Cardiovascular Disease In Type 2 Diabetes Mellitus Patients Research Articles

Determinants of cardiovascular disease among type 2 diabetic patients attending diabetic follow-up clinic in Arba Minch general hospital, southern Ethiopia: an unmatched case-control study.

Cardiovascular disease (CVD) is a major cause of death and disability among patients with type 2 diabetes, especially in low-income and middle-income countries. Type 2 diabetes mellitus (T2DM) patients have a 2-4-fold increased risk of CVD. There is limited data about cardiovascular disease risks and its determinants among T2DM patients in Ethiopia. This study aimed to identify possible predictors of cardiovascular diseases among adults with T2DM in southern Ethiopia. A hospital-based unmatched case-control study was conducted at southern Ethiopia Arbaminch Hospital on 196 randomly selected patients with type 2 diabetes on follow-up (98 cases and 98 controls). The authors collected data using a structured interviewer-administered questionnaire, laboratory checklist, and additional document review of T2DM patients. A multivariable binary logistic regression was fitted to identify cardiovascular disease determinants, and the findings were presented using an adjusted odds ratio (AOR) with a 95% CI. The mean reported age (±SD) of the cases and the controls was 56.3.3 (±8.9) and 52.3 (±9.3) years, respectively. The two identified independent determinants of cardiovascular disease with AOR [95% CI] were hypertension [AOR=4.953, 95% CI (2.47, 9.93) and persistent urine albuminuria [AOR=12.9, 95% CI (3.98, 41.7)]. This study showed that having high blood pressure and persistent urine albuminuria are independent predictors of cardiovascular disease in T2DM patients. The current study setting needs an intervention for mitigating these cardiovascular disease determinants.

A Cross-Sectional Evaluation of Cardiovascular Risk Assessment in Type 2 Diabetes Mellitus Patients Using the Framingham Risk Score.

The global burden of type 2 diabetesmellitus (T2DM) is continuously increasing, particularly in India. The risk of cardiovascular disease (CVD) is higher in T2DM individuals when compared to non-diabetics, which imposes significant morbidity and mortality. The main aim of the present study was to assess the risk factorsfor CVD in T2DM patients. The secondary aim was to assess the association between cardiovascular risk profile and10-year cardiovascular risk using theFramingham risk score. This was a cross-sectional study conducted on 110 T2DM patients, and the anthropometric and biochemical parameters were analyzed. The Framingham cardiovascular risk prediction model was used to calculate the 10-year risk for CVD. The CVD risk factor was compared among the genders. Further, the association between the Framingham cardiovascular risk and the various categories of risk factors was also analyzed. Based on the Framingham cardiovascular risk score, 23 (20.9%) were at low risk, 39 (35.5%) were at moderate risk, and 48 (43.6%) were at low risk. A higher proportion of males had hypertension (55.2 vs. 17.3%; p=0.007), elevated cholesterol levels (48.3% vs. 23.1%; p=0.008), and smoking or tobacco use (31% vs. 7.7%; p=0.006) as compared to females. The significant risk factors for high 10-year CVD risk were hypertension (p=0.001), elevated total cholesterol (p=0.03), smoking or tobacco use (p=0.007), and glycemic control (p=0.04). The Framingham cardiovascular risk score estimates reveal that male gender, hypertension, smoking, and uncontrolled diabetes are the important risk factors for CVD progression among diabetic patients. Therefore, it is imperative to generate awareness regarding the potential risks and then implement suitable interventions during the early phases at the primary healthcare level.

Effects of sugary drinks, coffee, tea and fruit juice on incidence rate, mortality and cardiovascular complications of type2 diabetes patients: a systematic review and meta-analysis

Abstract Aims Despite more and more studies indicate that beverages play an important role in type 2 diabetes mellitus(T2DM), the efficacy of intaking different beverages for T2DM has not been clearly stated in one article. The meta-analysis was performed, which aims to assess the effects of beverages on mortality and cardiovascular complications in patients with type 2 diabetes and the incidence of T2DM. Method PubMed, Embase, Web of Science and Cochrane Library databases were search up to March, 2023 to identify relevant studies, including studies researching beverage consumption, the incidence and mortality of T2DM and incidence of cardiovascular disease, a kind of complication of T2DM. The way to explore the source of heterogeneity is performing subgroup analyses and sensitivity analyses. Funnel plots and Egger’s regression test were performed to assess publication bias. The Hazard ratio (HR) and 95% confidence intervals (95% CIs) were used to analysis the results. Fifteen observational studies were included in our meta-analysis. Results Fifteen eligible articles were included sugar-sweetened beverages(SSB) consumption increased the mortality and incidence of T2DM ( Hazard ratio (HR), 1.20; 95% confidence interval (CI), 1.05–1.38; P = 0.01 and HR, 1.15; 95% CI,1.06–1.24; P = 0.001), respectively. Artificially-sweetened beverages (ASB) consumption was not associated with the mortality and incidence of T2DM (HR,0.96;95%CI, 0.86–1.07; P = 0.464 and HR, 1.15; 95% CI,1.05–1.26; P = 0.003), respectively. Fruit juice consumption increased the incidence of T2DM (HR,1.08;95%CI,1.02–1.14, P = 0.296). Tea or coffee consumption can reduce the incidence of T2DM (HR, 0.89; 95%CI,0.81–0.98; P = 0.016). Tea or coffee consumption was associated with a lower risk of mortality of T2DM (HR,0.84; 95% Cl, 0.75–0.94; P = 0.002 and HR,0.75; 95% CI, 0.65–0.87; P < 0.001), respectively. Additionally, beverage consumption was not associated with cardiovascular disease in T2DM patients (HR,1.03; 95% Cl, 0.82–1.30, P > 0.05). Conclusions High consumption of SSBs led to a higher risk and mortality of T2DM, while high consumption of coffee or tea showed significant associations with a lower risk of the incidence and mortality of T2DM.

Low expression of lncRNA UCA1 assists the diagnosis of type 2 diabetes mellitus and predicts an increased risk of cardiovascular complications

ABSTRACT Type 2 diabetes mellitus (T2DM) is a leading global health concern. The study estimated the lncRNA UCA1 expression in peripheral blood of T2DM patients and its clinical value for diagnosing T2DM and predicting cardiovascular disease (CVD) in T2DM. A total of 80 T2DM patients (37 cases with T2DM complicated with CVD) were selected, with another 70 healthy people as controls. UCA1 expression was measured, and its diagnostic efficacy for T2DM was assessed. Median UCA1 level divided T2DM patients into UCA1 low expression group and UCA1 high expression group, and its correlation with clinical indicators of T2DM patients was analyzed. Relevance between UCA1 and SADN, YKL-40 or CTRP-3 in T2DM complicated with CVD patients, and independent correlation between UCA1 and CVD in T2DM were evaluated. UCA1 was downregulated in T2DM patients, associated with clinical indicators, and assisted the diagnosis of T2DM. UCA1 was positively-correlated with SADN and CTRP-3, and negatively interrelated with YKL-40. UCA1 low expression was independently linked with and predicted an enhanced risk of CVD in T2DM patients. Briefly, UCA1 low expression assists the diagnosis of T2DM and predicts an increased risk of CVD in T2DM patients.

Plasma fingerprint of free fatty acids and their correlations with the traditional cardiac biomarkers in patients with type 2 diabetes complicated by coronary heart disease.

Type 2 diabetes mellitus (T2DM) is a well-established risk factor for cardiovascular disease, with at least 2–3 fold higher risk of cardiovascular diseases than non-diabetics. Free fatty acids (FFAs) are believed to play important roles in the occurrence of cardiovascular disease in people with T2DM. The aim of this study was to investigate the fingerprint of plasma FFAs and their correlations with the tradition risk factors of cardiovascular disease in T2DM patients complicated by coronary heart disease (CHD-T2DM). A total of 401 participants, including healthy control (HC, n = 143), T2DM patients (n = 134), and CHD-T2DM patients (n = 126) were enrolled in this study. Plasma levels of 36 FFAs with carbon chain length ranged from 3 to 22 were quantified by using reverse phase ultra-high performance liquid chromatography coupled with tandem mass spectrometry (UHPLC-MS/MS). Tradition risk factors of cardiovascular disease were tested in clinical laboratory, including homocysteine (HCY), creatine kinase (CK), high sensitivity C reactive protein (hsCRP), and N-terminal pro-brain natriuretic peptide (NT-proBNP) and so on. Almost all the FFAs with different carbon chain length and unsaturation were significantly upregulated in the T2DM-CHD groups, compared to the HC and T2DM groups. Both n-3 and n-6 polyunsaturated fatty acids (PUFA) were also found to be significantly upregulated in T2DM-CHD group compared to the T2DM group. However, no significantly differences of the n-6/n-3 PUFA ratio, arachidonic acid/eicosapentaenoic acid (AA/EPA) ratio, and arachidonic acid/docosahexaenoic acid (AA/DHA) ratio were observed between T2DM-CHD and T2DM groups. Plasma FFA levels were found to be positively correlated with HCY, CK, hsCRP, NT-proBNP and other tradition risk factors of CHD. Multivariate logistic regression analysis indicated that a dozens of FFAs were the independent risk factors of CHD after adjustment for confounding factors and other risk factors. Excessively high plasma levels of FFAs were demonstrated to be independent risk factors for CHD in patients with T2DM, despite of the differences in chain length, unsaturation, and double bond position.

Serum Tenascin-C and Alarin Levels Are Associated with Cardiovascular Diseases in Type 2 Diabetes Mellitus.

Background Tenascin-C (TNC), an extracellular matrix glycoprotein, is elevated in inflammatory and cardiovascular pathologies, whereas alarin, a novel orexigenic peptide, participates in insulin resistance and glycometabolism. The roles of these molecules in individuals with cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM), clinical conditions associating with metabolic disorders, and chronic inflammation, remain controversial. Our study aimed at determining the potential role of TNC and alarin in CVD adult patients with T2DM. Methods This was a cross-sectional study. Basic and clinical information for 250 patients with T2DM were analyzed. Based on their cardiovascular disease status, participants were assigned into the CVD and non-CVD groups. Serum TNC and alarin levels were assessed by enzyme-linked immunosorbent assay (ELISA). Results Serum TNC and alarin concentrations in the CVD group were significantly higher than those of the non-CVD group. Moreover, serum TNC levels were positively correlated with age, waist circumference, and waist-hip ratio; however, they were negatively correlated with TC, LDL-C, and eGFR levels. Alarin levels were positively correlated with BMI, waist circumference, and hip circumference. In logistic regression models, TNC and alarin were also established to be independent determinants for CVD in T2DM patients and their increases were associated with CVD severity. Receiver operating characteristic (ROC) curve analysis showed that the area under curve (AUC) values for TNC and alarin were 0.68 and 0.67, respectively. TNC and alarin were good predictors of CVD occurrence. When the cutoff value for TNC was 134.05 pg/mL, its sensitivity was 69.47% while its specificity was 61.29%. When the cutoff value for alarin was 142.69 pg/mL, sensitivity and specificity were 38.95% and 90.97%, respectively. Conclusion Elevated TNC and alarin levels are independently associated with the occurrence and severity of CVD in T2DM individuals. Therefore, these two biomarkers are potential diagnostic and prognostic indicators for CVD in diabetics.

Cost-Effectiveness of Non-Statin Lipid-Modifying Agents for Primary and Secondary Prevention of Cardiovascular Disease among Patients with Type 2 diabetes mellitus: A Systematic Review

Background: Non-statin therapies (NSTs) have been shown to provide additional benefits for cardiovascular risk reduction among patients with type 2 diabetes mellitus (T2DM), but their economic merits have not been confirmed. The objective of this systematic review is to evaluate the cost-effectiveness of NSTs for primary and secondary prevention of cardiovascular disease (CVD) in T2DM patients.1Methods: A literature search was systematically performed using MeSH terms (Table 1) from January 1990 to January 2021 in ten databases (e.g. MEDLINE, PubMed, and EconLit). Two reviewers independently screened the included studies that evaluated the cost-effectiveness of NSTs versus any comparator. Quality of Health Economic Studies (QHES) checklist was used for quality assessment.2 Cost outputs were adapted to 2019 United States dollars (USD) to facilitate comparisons between studies.3Results: The search identified 21,182 records. Of which, 10,781 records were screened based on the title and abstract, and 185 articles based on the full text (Figure 1). After a full-text review, 12 studies were included in this study, where eight studies evaluated ezetimibe, four evaluated Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) inhibitors, two evaluated fenofibrate, one evaluated nicotinic acid, and one evaluated extended-release niacin/laropiprant (ER-ERN/LRPT). Six out of eight studies considered ezetimibe plus statin to be a cost-effective therapy for patients with T2DM and with or without CVD, three out of four studies suggested that PCSK9 inhibitors were not cost-effective. Fenofibrate, nicotinic acid, and ER- ERN/LRPT were cost-effective. Based on QHES, the majority of economic evaluations had good quality of reporting. The ICERs were consistent in the majority of studies after adaptation to 2019 USD values.1–3Conclusion: The systematic review demonstrated that most cost-effectiveness studies considered NSTs to be cost-effective compared with standard care but not PCSK9 inhibitors for primary and secondary prevention of CVD in T2DM patients.

English

BACKGROUND The occurrence of QT interval prolongation is higher in subjects with type 2 diabetes mellitus (T2DM). Duration of QT interval corrected (QTc) for heart rate is independently related with severity of cardiovascular diseases in diabetics. This study was proposed to assess the QTc prolongation as a diagnostic tool for cardiovascular disease in T2DM patients. METHODS This study included 100 diabetic patients admitted in wards of a tertiary care center. A thorough clinical examination was carried out for all the patients. Patients were investigated for the fasting blood glucose level, glycated haemoglobin (HbA1c), lipid profile & electrocardiogram (ECG). Data was represented as percentage. Mean and standard deviation (SD) of quantitative variables were tabulated, t test was used for correlation and receiver operating characteristic (ROC) curve was used for evaluating area under curve. P < 0.05 was considered statistically significant. RESULTS Male preponderance was observed. All the study subjects had a prolonged period of diabetes with various metabolic complications. The area under the curve estimation of QTc > 400 ms with respect to HbA1c and duration of diabetes showed significant correlation between longer duration of diabetes and raised HbA1c associated with raised QTc interval (P < 0.05). CONCLUSIONS Diagnosis of prolonged QTc interval could be utilized for estimating cardiovascular risk in diabetes patients. It can be easily assessed on ECG besides being a noninvasive investigation which is also affordable in evaluating the cardiovascular risk in T2DM patients. KEY WORDS Blood Glucose, Cardiovascular Diseases, Electrocardiography, Glycated Haemoglobin A, Long QT Syndrome, Type 2 Diabetes Mellitus

Systematic review and meta-analysis for prevention of cardiovascular complications using GLP-1 receptor agonists and SGLT-2 inhibitors in obese diabetic patients

Patients with type 2 diabetes mellitus (T2DM) and obesity are at high risk of developing cardiovascular disease (CVD). Both glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter (SGLT-2) inhibitors have been shown to prevent CVD in T2DM patients. Additionally, the two drugs reduce body mass. However, it is unknown which drug is more effective at reducing the risk of CVD in such patients. We searched Medline, EMBASE, and Cochrane Library records to February 20, 2021 and performed a network meta-analysis to compare the efficacy with which the drugs reduced the risk of major adverse cardiovascular events (MACE). We included 102,728 patients in 12 studies containing data of obesity subgroup analyses. In T2DM patients with obesity, GLP-1 RAs significantly reduced the risk of MACE versus placebo (relative risk, RR [95% confidence interval, CI]: 0.88 [0.81–0.96]), whereas SGLT-2 inhibitors showed a tendency (RR [95% CI]: 0.91 [0.83–1.00]). In an indirect comparison, GLP-1 RAs were not associated with a significant difference in MACE compared with SGLT-2 inhibitors (RR [95% CI]: 0.97 [0.85–1.09]). Thus, GLP-1 RAs are effective at preventing MACE than placebo in T2DM patients with obesity, although further studies are warranted to conclude their superiority to SGLT-2 inhibitors.

APTT (Activated Partial Thromboplastin Time) dan (Prothrombin Time) pada Penderita Diabetes Melitus Tipe 2 di RSUD dr. Doris Sylvanus Palangkaraya

Patients with type 2 diabetes mellitus (T2DM) have a high risk of atherothrombotic events. Hyperglycemia and other metabolic disorders in T2DM are associated with abnormalities of hemostasis system and thrombosis that contribute to cardiovascular disease. Routine laboratory tests to examine the hemostasis system are Activated Partial Thromboplastin Time (APTT) and Prothrombin Time (PT). This study aimed to describe the abnormalities of APTT and PT in patients with T2DM in RSUD dr. Doris Sylvanus Palangkaraya. Twenty subjects with T2DM in RSUD dr. Doris Sylvanus Palangkaraya were obtained using purposive sampling techniques and blood samples were examined with a COATX Biosystem coagulation using photocolorimetric method. This study found that was 70% APTT are shortened, 5% APTT are prolonged and 25% APTT were normal. While the PT results were 25% PT are shortened and 75% APTT were normal. Abnormalities of APTT and PT in T2DM patients in RSUD dr. Doris Sylvanus Palangkaraya showed an abnormality of the coagulation system so as to allow a tendency for bleeding and cardiovascular disease in T2DM patients. Routine coagulation test should be continued to help better diabetes mellitus management in order to prevent micro or macrovascular complications.

PDB8 - HBA1C As A Risk Factor For Cardiovascular Disease in Type 2 Diabetes Mellitus: A Hospital-Based Study in Taiwan

Cardiovascular disease (CVD) is the major cause for death in type 2 diabetes mellitus (T2DM) patients worldwide. Evidence has emerged that HbA1c may increase the risk for CVD and others. This study was to examine the relationship between HbA1c and onset cardiovascular disease, and target HbA1c in T2DM patients in Taiwan. Data in T2DM patients were extracted from Chang Gung Memorial Hospital between 2007 and 2014. CV outcome events were derived post T2DM diagnosed with data in medical charts such as HbA1c until end of the year 2014. A total of 126,079 T2DM patients were enrolled into the analysis. Per 1% unit increase in baseline HbA1c and mean HbA1c, hazard ratio (HR) for CVD were 1.05 (95% CI: 1.04 ~ 1.06, p < 0.001) and 1.31 (1.29 ~ 1.33, p < 0.001) when patients had previous CVD, respectively (p < 0.001). Per 1% unit increase in mean HbA1c, hazard of CVD increased 23% (17% ~ 29%), 21% (19% ~ 29%), and 6% (3% ~ 9%) for other treatment, oral anti-diabetic drug (OAD), and combination of insulin and OAD, respectively (all p < 0.001). Hazard of CVD increased more than 100% when mean HbA1c was higher than 8% compare with mean HbA1c was lower than 7% (p < 0.001). The rate of achieving target HbA1c level were significantly higher in OAD (1.45, 1.37 ~ 1.53) and lower in combination of insulin and OAD group (0.87, 0.82 ~ 0.93) when compared with the other treatment group (all p < 0.001). High HbA1c increases risk for CVD in T2DM patients revealed from large hospital based cohort in Taiwan. Maintenance of HbA1c control needs to be monitored continuously, especially in T2DM patients whose mean HbA1c was higher than 8%, with treatments in combination of insulin and OAD.

Interaction between endothelial nitric oxide synthase rs1799983, cholesteryl ester-transfer protein rs708272 and angiopoietin-like protein 8 rs2278426 gene variants highly elevates the risk of type 2 diabetes mellitus and cardiovascular disease

BackgroundThe aim of the present study was to examine the association of angiopoietin-like proteins-8 (ANGPTL8) rs2278426, cholesteryl ester-transfer protein (CETP) rs708272 and endothelial nitric oxide synthase (NOS3) rs1799983 variants with type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), and to investigate the effect of the potential interaction between these variants on disease risk.MethodsOur study included 272 subjects classified into 68 patients with T2DM, 68 patients with T2DM complicated with CVD and 136 control subjects. ANGPTL8 c194C>T, CETP Taq1B and NOS3 G894T polymorphisms were genotyped using TaqMan® SNP Genotyping Assay.ResultsThe presence of NOS3, ANGPTL8, and homozygous CETP B1 variants were associated with increased risk of T2DM by 3.07-, 2.33- and 1.75-fold, respectively. NOS3 variant was associated with 3.08-fold increased risk of CVD (95% CI 1.70–5.60), while ANGPTL8 C allele was associated with 2.8-fold increased risk of CVD in T2DM patients (95% CI 1.13–6.97). Concomitant presence of both, CETP B1 and NOS3 T allele, associated with increased risk of T2DM, CVD and CVD in T2DM by 8.36-, 6.33- and 7.87-fold, respectively, while concomitant presence of ANGPTL8 variant with either CETP B1 or NOS3 T allele was not associated with increased risk of T2DM or CVD. However, concomitant presence of the three variants together elevated the risk of T2DM by 13.22-fold (p = 0.004), CVD risk by 8.86-fold (p = 0.03) and highly elevated the risk of CVD in T2DM patients by 13.8-fold (p = 0.008).ConclusionsConcomitant presence of CETP B1, NOS3 T and ANGPTL8 T alleles augments the risk of CVD and T2DM. Further studies to clarify the mechanism of gene–gene interaction in the pathogenesis of CVD and T2DM are needed.

Glycation of high-density lipoprotein triggers oxidative stress and promotes the proliferation and migration of vascular smooth muscle cells.

BackgroundIn type 2 diabetes mellitus (T2DM), high-density lipoprotein (HDL) impairs its anti-atherogenic properties and even develops to a pro-inflammatory and pro-atherogenic phenotype because of abnormal compositions and modifications. In this study, we examined the effects and the related mechanisms of glycation of HDL on the proliferation and migration of vascular smooth muscle cells (VSMCs).Methods & ResultsGlycated HDL (G-HDL) was modified with D-glucose (25 mmol/L) in vitro. Diabetic HDL (D-HDL) was isolated from T2DM patients. Rat VSMCs were isolated from the thoracic aortas. Human VSMCs were obtained from ScienCell Research Laboratories. Alpha-actin was detected through immunofluorescence. VSMC proliferation was assayed by Cell Count. VSMC migration was determined by transwell chamber and scratch-wound assay. Intracellular reactive oxygen species (ROS) was detected based on ROS-mediated 2′,7′-dichlorofluorescein (DCFH-DA) fluorescence. Compared to native HDL (N-HDL), G-HDL remarkably promoted VSMC proliferation and migration in the dose and time-dependent manners. In addition, G-HDL enhanced ROS generation in VSMCs. However, the ROS scavenger, N-acetylcysteine, efficiently decreased ROS production and subsequently inhibited the proliferation of VSMCs induced by G-HDL. Similarly, D-HDL from T2DM patients also promoted ROS release and VSMC proliferation and migration.ConclusionsHDL either glycated in vitro or isolated from T2DM patients triggered VSMC proliferation, migration, and oxidative stress. These results might partly interpret the higher morbidity of cardiovascular disease in T2DM patients.

Relationship between dietary patterns and risk factors for cardiovascular disease in patients with type 2 diabetes mellitus: a cross-sectional study.

BackgroundWhile some dietary patterns are associated with the incidence of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), the relationship between dietary pattern and risk factors for CVD in patients with T2DM remains to be clarified. The aim of this study was to identify dietary patterns and investigate the relationship between dietary patterns and potential risk factors for CVD in patients with T2DM.MethodsThe study participants comprised 726 Japanese T2DM outpatients free of history of CVD. Life styles were analyzed using self-reported questionnaires. The relationship between dietary patterns, identified by factor analysis, and potential risk factors for CVD was investigated by linear and logistic regression analyses.ResultsSix dietary patterns were identified by factor analysis. Especially, three dietary patterns were associated with risk factors for CVD. The “Seaweeds, Vegetables, Soy products and Mushrooms” pattern, characterized by high consumption of seaweeds, soy products and mushrooms, was associated with lower use of diabetes medication and healthier lifestyles. The “Noodle and Soup” pattern, characterized by high consumption of noodle and soup was associated with higher body mass index, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transpeptidase and triglyceride levels. The “Fruit, Dairy products and Sweets” pattern was associated with lower γ-glutamyl transpeptidase levels, blood pressure, albuminuria and brachial-ankle pulse wave velocity.ConclusionsThe findings suggested that dietary patterns correlated with risk factors for CVD in T2DM patients.

Metabolomic profile related to cardiovascular disease in patients with type 2 diabetes mellitus: A pilot study

Type 2 diabetes mellitus (T2DM) patients have an increased risk of cardiovascular disease (CVD) that represents one of the main causes of mortality in this population. The knowledge of the underlie factors involved in the development of CVD and the discovery of new biomarkers of the disease could help to early identification of high-risk patients.Using liquid chromatography coupled to high resolution mass spectrometry (LC-HRMS) we analyzed the serum metabolomic profile of 30 subject distributed according three groups: (i) T2DM patients with CVD; (ii) T2DM patients without CVD; (iii) non-diabetic subjects as controls (C) in order to identify potential biomarkers of the CVD related to T2DM.A partial least squares discriminant analysis (PLS-DA) and one-way analysis of variance (ANOVA) were applied to identify differential metabolites between different groups.Four glycerophospholipids were further identified as potential biomarkers of CVD in T2DM patients. Specifically, a reduction in phosphatidylcholine, lysophosphatidylcholine and lysophosphatidylethanolamine (LPE) serum levels were found in T2DM patients compared to controls, presenting the patients with CVD the lowest serum levels of these metabolites.These results show a generalized reduction of circulating phospholipids species in T2DM patients which is more pronounced in those with CVD providing information of the pathways involved in the pathogenesis and progression of CVD associated to T2DM.

Alternative health eating index and the Dietary Guidelines from American Diabetes Association both may reduce the risk of cardiovascular disease in type 2 diabetes patients.

In the general population, a higher Alternate Healthy Eating Index (AHEI)-2010 score is related to decreased cardiovascular disease (CVD) risk. Few studies have described the dietary patterns that reduce the risk of CVD or coronary heart disease (CHD) in type 2 diabetes mellitus (T2DM) patients. In the present study, the association between the American Diabetes Association (ADA)-recommended dietary pattern, AHEI-2010 , and CVD risk factors and the CVD incidence over 52 months in T2DM patients was evaluated. The ADA score was developed from the ADA dietary recommendations. In this prospective study, the 24-h dietary recall of 124 adult T2DM patients without nephropathy or chronic kidney disease was collected. The CVD risk factors were collected at baseline and at 6-month follow-up. Compared with lower ADA and AHEI-2010 score participants, the higher score participants exhibited a significantly lower waist circumference, serum low-density lipoprotein cholesterol level and 10-year risk of CHD. Participants with higher ADA dietary scores had a significantly reduced risk of central obesity and systolic blood pressure >140 mmHg. Higher AHEI-2010 scores were significantly related to a reduced risk of serum low-density lipoprotein cholesterol > 100 mg dL(-1) . Seven participants had their first-ever CVD during the follow-up period, although neither ADA score, nor AHEI-2010 score could predict CVD incidence. The ADA-recommended dietary pattern and a higher AHEI-2010 score might both exhibit reduced risk factors of CVD in T2DM patients.

Prevalence of dyslipidemia in adult Indian diabetic patients: A cross sectional study (SOLID).

Context:India leads the world with largest number of diabetic patients and is often referred to as the diabetes capital of the world. Diabetic dyslipidemia in India is one of the main cause for Coronary Artery Disease (CAD) mortality. Although diabetes continues to be a major lifestyle condition in India, there is a lack of studies in India on whether dyslipidemia in Indian diabetics is being adequately controlled. Our study provides critical insights into the insights into proportion of diabetes patients achieving lipid goal in India.Aims:The primary objective of our study was to assess the control of dyslipidemia in the Indian diabetic population treated with lipid lowering drugs (LLDs), as per American Diabetes Association (ADA) 2010 guidelines.Settings and Design:The study was carried out in a real world Indian clinical setting involving 178 sites. This is a multicenter, noninterventional, and cross-sectional observational study.Materials and Methods:A total of 5400 adult subjects with established type-2 diabetes mellitus (T2DM) and dyslipidemia were recruited for the study. Patients in the study were on LLD at a stable dose for at least last 3 months before the designated study visit. Routine lipid profile tests were conducted for all patients.Statistical Analysis Used:Descriptive statistics was used to analyze qualitative and discrete variables. Chi-square test and t-test were conducted to assess the existence of statistically significant association between the variables.Results:A total of 5400 patients with T2DM from 178 centers across India were recruited. Out of the total population, 56.75% (N = 3065) of them were males. Primary end-point of low-density lipoprotein cholesterol (LDL-C) level below ADA 2010 target was achieved in a total of 48.74% (N = 2632) patients. Gender was significantly associated with lipid levels and age was significantly (P < 0.05) correlated with all lipid levels. Control rates of other lipid parameters like high-density lipoprotein cholesterol, triglyceride, and total cholesterol in the study were 60.48% (N = 3236), 57.54% (N = 3107), and 92.24% (N = 4981) respectively. Among those with overt cardiovascular disease (CVD), target LDL-C level of < 70 mg/dL was achieved in 22.87% (70 out of 306) patients. The LDL-C levels of 49.03% (N = 1768) patients who were on statin therapy were within target levels, while 53.46% (N = 634) patients who were on statin and their combinations with other LLDs had their LDL-C levels within the stipulated range.Conclusions:This study has reveled that dyslipidemia control in Indian T2DM patients is very poor with almost half of them not reaching their LDL -C goal. Dyslipidemia being one of the main risk factors for CVD in T2DM patients there is a need to treat dyslipidemia aggressively to reduce risk of future CV events.

Subclinical cardiovascular disease in type 2 diabetes mellitus: To screen or not to screen.

The prevalence of type 2 diabetes mellitus (T2DM) has risen in recent decades, and cardiovascular disease remains the leading cause of death in this population. Several clinical trials have demonstrated the benefit of tight control of risk factors on the incidence and mortality of cardiovascular disease. However, in clinical practice, few patients achieve the therapeutic goals. The current diagnostic procedures for subclinical cardiovascular disease in T2DM patients have not been shown to improve prognosis or mortality, probably because they do not categorize cardiovascular risk. Thus, clinical practice guidelines do not systematically recommend screening for subclinical atherosclerosis in these patients, although it is known that patients with extra-coronary atherosclerosis, microangiopathy and poorly-controlled cardiovascular risk factors are at high risk for cardiovascular disease. Improvements in the reliability of diagnostic tests, with fewer side effects and better cost efficiency, may better help to stratify cardiovascular risk in this group of patients, and further evaluation on this topic should be considered.

Pharmacological primary and secondary cardiovascular prevention among diabetic patients in a multiethnic general practice population: still room for improvements

BackgroundEthnic minority groups have higher prevalence of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). We assessed general practitioners’ (GPs’) performance with respect to the pharmacological prevention of CVD in patients with T2DM from different ethnic backgrounds in Oslo.MethodsOf 1653 T2DM patients cared for by 49 GPs in 2005, 380 had a diagnosis of CVD. Ethnicity was categorized as Norwegian, South Asian and other. Risk factor levels, medication use, achievement of treatment targets (HbA1c ≤ 7.5%, systolic blood pressure (SBP) ≤ 140 mmHg, total cholesterol/HDL-cholesterol < 4) and therapeutic intensity (number of drugs targeting each risk factor) were recorded. Chi-square, Wald tests and multiple linear regression analyses were used.ResultsOf the 1273 patients receiving primary prevention, 1.5% had their Hb1Ac, 4.8% SBP and 12.7% lipids levels above treatment thresholds without relevant prescriptions. Among patients on pharmacological therapy, 66% reached the HbA1c, 62% SBP and 62% lipid target. Proportions not achieving the HbA1c target were 26% in Norwegians, 38% in South Asians and 29% in others (p = 0.008). Proportions not achieving the SBP target were 42% in Norwegians, 22% in South Asians and 25% in others (p ≤ 0.001). Of those not achieving the HbA1c and SBP targets, 43% and 35% respectively, used only one agent.In secondary prevention, 0.8% of the patients had their HbA1c, 0.5% SBP and 7.4% lipid levels above treatment thresholds without relevant prescriptions. Among patients on pharmacological therapy, 65% reached the HbA1c, 64% SBP and 66% lipid target. Proportions not achieving the HbA1c target were 26% in Norwegians, 47% in South Asians and 40% in others (p = 0.03). Proportions not achieving the SBP target were 36% in Norwegians, 22% in South Asians and 56% in others (p = 0.050). Of those not achieving HbA1c and SBP targets, 49% and 21% respectively, were on mono-therapy.ConclusionsNorwegian GPs comply reasonably well with guidelines for pharmacological prevention of CVD in T2DM patients across ethnic groups. However, lipid-lowering therapy was generally underused, and the achievement of treatment targets for HbA1c in ethnic minorities and for BP in Norwegians could be improved.

The relationship of ACE and CETP gene polymorphisms with cardiovascular disease in a cohort of Asian Indian patients with and those without type 2 diabetes

Introduction Hypertension and dyslipidemia have been associated with cardiovascular disease (CVD). We investigated the association of candidate gene polymorphisms in angiotensin-converting enzyme ( ACE) and cholesterol ester transfer protein ( CETP) genes in a cohort of Asian Indian patients with and those without type 2 diabetes. Methods PCR-based genotyping of insertion/deletion (I/D) polymorphism of ACE (rs4646994) and –629C>A of CETP (rs1800775) was carried out in 520 individuals, of whom 160 had CVD+type 2 diabetes mellitus (T2DM), 90 were CVD patients without T2DM, 150 had T2DM with no cardiovascular complications, and 120 were age- and sex-matched healthy controls. Results With respect to the ACE gene I/D polymorphism, there was a higher percentage of D/D genotype in CVD+T2DM patients, but it was not statistically significant, while the CETP –629A allele was significantly associated with CVD+T2DM patients ( P=.000007; odds ratio=0.46; 95% confidence interval=0.32–0.65) as compared with the normal controls and not with CVD alone. Additive interactions between the AA+I/I genotypes, AC+I/D genotypes, and AC+D/D were identified between the patients and the controls with P values of .0052, .0009, and .0078, respectively. Conclusions Our study suggests that candidate gene polymorphism –629C>A of CETP may serve as a susceptibility biomarker for CVD in T2DM patients. Analyzing the combined effect of both ACE and CETP genotypes would enhance the sensitivity and specificity of CVD risk estimation in the T2DM patients in our population.