Cardiovascular Endocrinology & Metabolism最新文献

The high prevalence of cardiovascular disease and worldwide diabetes epidemic has created an ever-increasing burden on the healthcare system. This calls for the creation of a new medicine subspecialty: cardiometabolic medicine. Using information from review articles listed on PubMed and professional society guidelines, the authors advocate for a cardiometabolic medicine specialization training program. The curriculum would integrate relevant knowledge and skills of cardiology and endocrinology as well as content of other disciplines essential to the optimal care of cardiometabolic patients, such as epidemiology, biostatistics, behavioral science and psychology. Cardiometabolic medicine should be seen as an opportunity for life-long learning, with core concepts introduced in medical school and continuing through CME courses for practicing physicians. To improve care for complex patients with multiple co-morbidities, a paradigm shift must occur, transforming siloed education, and treatment and training to interdisciplinary and collaborative work.

The black esophagus is a rare clinical entity, down to 0.2% in autopsy series and 0.001-0.2% in series of endoscopies. Although it is an entity that has already been reported in the literature, its etiopathogenesis is not completely known. Different theories have been proposed to clarify their cause. One of these theories makes a hypothesis of a viral infection as the underlying cause; this theory can be seen in the literature extensively, but only two cases were reported. The first case is a case with histopathological confirmation of Herpes virus infection. The second is a case in which vascular deterioration has been the main cause of esophageal necrosis. In both cases, diabetes is the factor that determines a bad evolution of the disease.

Introduction: Teriparatide, a recombinant formulation of endogenous PTH, is indicated for the treatment of osteoporosis in patients at high risk for fracture including postmenopausal women, men with primary or hypogonadal osteoporosis and patients with glucocorticoid-induced osteoporosis.

Case report: A 64-year-old Jewish osteoporotic woman initiated use of Teriparatide (FORTEOTM, 250 µg per 1 ml subcutaneously per day) in April 2018. Prior to therapy initiation, the patient has undergone eight echocardiograms with an aortic valve pressure gradient ranging between 29 and 39 mmHg, defined as mild aortic stenosis (AS), with no clear trend of progression. In two subsequent echo tests conducted 4 and 7 months after treatment initiation, there was a rapid progression of AS with gradient pressures of 55 and 58 mmHg, respectively.

Conclusion: Intermittent exposure to PTH analogues may be one of the causes of rapid progression of AS. Studies with sizeable populations are required to assess causal relationship between PTH analogues use and progression of AS.

Background: Type 2 diabetes mellitus (T2DM) is a global health tissue. We determined factors relating to the likelihood of developing T2DM in normal BMI individuals.

Methodology: This was a cross-sectional community-based representative survey, of people aged ≥20 years in Pakistan, using HBA1c as the screening tool. The prevalence of T2DM/prediabetes in people having normal BMI together with associated risk factors was estimated.

Results: Of 6824 normal BMI individuals, there was still a high prevalence of T2DM 14.92% and in underweight at 10.14% (overall prevalence 16.96%). Corresponding rates for prediabetes for the normal BMI category: 9.79% and underweight 8.99%. Multivariate logistic regression modeling for normal BMI individuals, showed a significantly increased risk of T2DM with increasing age (odds ratio [OR] 2.1, 3.3, 4.5 and 4.8, P < 0.001 for 31-40, 41-50, 51-60 and 61 years and above respectively, compared to age decade 20-30 years). Similarly, there was a significantly high risk of T2DM with lower education level [OR for no vs graduate 2.4, 95% confidence interval (CI) 1.5-3.8]. There was a significantly increased risk of T2DM in individuals having a positive family history [OR 4.3 (95% CI 7.0-11.5)]. Overall the influence of overweight/obese on T2DM occurrence (20% increased risk) was much less than in other regions of the world.

Conclusion: There are higher than expected rates of T2DM/prediabetes in Pakistani ethnicity normal BMI individuals. Targeted screening of older individuals with historical lack of educational opportunity, with a family history of T2DM even if of normal BMI may result in a significant benefit in the Pakistan population.

Alterations in dehydroepiandrosterone sulfate (DHEAS) levels have been shown to affect the cardiovascular system. This study examined the associations between DHEAS levels and cardiovascular risk in workers of a public hospital in Lima, Peru. The analytical cross-sectional study was conducted at the Hospital de Huaycán, Peru. The cardiovascular risk was assessed in health workers using the Framingham score and categorized into high and low cardiovascular risk groups, and then the DHEAS levels of both groups were compared. Two hundred ninety-six health workers were studied, 67.2% showed low cardiovascular risk, 22.3% intermediate and 10.5% high. DHEAS levels were lower in the high cardiovascular risk group (2156.9 vs 2814.6 ng/mL; P < 0.05) and showed negative association (prevalence rate ratio 0.14, 95% IC 0.04-0.53; P < 0.05) in multivariable analysis (P < 0.05). DHEAS, glycosylated hemoglobin, pulse pressure and mean arterial pressure show an independent association with high cardiovascular risk in a group of health workers. Additional variables should be considered for cardiovascular risk assessment.

Keshan disease (KD) is an endemic cardiomyopathy with myocardial lesions for which the precise etiology has not been determined. It was named after the location where it was first identified: Keshan County in China. KD is mainly distributed in a selenium-deficient zone from northeast to southwest China. In recent years, the incidence and prevalence of KD have significantly decreased. Meanwhile, more knowledge was accumulated about the etiology of KD and recent data indicated that genetic factor was involved. In this review, we will first update an overview of the epidemiological status and the environmental and genetic factors involved in this disease.

Endothelial dysfunction with subsequent degeneration and vasoocclusive remodeling is the hallmark of many cardiovascular disorders including pulmonary vascular disease (PVD). To date, the available treatments slows disease progression but does not prevent deterioration. Reversing such pathologies would spare many patients risky surgeries and long waiting lists for a possible organ donor. Peroxisome proliferator-activated receptor agonists were first introduced as sole insulin sensitizers, however, there is increasing body of evidence that they have different actions on DNA which might help reverse vascular degeneration. This effect appears to be mainly achieved through enhancement of DNA damage responses (DDR). The aforementioned effect could offer new insights about repurposing drugs for achieving organ or tissue regeneration, an understudied field named drug-induced regenerative medicine.

Introduction: Many people with type 1 diabetes continue to run high HbA1c levels with associated elevated risk of cardiovascular events and increased mortality. We describe here how use of the FreeStyle Libre flash monitor has improved the glycaemic control of many people with type 1 diabetes where the new technology has been intensively deployed.

Methods: We report the outcomes of 92 consecutive adults (18 years of age or more) with type 1 diabetes who have begun using the FreeStyle Libre flash glucose monitor in East Cheshire, UK. Initiation was with education and support from one of the diabetes specialist nurses. An HbA1c of 60 mmol/mol (7.6%) was taken as the threshold for suboptimal glycaemic control.

Results: The mean cohort age was 43 years for men and 39 years for women (overall range 17-83 years). In 92 consecutive users, HbA1c decreased by an average of 10.7 mmol/mol (0.98%) after 3 months, and by 16.1 mmol/mol (1.47%) after 6 months. There was also a narrowing of the distribution of HbA1c, with many fewer people running high HbA1c ≥80 mmol/mol (9.5%). After the 6-month follow-up, two 2/92 users did not wish to continue with the monitoring.

Conclusion: Flash glucose monitoring has great potential for the management of type 1 diabetes in the adult population and improving metabolic control/quality of life for people across the world. The technology provides significantly more data than the intermittent results obtained by traditional subcutaneous blood glucose monitoring, which may not capture intervals of extreme variability or nocturnal events.

Coronavirus disease 2019 (COVID-19) is a serious illness that has rapidly spread throughout the globe. The seriousness of complications puts significant pressures on hospital resources, especially the availability of ICU and ventilators. Current evidence suggests that COVID-19 pathogenesis majorly involves microvascular injury induced by hypercytokinemia, namely interleukin 6 (IL-6). We recount the suggested inflammatory pathway for COVID-19 and its effects on various organ systems, including respiratory, cardiac, hematologic, reproductive, and nervous organ systems, as well examine the role of hypercytokinemia in the at-risk geriatric and obesity subgroups with upregulated cytokines' profile. In view of these findings, we strongly encourage the conduction of prospective studies to determine the baseline levels of IL-6 in infected patients, which can predict a negative outcome in COVID-19 cases, with subsequent early administration of IL-6 inhibitors, to decrease the need for ICU admission and the pressure on healthcare systems. Video abstract: http://links.lww.com/CAEN/A24.