Risk Factors For Vascular Complications Research Articles

Prevalence, treatment efficacy, and risk factors of vascular complications in acute pancreatitis: A case-control study.

We aimed to investigate the prevalence of vascular complications in acute pancreatitis (AP), to compare patient outcomes using various treatments, and to explore the related risk factors. Consecutive AP patients admitted from January 2010 to July 2017 were retrospectively included. Demographics, vascular complications, laboratory indices, and imaging findings were collected. Univariate and multivariate analyses were used to explore potential risk factors of vascular complications. Of 3048 AP patients, 808 (26.5%) had vascular complications, including visceral vein thrombosis, sinistral portal hypertension, and arterial complications. And 38 (4.7%) patients received anticoagulant therapy and had a higher rate of recanalization (P < 0.001). Bleeding occurred in 95 (11.8%) patients, who received further treatment. Multivariate analysis identified male gender (odds ratio [OR] 1.650, 95% confidence interval [CI] 1.101-2.472), hyperlipidemia (OR 1.714, 95% CI 1.356-2.165), disease recurrence (OR 3.727, 95% CI 2.713-5.118), smoking (OR 1.519, 95% CI 1.011-2.283), hemoglobin level (OR 0.987, 95% CI 0.981-0.993), white blood cell (WBC) count (OR 1.094, 95% CI 1.068-1.122), non-vascular local complications (OR 3.018, 95% CI 1.992-4.573), computed tomography severity index (CTSI) (OR 1.425, 95% CI 1.273-1.596), and acute physiology and chronic health evaluation (APACHE) II score (OR 1.057, 95% CI 1.025-1.090) were related to vascular complications. Vascular complications in AP is prevalent and their treatment is challenging. Further investigations are warranted to determine the optimal treatment strategy. Independent risk factors included male gender, hyperlipidemia, disease recurrence, smoking, WBC count, non-vascular local complications, CTSI, and APACHE II score.

Renal anatomical classification systems cannot predict the occurrence of vascular complications after partial nephrectomy.

To determine the relationship between renal tumor complexity and vascular complications after partial nephrectomy using PADUA, RENAL, and ZS scores. Between January 2007 and December 2018, a total of 1917 patients with available cross-sectional imaging were enrolled in the study. Logistic regressions were used to identify independent predictors of vascular complications. Of 1917 patients, 31 (1.6%) developed vascular complications, including 10 females and 21 males. The high-complexity category was significantly associated with a decreased risk of vascular complication in PADUA (OR = 0.256; 95%CI = 0.086-0.762; P = 0.014) and ZS score (OR = 0.279; 95%CI = 0.083-0.946; P = 0.040). Laparoscopic partial nephrectomy and robot-assisted laparoscopic partial nephrectomy were independent risk factors for vascular complications. Meanwhile, the incidence was significantly reduced in the recent 4years in the high score tumor group alone in PADUA (0.2% [1/474] vs. 2.2% [3/139], P = 0.038) and ZS score (0.2% [1/469] vs. 2.7% [3/112], P = 0.024). In the first 8years, laparoscopic partial nephrectomy and robot-assisted laparoscopic partial nephrectomy were the only two independent risk factors for vascular complications. In the recent 4years, only the high-complexity category was significantly associated with a decreased risk of vascular complication in the PADUA score (OR = 0.110; 95%CI = 0.013-0.938; P = 0.044). The renal anatomic classification system cannot predict the occurrence of vascular complications after partial nephrectomy.

491 Clinical and Radiographic Features of Mesenteric Ischemia after Intra-Aortic Balloon Pump Placement

OBJECTIVES/GOALS: Intra-aortic balloon pumps are commonly used as circulatory support in patients with critically reduced cardiac function. The goal of this study is to estimate the incidence of mesenteric ischemia as an understudied vascular complication and to describe the clinical and radiographic characteristics of patients experiencing this complication. METHODS/STUDY POPULATION: We will be conducting a retrospective analysis of the electronic medical records of all patients who underwent intra-aortic balloon pump (IABP) placement between October 2020 and April 2023 at our academic medical center to identify the incidence of mesenteric ischemia. We will describe the clinical course of these patients and characterize them based on demographic features and risk factors for vascular complications including medical comorbidities. Finally, we will assess available chest x-ray and thoracoabdominal CT imaging for adequacy of balloon tip positioning, concordance between balloon size and aortic dimensions, and compromise of any visceral arteries in patients who experienced mesenteric ischemia vs. those who did not. RESULTS/ANTICIPATED RESULTS: We anticipate approximately 150 patients to have recieved IABPs over this period with at least 4 known cases of mesenteric ischemia. We will describe the clinical presentation of these cases and their often fatal outcomes. We expect several known risk factors will be present in these patients, including history of peripheral vascular disease, diabetes, or smoking history. On chest x-ray, we predict balloon tip positioning to be suboptimal (defined as &gt;5cm below the aortic arch) in many patients, both those with mesenteric ischemia and those without, but a greater discordance on CT imaging between balloon size and aortic dimensions with greater evidence of visceral compromise in patients with mesenteric ischemia compared to those without. DISCUSSION/SIGNIFICANCE: Mesenteric ischemia is a serious and poorly studied complication of intra-aortic balloon pumps. Understanding the hospital course, clinical characteristics, and radiographic features present in these patients may guide clinicians in the early recognition and management of this potentially fatal complication.

Hyperhomocysteinemia is a risk factor for vascular complications in patients with chronic kidney disease

Hyperhomocysteinemia is considered a risk factor for many diseases, including thrombosis. Patients with chronic kidney disease often have vascular complications in the form of arterial or venous thrombosis, and it is important to consider the blood homocysteine level as a predictor of thrombophilia. The causes of hyperhomocysteinemia can be both genetic mutations and deficiency of homocysteine metabolism enzymes, as well as deficiency of folic acid, vitamin B12 and, to a lesser extent, deficiency of vitamin B6, which affects methionine metabolism. Given the role of hyperhomocysteinemia as a predictor of cardiovascular events in patients with kidney diseases, in our opinion, the multifactorial nature of increased homocysteine requires further research into some links of its pathogenesis in chronic kidney disease and the development of targeted therapeutic interventions.

Management of intervenable factors to reduce vascular complications in patients with internal carotid artery occlusion treated by non-emergency endovascular treatment.

This study aims to identify risk factors for vascular complications during non-emergency endovascular treatment in patients with internal carotid artery occlusion (ICAO) and to propose potential interventions. A retrospective analysis of 92 patients with ICAO who received non-emergency endovascular treatment in our center from 1 January 2018 to 31 June 2023, was conducted. The correlation between intraoperative vascular complications and potential risk factors was studied, and interaction analysis was performed. Our findings revealed that the use of non-neurology guide wires to open vessels (adjusted OR: 4.1, 95%CI: 1.3-12.8; p = 0.014) and glycosylated hemoglobin (HbA1c) ≥ 6.5 mmol/L (adjusted OR: 3.2, 95%CI: 1.2-8.9; p = 0.023) was significantly associated with vascular complications in non-emergency endovascular treatment of ICAO patients. The restricted cubic spline (RCS) showed that the higher the HbA1c level, the higher the risk of vascular complications. The use of non-neurology guide wires for vessel opening during non-emergency endovascular treatment in patients with ICAO increases the risk of vascular complications. Preoperative assessment and management of HbA1c levels can reduce the incidence of intraoperative vascular complications.

Characteristics of hypertension in type 2 Diabetes mellitus patient at Internal Medicine Outpatient Clinic Prof. Dr. I. G. N. G. Ngoerah General Hospital in 2022

Type 2 diabetes mellitus (DM) is a chronic disease that often occurs alongside hypertension. Hypertension itself is a risk factor for vascular complications related to type 2 DM which will reduce the patient's quality of life in the long term. This study aims to determine the characteristics of hypertension in type 2 DM patients. The research design was descriptive observational study using a total sampling technique by taking secondary data from medical record. The research sample was type 2 DM patients at the Internal Medicine Outpatient Clinic Prof. Dr. I. G. N. G. Ngoerah General Hospital in 2022 who meets the inclusion and exclusion criteria. Data analysis using Microsoft Excel and SPSS programs. Of the total 154 samples, hypertension in type 2 DM was mostly found in the 50-59 year age group (43.5%), male gender (62.3%) with duration of type 2 DM in the category &lt;10 years (84.4%), normal total cholesterol levels (67.5%), abnormal LDL cholesterol levels (67.5%), normal triglyceride levels (59.1%), abnormal HDL cholesterol levels (63%) and normal e-LFG levels (51.9%). Further analysis is needed to determine the relationship between research variables and treatment history for dyslipidemia and kidney disease.

Prediction of vascular complications in free flap reconstruction with machine learning.

This study aims to explore the risk factors of vascular complications following free flap reconstruction and to develop a clinical auxiliary assessment tool for predicting vascular complications in patients undergoing free flap reconstruction leveraging machine learning methods. We reviewed the medical data of patients who underwent free flap reconstruction at the Affiliated Hospital of Zunyi Medical University retrospectively from January 1, 2019, to December 31, 2021. Statistical analysis was used to screen risk factors. A training data set was generated and augmented using the synthetic minority oversampling technique. Logistic regression, random forest and neural network, models were trained, using this dataset. The performance of these three predictive models was then evaluated and compared using a test set, with four metrics, area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity. A total of 570 patients who underwent free flap reconstruction were included in this study, 46 of whom developed postoperative vascular complications. Among the models tested, the neural network model exhibited superior performance on the test set, achieving an AUC of 0.828. Multivariate logistic regression analysis identified that preoperative hemoglobin levels, preoperative fibrinogen levels, operation duration, smoking history, the number of anastomoses, and peripheral vascular injury as statistically significant independent risk factors for vascular complications post-free flap reconstruction. The top five predictive factors in the neural network were fibrinogen content, operation duration, donor site, body mass index (BMI), and platelet count. Hemoglobin levels, fibrinogen levels, operation duration, smoking history, and anastomotic veins are independent risk factors for vascular complications following free flap reconstruction. These risk factors enhance the ability of machine learning models to predict the occurrence of vascular complications and identify high-risk patients. The neural network model outperformed the logistic regression and random forest models, suggesting its potential to aid clinicians in early identification of high-risk patients thereby mitigating patient suffering and improving prognosis.

Complications after percutaneous transluminal coronary angioplasty and associated factors

This study aimed to analyze the incidence of vascular complications and associated factors in patients undergoing elective percutaneous transluminal coronary angioplasty. This study is observational, quantitative, and longitudinal, and followed 50 patients undergoing elective percutaneous transluminal coronary angioplasty. An instrument for the sociodemographic, clinical, procedure, and vascular complications characterization was used for data collection. And descriptive statistics, bivariate analysis, and multiple binomial logistic regression were used for data analysis. The level of statistical significance considered was 95%. It was detected the prevalence of male patients (70%), elderly (54%), and diagnosed with systemic arterial hypertension (72%). As for the percutaneous access route prevailed the radial approach (64%). Age and body mass index were identified as possible risk factors for vascular complications. In the 50 procedures performed, there was a prevalence of hematomas (20%) and bleeding (10%). Among the complications prevailed radial Early Discharge After Transradial Stenting of Coronary (60%), large femoral hematoma (20%), small femoral hematoma (20%), and bleeding (Bleeding Academic Research Consortium 2) (100%). The results concluded an elevated incidence of vascular complications in the first 24 hours after elective percutaneous transluminal coronary angioplasty. This study contributes to research, assistance, and training in health and nursing by identifying post-PTCA vascular complications, minimizing their progression, handling their management, and developing health care safety protocols.

Risk factors for lower extremity vascular complications in adult patients on veno-arterial extracorporeal membrane oxygenation

ObjectiveUtilization of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has increased significantly over the last decade. Prior studies have reported worse mortality for patients with vascular complications on VA-ECMO; however, these were limited by small sample size. The purpose of this study is to investigate predictive risk factors for vascular complications in VA-ECMO patients and their potential impact on mortality. MethodsPatients who underwent peripheral VA-ECMO from January 2011 to December 2021 were identified. Primary outcomes were lower extremity vascular complications and in-hospital mortality. Multivariate stepwise logistic regression models were used to identify predictors of vascular complications and in-hospital mortality. ResultsA total of 605 VA-ECMO patients (25% female) were identified. The mean age was 56.3 ± 13 years, and 56 (10.4%) were black. In-hospital mortality was 63.8% (n = 386), and VA-ECMO ipsilateral vascular complications occurred in 72 patients (11.9%). Vascular surgical interventions (thromboembolectomy, fasciotomies, amputation, and surgical management of cannula bleeding) were required in 30 patients (41.7%). Same-side arterial and venous cannulas, cannula size, and absence of distal perfusion cannula did not increase risk of vascular complication. Multivariate analysis identified age (odds ratio, 0.948; 95% confidence interval, 0.909-0.988; P = .0116) and pre-existing peripheral arterial disease (odds ratio, 3.489; 95% confidence inteval, 1.146-10.624; P = .0278) as independent predictors of need for vascular surgery interventions. The mortality rate of patients who developed vascular complications was not significantly different compared with the mortality rate of those who did not develop vascular complications (61% vs 64%; P = .92). ConclusionsThis study represents one of the largest series to date of lower extremity vascular outcomes in patients undergoing VA-ECMO. Our results confirm the high mortality rate associated with VA-ECMO; however, vascular complications did not represent a risk factor for mortality as previously reported. Same-sided VA-ECMO cannulas, cannula size, and the presence or absence of distal perfusion cannula did not predict vascular complications. Increasing age and presence of peripheral arterial disease are independent predictors of need for vascular surgery intervention in patients on VA-ECMO.

SARS-CoV-2 infection increases risk of intracranial hemorrhage.

SARS-CoV-2 virus infection causes a dysbalanced and severe inflammatory response, including hypercytokinemia and immunodepression. Systemic inflammation triggered by a viral infection can potentially cause vascular damage, which may lead to cardiovascular and neurovascular events. The aim was to investigate whether CNS complications are related to COVID-19. We examined 21 patients suffering from stroke and intracranial hemorrhage (ICH) and 9 (43%) of them were male. We compared relative frequencies using Fisher's exact test. As we had few observations and many variables, we used principal component analysis (PCA) to reduce data dimensionality. We trained a linear support vector machine (SVM) on the first two PCs of the laboratory data to predict COVID-19. Patients suffering from stroke had either hypertension or SARS-CoV-2 infection, but seldom both (OR = 0.05, p = 0.0075). The presence of SARS-CoV-2 infection was strongly associated with the logarithm of CRP (p = 1.4e-07) and with D-DIMER (p = 1.6e-05) and moderately with PT (p = 0.0024). SARS-CoV-2 infection was not related to any other factor. CRP, D-DIMER, PT, and INR were all related to each other (R 2 ranging from 0.19 to 0.52, p ranging from 0.012 to < 0.0001). The first two PCs covered 96% of the variance in the four variables. Using them, perfect linear discrimination between patients suffering from COVID-19 and other patients could be achieved. SARS-CoV-2 infection causes systemic inflammation, which is suggested as a predictor of the severe course of ICH. SARS-CoV-2 infection is an additional risk factor for vascular complications.

Risk Factors For Lower Extremity Vascular Complications In Patients On Veno-arterial Extracorporeal Membrane Oxygenation

Utilization of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has increased significantly over the last decade. Prior studies have reported worse mortality for patients with vascular complications on VA-ECMO; however, these were limited by small sample size. We sought to investigate predictive risk factors for vascular complications in VA-ECMO patients and their potential impact on mortality.

Predictors of thrombosis and bleeding in 1613 myelofibrosis patients from the Spanish Registry of Myelofibrosis

Available data have proved insufficient to develop consensus recommendations on the prevention of thrombosis and bleeding in myelofibrosis (MF). We evaluated the incidence and risk factors of vascular complications in 1613 patients from the Spanish Myelofibrosis Registry. Over a total of 6981 patient-years at risk, 6.4% of the study population had at least one thrombotic event after MF diagnosis, amounting to an incidence rate of 1.65 per 100 patient-years. Prior history of thrombosis, the JAK2 mutation, and the intermediate-2/high-risk International Prognostic Scoring System (IPSS) categories conferred an increased thrombotic risk after adjustment for the risk-modifying effect of anti-thrombotic and cytoreductive treatments. History of thrombosis and the JAK2 mutation allowed us to pinpoint a group of patients at higher risk of early thrombosis. No decreased incidence of thrombosis was observed while patients were on anti-thrombotic or cytoreductive treatment. An increased risk of venous thrombosis was found during treatment with immunomodulatory agents. A total of 5.3% of patients had at least one episode of major bleeding, resulting in an incidence rate of 1.5 events per 100 patient-years. Patients in the intermediate-2/high-risk IPSS categories treated with anti-coagulants had an almost sevenfold increased risk of major bleeding. These findings should prove useful for guiding decision-making in clinical practice.

Vascular Complications in Children Following Button Battery Ingestions: A Systematic Review.

Children presenting to health care facilities with button battery (BB) impaction. To describe characteristics of children with vascular complications after BB impaction, as well as associated outcomes. National Capital Poison Center registry and PubMed database from inception to December 2021. All reports describing children aged <18 years with vascular, esophageal, or airway complications after BB ingestion. We extracted characteristics including date of publication, age and sex of child, battery type and size, duration and location of impaction, complications, subsequent interventions, and interval between battery removal and death. A total of 361 cases involved severe complications or death after BB ingestion (321 cases from the National Capital Poison Center registry database, 40 additional cases from PubMed). Nineteen percent (69 of 361) were fatal and 14% (51 of 361) involved vascular injuries. Three-quarters (75%) of vascular complications were aorto-esophageal fistulae and 82% of vascular injuries were not survivable. Fatal vascular cases had significantly longer median impaction time (96hours versus 144 hours, P <.05) and a wider range of presenting features than survivors. The total number of cases with vascular complications was small, data reported varied between cases, and no data were available on overall exposure. Long-term morbidity data were not available for the survivors. Prolonged BB impaction is a risk factor for vascular complications and death. A high index of suspicion is required for children representing with hematemesis after BB impaction, with prompt transfer to a tertiary center because vascular surgical intervention may offer a chance of survival.

An Analysis of the Implantable Doppler Probe for Postoperative Free-Flap Monitoring and Risk Factor Analysis for Revision Surgery in Facial Reanimation Surgery.

Background: Postoperative monitoring after free functional gracilis transfer for smile reconstruction in long-standing facial paralysis is challenging as clinical assessments are limited. Objective: In patients receiving free gracilis transfer for smile reconstruction, we compared the implantable Doppler probe with a handheld Doppler/intraoperative blood flow regarding the reliability in detecting perfusion compromised free flaps. Methods: In a retrospective cohort study we analyzed facial paralysis patients who, after free functional smile reconstruction, were postoperatively monitored using the implantable Doppler probe. Furthermore, we conducted a multiple logistic regression analysis on risk factors for vascular complications. Results: We included 119 patients who received 125 free functional gracilis transfers. The sensitivity of the implanted Doppler probe was 1.0 and the specificity 0.88. There were no false-negative results (negative predictive value = 1.0). The calculated positive predictive value was 0.41. We used a handheld Doppler device to verify signal changes. The combined positive predictive value of both tests was 0.91. Previous surgery in the surgical field was a risk factor for impaired blood flow. Conclusions: The implantable Doppler probe proved to be a reliable tool for postoperative monitoring of free functional gracilis transfer in facial reanimation surgery. Special care should be taken in preoperated patients.

Prevalence and risk factors of vascular complications in type 2 diabetes mellitus: Results from discover Middle East and Africa cohort.

BackgroundWe evaluated the prevalence of vascular complications and associated risk factors in individuals with type 2 diabetes mellitus (T2DM) initiating second-line glucose-lowering therapy from the Middle East and Africa (MEA) cohort of the 3-year prospective DISCOVER study involving 15,992 patients in 38 countries.MethodsBaseline cross-sectional data collected from healthcare settings were used to assess micro and macrovascular complications prevalence as crude and age- and sex-standardised. The multi‐variable analysis assessed factors associated with these complications.ResultsOf 3,525 enrolled patients (mean age: 54.3 ± 10.8 years), >40% had hypertension and hyperlipidaemia. Metformin monotherapy was the first-line therapy in 56.5%, followed by metformin+sulphonylurea (20.3%). Crude and standardised prevalence of microvascular complications were 17.7% and 16.9% (95% confidence interval [CI], 16.77‐16.98) and macrovascular complications were 10.7% and 8.7% (95% CI, 8.59–8.76). Factors significantly (p<0.05) associated with micro and macrovascular complications (odds ratios [95% CI]) were age (1.24 [1.12–1.39] and 1.58 [1.35–1.84]), male sex (1.33 [1.04‐1.70] and 1.71 [1.22–2.40]), hyperlipidaemia (1.33 [1.07-1.65] and 1.96 [1.46-2.63]) and hypertension (1.75 [1.40–2.19] and 2.84 [2.07-3.92]).ConclusionA substantial burden of vascular complications with prominent risk factors in the MEA cohort calls for early preventive interventions.

Survival and risk of vascular complications in myelofibrosis-A population-based study from the Swedish MPN group.

To gain knowledge of underlying risk factors for vascular complications and their impact on life expectancy in myelofibrosis. From a cohort of 392 myelofibrosis patients registered in the Swedish MPN registry 58 patients with vascular complications during follow-up were identified. Patients with vascular complications were compared with both 1:1 matched controls and the entire myelofibrosis cohort to explore potential risk factors for vascular complications and their impact on survival. Incidence of vascular complications was 2.8 events per 100 patient-years and the majority of complications were thrombotic. Patients with complications were significantly older and had lower hemoglobin when compared to the entire cohort. In the case-control analysis, no significant risk factor differences were observed. The major cause of death was vascular complications and median survival was significantly impaired in patients with vascular complications (48 months) compared to controls (92 months). Inferior survival in patients with vascular complications was found to be dependent on IPSS risk category in a Cox regression model. Vascular complications have a considerable impact on survival in MF. At diagnosis, risk assessment by IPSS does not only predict survival but is also associated with the risk of vascular complications.

MO968: Vascular Complications of Renal Transplantation: Risk Factors and Impact on Graft Survival

Abstract BACKGROUND AND AIMS Despite the progress made in renal transplantation, vascular complications can occur, jeopardizing the prognosis of the transplant. This study aims to investigate the risk factors of vascular complications and their impact on transplant survival. METHOD We performed a retrospective longitudinal descriptive study including all patients who had a kidney transplant in a Urology department from 1986 to 2017. Transplant Vascular complications included: Arterial thrombosis (AT), Venous thrombosis (VT), hemorrhagic complications (hemorrhage and hematoma) and arterial stenosis (AS). The potential risk factors for vascular complications that were investigated included characteristics related to the recipient, the donor, the transplant and the procedure. The impact of vascular complications on transplant survival was then studied. RESULTS A total of 720 patients were included with a mean age of 32.7 years. The transplant was from a living donor in 79% and a brain-dead donor in 21%. AT occurred in 15 patients (2.1%) and VT occurred in 10 patients (1.4%). Risk factors for vascular thrombosis were recipient age &amp;gt;35 years (P = 0.001; OR = 10.78), recipient smoking (P = 0.005; OR = 1.8), multiple arteries (P &amp;lt; 0.001; OR = 1.45) and prolonged warm ischemia (P = 0.02). Perirenal hematoma occurred in 11 patients (1.5%) and hemorrhage occurred in six patients (0.8%). The risk factors for bleeding complications were a prolonged pre-transplantation dialysis time (P = 0.03; OR = 1.35), and prolonged warm ischemia (P = 0.02; OR = 1.26). AS was the most frequent vascular complication, occurring in 20 cases (2.8%) and no risk factors were identified. Transplant survival was 77.9% at 5 years, with a median survival of 15.9 years. Vascular thrombosis led to the loss of the transplant in all cases, and externalized hemorrhage significantly reduced transplant survival (P &amp;lt; 0.001). Perirenal hematoma (P = 0.42) and transplant artery stenosis (P = 0.25) had no impact on transplant survival (Figure 1). CONCLUSION Our study showed that the vascular complications impacted the survival of the transplant and that they were related to factors related to the recipient, the transplant and the procedure insisting on a multidisciplinary and personalized management for each case.

IDF21-0174 Prevalence and Risk Factors of Vascular Complications in Type 2 Diabetes: DISCOVER Study-Middle East and Africa Cohort

Background: Vascular complications predominantly contribute to the burden in people with type 2 diabetes mellitus (T2DM), with nearly a third of adults worldwide affected with cardiovascular disease (CVD). Therefore the assessment of CVD and risk factors is key in T2DM management. Aim: To evaluate the prevalence of vascular complications and associated risk factors in people with T2DM initiating second-line glucose-lowering therapy in Middle East and Africa (MEA) cohort of the global DISCOVER study (NCT02322762; NCT02226822), a 3-year prospective observational study involving 15 992 patients in 38 countries. Method: Baseline cross-sectional analysis of MEA cohort (Algeria, Bahrain, Egypt, Jordan, Kuwait, Lebanon, Oman, Saudi Arabia, South Africa, Tunisia, Turkey and United Arab Emirates), describing microvascular and macrovascular complications prevalence and associated factors in T2DM patients recruited from primary and specialist healthcare settings. Prevalence was assessed as crude and standardized for age and sex. Multivariable analysis assessed factors associated with these complications. Results: 3525 patients were enrolled, mean age was 54.3±10.8 years, 52.5% were males and mean time since T2DM diagnosis was 74.6±64.4 months. Clinical characteristics (mean±SD) revealed HbA1c 8.7±1.7%, BMI 31.1±5.9 kg/m2, total cholesterol 191.3±47.1 mg/dL, LDL-C 116.7±40.8 mg/dL, HDL-C 43.5±12.5 mg/dL and triglycerides 188.3±142.0 mg/dL. 43.2% and 40.1% had history of hypertension and hyperlipidemia, respectively. Metformin monotherapy was the first-line therapy in 56.5% of cases, and metformin + sulphonylurea dual in 20.3%. Concomitant therapies included statins (42.2%), acetylsalicylic acid (22.4%), angiotensin-converting enzyme inhibitors (33.6%), and beta-blockers (12.1%). Crude and standardized prevalence of microvascular diseases were 17.7% and 16.9% (95% confidence interval [CI] 16.8 - 17.0) and that of macrovascular complications were 10.7% and 8.7% (95% CI 8.6 - 8.8), respectively. Common vascular complications included coronary artery disease (8.5%), peripheral neuropathy (8.2%), erectile dysfunction (4.6%). Age, T2DM duration, male gender, history of hypertension and hyperlipidemia were significantly associated with microvascular and macrovascular complications (Table 1).Table 1Multivariate analysis for factors associated with microvascular and macrovascular complicationsFactorsMicrovascularMacrovascularOR (95% CI)P-valueOR (95% CI)P-valueAge (per 10-year increment)1.24 (1.12 – 1.39)<0.0011.58 (1.35 – 1.84)<0.001Sex (Male)1.33 (1.04 – 1.70)0.0211.71 (1.22 – 2.40)0.002Smoking StatusEx-smoker vs non-smoker1.27 (0.93 – 1.72)0.1352.50 (1.72 – 3.61)<0.001Current smoker vs non-smoker1.17 (0.87 – 1.56)0.3001.52 (1.01 – 2.26)0.042BMI (per 5 kg/m2 increment)1.03 (0.94 – 1.13)0.5141.12 (0.99 – 1.27)0.069HbA1C (per 1% increment)1.02 (0.96 – 1.09)0.4651.04 (0.95 – 1.13)0.372T2DM duration (per 1-year increment)1.00 (1.00 – 1.01)<0.0011.00 (1.00 – 1.01)<0.001Hyperlipidemia (Yes vs No)1.33 (1.07 – 1.65)0.0101.96 (1.46 – 2.63)<0.001Hypertension (Yes vs No)1.75 (1.40 – 2.19)<0.0012.84 (2.07 – 3.92)<0.001*OR, odds ratio; CI, confidence interval. Open table in a new tab *OR, odds ratio; CI, confidence interval. Discussion: Despite an early stage of T2DM progression, there was a substantial vascular complications burden confirmed by causal association with prominent risk factors, in patients mainly treated with metformin and metformin + sulphonylurea. Early cardiovascular preventive decisions are important as reflected in the guidelines.

Early vascular toxicity after pediatric allogeneic hematopoietic stem cell transplantation

Treatment-related mortality and morbidity remain a challenge in hematopoietic stem cell transplantation (HSCT). In this retrospective, single-center study, we analyzed endothelial damage as a potential, common denominator and mechanism for the adverse effects. We evaluated the prevalence of key vascular complications and graft-versus-host disease among 122 pediatric patients with an allogeneic HSCT between 2001 and 2013. The spectrum and frequency of acute adverse events emerging ≤100 days post transplant were graded according to the CTCAE 4.03 and analyzed. We identified a total of 19/122 (15.6%) patients with vascular complications, fulfilling the criteria of capillary leak syndrome, veno-occlusive disease/sinusoidal obstruction syndrome or thrombotic microangiopathy. The patients had a poorer overall survival (77% versus 26%, p < 0.001). Nearly one half (56/122, 45.9%) had at least one, severe (grade 3 or 4) adverse event. Patients with vascular complications had more often edema/effusions (p = 0.023), thrombocytopenia (p = 0.001), gastrointestinal bleeding (p < 0.001), acute kidney injury (p < 0.001), ascites (p < 0.001) or bilirubin increase (p = 0.027). These endotheliopathy-related adverse events appeared early post HSCT, varied in their clinical phenotype and predicted a poor outcome. An unrelated donor but not previous exposure to leukemia or irradiation-based conditioning was identified as a risk factor for vascular complications and endotheliopathy.

Impact of metformin on hypertension; current knowledge

High blood pressure is a potential adjustable risk factor for vascular complications of diabetes. Numerous categories of anti-hypertensive medications have proven to effectively reduce these complications. Additionally, metformin, besides lowering glucose and lipid levels, has advantages on vascular blood flow and improving endothelial function. In this review, we investigate the potential benefits of metformin in lowering blood pressure. Previous studies suggested that the administration of metformin to non-diabetic patients could efficiently reduce systolic blood pressure. The whole comparison of the evidence shows that metformin may have small effects on lowering blood pressure; however, this effect is not directly via a change in sympathetic activity. Mechanisms of blood pressure reduction by metformin may be due to its indirect effects on insulin resistance, nephroprotective, cardioprotective, improvement of the sympatric nerve system, and endothelial function.