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Quality of Care Among Patients with Diabetes and Cerebrovascular Disease. Insights from The Diabetes Collaborative Registry
Not only do patients with type 2 diabetes have increased risks of coronary artery disease and peripheral artery disease, but they also have least a two-fold increased risk of experiencing a stroke. Further, patients with type 2 diabetes who have a stroke have worse outcomes compared with those without type 2 diabetes.1 While secondary prevention strategies and the quality of care of patients with type 2 diabetes and concomitant coronary artery disease have been well-studied,2 less is known about the management of patients with type 2 diabetes and cerebrovascular disease (e.g., stroke, transient ischemic attack, carotid artery disease).
Source: The American Journal of Medicine - July 21, 2022 Category: General Medicine Authors: Justin B. Echouffo-Tcheugui, Alexander Turchin, Robert S. Rosenson, Gregg C. Fonarow, Abhinav Goyal, James A. de Lemos, Suzanne V. Arnold Tags: Clinical Research Study Source Type: research

Polycythemia Vera Presenting as ST-Segment Elevation Myocardial Infarction
An 80-year-old woman with a history of hypertension, pre-diabetes, chronic kidney disease (stage 3b), and a remote ischemic stroke without residual deficits presented to the emergency department complaining of several hours of epigastric discomfort and malaise. An electrocardiogram (EKG) performed at triage revealed normal sinus rhythm with>1 mm ST segment elevation in leads V4-6 and lead 1, reciprocal ST depression in aVR, and Q waves in V1 and V2 (Figure 1). The troponin I was elevated to 1.66 ng/mL (reference range
Source: The American Journal of Medicine - March 31, 2022 Category: General Medicine Authors: Eric Hirsch, Lindor Qunaj, Azeem Latib, Benjamin Galen Tags: Diagnostic Dilemma Source Type: research

Effects of Anticoagulation on Low-Density Lipoprotein-Cholesterol and Ischemic Stroke in Patients with Nonvalvular Atrial Fibrillation
The study by Omelchenko et al1 concluded that, unlike the general population, low-density lipoprotein-cholesterol (LDL-C) levels were not associated with ischemic stroke risk among patients with atrial fibrillation treated with direct oral anticoagulants (DOACs). To arrive at this conclusion, they retrospectively analyzed data of 21,229 patients with a first-time diagnosis of nonvalvular atrial fibrillation treated with DOACs categorized according to the congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack (TIA), vascular disease, age 65 to 74 years, sex category, ...
Source: The American Journal of Medicine - September 28, 2021 Category: General Medicine Authors: Zeeshan H. Ismail, Zekarias T. Asnake, Joshua K. Salabei Tags: Letter Source Type: research

A comprehensive cardiovascular-renal-metabolic risk reduction approach to patients with Type 2 Diabetes Mellitus
Cardiovascular disease remains the leading cause of morbidity and mortality among patients with type 2 diabetes mellitus, despite decades of research into risk reduction strategies (1,2). While myocardial infarction and ischemic stroke are the most recognized drivers of mortality in this population, less well-appreciated forms of cardiovascular disease, including heart failure and peripheral arterial disease, also contribute significantly to this risk (3-5). Further, the development of renal disease among patients with type 2 diabetes mellitus is common (6), and it drastically increases the risk of cardiovascular disease a...
Source: The American Journal of Medicine - May 21, 2021 Category: General Medicine Authors: Neha J. Pagidipati, Dr. Prakash Deedwania Tags: Review Source Type: research

Oral Anticoagulation Use in High-Risk Patients Is Improved by Elimination of False-Positive and Inactive Atrial Fibrillation Cases
Multiple registries have reported that>40% of high-risk atrial fibrillation patients are not taking oral anticoagulants. The purpose of our study was to determine the presence or absence of active atrial fibrillation and CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥75 y, Diabetes mellitus, prior Stroke [or transient ischemic attack or thromboembolism], Vascular disease, Age 65-74 y, Sex category) risk factors to accurately identify high-risk atrial fibrillation (CHA2DS2-VASc ≥2) patients requiring oral anticoagulants and the magnitude of the anticoagulant treatment gap.
Source: The American Journal of Medicine - December 23, 2020 Category: General Medicine Authors: Gerald V. Naccarelli, Mohammed Ruzieh, Deborah L. Wolbrette, Mauricio Sendra-Ferrer, John van Harskamp, Barbara Bentz, Gregory Caputo, Nathan McConkey, Kevin Mills, Stephen Wasemiller, Jovan Plamenac, Douglas Leslie, Frendy D. Glasser, Thomas W. Abendroth Tags: Clinical Research Study Source Type: research

Albuminuria and Risk of Cardiovascular Events and Mortality in a General Population of Patients with Type 2 Diabetes without Cardiovascular Disease: A Danish Cohort Study
Albuminuria level is associated with cardiovascular events and mortality in patients with diabetes. However, little is known about the association between albuminuria level in diabetes patients without overt cardiovascular disease. We aimed to examine the association between albuminuria level and the risk of ischemic stroke, myocardial infarction, and all-cause mortality in patients with type 2 diabetes without overt cardiovascular disease.
Source: The American Journal of Medicine - March 19, 2020 Category: General Medicine Authors: Mia Vicki Fangel, Peter Br ønnum Nielsen, Jette Kolding Kristensen, Torben Bjerregaard Larsen, Thure Filskov Overvad, Gregory YH Lip, Martin Bach Jensen Tags: Clinical Research Study Source Type: research

Cardiovascular Protection in the Treatment of Type 2 Diabetes: A Review of Clinical Trial Results Across Drug Classes
Patients with type 2 diabetes (T2DM) have a significantly higher risk of developing cardiovascular disease (CVD) —namely myocardial infarction, heart failure, and stroke. Despite clear advances in the prevention and treatment of CVD, the impact of T2DM on CVD outcome remains high and continues to escalate. Available evidence indicates that the risk of macrovascular complications increases with the severity o f hyperglycemia, thus suggesting that the relation between metabolic disturbances and vascular damage is approximately linear.
Source: The American Journal of Medicine - May 26, 2017 Category: General Medicine Authors: Francesco Paneni, Thomas F. L üscher Tags: Clinical research study Source Type: research

Wunderlich Syndrome
A 55-year-old man presented to the Emergency Department with severe abdominal pain for 1 day. He had a history of hypertension, diabetes mellitus, and ischemic stroke. The pain was severe, sharp, and constant, in his left flank; it woke him up from sleep and radiated to the mid back. On physical examination, his vital signs were stable and he had tenderness over the left flank. However, he developed hypotension, with mean arterial pressures dropping to 55  mm Hg and lactic acidosis requiring aggressive volume resuscitation.
Source: The American Journal of Medicine - January 30, 2017 Category: Journals (General) Authors: Aron Simkins, Abhishek Maiti, Sujith V. Cherian Tags: Clinical communication to the editor Source Type: research

The Reply
The authors thank Xue et al for their interest in our article titled “Association between Anemia, Bleeding, and Transfusion with Long-Term Mortality Following Non-Cardiac Surgery.”1 We share the authors' concern about the potential for residual confounding in this observational analysis of a large single-center surgical database. The initial analysis adjusted for age, sex, race, elective vs emergency/urgent surgery, procedure type, and the individual components of the Revised Cardiac Risk Index including coronary artery disease, heart failure, stroke/transient ischemic attack, creatinine>2 mg/dL, and diabetes mellitus.
Source: The American Journal of Medicine - August 21, 2016 Category: Journals (General) Authors: Nathaniel R. Smilowitz, Jeffrey S. Berger Tags: AJM online Source Type: research

From Leptin, DEXA, and Beyond
Kahn and Bullard “recommend that waist circumference be added to BMI [body mass index] as a primary tool for assessing adiposity.”1 Suggesting “a need for alternative approaches to anthropometry”1 is necessary because BMI incorrectly classifies obesity by 39%.2 Many adults are obese by American Society of Ba riatric Physicians criteria of body fat: ≥25% for men and ≥30% for women.3 Normal-weight obese adults have increased mortality risk from diabetes, hypertension, heart disease, stroke, cancer, dyslipidemia, liver and gallbladder disease, sleep apnea and respiratory problems, and osteoarthritis.
Source: The American Journal of Medicine - July 28, 2016 Category: Journals (General) Authors: Eric R. Braverman Tags: AJM online Source Type: research

The Limited Public Health Impact of ‘Lifestyle’ Change
Two main factors are responsible for premature disease and mortality. One is smoking, often referred to as a “lifestyle choice,” but better described as a “habit.” The other is poor nutrition resulting largely from the sugar, alcohol, salt, and saturated fat content (SASS components) of ready-to-consume food and drink, much of which is manufactured on an industrial scale. Collectively, these dietar y components are the main drivers of the global epidemic of stroke, heart attack, obesity, and type 2 diabetes.
Source: The American Journal of Medicine - July 14, 2016 Category: Journals (General) Authors: Nicholas J. Wald Tags: Editorial Source Type: research

The limited public health impact of “lifestyle” change
Two main factors are responsible for premature disease and mortality. One is smoking, often referred to as a “lifestyle choice”, but better described as a “habit”. The other is poor nutrition resulting largely from the sugar, alcohol, salt, and saturated fat content (SASS components) of ready to consume food and drink, much of which is manufactured on an industrial scale. Collectively these dietary components are the main drivers of the global epidemic of stroke, heart attack, obesity, and type 2 diabetes.
Source: The American Journal of Medicine - July 14, 2016 Category: Journals (General) Authors: Nicholas J. Wald Tags: Editorial Source Type: research

Unmasking a Hidden Cause of Persistent Facial Ulceration The Relevancy of a Neurologic Examination
A 49-year-old woman presented to the emergency room of a tertiary medical center for evaluation of chronic facial ulceration. Her past medical history was significant for type II diabetes mellitus, hypothyroidism, antiphospholipid antibody syndrome, venous thromboembolism, and stroke. The patient noted progressive ulceration around the left nasal ala with extension to the left eyebrow and eyelid for 2 years. She had been evaluated for this problem numerous times at outside medical facilities. Previous treatments included three 6-week courses of intravenous vancomycin, one 6-week course of daptomycin, and one 2-week course of oral acyclovir.
Source: The American Journal of Medicine - May 19, 2016 Category: Journals (General) Authors: Kyle W. Mahoney, Jules B. Lipoff, Bennett W. Clark Tags: Diagnostic Dilemma Source Type: research

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