Risk Factors For Disease In Patients Research Articles

A2.2 Uveitis is not associated with cardiovascular disease risk factors in patients with ankylosing spondylitis

Background and ObjectivesAnkylosing spondylitis (AS) is a chronic, autoimmune, systemic, inflammatory disease. Recently, a link has been established between autoimmune inflammatory diseases, incl. AS, and the risk of developing cardiovascular...

Associations of oxidative stress status parameters with traditional cardiovascular disease risk factors in patients with schizophrenia

Background. The purpose of this study was to assess oxidative stress status parameters and their possible associations with traditional cardiovascular risk factors in patients with schizophrenia, as well as their potential for patient-control discrimination. Methods. Fasting glucose, lipid profile and oxidative stress status parameters were assessed in 30 schizophrenic patients with atypical antipsychotic therapy and 60 control subjects. Results. Malondialdehyde (MDA), pro-oxidant/antioxidant balance (PAB) and total anti-oxidant status (TAS) were significantly higher whereas total sulfhydryl (SH) groups were significantly lower in schizophrenic patients vs. control group. Higher serum PAB values showed an independent association with schizophrenia. The addition of PAB to conventional risk factors improved discrimination between healthy control subjects and patients. Conclusion. Increased oxidative stress and changed lipid profile parameters are associated in schizophrenic patients and may indicate risk for atherosclerosis. The serum PAB level may reflect the levels of oxidative stress in schizophrenia and improve discrimination of patients from controls.

A Pilot Study on Effects of Thai Orange Juice on Oxidative Stress, Neutrophil Function and Cardiovascular Disease Risk Factors in Patients with Type 2 Diabetes

This study aimed to investigate the effects of orange juice on oxidative stress, neutrophil functions and cardiovascular disease risk factors in patients with type 2 diabetes. Fifteen patients with type 2 diabetes with haemoglobin A1c = 8.5% ingested 500 ml of orange juice every day for 4 weeks. Only plasma vitamin C was significantly increased (0.783 ± 0.09 vs 0.844 ± 0.09 mg/dL, p <0.05) and superoxide dismutase was tended to increase (46.8 ± 1.44 vs 48 ± 1.45 U/mL, p =0.06) after the orange juice intake. The slope of correlation between phagocytic activities and percentages of oxidative burst in patients who had taken orange juice was higher than before the ingestion. The findings suggest that the ingestion of orange juice increased vitamin C although it did not change the level of oxidant, neutrophil function and cardiovascular disease risk factors in patients with type 2 diabetes. This is a pilot study which needs to be further investigated.

Quantifying cardiovascular disease risk factors in patients with psoriasis: a meta-analysis

In a previous meta-analysis on categorical data we found an association between psoriasis and cardiovascular disease and associated risk factors. To quantify the level of cardiovascular disease risk factors in order to provide additional data for the clinical management of the increased risk. This was a meta-analysis of observational studies with continuous outcome using random-effects statistics. A systematic search of studies published before 25 October 2012 was conducted using the databases Medline, EMBASE, International Pharmaceutical Abstracts, PASCAL and BIOSIS. We included 59 studies with up to 18 666 cases and 50 724 controls. Psoriasis cases had a higher total cholesterol [weighted mean difference 8·83 mg dL(-1) , 95% confidence interval (CI) 2·94-14·72, P = 0·003 (= 0·23 mmol L(-1) )], higher low-density lipoprotein cholesterol [9·90 mg dL(-1) , 95% CI 1·56-18·20, P = 0·020 (= 0·25 mmol L(-1) )], higher triglyceride [16·32 mg dL(-1) , 95% CI 12·02-20·63, P < 0·001 (= 0·18 mmol L(-1) )], a higher systolic blood pressure (4·77 mmHg, 95% CI 1·62-7·92, P = 0·003), a higher diastolic blood pressure (2·99 mmHg, 95% CI 0·60-5·38, P = 0·014), higher body mass idex (0·73 kg m(-2) , 95% CI 0·37-1·09, P < 0·001), higher waist circumference (3·61 cm, 95% CI 2·12-5·10, P < 0·001), higher fasting glucose [3·52 mg dL(-1) , 95% CI 0·64-6·41, P = 0·017 (= 0·20 mmol L(-1) )], higher nonfasting glucose [11·70 mg dL(-1) , 95% CI 11·24-12·15, P < 0·001 (= 0·65 mmol L(-1) )] and a higher HbA1c [1·09 mmol mol(-1) , 95% CI 0·87-1·31, P < 0·001 (= 2·2%)]. From a preventive medicine perspective, the weighted mean differences between cases and controls are significant, and therefore relevant to the clinical management of patients with psoriasis.

Cardiovascular disease risk factors in patients with non-alcoholic fatty liver disease

Clinical, epidemiological and biochemical studies strongly support the concept that the non-alcoholic fatty liver disease is a hepatic manifestation of the metabolic syndrome. Insulin resistance is a common factor connecting obesity, diabetes, hypertension and dyslipidemia with fatty liver and the progression of hepatic disease to steatohepatitis, fibrosis, cirrhosis and hepatocellular carcinoma. Since identification of cardiovascular risk factors is the first step in their prevention, the aim of this study was to analyze the prevalence of some risk factors in patients with fatty liver. The study included 130 patients who met metabolic syndrome criteria; their demographic and anthropometric characteristics were analyzed and some clinical characteristics were determined, such as smoking habit, arterial pressure and alcohol intake. Routine biochemical analyses were carried out by a standard laboratory procedure. Hepatic steatosis was detected by the abdominal ultrasound. Modified criteria of the National Cholesterol Education Program Adult Treatment Panel III were used to describe the metabolic syndrome. The study group consisted of 72 subjects (55.38%), who had been found by ultrasound to have fatty liver, whereas the control group included 58 respondents (44.62%) without pathological ultrasound findings. Differences in the number of fatty liver were highly statistically significant between the groups. The values of body mass index (33.56 +/- 6.05 vs 30.56 +/- 4.23 kg/m2; p = 0.001), glucose (6.23 +/- 0.95 vs 5.76 +/- 0.88 mmol/l; p < 0.01) and cholesterol (6.66 +/- 1.30 vs 6.23 +/- 0.95; p < 0.05) were significantly higher in the patients with fatty liver than in those without fatty liver. Our results indicate that the patients from the study group had a high percentage of cardiovascular risk factors.

Distributions of ischemic heart disease risk factors in patients who were admitted for angioplasty in Iran

The aim of this study was to study the prevalence of different risk factors of coronary artery disease (CAD) in Patients who were admitted for angioplasty. Methods: A cross-sectional study was conducted on 333 patients who were admitted with diagnosis as a CAD and candidates for angioplasty in Imam Khomeini hospital, Ahvaz city, Iran 2011. The prevalence of different risk factors was determined using descriptive statistics. Results: The prevalence of CAD risk factors in overall subjects were: 1) 45.3% hypertension (considering >140/90 mmHg); 2) 34.5% high cholesterol (>240 mg/dl); 3) 27.6% diabetic mellitus (>126 mg/dL); 4) family history of heart disease: 20.7%; 5) smokers: 19.9%. Conclusion: This data have shown the prevalence of IHD (Ischemic Heart Disease) risk factors specially about hypertension in patients with IHD was high, so could require urgent decision making to national control program of non-communicable diseases in Iran.

Association Between Resistin Level and Renal Function in Patients Undergoing Coronary Artery Bypass Graft Surgery

AimThe purpose of this study was to evaluate the association between resistin levels and renal function in patients undergoing coronary artery bypass graft (CABG) surgery.MethodsThirty-seven consecutive patients (mean ± SD,...

Reciprocal ST segment changes in acute inferior myocardial infarction: Clinical, hemodynamic and angiographic implications

To investigate the clinical significance of reciprocal ST segment depression on the presenting electrocardiogram in patients with acute inferior myocardial infarction. Design and setting: A prospective, randomized, controlled single center study done in the critical care department, Cairo university Hospital. Forty consecutive patients with acute inferior myocardial infarction were enrolled in this study divided into two groups, 20 patients with reciprocal ST depression (group 1) and 20 patients without such depression (group 2). Interventions: All patients were investigated with serial ECG, cardiac biomarkers, echocardiography and coronary angiography. There was no significant difference in the proportion of coronary disease risk factors in patients in group 1, versus those in group 2. Patients in group 1 had significant higher degree ST elevation (in inf. Leads) than patients in group 2, higher levels of peak total CPK and CKMB was also seen. In addition patients in group 1 developed complication more frequently than those in group 2. Although no statistically significant difference between the two groups was seen as regard the ejection fraction sought by echocardiography, it did show a higher incidence of mitral regurge in group 1 [14 (70%)] versus 6 (30%) in group 2 with P value of 0.01. In group 1 left anterior descending artery lesions was significantly more frequent than in group 2 with P value < 0.001, also multivessel disease was significantly more frequent in group 1. The significance of reciprocal ST depression on the electrocardiogram during the course of inferior MI remains uncertain, opinion is divided as to whether it is a benign electrical phenomenon or a sign of a greater myocardial necrosis and more frequent left coronary artery disease, from our study we support the latter opinion. This simple ECG finding may be used to differentiate high risk patients for a more aggressive approach.

Number of Coronary Heart Disease Risk Factors and Mortality in Patients With First Myocardial Infarction

Few studies have examined the association between the number of coronary heart disease risk factors and outcomes of acute myocardial infarction in community practice. To determine the association between the number of coronary heart disease risk factors in patients with first myocardial infarction and hospital mortality. Observational study from the National Registry of Myocardial Infarction, 1994-2006. We examined the presence and absence of 5 major traditional coronary heart disease risk factors (hypertension, smoking, dyslipidemia, diabetes, and family history of coronary heart disease) and hospital mortality among 542,008 patients with first myocardial infarction and without prior cardiovascular disease. All-cause in-hospital mortality. A majority (85.6%) of patients who presented with initial myocardial infarction had at least 1 of the 5 coronary heart disease risk factors, and 14.4% had none of the 5 risk factors. Age varied inversely with the number of coronary heart disease risk factors, from a mean age of 71.5 years with 0 risk factors to 56.7 years with 5 risk factors (P for trend < .001). The total number of in-hospital deaths for all causes was 50,788. Unadjusted in-hospital mortality rates were 14.9%, 10.9%, 7.9%, 5.3%, 4.2%, and 3.6% for patients with 0, 1, 2, 3, 4, and 5 risk factors, respectively. After adjusting for age and other clinical factors, there was an inverse association between the number of coronary heart disease risk factors and hospital mortality adjusted odds ratio (1.54; 95% CI, 1.23-1.94) among individuals with 0 vs 5 risk factors. This association was consistent among several age strata and important patient subgroups. Among patients with incident acute myocardial infarction without prior cardiovascular disease, in-hospital mortality was inversely related to the number of coronary heart disease risk factors.

Exercise Training and Reduction of Cardiovascular Disease Risk Factors in Patients With Chronic Kidney Disease

Observational studies have reported a significant inverse association between physical function/aerobic capacity and mortality in patients with CKD. Several randomized controlled trials have provided evidence of a cardioprotective effect of exercise training via multiple mechanisms, which may result in a reduction of cardiovascular disease risk factors in patients with CKD. This review focuses on the available evidence for the role of exercise training in the reduction of cardiovascular disease risk factors as classified into antiatherosclerotic, anti-ischemic, antiarrhythmic, and antithrombotic protective effects. Preliminary evidence, primarily from studies in patients requiring hemodialysis, suggests that exercise training improves arterial compliance, cardiac autonomic control, and left ventricular systolic function while decreasing inflammation, oxidative stress, and blood pressure levels. It is concluded that these studies have provided preliminary evidence that exercise training may result in a reduction of cardiovascular disease risk factors. The available evidence supports the use of therapeutic exercise training as an adjunct component of a comprehensive treatment program for patients with CKD. However, it is clear that much additional research is required to confirm the apparent, multiple, cardioprotective effects of exercise training and to identify additional mechanisms, especially in patients with predialysis CKD.

Beyond Cholesterol Lowering: Pleiotropic Effects of Bile Acid Binding Resins Against Cardiovascular Disease Risk Factors in Patients with Metabolic Syndrome

Prospective epidemiologic studies have shown that dyslipidemia and hyperglycemia are major risk factors for atherosclerotic cardiovascular diseases. Undesirable metabolic conditions are observed to coexist in patients with metabolic syndrome, which is an important risk factor for cardiovascular disease. To prevent cardiovascular disease, a pleiotropic agent is needed to improve the metabolic disorder in patients with metabolic syndrome. Bile acid binding resins increase the fecal excretion of bile acids. The decrease in bile acids returned to the liver leads to an up-regulation of hepatic low-density lipoprotein (LDL) receptor activity, which decreases LDL cholesterol (LDL-C) in the circulation and increases high-density lipoprotein cholesterol. On the other hand, bile acids can also regulate the transcription of genes involved in LDL-C synthesis and cholesterol homeostasis via nuclear hormone receptors. Consequently, these receptors may represent novel therapeutic targets for dyslipidemia and provide insight into the role of the bile acid pathway in other metabolic processes. This review focuses on the recent findings on bile acid binding resins and cardiovascular disease risk factors. Moreover, known and proposed mechanisms of how bile acid binding resins may improve glucose and energy metabolism are discussed; these effects may help to explain the mechanisms by which bile acid binding resins may reduce cardiovascular disease.

Coronary artery disease risk factors in patients with schizophrenia: effects of short term antipsychotic treatment

The aim of the present study was to investigate serum paraoxonase/arylesterase activities and oxidation/oxidizability of apolipoprotein B-containing lipoproteins and several coronary artery disease risk factors, including homocysteine, high sensitive C-reactive protein, tumour necrosis factor-alpha, leptin and adiponectin in patients with schizophrenia. Oxidation of lipoproteins plays an important role in atherogenesis, and the enzyme paraoxonase has been shown to prevent lipoprotein oxidation. Furthermore, low paraoxonase activity has been suggested to predict coronary artery disease. Forty patients who fully met the fourth Diagnostic and Statistical Manual of Mental Disorders criteria for schizophrenia and 35 healthy control subjects were included in the study. Serum paraoxonase/arylesterase activities were determined spectrophotometrically. Malondialdehyde levels of apolipoprotein B-containing lipoproteins were determined before and after incubation with copper-sulphate, which yielded basal- and Delta-malondialdehyde values, respectively. Homocysteine and highly sensitive C-reactive protein levels were determined using a fluorescence-polarization immunoassay and immunonephelometry, respectively. Leptin and adiponectin levels were measured with radioimmunoassay and tumour necrosis factor-alpha was determined by enzyme linked immunosorbent assay. Serum paraoxonase and arylesterase activities were significantly lower and Delta-malondialdehyde levels were significantly higher in the schizophrenia group compared with the control group. However, there were not any significant differences in other parameters of the study between the study groups. There was a significant increase in body mass index and serum triglyceride and very low density lipoprotein cholesterol levels in the schizophrenic group after 6 weeks of treatment. These parameters were significantly increased in patients treated with atypical antipsychotics but not in patients treated with typic or long acting antipsychotics. The results of the present study suggest that patients with schizophrenia might have increased risk for coronary artery disease related to reduced serum paraoxonase activity and increased oxidizability of apolipoprotein B-containing lipoproteins.

Impact of Simultaneous Pancreas and Kidney Transplantation on Cardiovascular Risk Factors in Patients With Type 1 Diabetes Mellitus

We retrospectively investigated the impact of pancreas transplantation on cardiovascular disease risk factors in patients with type 1 diabetic end-stage renal disease (ESRD). Two cohorts of patients, 44 simultaneous pancreas and kidney transplant patients (SPK) and 30 kidney transplant-alone patients (KTA), were included. Univariate and multivariate analyses were performed. Compared with KTA patients, SPK patients had significantly lower mean arterial pressure (88.5+/-12.7 vs. 98.2+/-13.0 mmHg, P=0.002), lower pulse pressure (51.6+/-15.1 vs. 61.4+/-15.6 mmHg, P=0.008), lower low-density lipoprotein cholesterol (83.5+/-20.6 vs. 99.2+/-32.5 mg/dl, P=0.02), and required fewer lipid-lowering medications (31.8% vs. 60.0%, P=0.02). Compared with pretransplant values, only SPK patients showed significant improvement in both blood pressure and total cholesterol. We conclude that SPK significantly improves blood pressure and dyslipidemia compared with KTA in type 1 diabetic ESRD patients.

Association Between Carotid Artery Intima-Media Thickness and Early-Stage CKD in a Chinese Population

Increased carotid artery intima-media thickness (IMT) predicts future vascular events in the general population. However, the relationship between IMT and chronic kidney disease (CKD) seldom was tested in subjects with early-stage CKD. Cross-sectional study. 1,046 residents in 1 district of Beijing participated in the study. Carotid artery IMT was measured by means of high-resolution B-mode ultrasonography. Estimated glomerular filtration rate (eGFR) was calculated using the modified Modification of Diet in Renal Disease Study equation based on data for Chinese patients with CKD. Albuminuria was evaluated by means of urinary albumin-creatinine ratio on a morning spot urine sample. Compared with subjects with eGFR greater than 90 mL/min/1.73 m(2) (>1.50 mL/s/1.73 m(2)), subjects with eGFR of 60 to 89 mL/min/1.73 m(2) (1.00 to 1.49 mL/s/1.73 m(2)) and 30 to 59 mL/min/1.73 m(2) (0.50 to 0.99 mL/s/1.73 m(2)) had higher mean IMT (0.74 +/- 0.27 versus 0.82 +/- 0.30 versus 0.94 +/- 0.38 mm; P < 0.001). IMTs of subjects with albuminuria tended to be higher than the mean value (0.79 +/- 0.29 versus 0.93 +/- 0.38 mm; P < 0.001). eGFR and urinary albumin-creatinine ratio significantly correlated with IMT in univariable analysis, but not after adjusting for traditional cardiovascular disease risk factors. Selection bias and low prevalence of CKD might affect the strength of the study. In this Chinese population older than 40 years, carotid artery IMT was significantly higher in subjects with early-stage CKD. The greater prevalence of cardiovascular disease risk factors in patients with CKD appeared to account for the higher carotid artery IMT.

Effects of tumor necrosis factor blockade on cardiovascular risk factors in psoriatic arthritis: A double‐blind, placebo‐controlled study

To conduct a robust, double-blind, placebo-controlled study examining the effects of tumor necrosis factor (TNF) modulation on concentrations of traditional and novel cardiovascular disease risk factors in patients with an inflammatory condition. In this double-blind study, 127 patients with psoriatic arthritis (PsA) and active psoriasis were randomized to 1 of 3 treatment arms (placebo, onercept 50 mg, or onercept 100 mg for 12 weeks). Traditional and novel biochemical risk factors were evaluated at baseline and at the end of the treatment period. At baseline, an elevated C-reactive protein (CRP) level correlated positively with lipoprotein(a) (Lp[a]), intercellular adhesion molecule 1, interleukin-6, and homocysteine levels but was inversely correlated with concentrations of all other lipid moieties and sex hormone binding globulin (SHBG). Onercept at a dose of 100 mg induced significant (P < or = 0.002) reductions in the levels of CRP (-14.0 versus 6.5 mg/liter with placebo), Lp(a) (-3.11 versus 1.52 mg/dl with placebo), and homocysteine (-1.72 versus 0.34 mumoles/liter with placebo) and an increase in the SHBG concentration (4.3 versus -1.3 mmoles/liter with placebo). The 100-mg dose of onercept was also associated with significant (P < 0.05) increases in the level of circulating apolipoprotein AI (Apo A-I) (4.0 versus -5.6 mg/dl with placebo); however, levels of Apo B (6.3 versus -0.4 mg/dl with placebo) and triglycerides (0.09 versus 0.04 mmoles/liter) were also increased. This study is the first to demonstrate that targeting the TNF pathway can significantly decrease Lp(a) and homocysteine levels and elevate Apo A-I and SHBG concentrations. These data support an important precursor role for high-grade inflammation in modulating these putative risk parameters. However, TNF blockade-induced increases in triglyceride and Apo B levels were unexpected and suggest that it is not possible, on the basis of biochemical changes in isolation, to suggest that cardioprotection would necessarily follow; rather, direct measures of atherosclerotic progression with TNF blockade (e.g., using carotid ultrasound) would be better.

Effects of a Short-Term Lifestyle Intervention on Myocardial Function in Patients with Type II Diabetes

Long-term lifestyle interventions improve insulin sensitivity and cardiovascular disease risk factors in patients with type II diabetes. Furthermore, pharmaceutical interventions targeting insulin sensitivity have shown improvements in myocardial function in these patients. PURPOSE: To investigate the effects of a short-term (4-week) lifestyle intervention on myocardial function in patients with type II diabetes. METHODS: Patients with type II diabetes were randomised into a control group (n = 85) or a lifestyle intervention group (n = 84). The lifestyle intervention consisted of two one-hour supervised exercise training sessions/week and a session with a dietician. The training sessions contained cardiorespiratory and resistance exercises individualised for each patient. Insulin sensitivity (QUICKI), glycemic control (HbA1 c), VO2max and myocardial function (left ventricular tissue velocity, strain and strain rate) were assessed before and after the intervention. RESULTS: There was a significant (p < 0.05) improvement in VO2max from pre-post between intervention and control group. Myocardial strain and insulin sensitivity were preserved in the lifestyle intervention group (p < 0.05). Bivariate analyses showed that changes in myocardial strain negatively correlated with changes in HbA1c (r = − 0.225, p = 0.020), fasting plasma glucose (r = − 0.200, p = 0.034) and positively correlated with changes in QUICKI (r = 0.353, p = 0.015), diastolic ventricular tissue velocity (r = 0.228, p = 0.015) and treatment group (r = 0.188, p = 0.046). Changes in QUICKI positively correlated with changes in VO2max (r = 0.298, p = 0.011) and negatively with changes in BMI (r = − 0.482, p < 0.001). Multiple regression analysis showed lifestyle intervention was an independent predictor of myocardial strain (? = 0.455, p = 0.008) and accounts for 20% of improvement in this myocardial function measure. CONCLUSIONS: A four-week lifestyle intervention improved exercise capacity and preserved myocardial function and insulin sensitivity in patients with type 2 diabetes. Improvements in myocardial function were associated with improvements in glycemic control and treatment group. Improvements in insulin sensitivity were correlated with improvements in body composition and exercise capacity. Furthermore, the short-term improvements in myocardial function were independently predicted by lifestyle intervention.

The spectrum of cardiovascular disease in children with predialysis chronic kidney disease

Cardiovascular disease is the major cause of mortality in adults and children on chronic dialysis and in adults after kidney transplantation. Cardiovascular disease burden and cardiovascular mortality are high in adults with chronic kidney disease. The early development of cardiovascular disease risk factors, some of which are modifiable, largely explain this phenomenon. Limited data are available on the prevalence of chronic kidney disease in children, the prevalence of cardiovascular disease in children with chronic kidney disease, and the prevalence of cardiovascular disease risk factors in these patients. This article summarizes the current knowledge of the prevalence of cardiovascular disease and of cardiovascular disease risk factors in pediatric patients with predialysis chronic kidney disease. Long-term prospective studies are needed to determine the impact of early identification and treatment of cardiovascular disease and its risk factors on the natural history of cardiovascular disease in children with chronic kidney disease.

Effect of metformin treatment on multiple cardiovascular disease risk factors in patients with type 2 diabetes mellitus

In light of the conflicting results of the recent United Kingdom Prospective Study (UKPDS), where diabetic patients on metformin monotherapy had lower all-cause mortality and the addition of metformin in sulfonylurea-treated patients was associated with an increased risk of diabetes-related death, we sought to compare the effects on cardiovascular disease (CVD) risk factors of metformin monotherapy with metformin treatment when added to a sulfonylurea compound in patients with type 2 diabetes. Thirty-one volunteers with type 2 diabetes mellitus, 16 on dietary therapy and 15 on sulfonylurea monotherapy (SU), were treated with metformin for 12 weeks. Measurements were made of (1) fasting plasma glucose, hemoglobin A 1c (HbA 1c), lipid, remnant lipoprotein cholesterol (RLP-C) levels, and low-density lipoprotein (LDL) particle size; (2) daylong plasma glucose, insulin, free fatty acid (FFA), triglyceride (TG), and RLP-C concentrations; and (3) fasting levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), and soluble E-selectin (sE-selectin). Fasting plasma glucose concentrations decreased to a similar degree after treatment with metformin in both the metformin monotherapy group (12.45 ± 0.48 v 9.46 ± 0.47 mmol/L, P < .001) and the combined SU and metformin therapy group (14.09 ± 0.51 v 10.57 ± 0.85 mmol/L, P = .001). Fasting plasma lipid concentrations and LDL particle size did not significantly change in either treatment group, whereas fasting RLP-C concentrations were significantly lower in the metformin monotherapy group (0.43 ± 0.09 v 0.34 ± 0.07 mmol/L, P = .02). Daylong concentrations of plasma glucose, FFA, TG, and RLP-C were lower to a similar degree in both treatment groups, whereas daylong plasma insulin concentrations were unchanged. Fasting plasma sVCAM-1 levels were significantly lower in both the metformin monotherapy group (484 ± 19 v 446 ± 18 ng/mL, P = .02) and the combined SU and metformin therapy group (496 ± 29 v 456 ± 31 ng/mL, P = .05), whereas fasting plasma sICAM-1 and sE-selectin levels were essentially unchanged. Administration of metformin, either as monotherapy or in combination with a sulfonylurea drug, improved glycemic control and led to a decrease in several CVD risk factors in patients with type 2 diabetes.

Association of C-reactive protein with coronary heart disease risk factors in patients with type 2 diabetes mellitus

The assessment of markers of systemic inflammation, such as C-reactive protein (CRP) and interleukin 6 (IL6), could be used to identify persons at high risk of coronary heart disease (CHD). This study evaluates the relationship of CRP and IL6 with CHD risk factors in patients with type 2 diabetes mellitus (DM) with CHD and age and sex matched type 2 DM controls without CHD. CRP, IL-6, total plasma homocysteine (tHcy), lipoprotein (a) [Lp(a)] and sialic acid (SA) were determined in 55 type 2 diabetic patients with CHD and 51 age- and sex-matched type 2 diabetic controls without CHD. Multivariate and logistic regression analyses were used to relate these markers with CHD risk factors. CRP (P=0.02) and tHcy (P=0.03) were significantly higher in patients with CHD compared with the control group even after correction for age and sex. IL6, Lp(a), SA and lipid parameters were not significantly different between the two groups of patients. After adjustment for potential confounders, the odds ratio (OR) for elevated CRP was 2.00 (95% confidence interval [CI], 1.12–3.58) (P=0.02) but the OR for IL6 was 3.41 95% CI, 0.70–17.17 (P=0.14). Partial correlation analyses of CRP and IL6 with other variables showed significant correlation of CRP with tHcy, and SA in patients with CHD only. Our results support the inclusion of CRP (high-sensitivity assay), in the risk assessment of diabetic subjects.

Effective and safe modification of multiple atherosclerotic risk factors in patients with peripheral arterial disease

Background Patients with peripheral arterial disease (PAD) are at an increased risk of cardiovascular mortality and morbidity and thus are an excellent group in whom to evaluate the feasibility and the effect of an aggressive multifactorial intervention on atherosclerotic vascular disease risk factors. The Arterial Disease Multiple Intervention Trial (ADMIT) was designed to determine the efficacy, safety, and compliance of an multifactorial therapy on selected atherosclerotic disease risk factors in patients with PAD. Methods By a 2 × 2 × 2 factorial design, eligible participants (N = 468) were randomly assigned to low-dose warfarin, antioxidant vitamins, and niacin or its corresponding placebo, and followed up for 1 year. All participants were encouraged to use aspirin. Pravastatin was added to the drug regimen for those who needed to reduce LDL cholesterol to recommended levels. Results Niacin increased HDL cholesterol levels by 30%, with the majority of effect achieved at a dosage of 500 mg twice daily. Warfarin had an anticoagulant effect. The antioxidant vitamins resulted in a significant increase in vitamin E, C, and beta-carotene plasma levels. Overall, compliance was high and few adverse effects were reported. Conclusions ADMIT demonstrates that it is both feasible and safe to modify multiple atherosclerotic disease risk factors effectively with intensive combination therapy in patients with PAD. (Am Heart J 2000;140:792-803.)