Diabetes Coronary Heart Disease Research Articles

Different effects of PPARA, PPARG and ApoE SNPs on serum lipids in patients with coronary heart disease based on the presence of diabetes

BackgroundThe aim of this study was to investigate the individual or combined effects of PPARA-L162V, PPARG-C161T and APOE polymorphisms on hyperlipidemia in coronary heart disease (CHD) patients. MethodsOur study included 223 patients with CHD (103 with type 2 diabetes (T2DM), 120 without diabetes) and 101 controls. All genotypes were determined by PCR–RFLP technique. ResultsGenotypic and allelic distributions of PPARA-L162V polymorphism were similar between study and control groups (p>0.05). The serum total-cholesterol (TC) and LDL-cholesterol (LDL-C) levels were higher in PPARA-V162 allele carriers in non-diabetic CHD patients (p=0.007 and p=0.038, respectively). The increasing effect of the PPARA-V162 allele on serum TC and LDL-C levels was weakened with the presence of PPARG-161T allele in the non-diabetic CHD patients. The ApoE4–PPARA-V162 allelic combination of the ApoE/PPARA genes was found to be more frequent in diabetic CHD patients independent of serum lipids (p=0.035). ConclusionsThe PPARA V162 allele has an increasing effect on TC and LDL-C levels and this effect was reduced by carrying PPARG T161 allele in non-diabetic CHD patients. On the other hand, the V162 allele may be associated with an increased risk of CHD in diabetic CHD patients due to the presence of ApoE4 allele independent of serum lipids. We suggest that the PPARA L162V polymorphism may have diverse effects on serum lipids and CHD risk depends on the presence of T2DM.

Abstract P050: Glycated Hemoglobin Versus Fasting Glucose in Defining Metabolic Syndrome and Prediction of Coronary Heart Disease

Introduction. Fasting glucose (FG) is part of the Adult Treatment Panel III (ATP III) criteria for defining the metabolic syndrome (MetS). Glycated hemoglobin (HbA1c) is a measure of 2-3 month endogenous glucose exposure and is now recommended for diabetes diagnosis and screening for high-risk individuals. The aim of this study was to evaluate if replacing FG with HbA1c to define MetS improves prediction of incident coronary heart disease (CHD) in the Atherosclerosis Risk in Communities (ARIC) cohort. Methods. We included 11,194 ARIC participants without diabetes (based on diagnosis, medication use, FG ≥126 mg/dL, or HbA1c ≥6.5%) or prevalent CHD at baseline (1990-92). Cox proportional hazards models (adjusted for age, race, and study center) were used to compare the association between MetS defined using HbA1c (5.7-6.4%) or FG (100-125 mg/dL, based on ATP III guidelines) and risk of CHD (defined by myocardial infarction or fatal CHD, event data available through 2009). Results. Study participants had a mean age at baseline of 57 years, 43% were male, and 79% were white; median follow-up time was 16 years. Thirty-four percent of the study population had both normal FG (<100 mg/dL) and HbA1c (<5.7%), 37% had elevated FG and normal HbA1c, 4% had normal FG and elevated HbA1c, and 25% had both elevated FG (100-125 mg/dL) and HbA1c (5.7-6.4%). The association of combined FG and HbA1c categories with incident CHD are shown in the Figure. The adjusted hazard ratio predicting for incident CHD from MetS status was 1.43 (95% CI: 1.25-1.63, c-statistic: 0.61) using FG in the definition of MetS and 1.69 (95% CI: 1.48-1.93, c-statistic: 0.62) in the model replacing FG with HbA1c. Conclusions. Incorporating HbA1c into the definition of the MetS may help in identifying individuals who should be targeted for aggressive CHD risk factor reduction. Additionally, HbA1c may be useful clinically and in research settings for identifying individuals with MetS in cases where FG measures are not available.

Health equity audits in general practice: a strategy to reduce health inequalities

This quality improvement project was set in Tower Hamlets, east London, with the aim of reducing health inequalities by ethnicity, age and gender in the management of three common chronic diseases. Routinely collected clinical data were extracted from practice computer systems using Morbidity Information Query and Export Syntax (MIQUEST) and Egton Medical Information Systems (EMIS) Web, between 2007 and 2010. Health equity audits for 38 practices in Tower Hamlets primary care trust (PCT) were constructed to cover key process and outcome measures for each of the three major chronic diseases: coronary heart disease (CHD), type 2 diabetes mellitus and chronic obstructive pulmonary disease (COPD). The equity audit was disseminated to practices along with facilitation sessions. We show evidence of baseline inequalities in each condition across the three east London PCTs. The intervention tracked four key indicators (cholesterol levels in CHD, blood pressure and haemoglobin A1c levels in diabetes and % smoking in COPD). Performance for physician-driven interventions improved, but smoking rates remained static. All ethnic groups showed improvement, but there was no evidence of a reduction in differences between ethnic groups. Reductions in gender and age group differences were noted in diabetes and CHD. Using routine clinical data, it is possible to develop practice-level health equity reports. These can unmask previously hidden inequalities between groups, and promote discussion with practice teams to stimulate strategies for improvements in performance. Steady improvements in chronic disease management were observed, however, systematic differences between ethnic groups remain. We are not able to attribute observed changes to the audits. These reports illustrate the importance of collecting ethnicity data at practice level. Tools such as this audit can be adapted to monitor inequalities in primary care settings.

Determinants of lipid goal achievement in patients on extended-release nicotinic acid/laropiprant in primary care clinical practice

Objectives:To establish determinants of lipid goal attainment in primary care patients, with particular focus on participation in a disease management programme (DMP) on diabetes mellitus (DM) and/or coronary heart disease (CHD), with real-world practical relevance.Methods:The present analysis was based on an observational study in 2359 patients with dyslipidaemia or hypercholesterolaemia that were treated with nicotinic acid 1000 mg/laropiprant 20 mg (Tredaptive) one or two tablets daily. Subgroups were formed by DMP participation (DMP vs. no DMP). A stepwise logistic regression model with backward selection of variables was applied to investigate factors influencing the probability of reaching lipid goals. Follow-up was 23 ± 7 weeks.Results:Low density lipoprotein cholesterol (LDL-C) <100 mg/dl was achieved by 30.8% in DMP versus 26.8% (no DMP), high density lipoprotein (HDL-C) >40/50 mg/dl in 61.3% versus 66.1%, and triglycerides (TG) <150 mg/dl in 28.9% versus 31.7%. On multivariate analysis, age, sex, concomitant high-risk cardiovascular disease, or participation in a DMP appeared to have inconsistent effects on reaching LDL-C, HDL-C and TG goals. Likelihood to reach the LDL-C goal tended to be higher in males, in patients outside DMP, and in patients with DM or CHD, and those treated with 1 tablet (versus 2 tablets) extended release nicotinic acid 1000 mg/laropiprant 20 mg. The likelihood of reaching the HDL-C goal was higher in males and in patients without DM or DM+CHD (no effect of DMP). The likelihood of reaching the TG goals was higher in females, in patients outside DMP, and in patients with DM and/or CHD. Limitations include potential bias due to study design, physician and patient selection, and missing values at follow-up.Conclusion:DMP participation was not associated with overall improved lipid goal attainment. Physicians cannot predict the magnitude of effects of newly initiated lipid modifying therapy based on baseline characteristics of their patients.

Diabetic Retinopathy and Coronary Heart Disease

Diabetic Retinopathy and Coronary Heart Disease

Hangover and the risk of stroke in middle-aged men

The aim of this study was to examine the association between hangover and the risk of stroke. A population-based sample of men with an average follow-up of 15.7 years. 2466 men with no history of stroke at baseline participated. Two hundred and six strokes occurred, of which 167 were ischemic strokes. The age-adjusted, relative risk (RR) for any stroke among men with ≥1 hangover per year was 2.33-fold (95% confidence interval (CI), 1.19-4.56; P = 0.013) relative to men without hangover, and 2.99-fold (95% CI, 1.52-5.86; P = 0.001) for ischemic stroke, respectively. After adjustment for age, smoking, high density lipoprotein (HDL)-cholesterol, LDL-cholesterol, BMI, SBP, myocardial ischemia during exercise, symptomatic coronary heart disease (CHD) and CHD in family, C-reactive protein, diabetes, and total alcohol consumption, the RR for any stroke was 1.94-fold (95% CI, 0.95-3.96; P = 0.070) and 2.58-fold (95% CI, 1.24-5.36; P = 0.011) for ischemic stroke among men with hangovers. Additional adjustment of atrial fibrillation and cardiac failure and risk was 2.45-fold (95% CI, 1.18-5.12; P = 0.017) for ischemic strokes. This study shows that at least one hangover a year is related to an increased risk of ischemic stroke in men.

Attainment of Normal Lipid Levels Among Patients on Lipid-Modifying Therapy in Hong Kong

Although low-density lipoprotein cholesterol (LDL-C) is the primary lipid target for coronary heart disease (CHD) risk reduction, high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) have also emerged as CHD risk factors. The objective of this study was to evaluate attainment of lipid goals and normal levels following lipid-modifying therapy (LMT) and its predictors in a representative sample of Chinese patients from Hong Kong. Using longitudinal data collected from patient medical records, the study identified 706 patients who initiated LMT from January 2004 to December 2006 and had full lipid panels 12 months before and after therapy. LDL-C goals and normal levels of HDL-C and TG were defined according to the National Cholesterol Education Program Adult Treatment Panel 3 guidelines. Patients with previous CHD, diabetes, and 10-year CHD risk > 20% were classified as high risk. Multiple logistic regressions evaluated predictors of normal lipid-level attainment. Among 706 patients (mean age 64.6 years, 58.6% male), 71.7% had elevated LDL-C, 32.4% had low HDL-C, and 24.9% had elevated TG before LMT. Despite therapy (91.2% statins only), 22.7% had elevated LDL-C, 31.9% had low HDL-C, 12.3% had elevated TG, and 13.9% had multiple abnormal lipid levels. The strongest predictors of attaining ≥ 2 normal lipid levels included male gender (odds ratio [OR]: 2.11 [1.12 to 4.01]), diabetes (OR: 0.43 [0.23 to 0.78]), obesity (OR: 0.91 [0.86 to 0.97]), and CHD risk > 20% (OR: 0.33 [0.15 to 0.71]). Current approaches to lipid management in Hong Kong, primarily using statins, considerably improve attainment of LDL-C goal. However, a large proportion of patients do not achieve normal HDL-C levels and control of multiple lipid parameters remains poor. Patients could benefit from a more comprehensive approach to lipid management that treats all three lipid risk factors, as suggested in clinical guidelines.

Assessment of coronary heart diseases in diabetics in al-Madinah al-Munawarah.

BackgroundCoronary heart disease is highly prevalent and a major cause of morbidity and mortality in diabetic patients. The aim of this study was to assess the major risk factors and their predictor score for coronary heart diseases in diabetic patients.MethodsThe present study was conducted in al-Madinah, Kingdom of Saudi Arabia. Using a cross-sectional case control study, 262 outpatient diabetics and 264 matched control subjects were examined for the risk factors and risk predictor scores for ischemic heart disease. The mean age of the patient and control groups was 49.61 ± 12.93 years and 48.39 ± 11.60 years, respectively.ResultsDiabetic patients had significantly higher positive family history of diabetes, but no significant difference regarding their family history of hypertension. There was a significantly higher body mass index (33.67 kg/m2), glycosylated hemoglobin (7.26%), significantly higher cholesterol, low-density lipoprotein, and triglyceride in diabetics compared to control. Diabetic patients had higher risk for developing coronary heart disease with a mean risk score of 6.07 while the control subject risk score was −6.81. However, females showed significantly higher risk for coronary heart diseases than did males.ConclusionOur study replicates the known fact of higher risk in diabetes, but higher risk of coronary heart disease in female diabetics compared with male diabetics.

Myocardial perfusion imaging: a plus for coronary risk classification in diabetics

Type 2 diabetes mellitus is the most common form of diabetes worldwide (>90%). Long-term complications of diabetes include microvascular and macrovascular damage. Life expectancy of patients with diabetes remains substantially shorter than that of individuals without diabetes, mainly because of coronary heart disease (CHD) [1]. However, CHD risk in patients with diabetes is highly variable and difficult to stratify by conventional clinical markers [2, 3]. Moreover, the early identification of CHD in diabetics is difficult due to its often silent or atypical presentation in this population. As a result, CHD in diabetics may be diagnosed several years after its onset, when the disease is in an advanced stage, frequently in the form ofmyocardial infarction (MI) or sudden cardiac death. To improve outcomes, common CHD risk factors should be assessed at least annually, along with the presence of microor macroalbuminuria, and be actively managed [4, 5]. The increasing prevalence of diabetes and the associated high CHD risk raises the question as to the need to develop noninvasive approaches to detect the patients with diabetes at the highest risk of CHD. This strategy could identify higher risk diabetics in whom coronary revascularization may improve the outcome beyond that achieved by currently recommended medical management. Stress/rest myocardial perfusion imaging (MPI) is effective in detecting CHD and predicting adverse cardiac events in diabetic patients [6, 7]. Nevertheless, the clinical utility of MPI in diabetics is debated due to the small number of prospective and outcome studies, along with some epidemiological and cost-effectiveness data. It has been reported that routine screening of asymptomatic diabetics who have a normal ECG does not have clinical benefit and that cardiac outcomes are essentially equal (and very low) in screened and unscreened patients (despite abnormal MPI in >20% of these patients) [8]. In addition, according to the large multicentre Bypass Angioplasty Revascularization Investigation 2 Diabetes trial (BARI 2D), optimal intensive medical therapy provides equal outcomes to revascularization in patients with diabetes [9]. In this randomized trial, only patients who had undergone coronary bypass surgery had significantly reduced major cardiac events, compared with those assigned in the intensive medical therapy group, but no difference in mortality was recorded. Therefore, only those diabetics with evidence of myocardial ischaemia and extensive multivessel disease would benefit from prompt surgical revascularization, mainly because of a lower rate of nonfatal MI. It is noteworthy that the majority of the patients enrolled had symptoms and all of them had stable CHD [9]. There is also some evidence that silent myocardial ischaemia may reverse over time with optimized medical treatment, adding to the controversy concerning aggressive screening strategies [10]. Finally, it has been reported that even asymptomatic diabetics with intermediate/high CHD risk have a low annual cardiac event rate (<1%), which is not affected by routine screening for inducible ischaemia [11]. Since screening for CHD in asymptomatic patients does not improve outcomes as long as CHD risk factors are treated, it is not routinely recommended by professional organizations or guidelines for appropriate use of cardiac A. Flotats Nuclear Medicine Department, Universitat Autonoma de Barcelona, Barcelona, Spain

The clinical analysis of diabetic nephropathy and coronary heart disease by Zheng Wu soup and danshen

Objective To explore the treatment effect of diabetic nephropathy and coronary heart disease by Zheng Wu soup and danshen.Methods 36 diabetic nephropathy complicated with coronary heart patients were randomly divided into two groups,18 patients in the control group used routine western medicine conservative treatment,18 patients in the treatment group used Zheng Wu soup and dansh based on the conventional western medicine treatment,patients were followed up for 1 ～ 3 months after treatment,compaired the treatment effect between two group patients.Results The total effective rate of treatment group patients was 94.4％,significantly better than control group which were 77.8％,the difference was statistically significant ( P ＜ 0.05 ).Conclusions Zhenwu soup combined with Danshen on the treatment diabetic nephropathy complicated with coronary heart patients could produce good results. Key words: Traditional Chinese medicine combined Western medicine; Zhenwu soup; Danshen; diabetic nephropathy; coronary heart disease

Clinical features of gout in female residents in coastal regions of Shandong province

The clinical features of 172 female and 1 067 male residents with gout in the coastal regions of Shandong province were analyzed.The results showed that as compared with male patients the onset of gout occurred at an older age in the female patients,and there were less obesity and tophi as well as less alcohol consumption and medication needed in the female patients.However,comorbidity with diabetes mellitus and coronary heart disease,as well as involvement of upper limb and other metatarsophalangeal joints were more prevalent in the female patients. Key words: Female ; Gout; Clinical features

Association between clusters of diseases and polypharmacy in hospitalized elderly patients: Results from the REPOSI study

Background Although the association between multimorbidity and polypharmacy has been clearly documented, no study has analyzed whether or not specific combinations of diseases influence the prescription of polypharmacy in older persons. We assessed which clusters of diseases are associated with polypharmacy in acute-care elderly in-patients. Methods This cross-sectional study was held in 38 Italian internal medicine and geriatric wards participating in the Registro Politerapie SIMI (REPOSI) study during 2008. The study sample included 1155 in-patients aged 65 years or older. Clusters of diseases, defined as two or more co-occurring specific chronic diseases, were identified using the odds ratio (OR) for the associations between pairs of diseases followed by cluster analysis. Polypharmacy was defined as the prescription of five or more different medications at hospital discharge. Logistic regression models were run to analyze the association between clusters of diseases and polypharmacy. Results Among clusters of diseases, the highest mean number of drugs (> 8) was found in patients affected by heart failure (HF) plus chronic obstructive pulmonary disease (COPD), HF plus chronic renal failure (CRF), COPD plus coronary heart disease (CHD), diabetes mellitus plus CRF, and diabetes mellitus plus CHD plus cerebrovascular disease (CVD). The strongest association between clusters of diseases and polypharmacy was found for diabetes mellitus plus CHD plus CVD, diabetes plus CHD, and HF plus atrial fibrillation (AF). Conclusions The observed knowledge of the relationship among co-occurring diseases and polypharmacy should help to identify and monitor older in-patients at risk of polypharmacy.

Pathways leading to coronary revascularisation among patients with diabetes in Finland: a longitudinal register-based study

BackgroundChronic conditions such as coronary heart disease (CHD) challenge health care to provide systematic and long-lasting disease management. In this study of patients who were revascularized, we examine whether treatment pathways leading to coronary revascularisation differ between patients with and without diabetes.MethodsThis retrospective, nationwide register-based study in Finland in 1998-2007 describes temporal trends in the proportions of 1) revascularisations performed at the first treatment period, and 2) suboptimal treatment pathways to revascularisations, i.e. pathways containing several cardiac emergency hospitalisations. Differences between patient groups were examined using a logistic regression model adjusting for age, comorbidity, and region.ResultsAmong patients who underwent revascularisation, upward trends were found in the proportions of revascularisations performed during first hospital admission: among men with CHD alone, the percentages were 28% in 1998 and 77% in 2007; among men with insulin-dependent diabetes (IDD) they were 16% vs. 58% for the respective years; and among men with non-insulin dependent diabetes (NIDD) they were 25% vs. 69%, respectively. Among women the percentages were for non-diabetic group 32% vs. 77%; for IDD group 36% vs. 64%; and for NIDD group 33% vs. 73% for the respective years. Patients with diabetes were less likely to undergo revascularisation during the first hospital admission, in 2005-2007, the odds ratio (OR) for IDD among men was 0.52 (95% confidence interval 0.42-0.64) and for NIDD among men it was 0.79 (95% CI 0.73-0.86) compared to patients with CHD alone. The respective ORs among women were 0.59 (95% CI 0.44-0.78), and 0.83 (95% CI 0.74-0.93).ConclusionsTreatment practices changed substantially during the study period to favour performing revascularisation during the first hospital admission. The large increase in coronary angioplasty operations is likely to be an important factor behind these changes. However, fewer operations are performed during the first CHD hospitalisation of diabetic patients who undergo coronary revascularisation and they experience more often emergency hospital admissions before the operation than patients without diabetes. To avoid adverse cardiac events, more attention is needed in managing diabetic CHD patients' referral pathways to revascularisation.

Clinical observation on the effect of Yiqi Huoxuehuatan recipe on 68 patients with elderly diabetic coronary heart disease

Objective To observe the effect of Yiqi Huoxuehuatan Recipe in treating elderly diabetic coronary heart disease. Methods 68 patients with elderly diabetic coronary heart disease were randomly assigned to the treatment group (34 patients) and control group (34 patients). The former received a routine western medicine treatment plus Yiqi Huoxuehuatan Recipe, one dose per day; while the latter group received a routine western medicine treatment only, both treated for a course of 60 days. When the treatments were finished,angina curing effect, alleviation of main symptoms, ECG, FPG, 2hPG, HbA1c, TC, TQ LDL-C, HDL-C, and indicators of blood rheology (low shear whole blood viscosity, plasma viscosity, RBC aggregation index, RBC deformation index) were compared. Results Changes in angina curing effect, alleviation of main symptoms,ECQ lipid and indicators of blood rheology were significant (χ2=4.53> 4.12, P<0.05) between the two groups.Conclusion Yiqi Huoxuehuatan Recipe has an obvious clinical effect in treating elderly diabetic coronary heart disease by improving clinical effect, helping in alleviation of angina, ameliorating lipid metabolism disorder and correcting the abnormal indicators of blood rheology. Key words: Yiqi Huoxuehuatan Recipe; Elderly diabetic coronary heart disease; Chinese medical treatment

Does Diabetes Always Confer Coronary Heart Disease Risk Equivalent to a Prior Myocardial Infarction?

The excess risk for future coronary heart disease (CHD) events attributable to diabetes alone in the absence of coexisting CHD was not well understood until the publication by Haffner et al. (1) on this subject in 1998, which concluded that the elevation in risk was essentially similar to nondiabetic individuals with a prior myocardial infarction. This conclusion was based on a nonsignificant adjusted hazard ratio of 1.2 for CHD mortality over 7 years of follow-up in a Finnish cohort. This article had a considerable impact on our thinking and approach to CHD prevention in diabetes given its publication in a prestigious medical journal and high number of citations since ( n = 3,676; scholar.google.com, accessed 4 October 2010). It provided justification for taking the same intensive approach to CHD prevention as used in individuals with a prior myocardial infarction, including aspirin as a cornerstone of treatment. In apparently equivalent high-risk states of diabetes and prior CHD, the benefit of aspirin in reducing risk of myocardial infarction has been believed to outweigh uncommon bleeding complications and yield a net average expected benefit. Given the finding of Haffner et al. and previous American Diabetes Association (ADA) recommendations in favor of the use of aspirin to prevent CHD in many individuals with diabetes, why then would a recent ADA position statement change course by recommending more limited aspirin use based on overall cardiovascular disease (CVD) risk (2,3)? A number of reasons seem to justify this change in recommendations. There have been major advances in treatment approaches to type 2 diabetes, replications of the finding by Haffner et al. are inconsistent, and recent data suggest that the utility of aspirin for CHD prevention may be of a lesser magnitude than previously believed. First, it should be pointed out that even though …

Myocardial revascularization in diabetic patients presenting with critical limbischemia

The frequency of diabetic complications remains high despite the development of improved therapeutic modalities. Macroangiopathy continues to bethe predominant complication while coronary heart disease is the main cause of mortality.This paper considers clinical features of diabetic patientswith coronary heart disease and critical limb ischemia; various aspects of optimal drug therapy, preoperative examination and diagnostics precedingvascular non-cardiac surgery; preoperative risk assessment; indications for coronary angiography and myocardial revascularization. The authors emphasizethe importance of development of algorithms for the treatment of patients with diabetes, critical limb ischemia, and coronary heart disease.

Lung function and risk of type 2 diabetes and fatal and nonfatal major coronary heart disease events: possible associations with inflammation.

OBJECTIVEWe prospectively examined the relationship between lung function and risk of type-2 diabetes and fatal and nonfatal coronary heart disease (CHD) events and investigated the hypothesis that inflammation may underlie these associations.RESEARCH DESIGN AND METHODSA prospective study of 4,434 men aged 40–59 years with no history of cardiovascular disease (CHD or stroke) or diabetes drawn from general practices in 24 British towns and followed up for 20 years.RESULTSThere were 680 major CHD events (276 fatal, 404 nonfatal) and 256 incident type 2 diabetes during the 20 years follow-up. Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) but not FEV1-to-FVC ratio were significantly and inversely associated with incident type 2 diabetes and fatal CHD events (not nonfatal events) after adjustment for age, potential confounders, and metabolic risk factors. The adjusted relative risk (RR) for type 2 diabetes (Quartile 1 vs. Quartile 4) were 1.59 (1.07–2.56) and 1.74 (1.16–2.61) for FVC and FEV1, respectively (P = 0.03 and P = 0.04 for trend). The corresponding RR for fatal CHD were 1.48 (1.00–2.21) and 1.81 (1.19–2.76) (P = 0.002 and P = 0.0003 for trend). Lung function was significantly and inversely associated with C-reactive protein and interleukin-6; the inverse associations with type 2 diabetes for FVC and FEV1 were attenuated after further adjustment for these factors (P = 0.14 and P = 0.11 for trend) but remained significant for fatal CHD (P = 0.03 and P = 0.01, respectively).CONCLUSIONSRestrictive rather than obstructive impairment of lung function is associated with incident type 2 diabetes (and fatal CHD) with both associations partially explained by traditional and metabolic risk factors and inflammation.

Diabetes and Coronary Heart Disease as Risk Factors for Mortality in Older Adults

Background Type 2 diabetes has been described as a coronary heart disease (CHD) “risk equivalent.” We tested whether cardiovascular and all-cause mortality rates were similar between participants with prevalent CHD vs diabetes in an older adult population in whom both glucose disorders and preexisting atherosclerosis are common. Methods The Cardiovascular Health Study is a longitudinal study of men and women (n = 5784) aged ≥65 years at baseline who were followed from baseline (1989/1992-1993) through 2005 for mortality. Diabetes was defined by fasting plasma glucose ≥7.0 mmol/L or use of diabetes control medications. Prevalent CHD was determined by confirmed history of myocardial infarction, angina, or coronary revascularization. Results Following multivariable adjustment for other cardiovascular disease risk factors and subclinical atherosclerosis, CHD mortality risk was similar between participants with CHD alone vs diabetes alone (hazard ratio [HR] 1.04, 95% confidence interval [CI], 0.83-1.30). The proportion of mortality attributable to prevalent diabetes (population-attributable risk percent = 8.4%) and prevalent CHD (6.7%) was similar in women, but the proportion of mortality attributable to CHD (16.5%) as compared with diabetes (6.4%) was markedly higher in men. Patterns were similar for cardiovascular disease mortality. By contrast, the adjusted relative hazard of total mortality was lower among participants with CHD alone (HR 0.85, 95% CI, 0.75-0.96) as compared with those who had diabetes alone. Conclusions Among older adults, diabetes alone confers a risk for cardiovascular mortality similar to that from established clinical CHD. The public health burden of both diabetes and CHD is substantial, particularly among women.

Total Level of Serum Homocysteine in Males and Females with Coronary Heart Disease of Different Age Groups

Problem statement: Elevated plasma total homocysteine concentration is a risk factor of cardiovascular disease. Total homocysteine level is a strong predictor of mortality in-patient with an angiographically confirmed Coronary Heart Disease (CHD), so we want to know at what age in males and females elevated homocysteine will be significa ntly elevated and this will help for better management and prognosis by decreasing the level of homocysteine. Approach: Plasma level of homocysteine was determined in male and female patients below and above 50 years old, who have coronary heart disease with diabetes or without dia betes. Fifty two coronary heart diseases with type 2 diabetic patients and a matched number of healthy s ubjects as a control and another 52 coronary heart disease patients without diabetes were included in this study. Plasma homocysteine was determined by Enzymatic Immuno Sorbant Assay (ELISA). Results: Plasma homocysteine level in coronary heart disease diabetic male and female patients who are 50 years old, respectively. Plasma homocysteine level in coronary heart disease nondiabetic male and female patients who are 50 years old, respecti vely. Conclusion: It is concluded that plasma level of homocysteine is significantly elevated in diabetic coronary heart disease female patients above 50 yea rs old and significantly elevated in nondiabetic coronary heart disease males and female patients, t hus nondiabetic coronary heart disease male and female patients and diabetic coronary female patien ts are at high risk of vascular diseases. It is recommended that these patients may take supplementation of folate and vitamin B12 to reduce the level of homocysteine.

Lipid abnormalities: A case study of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Background : Abnormal lipid levels, especially elevated total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and triglyceride (TG) and decreased high density lipoprotein cholesterol (HDL-C), contribute additional risk to patients with diabetes mellitus (DM) and coronary heart disease (CHD). Reports on the pattern of lipid profile abnormality in blacks are scanty and inconsistent. The aim of the present study has been to carry out a retrospective analysis of lipid profile investigation in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. Materials and Methods : A total of 448 patients with different disease conditions, such as type II DM, CHD, renal disorders, liver diseases and other abnormalities, who were referred to the chemical pathology laboratory from various clinics and hospitals for lipid profile analysis were assessed. The subjects were made up of 312 (69.67%) males and 136 (30.33%) females. The mean age for the total (combined males and females) was 58 (ranged 45-72) years and the mean age values for males and females were 62 (ranged 51-73) and 53 (ranged 35-65) years respectively. Results : The results show that abnormal lipid profile was found in 51 (11.38%) patients who were consisted of 33 (67.71%) males and 18 (35.29%) females. These also consisted of 35 (68.63%) patients with cardiovascular diseases (CVD), 5 (9.80%) patients with type II diabetes mellitus (DM) and 11 (21.57%) patients with other clinical conditions such as liver and renal diseases. Hypercholesterolemia and hypertriglyceridemia alone were observed in 8 and 15 patients respectively. Low density lipoprotein cholesterol (LDL-C) levels were elevated in 11 patients. Thirty six (36) patients had reduced levels of HDL-C only, with concomitant high levels of TC/HDL-C ratio. Combined hyperlipidemia was observed in only five patients. The results revealed that abnormal lipid profile pattern was higher in patients with CVD (68.60%) than in other cases. Conclusion : The results of the present study demonstrate that low HDL-C levels seemed to be more prevalent in this population. This report could contribute to the ongoing work on lipid research in Nigeria and the world at large.