Nonatherosclerotic Cardiovascular Disease Research Articles

Nailfold videocapillaroscopy as a non-invasive tool for the assessment of peripheral microangiopathy in cardiovascular diseases.

Cardiovascular disease (CVD) remains the main cause of morbidity and mortality worldwide. Accumulating evidence supports the presence of endothelial and microvascular dysfunction in CVD, which can be assessed using several methods in peripheral organs and tissues. Naifold videocapillaroscopy (NVC) is an established, noninvasive, easily applicable technique for the assessment of peripheral microcirculation. There is limited capillaroscopic data in the field of CVD, though, and the diagnostic or possible prognostic significance of the capillaroscopic alterations in this population is still a matter of research. This review aims to summarize the current knowledge on the capillaroscopic findings in patients with cardiovascular risk factors or established atherosclerotic and nonatherosclerotic CVD, focusing on the possible correlations of these alterations with clinical and laboratory markers of cardiac function.

Risk of Cancer After Diagnosis ofCardiovascular Disease.

Cardiovascular disease (CVD) and cancer share several risk factors. Although preclinical models show that various types of CVD can accelerate cancer progression, clinical studies have not determined the impact of atherosclerosis on cancer risk. The objective of this study was to determine whether CVD, especially atherosclerotic CVD, is independently associated with incident cancer. Using IBM MarketScan claims data from over 130 million individuals, 27 million cancer-free subjects with a minimum of 36months of follow-up data were identified. Individuals were stratified by presence or absence of CVD, time-varying analysis with multivariable adjustment for cardiovascular risk factors was performed, and cumulative risk of cancer was calculated. Additional analyses were performed according to CVD type (atherosclerotic vs nonatherosclerotic) and cancer subtype. Among 27,195,088 individuals, those with CVD were 13% more likely to develop cancer than those without CVD (HR: 1.13; 95% CI: 1.12-1.13). Results were more pronounced for individuals with atherosclerotic CVD (aCVD), who had a higher risk of cancer than those without CVD (HR: 1.20; 95% CI: 1.19-1.21). aCVD also conferred a higher risk of cancer compared with those with nonatherosclerotic CVD (HR: 1.11; 95% CI: 1.11-1.12). Cancer subtype analyses showed specific associations of aCVD with several malignancies, including lung, bladder, liver, colon, and other hematologic cancers. Individuals with CVD have an increased risk of developing cancer compared with those without CVD. This association may be driven in part by the relationship of atherosclerosis with specific cancer subtypes, which persists after controlling for conventional risk factors.

Severe hypertriglyceridemia caused by Gpihbp1 deficiency facilitates vascular remodeling through increasing endothelial activation and oxidative stress

Hypertriglyceridemia (HTG) is an independent risk factor for atherosclerosis. However, its impact on non-atherosclerotic cardiovascular diseases remains largely unknown. Glycosylphosphatidylinositol anchored high-density lipoprotein binding protein 1 (GPIHBP1) is essential for the hydrolysis of circulating triglycerides and loss of functional GPIHBP1 causes severe HTG. In this study, we used Gpihbp1 knockout (GKO) mice to investigate the potential effects of HTG on non-atherosclerotic vascular remodeling. We compared the aortic morphology and gene expressions between three-month-old and ten-month-old GKO mice and their age-matched wild-type controls. We also conducted similar comparisons between GKO mice and wild-type controls in an angiotensin II (AngII)-induced vascular remodeling model. Our data showed that the intima-media wall of ten-month-old GKO mice but not three-month-olds was significantly thickened compared to wild-type controls. Moreover, ten-month-old GKO mice but not three-month-olds had increased aortic macrophage infiltration and perivascular fibrosis, along with increased endothelial activation and oxidative stress. Similarly, the AngII-induced vascular remodeling, as well as endothelial activation and oxidative stress, were also exacerbated in the GKO mice compared to wild-type controls. In conclusion, we demonstrated that severe HTG caused by Gpihbp1 deficiency could facilitate the onset and progression of non-atherosclerotic vascular remodeling through endothelial activation and oxidative stress in mice.

Diverse cardiovascular risk of recurrent spontaneous abortion: A prospective cohort study using UK Biobank

Previous studies have reported that history of recurrent spontaneous abortion (RSA) can increase the risk for cardiovascular disease. However, previous studies mainly focused on atherosclerotic cardiovascular disease (ASCVD), such as coronary artery disease or stroke, hence the effect of RSA on non-atherosclerotic cardiovascular diseases (non-ASCVD) remains unknown. In the current study, we examined if women with a history of RSA have an increased risk for long-term cardiovascular outcomes including both ASCVD and non-ASCVD. The UK Biobank is a prospective cohort study that recruited participants 40 to 69 years old with ongoing follow-up. Among women enrolled in UK Biobank, those with at least one pregnancy history and without pre-existing cardiovascular disease were included. The new occurrence of ASCVD and non-ASCVD after enrollment were compared between the women with RSA history and without RSA history. To evaluate the incidence of cardiovascular outcomes, a Cox proportional hazard model was used with adjustment for covariates including age, race, BMI, nulliparity, use of hormones, smoking, early menopause, hysterectomy, prevalent diseases, and medication by Cox proportional hazards regression analysis. In the presence of a history of RSA, the risk of new occurrence of overall cardiovascular disease, was higher (adjusted hazard ratio (aHR), 1.24 (95% CI 1.15-1.35), Figure 1). Specifically, the incidence of coronary artery disease, myocardial infarction, peripheral artery disease, heart failure, mitral regurgitation, atrial fibrillation/flutter were all increased in cases with a history of RSA (Figure 2). The women with history of RSA had an increased long-term risk of not only ASCVD, but also non-ASCVD.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

“SERUM URIC ACID LEVELS WITH INSULIN RESISTANCE IN METABOLIC SYNDROME – A CORRELATION STUDY”

Background: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that includes hypertension, central obesity, insulin resistance, and atherogenic dyslipidemia, which is strongly associated with an increased risk for developing diabetes and atherosclerotic and nonatherosclerotic cardiovascular disease (CVD). The increasing prevalence of Obesity across the world will result in an increased prevalence of Metabolic syndrome. However, obesity along with the MetS increases the risk of acquiring Diabetes and cardiovascular diseases (CVD). The prevalence of metabolic syndrome in adults ranges from 20 to 25%, but in those with type 2 diabetes, it can almost always approach 80%. The death rate from high BMI has increased globally by 28.3%. According to the WHO denition of metabolic syndrome, CVD mortality was 2.6 to 3.0 times higher and all-cause death was 1.9 to 2.1 times higher. Elevated uric acid is one of the characteristic signs of metabolic syndrome patients that has been associated with several cardiometabolic risk factors. Despite frequently being thought of as secondary to hyperinsulinemia, current research suggests that uric acid has a primary role in mediating this condition. According to multiple logistic regression analysis, the risk of MetS rose around 2-fold for every 1 mg/dl increase in blood uric acid. This study seeks to determine if insulin resistance and asymptomatic hyperuricemia are related in patients with metabolic syndrome. Aim: To study the correlation of Serum Uric acid levels with Insulin Resistance in Metabolic syndrome. Materials And Methods: A Hospital-based cross-sectional study was conducted in the Department of General Medicine, Santhiram medical college, and the general hospital for six months. A total of 50 cases with asymptomatic Hyperuricemia and insulin resistance who satisfy the criteria for metabolic syndrome and patients that were admitted to the hospital during this period were taken into the study. Results: Out of 50 patients a male preponderance of 72% was found in the study. Subjects in the Metabolic syndrome group had higher BMI, WC, SBP, DBP, FBS, fasting insulin, HOMA-IR index, TG, and HDL levels than the subjects in the non-MetS group. In this study, the mean serum uric acid was signicantly higher in the MetS group than that in the non-MetS group. In the Mets group, the mean value of serum uric acid was 8.1±1.8mg/dl. In the study, 78.6% of women and 75.4% of men had asymptomatic hyperuricemia. In Mets, there was a strong positive correlation between serum uric acid and insulin resistance. Additionally, a favorable association between serum uric acid and several Mets factors such as BMI, waist size, fasting blood sugars, fasting insulin, and HDL was observed. Conclusion: Serum uric acid showed a signicant positive relation with insulin resistance in Mets. There was also a positive correlation noted between serum uric acid and various components of Mets i.e., BMI, waist circumference, fasting blood sugars, fasting insulin, and HDL

Fibroblast Growth Factor-23 and Risk of Cardiovascular Diseases: A Mendelian Randomization Study.

Fibroblast growth factor-23 (FGF-23) is associated with a range of cardiovascular and noncardiovascular diseases in conventional epidemiological studies, but substantial residual confounding may exist. Mendelian randomization approaches can help control for such confounding. SCALLOP Consortium data of 19,195 participants were used to generate an FGF-23 genetic score. Data from 337,448 UK Biobank participants were used to estimate associations between higher genetically predicted FGF-23 concentration and the odds of any atherosclerotic cardiovascular disease (n=26,266 events), nonatherosclerotic cardiovascular disease (n=12,652), and noncardiovascular diseases previously linked to FGF-23. Measurements of carotid intima-media thickness and left ventricular mass were available in a subset. Associations with cardiovascular outcomes were also tested in three large case-control consortia: CARDIOGRAMplusC4D (coronary artery disease, n=181,249 cases), MEGASTROKE (stroke, n=34,217), and HERMES (heart failure, n=47,309). We identified 34 independent variants for circulating FGF-23, which formed a validated genetic score. There were no associations between genetically predicted FGF-23 and any of the cardiovascular or noncardiovascular outcomes. In UK Biobank, the odds ratio (OR) for any atherosclerotic cardiovascular disease per 1-SD higher genetically predicted logFGF-23 was 1.03 (95% confidence interval [95% CI], 0.98 to 1.08), and for any nonatherosclerotic cardiovascular disease, it was 1.01 (95% CI, 0.94 to 1.09). The ORs in the case-control consortia were 1.00 (95% CI, 0.97 to 1.03) for coronary artery disease, 1.01 (95% CI, 0.95 to 1.07) for stroke, and 1.00 (95% CI, 0.95 to 1.05) for heart failure. In those with imaging, logFGF-23 was not associated with carotid or cardiac abnormalities. Genetically predicted FGF-23 levels are not associated with atherosclerotic and nonatherosclerotic cardiovascular diseases, suggesting no important causal link. This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_01_10_CJN05080422.mp3.

A COMPREHENSIVE REVIEW ON NATURAL REMEDIES FOR DIABETES: A METABOLIC DISORDER

Metabolic syndrome (MetS) is a group of metabolic imbalances that involves hypertension, central obesity, insulin resistance, and atherogenic dyslipidemia. It is linked to an increased risk of diabetes and atherosclerotic and non-atherosclerotic cardiovascular disease (CVD). MetS have gained significant importance recently due to the exponential increase in obesity worldwide. The two main causes of this kind of syndrome are an increase in high-calorie, low-fiber fast food consumption and a decrease in physical activity owing to mechanized transportation and sedentary leisure activities. The syndrome contributes to the spread of diseases such as type 2 diabetes, coronary artery disease, stroke, and others. Herbal treatments have a long history of use in the treatment and prevention of disorders, including diabetes, when compared to conventional medicine. Diabetes is one of the world's most serious public health issues. Diabetes mellitus is a syndrome marked by hyperglycemia, changes in lipid, carbohydrate, and protein metabolism, and long-term consequences affecting the eyes, kidneys, cardiovascular system, and nervous system. For thousands of years, plants and their derivatives are being used for the treatment of diabetes and continue to provide mankind with new remedies. Also, the recent increase in the number of people suffering from diabetes worldwide and several associated complications leads to paying more attention to remedies for diabetes. Hence a review of conventional and recently explored plants useful in the treatment of diabetes concise and aimed to revert back to the conventional plant benefits and utilization of medicinal plants.

Congenital Heart Diseases and Periodontal Diseases-Is There a Link?

An understanding in the field of periodontal medicine explains the fact that the oral cavity serves as a niche for numerous pathogenic microorganisms. When these microorganisms or their by-products disseminate to the various parts of the body, they are capable of triggering diseases characterized by an altered host immune-inflammatory response in the anatomically distinct organ. This mechanism is reported in the propagation of cardiovascular diseases with respect to periodontal medicine. Abundant amount of literature suggests an association between atherosclerotic cardiovascular disease and periodontal diseases. However, there is very less data available to highlight the association between periodontal disease and non-atherosclerotic cardiovascular disease, such as congenital anomalies of the heart. This review outlines the relationship between periodontal diseases and congenital heart diseases and also helps us understand whether the presence of periodontal disease can worsen the preexisting congenital cardiac disease.

Low-grade proteinuria and atherosclerotic cardiovascular disease: A transition study of patients with diabetic kidney disease.

Diabetic kidney disease (DKD) is heterogeneous in terms of proteinuria. Patients with DKD who present with low-grade proteinuria are more likely to have nephrosclerosis rather than traditional diabetic nephropathy. The amount of proteinuria might reflect the underlying pathology of renal failure and influence the prognosis after dialysis initiation. Clinical implications of proteinuria at the start of dialysis have not been confirmed, while greater proteinuria is associated with higher risk of cardiovascular disease (CVD) in the predialysis stages of chronic kidney disease. We performed a retrospective multicenter cohort study enrolling incident hemodialysis patients with diabetes. Patients were stratified using proteinuria quartiles. We examined the association of proteinuria quartiles with types of subsequent CVD. Among the enrolled 361 patients, the estimated mean glomerular filtration rate and proteinuria was 5.4 mL/min/1.73 m2 and 6.3 g/gCr, respectively. Lower quartile of proteinuria (cut-offs: 3.0, 5.4, and 8.8 g/gCr) was significantly associated with male, older age, and history of atherosclerotic CVD including coronary artery disease, peripheral arterial disease, and cerebral infarction (Ptrend<0.05). Kidney size was smaller in patients with lower levels of proteinuria. Patients with higher levels of proteinuria were more likely to have proliferative diabetic retinopathy (Ptrend<0.05). Multivariate competing risk analysis revealed that the first quartile of proteinuria was associated with a greater risk of atherosclerotic CVD than the third quartile (subhazard ratio [95% confidence interval]: 2.04 [1.00–4.14]). This association was attenuated after additional adjustments for history of atherosclerotic CVD. Furthermore, patients with lower quartiles of proteinuria were more likely to die of atherosclerotic CVD than those with non-atherosclerotic CVD (Ptrend = 0.01). Diabetic patients with lower proteinuria at dialysis initiation were characterized by severer macroangiopathy, as shown by a more atrophic kidney and higher prevalence of past atherosclerotic CVD. Hence, they are at a high risk of developing atherosclerotic CVD.

Anti-Insulin Resistance Effect of Black Seed (Nigella sativa) Extracts In Metabolic Syndrome Induced-Rats

Metabolic syndrome (MS) is a group of metabolic disorders that includes hypertension, central obesity, insulin resistance, and atherogenicdyslipidemia. It is closely linked to an elevated risk of diabetes and atherosclerotic and non-atherosclerotic cardiovascular disease. In the current study, Nigella sativa (NS) ethanolic and aqueous extracts were investigated for their effect on blood glucose level, insulin resistance and lipid profile in MS induced-rats. Metabolic syndrome were induced by fed rats on a high fat diets supplemented with 1 % cholesterol powder and treated with 10 % fructose added to drinking water for 5 weeks. Twenty-four albino male rats (180 ± 5 g) were divided into four groups: group 1 (normal control) was fed on basal diet, group 2 (positive control) treated with high fat diet and 10 % fructose in drinking water (about 25ml daily per rat).Group 3 and group 4 treated with (NS) ethanolic and aqueous extracts (300 mgkg), respectively, after induction of MS. Levels of glucose, insulin, lipid profile parameters, alanine aminotransaminase (ALT) and aspartate aminotransaminase (AST) were evaluated. Results revealed that at the end of experiment after eighty five days, in a comparison to positive control, both ethanolic and aqueous extracts of (NS) were recorded a significant increase in a high-density lipoprotein-cholesterol (HDL-C) level, accompanied by a significant decrease in levels of glucose, insulin, insulin resistance, (ALT), and (AST).There were no histological alterations in the pancreasafter aqueousextract treatment. In conclusion, (NS) could introduce a potential natural therapy against MS.

Harnessing the Therapeutic Potential of Decoys in Non-Atherosclerotic Cardiovascular Diseases: State of the Art

Cardiovascular disease (CVD) is the main cause of global death, highlighting the fact that conventional therapeutic approaches for the treatment of CVD patients are insufficient, and there is a need to develop new therapeutic approaches. In recent years, decoy technology, decoy oligodeoxynucleotides (ODN), and decoy peptides show promising results for the future treatment of CVDs. Decoy ODN inhibits transcription by binding to the transcriptional factor, while decoy peptide neutralizes receptors by binding to the ligands. This review focused on studies that have investigated the effects of decoy ODN and decoy peptides on non-atherosclerotic CVD.

Associations of Genetically Predicted Lp(a) (Lipoprotein [a]) Levels With Cardiovascular Traits in Individuals of European and African Ancestry.

Lp(a) (lipoprotein [a]) levels are higher in individuals of African ancestry (AA) than in individuals of European ancestry (EA). We examined associations of genetically predicted Lp(a) levels with (1) atherosclerotic cardiovascular disease subtypes: coronary heart disease, cerebrovascular disease, peripheral artery disease, and abdominal aortic aneurysm and (2) nonatherosclerotic cardiovascular disease phenotypes, stratified by ancestry. We performed (1) Mendelian randomization analyses for previously reported cardiovascular associations and (2) Mendelian randomization-phenome-wide association analyses for novel associations. Analyses were stratified by ancestry in electronic Medical Records and Genomics, United Kingdom Biobank, and Million Veteran Program cohorts separately and in a combined cohort of 804 507 EA and 103 580 AA participants. In Mendelian randomization analyses using the combined cohort, a 1-SD genetic increase in Lp(a) level was associated with atherosclerotic cardiovascular disease subtypes in EA-odds ratio and 95% CI for coronary heart disease 1.28 (1.16-1.41); cerebrovascular disease 1.14 (1.07-1.21); peripheral artery disease 1.22 (1.11-1.34); abdominal aortic aneurysm 1.28 (1.17-1.40); in AA, the effect estimate was lower than in EA and nonsignificant for coronary heart disease 1.11 (0.99-1.24) and cerebrovascular disease 1.06 (0.99-1.14) but similar for peripheral artery disease 1.16 (1.01-1.33) and abdominal aortic aneurysm 1.34 (1.11-1.62). In EA, a 1-SD genetic increase in Lp(a) level was associated with aortic valve disorders 1.34 (1.10-1.62), mitral valve disorders 1.18 (1.09-1.27), congestive heart failure 1.12 (1.05-1.19), and chronic kidney disease 1.07 (1.01-1.14). In AA, no significant associations were noted for aortic valve disorders 1.08 (0.94-1.25), mitral valve disorders 1.02 (0.89-1.16), congestive heart failure 1.02 (0.95-1.10), or chronic kidney disease 1.05 (0.99-1.12). Mendelian randomization-phenome-wide association analyses identified novel associations in EA with arterial thromboembolic disease, nonaortic aneurysmal disease, atrial fibrillation, cardiac conduction disorders, and hypertension. Many cardiovascular associations of genetically increased Lp(a) that were significant in EA were not significant in AA. Lp(a) was associated with atherosclerotic cardiovascular disease in four major arterial beds in EA but only with peripheral artery disease and abdominal aortic aneurysm in AA. Additionally, novel cardiovascular associations were detected in EA.

Mean corpuscular hemoglobin concentration: an anemia parameter predicting cardiovascular disease in incident dialysis patients.

Hemoglobin levels usuallydecline before dialysis initiation. The influence of overhydration on anemia progression and iron sequestration is poorly documented. Furthermore, clinical implications of anemia at dialysis initiation remain to be elucidated. This multicenter retrospective cohort study enrolled incident dialysis patients. The patients were stratified by tertiles of overhydration rate (OH-R) defined by (BW-DW)/DW*100 (BW: body weight just before dialysis initiation, DW: dry weight). Time courses (6months before, to 1month after, dialysis initiation) of hemoglobin, C-reactive protein (CRP), and iron sequestration index (ISI) were examined using mixed effects models. We used Cox models to identify anemia parameters predicting subsequent cardiovascular disease (CVD). Among the 905 enrolled patients, hemoglobin levels gradually decreased before dialysis initiation and rapidly increased thereafter. An inverse V-shaped time course was observed for CRP and ISI with an increase during dialysis initiation. Patients with a higher OH-R showed lower hemoglobin levels along with higher CRP and ISI levels before dialysis initiation. Mean corpuscular hemoglobin concentration (MCHC) was more stable before dialysis initiation than were mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). Low MCHC (< 32g/dL) was independently associated with the incidence of nonatherosclerotic CVD. Patients with low MCHC tended to have increased left ventricular wall thickness and left atrial diameter. Progression of anemia before dialysis among overhydrated patients may mainly occurthrough hemodilution and iron sequestration partly induced by inflammation. Low MCHC reflects left atrial overload and left ventricular hypertrophy and hence maypredict nonatherosclerotic CVD.

Electrocardiogram findings at the initiation of hemodialysis and types of subsequent cardiovascular events.

The prognostic value of electrocardiograms (ECGs) has been reported in predialysis patients but not in incident hemodialysis patients with overhydration and electrolyte disturbances, both of which potentially affect ECG results. We performed a retrospective multicenter cohort study involving incident hemodialysis patients and examined whether ECG parameters immediately before hemodialysis initiation can predict subsequent cardiovascular disease (CVD) using Cox proportional hazards models. We explored potential effect modifications by several electrolytes on the predictive power of ECG abnormalities. Among the 618 enrolled patients, 16%, 10%, 46%, and 22% showed a PR interval ≥ 200 ms, QRS interval ≥120 ms, QTc interval ≥ 450/460 ms (male/female), and left ventricular hypertrophy (LVH) by voltage criteria, respectively. Over a median 3-year follow-up, 19% and 16% of the patients developed atherosclerotic and nonatherosclerotic CVD, respectively. The Cox regression model results revealed that the sum of the number of abnormalities in PR, QRS, and QT intervals was a significant risk factor for nonatherosclerotic CVD (hazard ratios (HRs) [95% confidence interval (CI)]: 1.58 [1.24-2.01] per number of abnormalities). The predictive value of LVH for atherosclerotic CVD was attenuated over time. At up to 36 months, although the proportional hazards assumption was met, LVH was significantly associated with atherosclerotic CVD (HR [95% CI]: 1.89 [1.15-3.11]). The adjusted HR was particularly high (HR [95% CI]: 4.02 [1.68-9.60]) among patients who were in the lowest tertile of serum magnesium levels (P for interaction = 0.04). PR, QRS, and QT prolongation additively predicted nonatherosclerotic CVD, while LVH predicted atherosclerotic CVD in the short term.

A review of metabolic syndrome parameters: Key players in aging pathogenesis

Metabolic syndrome represents a cluster of metabolic abnormalities (e.g., central obesity, hypertension, dyslipidemia, atherogenic, and insulin resistance), and is strongly linked to an enhanced risk for developing atherosclerotic, diabetes and nonatherosclerotic cardiovascular disease. To determine to what extent metabolic syndrome parameters are involved in the pathogenesis, and progression of aging. The scientific literature (Scopus, Google scholar, and PubMed) was searched from 1980 and 2020. The relationship among metabolic syndrome profiles and the aging is emerging as a public health question of importance to primary care practitioners. A number of studies have suggested a link between metabolic syndrome parameters with aging. Therefore, further investigations on the parameters of metabolic syndrome may be involved in the pathogenesis of aging. This review emphasizes the studies investigating the roles of metabolic syndrome, oxidative stress, inflammation, dyslipidemia, insulin resistance, overweight, high blood pressure, cardiovascular, type 2 diabetes in aging. © 2020, Advanced Scientific Research. All rights reserved.

Targeting multiple domains of residual cardiovascular disease risk in patients with diabetes.

There has been a recent resurgence of diabetes-related cardiovascular complications after years of steady improvement. This review highlights established and emerging contemporary secondary prevention approaches that lower the risk of atherosclerotic and nonatherosclerotic cardiovascular disease events among patients with diabetes. Secondary prevention therapies modify residual risk targets, including cardiometabolic pathways, lipoproteins, thrombosis, and inflammation. Large-scale clinical trials of sodium-glucose cotransporter-2 inhibitors have demonstrated significant reductions in hospitalization for heart failure. Glucagon-like peptide-1 receptor agonists have reduced the risk of major adverse cardiovascular events. Recent clinical trials provide evidence supporting the use of nonstatin lipid-lowering therapies, novel antiplatelet and anticoagulant strategies, and antiinflammatory strategies in select cases. Therapeutic approaches targeting multiple distinct pathways have been shown to improve cardiometabolic risk in diabetes. Individual patient characteristics and consideration of residual risk targets may help guide selection of comprehensive secondary prevention approaches.

Metabolic syndrome and myocardium steatosis in subclinical type 2 diabetes mellitus: a 1H-magnetic resonance spectroscopy study

BackgroundMetabolic syndrome (MetS) is a cluster of metabolic abnormalities that collectively cause an increased risk of type 2 diabetes mellitus (T2DM) and nonatherosclerotic cardiovascular disease. This study aimed to evaluate the role of myocardial steatosis in T2DM patients with or without MetS, as well as the relationship between subclinical left ventricular (LV) myocardial dysfunction and myocardial steatosis.Methods and materialsWe recruited 53 T2DM patients and 20 healthy controls underwent cardiac magnetic resonance examination. All T2DM patients were subdivide into two group: MetS group and non-MetS. LV deformation, perfusion parameters and myocardial triglyceride (TG) content were measured and compared among these three groups. Pearson’s and Spearman analysis were performed to investigate the correlation between LV cardiac parameters and myocardial steatosis. The receiver operating characteristic curve (ROC) was performed to illustrate the relationship between myocardial steatosis and LV subclinical myocardial dysfunction.ResultsAn increase in myocardial TG content was found in the MetS group compared with that in the other groups (MetS vs. non-MetS: 1.54 ± 0.63% vs. 1.16 ± 0.45%; MetS vs. normal: 1.54 ± 0.63% vs. 0.61 ± 0.22%; all p < 0.001). Furthermore, reduced LV deformation [reduced longitudinal and radial peak strain (PS); all p < 0.017] and microvascular dysfunction [increased time to maximum signal intensity (TTM) and reduced Upslope; all p < 0.017)] was found in the MetS group. Myocardial TG content was positively associated with MetS (r = 0.314, p < 0.001), and it was independently associated with TTM (β = 0.441, p < 0.001) and LV longitudinal PS (β = 0.323, p = 0.021). ROC analysis exhibited that myocardial TG content might predict the risk of decreased LV longitudinal myocardial deformation (AUC = 0.74) and perfusion function (AUC = 0.71).ConclusionMyocardial TG content increased in T2DM patients with concurrent MetS. Myocardial steatosis was positively associated with decreased myocardial deformation and perfusion dysfunction, which may be an indicator for predicting diabetic cardiomyopathy.

Metabolic Syndrome: An Emerging Threat

Metabolic syndrome (MetS) is a multifaceted syndrome, which occurs frequently in the general population. It represents a cluster of metabolic abnormalities that include hypertension, central obesity, insulin resistance, and atherogenic dyslipidemia, and is strongly associated with an increased risk for developing diabetes and atherosclerotic and nonatherosclerotic cardiovascular disease (CVD). The pathogenesis of MetS involves both genetic and acquired factors that contribute to the final pathway of inflammation that leads to CVD. MetS has gained significant importance recently due to the exponential increase in obesity worldwide. Early diagnosis is important in order to employ lifestyle and risk factor modification. Here, we review the epidemiology, diagnostic criteria, pathogenesis and disease associations of MetS, and summarize existing management modalities.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.14 (2) 2018: 203-208

Lipid-modifying therapy in chronic kidney disease: Pathophysiological and clinical considerations.

Chronic kidney disease (CKD), which affects >10% of the population worldwide, is associated with a dramatically increased rate of cardiovascular disease (CVD). More people with CKD will die from CVD than develop end-stage renal disease with dialysis-dependency. However, the contribution of classical atherosclerotic cardiovascular risk factors is less evident than in the general population. Particularly, the relationship between dyslipidemia and CVD morbidity and mortality in CKD patients is not as evident as in the general population. While LDL cholesterol-lowering drugs such as statins significantly reduce the rate of cardiovascular events in the general population, their role in patients with end-stage renal disease has been questioned. This could be caused by a shift from atherosclerotic to non-atherosclerotic CVD in patients with advanced CKD, which cannot be effectively prevented by lipid-lowering drugs. In addition, many lines of evidence suggest that impaired renal function directly affects the metabolism, composition and functionality of lipoproteins, which may affect their responsiveness to pharmacological interventions. In this review, we highlight the challenges for the therapeutic application of lipid-lowering treatment strategies in CKD and discuss why treatment strategies used in the general population cannot be applied uncritically to CKD patients.

Navigating the "MACE" in Cardiovascular Outcomes Trials and decoding the relevance of Atherosclerotic Cardiovascular Disease benefits versus Heart Failure benefits.

The publication of results from recent cardiovascular outcome trials (CVOTs) has transformed the landscape of diabetes treatment. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium glucose co-transporter-2 (SGLT2) inhibitors have demonstrated CV benefits in large, well-conducted, randomized studies. Today, empagliflozin, canagliflozin and liraglutide are US Food and Drug Administration-approved not only for glucose-lowering, but also to reduce the risk of cardiovascular (CV) events/CV mortality in people with type 2 diabetes (T2DM) and established CV disease (CVD)/high CVD risk. Although the CVOTs were primarily powered for CV safety (non-inferiority), they also demonstrated CV efficacy (superiority). This initially surprised many in the diabetes community, but the replication of the CV benefits with different compounds in the same class alleviated concerns about the CV benefits being chance findings. However, many questions remain. While the heterogeneity in the CV benefits in the various CVOTs can be attributed to the variability in CV risk in the different studies, the reason(s) for the differences in the CV benefits between the GLP-1RA class and the SGLT2 inhibitor class appear to be more complex. An analysis of major adverse cardiovascular events (MACE) in the CVOTs shows that the CV benefits of GLP-1RAs are predominantly specific to atherosclerotic CV events (non-fatal myocardial infarction [MI], non-fatal stroke and CV death). By contrast, the SGLT2 inhibitors do not have any significant effects on atherosclerotic CV events (non-fatal MI/stroke). Their benefits are predominantly on hospitalization for heart failure (HF), suggesting effects primarily on myocardial function ("the pump"), and not on the "pipes" (coronary arteries). In the present review, we discuss the rationale for the conduct of CVOTs, highlight the inability of the classic three-point MACE to capture the entire spectrum of atherosclerotic and non-atherosclerotic CVD morbidity, especially HF in T2DM, and discuss the results of the CVOTs with a focus on the clinical significance of atherosclerotic CVD (ASCVD) versus HF, which develops in a sizeable proportion of people with diabetes and without prior ASCVD.