Previous Diagnosis Of Diabetes Mellitus Research Articles

Ramipril: a review of its use in the prevention of cardiovascular outcomes.

Ramipril, an angiotensin-converting enzyme (ACE) inhibitor, is a prodrug which is rapidly hydrolysed after absorption to the active metabolite ramiprilat. Earlier trials have shown that ACE inhibitors, when given to patients with low ejection fractions, have reduced the relative risk of myocardial infarction (MI) and other ischaemic events by 14 to 23%. Subsequently, the double-blind, randomised, placebo-controlled, multicentre Heart Outcomes Prevention Evaluation (HOPE) study has shown that, in patients who are not known to have low ejection fraction or heart failure but are at increased risk for developing cardiovascular events, ramipril reduced the incidence of stroke, MI and death due to cardiovascular disease. Results from the HOPE study, in which 9297 patients were randomised to receive either ramipril 10 mg/day or placebo for a mean of 4.5 years, indicate that ramipril reduced the relative risk of the composite outcome of MI, stroke and cardiovascular death by 22%. The incidence of the composite outcome was significantly lower in the ramipril group than in the placebo group (14.0 vs 17.8%). Patients who received ramipril, compared with placebo recipients, had a significantly decreased incidence of stroke, MI or death due to cardiovascular disease (3.4 vs 4.9%, 9.9 vs 12.3% and 6.1 vs 8.1%, respectively). The relative risk of death from any cause was reduced among patients who received ramipril. In addition, treatment with ramipril reduced as the incidence of revascularisation procedures, and, among patients with diabetes mellitus, ramipril reduced the incidence of complications related to diabetes mellitus, including the development of overt nephropathy. Moreover, in patients without a previous diagnosis of diabetes mellitus, ramipril, compared with placebo, significantly reduced the development of diabetes mellitus. Furthermore, compared with patients receiving placebo, patients receiving ramipril had a reduced rate of progression of carotid artery wall thickness. Ramipril 10 mg/day can significantly reduce the incidence of MI, stroke or death from cardiovascular causes in patients aged > or =55 years who are at increased risk for the development of ischaemic cardiovascular events due to a history of stroke, coronary artery disease (with controlled blood pressure), diabetes mellitus plus at least one other risk factor or peripheral vascular disease but no heart failure or low ejection fraction. Therefore, in addition to dietary and lifestyle modifications, ramipril should be an integral part of secondary prevention therapy in patients at increased risk for the development of cardiovascular events.

Diabetes mellitus is a strong negative prognostic factor in patients with myocardial infarction treated with thrombolytic therapy.

To assess the long-term prognostic values of baseline demographic data, occurrence of vectorcardiographic signs of reperfusion, left ventricular function and coronary angiographic features. Longitudinal study of morbidity and mortality. Coronary care unit at Danderyd Hospital, Stockholm, Sweden. A total of 222 patients (mean age 61 years) with a suspected acute myocardial infarction treated with thrombolysis were investigated and followed for 2-5 years (mean 1216 days). Death or a new myocardial infarction. Age above 55 years (P < 0.05), a previous diagnosis of diabetes mellitus (P < 0.005), hypertension (P < 0.05), heart failure (P < 0.001) and myocardial infarction (P < 0.05), a previous use of beta-blockers (P < 0.05) and an ejection fraction below 60% (P < 0.01) were predictors for death or a new myocardial infarction in univariate analysis. Sex, a previous history of smoking or angina pectoris, vectorcardiographic signs of reperfusion or degree of coronary artery disease had no prognostic values. In multivariate analysis including age above 55 years, a previous diagnosis of diabetes mellitus, hypertension and myocardial infarction, and an ejection fraction below 60%, only age (P < 0.05), diabetes mellitus (P < 0. 01) and ejection fraction (P < 0.05) were predictors for death or a new myocardial infarction. The results of the present study emphasize the importance of diabetes mellitus as a long-term prognostic risk factor in patients with myocardial infarction treated with thrombolysis. Further studies are needed to determine the mechanisms behind this increased risk.

A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women

Little is known about the effects of the amount and type of carbohydrates on risk of coronary heart disease (CHD). The objective of this study was to prospectively evaluate the relations of the amount and type of carbohydrates with risk of CHD. A cohort of 75521 women aged 38-63 y with no previous diagnosis of diabetes mellitus, myocardial infarction, angina, stroke, or other cardiovascular diseases in 1984 was followed for 10 y. Each participant's dietary glycemic load was calculated as a function of glycemic index, carbohydrate content, and frequency of intake of individual foods reported on a validated food-frequency questionnaire at baseline. All dietary variables were updated in 1986 and 1990. During 10 y of follow-up (729472 person-years), 761 cases of CHD (208 fatal and 553 nonfatal) were documented. Dietary glycemic load was directly associated with risk of CHD after adjustment for age, smoking status, total energy intake, and other coronary disease risk factors. The relative risks from the lowest to highest quintiles of glycemic load were 1.00, 1.01, 1. 25, 1.51, and 1.98 (95% CI: 1.41, 2.77 for the highest quintile; P for trend < 0.0001). Carbohydrate classified by glycemic index, as opposed to its traditional classification as either simple or complex, was a better predictor of CHD risk. The association between dietary glycemic load and CHD risk was most evident among women with body weights above average ¿ie, body mass index (in kg/m(2)) >/= 23. These epidemiologic data suggest that a high dietary glycemic load from refined carbohydrates increases the risk of CHD, independent of known coronary disease risk factors.

Vitreous humor fructosamine concentrations in the autopsy diagnosis of diabetes mellitus.

In clinical practice, biochemical markers, particularly serum glucose levels are used to diagnose diabetes mellitus. However, at autopsy this marker is of no value due to the substantial and capricious fluctuations in glucose levels after death. The aim of this study was to evaluate the usefulness of the postmortem determination of fructosamine in vitreous humor for confirming the presence of antemortem hyperglycemia. This was a study of 92 cadavers with a mean age of 60.05 years (SD 17.73) and a mean postmortem interval of 17.02 h (SD 9.76, range 2-58 h). Cases were assigned to two diagnostic groups according to the antemortem diagnosis of diabetes mellitus based on the patients' medical records. In vitreous humor statistically significant differences were found in glucose and fructosamine concentrations between the two diagnostic groups, the highest values being obtained in the group of subjects with a previous diagnosis of diabetes mellitus.

29 Is there a neurochemical link between vascular dementia and Alzheimer's disease?

The prevalence of dementia is predicted to increase rapidly in developing countries. Vascular risk factors may contribute to this rise. Our aim was to estimate the proportions of Alzheimer's disease (ADD) and vascular dementia (VAD) in a prevalent cohort of dementia cases in rural Tanzania.A two-stage door-to-door dementia prevalence study.Hai district, TanzaniaIn Phase I, the Community Screening Instrument for Dementia (CSI-D) was used to screen 1198 community-dwelling people for dementia. In Phase II, 168/184 (91.3%) of those with poor performance, 56/104 (53.8%) of those with intermediate performance and 72/910 (7.9%) of those with good performance on CSI-D were interviewed and diagnoses were made using the DSM-IV criteria.For subtype diagnosis, DSM-IV dementia criteria plus NINCDS-ADRDA criteria were used for ADD and NINDS-AIREN criteria for VAD. Other dementias were diagnosed by international consensus criteria. Diagnoses were confirmed or excluded by computerised tomography where clinically appropriate.Of 78 dementia cases, 38 (48.7%) were ADD and 32 (41.0%) were VAD. The crude prevalence of ADD was 3.7% (95% CI 2.5 to 4.9) and of VAD was 2.9% (95% CI 1.9 to 3.9). The age-adjusted prevalence was 3.0% (95% CI 1.8 to 4.2) for ADD and 2.6% (95% CI 1.6 to 3.6) for VAD. A previous diagnosis of diabetes mellitus was independently associated with greater odds of having VAD than ADD.VAD accounted for a greater proportion of dementia cases than expected. Further investigation and treatment of risk factors is required in this setting.

Breast cancer risk and history of selected medical conditions linked with female hormones

The relation between history of several medical conditions and procedures and risk of breast cancer was evaluated in data from a hospital-based case-control study of 2663 cases of breast cancer and 2344 controls with acute conditions unrelated to any of the established or potential risk factors for breast cancer. Whereas previous diagnosis of diabetes mellitus, thyroid disease, hypertension at any age, hyperlipidaemia, cholelithiasis, pelvic inflammatory disease and physician-diagnosed subfertility were unrelated to cancer risk, history of severe obesity in postmenopausal women (odds ratio [OR] 1.4), benign breast disease (OR 1.8) and history of breast biopsies (OR 2.4) were associated with significant risk elevation. Conversely, lifelong history of menstrual irregularities (OR 0.6) seemed to confer some protection against onset of breast cancer. This study supports the hypothesis that, unlike endometrial cancer, breast cancer risk is not enhanced by medical conditions known or suspected to be linked with female hormones, with the exception of benign breast disease and severe overweight in postmenopausal women.

Clinical evaluation of Ménière's disease.

A retrospective review of 211 consecutive patients with classic Meniere's disease was performed to determine the efficacy of diagnostic studies. The patients' ages averaged 47 years and ranged between 8 and 86 years. Females outnumbered males 1.3 to 1. Left and right ears were affected with equal frequency and, in 12% of patients, the disease was bilateral. Audiologic patterns were flat in 42%, rising in 7%, peaked in 32%, and sloping downward in the remaining 19%. Electronystagmography was normal in 21% of the patients and demonstrated canal paresis in 65% and directional preponderance in 14%. Studies of glucose metabolism were abnormal in 2 of the 204 patients tested. The 7 patients not tested had a previous diagnosis of diabetes mellitus. Thyroid function studies were abnormal in 1 of the 208 patients studied. The 3 patients not studied were known hypothyroid. FTA-abs was positive in 12 patients and special radiographic studies of the petrous apex were normal in all cases. Conclusions suggested by this study are that audiology, electronystagmography, and treponemal antigen tests for syphilis are cost effective in evaluating patients with Meniere's disease. Studies of glucose metabolism and thyroid function, however, are probably not indicated in patients without a history suggestive of a metabolic disorder and specialized radiographs of the petrous apex should be reserved for patients suspected of having acoustic neuroma.