JC, Brown JB, Adrienne Cupples L, Hansen T, Ingelsson E, Karter AJ, Lorenzo C, Mathias RA, Norris JM, Peloso GM, Sheu WHH, Toniolo D, Vaidya D, Varma R, Wagenknecht LE, Boeing H, Bottinger EP, Dedoussis G, Deloukas P, Ferrannini E, Franco OH, Franks PW, Gibbs RA, Gudnason V, Hamsten A, Harris TB, Hattersley AT, Hayward C, Hofman A, Jansson JH, Langenberg C, Launer LJ, Levy D, Oostra BA, O'Donnell CJ, O'Rahilly S, Padmanabhan S, Pankow JS, Polasek O, Province MA, Rich SS, Ridker PM, Rudan I, Schulze MB, Smith BH, Uitterlinden AG, Walker M, Watkins H, Wong TY, Zeggini E, Laakso M, Borecki IB, Chasman DI, Pedersen O, Psaty BM, Shyong Tai E, van Duijn CM, Wareham NJ, Waterworth DM, Boerwinkle E, Linda Kao WH, Florez JC, Loos RJ, Wilson JG, Frayling TM, Siscovick DS, Dupuis J, Rotter JI, Meigs JB, Scott RA, Goodarzi MO. Low-frequency and rare exome chip variants associate with fasting glucose and type 2 diabetes susceptibility. Nat Commun 2015; 6:5897. [PMID: 25631608 PMCID: PMC4311266 DOI: 10.1038/ncomms6897] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 11/12/2014] [Indexed: 12/30/2022] Open
Abstract
Fasting glucose and insulin are intermediate traits for type 2 diabetes. Here we explore the role of coding variation on these traits by analysis of variants on the HumanExome BeadChip in 60,564 non-diabetic individuals and in 16,491 T2D cases and 81,877 controls. We identify a novel association of a low-frequency nonsynonymous SNV in GLP1R (A316T; rs10305492; MAF=1.4%) with lower FG (β=-0.09±0.01 mmol l(-1), P=3.4 × 10(-12)), T2D risk (OR[95%CI]=0.86[0.76-0.96], P=0.010), early insulin secretion (β=-0.07±0.035 pmolinsulin mmolglucose(-1), P=0.048), but higher 2-h glucose (β=0.16±0.05 mmol l(-1), P=4.3 × 10(-4)). We identify a gene-based association with FG at G6PC2 (pSKAT=6.8 × 10(-6)) driven by four rare protein-coding SNVs (H177Y, Y207S, R283X and S324P). We identify rs651007 (MAF=20%) in the first intron of ABO at the putative promoter of an antisense lncRNA, associating with higher FG (β=0.02±0.004 mmol l(-1), P=1.3 × 10(-8)). Our approach identifies novel coding variant associations and extends the allelic spectrum of variation underlying diabetes-related quantitative traits and T2D susceptibility.
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Affiliation(s)
- Jennifer Wessel
- Department of Epidemiology, Fairbanks School of Public Health, Indianapolis, Indiana 46202, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
| | - Audrey Y Chu
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02215, USA
- National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study, Framingham, Massachusetts 01702, USA
| | - Sara M Willems
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0SL, UK
| | - Shuai Wang
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts 02118, USA
| | - Hanieh Yaghootkar
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK
| | - Jennifer A Brody
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington 98101, USA
- Department of Medicine, University of Washington, Seattle, Washington 98195, USA
| | - Marco Dauriz
- Massachusetts General Hospital, General Medicine Division, Boston, Massachusetts 02114, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona Medical School and Hospital Trust of Verona, Verona 37126, Italy
| | - Marie-France Hivert
- Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts 02215, USA
- Division of Endocrinology and Metabolism, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada J1K 2R1
- Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Sridharan Raghavan
- Massachusetts General Hospital, General Medicine Division, Boston, Massachusetts 02114, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Leonard Lipovich
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan 48201, USA
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan 48202, USA
| | - Bertha Hidalgo
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA
| | - Keolu Fox
- Department of Medicine, University of Washington, Seattle, Washington 98195, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington 98195, USA
| | - Jennifer E Huffman
- National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study, Framingham, Massachusetts 01702, USA
- MRC Human Genetics Unit, MRC IGMM, University of Edinburgh, Edinburgh, Scotland EH4 2XU, UK
| | - Ping An
- Division of Statistical Genomics and Department of Genetics, Washington University School of Medicine, St. Louis, Missouri 63108, USA
| | - Yingchang Lu
- The Charles Bronfman Institute for Personalized Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
- The Genetics of Obesity and Related Metabolic Traits Program, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Niels Grarup
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark
| | - Margaret G Ehm
- Quantitative Sciences, PCPS, GlaxoSmithKline, North Carolina 27709, USA
| | - Li Li
- Quantitative Sciences, PCPS, GlaxoSmithKline, North Carolina 27709, USA
| | - Abigail S Baldridge
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Alena Stančáková
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland, Kuopio FI-70211, Finland
| | - Ravinder Abrol
- Department of Medicine and Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
- Materials and Process Simulation Center, California Institute of Technology, Pasadena, California 91125, USA
| | - Céline Besse
- CEA, Institut de Génomique, Centre National de Génotypage, 2 Rue Gaston Crémieux, EVRY Cedex 91057, France
| | - Anne Boland
- CEA, Institut de Génomique, Centre National de Génotypage, 2 Rue Gaston Crémieux, EVRY Cedex 91057, France
| | - Jette Bork-Jensen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, Houston, Texas 77030, USA
| | - Daniel F Freitag
- The Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK
- Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge CB1 8RN, UK
| | - Melissa E Garcia
- Intramural Research Program, National Institute on Aging, Bethesda, Maryland 21224, USA
| | - Xiuqing Guo
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
| | - Kazuo Hara
- The Charles Bronfman Institute for Personalized Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
- The Genetics of Obesity and Related Metabolic Traits Program, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Aaron Isaacs
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
| | | | - Leslie A Lange
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Jill C Layton
- Indiana University, Fairbanks School of Public Health, Indianapolis, Indiana 46202, USA
| | - Man Li
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland 21205, USA
| | - Jing Hua Zhao
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0SL, UK
| | - Karina Meidtner
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal DE-14558, Germany
| | - Alanna C Morrison
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas 77225, USA
| | - Mike A Nalls
- Laboratory of Neurogenetics, National Institute on Aging, Bethesda, Maryland 20892, USA
| | - Marjolein J Peters
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
- The Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging (NGI-NCHA), Leiden/Rotterdam 2300 RC, The Netherlands
| | - Maria Sabater-Lleal
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm SE-171 77, Sweden
| | - Claudia Schurmann
- The Charles Bronfman Institute for Personalized Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
- The Genetics of Obesity and Related Metabolic Traits Program, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Angela Silveira
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm SE-171 77, Sweden
| | - Albert V Smith
- Icelandic Heart Association, Holtasmari 1, Kopavogur IS-201, Iceland
- University of Iceland, Reykjavik IS-101, Iceland
| | - Lorraine Southam
- The Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK
- Wellcome Trust Centre for Human Genetics, Oxford OX3 7BN, UK
| | - Marcus H Stoiber
- Department of Genome Dynamics, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - Rona J Strawbridge
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm SE-171 77, Sweden
| | - Kent D Taylor
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
| | - Tibor V Varga
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden
| | - Kristine H Allin
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark
| | - Najaf Amin
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
| | - Jennifer L Aponte
- Quantitative Sciences, PCPS, GlaxoSmithKline, North Carolina 27709, USA
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Department of Ophthalmology, National University of Singapore and National University Health System, Singapore 119228, Singapore
| | - Caterina Barbieri
- Division of Genetics and Cell Biology, San Raffaele Research Institute, Milano 20132, Italy
| | - Nathan A Bihlmeyer
- Predoctoral Training Program in Human Genetics, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Maryland 21205, USA
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Michael Boehnke
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Cristina Bombieri
- Section of Biology and Genetics, Department of Life and Reproduction Sciences, University of Verona, Verona 37100, Italy
| | - Donald W Bowden
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA
| | - Sean M Burns
- Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Yuning Chen
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts 02118, USA
| | - Yii-DerI Chen
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Department of Ophthalmology, National University of Singapore and National University Health System, Singapore 119228, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 119228, Singapore
- Office of Clinical Sciences, Duke-NUS Graduate Medical School, National University of Singapore, Singapore 169857, Singapore
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA
| | - Jacek Czajkowski
- Division of Statistical Genomics and Department of Genetics, Washington University School of Medicine, St. Louis, Missouri 63108, USA
| | - Abbas Dehghan
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
| | - Georg B Ehret
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA
- Division of Cardiology, Geneva University Hospital Geneva 1211, Switzerland
| | | | - Stefan A Escher
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden
| | - Aliki-Eleni Farmaki
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens 17671, Greece
| | - Mattias Frånberg
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm SE-171 77, Sweden
- Department of Numerical Analysis and Computer Science, SciLifeLab, Stockholm University, Stockholm SE-106 91, Sweden
| | - Giovanni Gambaro
- Division of Nephrology, Department of Internal Medicine and Medical Specialties, Columbus-Gemelli University Hospital, Catholic University, Rome 00168, Italy
| | - Franco Giulianini
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02215, USA
| | - William A Goddard
- Materials and Process Simulation Center, California Institute of Technology, Pasadena, California 91125, USA
| | - Anuj Goel
- Department of Cardiovascular Medicine, The Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Omri Gottesman
- The Charles Bronfman Institute for Personalized Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Megan L Grove
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas 77225, USA
| | - Stefan Gustafsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala SE-751 85, Sweden
| | - Yang Hai
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
| | - Göran Hallmans
- Department of Biobank Research, Umeå University, Umeå SE-901 87, Sweden
| | - Jiyoung Heo
- Department of Biomedical Technology, Sangmyung University, Chungnam 330-720, Korea
| | - Per Hoffmann
- Institute of Human Genetics, Department of Genomics, Life & Brain Center, University of Bonn, Bonn DE-53127, Germany
- Human Genomics Research Group, Division of Medical Genetics, University Hospital Basel Department of Biomedicine 4031, Basel, Switzerland
- Institute of Neuroscience and Medicine (INM-1) Genomic Imaging Research Center Juelich, Juelich DE-52425, Germany
| | - Mohammad K Ikram
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Office of Clinical Sciences, Duke-NUS Graduate Medical School, National University of Singapore, Singapore 169857, Singapore
- Memory Aging & Cognition Centre (MACC), National University Health System, Singapore 117599, Singapore
| | - Richard A Jensen
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington 98101, USA
- Department of Medicine, University of Washington, Seattle, Washington 98195, USA
| | | | - Torben Jørgensen
- Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup DK-2600, Denmark
- Faculty of Medicine, University of Aalborg, Aalborg DK-9220, Denmark
| | | | - Chiea C Khor
- Department of Ophthalmology, National University of Singapore and National University Health System, Singapore 119228, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 119228, Singapore
- Division of Human Genetics, Genome Institute of Singapore, Singapore 138672, Singapore
| | - Andrea Kirkpatrick
- Materials and Process Simulation Center, California Institute of Technology, Pasadena, California 91125, USA
| | - Aldi T Kraja
- Division of Statistical Genomics and Department of Genetics, Washington University School of Medicine, St. Louis, Missouri 63108, USA
| | - Johanna Kuusisto
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio FI-70211, Finland
| | - Ethan M Lange
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina 27599, USA
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - I T Lee
- Division of Endocrine and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Wen-Jane Lee
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Aaron Leong
- Massachusetts General Hospital, General Medicine Division, Boston, Massachusetts 02114, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Jiemin Liao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Department of Ophthalmology, National University of Singapore and National University Health System, Singapore 119228, Singapore
| | - Chunyu Liu
- National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study, Framingham, Massachusetts 01702, USA
| | - Yongmei Liu
- Department of Epidemiology & Prevention, Division of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina 27106, USA
| | - Cecilia M Lindgren
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Allan Linneberg
- Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup DK-2600, Denmark
- Department of Clinical Experimental Research, Copenhagen University Hospital Glostrup, Glostrup DK-2600, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark
| | - Giovanni Malerba
- Section of Biology and Genetics, Department of Life and Reproduction Sciences, University of Verona, Verona 37100, Italy
| | - Vasiliki Mamakou
- National and Kapodistrian University of Athens, Faculty of Medicine, Athens 115 27, Greece
- Dromokaiteio Psychiatric Hospital, Athens 124 61, Greece
| | - Eirini Marouli
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens 17671, Greece
| | - Nisa M Maruthur
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland 21205, USA
| | - Angela Matchan
- The Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK
| | - Roberta McKean-Cowdin
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles 90033, USA
| | - Olga McLeod
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm SE-171 77, Sweden
| | - Ginger A Metcalf
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Karen L Mohlke
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Donna M Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Ioanna Ntalla
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens 17671, Greece
- University of Leicester, Leicester LE1 7RH, UK
| | - Nicholette D Palmer
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, North Carolina 27106, USA
| | - Dorota Pasko
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK
| | - Andreas Peter
- Department of Internal Medicine, Division of Endocrinology, Metabolism, Pathobiochemistry and Clinical Chemistry and Institute of Diabetes Research and Metabolic Diseases, University of Tübingen, Tübingen DE-72076, Germany
- German Center for Diabetes Research (DZD), Neuherberg DE-85764, Germany
| | - Nigel W Rayner
- The Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK
- Wellcome Trust Centre for Human Genetics, Oxford OX3 7BN, UK
- The Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford OX3 7LE, UK
| | - Frida Renström
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden
| | - Ken Rice
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington 98101, USA
- Department of Biostatistics, University of Washington, Seattle, Washington 98195, USA
| | - Cinzia F Sala
- Division of Genetics and Cell Biology, San Raffaele Research Institute, Milano 20132, Italy
| | - Bengt Sennblad
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm SE-171 77, Sweden
- Science for Life Laboratory, Karolinska Institutet, Stockholm SE-171 77, Sweden
| | | | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Nicole Soranzo
- The Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK
- Department of Hematology, Long Road, Cambridge CB2 0XY, UK
| | - Elizabeth K Speliotes
- Department of Internal Medicine, Division of Gastroenterology and Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Eli A Stahl
- Division of Psychiatric Genomics, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Kathleen Stirrups
- The Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
| | - Nikos Tentolouris
- First Department of Propaedeutic and Internal Medicine, Athens University Medical School, Laiko General Hospital, Athens 11527, Greece
| | - Anastasia Thanopoulou
- Diabetes Centre, 2nd Department of Internal Medicine, National University of Athens, Hippokration General Hospital, Athens 11527, Greece
| | - Mina Torres
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles 90033, USA
| | - Michela Traglia
- Division of Genetics and Cell Biology, San Raffaele Research Institute, Milano 20132, Italy
| | | | - Sundas Javad
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0SL, UK
| | - Lisa R Yanek
- The GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Eleni Zengini
- Dromokaiteio Psychiatric Hospital, Athens 124 61, Greece
- University of Sheffield, Sheffield S10 2TN, UK
| | - Diane M Becker
- The GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Joshua C Bis
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington 98101, USA
- Department of Medicine, University of Washington, Seattle, Washington 98195, USA
| | - James B Brown
- Department of Genome Dynamics, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- Department of Statistics, University of California at Berkeley, Berkeley, California 94720, USA
| | - L Adrienne Cupples
- National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study, Framingham, Massachusetts 01702, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts 02118, USA
| | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark
- Faculty of Health Science, University of Copenhagen, Copenhagen 1165, Denmark
| | - Erik Ingelsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala SE-751 85, Sweden
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Andrew J Karter
- Division of Research, Kaiser Permanente, Northern California Region, Oakland, California 94612, USA
| | - Carlos Lorenzo
- Department of Medicine, University of Texas Health Science Center, San Antonio, Texas 77030, USA
| | - Rasika A Mathias
- The GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado 80204, USA
| | - Gina M Peloso
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts 02142, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Wayne H.-H. Sheu
- Division of Endocrine and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
- College of Medicine, National Defense Medical Center, Taipei 114, Taiwan
| | - Daniela Toniolo
- Division of Genetics and Cell Biology, San Raffaele Research Institute, Milano 20132, Italy
| | - Dhananjay Vaidya
- The GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Rohit Varma
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles 90033, USA
| | - Lynne E Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina 27106, USA
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam Rehbrücke, Nuthetal DE-14558, Germany
| | - Erwin P Bottinger
- The Charles Bronfman Institute for Personalized Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - George Dedoussis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens 17671, Greece
| | - Panos Deloukas
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
- Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1SA, UK
- Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders (PACER-HD), King Abdulaziz University, Jeddah 22254, Saudi Arabia
| | | | - Oscar H Franco
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
| | - Paul W Franks
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital, Malmö SE-205 02, Sweden
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA
- Department of Public Health & Clinical Medicine, Umeå University, Umeå SE-901 87, Sweden
| | - Richard A Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Holtasmari 1, Kopavogur IS-201, Iceland
- University of Iceland, Reykjavik IS-101, Iceland
| | - Anders Hamsten
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm SE-171 77, Sweden
| | - Tamara B Harris
- Intramural Research Program, National Institute on Aging, Bethesda, Maryland 21224, USA
| | - Andrew T Hattersley
- Genetics of Diabetes, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK
| | - Caroline Hayward
- MRC Human Genetics Unit, MRC IGMM, University of Edinburgh, Edinburgh, Scotland EH4 2XU, UK
| | - Albert Hofman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
| | - Jan-Håkan Jansson
- Department of Public Health & Clinical Medicine, Umeå University, Umeå SE-901 87, Sweden
- Research Unit, Skellefteå SE-931 87, Sweden
| | - Claudia Langenberg
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0SL, UK
| | - Lenore J Launer
- Intramural Research Program, National Institute on Aging, Bethesda, Maryland 21224, USA
| | - Daniel Levy
- Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
- Framingham Heart Study, Framingham, Massachusetts 01702, USA
| | - Ben A Oostra
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
| | - Christopher J O'Donnell
- National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study, Framingham, Massachusetts 01702, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Stephen O'Rahilly
- University of Cambridge Metabolic Research Laboratories, MRC Metabolic Diseases Unit and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 1TN, UK
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - James S Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Ozren Polasek
- Department of Public Health, Faculty of Medicine, University of Split, Split 21000, Croatia
| | - Michael A Province
- Division of Statistical Genomics and Department of Genetics, Washington University School of Medicine, St. Louis, Missouri 63108, USA
| | - Stephen S Rich
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia 22908, USA
| | - Paul M Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02215, USA
- Division of Cardiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Igor Rudan
- Centre for Population Health Sciences, Medical School, University of Edinburgh, Edinburgh, Scotland EH8 9YL, UK
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal DE-14558, Germany
- German Center for Diabetes Research (DZD), Neuherberg DE-85764, Germany
| | - Blair H Smith
- Medical Research Institute, University of Dundee, Dundee DD1 9SY, UK
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
| | - Mark Walker
- Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne NE1 7RU, UK
| | - Hugh Watkins
- Department of Cardiovascular Medicine, The Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Department of Ophthalmology, National University of Singapore and National University Health System, Singapore 119228, Singapore
- Office of Clinical Sciences, Duke-NUS Graduate Medical School, National University of Singapore, Singapore 169857, Singapore
| | | | - Markku Laakso
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio FI-70211, Finland
| | - Ingrid B Borecki
- Division of Statistical Genomics and Department of Genetics, Washington University School of Medicine, St. Louis, Missouri 63108, USA
| | - Daniel I Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02215, USA
- Division of Genetics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Oluf Pedersen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington 98101, USA
- Department of Medicine, University of Washington, Seattle, Washington 98195, USA
- Department of Epidemiology, University of Washington, Seattle, Washington 98195, USA
- Department of Health Services, University of Washington, Seattle, Washington 98195, USA
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington 98195, USA
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Cornelia M van Duijn
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam 3000 CE, The Netherlands
- Center for Medical Systems Biology, Leiden 2300, The Netherlands
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0SL, UK
| | - Dawn M Waterworth
- Genetics, PCPS, GlaxoSmithKline, Philadelphia, Pennsylvania 19104, USA
| | - Eric Boerwinkle
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas 77225, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - W H Linda Kao
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland 21205, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland 21205, USA
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA
| | - Jose C Florez
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA
- Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts 02142, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Ruth J.F. Loos
- The Charles Bronfman Institute for Personalized Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
- The Genetics of Obesity and Related Metabolic Traits Program, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
- The Mindich Child Health and Development Institute, The Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi 38677, USA
| | - Timothy M Frayling
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK
| | - David S Siscovick
- New York Academy of Medicine, New York, New York 10029, USA
- Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington 98195, USA
| | - Josée Dupuis
- National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study, Framingham, Massachusetts 01702, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts 02118, USA
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
| | - James B Meigs
- Massachusetts General Hospital, General Medicine Division, Boston, Massachusetts 02114, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Robert A Scott
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0SL, UK
| | - Mark O Goodarzi
- Department of Medicine and Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
- Division of Endocrinology, Diabetes and Metabolism, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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Protogerou A, Zampeli E, Tentolouris N, Makrilakis K, Kitas G, Sfikakis P. AB0379 Subclinical atherosclerosis in the femoral arteries: similar prevalence in rheumatoid arthritis and diabetes mellitus in a case control study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gelev S, Toshev S, Trajceska L, Pavleska S, Selim G, Dzekova P, Shikole A, Gelev S, Toshev S, Trajceska L, Pavleska S, Selim G, Dzekova P, Shikole A, Ulu SM, Yilmaz F, Ahsen A, Akci A, Yuksel S, Mihaescu A, Olariu N, Avram C, Schiller O, Schiller A, Xiao DM, Niu JY, Gu Y, Drechsler C, van den Broek H, Vervloet M, Hoekstra T, Dekker F, Ketteler M, Brandenburg V, Turkvatan A, Kirkpantur A, Mandiroglu S, Afsar B, Seloglu B, Alkis M, Erkula S, GURBUZ H, Serin M, CALIK Y, Mandiroglu F, Balci M, Choi BS, Choi SR, Park HS, Hong YA, Chung BH, Kim YS, Yang CW, Kim YS, Park CW, Jung JY, Sung JY, Kim AJ, Kim HS, Lee C, Ro H, Chang JH, Lee HH, Chung W, Sezer S, Bal Z, Tutal E, Bal U, Erkmen Uyar M, Ozdemir Acar N, Karakas Y, Sahin G, Urfali F, Bal C, Akcar Degirmenci N, Sirmagul B, Janda K, Krzanowski M, Dumnicka P, Kusnierz-Cabala B, Sulowicz W, Balci M, Kirkpantur A, Mandiroglu S, Afsar B, Seloglu B, Alkis M, Serin M, CALIK Y, Erkula S, GURBUZ H, Mandiroglu F, Turkvatan A, Valtuille RA, Gonzalez MS, Casos ME, Yoshida T, Yamashita M, Hayashi M, Raikou VD, Tentolouris N, Makropoulos I, Kaisidis P, Boletis JN, Abdalla AA, Roche D, Forbes JF, Hannigan A, Hegarty A, Cronin CJ, Casserly LF, Stack AG, Guinsburg A, Raimann JG, Usvyat L, Kooman J, Marelli C, Etter M, Marcelli D, Levin NW, Kotanko P, Kim CS, Choi JS, Bae EH, Ma SK, Kim SW, Ryu JH, Lee S, Ryu DR, Kim SJ, Kang DH, Choi KB, Shoji T, Tsuchikura S, Shimomura N, Kakiya R, Tsujimoto Y, Tabata T, Emoto M, Nishizawa Y, Inaba M, Selim G, Stojceva-Taneva O, Tozija L, Georgievska-Ismail L, Gelev S, Dzekova-Vidimliski P, Trajceska L, Petronievic Z, Sikole A, Wu CJ, Pan CF, Chen HH, Lin CJ, Kim Y, Kim JK, Song YR, Kim SG, Kim HJ, Kuwahara M, Bannai K, Kikuchi K, Yamato H, Segawa H, Miyamoto KI, De Mauri A, Chiarinotti D, Ruva CE, David P, Capurro F, De Leo M, Han JH, Kim HR, Ko KI, Kim CH, Koo HM, Doh FM, Lee MJ, Oh HJ, Han SH, Yoo TH, Choi KH, Kang SW, Shibata K, Sohara H, Kuji T, Kawata S, Kogudhi N, Nishihara M, Satta H, Jung JY, Ro H, Lee C, Kim SM, Kim AJ, Kim HS, Chang JH, Lee HH, Chung W, Kramann R, Erpenbeck J, Becker M, Brandenburg V, Kruger T, Marx N, Floege J, Schlieper G, Power A, Fogarty D, Wheeler D, Kerschbaum J, Schwarz CP, Mayer G, Prajitno CW, Matsuzawa R, Matsunaga A, Ishii A, Abe Y, Yoneki K, Harada M, Takagi Y, Yoshida A, Takahira N, Sirch J, Pfeiffer S, Fischlein T, El-Nahid MS, Issac MS, Bal Z, Tutal E, Bal U, Erkmen Uyar M, Guliyev O, Sayin B, Sezer S, Bajari T, Hermann M, Gmeiner B, Regele H, Aumayr K, Gensberger ET, Scharrer S, Sengoge G, Novo A, Tania S, Anes E, Domingues A, Mendes E, Batista G, Viana J, Rroji M, Cafka M, Seferi S, Seiti J, Petrela E, Likaj E, Thereska N, Selim G, Stojceva-Taneva O, Tozija L, Georgievska-Ismail L, Gelev S, Dzekova-Vidimliski P, Trajceska L, Petronievic Z, Sikole A, Turkmen K, Ozcicek F, Erdur F, Turk S, Yeksan M, Tonbul H, Castellano S, Palomares I, Merello JI, Mandiroglu S, Torkvatan A, Balci M, Seloglu B, Alkis M, Serin M, Erkula S, Gurbuz H, Calik Y, Afsar B, Mandiroglu F, Kirkpantur A, Ulusal Okyay G, Okyay K, Polattas Solak E, Sahinaslan A, Pasaoglu O, Ayerden Ebinc F, Boztepe Derici U, Sindel S, Arinsoy T, Lee YK, Son SY, Choi MJ, Lee SM, Yoon JW, Koo JR, Noh JW, Vaziri ND, Matias P, Amaral T, Ferreira AC, Mendes M, Azevedo A, Jorge C, Aires I, Gil C, Ferreira A, Carretero Dios D, Merello Godino JI, Moran Risco JE, Castellano Gasch S, Schwermer K, Hoppe K, Klysz P, Radziszewska D, Sikorska D, Nealis J, Polcyn-Adamczak M, Zaremba-Drobnik D, Pawlaczyk K, Oko A, Mentese A, Yavuz A, Karahan C, Sumer A, Ozkan G, Ulusoy S, Yildiz G, Duman A, Aydin H, Yilmaz A, Hur E, Magden K, Cetin G, Candan F, Franczyk-Skora B, Gluba A, Kowalczyk M, Banach M, Rysz J, Novo A, Domingues A, Preto L, Sousa T, Mendes E, Batista G, Vaz J, Oue M, Kuragano T, Hamahata S, Fukao W, Toyoda K, Nakanishi T, Otsubo S, Tsuchiya K, Akiba T, Nitta K, Afsar B, Saglam M, Yuceturk C, Agca E, Tosic J, Djuric Z, Popovic J, Buzadzic I, Djuric P, Jankovic A, Dimkovic N, Simone S, Dell'Oglio MP, Ciccone M, Castellano G, Corciulo R, Balestra C, Giangrande M, Gigante M, Grandaliano G, Gesualdo L, Pertosa GP, Mohamed EA, Marouane B, Mohamed Reda EF, Aziz R, Hicham B, Youssef B, Abdennasser EK, Salaheddine T, Mohammed A, Hwang JC, Jiang MY, Lu YH, Wang CT, Grzegorzewska A, Cieszynski K, Niepolski L, Sowinska A, Abdallah E, Al-Helal B, Waked E, Abdel-Khalik A, Nabil M, El-Shanawany F, Tekce H, Kursat S, Bahadir Colak H, Aktas G, Ozcicek A, Turkmen K, Ozcicek F, Akbas E, Demirtas L, Ozbicer A, Cetinkay R, Capoglu I, Valocikova I, Valocik G, Vachalcova M, Kolesarova E, Nowak A, Friedrich B, Artunc F, Serra A, Breidthardt T, Twerenbold R, Peter M, Potocki M, Muller C. Cardiovascular complications in CKD 5D. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Papanas N, Boulton AJM, Malik RA, Manes C, Schnell O, Spallone V, Tentolouris N, Tesfaye S, Valensi P, Ziegler D, Kempler P. A simple new non-invasive sweat indicator test for the diagnosis of diabetic neuropathy. Diabet Med 2013; 30:525-34. [PMID: 22924579 DOI: 10.1111/dme.12000] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A simple non-invasive indicator test (Neuropad(®)) has been developed for the assessment of sweating and, hence, cholinergic innervation in the diabetic foot. The present review summarizes current knowledge on this diagnostic test. The diagnostic ability of this test is based on a colour change from blue to pink at 10 min, with excellent reproducibility, which lends itself to patient self-examination. It has a high sensitivity (65.1-100%) and negative predictive value (63-100%), with moderate specificity (32-78.5%) and positive predictive value (23.3-93.2%) for the diagnosis of diabetic peripheral neuropathy. It also has moderate to high sensitivity (59.1-89%) and negative predictive value (64.7-91%), but low to moderate specificity (27-78%) and positive predictive value (24-48.6%) for the diagnosis of diabetic cardiac autonomic neuropathy. There are some data to suggest that Neuropad can detect early diabetic neuropathy, but this needs further evaluation. It remains to be established whether this test can predict foot ulceration and amputation, thereby contributing to the identification of high-risk patients.
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Affiliation(s)
- N Papanas
- Outpatient Clinic of the Diabetic Foot, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece University of Manchester and Manchester Diabetes Centre, Manchester, UK.
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Protogerou A, Zampeli E, Tentolouris N, Makrilakis K, Kitas G, Sfikakis PP. Subclinical femoral atheromatosis in rheumatoid arthritis: comparable prevalence to diabetes mellitus in a case-control study. Ann Rheum Dis 2012; 71:1534-6. [PMID: 22764043 DOI: 10.1136/annrheumdis-2011-201278] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is associated with increased coronary artery disease (CAD) and subclinical carotid atheromatosis, reportedly to equal diabetes mellitus (DM). The presence of atheromatic plaques in femoral arteries of RA patients without DM was compared with with DM patients. METHODS Femoral plaques were recorded in 30 (17 men, age 43.0±12 years, disease duration 9.9±7.1 years) and 60 older RA patients (27 men, age 63.0±7.1 years, disease duration 11.4±7.9 years) matched 1:1 for age, gender and disease duration with DM types 1 and 2 patients, respectively. All were asymptomatic and free of CAD. RESULTS The number of femoral plaques per patient in either RA subgroup was comparable with DM (0.64±0.82 vs 0.77±0.89 in total respective populations, p=0.340); percentages of patients with femoral plaques were also comparable (RA vs DM type 1 20% and 13%, respectively; RA vs DM type 2 58% and 66%, respectively). Hypertension and dyslipidaemia were significantly more frequent in both DM groups than RA groups. CONCLUSIONS Subclinical femoral atheromatosis in RA is analogous to DM, further confirming the territorial unrestricted acceleration of the atheromatic process in these patients. Cardiovascular risk stratification based on both carotid and femoral plaque detection in RA should be addressed prospectively.
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Affiliation(s)
- Athanase Protogerou
- First Department of Propaedeutic and Internal Medicine, Medical School, University of Athens, 'Laikon' Hospital, Ag. Thoma, 17, 11527 Athens, Greece
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Grigoropoulou P, Eleftheriadou I, Zoupas C, Tentolouris N. The role of the osteoprotegerin/RANKL/RANK system in diabetic vascular disease. Curr Med Chem 2012; 18:4813-9. [PMID: 21919846 DOI: 10.2174/092986711797535281] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 08/12/2011] [Accepted: 08/15/2011] [Indexed: 11/22/2022]
Abstract
Over the last years our knowledge on the mechanisms involved in the pathogenesis of cardiovascular disease has been enriched by the discovery of new molecules emerging as novel risk factors. Osteoprotegerin (OPG) is a soluble glycoprotein, member of the tumor necrosis factor (TNF)-related superfamily, involved in bone resorption. It was first described as a key regulator of bone homeostasis and vascular calcification in mice. Clinical studies have suggested that serum OPG is associated with vascular calcification in humans. The role of OPG in the development of macroangiopathy in diabetes is not yet clear. It is possible that the increased OPG levels in diabetes reflect a compensatory response to arterial injury and that it is not involved in the pathogenesis of atherosclerosis. Whether harmful or not, determination of serum OPG levels has been suggested as a prognostic biomarker of cardiovascular disease. In addition, increased OPG levels have been reported in diabetic patients with microvascular complications. The potential of OPG administration for therapeutic reasons is challenging for future investigators. This review summarizes the current knowledge on the association between OPG and macrovascular as well microvascular complications of diabetes.
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Affiliation(s)
- P Grigoropoulou
- First Department of Propaedeutic and Internal Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece
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Papanas N, Eleftheriadou I, Tentolouris N, Maltezos E. Advances in the topical treatment of diabetic foot ulcers. Curr Diabetes Rev 2012; 8:209-18. [PMID: 22429013 DOI: 10.2174/157339912800563963] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/09/2011] [Accepted: 01/16/2012] [Indexed: 11/22/2022]
Abstract
The diabetic foot remains a major cause of morbidity worldwide. Even though considerable progress has been achieved over the past years, there is still an urgent need for improvement. While established therapeutic modalities (revascularization, casting and debridement) remain the mainstay of management, there is, therefore, continuous development of new treatment options. This review provides an outlook of advances in topical treatment, including bioengineered skin substitutes (such as Dermagraft, Apligraf, HYAFF, OASIS and Graftjacket), extracellular matrix proteins (such as Hyalofill and E-matrix), as well as miscellaneous further therapeutic adjuncts. Although promising, new therapies should not, for the time being, constitute the basis of management, since clinical experience has not yet confirmed their effectiveness in hard-to-heal diabetic foot ulcers. Furthermore, their cost-effectiveness merits further investigation. Instead, they should only be considered in combination with established treatments or be attempted when these have not been successful. Moreover, we should not be oblivious to the fact that established and emerging treatments need to be practised in the setting of multidisciplinary foot clinics to reduce the number of amputations.
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Affiliation(s)
- N Papanas
- Outpatient Clinic of the Diabetic Foot, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
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Voulqari C, Paximadas S, Tentolouris N. 563 COST EFFICACY IN HOSPITALIZED PATIENTS WITH DIABETES IS RELATIVE TO TREATMENT DECISION MAKING AND CLINICAL OUTCOME. ATHEROSCLEROSIS SUPP 2011. [DOI: 10.1016/s1567-5688(11)70564-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Papazafiropoulou A, I. Pappas S, Papadogiannis D, Tentolouris N. Cardiovascular Effects of Glucagon-Like Peptide 1. Mini Rev Med Chem 2011; 11:97-105. [DOI: 10.2174/138955711793564033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Accepted: 10/14/2010] [Indexed: 11/22/2022]
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Voulgari C, Moyssakis I, Perrea D, Kyriaki D, Katsilambros N, Tentolouris N. The association between the spatial QRS-T angle with cardiac autonomic neuropathy in subjects with Type 2 diabetes mellitus. Diabet Med 2010; 27:1420-9. [PMID: 21059095 DOI: 10.1111/j.1464-5491.2010.03120.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To examine differences in the spatial QRS-T angle in patients with Type 2 diabetes mellitus with and without cardiac autonomic neuropathy. METHODS Two hundred and thirty-two patients with diabetes mellitus (105 with cardiac autonomic neuropathy and 127 without cardiac autonomic neuropathy) and 232 control subjects, matched by gender and age, were studied. Diagnosis of cardiac autonomic neuropathy was based on the classic autonomic function tests. All subjects underwent a digital electrocardiographic recording. Electrocardiographic parameters were measured using the Modular Electrocardiographic Analysis (MEANS) program. Left ventricular mass index (LVMi) and global myocardial performance index (Tei index) of the left ventricle were assessed by ultrasonography. RESULTS The spatial QRS-T angle was higher in the patients with diabetes in comparison with the control subjects (24.5 ± 10.7 vs. 9.7 ± 4.5°, P < 0.001) and in the patients with diabetes and cardiac autonomic neuropathy than in those without cardiac autonomic neuropathy (30.1 ± 11.3 vs. 19.5 ± 7.1, P < 0.001). No differences were found in the QT interval between the studied groups. Multivariate linear regression analysis in subjects with diabetes after controlling for age, gender, BMI, blood pressure, diabetes duration, HbA(1c) , lipids, microalbuminuria and insulin resistance, demonstrated significant and independent associations between the spatial QRS-T angle with presence and severity of cardiac autonomic neuropathy, all parameters of heart rate variability, LVMi and Tei index. CONCLUSIONS The spatial QRS-T angle is increased in patients with Type 2 diabetes who have cardiac autonomic neuropathy, suggesting increased ventricular arrhythmogenicity, and is associated with the structural and functional properties of the myocardium. Further research is warranted to evaluate its role in cardiovascular risk stratification of patients with diabetes.
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Affiliation(s)
- C Voulgari
- 1st Department of Propaedeutic and Internal Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece
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Doupis J, Eleftheriadou I, Kokkinos A, Perrea D, Pavlatos S, Gonis A, Katsilambros N, Tentolouris N. Acute Hyperhomocysteinemia Impairs Endothelium Function in Subjects with Type 2 Diabetes Mellitus. Exp Clin Endocrinol Diabetes 2010; 118:453-8. [DOI: 10.1055/s-0030-1248290] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Papazafiropoulou A, Tentolouris N, Bousboulas S, Sotiropoulos A, Tamvakos E, Peppas T, Kardara M, Pappas S. In-Hospital Mortality in a Tertiary Referral Hospital: Causes Of Death and Comparison between Patients with and without Diabetes. Exp Clin Endocrinol Diabetes 2010; 118:315-9. [DOI: 10.1055/s-0029-1241215] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Diabetic patients are at high risk for peripheral arterial disease (PAD) characterized by symptoms of intermittent claudication or critical limb ischaemia. Given the inconsistencies of clinical findings in the diagnosis of PAD in the diabetic patient, measurement of ankle-brachial pressure index (ABI) has emerged as the relatively simple, non-invasive and inexpensive diagnostic tool of choice. An ABI < 0.9 is not only diagnostic of PAD even in the asymptomatic patient, but is also an independent marker of increased morbidity and mortality from cardiovascular diseases. With better understanding of the process of atherosclerosis, avenues for treatment have increased. Modification of lifestyle and effective management of the established risk factors such as smoking, dyslipidaemia, hyperglycaemia and hypertension retard the progression of the disease and reduce cardiovascular events in these patients. Newer risk factors such as insulin resistance, hyperfibrinogenaemia, hyperhomocysteinaemia and low-grade inflammation have been identified, but the advantages of modifying them in patients with PAD are yet to be proven. Therapeutic angiogenesis, on the other hand, represents a promising therapeutic adjunct in the management of PAD in these patients. Outcomes after revascularization procedures, such as percutaneous transluminal angioplasty and surgical bypasses in diabetic patients, are poorer, with increased perioperative morbidity and mortality compared with that in non-diabetic patients. Amputation rates are higher due to the distal nature of the disease. Efforts towards increasing awareness and intensive treatment of the risk factors will help to reduce morbidity and mortality in diabetic patients with PAD.
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Affiliation(s)
- E B Jude
- Tameside General Hospital, Ashton-Under-Lyne, Lancashire, UK.
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Papazafiropoulou A, Tentolouris N. Matrix metalloproteinases and cardiovascular diseases. Hippokratia 2009; 13:76-82. [PMID: 19561775 PMCID: PMC2683462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Matrix metalloproteinases (MMPs) are extracellular enzymes that are important in many physiologic and pathologic processes. Their activity is regulated mainly by tissue inhibitors of metalloproteinases (TIMPs). MMPs expression is related with the classical cardiovascular risk factors as well as with inflammation. They play a central role in atherosclerosis, plaque formation, platelet aggregation, acute coronary syndrome, restenosis, aortic aneurysms and peripheral vascular disease. Many studies have shown that commonly prescribed antihypertensive medications, glitazones and statins may influence MMPs activity. The aim of the review is to present literature data on the role of MMPs and their inhibitors in cardiovascular disease.
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Affiliation(s)
- A Papazafiropoulou
- Department of Propaedeutic Medicine, Laiko Hospital, Athens University Medical School, Athens, Greece.
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Eleftheriadou I, Koliaki C, Grigoropoulou P, Perrea D, Kokkinos A, Tentolouris N, Katsilambros N. Die Sensitivität und Spezifität des Knöchel-Arm-Index für die Diagnose der peripheren arteriellen Verschlusskrankheit in Patienten mit Typ 2 Diabetes mellitus mit oder ohne diabetische Neuropathie. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tentolouris N, Andrianakos A, Karanikolas G, Karamitsos D, Trontzas P, Krachtis P, Christoyannis F, Tavaniotou E, Nikolia Z, Kaskani E, Kontelis L, Sfikakis PP. Prevalence of diabetes mellitus and obesity in the general adult population of Greece: a door-to-door epidemiological study. Diabet Med 2009; 26:451-2. [PMID: 19388978 DOI: 10.1111/j.1464-5491.2009.02692.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
AIM To examine the relationship between sudomotor dysfunction and foot ulceration (FU) in patients with diabetes. METHODS Ninety patients with either Type 1 or Type 2 diabetes [30 without peripheral sensorimotor neuropathy (PN), 30 with PN but without FU and 30 with FU] were recruited in this cross-sectional study. Assessment of PN was based on neuropathy symptom score (NSS), neuropathy disability score (NDS) and vibration perception threshold (VPT). Sudomotor dysfunction was assessed using the sympathetic skin response (SSR). Cardiac autonomic nervous system activity was assessed by the battery of the classical autonomic function tests. RESULTS Patients with foot ulcers had longer duration of diabetes, higher values of VPT and NDS and lower values of the autonomic functions tests in comparison with the other study groups. Sudomotor dysfunction and cardiac autonomic neuropathy were significantly more common in the FU group. Multivariate logistic regression analysis after adjustment for gender, body mass index, duration of diabetes and glycated haemoglobin (HbA(1c)) demonstrated that the odds ratio (95% confidence intervals) of FU increased with measures of neuropathy such as NDS >or= 6 (10.2, 6.2-17.3) and VPT >or= 25 volts (19.8, 9.9-47.5), but was also significantly increased with absent SSR (15.3, 5.3-38.4). CONCLUSIONS Sudomotor dysfunction is associated with increased risk of FU and should be included in the screening tests for identification of diabetic patients at risk of ulceration.
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Affiliation(s)
- N Tentolouris
- 1st Department of Propaedeutic Medicine, Laiko General Hospital, Athens University Medical School, Athens, Greece.
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Tentolouris N, Eleftheriadou I, Katsilambros N. The Effects of Medications Used for the Management of Dyslipidemia on Postprandial Lipemia. Curr Med Chem 2009; 16:203-17. [DOI: 10.2174/092986709787002763] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Tentolouris N, Arapostathi C, Voulgari C, Grammatikou S, Andrianakos A, Sfikakis PP. The effect of diabetes mellitus on the prevalence of rheumatoid arthritis: a case-control study. Diabet Med 2008; 25:1010-1. [PMID: 18959621 DOI: 10.1111/j.1464-5491.2008.02487.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mylonopoulou M, Antonopoulos S, Mikros S, Katsaros K, Papadakis G, Melidonis A, Tentolouris N, Katsilambros N. LIPIDAEMIC PROFILE AND HEART RATE VARIABILITY (HRV) IN CHRONIC KIDNEY DISEASE (CKD) PATIENTS WITH OR WITHOUT TYPE2 DIABETES MELLITUS (T2DM). ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70949-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Moyssakis I, Gialafos E, Tentolouris N, Floudas CS, Papaioannou TG, Kostopoulos C, Latsi P, Vaiopoulos G, Votteas V, Rapti A. Impaired aortic elastic properties in patients with systemic sarcoidosis. Eur J Clin Invest 2008; 38:82-9. [PMID: 18226041 DOI: 10.1111/j.1365-2362.2007.01906.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Systemic sarcoidosis (Sar) is a granulomatous disorder involving multiple organs. Widespread vascular involvement and microangiopathy are common in patients with Sar. In addition, subclinical cardiac involvement is increasingly recognized in patients with Sar. However, data on the effect of Sar on the elastic properties of the arteries and myocardial performance are limited. In this study we looked for differences in aortic distensibility (AoD) which is an index of aortic elasticity, and myocardial performance of the ventricles, between patients with Sar and healthy subjects. In addition, we examined potential associations between AoD and clinical, respiratory and echocardiographic findings in patients with Sar. MATERIALS AND METHODS A total of 83 consecutive patients (26 male/57 female, mean age 51.1 +/- 13.3 years) with Sar, without cardiac symptoms, were included. All patients underwent echocardiographic and respiratory evaluation including lung function tests. Additionally, 83 age- and sex-matched healthy subjects served as controls. AoD was determined non-invasively by ultrasonography. RESULTS AoD was lower in the Sar compared to the control group (2.29 +/- 0.26 vs. 2.45 +/- 0.20 .10(-) (6) cm2 x dyn(-1), P < 0.01), while left ventricular mass (LVM) was higher in the Sar group (221.3 +/- 50.2 vs. 195.6 +/- 31.3 g, P = 0.007). Furthermore, myocardial performance of both ventricles was impaired in the Sar group. Multivariate linear regression analysis in the total sample population demonstrated a significant and independent inverse relationship between AoD and the presence of Sar (P < 0.001). The same analysis in the Sar patients showed that AoD was associated significantly and independently with the stage of Sar, age, systolic blood pressure, LVM and myocardial performance of both ventricles. No significant relationship was found between AoD and disease duration, pulmonary artery pressure or lung function tests. CONCLUSIONS Presence and severity of Sar are associated with reduced aortic distensibility, irrespective of the disease duration, pulmonary artery pressure and lung function. In addition, patients with Sar have increased LVM and impaired myocardial performance.
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Affiliation(s)
- I Moyssakis
- Department of Cardiology, Medical School, National University of Athens, Laiko Hospital, Athens, Greece.
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Grigoropoulou P, Eleftheriadou I, Tentolouris N, Perrea D, Zoupas C, Danias V, Katsilambros N. Effekt der Atorvastatin Therapie auf die Elastizitätseigenschaften der Arterien in Patienten mit Typ-2-Diabetes mellitus und Dyslipidämie. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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37
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Eleftheriadou I, Danias V, Grigoropoulou P, Koliaki C, Kolovou I, Perrea D, Katsilambros N, Tentolouris N. PWV für die Diagnose der peripheren arteriellen Verschlusskrankheit in Patienten mit und ohne Typ-2-Diabetes mellitus. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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38
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Liatis S, Marinou K, Tentolouris N, Pagoni S, Katsilambros N. Usefulness of a new indicator test for the diagnosis of peripheral and autonomic neuropathy in patients with diabetes mellitus. Diabet Med 2007; 24:1375-80. [PMID: 17941862 DOI: 10.1111/j.1464-5491.2007.02280.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS The aim of the present study was to assess the performance of a new indicator test (NIT), based on the measurement of sweat production after exposure to dermal foot perspiration, in the diagnosis of both peripheral sensorimotor polyneuropathy (PSN) and autonomic neuropathy in patients with diabetes. METHODS One hundred and seventeen diabetic patients were examined. PSN was assessed using the neuropathy symptoms score, the neuropathy disability score and the vibration perception threshold. Cardiac autonomic neuropathy (CAN) was assessed using the battery of the four classical standardized tests proposed by Ewing et al., Diabetes Care 1985; 8: 491-498. Sudomotor dysfunction was assessed using the NIT. RESULTS Fifty patients (42.7%) had PSN and 44 patients (37.6%) had CAN. Of the 50 patients with PSN, 43 had a positive NIT (sensitivity 86%) and, out of the 67 patients without PSN, a negative NIT was obtained in 45 patients (specificity 67%). The positive and the negative predictive value of the NIT in detecting PSN were 66.2 and 86.5%, respectively. The sensitivity and specificity of NIT in detecting CAN was 59.1 and 46.5%, respectively. In the case of severe CAN, the sensitivity was increased to 80.9% and the specificity to 50%. CONCLUSIONS The NIT has good sensitivity and negative predictive value for diagnosis of PSN and can be used as a screening method for detection of this complication in patients with diabetes. In addition, the test has a low sensitivity for detection of autonomic neuropathy in patients with milder forms of CAN.
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Affiliation(s)
- S Liatis
- First Department of Internal Medicine, Athens University Medical School and Diabetes Centre, Laiko General Hospital, Athens, Greece.
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Papazafiropoulou A, Tentolouris N, Eleftheriadou I, Perrea D, Diamantopoulos E, Katsilambros N. Elastizitätsverminderung der Arterien bei Patienten mit Typ 2 Diabetes Mellitus und Mikroalbuminurie. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Obesity is a very common disease worldwide, resulting from a disturbance in the energy balance. The metabolic syndrome is also a cluster of abnormalities with basic characteristics being insulin resistance and visceral obesity. The major concerns of obesity and metabolic syndrome are the comorbidities, such as type 2 diabetes, cardiovascular disease, stroke, and certain types of cancers. Sympathetic nervous system (SNS) activity is associated with both energy balance and metabolic syndrome. Sympathomimetic medications decrease food intake, increase resting metabolic rate (RMR), and thermogenic responses, whereas blockage of the SNS exerts opposite effects. The contribution of the SNS to the daily energy expenditure, however, is small ( approximately 5%) in normal subjects consuming a weight maintenance diet. Fasting suppresses, whereas meal ingestion induces SNS activity. Most of the data agree that obesity is characterized by SNS predominance in the basal state and reduced SNS responsiveness after various sympathetic stimuli. Weight loss reduces SNS overactivity in obesity. Metabolic syndrome is characterized by enhanced SNS activity. Most of the indices used for the assessment of its activity are better associated with visceral fat than with total fat mass. Visceral fat is prone to lipolysis: this effect is mediated by catecholamine action on the sensitive beta(3)-adrenoceptors found in the intraabdominal fat. In addition, central fat distribution is associated with disturbances in the hypothalamo-pituitary-adrenal axis, suggesting that a disturbed axis may be implicated in the development of the metabolic syndrome. Furthermore, SNS activity induces a proinflammatory state by IL-6 production, which in turn results in an acute phase response. The increased levels of inflammatory markers seen in the metabolic syndrome may be elicited, at least in part, by SNS overactivity. Intervention studies showed that the disturbances of the autonomic nervous system seen in the metabolic syndrome are reversible.
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Affiliation(s)
- N Tentolouris
- 1st Department of Propaedeutic Medicine, Athens University Medical School, 11523 Athens, Greece.
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41
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Voulgari C, Tentolouris N, Moyssakis I, Dilaveris P, Gialafos E, Papadogiannis D, Votteas V, Cokkinos DV, Stefanadis C, Katsilambros N. Spatial QRS-T angle: association with diabetes and left ventricular performance. Eur J Clin Invest 2006; 36:608-13. [PMID: 16919042 DOI: 10.1111/j.1365-2362.2006.01697.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The spatial QRS-T angle obtained by vectorcardiography is a combined measurement of the electrical activity of the heart and predicts cardiovascular morbidity and mortality. Disturbances in repolarization and depolarization are common in diabetes. No data, however, exist on the effect of diabetes on QRS-T angle. In this study we examined differences in QRS-T angle between type 2 diabetic and non-diabetic subjects; in addition, the potential relationship between QRS-T angle and left ventricular performance as well as glycaemic control were also examined. A total of 74 subjects with type 2 diabetes and 74 non-diabetic individuals, matched for age and sex with the diabetic subjects were examined. All subjects were free of clinically apparent macrovascular complications. Spatial vectorcardiogaphic descriptors of ventricular depolarization and repolarization were reconstructed from the 12-electrocardiographic leads using a computer-based electrocardiogram. Left ventricular mass and performance were measured using M-mode and Doppler echocardiography. QRS-T angle values were higher (by almost 2-fold) in the diabetic in comparison with the non-diabetic subjects (P < 0.001). After multivariate adjustment, QRS-T angle was independently associated with age (P = 0.01), HbA(1c) (P = 0.003), and low-density lipoprotein cholesterol levels (P = 0.04) in the non-diabetic, and with HbA(1c) (P = 0.03) as well as Tei index (P = 0.003) in the diabetic subjects. The spatial QRS-T angle is high in subjects with type 2 diabetes and is associated with glycaemic control and left ventricular performance. The prognostic importance of the higher spQRS-T angle values in subjects with diabetes remains to be evaluated in prospective studies.
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Affiliation(s)
- Ch Voulgari
- Laiko Hospital, Athens University Medical School, Athens, Greece
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42
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Tentolouris N, Petrikkos G, Vallianou N, Zachos C, Daikos GL, Tsapogas P, Markou G, Katsilambros N. Prevalence of methicillin-resistant Staphylococcus aureus in infected and uninfected diabetic foot ulcers. Clin Microbiol Infect 2006; 12:186-9. [PMID: 16441460 DOI: 10.1111/j.1469-0691.2005.01279.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study investigated the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in infected and uninfected diabetic foot ulcers of 84 patients with the two types of diabetes. S. aureus was the most common pathogen among the Gram-positive bacteria isolated from ulcers, and almost 50% of S. aureus isolates were MRSA. The prevalence of MRSA was significantly higher in patients with infected foot ulcers. MRSA infection or colonisation was not associated with factors (previous hospitalisation, use of antibiotics, etc.) known to predispose to MRSA colonisation or infection. The high prevalence of MRSA in patients with foot ulcers may reflect the increased prevalence of MRSA in the community.
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Affiliation(s)
- N Tentolouris
- First Department of Propaedeutic Medicine, Athens University Medical School, Athens, Greece.
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43
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Moyssakis I, Tentolouris N, Daskalaki M, Gialafos E, Paizis I, Vichos S, Votteas V. Tu-P7:118 Patients with type 2 diabetes mellitus and cardiac autonomic neuropathy have impaired elastic properties of ascending aorta. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)80824-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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44
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Tsapogas P, Tentolouris N, Kokkinos A, Papazafiropoulou A, Liatis S, Tsiakou A, Pagoni S, Katsilambros N. Identifizierung des Metabolischen Syndromes bei Patienten mit Diabetes mellitus Typ 1 bzw. 2 und nichtdiabetischen Personen gemäss den IDF- und NCEP-ATPIII-Kriterien. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-944080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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45
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Pavlatos S, Kokkinos A, Tentolouris N, Doupis J, Kyriaki D, Katsilambros N. Acute effects of high-protein and high-fat isoenergetic meals on total ghrelin plasma concentrations in lean and obese women. Horm Metab Res 2005; 37:773-5. [PMID: 16372233 DOI: 10.1055/s-2005-921101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- S Pavlatos
- First Department of Propaedeutic Medicine, University of Athens Medical School, Laiko University Hospital, 5 Dorylaiou St., 11521 Athens, Greece
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46
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Tentolouris N, Makrilakis K, Doulgerakis D, Moyssakis I, Kokkinos A, Kyriaki D, Georgoulias C, Stathakis C, Katsilambros N. Increased plasma ghrelin levels in chronic renal failure are not associated with hemodynamic parameters. Horm Metab Res 2005; 37:646-52. [PMID: 16278789 DOI: 10.1055/s-2005-870530] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND/AIMS Hardly anything is known about the effect of renal function on plasma ghrelin levels. Ghrelin is an orexigenic hormone with important hemodynamic effects. We examined differences in plasma ghrelin levels between chronic renal failure (CRF) patients and healthy subjects, and ghrelin's relationship with indices of left ventricular (LV) function. METHODS Fasting total plasma ghrelin levels were measured in 122 CRF patients (57 on, 65 not on hemodialysis) and 57 control subjects. Indices of LV function were evaluated using echocardiography. RESULTS Total plasma ghrelin levels were higher in patients with CRF compared to controls, but were not different between patients on and those not on hemodialysis. In a multivariate linear regression model, presence of kidney dysfunction explained 41 % of the variability of ghrelin values. The etiology of renal failure (diabetic nephropathy or not) had no influence on ghrelin levels in the renal patients. Ghrelin levels were not associated with indices of LV systolic function or blood pressure in these patients. CONCLUSION Fasting plasma ghrelin concentrations are higher in CRF patients regardless of their need for hemodialysis compared to controls. The etiology of renal failure does not have any effect on plasma ghrelin levels. In addition, ghrelin levels are not associated with hemodynamic parameters in patients with CRF.
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Affiliation(s)
- N Tentolouris
- First Department of Propedeutic Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece
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47
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Tentolouris N, Matsagura M, Psallas M, Chatzizacharias A, Fotia M, Arvanitis M, Katsilambros N. Relationship between Antidiabetic Treatment with QT Dispersion During Acute Coronary Syndromes in Type 2 Diabetes: Comparison between Patients Receiving Sulfonylureas and Insulin. Exp Clin Endocrinol Diabetes 2005; 113:298-301. [PMID: 15926117 DOI: 10.1055/s-2005-865641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Patients with acute coronary syndromes (ACS) show prolongation of QT interval duration and its dispersion (QTd). Prolongation of QTd has been associated with inhomogeneity of ventricular recovery times and high arrhythmyogenic potential. Previous studies have shown that preservation of the ischaemic preconditioning is associated with shorter QTd. Sulfonylureas may inhibit cardiac ischaemic preconditioning. The effect, however, of the previous treatment with sulfonylureas on QTd in patients with ACS has not been studied so far. This cross-sectional study examined the effect of the previous antidiabetic treatment on QTd in patients with type 2 diabetes during ACS. A total of 150 patients with ACS (myocardial infarction: n = 120; unstable angina: n = 30) admitted to the coronary care unit of our hospital were studied. Three groups of patients were examined: patients without diabetes (n = 60); patients with type 2 diabetes treated with sulfonylureas alone or in combination with metformin (n = 50); and patients treated with insulin alone or in combination with metformin (n = 40). Standard 12-lead ECG recordings at admission to the coronary care unit were obtained. QT interval duration and QTd were measured using ECG analysis software. At admission, QTd was not different between diabetic and non-diabetic patients (72.1 +/- 21.7 vs. 78.4 +/- 21.3 msec, p = 0.13, respectively). Similarly, the values of the above interval were also not different between patients with type 2 diabetes treated with sulfonylureas and insulin (73.8 +/- 23.9 vs. 70.1 +/- 18.5 msec, p = 0.55, respectively). It is concluded that the previous treatment with either sulfonylureas or insulin does not affect QTd in patients with type 2 diabetes and ACS.
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Affiliation(s)
- N Tentolouris
- 1st Department of Propaedeutic Medicine, Athens University Medical School, Laiko Hospital, Athens, Greece
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48
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Diakoumopoulou E, Tentolouris N, Kirlaki E, Perrea D, Kitsou E, Psallas M, Doulgerakis D, Katsilambros N. Plasma homocysteine levels in patients with type 2 diabetes in a Mediterranean population: relation with nutritional and other factors. Nutr Metab Cardiovasc Dis 2005; 15:109-117. [PMID: 15871859 DOI: 10.1016/j.numecd.2004.01.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2003] [Accepted: 01/16/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIM Hyperhomocysteinemia is a major and independent risk factor for atherothrombotic vascular disease. It may be promoted by genetic factors, nutritional deficiencies of the vitamin cofactors required for homocysteine metabolism, and other modifiable factors. This cross-sectional study investigated the effect of dietary habits and lifestyle on plasma total homocysteine (tHcy) levels in patients with type 2 diabetes in a Mediterranean population. METHODS AND RESULTS A total of 126 diabetic and 76 healthy subjects were interviewed using a food-frequency questionnaire. Information consisted of dietary and smoking habits, coffee and alcohol consumption and physical activity recording, during the month prior to enrollment. Measurements included blood pressure, body mass index (BMI), waist-to-hip ratio (WHR), plasma tHcy, folate, vitamin B12, lipids, HbA(1c), creatinine, uric acid, and glomerular filtration rate (GFR). Plasma tHcy levels were not different between diabetic and control subjects (11.49+/-3.68 vs 12.67+/-3.79 micromol/l respectively, P = 0.40). Diabetic subjects had significantly higher plasma folate levels and consumed more fish, fruit and vegetables, in comparison with controls. Controls consumed more red meat, coffee, and alcohol. Multivariate analysis in diabetic subjects, after controlling for age, sex, systolic blood pressure, duration of diabetes, GFR, plasma uric acid levels, and the amount of the weekly consumption of fruit and vegetables, demonstrated that age, GFR and the weekly amount of fruit and vegetable consumption were independently associated with plasma tHcy concentrations [regression coefficient (B) = 0.11, SE (B) = 0.03, P = 0.001, B = -0.07, SE (B) = 0.01, P < 0.0001, and B = -0.05, SE (B) = 0.02, P = 0.04, respectively]. The weekly amount of coffee, alcohol and red meat consumption, and physical activity level were not related with plasma tHcy levels in either study group. CONCLUSIONS 1) Plasma tHcy levels were not different in the diabetic group as compared to the control group. 2) In patients with type 2 diabetes age, GFR and the consumption of fruit and vegetables were strong and independent determinants of plasma tHcy levels.
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Affiliation(s)
- E Diakoumopoulou
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko Hospital, 5 Doryleou street, 115 21 Athens, Greece
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49
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Tentolouris N, Christodoulakos G, Lambrinoudaki I, Mandalaki E, Panoulis C, Maridaki C, Creatsas G, Katsilambros N. Effect of hormone therapy on the elastic properties of the arteries in healthy postmenopausal women. J Endocrinol Invest 2005; 28:305-11. [PMID: 15966502 DOI: 10.1007/bf03347195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of the study was to assess the effect of continuous hormone therapy (HT) for 1 yr on pulse wave analysis and central aortic pressure in healthy postmenopausal women. Sixty-five healthy postmenopausal women were randomly allocated to receive either conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 5 mg (CEE/MPA, Premelle 5, Wyeth-Ayerst Lab, Philadelphia, PA, no.=32) or no therapy (no.=33). Treatment was continuous, and the study period lasted 12 months. Central aortic pressure, augmentation and augmentation index (AI) were determined non-invasively using applanation tonometry. All measurements were performed at baseline and at the end of the study by the same person. Ns differences were found between baseline values and values at the end of the study in either the control or the CEE/MPA group in central systolic aortic pressure (107.0 +/- 13.1 vs 107.6 +/- 11.3 mmHg, p=0.80, and 110.8 +/- 10.8 vs 112.3 +/- 11.4 mmHg, p=0.23, respectively), augmentation (12.6 +/- 4.2 vs 11.9 +/- 4.8 mmHg, p=0.45 and 11.7 +/- 3.7 vs 12.6 +/- 4.2 mmHg, p=0.34, respectively), and percentage of AI (36.8 +/- 9.3 vs 36.3 +/- 10.3, p=0.81 and 34.1 +/- 8.9 vs 34.9 +/- 9.8, p=0.72, respectively). The results of this preliminary report suggest that HT for 1 yr does not have any significant effect on central aortic pressure and wave reflection in healthy postmenopausal women.
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Affiliation(s)
- N Tentolouris
- Department of Propedeutic Medicine, Laiko Hospital, Athens, Greece
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50
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Tentolouris N, Boutati E, Karambakalis N, Perrea D, Tselepis AD, Tsoukala C, Kyriaki D, Lourida E, Anastasopoulou I, Karafoullidou A, Raptis SA, Katsilambros N. Acute nateglinide administration in subjects with type 2 diabetes: effects on postprandial metabolism, coagulation, and fibrinolysis. Nutr Metab Cardiovasc Dis 2005; 15:6-12. [PMID: 15871845 DOI: 10.1016/j.numecd.2004.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2004] [Revised: 06/18/2004] [Accepted: 06/18/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM Postprandial glycaemia and lipaemia are known risk factors for atherosclerosis in type 2 diabetes. Coagulation activation in the postprandial state also contributes to acceleration of atherosclerosis. Nateglinide is effective in reducing postprandial glycaemia. Its effect on glycaemia may also be beneficial in postprandial lipaemia and coagulation. The aim of this study was to examine the potential effect of a single dose of nateglinide on postprandial triglyceridaemia, coagulation, and fibrinolysis in patients with type 2 diabetes. METHODS AND RESULTS Ten subjects with type 2 diabetes, treated with diet alone were recruited in a crossover randomized study. In the morning, after a 12- to 14-h fast, each subject received a standard mixed meal (total energy 783 kcal), preceded by one tablet of 120 mg nateglinide or placebo. Venous blood samples were drawn prior to meal consumption and 6h afterwards for the measurement of plasma glucose, insulin, and C-peptide, lipids, coagulation, and fibrinolysis factors. As expected, there was a significant reduction in postprandial glycaemia after nateglinide administration compared to placebo (P<0.001). Plasma insulin levels were significantly higher after nateglinide than after placebo (P=0.002). Nateglinide administration resulted in a lower overall postprandial reduction of tissue-plasminogen activator than placebo (-2.9+/-1.3 vs. -8.3+/-3.7 ng/ml h, P=0.003). In addition, a significant reduction of postprandial plasminogen activator inhibitor-1 was observed in comparison with the baseline values after nateglinide (P=0.001), although the overall response was not significantly different after nateglinide and placebo (P=0.31). Plasma concentrations of C-peptide, lipids and the remaining coagulation parameters studied were not different between nateglinide and placebo. CONCLUSIONS Acute nateglinide administration improves postprandial glycaemia and fibrinolytic activity in patients with type 2 diabetes. This combined effect, if confirmed by a long-treatment study, might reduce cardiovascular risk in type 2 diabetes.
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Affiliation(s)
- N Tentolouris
- First Department of Propaedeutic Medicine, Laiko Hospital, Athens University Medical School, Athens, Greece
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