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Relationships between ankle blood pressure indices and major adverse cardiovascular events in people with and without type 2 diabetes. 2 型糖尿病患者和非 2 型糖尿病患者脚踝血压指数与主要不良心血管事件之间的关系。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-03 DOI: 10.1186/s12933-024-02383-z
Kamel Mohammedi, Marie Pigeyre, Jackie Bosch, Salim Yusuf, Hertzel C Gerstein

Background: The relationship between ankle blood pressure (BP) and cardiovascular disease remains unclear. We examined the relationships between known and new ankle BP indices and major cardiovascular outcomes in people with and without type 2 diabetes.

Methods: We used data from 3 large trials with measurements of ankle systolic BP (SBP), ankle-brachial index (ABI, ankle SBP divided by arm SBP), and ankle-pulse pressure difference (APPD, ankle SBP minus arm pulse pressure). The primary outcome was a composite of cardiovascular mortality, myocardial infarction, hospitalization for heart failure, or stroke. Secondary outcomes included death from cardiovascular causes, total (fatal and non-fatal) myocardial infarction, hospitalization for heart failure, and total stroke.

Results: Among 42,929 participants (age 65.6 years, females 31.3%, type 2 diabetes 50.1%, 53 countries), the primary outcome occurred in 7230 (16.8%) participants during 5 years of follow-up (19.4% in people with diabetes, 14.3% in those without diabetes). The incidence of the outcome increased with lower ankle BP indices. Compared with people whose ankle BP indices were in the highest fourth, multivariable-adjusted hazard ratios (HRs, 95% CI) of the outcome for each lower fourth were 1.05 (0.98-1.12), 1.17 (1.08-1.25), and 1.54 (1.54-1.65) for ankle SBP; HR 1.06 (0.99-1.14), 1.26 (1.17-1.35), and 1.48 (1.38-1.58) for ABI; and HR 1.02 (0.95-1.10), 1.15 (1.07-1.23), and 1.48 (1.38-1.58) for APPD. The largest effect size was noted for ankle SBP (HRs 1.05 [0.90-1.21], 1.21 [1.05-1.40], and 1.93 [1.68-2.22]), and APPD (HRs 1.08 [0.93-1.26], 1.30 [1.12-1.50], and 1.97 [1.72-2.25]) with respect to hospitalization for heart failure, while only a marginal association was observed for stroke. The relationships were similar in people with and without diabetes (all p for interaction > 0.05).

Conclusions: Inverse and independent associations were observed between ankle BP and cardiovascular events, similarly in people with and without type 2 diabetes. The largest associations were observed for heart failure and the smallest for stroke. Including ankle BP indices in routine clinical assessments may help to identify people at highest risk of cardiovascular outcomes.

背景:踝部血压(BP)与心血管疾病之间的关系仍不清楚。我们研究了已知的和新的踝关节血压指数与 2 型糖尿病患者和非 2 型糖尿病患者主要心血管结局之间的关系:我们使用了 3 项大型试验的数据,这些试验测量了踝关节收缩压(SBP)、踝肱指数(ABI,踝关节收缩压除以手臂收缩压)和踝脉压差(APPD,踝关节收缩压减去手臂脉压)。主要结果是心血管死亡、心肌梗死、心力衰竭住院或中风的综合结果。次要结果包括心血管原因导致的死亡、心肌梗死总数(致死和非致死)、心力衰竭住院治疗和中风总数:在 42929 名参与者(年龄 65.6 岁,女性占 31.3%,2 型糖尿病患者占 50.1%,53 个国家)中,有 7230 人(16.8%)在 5 年随访期间出现了主要结果(糖尿病患者占 19.4%,非糖尿病患者占 14.3%)。踝部血压指数越低,结果发生率越高。与踝关节血压指数处于最高四分位的患者相比,每降低四分之一,其结果的多变量调整危险比(HRs,95% CI)分别为 1.05(0.98-1.12)、1.17(1.踝SBP的HR分别为1.05(0.98-1.12)、1.17(1.08-1.25)和1.54(1.54-1.65);ABI的HR分别为1.06(0.99-1.14)、1.26(1.17-1.35)和1.48(1.38-1.58);APPD的HR分别为1.02(0.95-1.10)、1.15(1.07-1.23)和1.48(1.38-1.58)。踝部 SBP(HRs 1.05 [0.90-1.21]、1.21 [1.05-1.40]和 1.93 [1.68-2.22])和 APPD(HRs 1.08 [0.93-1.26]、1.30 [1.12-1.50]和 1.97 [1.72-2.25])对心力衰竭住院的影响最大,而对中风的影响则微乎其微。糖尿病患者和非糖尿病患者之间的关系相似(交互作用的 P 均大于 0.05):结论:踝部血压与心血管事件之间存在独立的反向关系,这一点在2型糖尿病患者和非2型糖尿病患者中都相似。心力衰竭的相关性最大,中风的相关性最小。在常规临床评估中纳入踝部血压指数可能有助于识别心血管事件的高危人群。
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引用次数: 0
Exploring the mortality and cardiovascular outcomes with SGLT-2 inhibitors in patients with T2DM at dialysis commencement: a health global federated network analysis. 探索开始透析时使用 SGLT-2 抑制剂的 T2DM 患者的死亡率和心血管后果:健康全球联合网络分析。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-03 DOI: 10.1186/s12933-024-02424-7
Chung-An Wang, Li-Chun Lin, Jui-Yi Chen, Wei-Jie Wang, Vin-Cent Wu

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT-2is) have demonstrated associations with lowering cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM). However, the impact of SGLT-2is on individuals at dialysis commencement remains unclear. The aim of this real-world study is to study the association between SGLT-2is and outcomes in patients with T2DM at dialysis commencement.

Methods: This is a retrospective cohort study of electronic health records (EHRs) of patients with T2DM from TriNetX Research Network database between January 1, 2012, and January 1, 2024. New-users using intention to treatment design was employed and propensity score matching was utilized to select the cohort. Clinical outcomes included major adverse cardiac events (MACE) and all-cause mortality. Safety outcomes using ICD-10 codes, ketoacidosis, urinary tract infection (UTI) or genital infection, dehydration, bone fracture, below-knee amputation, hypoglycemia, and achieving dialysis-free status at 90 days and 90-day readmission.

Results: Of 49,762 patients with T2DM who initiated dialysis for evaluation, a mere 1.57% of patients utilized SGLT-2is within 3 months after dialysis. 771 SGLT-2i users (age 63.3 ± 12.3 years, male 65.1%) were matched with 771 non-users (age 63.1 ± 12.9 years, male 65.8%). After a median follow-up of 2.0 (IQR 0.3-3.9) years, SGLT-2i users were associated with a lower risk of MACE (adjusted Hazard Ratio [aHR] = 0.52, p value < 0.001), all-cause mortality (aHR = 0.49, p < 0.001). SGLT-2i users were more likely to become dialysis-free 90 days after the index date (aHR = 0.49, p < 0.001). No significant differences were observed in the incidence of ketoacidosis, UTI or genital infection, hypoglycemia, dehydration, bone fractures, below-knee amputations, or 90-day readmissions.

Conclusions: Our findings indicated a lower incidence of all-cause mortality and MACE after long-term follow-up, along with a higher likelihood of achieving dialysis-free status at 90 days in SGLT-2i users. Importantly, they underscored the potential cardiovascular protection and safety of SGLT-2is use in T2DM patients at the onset of dialysis.

背景:钠-葡萄糖共转运体 2 抑制剂(SGLT-2is)已证明可降低 2 型糖尿病(T2DM)患者的心血管后果。然而,SGLT-2is 对开始透析患者的影响仍不清楚。这项真实世界研究旨在研究 SGLT-2is 与开始透析的 T2DM 患者的预后之间的关系:这是一项回顾性队列研究,研究对象是 2012 年 1 月 1 日至 2024 年 1 月 1 日期间 TriNetX 研究网络数据库中 T2DM 患者的电子健康记录(EHR)。研究采用了新用户意向治疗设计和倾向得分匹配来选择队列。临床结果包括主要心脏不良事件(MACE)和全因死亡率。安全结果包括ICD-10编码、酮症酸中毒、尿路感染(UTI)或生殖器感染、脱水、骨折、膝下截肢、低血糖、90天无透析状态和90天再入院:在 49,762 名接受透析评估的 T2DM 患者中,仅有 1.57% 的患者在透析后 3 个月内使用了 SGLT-2i。771 名使用 SGLT-2i 的患者(年龄为 63.3 ± 12.3 岁,男性占 65.1%)与 771 名未使用 SGLT-2i 的患者(年龄为 63.1 ± 12.9 岁,男性占 65.8%)进行了配对。中位随访 2.0(IQR 0.3-3.9)年后,SGLT-2i 使用者的 MACE 风险较低(调整后危险比 [aHR] = 0.52,P 值 结论:SGLT-2i 使用者的 MACE 风险较低:我们的研究结果表明,长期随访后,SGLT-2i 使用者的全因死亡率和 MACE 发生率较低,90 天后达到无透析状态的可能性较高。重要的是,他们强调了在开始透析的 T2DM 患者中使用 SGLT-2i 潜在的心血管保护和安全性。
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引用次数: 0
Structured diabetes care routines in cardiac rehabilitation are associated with increased diabetes detection and improved treatment after myocardial infarction: a nationwide observational study. 心肌梗死后,心脏康复中结构化的糖尿病护理常规与糖尿病检测率的提高和治疗效果的改善有关:一项全国范围的观察性研究。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-03 DOI: 10.1186/s12933-024-02425-6
Bashaaer Sharad, Nils Eckerdal, Martin Magnusson, Halldora Ögmundsdottir Michelsen, Amra Jujic, Matthias Lidin, Linda Mellbin, Nael Shaat, Ronnie Pingel, John Wallert, Emil Hagström, Margrét Leósdóttir

Background: Despite the detrimental impact of abnormal glucose metabolism on cardiovascular prognosis after myocardial infarction (MI), diabetes is both underdiagnosed and undertreated. We investigated associations between structured diabetes care routines in cardiac rehabilitation (CR) and detection and treatment of diabetes at one-year post-MI.

Methods: Center-level data was derived from the Perfect-CR survey, which evaluated work routines applied at Swedish CR centers (n = 76). Work routines involving diabetes care included: (1) routine assessment of fasting glucose and/or HbA1c, (2) routine use of oral glucose tolerance test (OGTT), (3) having regular case rounds with diabetologists, and (4) whether glucose-lowering medication was adjusted by CR physicians. Patient-level data was obtained from the national MI registry SWEDEHEART (n = 7601, 76% male, mean age 62.6 years) and included all post-MI patients irrespective of diabetes diagnosis. Using mixed-effects regression we estimated differences between patients exposed versus. not exposed to the four above-mentioned diabetes care routines. Outcomes were newly detected diabetes and the proportion of patients receiving oral glucose-lowering medication at one-year post-MI.

Results: Routine assessment of fasting glucose/HbA1c was performed at 63.2% (n = 48) of the centers, while 38.2% (n = 29) reported using OGTT for detecting glucose abnormalities. Glucose-lowering medication adjusted by CR physicians (n = 13, 17.1%) or regular case rounds with diabetologists (n = 7, 9.2%) were less frequently reported. In total, 4.0% of all patients (n = 304) were diagnosed with diabetes during follow-up and 17.9% (n = 1361) were on oral glucose-lowering treatment one-year post-MI. Routine use of OGTT was associated with a higher rate of newly detected diabetes at one-year (risk ratio [95% confidence interval]: 1.62 [1.26, 1.98], p = 0.0007). At one-year a higher proportion of patients were receiving oral glucose-lowering medication at centers using OGTT (1.22 [1.07, 1.37], p = 0.0046) and where such medication was adjusted by CR physicians (1.31 [1.06, 1.56], p = 0.0155). Compared to having none of the structured diabetes care routines, the more routines implemented the higher the rate of newly detected diabetes (from 0 routines: 2.7% to 4 routines: 6.3%; p for trend = 0.0014).

Conclusions: Having structured routines for diabetes care implemented within CR can improve detection and treatment of diabetes post-MI. A cluster-randomized trial is warranted to ascertain causality.

背景:尽管糖代谢异常对心肌梗死(MI)后的心血管预后有不利影响,但糖尿病的诊断和治疗都不足。我们研究了心脏康复(CR)中结构化糖尿病护理常规与心肌梗死后一年糖尿病的检测和治疗之间的关系:中心层面的数据来自 Perfect-CR 调查,该调查评估了瑞典 CR 中心(n = 76)采用的工作常规。涉及糖尿病护理的工作常规包括(1) 空腹血糖和/或 HbA1c 的常规评估;(2) 口服葡萄糖耐量试验 (OGTT) 的常规使用;(3) 定期与糖尿病专家进行病例查房;(4) CR 医生是否调整降糖药物。患者层面的数据来自全国心肌梗死登记处 SWEDEHEART(n = 7601,76% 为男性,平均年龄 62.6 岁),包括所有心肌梗死后患者,无论其是否确诊为糖尿病。我们采用混合效应回归法估算了接触与未接触上述四种糖尿病护理常规的患者之间的差异。结果是在心肌梗死后一年新发现的糖尿病患者和接受口服降糖药的患者比例:63.2%的中心(n = 48)对空腹血糖/HbA1c进行了常规评估,38.2%的中心(n = 29)报告使用OGTT检测血糖异常。由 CR 医生调整降糖药物(13 人,17.1%)或与糖尿病专家定期进行病例查房(7 人,9.2%)的报告较少。总共有 4.0% 的患者(n = 304)在随访期间被诊断出患有糖尿病,17.9% 的患者(n = 1361)在心肌梗死一年后接受了口服降糖治疗。常规使用 OGTT 与一年后新发现糖尿病的比例较高有关(风险比 [95% 置信区间]:1.62 [1.26, 1.98],p = 0.0007)。一年后,在使用 OGTT(1.22 [1.07, 1.37],p = 0.0046)和由 CR 医生调整药物的中心,接受口服降糖药的患者比例更高(1.31 [1.06, 1.56],p = 0.0155)。与没有结构化糖尿病护理常规相比,实施的常规越多,新发现糖尿病的比例越高(从 0 个常规:2.7% 到 4 个常规:6.3%;趋势 p = 0.0014):结论:在 CR 中实施糖尿病护理的结构化例行程序可改善对心肌梗死后糖尿病的检测和治疗。结论:在 CR 中实施结构化的糖尿病护理常规可改善对心肌梗死后糖尿病的检测和治疗,有必要进行分组随机试验以确定因果关系。
{"title":"Structured diabetes care routines in cardiac rehabilitation are associated with increased diabetes detection and improved treatment after myocardial infarction: a nationwide observational study.","authors":"Bashaaer Sharad, Nils Eckerdal, Martin Magnusson, Halldora Ögmundsdottir Michelsen, Amra Jujic, Matthias Lidin, Linda Mellbin, Nael Shaat, Ronnie Pingel, John Wallert, Emil Hagström, Margrét Leósdóttir","doi":"10.1186/s12933-024-02425-6","DOIUrl":"10.1186/s12933-024-02425-6","url":null,"abstract":"<p><strong>Background: </strong>Despite the detrimental impact of abnormal glucose metabolism on cardiovascular prognosis after myocardial infarction (MI), diabetes is both underdiagnosed and undertreated. We investigated associations between structured diabetes care routines in cardiac rehabilitation (CR) and detection and treatment of diabetes at one-year post-MI.</p><p><strong>Methods: </strong>Center-level data was derived from the Perfect-CR survey, which evaluated work routines applied at Swedish CR centers (n = 76). Work routines involving diabetes care included: (1) routine assessment of fasting glucose and/or HbA1c, (2) routine use of oral glucose tolerance test (OGTT), (3) having regular case rounds with diabetologists, and (4) whether glucose-lowering medication was adjusted by CR physicians. Patient-level data was obtained from the national MI registry SWEDEHEART (n = 7601, 76% male, mean age 62.6 years) and included all post-MI patients irrespective of diabetes diagnosis. Using mixed-effects regression we estimated differences between patients exposed versus. not exposed to the four above-mentioned diabetes care routines. Outcomes were newly detected diabetes and the proportion of patients receiving oral glucose-lowering medication at one-year post-MI.</p><p><strong>Results: </strong>Routine assessment of fasting glucose/HbA1c was performed at 63.2% (n = 48) of the centers, while 38.2% (n = 29) reported using OGTT for detecting glucose abnormalities. Glucose-lowering medication adjusted by CR physicians (n = 13, 17.1%) or regular case rounds with diabetologists (n = 7, 9.2%) were less frequently reported. In total, 4.0% of all patients (n = 304) were diagnosed with diabetes during follow-up and 17.9% (n = 1361) were on oral glucose-lowering treatment one-year post-MI. Routine use of OGTT was associated with a higher rate of newly detected diabetes at one-year (risk ratio [95% confidence interval]: 1.62 [1.26, 1.98], p = 0.0007). At one-year a higher proportion of patients were receiving oral glucose-lowering medication at centers using OGTT (1.22 [1.07, 1.37], p = 0.0046) and where such medication was adjusted by CR physicians (1.31 [1.06, 1.56], p = 0.0155). Compared to having none of the structured diabetes care routines, the more routines implemented the higher the rate of newly detected diabetes (from 0 routines: 2.7% to 4 routines: 6.3%; p for trend = 0.0014).</p><p><strong>Conclusions: </strong>Having structured routines for diabetes care implemented within CR can improve detection and treatment of diabetes post-MI. A cluster-randomized trial is warranted to ascertain causality.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":null,"pages":null},"PeriodicalIF":8.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11373097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Fenofibrate to prevent amputation and reduce vascular complications in patients with diabetes: FENO-PREVENT. 非诺贝特预防糖尿病患者截肢并减少血管并发症:FENO-PREVENT。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-03 DOI: 10.1186/s12933-024-02422-9
Eu Jeong Ku, Bongseong Kim, Kyungdo Han, Seung-Hwan Lee, Hyuk-Sang Kwon

Background: The potential preventive effect of fenofibrate on lower extremity amputation (LEA) and peripheral arterial disease (PAD) in patients with type 2 diabetes (T2D) is not fully elucidated.

Methods: We selected adult patients ≥ 20 years of age with T2D from the Korean National Health Insurance Service Database (2009-2012). The fenofibrate users were matched in a 1:4 ratio with non-users using propensity scores (PS). The outcome variables were a composite of LEA and PAD and the individual components. The risks of outcomes were implemented as hazard ratio (HR) with 95% confidence intervals (CI). For safety issues, the risks of acute kidney injury, rhabdomyolysis and resulting hospitalization were analyzed.

Results: A total of 114,920 patients was included in the analysis with a median follow-up duration of 7.6 years (22,984 and 91,936 patients for the fenofibrate user and non-user groups, respectively). After PS matching, both groups were well balanced. The fenofibrate group was associated with significantly lower risks of composite outcome of LEA and PAD (HR 0.81; 95% CI 0.70-0.94), LEA (HR 0.76; 95% CI 0.60-0.96), and PAD (HR 0.81; 95% CI 0.68-0.96). The risk of acute kidney injury, rhabdomyolysis, or hospitalization for these events showed no significant difference between the two groups. Subgroup analyses revealed consistent benefits across age groups, genders, and baseline lipid profiles.

Conclusions: This nationwide population-based retrospective observational study suggests that fenofibrate can prevent LEA and PAD in patients with T2D who are on statin therapy.

背景:非诺贝特对 2 型糖尿病(T2D)患者下肢截肢(LEA)和外周动脉疾病(PAD)的潜在预防作用尚未完全阐明:我们从韩国国民健康保险服务数据库(2009-2012 年)中选取了年龄≥ 20 岁的 2 型糖尿病成年患者。使用倾向评分(PS)将非诺贝特使用者与非使用者按 1:4 的比例进行匹配。结果变量为 LEA 和 PAD 的复合变量以及单个变量。结果风险以危险比(HR)和 95% 置信区间(CI)表示。在安全问题上,分析了急性肾损伤、横纹肌溶解症和由此导致的住院风险:共有 114920 名患者参与分析,中位随访时间为 7.6 年(非诺贝特使用者组和非使用者组分别有 22984 名和 91936 名患者)。经过 PS 匹配后,两组患者的情况非常均衡。非诺贝特组患者的 LEA 和 PAD(HR 0.81;95% CI 0.70-0.94)、LEA(HR 0.76;95% CI 0.60-0.96)和 PAD(HR 0.81;95% CI 0.68-0.96)综合结果风险明显较低。两组患者发生急性肾损伤、横纹肌溶解症或住院治疗的风险无显著差异。亚组分析显示,不同年龄组、性别和基线血脂状况的患者均可获得一致的益处:这项基于全国人群的回顾性观察研究表明,非诺贝特可以预防正在接受他汀类药物治疗的 T2D 患者的 LEA 和 PAD。
{"title":"Fenofibrate to prevent amputation and reduce vascular complications in patients with diabetes: FENO-PREVENT.","authors":"Eu Jeong Ku, Bongseong Kim, Kyungdo Han, Seung-Hwan Lee, Hyuk-Sang Kwon","doi":"10.1186/s12933-024-02422-9","DOIUrl":"10.1186/s12933-024-02422-9","url":null,"abstract":"<p><strong>Background: </strong>The potential preventive effect of fenofibrate on lower extremity amputation (LEA) and peripheral arterial disease (PAD) in patients with type 2 diabetes (T2D) is not fully elucidated.</p><p><strong>Methods: </strong>We selected adult patients ≥ 20 years of age with T2D from the Korean National Health Insurance Service Database (2009-2012). The fenofibrate users were matched in a 1:4 ratio with non-users using propensity scores (PS). The outcome variables were a composite of LEA and PAD and the individual components. The risks of outcomes were implemented as hazard ratio (HR) with 95% confidence intervals (CI). For safety issues, the risks of acute kidney injury, rhabdomyolysis and resulting hospitalization were analyzed.</p><p><strong>Results: </strong>A total of 114,920 patients was included in the analysis with a median follow-up duration of 7.6 years (22,984 and 91,936 patients for the fenofibrate user and non-user groups, respectively). After PS matching, both groups were well balanced. The fenofibrate group was associated with significantly lower risks of composite outcome of LEA and PAD (HR 0.81; 95% CI 0.70-0.94), LEA (HR 0.76; 95% CI 0.60-0.96), and PAD (HR 0.81; 95% CI 0.68-0.96). The risk of acute kidney injury, rhabdomyolysis, or hospitalization for these events showed no significant difference between the two groups. Subgroup analyses revealed consistent benefits across age groups, genders, and baseline lipid profiles.</p><p><strong>Conclusions: </strong>This nationwide population-based retrospective observational study suggests that fenofibrate can prevent LEA and PAD in patients with T2D who are on statin therapy.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":null,"pages":null},"PeriodicalIF":8.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11373174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparative effects of glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors on heart failure with preserved ejection fraction in diabetic patients: a meta-analysis. 胰高血糖素样肽-1 受体激动剂和钠-葡萄糖共转运体-2 抑制剂对糖尿病患者射血分数保留型心力衰竭的比较效应:一项荟萃分析。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-31 DOI: 10.1186/s12933-024-02415-8
Arif Albulushi, Desmond Boakye Tanoh, Ahmed Almustafa, Nadya Al Matrooshi, Ronald Zolty, Brian Lowes

Background: Heart failure with preserved ejection fraction (HFpEF) is common in type 2 diabetes mellitus (T2D), leading to high morbidity and mortality. Managing HFpEF in diabetic patients is challenging with limited treatments. Sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP1-RA) have shown potential cardiovascular benefits. This meta-analysis compares the effects of GLP1-RA and SGLT2 inhibitors on HFpEF in T2D patients.

Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) and observational studies evaluating GLP1-RA and SGLT2 inhibitors' impact on HFpEF in T2D patients. Databases searched included PubMed, MEDLINE, and Cochrane Library up to July 2024. Primary outcomes were changes in left ventricular ejection fraction (LVEF), myocardial fibrosis (extracellular volume fraction, ECV), and functional capacity (6-minute walk test, 6MWT). Secondary outcomes included HbA1c, body weight, and systolic blood pressure (SBP).  RESULTS: Twelve studies with 3,428 patients (GLP1-RA: 1,654; SGLT2 inhibitors: 1,774) were included. Both GLP1-RA and SGLT2 inhibitors significantly improved LVEF compared to placebo (GLP1-RA: mean difference [MD] 2.8%, 95% confidence interval [CI] 1.5 to 4.1, p < 0.001; SGLT2 inhibitors: MD 3.2%, 95% CI 2.0 to 4.4, p < 0.001). SGLT2 inhibitors significantly reduced myocardial fibrosis (MD -3.5%, 95% CI -4.2 to -2.8, p < 0.001) more than GLP1-RA (MD -2.3%, 95% CI -3.0 to -1.6, p < 0.001). Functional capacity improved significantly with both treatments (GLP1-RA: MD 45 m, 95% CI 30 to 60, p < 0.001; SGLT2 inhibitors: MD 50 m, 95% CI 35 to 65, p < 0.001). Secondary outcomes showed reductions in HbA1c (GLP1-RA: MD -1.1%, 95% CI -1.4 to -0.8, p < 0.001; SGLT2 inhibitors: MD -1.0%, 95% CI -1.3 to -0.7, p < 0.001) and body weight (GLP1-RA: MD -2.5 kg, 95% CI -3.1 to -1.9, p < 0.001; SGLT2 inhibitors: MD -2.0 kg, 95% CI -2.6 to -1.4, p < 0.001). Both treatments significantly lowered SBP (GLP1-RA: MD -5.2 mmHg, 95% CI -6.5 to -3.9, p < 0.001; SGLT2 inhibitors: MD -4.8 mmHg, 95% CI -6.0 to -3.6, p < 0.001).

Conclusions: GLP1-RA and SGLT2 inhibitors significantly benefit HFpEF management in T2D patients. SGLT2 inhibitors reduce myocardial fibrosis more effectively, while both improve LVEF, functional capacity, and metabolic parameters. These therapies should be integral to HFpEF management in diabetic patients. Further research is needed on long-term outcomes and potential combined therapy effects.

背景:射血分数保留型心力衰竭(HFpEF)在 2 型糖尿病(T2D)患者中很常见,会导致很高的发病率和死亡率。由于治疗手段有限,糖尿病患者的射血分数保留型心力衰竭治疗具有挑战性。钠-葡萄糖共转运体 2 (SGLT2) 抑制剂和胰高血糖素样肽-1 受体激动剂 (GLP1-RA) 显示出对心血管的潜在益处。本荟萃分析比较了 GLP1-RA 和 SGLT2 抑制剂对 T2D 患者高房颤的影响:我们对评估 GLP1-RA 和 SGLT2 抑制剂对 T2D 患者 HFpEF 影响的随机对照试验 (RCT) 和观察性研究进行了荟萃分析。检索的数据库包括 PubMed、MEDLINE 和 Cochrane Library(截至 2024 年 7 月)。主要结果包括左心室射血分数(LVEF)、心肌纤维化(细胞外容积分数,ECV)和功能能力(6 分钟步行测试,6MWT)的变化。次要结果包括 HbA1c、体重和收缩压 (SBP)。 结果:12 项研究共纳入 3428 名患者(GLP1-RA:1654 人;SGLT2 抑制剂:1774 人)。与安慰剂相比,GLP1-RA 和 SGLT2 抑制剂都能显著改善 LVEF(GLP1-RA:平均差异 [MD] 2.8%,95% 置信区间 [CI] 1.5 至 4.1,P 结论:GLP1-RA 和 SGLT2 抑制剂都能显著改善 LVEF:GLP1-RA和SGLT2抑制剂对治疗T2D患者的HFpEF大有裨益。SGLT2 抑制剂能更有效地减少心肌纤维化,同时两者都能改善 LVEF、功能能力和代谢参数。这些疗法应成为糖尿病患者 HFpEF 治疗的组成部分。关于长期疗效和潜在的联合治疗效果,还需要进一步研究。
{"title":"Comparative effects of glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors on heart failure with preserved ejection fraction in diabetic patients: a meta-analysis.","authors":"Arif Albulushi, Desmond Boakye Tanoh, Ahmed Almustafa, Nadya Al Matrooshi, Ronald Zolty, Brian Lowes","doi":"10.1186/s12933-024-02415-8","DOIUrl":"10.1186/s12933-024-02415-8","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with preserved ejection fraction (HFpEF) is common in type 2 diabetes mellitus (T2D), leading to high morbidity and mortality. Managing HFpEF in diabetic patients is challenging with limited treatments. Sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP1-RA) have shown potential cardiovascular benefits. This meta-analysis compares the effects of GLP1-RA and SGLT2 inhibitors on HFpEF in T2D patients.</p><p><strong>Methods: </strong>We conducted a meta-analysis of randomized controlled trials (RCTs) and observational studies evaluating GLP1-RA and SGLT2 inhibitors' impact on HFpEF in T2D patients. Databases searched included PubMed, MEDLINE, and Cochrane Library up to July 2024. Primary outcomes were changes in left ventricular ejection fraction (LVEF), myocardial fibrosis (extracellular volume fraction, ECV), and functional capacity (6-minute walk test, 6MWT). Secondary outcomes included HbA1c, body weight, and systolic blood pressure (SBP).  RESULTS: Twelve studies with 3,428 patients (GLP1-RA: 1,654; SGLT2 inhibitors: 1,774) were included. Both GLP1-RA and SGLT2 inhibitors significantly improved LVEF compared to placebo (GLP1-RA: mean difference [MD] 2.8%, 95% confidence interval [CI] 1.5 to 4.1, p < 0.001; SGLT2 inhibitors: MD 3.2%, 95% CI 2.0 to 4.4, p < 0.001). SGLT2 inhibitors significantly reduced myocardial fibrosis (MD -3.5%, 95% CI -4.2 to -2.8, p < 0.001) more than GLP1-RA (MD -2.3%, 95% CI -3.0 to -1.6, p < 0.001). Functional capacity improved significantly with both treatments (GLP1-RA: MD 45 m, 95% CI 30 to 60, p < 0.001; SGLT2 inhibitors: MD 50 m, 95% CI 35 to 65, p < 0.001). Secondary outcomes showed reductions in HbA1c (GLP1-RA: MD -1.1%, 95% CI -1.4 to -0.8, p < 0.001; SGLT2 inhibitors: MD -1.0%, 95% CI -1.3 to -0.7, p < 0.001) and body weight (GLP1-RA: MD -2.5 kg, 95% CI -3.1 to -1.9, p < 0.001; SGLT2 inhibitors: MD -2.0 kg, 95% CI -2.6 to -1.4, p < 0.001). Both treatments significantly lowered SBP (GLP1-RA: MD -5.2 mmHg, 95% CI -6.5 to -3.9, p < 0.001; SGLT2 inhibitors: MD -4.8 mmHg, 95% CI -6.0 to -3.6, p < 0.001).</p><p><strong>Conclusions: </strong>GLP1-RA and SGLT2 inhibitors significantly benefit HFpEF management in T2D patients. SGLT2 inhibitors reduce myocardial fibrosis more effectively, while both improve LVEF, functional capacity, and metabolic parameters. These therapies should be integral to HFpEF management in diabetic patients. Further research is needed on long-term outcomes and potential combined therapy effects.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":null,"pages":null},"PeriodicalIF":8.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The association between index-year, average, and variability of the triglyceride-glucose index with health outcomes: more than a decade of follow-up in Tehran lipid and glucose study. 甘油三酯-葡萄糖指数的指数年、平均值和变异性与健康结果之间的关联:德黑兰血脂和血糖研究十多年的随访。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-31 DOI: 10.1186/s12933-024-02387-9
Danial Molavizadeh, Neda Cheraghloo, Maryam Tohidi, Fereidoun Azizi, Farzad Hadaegh

Background: The association between baseline triglyceride glucose index (TyG index) and incident non-communicable diseases, mainly in Asian populations, has been reported. In the current study, we aimed to evaluate the association between index-year, average, and visit-to-visit variability (VVV) of the TyG index with incident type 2 diabetes mellitus (T2DM), hypertension, cardiovascular disease (CVD), and all-cause mortality among the Iranian population.

Methods: The study population included 5220 participants (2195 men) aged ≥ 30 years. TyG index was calculated as Ln (fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2). Average values of the TyG index and also VVV (assessed by the standard deviation (SD) and variability independent of mean) were derived during the exposure period from 2002 to 2011 (index-year). Multivariable Cox proportional hazards regression models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of the TyG index for incident different health outcomes.

Results: During more than 6 years of follow-up after the index year, 290, 560, 361, and 280 events of T2DM, hypertension, CVD, and all-cause mortality occurred. 1-SD increase in the TyG index values at the index-year was independently associated with the incident T2DM [HR (95% CI) 2.50 (2.13-2.93)]; the corresponding values for the average of TyG index were 2.37 (2.03-2.76), 1.12 (0.99-1.26, pvalue = 0.05), 1.18 (1.01-1.36), and 1.29 (1.08-1.53) for incident T2DM, hypertension, CVD, and all-cause mortality, respectively. Compared to the first tertile, tertile 3 of VVV of the TyG index was independently associated with incident hypertension [1.33 (1.07-1.64), Ptrend <0.01]. Likewise, a 1-SD increase in VVV of the TyG index was associated with an 11% excess risk of incident hypertension [1.11 (1.02-1.21)]. However, no association was found between the VVV of the TyG index and other outcomes. Moreover, the impact of index-year and average values of the TyG index was more prominent among women regarding incident CVD (P for interactions < 0.05).

Conclusion: Although the higher TyG index at index-year and its VVV were only associated with the incident T2DM and hypertension, respectively, its average value was capable of capturing the risk for all of the health outcomes.

背景:有报道称,基线甘油三酯血糖指数(TyG指数)与非传染性疾病发病率之间存在关联,这主要是在亚洲人群中。在本研究中,我们旨在评估伊朗人群中的指数年、平均值和访问间变异性(VVV)TyG 指数与 2 型糖尿病(T2DM)、高血压、心血管疾病(CVD)和全因死亡率之间的关系:研究对象包括 5220 名年龄≥ 30 岁的参与者(男性 2195 人)。TyG指数的计算公式为Ln(空腹甘油三酯(毫克/分升)×空腹血浆葡萄糖(毫克/分升)/2)。TyG指数的平均值以及VVV(通过标准偏差(SD)和独立于平均值的变异性评估)来自2002年至2011年(指数年)的暴露期。采用多变量考克斯比例危险回归模型估算了TyG指数对不同健康结果事件的危险比(HR)和95%置信区间(CI):在指数年后超过6年的随访期间,分别发生了290、560、361和280起T2DM、高血压、心血管疾病和全因死亡事件。指数年TyG指数值增加1-SD与T2DM事件独立相关[HR (95% CI) 2.50 (2.13-2.93)];TyG指数平均值的相应值分别为2.37 (2.03-2.76)、1.12 (0.99-1.26, pvalue = 0.05)、1.18 (1.01-1.36)和1.29 (1.08-1.53),分别与T2DM事件、高血压、心血管疾病和全因死亡率相关。与第一分位数相比,TyG指数VVV的第三分位数与高血压发病率独立相关[1.33(1.07-1.64),Ptrend 结论:虽然指数年较高的 TyG 指数及其 VVV 仅分别与 T2DM 和高血压的发病相关,但其平均值能够捕捉到所有健康结果的风险。
{"title":"The association between index-year, average, and variability of the triglyceride-glucose index with health outcomes: more than a decade of follow-up in Tehran lipid and glucose study.","authors":"Danial Molavizadeh, Neda Cheraghloo, Maryam Tohidi, Fereidoun Azizi, Farzad Hadaegh","doi":"10.1186/s12933-024-02387-9","DOIUrl":"10.1186/s12933-024-02387-9","url":null,"abstract":"<p><strong>Background: </strong>The association between baseline triglyceride glucose index (TyG index) and incident non-communicable diseases, mainly in Asian populations, has been reported. In the current study, we aimed to evaluate the association between index-year, average, and visit-to-visit variability (VVV) of the TyG index with incident type 2 diabetes mellitus (T2DM), hypertension, cardiovascular disease (CVD), and all-cause mortality among the Iranian population.</p><p><strong>Methods: </strong>The study population included 5220 participants (2195 men) aged ≥ 30 years. TyG index was calculated as Ln (fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2). Average values of the TyG index and also VVV (assessed by the standard deviation (SD) and variability independent of mean) were derived during the exposure period from 2002 to 2011 (index-year). Multivariable Cox proportional hazards regression models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of the TyG index for incident different health outcomes.</p><p><strong>Results: </strong>During more than 6 years of follow-up after the index year, 290, 560, 361, and 280 events of T2DM, hypertension, CVD, and all-cause mortality occurred. 1-SD increase in the TyG index values at the index-year was independently associated with the incident T2DM [HR (95% CI) 2.50 (2.13-2.93)]; the corresponding values for the average of TyG index were 2.37 (2.03-2.76), 1.12 (0.99-1.26, p<sub>value</sub> = 0.05), 1.18 (1.01-1.36), and 1.29 (1.08-1.53) for incident T2DM, hypertension, CVD, and all-cause mortality, respectively. Compared to the first tertile, tertile 3 of VVV of the TyG index was independently associated with incident hypertension [1.33 (1.07-1.64), P<sub>trend</sub> <0.01]. Likewise, a 1-SD increase in VVV of the TyG index was associated with an 11% excess risk of incident hypertension [1.11 (1.02-1.21)]. However, no association was found between the VVV of the TyG index and other outcomes. Moreover, the impact of index-year and average values of the TyG index was more prominent among women regarding incident CVD (P for interactions < 0.05).</p><p><strong>Conclusion: </strong>Although the higher TyG index at index-year and its VVV were only associated with the incident T2DM and hypertension, respectively, its average value was capable of capturing the risk for all of the health outcomes.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":null,"pages":null},"PeriodicalIF":8.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impaired glucose metabolism and the risk of vascular events and mortality after ischemic stroke: A systematic review and meta-analysis. 葡萄糖代谢受损与缺血性中风后血管事件和死亡风险:系统回顾与荟萃分析。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-31 DOI: 10.1186/s12933-024-02413-w
Nurcennet Kaynak, Valentin Kennel, Torsten Rackoll, Daniel Schulze, Matthias Endres, Alexander H Nave

Background: Diabetes mellitus (DM), prediabetes, and insulin resistance are highly prevalent in patients with ischemic stroke (IS). DM is associated with higher risk for poor outcomes after IS.

Objective: Investigate the risk of recurrent vascular events and mortality associated with impaired glucose metabolism compared to normoglycemia in patients with IS and transient ischemic attack (TIA).

Methods: Systematic literature search was performed in PubMed, Embase, Cochrane Library on 21st March 2024 and via citation searching. Studies that comprised IS or TIA patients and exposures of impaired glucose metabolism were eligible. Study Quality Assessment Tool was used for risk of bias assessment. Covariate adjusted outcomes were pooled using random-effects meta-analysis.

Main outcomes: Recurrent stroke, cardiac events, cardiovascular and all-cause mortality and composite of vascular outcomes.

Results: Of 10,974 identified studies 159 were eligible. 67% had low risk of bias. DM was associated with an increased risk for composite events (pooled HR (pHR) including 445,808 patients: 1.58, 95% CI 1.34-1.85, I2 = 88%), recurrent stroke (pHR including 1.161.527 patients: 1.42 (1.29-1.56, I2 = 92%), cardiac events (pHR including 443,863 patients: 1.55, 1.50-1.61, I2 = 0%), and all-cause mortality (pHR including 1.031.472 patients: 1.56, 1.34-1.82, I2 = 99%). Prediabetes was associated with an increased risk for composite events (pHR including 8,262 patients: 1.50, 1.15-1.96, I2 = 0%) and recurrent stroke (pHR including 10,429 patients: 1.50, 1.18-1.91, I2 = 0), however, not with mortality (pHR including 9,378 patients, 1.82, 0.73-4.57, I2 = 78%). Insulin resistance was associated with recurrent stroke (pHR including 21,363 patients: 1.56, 1.19-2.05, I2 = 55%), but not with mortality (pHR including 21,363 patients: 1.31, 0.66-2.59, I2 = 85%).

Discussion: DM is associated with a 56% increased relative risk of death after IS and TIA. Risk estimates regarding recurrent events are similarly high between prediabetes and DM, indicating high cardiovascular risk burden already in precursor stages of DM. There was a high heterogeneity across most outcomes.

背景:糖尿病(DM)、糖尿病前期和胰岛素抵抗在缺血性卒中(IS)患者中非常普遍。糖尿病与缺血性中风后不良预后的高风险相关:调查在 IS 和短暂性脑缺血发作(TIA)患者中,与正常血糖相比,糖代谢受损与复发性血管事件和死亡率相关的风险:于 2024 年 3 月 21 日在 PubMed、Embase 和 Cochrane 图书馆进行了系统文献检索,并进行了引文检索。符合条件的研究包括 IS 或 TIA 患者以及葡萄糖代谢受损的暴露。研究质量评估工具用于评估偏倚风险。采用随机效应荟萃分析法对相关因素调整后的结果进行汇总:主要结果:复发性中风、心脏事件、心血管和全因死亡率以及血管综合结果:在 10974 项已确定的研究中,有 159 项符合条件。67%的研究存在低偏倚风险。糖尿病与复合事件的风险增加有关(包括 445 808 名患者在内的汇总 HR (pHR):1.58,95% CI:1.58,95% CI:1.58):1.58,95% CI 1.34-1.85,I2 = 88%)、复发性中风(pHR,包括 1.161 527 名患者:1.42(1.29-1.56,I2 = 92%)、心脏事件(包括 443 863 名患者的 pHR:1.55,1.50-1.61,I2 = 0%)和全因死亡率(包括 1 031 472 名患者的 pHR:1.56,1.34-1.82,I2 = 99%)。糖尿病前期与复合事件风险增加(包括 8262 名患者的 pHR:1.50,1.15-1.96,I2 = 0%)和复发性中风(包括 10429 名患者的 pHR:1.50,1.18-1.91,I2 = 0)有关,但与死亡率无关(包括 9378 名患者的 pHR:1.82,0.73-4.57,I2 = 78%)。胰岛素抵抗与中风复发有关(包括 21,363 名患者的 pHR:1.56,1.19-2.05,I2 = 55%),但与死亡率无关(包括 21,363 名患者的 pHR:1.31,0.66-2.59,I2 = 85%):讨论:糖尿病与IS和TIA后死亡相对风险增加56%有关。糖尿病前期和糖尿病并发症的复发风险估计值同样很高,这表明糖尿病前兆阶段的心血管风险负担已经很高。大多数结果存在高度异质性。
{"title":"Impaired glucose metabolism and the risk of vascular events and mortality after ischemic stroke: A systematic review and meta-analysis.","authors":"Nurcennet Kaynak, Valentin Kennel, Torsten Rackoll, Daniel Schulze, Matthias Endres, Alexander H Nave","doi":"10.1186/s12933-024-02413-w","DOIUrl":"10.1186/s12933-024-02413-w","url":null,"abstract":"<p><strong>Background: </strong>Diabetes mellitus (DM), prediabetes, and insulin resistance are highly prevalent in patients with ischemic stroke (IS). DM is associated with higher risk for poor outcomes after IS.</p><p><strong>Objective: </strong>Investigate the risk of recurrent vascular events and mortality associated with impaired glucose metabolism compared to normoglycemia in patients with IS and transient ischemic attack (TIA).</p><p><strong>Methods: </strong>Systematic literature search was performed in PubMed, Embase, Cochrane Library on 21st March 2024 and via citation searching. Studies that comprised IS or TIA patients and exposures of impaired glucose metabolism were eligible. Study Quality Assessment Tool was used for risk of bias assessment. Covariate adjusted outcomes were pooled using random-effects meta-analysis.</p><p><strong>Main outcomes: </strong>Recurrent stroke, cardiac events, cardiovascular and all-cause mortality and composite of vascular outcomes.</p><p><strong>Results: </strong>Of 10,974 identified studies 159 were eligible. 67% had low risk of bias. DM was associated with an increased risk for composite events (pooled HR (pHR) including 445,808 patients: 1.58, 95% CI 1.34-1.85, I<sup>2</sup> = 88%), recurrent stroke (pHR including 1.161.527 patients: 1.42 (1.29-1.56, I<sup>2</sup> = 92%), cardiac events (pHR including 443,863 patients: 1.55, 1.50-1.61, I<sup>2</sup> = 0%), and all-cause mortality (pHR including 1.031.472 patients: 1.56, 1.34-1.82, I<sup>2</sup> = 99%). Prediabetes was associated with an increased risk for composite events (pHR including 8,262 patients: 1.50, 1.15-1.96, I<sup>2</sup> = 0%) and recurrent stroke (pHR including 10,429 patients: 1.50, 1.18-1.91, I<sup>2</sup> = 0), however, not with mortality (pHR including 9,378 patients, 1.82, 0.73-4.57, I<sup>2</sup> = 78%). Insulin resistance was associated with recurrent stroke (pHR including 21,363 patients: 1.56, 1.19-2.05, I<sup>2</sup> = 55%), but not with mortality (pHR including 21,363 patients: 1.31, 0.66-2.59, I<sup>2</sup> = 85%).</p><p><strong>Discussion: </strong>DM is associated with a 56% increased relative risk of death after IS and TIA. Risk estimates regarding recurrent events are similarly high between prediabetes and DM, indicating high cardiovascular risk burden already in precursor stages of DM. There was a high heterogeneity across most outcomes.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":null,"pages":null},"PeriodicalIF":8.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Two-week continuous glucose monitoring-derived metrics and degree of hepatic steatosis: a cross-sectional study among Chinese middle-aged and elderly participants. 两周连续血糖监测指标与肝脂肪变性程度:一项针对中国中老年参与者的横断面研究。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-31 DOI: 10.1186/s12933-024-02409-6
Haili Zhong, Ke Zhang, Lishan Lin, Yan Yan, Luqi Shen, Hanzu Chen, Xinxiu Liang, Jingnan Chen, Zelei Miao, Ju-Sheng Zheng, Yu-Ming Chen

Background: Continuous glucose monitoring (CGM) devices provide detailed information on daily glucose control and glycemic variability. Yet limited population-based studies have explored the association between CGM metrics and fatty liver. We aimed to investigate the associations of CGM metrics with the degree of hepatic steatosis.

Methods: This cross-sectional study included 1180 participants from the Guangzhou Nutrition and Health Study. CGM metrics, covering mean glucose level, glycemic variability, and in-range measures, were separately processed for all-day, nighttime, and daytime periods. Hepatic steatosis degree (healthy: n = 698; mild steatosis: n = 242; moderate/severe steatosis: n = 240) was determined by magnetic resonance imaging proton density fat fraction. Multivariate ordinal logistic regression models were conducted to estimate the associations between CGM metrics and steatosis degree. Machine learning models were employed to evaluate the predictive performance of CGM metrics for steatosis degree.

Results: Mean blood glucose, coefficient of variation (CV) of glucose, mean amplitude of glucose excursions (MAGE), and mean of daily differences (MODD) were positively associated with steatosis degree, with corresponding odds ratios (ORs) and 95% confidence intervals (CIs) of 1.35 (1.17, 1.56), 1.21 (1.06, 1.39), 1.37 (1.19, 1.57), and 1.35 (1.17, 1.56) during all-day period. Notably, lower daytime time in range (TIR) and higher nighttime TIR were associated with higher steatosis degree, with ORs (95% CIs) of 0.83 (0.73, 0.95) and 1.16 (1.00, 1.33), respectively. For moderate/severe steatosis (vs. healthy) prediction, the average area under the receiver operating characteristic curves were higher for the nighttime (0.69) and daytime (0.66) metrics than that of all-day metrics (0.63, P < 0.001 for all comparisons). The model combining both nighttime and daytime metrics achieved the highest predictive capacity (0.73), with nighttime MODD emerging as the most important predictor.

Conclusions: Higher CGM-derived mean glucose and glycemic variability were linked with higher steatosis degree. CGM-derived metrics during nighttime and daytime provided distinct and complementary insights into hepatic steatosis.

背景:连续血糖监测(CGM)设备可提供有关日常血糖控制和血糖变异性的详细信息。然而,基于人群的研究很少探讨 CGM 指标与脂肪肝之间的关系。我们旨在研究 CGM 指标与肝脂肪变性程度之间的关系:这项横断面研究纳入了广州营养与健康研究的 1180 名参与者。CGM 指标包括平均血糖水平、血糖变异性和范围内指标,分别在全天、夜间和白天进行处理。肝脏脂肪变性程度(健康:n = 698;轻度脂肪变性:n = 242;中度/重度脂肪变性:n = 240)由磁共振成像质子密度脂肪分数确定。采用多变量序数逻辑回归模型来估计 CGM 指标与脂肪变性程度之间的关联。采用机器学习模型评估 CGM 指标对脂肪变性程度的预测性能:结果:平均血糖、血糖变异系数(CV)、血糖偏移平均幅度(MAGE)和日差异平均值(MODD)与脂肪变性程度呈正相关,全天相应的几率比(OR)和 95% 置信区间(CI)分别为 1.35(1.17,1.56)、1.21(1.06,1.39)、1.37(1.19,1.57)和 1.35(1.17,1.56)。值得注意的是,较低的日间在量程内时间(TIR)和较高的夜间 TIR 与较高的脂肪变性程度相关,ORs(95% CIs)分别为 0.83(0.73,0.95)和 1.16(1.00,1.33)。在预测中度/重度脂肪变性(与健康相比)时,夜间(0.69)和白天(0.66)指标的接收者操作特征曲线下的平均面积高于全天指标(0.63,P 结论):较高的 CGM 平均血糖和血糖变异性与较高的脂肪变性程度有关。夜间和白天 CGM 导出的指标对肝脏脂肪变性提供了不同且互补的见解。
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引用次数: 0
Causal associations between insulin and Lp(a) levels in Caucasian population: a Mendelian randomization study. 白种人胰岛素与脂蛋白(a)水平之间的因果关系:孟德尔随机研究。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-29 DOI: 10.1186/s12933-024-02389-7
Mateusz Lejawa, Marcin Goławski, Martyna Fronczek, Tadeusz Osadnik, Francesco Paneni, Massimiliano Ruscica, Natalia Pawlas, Małgorzata Lisik, Maciej Banach

Background: Numerous observational studies have demonstrated that circulating lipoprotein(a) [Lp(a)] might be inversely related to the risk of type 2 diabetes (T2D). However, recent Mendelian randomization (MR) studies do not consistently support this association. The results of in vitro research suggest that high insulin concentrations can suppress Lp(a) levels by affecting apolipoprotein(a) [apo(a)] synthesis. This study aimed to identify the relationship between genetically predicted insulin concentrations and Lp(a) levels, which may partly explain the associations between low Lp(a) levels and increased risk of T2D.

Methods: Independent genetic variants strongly associated with fasting insulin levels were identified from meta-analyses of genome-wide association studies in European populations (GWASs) (N = 151,013). Summary level data for Lp(a) in the population of European ancestry were acquired from a GWAS in the UK Biobank (N = 361,194). The inverse-variance weighted (IVW) method approach was applied to perform two-sample summary-level MR. Robust methods for sensitivity analysis were utilized, such as MR‒Egger, the weighted median (WME) method, MR pleiotropy residual sum and outlier (MR-PRESSO), leave-one-out analysis, and MR Steiger.

Results: Genetically predicted fasting insulin levels were negatively associated with Lp(a) levels (β = - 0.15, SE = 0.05, P = 0.003). The sensitivity analysis revealed that WME (β = - 0.26, SE = 0.07, P = 0.0002), but not MR‒Egger (β = - 0.22, SE = 0.13, P = 0.11), supported a causal relationship between genetically predisposed insulin levels and Lp(a).

Conclusion: Our MR study provides robust evidence supporting the association between genetically predicted increased insulin concentrations and decreased concentrations of Lp(a). These findings suggest that hyperinsulinaemia, which typically accompanies T2D, can partially explain the inverse relationship between low Lp(a) concentrations and an increased risk of T2D.

背景:大量观察性研究表明,循环中的脂蛋白(a)[Lp(a)]可能与罹患 2 型糖尿病(T2D)的风险成反比。然而,最近的孟德尔随机化(MR)研究并不一致地支持这种关联。体外研究结果表明,高浓度胰岛素可通过影响载脂蛋白(a)[apo(a)]的合成来抑制脂蛋白(a)水平。本研究旨在确定基因预测的胰岛素浓度与脂蛋白(a)水平之间的关系,这可能部分解释了低脂蛋白(a)水平与T2D风险增加之间的关联:从欧洲人群全基因组关联研究(GWASs)的荟萃分析(N = 151,013)中确定了与空腹胰岛素水平密切相关的独立遗传变异。欧洲血统人群脂蛋白(a)的汇总数据来自英国生物库(UK Biobank)的一项全基因组关联研究(GWASs)(N = 361,194)。应用逆方差加权(IVW)方法进行了双样本汇总水平 MR 分析。采用了稳健的方法进行敏感性分析,如MR-Egger、加权中位数(WME)法、MR pleiotropy residual sum and outlier (MR-PRESSO)、leave-one-out analysis和MR Steiger:结果:基因预测的空腹胰岛素水平与脂蛋白(a)水平呈负相关(β = - 0.15,SE = 0.05,P = 0.003)。敏感性分析显示,WME(β = - 0.26,SE = 0.07,P = 0.0002)而非 MR-Egger(β = - 0.22,SE = 0.13,P = 0.11)支持遗传易感性胰岛素水平与脂蛋白(a)之间的因果关系:我们的磁共振研究提供了强有力的证据,支持遗传预测的胰岛素浓度升高与脂蛋白(a)浓度降低之间的关联。这些研究结果表明,高胰岛素血症通常伴随着终末期糖尿病,它可以部分解释低脂蛋白(a)浓度与终末期糖尿病风险增加之间的反向关系。
{"title":"Causal associations between insulin and Lp(a) levels in Caucasian population: a Mendelian randomization study.","authors":"Mateusz Lejawa, Marcin Goławski, Martyna Fronczek, Tadeusz Osadnik, Francesco Paneni, Massimiliano Ruscica, Natalia Pawlas, Małgorzata Lisik, Maciej Banach","doi":"10.1186/s12933-024-02389-7","DOIUrl":"10.1186/s12933-024-02389-7","url":null,"abstract":"<p><strong>Background: </strong>Numerous observational studies have demonstrated that circulating lipoprotein(a) [Lp(a)] might be inversely related to the risk of type 2 diabetes (T2D). However, recent Mendelian randomization (MR) studies do not consistently support this association. The results of in vitro research suggest that high insulin concentrations can suppress Lp(a) levels by affecting apolipoprotein(a) [apo(a)] synthesis. This study aimed to identify the relationship between genetically predicted insulin concentrations and Lp(a) levels, which may partly explain the associations between low Lp(a) levels and increased risk of T2D.</p><p><strong>Methods: </strong>Independent genetic variants strongly associated with fasting insulin levels were identified from meta-analyses of genome-wide association studies in European populations (GWASs) (N = 151,013). Summary level data for Lp(a) in the population of European ancestry were acquired from a GWAS in the UK Biobank (N = 361,194). The inverse-variance weighted (IVW) method approach was applied to perform two-sample summary-level MR. Robust methods for sensitivity analysis were utilized, such as MR‒Egger, the weighted median (WME) method, MR pleiotropy residual sum and outlier (MR-PRESSO), leave-one-out analysis, and MR Steiger.</p><p><strong>Results: </strong>Genetically predicted fasting insulin levels were negatively associated with Lp(a) levels (β = - 0.15, SE = 0.05, P = 0.003). The sensitivity analysis revealed that WME (β = - 0.26, SE = 0.07, P = 0.0002), but not MR‒Egger (β = - 0.22, SE = 0.13, P = 0.11), supported a causal relationship between genetically predisposed insulin levels and Lp(a).</p><p><strong>Conclusion: </strong>Our MR study provides robust evidence supporting the association between genetically predicted increased insulin concentrations and decreased concentrations of Lp(a). These findings suggest that hyperinsulinaemia, which typically accompanies T2D, can partially explain the inverse relationship between low Lp(a) concentrations and an increased risk of T2D.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":null,"pages":null},"PeriodicalIF":8.5,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11360791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Gestational diabetes mellitus and development of intergenerational overall and subtypes of cardiovascular diseases: a systematic review and meta-analysis. 妊娠糖尿病与心血管疾病的代际总体和亚型发展:系统回顾和荟萃分析。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-28 DOI: 10.1186/s12933-024-02416-7
Ashley Chen, Breanna Tan, Ruochen Du, Yap Seng Chong, Cuilin Zhang, Angela S Koh, Ling-Jun Li

Objective: We aimed to summarize the association between gestational diabetes mellitus (GDM) and its intergenerational cardiovascular diseases (CVDs) impacts in both mothers and offspring post-delivery in existing literature.

Methods: PubMed, Embase, Web of Science, and Scopus were utilized for searching publications between January 1980 and June 2024, with data extraction and meta-analysis continuing until 31 July 2024. Based on a predefined PROSPERO protocol, studies published as full-length, English-language journal articles that reported the presence of GDM during pregnancy and its association with any CVD development post-delivery were selected. All studies were evaluated using the Newcastle-Ottawa Scale. Maximally adjusted risk estimates were pooled using random-effects meta-analysis to assess the risk ratio (RR) of GDM, and overall and subtypes of CVDs in both mothers and offspring post-delivery.

Results: The meta-analysis was based on 38 studies with a total of 77,678,684 participants. The results showed a 46% increased risk (RR 1.46, 95% CI 1.34-1.59) for mothers and a 23% increased risk (1.23, 1.05-1.45) for offspring of developing overall CVDs after delivery, following a GDM-complicated pregnancy. Our subgroup analysis revealed that mothers with a history of GDM faced various risks (20% to 2-fold) of developing different subtypes of CVDs, including cerebrovascular disease, coronary artery disease, heart failure, and venous thromboembolism.

Conclusions: These findings underscore the heightened risk of developing various CVDs for mothers and offspring affected by GDM, emphasizing the importance of preventive measures even right after birth to mitigate the burden of CVDs in these populations.

目的:我们的目的是总结现有文献中妊娠期糖尿病(GDM)与其对母婴产后心血管疾病(CVDs)的代际影响之间的关系:利用PubMed、Embase、Web of Science和Scopus检索1980年1月至2024年6月期间的出版物,数据提取和荟萃分析持续到2024年7月31日。根据预先确定的 PROSPERO 方案,筛选出以英文期刊论文形式发表的、报道孕期 GDM 存在及其与产后心血管疾病发展相关性的研究。所有研究均采用纽卡斯尔-渥太华量表进行评估。采用随机效应荟萃分析法对最大调整风险估计值进行汇总,以评估GDM的风险比(RR)以及母亲和后代产后心血管疾病的总体和亚型:荟萃分析基于 38 项研究,共有 77 678 684 人参与。结果显示,GDM 并发症妊娠的母亲和后代在分娩后患心血管疾病的风险分别增加了 46%(RR 1.46,95% CI 1.34-1.59)和 23%(1.23,1.05-1.45)。我们的亚组分析显示,有GDM病史的母亲患不同亚型心血管疾病的风险不同(20%至2倍),包括脑血管疾病、冠状动脉疾病、心力衰竭和静脉血栓栓塞:这些研究结果表明,受 GDM 影响的母亲和后代罹患各种心血管疾病的风险增加,这就强调了采取预防措施的重要性,即使是在孩子出生后也应采取预防措施,以减轻心血管疾病给这些人群带来的负担。
{"title":"Gestational diabetes mellitus and development of intergenerational overall and subtypes of cardiovascular diseases: a systematic review and meta-analysis.","authors":"Ashley Chen, Breanna Tan, Ruochen Du, Yap Seng Chong, Cuilin Zhang, Angela S Koh, Ling-Jun Li","doi":"10.1186/s12933-024-02416-7","DOIUrl":"10.1186/s12933-024-02416-7","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to summarize the association between gestational diabetes mellitus (GDM) and its intergenerational cardiovascular diseases (CVDs) impacts in both mothers and offspring post-delivery in existing literature.</p><p><strong>Methods: </strong>PubMed, Embase, Web of Science, and Scopus were utilized for searching publications between January 1980 and June 2024, with data extraction and meta-analysis continuing until 31 July 2024. Based on a predefined PROSPERO protocol, studies published as full-length, English-language journal articles that reported the presence of GDM during pregnancy and its association with any CVD development post-delivery were selected. All studies were evaluated using the Newcastle-Ottawa Scale. Maximally adjusted risk estimates were pooled using random-effects meta-analysis to assess the risk ratio (RR) of GDM, and overall and subtypes of CVDs in both mothers and offspring post-delivery.</p><p><strong>Results: </strong>The meta-analysis was based on 38 studies with a total of 77,678,684 participants. The results showed a 46% increased risk (RR 1.46, 95% CI 1.34-1.59) for mothers and a 23% increased risk (1.23, 1.05-1.45) for offspring of developing overall CVDs after delivery, following a GDM-complicated pregnancy. Our subgroup analysis revealed that mothers with a history of GDM faced various risks (20% to 2-fold) of developing different subtypes of CVDs, including cerebrovascular disease, coronary artery disease, heart failure, and venous thromboembolism.</p><p><strong>Conclusions: </strong>These findings underscore the heightened risk of developing various CVDs for mothers and offspring affected by GDM, emphasizing the importance of preventive measures even right after birth to mitigate the burden of CVDs in these populations.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":null,"pages":null},"PeriodicalIF":8.5,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11360578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142092248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Cardiovascular Diabetology
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