Prevalence Of Macrovascular Complications Research Articles

Predictors of macrovascular complications in Al-Madinah Al-Munawara type 2 diabetes mellitus patients, Saudi Arabia: A cross-sectional study

Background/aim Diabetes mellitus is a metabolic disease characterized by chronic hyperglycemia, which causes macrovascular complications that account for most of the morbidity, hospitalizations, and deaths. The goal of this study is to evaluate the relationship between macrovascular complications and associated risk factors in Al-Madinah Al-Munawara patients suffering from type 2 diabetes mellitus. Patients and methods This descriptive cross-sectional study involved 275 type 2 diabetes mellitus patients who resided in Al-Madinah Al-Munawara and visited the diabetic clinic at King Fahd Hospital on a regular basis. Participants in the study ranged in age from 20 to 65. Hemoglobin, glycated hemoglobin, serum calcium, fasting blood glucose, and lipid profile were analyzed. Results Out of 275 patients with type 2 diabetes mellitus, 113 have had macrovascular complications. A significant association (P<0.05) has been observed between the age of the patients and different forms of macrovascular complications, which impact 62.7% of the elderly (41–65 years old). The prevalence of macrovascular complications was higher among females. Glycated hemoglobin levels positively correlated with the number of hospitalizations, high blood pressure, hemoglobin, and serum cholesterol levels. Macrovascular complications are positively correlated with age, sex, hypertension, and therapy type (P<0.05), while physical activity has a negative significant effect on the appearance of macrovascular complications by multiple regression analysis. Conclusion In this study, diabetic macrovascular complications were prevalent. The age, sex of participants, and type of treatment were independent predictors of macrovascular complications. Hypertension has a significant positive effect on the appearance of macrovascular complications. Physically inactive patients have a higher risk of macrovascular complications.

Influence of hepatitis B virus on the prevalence of diabetes complications in patients with type2 diabetes.

Diabetes and hepatitis B are both global problems. The influence of diabetes on complications and prognosis of hepatitis B has been widely studied. However, the association between hepatitis B virus (HBV) infection and the prevalence of diabetes-related complications is less documented and is uncertain. This was a retrospective study. We collected information from a large clinical database. A total of 1,090 Chinese inpatients with type 2 diabetes were included. The participants were divided into two groups, including 135 patients with HBV infection and 955 patients without HBV infection. Patients with HBV infection were younger and had worse control of blood glucose than those without HBV infection. No significant difference was found in the prevalence of diabetic retinopathy, neuropathy, nephropathy, diabetic ketosis or diabetic ketoacidosis between the patients with HBV infection and the patients without HBV infection. The prevalence of macrovascular complications was 54.1% and 64.4% in diabetes patients complicated with HBV infection and without HBV infection, respectively. The P-value was <0.05. However, through the logistic regression analysis, we found HBV infection was not an independent risk factor for macrovascular complications of diabetes. There was no significant correlation between the prevalence of macrovascular complications, microvascular complications of diabetes, diabetic ketosis or diabetic ketoacidosis and HBV infection status.

Associations of Thyroid Hormone Levels and Macrovascular Complications in Euthyroid Type 2 Diabetic Patients.

PurposeThe purpose of this study is to evaluate whether thyroid hormone in euthyroid patients with type 2 diabetes mellitus (T2DM) is associated with macrovascular complications.Patients and MethodsThe authors examined 311 patients enrolled from February 2019 to December 2019 in Tianjin Medical University Chu Hsien-I Memorial Hospital. A medical record review enabled the collection of demographic and anthropometric information. We classified the patients into two groups based on the echocardiography and vascular ultrasonography results, namely, non-macrovascular complications (n=131) group and macrovascular complications (n=180) group. Odds ratios (OR) and 95% confidence intervals (CI) were calculated, adjusting for potential confounders, the prevalence of macrovascular complications was determined using multivariate logistic regression.ResultsA significant association was observed for diabetic macrovascular complications with normal free triiodothyronine (FT3) (OR=0.534, 95% CI 0.358–0.796, p = 0.002) and free thyroxine (FT4) (OR= 0.844, 95% CI 0.760–0.937, p = 0.001). Nevertheless, there was no evidence of any association between thyroid-stimulating hormone (TSH) and the development of diabetic macrovascular complications. When stratified by the body mass index (BMI), a similar relationship existed with the overall results. The positive association remained in restricted analyses involving only patients with HbA1c abnormalities.ConclusionOverweight or obese T2DM patients are at high risk due to the implicit association between low but clinically normal thyroid hormone levels and elevated risk of macrovascular complications. However, there were no statistically significant associations between TSH and diabetic macrovascular complications.

Endothelial dysfunction and intima media thickness are selectively related to the different carbohydrate disturbances across the glucose continuum

Aim: The aim of the present study was to investigate the prevalence of macrovascular complications across different carbohydrate disturbances.Patients and methods: In the study, we included 167 patients, divided them into three age and BMI matched groups – group 1 with obesity without carbohydrate disturbances (n = 66), group 2 with prediabetes (n = 68) and group 3 with newly diagnosed type 2 diabetes (n = 33). Endothelial function was evaluated using EndoPAT, intima media thickness (IMT) was measured on the common carotid artery and ankle-brachial index (ABI) was calculated.Results: The patients with T2D had significantly higher mean IMT than the other two groups. The best predictors of increased IMT were fasting blood glucose followed by age and SBP. ROC-analysis showed that blood glucose on 60 min of OGTT had a very good predictive value for endothelial dysfunction.Conclusions: Patients with newly diagnosed diabetes have increased IMT and a tendency towards higher ABI compared to normoglycemic and prediabetic subjects.

MRNA expression of platelet activating factor receptor (PAFR) in peripheral blood mononuclear cells is associated with albuminuria and vascular dysfunction in patients with type 2 diabetes

AimsRenal dysfunction in addition to diabetes is a serious risk factor for cardiovascular events. We hypothesized that some of the changes in gene expression in blood cells cause renal dysfunction and macrovascular disease through impaired endothelial function. This study aimed to define which changes in gene expression in peripheral blood mononuclear cells (PBMCs) are related to renal function parameters and endothelial function of large arteries in patients with type 2 diabetes mellitus (T2DM). MethodsWe recruited 95 patients with T2DM. After matching for gender, age, BMI and HbA1c levels, the patient cohort included 42 with normoalbuminuria, 28 with microalbuminuria, and 25 with macroalbuminuria. All patients in the three groups were assessed for urinary albumin to creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), flow-mediated dilatation (FMD), and mRNA expression in PBMCs. ResultsThe mRNA expression of platelet activating factor receptor (PAFR) differed most markedly between the three groups and was significantly higher in the macroalbuminuric group (p < 0.001 vs. normoalbuminuric group; p < 0.05 vs. microalbuminuric group). PAFR mRNA expression significantly correlated with log transformed ACR (ρ = 0.424, p < 0.001) but not eGFR. PAFR mRNA expression also had a significant negative correlation with FMD (ρ = −0.379, p < 0.001). Furthermore, the prevalence of macrovascular complications, particularly stroke, was significantly higher in patients with elevated PAFR mRNA expression in PBMCs. ConclusionsPAFR overexpression in PBMCs may link diabetic nephropathy to macroangiopathy through impairment of endothelial function in patients with T2DM.

Prevalence of Macrovascular Complications and Their Associated Risk Factors Among Type 2 Diabetic Patients Attending In A Tertiary Level Hospital

Background: Macrovascular complications cause much of the serious morbidity and mortality in patients with diabetes. The aim of the study was to determine the prevalence and risk factors of different macrovascular complications among type 2 diabetic patients.Materials and Methods: We studied two fifty cases of type 2 diabetic patients in this cross-sectional study which was conducted in the out-patient department of BIRDEM hospital, Bangladesh. The randomly selected patients were evaluated for the presence of coronary heart diseases (CHD), stroke and peripheral vascular diseases (PVD) through the review of their registered diabetic guide book. We included sociodemographic information, blood pressure, anthropometry (height, weight, body mass index) and lipid profile of the patients. Glycaemic status was assessed by HbA1c (HbA1c was categorized into 3 groups) and plasma glucose levels. We used logistic regression analysis to determine and quantify the association of CHD, stroke and PVD with various risk factors. Results: Two hundred and fifty cases of type 2 diabetic patients (male 129 and female 121 were studied. The prevalence of macro-vascular complications was 28.8%. Among them CHD was 21.2% (95% CI: 16.13- 26.27%), stroke in 8.4% (95% CI: 4.96-11.84%) and PVD in 7.2% (95% CI: 4-10.4%). Logistic regression models showed that macrovascular complications were more common in females; the risk increased significantly with age, longer duration of diabetes, lacking of physical exercise, presence of hypertension, HbA1c, Fasting Blood Glucose (FBG) and blood glucose 2 hours ABF.Conclusions: CHD is the most common macrovascular complication among type 2 DM patients. Advanced age, longer duration of diabetes, hypertension, poor glycaemic control, lacking of physical exercise etc. are significant risk factors of macrovascular complications in type 2 diabetic patients.KYAMC Journal Vol. 7, No.-1, Jul 2016, Page 662-667

HbA1c but not diabetes duration predicts increased arterial stiffness in adolescents with poorly controlled type 1 diabetes.

The prevalence of macrovascular complications is probably underestimated in children with type 1 diabetes (T1D). Arterial stiffness (AS) is a subclinical marker of cardiovascular (CV) risk. The most validated, non-invasive method for AS measurement is pulse wave velocity (PWV). Only a few PWV studies have been performed in children with T1D. To explore the risk factors associated with AS in adolescents with suboptimally controlled T1D. Seventy-seven adolescents with T1D were included (39 girls, 38 boys) in this study. The adolescents had a median age of 16 yr (IQR 14-17), median duration of T1D was 9 yr (IQR 6-16), and HbA1c 71 mmol/mol (median, IQR 62-81). PWV was measured as the carotid-femoral pulse transmission time and converted into standard deviation scores (SDS) (adjusted for gender and age) using normative values for children. The risk factors assessed were HbA1c, T1D duration, treatment modality, serum lipids, and blood pressure (BP) measured via ambulatory blood pressure monitoring (ABPM). The PWV did not differ from the reference data (median PWV was 5.1 m/s, i.e., -0.01 SDS). A significant positive association was observed between PWV-SDS and HbA1c (p = 0.001), total cholesterol (p = 0.003), LDL-cholesterol (p = 0.003), but not T1D duration (p = 0.78) according to the univariate analyses. In the multivariate model, the only significant variable that remained positively associated with PWV-SDS was HbA1c (p = 0.03). Most adolescents with suboptimally controlled T1D have normal mean PWV compared to a healthy reference population. Chronic hyperglycemia, not T1D duration, is the main predictor of AS in adolescents.

The prevalence of Type 2 diabetes and related complications in a nationally representative sample of adults aged 50 and over in the Republic of Ireland.

To investigate the prevalence of diagnosed Type 2 diabetes and its related complications in a nationally representative sample of older adults in the Republic of Ireland. Cross-sectional analysis of a population-based sample of adults aged ≥ 50 years from the first wave of The Irish Longitudinal Study on Ageing (TILDA), (2009-2011). Diagnosed Type 2 diabetes prevalence was estimated by self-report or the use of oral hypoglycaemic agents. The prevalence of microvascular and macrovascular complications was determined by self-report. Diagnosed Type 2 diabetes prevalence was 8.4% [95% confidence interval (CI): 7.8-9.0%] and was higher among men [10.3% (95% CI: 9.4-11.2%)] than women [6.6% (95% CI: 5.9-7.5%)]; P ≤ 0.001. Among participants with diagnosed Type 2 diabetes, the overall prevalence of microvascular complications was 26.0% (95% CI: 22.4-30.0%) with no evidence of gender-specific differences (P = 0.7). The overall prevalence of macrovascular complications was 15.1% (95% CI: 12.2-18.4%) and was higher among men [17.8% (95% CI: 14.3-23.1%)] than women [11.4% (95% CI: 7.7-16.4%)]; P ≤ 0.001. In the absence of a national diabetes register, these findings provide a robust estimate of the national prevalence of diagnosed Type 2 diabetes and level of complications among adults aged 50 years and over in Ireland.

Recognition and Management of Individuals With Hyperglycemia Because of a Heterozygous Glucokinase Mutation.

Glucokinase-maturity-onset diabetes of the young (GCK-MODY), also known as MODY2, is caused by heterozygous inactivating mutations in the GCK gene. GCK gene mutations are present in ∼1 in 1,000 of the population, but most are not diagnosed. They are common causes of MODY (10-60%): persistent incidental childhood hyperglycemia (10-60%) and gestational diabetes mellitus (1-2%). GCK-MODY has a unique pathophysiology and clinical characteristics, so it is best considered as a discrete genetic subgroup. People with GCK-MODY have a defect in glucose sensing; hence, glucose homeostasis is maintained at a higher set point resulting in mild, asymptomatic fasting hyperglycemia (5.4-8.3 mmol/L, HbA1c range 5.8-7.6% [40-60 mmol/mol]), which is present from birth and shows slight deterioration with age. Even after 50 years of mild hyperglycemia, people with GCK-MODY do not develop significant microvascular complications, and the prevalence of macrovascular complications is probably similar to that in the general population. Treatment is not recommended outside pregnancy because glucose-lowering therapy is ineffective in people with GCK-MODY and there is a lack of long-term complications. In pregnancy, fetal growth is primarily determined by whether the fetus inherits the GCK gene mutation from their mother. Insulin treatment of the mother is only appropriate when increased fetal abdominal growth on scanning suggests the fetus is unaffected. The impact on outcome of maternal insulin treatment is limited owing to the difficulty in altering maternal glycemia in these patients. Making the diagnosis of GCK-MODY through genetic testing is essential to avoid unnecessary treatment and investigations, especially when patients are misdiagnosed with type 1 or type 2 diabetes.

Geographic variation in Medicare spending and mortality for diabetic patients with foot ulcers and amputations

AimsThe purpose of this study was to identify the presence or absence of geographic variation in Medicare spending and mortality rates for diabetic patients with foot ulcers (DFU) and lower extremity amputations (LEA). MethodsDiabetic beneficiaries with foot ulcers (n=682,887) and lower extremity amputations (n=151,752) were enrolled in Medicare Parts A and B during the calendar year 2007. We used ordinary least squares (OLS) regression to explain geographic variation in per capita Medicare spending and one-year mortality rates. ResultsHealth care spending and mortality rates varied considerably across the nation for our two patient cohorts. However, higher spending was not associated with a statistically significant reduction in one-year patient mortality (P=.12 for DFU, P=.20 for LEA). Macrovascular complications for amputees were more common in parts of the country with higher mortality rates (P<.001), but this association was not observed for our foot ulcer cohort (P=.12). In contrast, macrovascular complications were associated with increased per capita spending for beneficiaries with foot ulcers (P=.01). Rates of hospital admission were also associated with higher per capita spending and increased mortality rates for individuals with foot ulcers (P<.001 for health spending and mortality) and lower extremity amputations (P<.001 for health spending, P=.01 for mortality). ConclusionsGeographic variation in Medicare spending and mortality rates for diabetic patients with foot ulcers and amputations is associated with regional differences in the utilization of inpatient services and the prevalence of macrovascular complications.

Association between serum C-peptide levels and chronic microvascular complications in Korean type 2 diabetic patients

This study evaluated the association between serum C-peptide levels and chronic vascular complications in Korean patients with type 2 diabetes. Data for 1,410 patients with type 2 diabetes were evaluated cross-sectionally. Fasting and postprandial 2-hour serum C-peptide levels were analyzed with respect to diabetic micro- and macrovascular complications. In the group of patients with lower fasting serum C-peptide quartile, the prevalences of diabetic retinopathy and neuropathy were significantly higher (P = 0.035, P < 0.001, respectively). In the group of patients with lower delta C-peptide (postprandial - fasting C-peptide) quartile, the prevalences of diabetic retinopathy, nephropathy, and neuropathy were significantly higher (P < 0.001 for all). Low delta C-peptide quartile was also associated with increased severity of retinopathy and nephropathy. The age- and sex-adjusted odds ratios (ORs) for retinopathy, neuropathy, and nephropathy in the lowest versus the highest delta C-peptide quartile were 6.45 (95% confidence interval 3.41-12.22), 3.01 (2.16-4.19), and 2.65 (1.71-4.12), respectively. After further adjustment for the duration of diabetes, type of antidiabetic therapy, mean hemoglobin A1c, body mass index, and blood pressure, the ORs were reduced to 2.83 (1.32-6.08), 1.68 (1.12-2.53), and 1.61 (1.05-2.47), respectively, but remained significant. No significant difference was observed in the prevalence of macrovascular complications with respect to fasting or delta C-peptide quartiles. These results suggest that low C-peptide level is associated with diabetic microvascular, but not macrovascular complications in patients with type 2 diabetes mellitus.

The prevalence of peripheral neuropathy in a population-based study of patients with type 2 diabetes in Sweden

Aims To assess peripheral neuropathy following a standardized foot examination protocol in a representative population-based cohort of subjects with type 2 diabetes. Methods In a geographically defined population, aged 40–70 years with diabetes prevalence of 3.5% according to medical records, we investigated 156 type 2 diabetic subjects, 95% Caucasian, mean age 61.7±7.2 years, duration of diabetes 7.0±5.7 years, and HbA 1c 7.3±2.4% (6.4% Mono-S), by questionnaires, clinical examinations, blood sampling, and review of medical records. Foot examination included clinical signs of peripheral neuropathy and tests of sensibility with monofilament, tuning fork, and assessments of the vibration perception thresholds (VPT). Results Peripheral autonomic neuropathy (PAN) as judged by two or more signs of dysfunction was the most common and affected 43%. The prevalence of peripheral sensory neuropathy (PSN) was 15% by monofilament, 24% by tuning fork, and 28% by VPT expressed as ZscoreVPT ≥2.0 S.D. Twenty-nine percent had a VPT ≥25 V. Signs of peripheral motor neuropathy (PMN) affected 15%. Peripheral neuropathy, at least one variable, affected 67%, whereas 25% were affected by more than one variable of neuropathy, i.e., polyneuropathy. Exclusion of other identified causes for neuropathy than diabetes reduced the prevalence of diabetic polyneuropathy to 23%. Concurrent diabetic complications were 29% for retinopathy, 14% for incipient nephropathy, and 8% for overt nephropathy. The prevalence of macrovascular complications was 62% for CVD, 26% for PVD, and 11% for cerebrovascular lesion (CVL). Conclusion Peripheral neuropathy was common in this representative type 2 diabetes population. Clinical signs of PAN were the most frequent followed by diminished perception of vibration and touch.

Type 2 diabetes mellitus: a high-risk condition for cardiovascular disease irrespective of the different degrees of obesity

Measurement of body weight with body mass index (BMI) is often utilized to stratify cardiovascular disease (CVD) risk. To determine CVD risk profile and disease burden in subjects with type 2 diabetes mellitus (T2DM) across different categories of body weight as defined by BMI. Prospective observational study. CVD risk including metabolic syndrome (MetS) and prevalence of macrovascular complications were determined for each category of body weight as defined by the World Health Organisation (WHO) classification. A total of 390 subjects were included in this study of which 35.9% were non-obese (BMI <30 kg/m(2)). Although increasing obesity as defined by BMI was associated with higher prevalence of central abdominal obesity, hypertension and MetS (P < 0.05), dyslipidaemia and macrovascular complications were not significantly different across the various body weight categories (P = NS). Similar observation was seen in non-obese (BMI <30 kg/m(2)) and obese subjects (BMI >30 kg/m(2)). Among non-obese (including normal weight) cohort, the majority of these subjects had adverse CVD risk profile including presence of at least two co-existing risk factors. Subjects with T2DM possess adverse CVD risk factors with significant burden of macrovascular disease irrespective of their baseline body weight.

Prevalence of macrovascular complications and cardiovascular risk factors in people treated for diabetes and living in France: The ENTRED study 2001

Aim The aim of this study is to estimate the prevalence of macrovascular complications and cardiovascular risk factors among people with diabetes living in France and to compare these prevalences with other national estimates. Methods We randomly sampled 10,000 people who received one or more reimbursements for insulin or oral hypoglycaemic treatment from the major national medical insurance system during the period October–December 2001; 3646 of the 10,000 people completed a questionnaire; for a subgroup of 1718 people, their care providers completed a medical questionnaire. Results The prevalence of diagnosed macrovascular complications was of 17% according to patients (angina or myocardial infarction, 15%; coronary revascularization, 9%) and of 20% overall, according to physicians (angina or myocardial infarction, 16%; coronary revascularization, 6%; stroke, 5%). Macrovascular complications were more frequent in people with type 2 than type 1 diabetes, reflecting an age effect. The prevalences of cardiovascular risk factors in type 1 and type 2 diabetes were: current smoking, 35 and 14%; overweight, 28 and 42%; obesity, 9 and 36%; blood pressure superior to 130/80 mmHg, 29 and 59%; LDL cholesterol superior or equal to 3.4 mmol/l, 18 and 26%, respectively. Conclusions Compared with other European countries, elevated blood pressure is more frequent in people with diabetes living in France; compared with US estimates, the prevalence of macrovascular complications is lower, glucose control better and blood pressure control poorer in France. These data, observed in a country with widespread access to care and at low cost to the patient, nevertheless demonstrate an urgent need for improving the cardiovascular risk profile of people with type 1 and type 2 diabetes, both with and without macrovascular complications.

TNF-alpha -308G&gt;A Polymorphism Modulates Cytokine Serum Concentrations and Macrovascular Complications in Diabetic Patients on Aspirin

Tumor necrosis factor (TNF)-alpha has pleiotropic effects in cytokine-mediated inflammation underlying atherogenesis. Activation of this inflammatory process is assumed to be different in diabetic and non-diabetic individuals. Previous studies in non-diabetic subjects showed no association between TNF-alpha -308G>A polymorphism and coronary artery disease. Vascular complications and cytokine serum concentrations were assessed as a function of the TNF-alpha -308G>A polymorphism in 76 diabetic patients on low-dose aspirin. Of 76 adult diabetic patients, 18 (24%) carried the TNF-alpha -308A allele (17 AG, 1 AA) and 58 (76%) carried wild-type alleles (GG). Prevalence of macrovascular complications was 33% in TNF-alpha -308A allele carriers (AG+AA) and 78% in wild-type allele carriers (GG) (p<0.001). In contrast, prevalence of microvascular complications was 78% and 84%, respectively, and did not significantly differ between the study groups. TNF-alpha -308A allele carriers (AG+AA) compared to wild-type allele carriers (GG) had significantly lower median serum concentrations of hs-C-reactive protein (1.5 vs 2.9 mg/L, p=0.030), interleukin 1-beta (0.9 vs 1.2 ng/L, p=0.046), and interleukin-6 (3.6 vs 4.9 ng/L, p=0.023). In multiple regression analysis, the prevalence of macrovascular diabetic complications was significantly associated with TNF-alpha -308G>A polymorphism (p<0.001) and serum concentrations of HDL-cholesterol (p=0.007) while confounding effects of further variables were excluded. TNF-alpha -308G>A polymorphism modulates cytokine serum concentrations and macrovascular complications in diabetic patients on aspirin. Diabetic carriers of the TNF-alpha -308A allele might benefit more from a prophylaxis with low dose aspirin than non-carriers.

The prevalence of macrovascular complications among diabetic patients in the United Arab Emirates.

BackgroundDiabetes Mellitus (DM) is a major public health problem in the UAE with a prevalence rate reaching 24% in national citizens and 17.4% in expatriates. The aim of this study was to determine the prevalence and risk factors of macrovascular complications among diabetic patients in the Al-Ain district of the United Arab Emirates (UAE).MethodsThe study was part of a general cross-sectional survey carried out to assess the prevalence of diabetes (DM) complications among known diabetic patients in Al-Ain District, UAE. Patients were randomly selected during 2003/2004. Patients completed an interviewer-administered questionnaire carried out by treating doctors and underwent a complete medical assessment including measurement of height, weight, blood pressure and examination for evidence of macrovascular complications. A standard ECG was recorded and blood samples were taken to document fasting blood sugar, glycosylated haemoglobin (HbA1C) and lipid profile.ResultsA sample of 513 diabetic patients was selected with a mean age of 53 years (SD ± 13.01). Overall, 29.5% of DM patients had evidence of macrovascular complications: 11.6% (95% CI: 8.8–14.4) of patients had peripheral vascular disease (PVD), 14.4% (95% CI: 11.3–17.5) had a history of coronary artery disease (CAD) and 3.5% (95% CI: 1.9–5.1%) had cerebrovascular disease (CVD). Of the total population surveyed 35% (95%CI: 30.8–39) had hypertension. The analysis showed that macrovascular complications in diabetic patients were more common among males, increased with age, were more common among hypertensive patients and its prevalence increased steadily with duration of DM.ConclusionOur data revealed a significant association between hypertension and presence of macrovascular disease among diabetic patients. However, the risk of CAD in the UAE was relatively low compared to that seen in patients in other geographical settings. In addition, a lack of correlation between macrovascular disease and glycemic control among patients with DM was observed.

Relationship Between TaqIB Cholesteryl Ester Transfer Protein Gene Polymorphism and Macrovascular Complications in Japanese Patients With Type 2 Diabetes

Cholesteryl ester transfer protein (CETP) is a key regulating factor of lipid metabolism, and the polymorphism of its gene may therefore be a candidate for modulating the lipid parameters, altering the susceptibility to atherosclerosis in type 2 diabetic subjects. In a group of 443 unrelated Japanese patients with type 2 diabetes, we studied the B1B2 polymorphism at the CETP locus, which is detectable with the restriction enzyme TaqI. Patients were separated into three groups according to genotype and compared based on their clinical characteristics, lipid parameters, and macrovascular complications. The B2 allele was associated in a dose-dependent fashion with higher HDL cholesterol and apolipoprotein AI levels, together with lower CETP concentrations. Furthermore, the prevalence of macrovascular complications, such as coronary heart disease, arteriosclerosis obliterans, and cerebral vascular disease, was significantly higher in subjects with the B1B1 genotype. Multiple logistic regression analysis also showed that the B1 allele of CETP genotype was associated with the incidence of these three complications independently of other risk factors. Thus, in type 2 diabetic patients, the B1B2 polymorphism of CETP gene is likely to be a strong genetic predictor of macrovascular complications.

The cardiovascular dysmetabolic syndrome

Aclustering of metabolic abnormalities associated with cardiovascular disease has been recognized since at least 1988. This clustering has been given many names including Syndrome X, The Deadly Quartet, and The Insulin Resistance Syndrome. For various reasons each of these names is unsatisfactory. The Western Working Group believes that cardiovascular dysmetabolic syndrome (CDS) is the name that best describes this group of abnormalities, because it emphasizes the cardiovascular consequences of these abnormalities, recognizes that they are distinguishable abnormalities, and indicates that any given patient may have some or all of the components of the syndrome. The CDS is summarized in Table 1. The mnemonic D-R-O-P stands for Dyslipidemia, insulin Resistance, Obesity, and high blood Pressure. Other abnormalities that may be associated include elevated serum uric acid and elevated plasminogen activator inhibitor-1 (PAI-1) levels. Insulin resistance is thought to be central to the metabolic abnormalities, but all of the mechanisms are not established and other etiologies are possible. A diagnosis of CDS requires the presence of criteria for at least 2 of the first 3 components (dyslipidemia, insulin resistance, and obesity). Any component is a risk factor for macrovascular (coronary, cerebral, or peripheral vascular) disease. Additional components confer additional risk, although some, such as diabetes mellitus, confer more risk than others. These risk factors are in addition to, but not necessarily completely independent of, other traditional risk factors, such as established vascular disease, smoking, age, gender, elevated LDL cholesterol, sedentary lifestyle, and positive family history of vascular disease. All risk factors do not convey equal risk of atherosclerotic cardiovascular disease. Existing vascular disease increases risk of a subsequent event 5-fold compared to a patient without pre-existing vascular disease. Diabetes mellitus increases the risk of macrovascular disease 2-fold in men and 4 –5-fold in women. Thus, women with diabetes lose the protective effect of their gender and are at equally high risk of coronary artery disease (CAD) as men of the same age with the same additional risk factors. Hyperinsulinemia has been shown to be associated with CAD in multiple studies in nondiabetic men, but most studies in women have not shown a significant relationship. Recently, the Atherosclerosis Risk in Communities study has shown a significant relationship between plasma insulin levels and CAD in women. The relationship between CAD risk and increased plasma insulin levels is stronger in younger compared to older individuals. Whether hyperinsulinemia is a marker for insulin resistance and/or causative of atherosclerosis is unclear. Insulin resistance (which is harder to document than frank diabetes mellitus) is more highly correlated with atherosclerotic cardiovascular disease than is elevated insulin, per se. This may be because insulin levels are affected by many factors and elevated plasma insulin is only a surrogate for insulin resistance, and/or because insulin resistance impairs insulin-dependent production of nitric oxide (NO), which is anti-atherogenic, without affecting insulin-dependent vascular smooth muscle cell growth and migration, which are pro-atherogenic. Insulin resistance, rather than hyperglycemia, appears to be the primary factor in endothelial dysfunction in type 2 diabetes. Furthermore, insulin potentiates angiotensin II–stimulated production of PAI-1, which may contribute to a prothrombotic effect. Adequate studies are lacking regarding whether different insulin regimens—and specifically the 4 classes of oral hypoglycemic agents— have different effects on morbidity and mortality due to cardiovascular disease. Insulin resistance is difficult to detect clinically, although the extreme of type 2 diabetes mellitus is well defined. Fasting plasma glucose $110 mg/dL identifies persons who have insulin resistance. Diabetes mellitus affects approximately 6% of the US population, yet only 50% of those individuals have been diagnosed. These patients have predominantly type 2 diabetes mellitus. Significant sequelae often develop prior to diagnosis; at the time of diagnosis of type 2 diabetes, 20% of patients have retinopathy, 8% have nephropathy, and 9% have neuropathy. In addition to these microvascular complications, the prevalence of macrovascular complications is similar to that in diagnosed type 2 diabetes. The new classification promulgated by the American Diabetes Association (ADA) divides diabetes mellitus into type 1 (absolute insulin deficiency) and type 2 (insulin resistance with inadequate compensatory insulin secretory response), as well as gestational diabetes and From the Departments of Medicine and Pharmacology, University of Arizona College of Medicine, Tucson, Arizona; Cardiology Division, Department of Medicine, University of California, San Francisco, San Francisco, California; Stanford University Medical Center, Palo Alto, California. Requests for reprints should be addressed to Timothy C. Fagan, MD, University Health Care at Ventana Vista, 5620 North Kolb Road, Suite 166, Tucson, Arizona 85750.

149 Prevalence of macrovascular complications and its consequences for lipid lowering treatment in patients with diabetes mellitus type II

149 Prevalence of macrovascular complications and its consequences for lipid lowering treatment in patients with diabetes mellitus type II

Macrovascular Complications in Mexican Americans With Type II Diabetes

Mexican Americans have a threefold greater prevalence of non-insulin-dependent (type II) diabetes mellitus than non-Hispanic whites in the San Antonio Heart Study, a population-based study of diabetes. In addition, Mexican-American diabetic subjects (n = 365) have greater fasting glycemia than non-Hispanic white diabetic subjects (P less than 0.001). Despite these findings, and despite a higher prevalence of microvascular complications among Mexican Americans, there does not appear to be a marked difference in prevalence of macrovascular complications between Mexican-American and non-Hispanic white diabetic subjects. Mexican-American diabetic subjects have only a moderate excess of peripheral vascular disease (as judged by ankle-arm blood pressure ratios) relative to non-Hispanic white diabetic subjects (sex-adjusted Mantel-Haenszel odds ratio 1.84, 95% confidence interval 0.75-4.49). Mexican-American diabetic subjects actually reported fewer myocardial infarctions than non-Hispanic white diabetic subjects (sex-adjusted Mantel-Haenszel odds ratio 0.73, 95% confidence interval 0.31-1.71). Duration was not associated with either peripheral vascular disease or myocardial infarction. Severity of glycemia was only mildly associated with presence of peripheral vascular disease and negatively associated with self-reported myocardial infarction. This latter finding may represent a survival bias in that more severe diabetic subjects have already died and are not ascertained in a prevalence study. The absence of an ethnic difference in the prevalence of macrovascular disease contrasts with our previous reports from the San Antonio Heart Study, in which the prevalence of both retinopathy and proteinuria was observed to be higher in Mexican-American diabetic subjects.(ABSTRACT TRUNCATED AT 250 WORDS)