Screening for Atherosclerotic Cardiovascular Disease in Patients with Diabetes: Controversies and Guidelines
Publication date: Available online 23 August 2019Source: Canadian Journal of DiabetesAuthor(s): Paolo RaggiAbstractIf a disease state is highly prevalent and its consequences are severe, it may be appropriate to seek methods to identify it early in order to forestall its development and complications. Diabetes mellitus is a proven risk factor for the development of atherosclerosis although its face and outcome are changing as shown in contemporary clinical trials. In fact, decompensated heart failure (HF) seems to drive the hospitalization rate in patients with diabetes and the mortality from HF is reduced with modern hypoglycemic treatments. Nonetheless, atherosclerotic complications continue to be a major health concern in this segment of the population and cardiovascular imaging has been employed in an attempt to achieve a more accurate risk stratification of patients with diabetes. While imaging for detection of obstructive coronary artery disease (CAD) failed to reach such a goal, imaging for pre-clinical atherosclerosis may be more successful. In this review we discuss use of computed tomography and positron emission tomography to detect pre-clinical coronary atherosclerosis in asymptomatic patients with diabetes. Despite recent advances in the field, several questions remain to be answered as to the ultimate benefit of imaging for prevention in diabetes mellitus.
In this study, the trends of risk factors and macrovascular complications were examined in patients with DM in Taiwan.MethodsHealth care information and International Classification of Diseases, Ninth Revision diagnostic codes were retrieved from the Taiwan Bureau of National Health Insurance claims files between 2005 and 2014. Using these data, the number of cases and annual prevalence of diabetic macrovascular complications in individuals with DM were stratified by age and sex.ResultsThe prevalence of DM with either stroke or cardiovascular disease (CVD) showed a decreasing trend in enrolled patients with DM (p for trend
Authors: PMID: 31525098 [PubMed - in process]
AbstractPurpose of ReviewTo review the clinical trial data and underlying mechanistic principles in support of the robust cardiovascular (CV) benefits, in particular, heart failure (HF) outcomes association with sodium-glucose co-transporter-2 (SGLT2) inhibitors.Recent FindingsSeveral large CV outcome trials in patients with type 2 diabetes mellitus (T2DM) and with either established atherosclerotic CV disease (ASCVD) or at high risk for ASCVD reveal that SGLT2 inhibitors cause reductions in CV and HF endpoints. The reduction in ASCVD appears to be confined to those with established ASCVD on the order of ≈ 14%...
Conclusion: Carvacrol protected against DCM in mice with T1DM and T2DM by restoring PI3K/AKT signaling-mediated GLUT4 membrane translocation and is a potential treatment of DCM.
Publication date: Available online 9 September 2019Source: Canadian Journal of CardiologyAuthor(s): Mony Shuvy, Donna R. Zwas, Chaim Lotan, Andre Keren, Israel GotsmanAbstractBackgroundUrinary albumin to creatinine ratio (UACR) is common in patients with heart failure (HF) and may have an impact on clinical outcome. We evaluated the effect of UACR on clinical outcome in a real-world cohort of patients with HF.MethodsAll patients with HF at a health maintenance organization were followed for cardiac-related hospitalizations and death.ResultsThe study cohort included 4,668 HF patients and was divided into 3 groups based on U...
We propose a unifying perspective of heart failure in patients with type 2 diabetes mellitus. The reasoning is as follows: cellular responses to fuel overload include dysregulated insulin signaling, impaired mitochondrial respiration, reactive oxygen species formation and the accumulation of certain metabolites, collectively termed glucolipotoxicity. As a consequence, cardiac function is impaired with intracellular calcium cycling and diastolic dysfunction as an early manifestation. In this setting, increasing glucose uptake by insulin or insulin sensitizing agents only worsens the disrupted fuel homeostasis of the heart.
Sodium-glucose co-transporter 2 (SGLT2) receptors are primarily located in the proximal convoluted tubule of the nephron. These receptors are responsible for almost 90-95% of tubular reabsorption of the glucose in the nephron. In patients with diabetes mellitus (DM), due to upregulation of SGLT2 receptors, glucose reabsorption is further increased. The Food and Drug Administration (FDA) approved SGLT2 inhibitors, such as canagliflozin, empagliflozin, dapagliflozin, and ertugliflozin, for the treatment of type 2 diabetes.
CONCLUSION: The occurrence of pathological FFR values, most frequently documented in the LAD, was the same in patients with or without HFrEF, HFpEF, diabetes mellitus, AF, and LVH, demonstrating that these comorbidities did not influence FFR values and, thus, the indication for PCI. PMID: 31485776 [PubMed - as supplied by publisher]
Breath analysis is used to detect the composition of exhaled gas. As a quick and non-invasive detection method, breath analysis provides deep insights into the progression of various kinds of diseases, especially those with metabolism disorders. Abundant information on volatile compounds in diabetic patients has been studied in numerous articles in the literature. However, exhaled gas in diabetic patients can be altered by various complications. So far, little attention has been paid to this alteration. In our paper, we found that under air pollution conditions, diabetic patients exhale more nitric oxide. Diabetic pa...
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a novel class of medications that reduce plasma glucose concentrations through an insulin-independent mechanism of increased urinary glucose excretion, with concomitant natriuresis and diuresis. Clinical outcomes trials with SGLT2 inhibitors revealed a cardioprotective benefit among patients with diabetes mellitus, with a consistent reduction in hospitalization for heart failure. As such, the 2018 updated US and European treatment guidelines for diabetes mellitus incorporated SGLT2 inhibitors as second line glucose lowering agents after metformin.