Prevalence Of Microvascular Disease Research Articles

Relationship of microvascular complications and healthy lifestyle with all-cause and cardiovascular mortality in women compared with men with type 2 diabetes

Sex differences exist in the prevalence of microvascular disease (MVD) and healthy-lifestyle adherence. Whether MVD and healthy lifestyles are associated with mortality risk similarly for women and men who have type 2 diabetes mellitus (T2DM) remains unknown. The present study included 9992 women and 15,860 men with T2DM from the UK Biobank. MVDs included retinopathy, peripheral neuropathy, and chronic kidney disease. Healthy lifestyle factors consisted of ideal BMI, nonsmoking, healthy diet, regular exercise, and appropriate sleep duration. Sex-specific hazard ratios (HRs) of mortality associated with the MVDs or healthy lifestyles were calculated and women-to-men ratio of HRs (RHR) were further estimated, after multivariable adjustment for potential confounders. During a median of 12.7 years of follow-up, 4346 (1202 in women) all-cause and 1207 (254 in women) CVD deaths were recorded. The adjusted HRs (95% CI) of all-cause mortality for 1 additional increment of the MVDs were 1.71 (1.55, 1.88) for women and 1.48 (1.39, 1.57) for men, with an RHR of 1.16 (1.03, 1.30). The corresponding RHR was 1.36 (1.09, 1.69) for cardiovascular mortality. Adhering to a healthy lifestyle (≥4 vs. ≤1 lifestyle factor) was associated with an approximately 60%-70% lower risk of all-cause and cardiovascular mortality without sex differences (P-interaction >0.70). Furthermore, as compared with having no MVD and an unfavorable lifestyle, having ≥2 MVDs but a favorable lifestyle was not associated with a higher risk of all-cause mortality either in women (HR=0.88; 95% CI: 0.49, 1.60) or in men (HR=0.95; 95% CI: 0.64, 1.40), similarly when considering cardiovascular mortality. In T2DM, while MVDs are more strongly associated with mortality risk in women than in men, adhering to a favorable lifestyle is associated with a substantially lower risk of mortality and may eliminate the detrimental impact of MVDs in both sexes.

Predictors Factors of Onset de Novo Heart failure after STEMI

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION STEMI gets complicated very often by a heart failure (HF), which it is important to know associated factors. The aim of this study was to determinate the predictor factors of onset of de novo HF after STEMI in patients with no prior history of heart failure recorded at baseline. METHODS A retrospective, descriptive study from 1 center in Morocco, including 210 patients hospitalized in a cardiology intensive care unit for STEMI from September 2019 to November 2020. The main outcomes were HF Killip class at hospital presentation and intra-hospital mortality. RESULTS The main age was 59.3 ± 7.02 and Sex ratio: 2, 86. The incidence of de novo HF at admission was higher in women (40, 4% vs. 29.5%, [OR 1, 61; 95%, [CI] 0, 83-3, 11). Forty-nine point eight percent were in Killip≥ 2. The method of early revascularization was Thrombolysis in 82, 3% compared to primary coronary angioplasty without significant difference in onset of the novo HF. There was no association of age, comorbidities, delay to hospital presentation and coronary involvement with incidence of onset of de novo HF. Women had higher mortality than men with the novo HF (28, 6% vs. 20.5%; OR: 1, 55; 95%). CONCLUSION Gender has appeared associated to onset of de novo HF after STEMI with a superiority of the female sex after controlling for others factors described in the literature. Anterior studies have related this to the increased prevalence of microvascular disease in women predisposing them to heart failure after STEMI.

Regression From Prediabetes to Normal Glucose Regulation and Prevalence of Microvascular Disease in the Diabetes Prevention Program Outcomes Study (DPPOS).

OBJECTIVERegression from prediabetes to normal glucose regulation (NGR) was associated with reduced incidence of diabetes by 56% over 10 years in participants in the Diabetes Prevention Program Outcomes Study (DPPOS). In an observational analysis, we examined whether regression to NGR also reduced risk for microvascular disease (MVD).RESEARCH DESIGN AND METHODSGeneralized estimating equations were used to examine the prevalence of aggregate MVD at DPPOS year 11 in people who regressed to NGR at least once (vs. never) during the Diabetes Prevention Program (DPP). Logistic regression assessed the relationship of NGR with retinopathy, nephropathy, and neuropathy, individually. Generalized additive models fit smoothing splines to describe the relationship between average A1C during follow-up and MVD (and its subtypes) at the end of follow-up.RESULTSRegression to NGR was associated with lower prevalence of aggregate MVD in models adjusted for age, sex, race/ethnicity, baseline A1C, and treatment arm (odds ratio [OR] 0.78, 95% CI 0.65–0.78, P = 0.011). However, this association was lost in models that included average A1C during follow-up (OR 0.95, 95% CI 0.78–1.16, P = 0.63) or diabetes status at the end of follow-up (OR 0.92, 95% CI 0.75–1.12, P = 0.40). Similar results were observed in examination of the association between regression to NGR and prevalence of nephropathy and retinopathy, individually. Risk for aggregate MVD, nephropathy, and retinopathy increased across the A1C range.CONCLUSIONSRegression to NGR is associated with a lower prevalence of aggregate MVD, nephropathy, and retinopathy, primarily due to lower glycemic exposure over time. Differential risk for the MVD subtypes begins in the prediabetes A1C range.

Prevalence of microvascular diseases among tertiary care Chinese with early versus late onset of type 2 diabetes

AimsThis study aimed to investigate the impact of early-onset diabetes on the risk of microvascular diseases in Chinese with type 2 diabetes mellitus (T2DM). MethodsA cross sectional survey of 29,442 patients with T2DM in 77 tertiary hospitals in China was conducted in 2011. Early-onset diabetes was defined as diagnosis of diabetes before 40years of age. Microvascular complications and risk factors were documented. Prevalence of microvascular disease was standardized to the Chinese population in 2010. Logistic regression analysis was performed to obtain odds ratios (OR) for early versus late onset of T2DM. ResultsA total of 1,303 (4.4%) patients had nephropathy, 2,137 (7.3%) had retinopathy and 3,012 (10.2%) had either of them. Early-onset diabetes greatly increased the prevalence of microvascular diseases compared with late-onset diabetes (nephropathy: 5.1% vs. 1.5%; retinopathy: 7.1% vs. 2.7%; either: 9.7% vs. 3.6%), especially among patients from 45 to 59years of age. After adjusting for age and sex, patients with early-onset T2DM were at 1.69-fold (95% CI 1.46–1.95) higher risk of microvascular diseases than those with late-onset T2DM. However, this was not significant after adjusting for traditional risk factors and disease duration (p=0.162). ConclusionChinese patients with early-onset T2DM are at a marked increased risk of microvascular diseases.

Diabetes Microvascular Disease and the Risk for bisphosphonate-related Osteonecrosis of the Jaw: A Single Center Study

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a severe bone disease for which the exact pathogenesis mechanisms are not fully understood. The objective of the study is to investigate a possible contribution of diabetes and microvascular disease to the pathophysiology of BRONJ. We identified 46 patients treated with bisphosphonates who were diagnosed with BRONJ based on their medical history during 2009 to 2012 and invited them for a dental assessment to confirm the diagnosis. Diabetes diagnosis was based on the American Diabetes Association criteria. The study group was compared to a control group of 38 patients treated with bisphosphonates without evidence of BRONJ. The study was conducted at Rambam Health Care Campus, a referral center, Haifa, Israel. The results of our study showed that of the 46 patients with BRONJ, 31 (67.4%) had diabetes or impaired fasting glucose. The proportion with diabetes (37%) was higher than in the control group (26.3%; P = .009). The presence of diabetes or impaired fasting glucose increased the association with BRONJ by 2.78-fold (confidence interval = 1.27-6.07, P = .009). The prevalence of microvascular disease (neuropathy, retinopathy, nephropathy) was significantly higher in the BRONJ than in the control group (P = .01). The presence of diabetic nephropathy increased the association with BRONJ by 3.9-fold (confidence interval = 1.12-13.52, P = .02). This retrospective study suggests an association between diabetes, perhaps mediated through microvascular complications, and the development of BRONJ.

PP.27 Micro-Vascular Disease at Booking in T1DM and Associated Risk of Developing Pre-Eclampsia

Background and AimsMicro-vascular disease affects the majority of T1DM patients and is directly related to both duration and glycemic control of diabetes. The aim of this study is to identify...

Frequencies and Related Factors for Microvascular Complications in Patients with Type 1 Diabetes

Purpose: We observed the frequencies of microvascular complications and their related factors in patients with type 1 diabetes. Methods: Two hundred seventy one patients (111 males and 160 females, mean age 21.9 ± 5.8 years) with type 1 diabetes were included. Subjects were all at least 10 years old and had diabetes for at least two years. Three types of microvascular complications (diabetic nephropathy, retinopathy, and neuropathy) were evaluated, and their frequen cies and risk factors were analyzed. Results: The overall prevalence of microvascular disease was 83/271 (30.6%). Microalbu­ minuria had developed in 39 patients (14.4%), persistent microalbuminuria in 31 patients (11.4%), and proteinuria in 12 (4.4%). Diabetic retinopathy had developed in 35 patients (12.9%) and neuropathy in 39 patients (13.7%). The mean HbA1c for 10 years was significantly higher in the patients with microvascular complications (10.5 ± 2.8% vs. 8.4 ± 1.4%). The rate of intensive management in the non­complication group was higher than in the microvascular complication group. The incidence of microalbuminuria was greater in males than females, but there were no gender differences in either diabetic retinopathy or neuropathy. Puberty and the duration of diabetes may be associated with microvascular complications. Conclusion: The incidence of microvascular complications in type 1 diabetes is declining. Sex, puberty, and the duration of diabetes as well as prolonged hypergly­ cemia are all related to microvascular complications. Therefore, intensive insulin mana­ gement and regular screening for microvascular complications should be performed in patients who have either entered into puberty or have had diabetes for more than 5 years.

Insulin resistance and microalbuminuria are associated with microvascular disease in patients with cirrhosis

Cardiovascular (CV) disease has a significant impact on post-liver transplantation (LT) survival. Finding surrogate markers for occult CV disease would improve CV assessment in the LT evaluation. This study was designed to determine the prevalence of microvascular disease (MVD) and the utility of both microalbuminuria and the homeostatic model for insulin resistance (HOMA-IR) for assessing the presence of MVD in potential LT recipients. In this study, we examined the prevalence of MVD in 72 diabetics and 71 nondiabetics; both groups were matched for age, sex, race, and etiology of cirrhosis while awaiting LT. We prospectively collected data including fasting serum insulin and glucose levels, urine creatinine and microalbumin, and macrovascular and microvascular complications. MVD was present in 58 (40.5%) patients; MVD was more common in diabetics (n = 45, 62.5%) than nondiabetics (n = 13, 18.3%). The presence of diabetes mellitus (DM; P = 0.03), insulin use (P = 0.002), and duration (months) of DM (85.3 +/- 96.1 versus 22.1 +/- 46.3, P < 0.0001), hypertension (51.3 +/- 101.5 versus 22.7 +/- 58.2, P = 0.03), and hypertriglyceridemia (7.2 +/- 17.4 versus 3.8 +/- 18.5, P = 0.04) were associated with MVD. Significant microalbuminuria had a sensitivity of 85%, a specificity of 100%, and a positive predictive value of 100% for the presence of MVD. HOMA-IR also was associated with MVD (P = 0.0001). In conclusion, at our center, 62.5% of DM patients and 18% of non-DM patients awaiting LT have MVD. Patients with DM, significant microalbuminuria, or an elevated HOMA-IR should undergo rigorous CV assessment prior to LT.

Albuminuria is a marker of increasing intracranial and extracranial vascular involvement in Type 2 diabetic Chinese patients.

Albuminuria has been reported to be a marker of cardiovascular risk factors and disease morbidity and mortality, but its relationship with intracerebral atherosclerotic disease is less clear. The aim of this study was to investigate the association between albuminuria and intracranial and extracranial vascular involvement in Chinese Type 2 diabetic patients. The anthropometric and fasting biochemical measurements of 966 Type 2 diabetic patients with normoalbuminuria (55.6%), microalbuminuria (27.7%) or macroalbuminuria (16.7%) were compared. The prevalence of microvascular and macrovascular disease and middle cerebral artery (MCA) stenosis, measured by transcranial Doppler ultrasound, were also compared between the groups. Albuminuria was closely associated with a range of adverse parameters, including high BP, dyslipidaemia, smoking and adiposity (all p<0.01). The prevalence of microvascular disease (retinopathy p<0.001) and macrovascular disease (peripheral vascular disease p=0.012, myocardial infarction, p=0.004, MCA stenosis p<0.001) increased significantly with increasing levels of albuminuria. Albuminuria was also found to be an independent predictor of microvascular and macrovascular disease. Albuminuria was an independent predictor of increasing levels of vascular risk factors and microvascular and macrovascular disease in this group of Type 2 diabetic patients, and a possible role for albuminuria as a marker of intracranial cerebrovascular disease should be further investigated.

Different risk factors of microangiopathy in patients with type I diabetes mellitus of short versus long duration. The EURODIAB IDDM Complications Study.

To identify factors associated with early development of and late protection from microvascular complications in subjects with Type I (insulin-dependent) diabetes mellitus. The frequency of microvascular complications and their relation to risk factors were studied in 300 Type I diabetic subjects with short duration of disease (< or = 5 years) compared with 1062 subjects with long duration (> or = 14 years). Microvascular disease was defined as the presence of either retinopathy (assessed from centrally-graded retinal photographs) or urinary albumin excretion rate of more than 20 micrograms/min. The prevalence of microvascular disease was 25% in the short duration group. In the long duration group 18% had no evidence of microvascular complications. In the short duration group factors associated with early development of complications were cigarette smoking and a family history of hypertension. Subjects free of microvascular complications in spite of long duration of diabetes had better glycaemic control, lower blood pressure, better lipid profile and lower von Willebrand factor levels. At the early stages of Type I diabetes, cigarette smoking and genetic susceptibility to hypertension are important risk factors for microvascular complications. At a later stage, additional risk factors are poorer glycaemic control, higher blood pressure, and an unfavourable lipid profile possibly associated with endothelial dysfunction. Many of these factors are amenable to long-term intervention which should be started as soon as possible in the course of the disease.

Prevalence of microvascular disease in patients with significant coronary artery disease.

Coronary flow velocity reserve (CFVR) measurement using intracoronary Doppler techniques has been increasing accepted for the assessment of physiological significance of epicardial stenosis and the functional changes after coronary interventions. However, large discrepancy exists concerning the acute changes of CFVR immediately after intervention. The purpose of this study was to investigate the prevalence of microvascular dysfunction in patients with significant coronary artery disease. Intracoronary Doppler flow measurements were performed in a total of 212 patients who underwent coronary interventions because of significant epicardial stenosis using 0.014" Doppler flow wire (Cardiometrics, Inc, Mountain View, CA). Intracoronary bolus injection of adenosine (12 micrograms for the right coronary and 18 micrograms for the left coronary arteries) was used to induce hyperemic reaction. CFVR was registered as the ratio of average peak velocity during hyperemia (hAPV) to at baseline (bAPV). Successful coronary interventions either by percutaneous transluminal coronary balloon angioplasty (PTCA) or by stenting could significantly improve the CFVR. In 80 patients with PTCA, the bAPV elevated from 16.6 +/- 2.1 cm/s to 20.6 +/- 13.4 cm/s and hAPV from 30.1 +/- 15.9 cm/s to 45.2 +/- 17.7 cm/s (both p < 0.001) with PTCA and the CFVR increased from 1.94 +/- 0.78 to 2.58 +/- 0.87 correspondingly (p < 0.001). Significant elevation of coronary flow parameters were also found in 132 patients with subsequent stent implantation (bAPV from 15.3 +/- 6.7 cm/s to 18.7 +/- 9.1 cm/s, hAPV from 28.7 +/- 14.4 cm/s to 44.3 +/- 17.7 cm/s and CFVR from 1.90 +/- 0.70 to 2.59 +/- 0.87, all p < 0.001). Reduction of CFVR (< 3.0) after intervention still existed in 46 (61.3%) of 80 patients after PTCA and 88 (66.7%) of 132 patients after stenting. Moreover, CFVR < 3.0 were found in 50 (45.9%) of 109 reference vessels in patients with single vessel disease. Significant improvement of coronary flow velocity and coronary flow velocity reserve could be obtained after successful angioplasty. However, microvascualr dysfunction existed in a large proportion of patients either in normal reference vessels or in target vessels after interventions.

Hypertension in Diabetes Study (HDS): II. Increased risk of cardiovascular complications in hypertensive type 2 diabetic patients.

To determine the degree to which hypertension is a risk factor for macrovascular and microvascular complications in type 2 diabetes. Observational prospective study. Newly diagnosed Type 2 diabetic patients recruited into the UK Prospective Diabetes Study (n = 3648; mean age 52 years), 40% of whom were hypertensive (blood pressure > or = 160 mmHg systolic and/or > or = 90 mmHg diastolic or already being treated for hypertension). The incidence of fatal and non-fatal major diabetes- and hypertension-related clinical events was determined over a median of 4.6 years' follow-up. The 3-year change in prevalence of subclinical indices of macrovascular and microvascular disease was assessed, including ECG abnormalities (Minnesota coding), left ventricular hypertrophy (ECG and chest x-ray), microalbuminuria (albumin/creatinine ratio) and moderately severe retinopathy (grading of retinal photographs). The hypertensive patients had (1) a greater incidence than normotensive patients of death from diabetes-related, mainly cardiovascular events (age-adjusted odds ratio 1.82) and (2) a greater incidence of diabetes-related death and major morbidity combined, including myocardial infarctions, angina, strokes and amputation (age-adjusted odds ratio 1.56). These associations were still present after allowance for other risk factors present at the time diabetes was diagnosed. The change in the prevalence of microvascular disease over 3 years was similar in both hypertensive and normotensive subjects. Hypertension is a major risk factor for cardiovascular morbidity and mortality in type 2 diabetes. Comparison with other studies suggests that patients with both hypertension and diabetes have approximately four times the cardiovascular risk of non-diabetic non-hypertensive subjects. Antihypertensive therapy may provide greater benefit in this high-risk group than in the general population.