Metabolic Disorders In Patients Research Articles

Случай сочетания синдрома Беквита–Видемана с синдромом Веста

Beckwith-Wiedemann syndrome (BWS) is etiologically connected with genetic/epigenetic growth dysregulation. The supposed localization of this disorder is a short arm of chromosome 11 (11p 15.5). Its prevalence is 1:13 per 700 newborns. West syndrome is an age-dependent epileptic syndrome related to a group of infantile epileptic encephalopathies and characterized by a triad of basic symptoms: series of infantile spasms, psychomotor retardation and severe paroxysmal EEG changes. The incidence of West syndrome is estimated at 1 case per 2,000-4,000 newborns. The article describes a rare clinical case: a combination of BWS with one of the types of infantile epileptic encephalopathies--West syndrome. A detailed analysis of the West syndrome progression in a female patient with BWS is given, the tactics of antiepileptic therapy is analyzed, and its complexity in terms of metabolic disorders caused by the presence of a genetic syndrome in a patient is shown. The results of a long catamnesis are described. The figures are the fragments of native electroencephalograms at the eruptive phase of West syndrome and against the background of a long-term remission. When describing the clinical case in detail, the authors actively discuss the obtained information and available literature data. The article also presents practical guidelines for the early detection of metabolic disorders in patients with infantile epileptic encephalopathies. In addition to anti-epileptic drugs, the authors propose to include a mandatory metabolic correction in the therapy complex for these patients.

The role of estrogen in adipose tissue metabolism: insights into glucose homeostasis regulation [Review

Adipose tissue is an organ with active endocrine function involved in the regulation of energy balance and glucose homeostasis via multiple metabolic signaling pathways targeting the brain, liver, skeletal muscle, pancreas, and other organs. There is increasing evidence demonstrating that the female sex hormone, estrogen, regulates adipose development and improves systemic glucose homeostasis in both males and females. The underlying mechanism linking estrogenic regulation in adipose tissue and systemic glucose metabolism has not been fully elucidated, but is thought to include interactions of estrogen receptor signaling events involving lipolytic and/or lipogenic enzyme activity, free fatty acid metabolism, and adipocytokine production. Thus, understanding the effects of estrogen replacement on adipose tissue biology and metabolism is important in determining the risk of developing obesity-related metabolic disorders in patients undergoing treatment for sex hormone deficiency. In this report, we review literature regarding the role of estrogens and their corresponding receptors in the control of adipose metabolism and glucose homeostasis in both rodents and humans. We also discuss the effects of selective estrogen receptor modulators on glucose metabolism.

Effect of metabolitotropic therapy on metabolic blood indices in patients with stage 2 essential hypertension associated with cardiac ischemia and type 2 diabetes mellitus with different genotypes of PPARγ2 gene

Objective — to study peculiarities of metabolic disorders in patients with stage 2 essential hypertension associated with cardiac ischemia and type 2 diabetes mellitus (DM2) depending on polymorphism of PPARγ2 gene and to examine the efficacy of their correction by means of Quercetin (Corvitin), a 5-lipoxygenase inhibitor, and Arginine hydrochloride (Tivortin), a NO donator, against the ground of basic therapy administration. Material and methods. The study included 62 patients with stage 2 essential hypertension of 1–3 degree associated with cardiac ischemia (effort angina of I–II functional class) and DM2. The efficacy of metabolitotropic therapy with administration of Quercetin (Corvitin) and Arginine hydrochloride (Tivortin) was examined on 35 patients depending on polymorphism of PPARγ2 gene. The indices of carbohydrate, lipid metabolism and oxidative-antioxidative system were investigated. Results. All the examined indices of metabolism, except glutathione peroxidase and catalase in patients with Pro/Pro genotypes, in the examined patients with stage 2 essential hypertension and DM2 with Pro/Pro and Pro/Ala genotypes of PPARγ2 gene differ from those of healthy individuals. Reliably higher (p<0,05) glucose levels on an empty stomach, immune reactive insulin, HOMA-IR index, triacylglycerols are found in patients with Pro/Pro genotype in comparison with Pro/Ala genotype. Availability of a protective Pro/Ala genotype of PPARγ2 gene in patients was associated with more considerable positive dynamics of metabolism after treatment with Corvitin and Tivortin administration in addition to the basic therapy. Conclusion. Reliably higher (p<0,05) glucose levels on an empty stomach, immune reactive insulin, HOMA-IR index, triacylglycerols, malone aldehyde of erythrocytes and lower levels (p<0,05) of glutathione peroxidase and catalase were found in patients with stage 2 essential hypertension associated with cardiac ischemia and type 2 diabetes mellitus with Pro/Pro genotype in comparison with Pro/Ala genotype. After metabolitotropic therapy with administration of Corvitin and Tivortin, a reliable improvement of metabolic homeostasis examined indices occurred, more considerably in patients with Pro/Ala genotype of PPARγ2 gene.

THE EFFECT OF THE HYPERLEPTINEMIA ON THE QUALITY OF LIFE OF HYPERTENSIVE PATIENTS WITH METABOLIC SYNDROME

Objective. To study interconnection between hyperleptinemia, the quality of life (QOL) and the severity of metabolic disorders in patients with essential hypertension with metabolic syndrome (MS). Design and methods.We have examined 46 patients with essential hypertension (blood pressure &lt; 180/110 mm Hg), accompanied by MS. Along with complete clinical, laboratory and instrumental examination, customary in a specialized cardiologic clinic, the QOL research was carried out using MOS SF-36questionnaire. Besides, the concentration of leptin in blood serum was determined.Results and conclusions. Patients with essential hypertension with hyperleptinemia show higher intensity of clinical and laboratory markers of MS, higher activity of the systemic inlammatory response and increased QOL. A statistically signiicant inverse correlation between serum leptin level and QOL scales (SF-36) was detected.

Cross-sectional study of multiple metabolic disorders in patients with essential hypertension and nonalcoholic fatty liver disease

Objective To investigate the incidence of non-alcoholic fatty liver disease (NAFLD) in essential hypertension patients and the relation between NAFLD and multiple metabolic disorders. Methods Cross-sectional study.Between January 2006 and July 2008,1109 inpatients in Beijing Anzhen hospital diagnosed with essential hypertension were enrolled into this study (542 femal,567 male,mean age 61±11).All patients had ultrasound screening for fatty liver.The prevalence of NAFLD,serum alanine aminotransferase abnormality ratio,the relationship between NAFLD and multiple metabolic abnormalitiesincluding glucose,dyslipidemia,hyperuricemia.471 cases of non-EH as a control group in the same period of admission (216 femal,255 male,mean age 62±10).The measurement data of two groups were compared with t test,while the count data were compared withχ2test.Multiple Logistic regression was used to analysis therisk factors of EH with NAFLD. Results Among 1109 recruited patients,37.3% (414/1109) had fatty liver by ultrasonography.EH patients were divided into NAFLD group and non-NAFLD group.In EH co-existed with NAFLD group,the prevalence of diabetes mellitus (21.0%∶10.8%),metabolic syndrome (59.4%∶44.7%),overweight (71.3%∶62.9%) and the levels of BMI (26.90±3.66∶26.35±3.56),TC (5.30±1.17∶5.12±1.09),TG (2.11±1.43∶1.85±1.33),ALT (45.18±37.62∶39.22±32.27) were significantly higher than those in the non-NAFLD group (P<0.05).HDL-C (1.53±0.53:1.62±0.54) was significantly lower than that in the non-NAFLD group (P<0.05).In non-NAFLD group,prevalence of overweight and the levels of BMI,TC,TG,ALT were significantly higher than those in non-EH group (P<0.01).By multivariable logistic regression analysis,diabetes mellitus, hypercholesteremia,hyperuricemia and BMI were risk factors in NAFLD patients with essential hypertension. Conclusion NAFLD was more prevalent in patients with EH complicated with multiple metabolic disorders,such as hyperlipemia and hyperuricemia.(Chin J Lab Med,2013,36:926-930) Key words: Hypertension; Fatty liver; Metabolic diseases

Secondary osteoporosis or secondary contributors to bone loss in fracture. Bone metabolic disorders in patients with diabetes mellitus

Several clinical studies including two meta-analyses revealed that patients with diabetes mellitus have an elevated fracture risk compared to non-diabetic subjects, suggesting that diabetes mellitus is a underlying illness for secondary osteoporosis. The fracture risk observed in these patients was higher than those expected by BMD, indicating that bone fragility in these patients may be caused by poor bone such as excessively glycated bone collagen, low bone turnover, thinner cortical thickness, and increased cortical porosity. Diabetic osteoporosis may be one of most common disease in secondary osteoporosis. Large scale observation and prevention studies for fracture are needed to establish diagnostic criterion and standard treatment for diabetic osteoporosis.

Diabetes in Friedreich Ataxia

Diabetes is a common metabolic disorder in patients with Friedreich ataxia. In this Supplement article, we review the clinical data on diabetes in Friedreich ataxia, and the experimental data from rodent and in vitro models of the disease. Increased body adiposity and insulin resistance are frequently present in Friedreich ataxia, but pancreatic β cell dysfunction and death are a conditio sine qua non for the loss of glucose tolerance and development of diabetes. The loss of frataxin function in mitochondria accounts for these pathogenic processes in Friedreich ataxia. Mitochondria are essential for the sensing of nutrients by the β cell and for the generation of signals that trigger and amplify insulin secretion, known as stimulus-secretion coupling. Moreover, in the intrinsic pathway of apoptosis, pro-apoptotic signals converge on mitochondria, resulting in mitochondrial Bax translocation, membrane permeabilization, cytochrome c release and caspase cleavage. How and at which level frataxin deficiency impacts on these processes in β cells is only partially understood. A better understanding of the molecular mechanisms mediating β cell demise in Friedreich ataxia will pave the way for new therapeutic approaches.

Technological challenges and strategies for developing low-protein/protein-free cereal foods for specific dietary management

Western countries are finding health care costs to be a continuously increasing financial burden in excess of previous budgetary allocations. With current health care costs accounting for greater than 15% of the national expenditure, governments are seeking innovative cost-limiting strategies. Medical nutrition therapy (MNT) has proven to be an efficient cost minimising tool whilst concurrently ameliorating the patient's quality of life. In the MNT approach, the incorporation of foodomics technologies in medical foods has a pivotal role regarding quality, safety, nutrition and health. These MNTs are defined as specially processed or formulated foods that are used for the dietary management of patients. Amongst the medical foods, low-protein/protein-free (LP/PF) foods have been shown to improve the physical manifestation of metabolic disorders in patients with amino acid or protein-related diseases, such as Phenylketonuria, Tyrosinaemia type I, as well as chronic kidney, and coeliac. Most of the cereal-based LP/PF foods currently marketed are a blend of refined or chemically-based food ingredients with unpalatable, frequently artificial flavours, having excessive sweetness to mask the chemical tasting ingredients (drug-like approach). However, the adoption of an alternative to convention, such as a food-like approach to developing medical foods, is a surprisingly complex process. This is specifically true when the technological aspects of LP/PF foods and, in particular, protein-free cereal foods are considered. The primary processing issues arise when trying to replace gluten in baked cereal products. This presents a significant technological challenge, as gluten is an essential structural network-building protein necessary for formulating high-quality baked goods. Additional considerations such as physical/chemical compatibility, product shelf life, appearance, and palatability determine the success and potential for commercialisation of these therapeutic foods. In this review, the suitable food technology strategies, in particular the foodomics research areas comprising genomics, proteomics, metabolomics and materiomics, for developing LP/PF cereal foods able to overcome the significant limitations of a food-like approach will be addressed.

Impact métabolique de la suppression androgénique dans le cancer de la prostate

Because of the low mortality rates associated with prostate cancer, treatments long-term adverse effects constitute an important parameter in the management of patients. In particular, androgen deprivation has been shown to be linked to several metabolic disorders which are already frequent in men after age 60, such as weight and fat gain, insulin resistance likely to evolve into diabetes, and dyslipidemia. So far no consensus guidelines have been published regarding the screening and treatment of metabolic disorders in men with prostate cancer. It is essential to detect and manage these metabolic disorders, all the more so as they seem to be associated with an increased aggressiveness of prostate cancer. Here we report the development of a new questionnaire, which might contribute to the systematic management, and potentially the screening and treatment or the prevention of these metabolic disorders in patients with prostate cancer. In accordance with recent reviews and on the basis of experience, our French board of experts also recommends systematic screening and selective treatment for diabetes, regular follow-up of fasting glucose rates, lipid profile and blood pressure in all patients under long-term androgen deprivation treatment, as well as lifestyle changes (practice of exercise, nutritional habits).

Diabetes mellitus and osteoporosis. Bone metabolic disorder in diabetic nephropathy

Life prognosis of hemodialysis patients with diabetes is remarkably bad compared with hemodialysis patients without diabetes. The major factor is existence of the specific bone metabolic disorder in patients with diabetes. Bone metabolic disorder is closely connected with vascular calcification, and it is thought that each disorder is induced by poor glycemic control. We will give an outline the influence which glycemic control has on bone metabolism and vascular calcification in hemodialysis patients with diabetes.

Functional Magnetic Resonance Imaging Analysis of Food-Related Brain Activity in Patients with Lipodystrophy Undergoing Leptin Replacement Therapy

Lipodystrophy is a disease characterized by a paucity of adipose tissue and low circulating concentrations of adipocyte-derived leptin. Leptin-replacement therapy improves eating and metabolic disorders in patients with lipodystrophy. The aim of the study was to clarify the pathogenic mechanism of eating disorders in lipodystrophic patients and the action mechanism of leptin on appetite regulation. We investigated food-related neural activity using functional magnetic resonance imaging in lipodystrophic patients with or without leptin replacement therapy and in healthy controls. We also measured the subjective feelings of appetite. Although there was little difference in the enhancement of neural activity by food stimuli between patients and controls under fasting, postprandial suppression of neural activity was insufficient in many regions of interest including amygdala, insula, nucleus accumbens, caudate, putamen, and globus pallidus in patients when compared with controls. Leptin treatment effectively suppressed postprandial neural activity in many of these regions of interest, whereas it showed little effect under fasting in patients. Consistent with these results, postprandial formation of satiety feeling was insufficient in patients when compared with controls, which was effectively reinforced by leptin treatment. This study demonstrated the insufficiency of postprandial suppression of food-related neural activity and formation of satiety feeling in lipodystrophic patients, which was effectively restored by leptin. The findings in this study emphasize the important pathological role of leptin in eating disorders in lipodystrophy and provide a clue to understanding the action mechanism of leptin in human, which may lead to development of novel strategies for prevention and treatment of obesity.

Management of dyslipidemia in CKD, dialysis and renal transplant recipient

Abstract Dyslipidemia is a well-established metabolic disorder in patients with chronic kidney diseases (CKD), on dialysis and renal transplant recipient. The elevated serum cholesterol levels have a definite role in the development and progression of atherosclerosis and the correlation between elevated serum LDL cholesterol as a risk factor for development of CHD has been firmly established. The HMG-CoA reductase inhibitors (statins) are the current drugs of choice for the treatment of hypercholesterolemia. The treatment with statins effectively lower total and LDL-cholesterol levels, moderately decreases triglycerides (TGs) levels, and have a little effect in increasing HDL-cholesterol levels. The statins therapy reduces the morbidity and mortality associated with CHD in patients with normal renal function. However, the beneficial effect of statin therapy on CVD morbidity and mortality in patients with CKD and advanced ESRD are controversial. Statin therapy reduces CVD mortality in patient with early CKD (not yet requiring dialysis) and their use is recommended for patients with early CKD. However, the recent results from the AURORA and SHARP studies have revealed statins treatment provide no CV mortality benefit in patient with advanced CKD or on long-term dialysis. This may be because athermatous coronary artery disease account for a small proportion of the CVD observed in patients with ESRD and/or on dialysis. In addition, advanced CKD result in structural and functional abnormalities of HDL, impaired cholesterol and chylomicron metabolism which leads to accelerated atherosclerosis and CVD in such patients. Collectively, these abnormalities are largely independent of cholesterol biosynthesis, and consequently are not corrected by statin therapy. Therefore lipid lowering therapy in patient with ESRD should be individualized. Atorvastatin and Rosuvastatin are most potent agents among the available statins in cholesterol lowering but are the most expensive. Simvastatin (20 mg/day) should be considered the drug of choice for most patients with chronic kidney disease because it is less expensive. Pravastatin and fluvastatin are the most suitable agents for transplant patients to achieve target cholesterol levels because of the reduced risk of drug interactions.

Quality of life and metabolic disorders in patients with obstructive sleep apnea

Quality of life (QoL) may be poor in patients with sleep apnea depending on multifactorial reasons. In this observational study, we examined the factors determining QoL in patients with obstructive sleep apnea (OSA) and nonapneic snoring subjects. Complete assessments were obtained on 111 subjects who diagnosed OSA and 18 nonapneic snoring subjects. Fasting blood samples of all of subjects were taken to determine insulin resistance (IR) and oral glucose tolerance tests were performed to diagnose disorders of glucose metabolism (DGM). Quality of life, with short form (SF)-36, and excessive daytime sleepiness, with epwort sleepness scale (ESS), were evaluated. The mean age of the patients with OSA was higher than that of the nonapneic snoring subjects (48.4 ± 9.6 years and 43.0 ± 11.8 years, respectively; p=0.03). BMI was also significantly higher in the patients with OSA than in the nonapneic snorers (31.0 ± 4.5 and 27.1 ± 4.0, respectively; p=0.001). The mental health component in the patients with OSA was slightly but not significantly lower than the nonapneic snoring subjects (p=0.05). A negative correlation among most domains of quality of life with scores of ESS, body mass index (BMI), presence of hypertension (HT) and DGM was found. Only physicial functioning was negatively correlated with apnea hypopnea index (AHI). In linear regression analysis, there were negative associations among physical functioning with BMI, presence of HT and DGM while there was no association between physicial functioning and AHI. In addition, there were negative correlations between mental health component with BMI and presence of HT in the multivariate analysis. Obese patients with OSA had lower physicial and mental components compared with nonobese patients with OSA. The impact of OSA on quality of life can be attributed to excessive daytime sleepiness. Obesity and metabolic disorders in patients with OSA may also negatively affect the quality of life.

Endocrine Metabolic Disorders in Patients with Breast Cancer, Carriers of BRCA1 Gene Mutations

Two groups of breast cancer patients (53±2 years) in clinical remission receiving no specific therapy were examined: group 1, with BRCA1 gene mutations (N=11) and group 2, without mutations of this kind (N=11). The two groups did not differ by insulinemia and glycemia, insulin resistance index, blood levels of thyrotropic hormone, sex hormone-binding globulin, insulin-like growth factor-1, triglycerides, or lipoproteins. In group 1, blood estradiol level was higher. Intensive glucose-induced generation of reactive oxygen species in these patients was associated with a decrease of cholesterolemia, of the C-peptide/insulin proportion, and a trend to higher urinary excretion of 4-hydroxyestrone, one of the most genotoxic catecholestrogens. BRCA1 gene mutations in breast cancer patients were associated with signs of estrogenization and a pro-genotoxic shift in the estrogen and glucose system, which could modulate the disease course and requires correction.

POLYMETABOLIC DISORDERS AFTER HYSTERECTOMY: A CHANCE OR A RULE?

Aim. To study the dynamic of metabolic disorders in patients after hysterectomy with intact ovaries. Material and methods. 104 women (aged 44.0±2.1) after hysterectomy with intact ovaries were examined. All patients were split into three subgroups according to time after hysterecto- my (1, 3, and 5 years). 25 women (aged 43.0±1.6) with normal menstrual function were included into the control group. Blood pressure (BP) levels and body mass index were measured. Serum lipids profile, plasma levels of immune-reactive insulin (IRI) and C-peptide were investigated in fasting condition and after oral glucose tolerance test. Results. Increase in time after hysterectomy was associated with significant elevation of body mass index, systolic and diastolic BP , basal and stimulated IRI and C-peptide levels, as well as serum levels of total cholesterol and low density lipoprotein cholesterol. These parameters had significant positive correlations with time after hysterectomy. Conclusion. Polymetabolic disorders were more prominent in patients with longer time after hysterectomy. These findings can be basis for definition of post-hysterectomy metabolic syndrome stages.

Goiter, cardiovascular and metabolic disorders in patients with acromegaly

This study evaluated the relationship between selected acromegaly complications such as IGF-1 serum concentrations at diagnosis as well as of controlled and uncontrolled disease. A total of 113 acromegaly patients were enrolled to the study and the duration of active and uncontrolled disease was evaluated as a crucial cause of selected complications. Goiter, diabetes, hypercholesterolemia, hypertriglycerydemia, hypertension and ischemic heart disease were diagnosed in 85(75.2 %), 23(20.3 %), 48(51.0 %), 15(13.3 %), 65(57.5 %) and 18(15.9%) patients, respectively. Prevalence of goiter and diabetes was significantly related to the duration of uncontrolled acromegaly (p<0.01) as well as to the prevalence of hypertension and ischaemic heart disease (p0.05). After three years, there was a significant risk of an acromegaly patient being diagnosed at least with one of the above mentioned diseases (p<0.05) and such risk became more significant after four years (p0.05) related to the prevalence of the already mentioned complications. The treatment of acromegaly patients should be geared towards fulfilling all criteria for controlled disease, thereby alleviating potential complications and decreasing mortality.

The METEOR study of diabetes and other metabolic disorders in patients with schizophrenia treated with antipsychotic drugs. I. Methodology

Patients with schizophrenia present a two- to three-fold higher prevalence of diabetes, of metabolic syndrome and of cardiovascular morbidity. The reason for this increased prevalence may involve intrinsic vulnerability, lifestyle factors and iatrogenic effects of antipsychotic drugs. The objective of this multinational, cross-sectional, pharmacoepidemiological study was to determine the prevalence of diabetes, lipid disorders, obesity, hypertension and the metabolic syndrome in patients with schizophrenia treated with antipsychotic drugs. Particular attention was taken to acquire data on a wide a range as possible of demographic, clinical and lifestyle variables that may influence the risk of metabolic disorders, which were taken into account in the calculation of prevalence data by propensity scoring. The study included 2270 subjects from 16 European countries, predominantly from Central and Eastern Europe. The proportion of subjects presenting the pathologies of interest was relatively high, ranging from 28% for glycaemic disorders to 70% for lipid disorders.

Metabolic disorders associated with chronic hepatitis C: impact of genotype and ethnicity

Patients with hepatitis C virus (HCV) infection, especially those with genotypes 1 and 4, have an increased risk of developing metabolic disorders. The aim of this study was to evaluate the associations among metabolic disorders, ethnicity and genotype in a large cohort of patients with chronic hepatitis C (CHC). All consecutive patients with CHC who were seen in our hepato-gastroenterology unit between January 2002 and September 2008 were included. Demographical data and variables related to the metabolic syndrome were collected. Insulin resistance was assessed using the homeostasis model for the assessment of insulin resistance test (HOMA-IR) test. Among the 454 CHC patients, the prevalence of the metabolic syndrome was 12.4%. The HOMA-IR test was performed in 140 patients, and 35.0% had insulin resistance. There were more Black Africans among the patients with genotypes 1/4 than among those with genotypes 2/3 (32.0 vs 1.2%, P<0.0001). Insulin resistance was more common in patients with genotypes 1/4 than in those with genotypes 2/3 (17 vs 1.7%, P=0.0001 and 43.3 vs 16.3%, P=0.001, respectively). Genotypes 1/4 were more frequently present in patients with insulin resistance than in those without insulin resistance (85.7 vs 60.5%, P=0.001). By logistic regression, genotypes 1/4 [odds ratio (OR)=2.79; 95% confidence interval (CI): 1.09-7.12, P=0.032] and older age (OR=1.03; 95% CI: 1.004-1.06, P=0.024) were independently associated with the presence of insulin resistance. In CHC, insulin resistance is independently associated with the presence of genotypes 1/4. Ethnicity is not independently associated with metabolic disorders in patients with CHC.

Insulin resistance in chronic kidney disease: its clinical characteristics and prognosis significance

Insulin resistance (IR) increases significantly the risk for cardiovascular disease (CV) in the general population. IR is a common metabolic disorder in patients with chronic kidney disease (CKD). However, the influence of IR on the evolution of CKD patients has scarcely been studied. This study aims to determine whether IR is associated with the progression of CKD, the development of new CV events, or all-cause mortality of non-diabetic patients with CKD stage 4 or 5 not yet on dialysis. The study group consisted of 365 non-diabetic patients (63 ± 16 year, 169 females) with GFR < 30 ml/min. The degree of IR was estimated by the Homeostasis Model Assessment parameter (HOMA). The outcome measures were: progression of CKD (composite of initiation of dialysis or doubling of baseline serum creatinine level), new cardiovascular events, and all-cause mortality. Unadjusted and multivariable-adjusted relative risks were calculated for HOMA either as a continuous or qualitative variable (tertiles), using Cox proportional hazards models. Mean HOMA value (± SD) was 4.28 ± 2.07. HOMA values correlated significantly with body mass index (beta = 0.37; p < 0.0001), plasma triglycerides (beta = 0.22; p < 0.0001), plasma albumin (beta = 0.19; p = 0.007), and serum phosphate (beta = 0.17; p = 0.031). Progression of CKD was observed in 234 patients (64%) with a median follow-up of 542 days. Patients with HOMA values in the lower tertile (< 3.13) showed a slower progression of CKD than that of the rest of study patients (log rank 4.16, p < 0.05). In adjusted models for age, sex, baseline GFR, body mass index, and proteinuria, HOMA values in the lower tertile entered as an independent variable in the best predictive equation for progression of CKD (HR 0.72, p < 0.03). Fifty-one patients developed a new CV event and 103 patients died during the study period (median follow-up of 1,103 days). HOMA did not relate to the development of new CV events or all-cause mortality in unadjusted or adjusted models for age, sex, comorbid index, plasma albumin, and C-reactive protein. In conclusion, progression of renal disease was slower in those non-diabetic CKD patients with low HOMA values; however, HOMA values did not relate to the development of new CV events or all-cause mortality.

006 Admission glycemia in acute myocardial infarction: incremental prognostic value for mortality over GRACE risk score and left ventricular ejection fraction. Data from the RICO survey

High blood glucose (HBG) on admission is a major common metabolic disorder in patients with acute myocardial infarction (MI) and is associated with worse prognosis. However, only few data have examined its predictive performance over established risk score. From a French regional survey for acute MI, we analyzed the relationship between HBG, as defined by admission glycemia >11 mmol/L, and 1 year mortality in patients with acute MI. All multivariate Cox models were adjusted for the Global Registry of Acute Coronary Events (GRACE) risk score, which is a validated 9 variables prediction tool, and left ventricular ejection fraction as assessed by echocardiography <3 days after admission. The additional prognostic information of HBG was tested by comparing the –2log likelihood of the Cox models with vs without HBG (χ 2 ). In the study population (n=3358), both admission glycemia as a continuous variable and HBG were univariately associated with increased mortality (HR(95%CI: 1.06(1.05-1.07) and 2.67(2.17-3.29), respectively). The addition of either admission glycemia as a continuous variable (HR(95%CI): 1.04(1.01-1.06) or of HBG (HR(95%CI): 1.61(1.28-2.03)) significantly improved the risk prediction in the multivariate model (χ 2 : p<0.001). However, in diabetic patients (n=756), HBG failed to independently predict mortality (HR(95%CI):1.17(0.80-1.71)). In contrast, in non diabetic patients (n=2592), HBG remained an independent predictor of death (HR(95%CI): 1.93(1.39-2.67)) and added incremental prognostic value in the model over the GRACE risk score and LVEF (χ 2 : p<0.001). High blood glucose on admission provides incremental prognostic information over established risk score and LVEF, in particular in non diabetic patients. Admission glycemia is not an independent predictive marker in diabetic patients.