Residual inflammatory risk appeared related to weight, atherogenic lipid profile and biomarkers of inflammation, but not to glycaemic control in type 1 diabetes

Background

Mortality associated with atherosclerotic cardiovascular disease reduces average life expectancy by more than a decade in type 1 diabetes. Systemic inflammation drives atherosclerosis, and the concept of residual inflammatory risk (defined by high-sensitivity C-reactive protein (hsCRP) ≥2 mg/l) poses a potential, new therapeutic target for lowering residual cardiovascular risk in type 1 diabetes. However, the characteristics of individuals with residual inflammatory risk in type 1 diabetes are unknown.

Purpose

Identify differences in relevant demographics, clinical and paraclinical parameters for individuals with residual inflammatory risk as compared to those without in type 1 diabetes.

Methods

Baseline characteristics as stratified for CRP ≥2 mg/l were analysed in 105 patients with type 1 diabetes participating in a previously published clinical trial. The study population was sampled to represent the broad background population struggling with glycaemic control and with a high cardiovascular risk.

Results

Residual inflammatory risk was seen in 39.1% of the study population. Compared to individuals without residual inflammatory risk, individuals with residual inflammatory risk were more frequently women, had increased body weight, body mass index and dual-energy X-ray absorptiometry (DXA)-assessed fat mass and exhibited elevated levels of low-density lipoprotein (LDL), very low-density lipoprotein (VLDL) and total cholesterol as well as triglycerides, interleukin 6 and tumour necrosis factor alpha (Table 1). Glycated haemoglobin, blood pressure and markers of renal function were similar between groups (Table 1).

Conclusion

In the present cohort of individuals with type 1 diabetes, residual inflammatory risk was seen in 39.1% (similar to what is observed outside of type 1 diabetes) and appeared related to overweight/obesity, an atherogenic lipid profile and circulating biomarkers of inflammation but not to glycaemic control, blood pressure or renal function.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): AstraZenecaHerlev Gentofte Hospital

21-year-old silicone breast implants causing recurrent pneumonia, chest pain and coughing

A 50-year-old former smoker presented with recurrent pneumonia, fever and atypical chest pain on and off for a year and was treated with antibiotics several times. Meanwhile, her lung function deteriorated with an obstructive pattern and therefore she was treated with inhalation medication without effect. Tests of the heart, bronchoscopy, gastroscopy and a CT-scan of the lungs did not reveal the cause. Finally, an FDG-PET scan showed inflammation of the tissue on the backside of a 21-year-old silicone chest implant, which was intact but encapsulated. The chest implants were removed after which the patient has remained free of infections. However, the lung function impairment did not improve, and a new HRCT-scan demonstrated widespread emphysema.

[Examination for osteoporosis in patients with chronic obstructive pulmonary disease]

Patients with chronic obstructive pulmonary disease (COPD) are at risk of developing osteoporosis, as the COPD in itself as well as continued smoking and treatment with systemic corticosteroid all increase the risk of developing osteoporosis. Other risk factors for osteoporosis are low vitamin D levels, malnutrition and physical inactivity. All patients who have risk factors in the form of severe COPD, and all patients with COPD in active treatment with systemic corticosteroid and/or other risk factors should be examined with a DEXA-scan. Treatment of osteoporosis in patients with COPD does not differ from general recommendations.

Effects of nitric oxide blockade and cyclosporin A on cardiovascular and renal function in normal man

OBJECTIVE

The present study investigated whether the nitric oxide (NO) system is involved in cyclosporin A (CsA)-induced changes in cardiovascular and renal function in man.

SUBJECTS AND METHODS

Ten healthy volunteers were investigated twice--with and without intake of a single dose of CsA (8 mg/kg). N(G)-monomethyl-L-arginine (L-NMMA; 3 mg/kg) was injected 4 h after study start on each day.

RESULTS

There was no change in glomerular filtration rate (GFR) on the day without CsA. CsA alone did not change GFR, but after L-NMMA injection, GFR decreased significantly from 101 +/- 4 to 91 +/- 4 ml/min. L-NMMA increased renal vascular resistance with no difference between the two study days. CsA increased significantly the diastolic blood pressure (BP) by 8 +/- 2% and the heart rate (HR) by 30 +/- 4%, without changes in cardiac output L-NMMA further increased BP by around 8%, and decreased HR by 11% and cardiac output by 20% on both study days. L-NMMA decreased urinary flow rate by around 25% and renal sodium clearance from 1.1 to approximately 0.6 ml/min on both study days. CsA decreased plasma renin significantly and increased the urinary excretion rate of prostaglandin E2 (PgE2), 6-keto-prostaglandin F1alpha (6-keto-PgF1alpha) and thromboxane B2(TxB2) when compared to the control day. The urinary excretion rate of NOx and cGMP declined gradually on the control day. In contrast, there was a minor, non-significant increase in NOx and cGMP excretion after CsA, followed by a decrease (29 +/- 2 and 16 +/- 4%, respectively) after L-NMMA in parallel with the decrease in GFR.

CONCLUSION

The present findings suggest that NO does not play a major role during acute CsA-induced changes in cardiovascular function and renal haemodynamics in man. Renal NO synthesis, however, may attenuate the acute CsA-induced decrease in GFR.