Symposium report on lipid regulation: A new era in the prevention of coronary heart diseaseLipids, diabetes, and coronary heart disease: Insights from the Framingham Study
Abstract
Both risk factors and the incidence of cardiovascular disease are higher in diabetic patients. Total serum cholesterol has the same impact on coronary heart disease (CHD) incidence in diabetic patients as in nondiabetic individuals. Abnormal blood lipids in diabetic patients include elevated very low-density lipoproteins (VLDL) and triglyceride and reduced levels of high-density lipoproteins (HDL). These are associated with obesity and precede the onset of diabetes. Diabetes increases the risk of all clinical manifestations of CHD, has a greater impact in women, and predisposes to cardiac failure and fatal outcome. In men, it predisposes to silent myocardial infarctions. CHD risk reduction in the diabetic patient requires multifactorial control. In evaluating the lipid-induced CHD risk, the level of low-density lipoprotein (LDL) cholesterol is not as valuable as the cholesterol ratio, which is the most rellable criterion. Triglyceride levels make no independent contribution. Most CHD preventive measures, including weight control, exercise, avoidance of cigarettes, and improvement of glucose tolerance also increase HDL cholesterol, reduced levels of which are chiefly responsibie for the poor ratio in diabetics. Weight control merits a high priority because of its favorable influence on the lipid profile, glucose tolerance, and blood pressure.
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Cited by (593)
Wakabayashi & Daimon cardiometabolic index as an indicator to assess risk in adults. A systematic review
2024, Atencion PrimariaTo analyze the Wakabayashi & Daimon (2015) equation, as a predictive indicator of cardiometabolic diseases and its comparison with other indices.
A systematic review was carried out between January and March 2023, according to the PRISMA statement.
Scopus, Web of Science, and PubMed databases were reviewed using “cardiometabolic index” (CMI) as the search term.
The following inclusion criteria were determined: studies in adults with cardiometabolic diseases using the Wakabayashi & Daimon (2015) CMI formula in different populations; studies that validate or compare the equation or that demonstrate the effects of the intervention.
Of the 11 selected articles, the characteristics of the population, type of study, indicators for the validation of the CMI, the reported statistics and the conclusions that were recorded in a comparative table were obtained.
Odds ratio, hazard ratio, sensitivity, and specificity were used to assess associations, risk, effectiveness, and validity of the tests, indicating favorable relationships between the factors analyzed and the results obtained. Validation and probabilistic analysis of the CMI were performed against diverse diseases such as obesity [Man >60y = AUC = 0.90 (0.75–1.00) (p = 0.01), Se = 100, Sp = 81.8, YI = 0.82 and OR 4.66 and Women >60y = AUC = 0.95 (0.88–1.00), p = 0.001, Se = 90.0, Sp = 100, YI = 0.90 and OR = 36.27]; cardiovascular diseases [AUC = 0.617, Se = 0.675, Sp = 0.509; HR = 1.48 (1.33, 1.65), p = < 0.001], among others. In conclusion CMI is a new utility index that broadly identifies the presence of risk that leads to cardiometabolic diseases in adults.
Analizar la ecuación de Wakabayashi et al. del 2015 como indicador de predicción de enfermedades cardiometabólicas y su comparación con otros índices.
Se realizó una revisión sistemática entre enero y marzo del 2023, de acuerdo con la declaración PRISMA.
Se revisaron las bases de datos Scopus, Web of Science y PubMed utilizando «índice cardiometabólico» (ICM) como término de búsqueda.
Se determinaron los siguientes criterios de inclusión: estudios en adultos con enfermedades cardiometabólicas que utilizaron la fórmula ICM de Wakabayashi et al. en diferentes poblaciones; que validaran o compararan la ecuación o que demostraran los efectos de la intervención.
De los 11 artículos seleccionados, se obtuvieron las características de la población, tipo de estudio, indicadores para la validación del ICM, la estadística reportada y las conclusiones que se registraron en una tabla comparativa.
Para evaluar las asociaciones, el riesgo, la efectividad y la validez de las pruebas se utilizaron odds ratio (OR), hazard ratio (HR), sensibilidad y especificidad, indicando relaciones favorables entre los factores analizados y los resultados obtenidos. La validación y el análisis probabilístico del ICM se realizaron frente a diversas enfermedades como obesidad (hombres >60 años = AUC = 0,90 [0,75-1,00], [p = 0,01], Se = 100, Sp = 81,8, YI = 0,82 y OR 4,66; y mujeres >60 años = AUC = 0,95 [0,88-1,00], p = 0,001, Se = 90,0, Sp = 100, YI = 0,90 y OR = 36,27); enfermedades cardiovasculares (AUC = 0,617, Se = 0,675, Sp = 0,509; HR = 1,48 [1,33, 1,65] p ≤ 0,001), entre otros. En conclusión, el ICM es un nuevo índice de utilidad que identifica ampliamente la presencia de riesgo para conducir a enfermedades cardiometabólicas en adultos.
The Effect of Glycemic Control on Left Ventricular Function in Clinical and Experimental Diabetes
2023, CJC OpenGlycemic control in diabetes mellitus (DM) has not improved cardiovascular outcomes with normal left ventricular (LV) function. We assessed the effect on LV dysfunction using a canine model of LV dysfunction and DM, and in patients with DM and LV dysfunction.
Chronic LV dysfunction was produced by coronary microsphere embolization in 34 canines (15-25 kg). Following 8 weeks of stabilization, DM was induced in 24 canines and randomized to good or poor glycemic control for 3 months. Ten canines without DM were controls. Hemodynamic and Doppler echocardiographic data were obtained prior to and following pressure loading. We reviewed the Doppler-echocardiography at baseline and follow-up in 207 patients with DM with reduced ejection fraction (EF; median follow-up = 612 days) and 60 age- and sex-matched non-DM patients with normal EF. Laboratory results, medications, and incident adverse events from medical records were obtained.
EF = 43.8% ± 11.2% for all canines at 8 weeks. Canines with poor glycemic control (hemoglobin [Hb]A1c = 8.05% ± 3.02%) demonstrated reduced LV mass and rate-corrected velocity of circumferential fiber shortening, compared to those with LV dysfunction (1.36 ± 0.73 vs 0.88 ± 0.13 circumference per second, P < 0.01). Good glycemic control (HbA1c = 3.88% ± 0.89%) demonstrated similar LV parameters, compared to controls (HbA1c = 2.99% ± 0.44%). EF was similar among groups. Patients with vs without DM were followed for up to 3 years. Patients with DM and poor glycemic control had reduced EF, lower rate-corrected velocity of circumferential fiber shortening = 0.93 ± 0.26 vs 1.11 ± 0.26, P < 0.001), and greater incidence of heart failure.
Poor glycemic control had an adverse effect on preexisting LV dysfunction experimentally and in patients with type 2 diabetes.
Chez les personnes atteintes de diabète sucré (DS), la maîtrise glycémique n’a pas amélioré les résultats cardiovasculaires en présence d’une fonction ventriculaire gauche (VG) normale. Nous avons évalué l’effet d’une dysfonction VG au moyen d’un modèle canin de dysfonction VG et de DS, ainsi que chez des patients atteints de ces deux troubles.
Une dysfonction VG chronique a été produite chez 34 chiens (pesant de 15 à 25 kg) au moyen d’une embolisation coronarienne par microsphères. Après huit semaines de stabilisation, un DS a été provoqué chez 24 chiens, qui ont été répartis aléatoirement pour faire l’objet d’une bonne ou d’une mauvaise maîtrise glycémique pendant trois mois. Les 10 chiens sans DS ont servi de témoins. Des données hémodynamiques et échocardiographiques (Doppler) ont été obtenues avant et après la mise en charge. Nous avons aussi étudié l’échocardiogramme Doppler, au départ et lors du suivi, de 207 patients atteints de DS et présentant une fraction d’éjection (FE) réduite (suivi médian de 612 jours) et de 60 patients non atteints de DS qui ont été appariés en fonction de l’âge et du sexe et dont la FE était normale. Enfin, nous avons obtenu leurs dossiers médicaux : résultats des épreuves de laboratoire, listes de médicaments et manifestations indésirables découvertes fortuitement.
La FE était de 43,8 % ± 11,2 % pour l’ensemble des chiens après huit semaines. Chez les chiens dont la maîtrise glycémique était mauvaise (hémoglobine [Hb]A1c = 8,05 % ± 3,02 %), la masse VG et la vitesse de raccourcissement circonférentiel des fibres myocardiques corrigée en fonction de la fréquence cardiaque (VCFc) étaient toutes deux réduites comparativement à celles observées chez les chiens présentant une dysfonction VG (1,36 ± 0,73 vs 0,88 ± 0,13 circonférence par seconde [circ/s], p < 0,01). Chez les chiens avec une bonne maîtrise glycémique (HbA1c = 3,88 % ± 0,89 %), les paramètres VG étaient semblables à ceux observés chez les témoins (HbA1c = 2,99 % ± 0,44 %). La FE était également similaire dans tous les groupes. Les patients atteints de DS ont été suivis et comparés à des patients non atteints de DS pendant une durée allant jusqu’à trois ans. Les patients qui étaient atteints de DS et dont la glycémie était mal maîtrisée présentaient une FE réduite, une diminution de la VCFc (0,93 ± 0,26 vs 1,11 ± 0,26; p < 0,001) et une incidence accrue de cas d’insuffisance cardiaque.
Une mauvaise maîtrise glycémique a eu un effet indésirable sur une dysfonction VG préexistante, tant dans le modèle animal que chez les patients atteints de diabète de type 2.
Efficacy and safety of PCSK9 inhibitors in patients with diabetes: A systematic review and meta-analysis
2023, Nutrition, Metabolism and Cardiovascular DiseasesIndividuals with diabetes have increased cardiovascular risk. Although PCSK9 inhibitors bring about a wide reduction in lipids, there is uncertainty about the effects for diabetic patients. We conducted a systematic review and meta-analysis to assess the efficacy and safety of PCSK9 inhibitors for diabetes.
We performed a meta-analysis comparing treatment with PCSK9 inhibitors versus controls up to July 2022. Primary efficacy endpoints were percentage changes in lipid profile parameters. We used random effects meta-analyses to combine data. Subgroups of diabetic patients (by diabetes type, baseline LDL-C, baseline HbA1c and follow-up time) were also compared. We included 12 RCTs comprising 14,702 patients. Mean reductions in LDL-C were 48.20% (95% CI: 35.23%, 61.17%) in patients with diabetes. Reductions observed with PCSK9 inhibitors were 45.23% (95% CI: 39.43%, 51.02%) for non-HDL-cholesterol, 30.39% (95% CI: 24.61%, 36.17%) for total cholesterol, 11.96% (95% CI: 6.73%, 17.19%) for triglycerides, 27.87% (95% CI: 22.500%, 33.17%) for lipoprotein(a), 42.43% (95% CI: 36.81%, 48.06%) for apolipoprotein B; increases in HDL-C of 5.97% (95% CI: 4.59%, 7.35%) were also observed. There was no significant difference in fasting plasma glucose (FPG) (WMD: 2.02 mg/mL; 95% CI: −1.83, 5.87) and HbA1c (WMD: 1.82%; 95% CI: −0.63, 4.27). Use of a PCSK9 inhibitor was not associated with increased risk of treatment-emergent adverse event (TEAE) (p = 0.542), serious adverse event (SAE) (p = 0.529) and discontinuations due to AEs (p = 0.897).
PCSK9 inhibitor therapy should be considered for all diabetic individuals at high risk of atherosclerotic cardiovascular disease.
CRD42022339785.
Formulation and evaluation of SGLT2 inhibitory effect of a polyherbal mixture inspired from Ayurvedic system of medicine
2022, Journal of Traditional and Complementary MedicineThe ingredients viz., Artemisia roxburghiana, Cissampelos pareira, Stephania glabra, Drimia indica, Roylea cinerea, Tinospora sinensis and Curcuma longa of the present formulation are used to treat diabetes in the Indian traditional medical system. Adopting the concept of multiple herbal mixtures for better therapeutic effects from the ancient Ayurvedic text Sarangdhar Samhita, the present study aimed to develop a polyherbal formulation (PHF) of seven herbs and to evaluate its sodium-glucose cotransporter protein-2 (SGLT2) inhibitory effect on type 2 diabetic rats.
Streptozotocin (STZ) (60 mg/kg) and nicotinamide (NAM) (120 mg/kg) were intraperitoneally administered to induce type 2 diabetes in Wistar rats. The animals were divided into 5 groups viz. normal control, diabetic control, positive control (dapagliflozin at 0.1 mg/kg) and two test groups (PHF at 250 and 500 mg/kg). Various parameters including blood glucose, serum glutamic pyruvic transaminase (SGPT), serum glutamic-oxaloacetic transaminase (SGOT), bilirubin, triglycerides and creatinine were measured.
The treatment with PHF (250 and 500 mg/kg) showed a significant (p < 0.05) decrease in blood glucose levels by 56.37% and 58.17%, respectively. The levels of SGOT, SGPT and bilirubin were significantly reduced in PHF-fed diabetic rats. Histopathological examination revealed no major changes in the treated groups as compared to the normal control. The molecular docking study showed strong binding of β-sitosterol, insulanoline, warifteine, dehydrocorydalmine, taraxerol acetate, lupeol, corydalmine and luteolin to SGLT2 protein. The present study concludes that PHF has promising antidiabetic activity via inhibiting SGLT2 protein without showing any adverse effects.
Characteristics associated with early- vs. later-onset adult diabetes: The CARDIA study
2021, Diabetes Research and Clinical PracticeDifferences in risk profiles for individuals with early- (<40 years old) vs. later-onset (≥40 years old) diabetes were examined.
A nested case-comparison study design using 30-year longitudinal data from the Coronary Artery Risk Development in Young Adults (CARDIA) study was used. Survey data (socio-demographics, family history, medical records, and lifestyle behaviors), obesity-related measures (body mass index, weight), blood pressure, and laboratory data (insulin, fasting glucose, 2-h glucose, and lipids) were used to examine progression patterns of diabetes development in those with early-onset vs. later-onset diabetes.
Of 605 participants, 120 were in early-onset group while 485 were in later-onset group. Early-onset group had a lower A Priori Diet Quality Score, but not statistically significant at baseline; however, the between-group difference became significant at the time that diabetes was first detected (p = 0.026). The physical activity intensity score consistently decreased from baseline to the development of diabetes in both the early- and later-onset groups. Early-onset group showed more dyslipidemia at baseline and at the time that diabetes was first detected, and rapid weight gain from baseline to the development of diabetes.
Emphases on lifestyle modification and risk-based diabetes screening in asymptomatic young adults are necessary for early detection and prevention.
Use of statin for the primary prevention of cardiovascular outcomes in elderly patients: A propensity-matched cohort study
2021, AtherosclerosisHerein, we investigate whether statin treatment as primary prevention reduces cardiovascular outcomes in elderly Asian patients.
Data were obtained from the Korean National Health Insurance Service-Senior Cohort database (n = 558,147). A total of 81,729 elderly patients (≥75 years) without clinically recognized atherosclerotic cardiovascular disease (CVD) were included. The patients who did not have a history of statin use in year 2003 were followed from January 2004 to the end of 2012. New statin users (n = 3670) were matched on the basis of the propensity score in a 1:2 ratio with non-users. Incidences of myocardial infarction, ischemic stroke, and death from CVD were compared using the Cox proportional hazards model.
The risk of cardiovascular death was significantly reduced in the statin treatment group compared with the non-user group (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.29 to 0.40; p < 0.001). This effect was observed in both patient groups with and without diabetes. In patients with diabetes, the HR for statin use was 0.85 (95% CI 0.55 to 1.33) for myocardial infarction and 0.75 (95% CI 0.60 to 0.93) for ischemic stroke. In participants without diabetes, the HR of statin use was 0.95 (95% CI 0.73 to 1.24) for myocardial infarction and 1.13 (95% CI 1.01 to 1.26) for ischemic stroke. The presence of hypertension was also a significant factor in the prevention of ischemic stroke by statin treatment.
In elderly patients without clinically recognized atherosclerotic CVD, the risk of cardiovascular mortality was significantly reduced with statin treatment than with non-users. In participants with type 2 diabetes, statin treatment was associated with a reduction in ischemic stroke.