Implications of Haptoglobin Genotype and Cardiovascular Risk in Patients with Diabetes

2020 ◽  
Vol 2 (2) ◽  
pp. 41-49
Author(s):  
Brian K Irons ◽  
Keyword(s):  
Cardiovascular Risk ◽  
Glycemic Control ◽  
Cardiovascular Events ◽  
The Other ◽  
Main Function ◽  
Increased Risk ◽  
Genotype 2 ◽  
Haptoglobin Genotype ◽  
Patients With Diabetes ◽  
Post Hoc

Haptoglobin (HAP) is genetically polymorphic with three primary genotypes, HAP 1-1, 2-1 and 2-2. Each genotype differs phenotypically in HAP structure and ability to perform its main function, scavenging free hemoglobin (Hb) released from old red blood cells. Patients with both diabetes and the genotype 2-2 appear to be at an increased cardiovascular risk than those with the other genotypes or patients without diabetes. This risk appears elevated with worse glycemic control. The exact mechanism for this increased risk is unknown but there are several proposed causes. Vitamin E has shown to reduce cardiovascular events in patients with both diabetes and the 2-2 genotype but the safety of implementing such therapy remains unknown. Recent post-hoc evaluation of a landmark study originally designed to assess the benefits and risks of more aggressive glycemic control suggests there may be a cardiovascular benefit in patients with diabetes and the 2-2 genotype that is not seen in those with the other genotypes. This information, if confirmed with post-hoc evaluation of other similar landmark studies as well as evaluation of genotype differences in recent cardiovascular safety studies with glucagon-like peptide agonists or sodium-glucose cotransporter inhibitors, could provide clinicians with an avenue to better identify patients most at risk for cardiovascular events and who may benefit the most from more aggressive glycemic control or use of other antihyperglycemic agents.

scholarly journals Ten-year cardiovascular risk in diabetes patients without of coronary artery disease – a Danish cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K.K.W Olesen ◽  
M Madsen ◽  
C Gyldenkerne ◽  
P.G Thrane ◽  
T Thim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Ischemic Stroke ◽  
Cardiovascular Risk ◽  
General Population ◽  
Funding Source ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Artery Disease ◽  
Diabetes Patients

Abstract Background Patients with diabetes without obstructive coronary artery disease (CAD) by coronary angiography (CAG) have a risk of myocardial infarction (MI) similar to that of non-diabetes patients without CAD. Their cardiovascular risk compared to the general population is unknown. Purpose We examined the 10-year risks of myocardial infarction (MI), ischemic stroke, and death in diabetes patients without CAD after CAG compared to the general population. Methods We included all diabetes patients without obstructive CAD examined by CAG from 2003–2016 in Western Denmark and an age and sex matched comparison group, sampled from the general population in Western Denmark without previous history of coronary heart disease. Outcomes were MI, ischemic stroke, and death. The 10-year cumulative incidences were estimated. Adjusted hazard ratios (HRs) were estimated by stratified Cox regression using the general population as the reference group. Results We identified 5,760 diabetes patients without obstructive CAD and 29,139 individuals from the general population. Median follow-up was 7 years with 25% of participants followed for up to 10 years. Diabetes patients without obstructive CAD had an almost similar 10-year risk of MI (3.2% vs 2.9%, adjusted HR 0.91, 95% CI 0.70–1.17, Figure) compared to the general population cohort. Diabetes patients had an increased risk of ischemic stroke (5.2% vs 2.2%, adjusted HR 1.88, 95% CI 1.48–2.39), and death (29.7% vs 17.9%, adjusted HR 1.41, 95% CI 1.29–1.54). The duration of diabetes was associated with increased cardiovascular risk. Conclusions Absence of obstructive CAD by CAG in patients with diabetes ensures a low MI risk similar to the general population, but diabetes patients still have an increased risk of ischemic stroke and all-cause death despite absence of CAD. Figure 1 Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Department of Cardiology, Aarhus University Hospital

scholarly journals Cardiovascular complications according to severity of renal artery stenosis based on Doppler ultrasound

2021 ◽  
Author(s):  
Łukasz Artyszuk ◽  
Bartosz Symonides ◽  
Zbigniew Gaciong ◽  
Cezary Szmigielski
Keyword(s):  
Cardiovascular Risk ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Doppler Ultrasound ◽  
Cardiovascular Events ◽  
Cardiovascular Complications ◽  
Artery Stenosis ◽  
Control Group ◽  
Percutaneous Coronary Angioplasty ◽  
Increased Risk

IntroductionThe interactions between atherosclerotic renal artery stenosis, independently of severity, and cardiovascular risk, and mortality, are complex and have not been fully researched. The aim of this study was the assessment of the risk of cardiovascular events and mortality in patients with haemodynamically non-significant (NS-RAS) and significant renal artery stenosis (S-RAS) diagnosed with ultrasonography.Material and methodsThe study group consisted of all consecutive patients (n = 2059) who underwent Doppler ultrasound of the renal arteries during a 4-year period. The patients were divided, according to the renal aortic ratio (RAR), into the following groups: S-RAS (RAR ≥ 3.5), NS-RAS (1 < RAR < 3.5), and normal RAR (control group; RAR ≤ 1). The risk of cardiovascular events and death was estimated using Cox’s proportional hazard model, including severity of RAS, age, and gender, based on the data from the National Health Fund on causes of hospitalization, deaths, and statistics on percutaneous coronary angioplasty procedures.ResultsSignificant renal artery stenosis was found in 112 patients (5.4%), NS-RAS in 313 patients (15.2%), and 1634 patients (79.4%) were qualified to the control group. The NS-RAS group had an increased risk of stroke (7.0% vs. 3.0%, HR = 1.77, p = 0.032); S-RAS patients were at increased risk of heart failure (16.1% vs. 5.2%, HR = 2.19, p = 0.002) and death (19.6% vs. 4.3%, HR = 3.08, p < 0.001).ConclusionsThe presence of haemodynamically non-significant renal artery stenosis is an indicator of systemic atherosclerotic changes in vital organs and an important cardiovascular risk factor for stroke.

scholarly journals Cardiovascular Risk in Non-Alcoholic Fatty Liver Disease: Mechanisms and Therapeutic Implications

2019 ◽  
Vol 16 (17) ◽  
pp. 3104 ◽  
Author(s):  
Claudio Tana ◽  
Stefano Ballestri ◽  
Fabrizio Ricci ◽  
Angelo Di Vincenzo ◽  
Andrea Ticinesi ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Cardiovascular Risk ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Cardiovascular Events ◽  
Alcoholic Fatty Liver ◽  
The Metabolic Syndrome ◽  
Increased Risk ◽  
Alcoholic Fatty Liver Disease

New evidence suggests that non-alcoholic fatty liver disease (NAFLD) has a strong multifaceted relationship with diabetes and metabolic syndrome, and is associated with increased risk of cardiovascular events, regardless of traditional risk factors, such as hypertension, diabetes, dyslipidemia, and obesity. Given the pandemic-level rise of NAFLD—in parallel with the increasing prevalence of obesity and other components of the metabolic syndrome—and its association with poor cardiovascular outcomes, the question of how to manage NAFLD properly, in order to reduce the burden of associated incident cardiovascular events, is both timely and highly relevant. This review aims to summarize the current knowledge of the association between NAFLD and cardiovascular disease, and also to discuss possible clinical strategies for cardiovascular risk assessment, as well as the spectrum of available therapeutic strategies for the prevention and treatment of NAFLD and its downstream events.

The Role of Anti-obesity Drugs in Patients with Type 2 Diabetes

2013 ◽  
Vol 09 (02) ◽  
pp. 101 ◽  
Author(s):  
Priscilla Hollander ◽  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Lifestyle Changes ◽  
Important Concern ◽  
Increased Risk ◽  
The Us ◽  
Patients With Diabetes ◽  
Obesity Drugs

The prevalence of diabetes continues to rise, following the rising rates of obesity. Obesity is not only associated with an increased risk for developing type 2 diabetes but also an elevated probability of developing long-term complications associated with the disease. Weight gain is also an important concern as a potential side effect of therapies that improve glycemic control in diabetes, including insulin therapy. As a result, patients with type 2 diabetes are at risk for a vicious circle of increasing weight and increasing insulin resistance, thus requiring further intensification of glycemic treatment. It is therefore important to address the problem of obesity in patients with type 2 diabetes. In 2012, the US Food and Drug Administration (FDA) approved two new anti-obesity medications: lorcaserin and phentermine/topiramate extended-release. Both agents have demonstrated clinically meaningful weight reduction as well as significant improvements in glycemic control in obese patients with diabetes. Liraglutide has also shown weight loss and improvements in glycemic control in patients with diabetes. Anti-obesity drugs, in conjunction with lifestyle changes, may play a valuable role in the management of diabetes.

scholarly journals Family history and polygenic risk of cardiovascular disease: independent factors associated with secondary cardiovascular events in patients undergoing carotid endarterectomy

2019 ◽  
Author(s):  
Nathalie Timmerman ◽  
Dominique P.V. de Kleijn ◽  
Gert J. de Borst ◽  
Hester M. den Ruijter ◽  
Folkert W. Asselbergs ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Family History ◽  
Carotid Endarterectomy ◽  
Cardiovascular Risk Factors ◽  
Cardiovascular Events ◽  
Polygenic Risk ◽  
Increased Risk ◽  
The Impact

AbstractBackgroundFamily history (FHx) of cardiovascular disease (CVD) is a risk factor for CVD and a proxy for cardiovascular heritability. Polygenic risk scores (PRS) summarizing >1 million variants for coronary artery disease (CAD) are associated with incident and recurrent CAD events. However, little is known about the influence of FHx or PRS on secondary cardiovascular events (sCVE) in patients undergoing carotid endarterectomy (CEA).MethodsWe included 1,788 CEA patients from the Athero-Express Biobank. A weighted PRS for CAD including 1.7 million variants was calculated (MetaGRS). The composite endpoint of sCVE during three years follow-up included coronary, cerebrovascular and peripheral events and cardiovascular death. We assessed the impact of FHx and MetaGRS on sCVE and carotid plaque composition.ResultsPositive FHx was associated with a higher 3-year risk of sCVE independent of cardiovascular risk factors and MetaGRS (adjusted HR 1.40, 95%CI 1.07-1.82, p=0.013). Patients in the highest MetaGRS quintile had a higher 3-year risk of sCVE compared to the rest of the cohort independent of cardiovascular risk factors including FHx (adjusted HR 1.35, 95%CI 1.01-1.79, p=0.043), and their atherosclerotic plaques contained more fat (adjusted OR 1.59, 95%CI, 1.11-2.29, p=0.013) and more macrophages (OR 1.49, 95%CI 1.12-1.99, p=0.006).ConclusionIn CEA patients, both positive FHx and higher MetaGRS were independently associated with increased risk of sCVE. Moreover, higher MetaGRS was associated with vulnerable plaque characteristics. Future studies should unravel underlying mechanisms and focus on the added value of PRS and FHx in individual risk prediction for sCVE.

scholarly journals A higher non-severe hypoglycaemia rate is associated with an increased risk of subsequent severe hypoglycaemia and major adverse cardiovascular events in individuals with type 2 diabetes in the LEADER study

Diabetologia ◽  
2021 ◽  
Author(s):  
Simon R. Heller ◽  
Milan S. Geybels ◽  
Ahmed Iqbal ◽  
Lei Liu ◽  
Lily Wagner ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Events ◽  
Severe Hypoglycaemia ◽  
Cardiovascular Death ◽  
Cardiovascular Outcomes ◽  
Post Hoc Analysis ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Post Hoc

Abstract Aims/hypothesis Hypoglycaemia is a common side effect of insulin and some other antihyperglycaemic agents used to treat diabetes. Severe hypoglycaemia has been associated with adverse cardiovascular events in trials of intensive glycaemic control in type 2 diabetes. The relationship between non-severe hypoglycaemic episodes (NSHEs) and severe hypoglycaemia in type 2 diabetes has been documented. However, an association between more frequent NSHEs and cardiovascular events has not been verified. This post hoc analysis of the LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results) trial aimed to confirm whether there is an association between NSHEs and severe hypoglycaemic episodes in individuals with type 2 diabetes. In addition, the possible association between NSHEs and major adverse cardiac events (MACE), cardiovascular death and all-cause mortality was investigated. Methods LEADER was a double-blind, multicentre, placebo-controlled trial that found that liraglutide significantly reduced the risk of MACE compared with the placebo. In this post hoc analysis, we explored, in all LEADER participants, whether the annual rate of NSHEs (defined as self-measured plasma glucose <3.1 mmol/l [56 mg/dl]) was associated with time to first severe hypoglycaemic episode (defined as an episode requiring the assistance of another person), time to first MACE, time to cardiovascular death and time to all-cause mortality. Participants with <2 NSHEs per year were used as reference for HR estimates. Cox regression with a time-varying covariate was used. Results We demonstrate that there is an association between NSHEs (2–11 NSHEs per year and ≥12 NSHEs per year) and severe hypoglycaemic episodes (unadjusted HRs 1.98 [95% CI 1.43, 2.75] and 5.01 [95% CI 2.84, 8.84], respectively), which was consistent when baseline characteristics were accounted for. Additionally, while no association was found between participants with 2–11 NSHEs per year and adverse cardiovascular outcomes, higher rates of NSHEs (≥12 episodes per year) were associated with higher risk of MACE (HR 1.50 [95% CI 1.01, 2.23]), cardiovascular death (HR 2.08 [95% CI 1.17, 3.70]) and overall death (HR 1.80 [95% CI 1.11, 2.92]). Conclusions/interpretation The analysis of data from the LEADER trial demonstrated that higher rates of NSHEs were associated with both a higher risk of severe hypoglycaemia and adverse cardiovascular outcomes in individuals with type 2 diabetes. Therefore, irrespective of the cause of this association, it is important that individuals with high rates of hypoglycaemia are identified so that the potentially increased risk of cardiovascular events can be managed and steps can be taken to reduce NSHEs. Trial registration ClinicalTrials.gov (NCT01179048). Graphical abstract

scholarly journals Underlying cardiovascular risk and major adverse cardiovascular events after acute respiratory infection: a population-based cohort study of over 4.2 million individuals in England, 2008-2018

2021 ◽  
Author(s):  
Jennifer Davidson ◽  
Amitava Banerjee ◽  
Liam Smeeth ◽  
Helen I McDonald ◽  
Daniel J Grint ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiovascular Risk ◽  
Cardiovascular Events ◽  
Respiratory Infections ◽  
Cardiovascular Complications ◽  
Major Adverse Cardiovascular Events ◽  
Mortality Data ◽  
Clinical Practice Research Datalink ◽  
Increased Risk ◽  
One Year

Background While acute respiratory infections (ARIs) can lead to cardiovascular complications, the effect of underlying cardiovascular risk profile on ARI incidence and cardiovascular complications in those without established cardiovascular disease (CVD) is unknown. Whether to consider individuals at raised cardiovascular risk a priority group for vaccination against respiratory infections therefore remains unclear. Methods We conducted a cohort study in individuals aged 40-64 years without established CVD or a chronic health condition eligible for influenza vaccination, using Clinical Practice Research Datalink GOLD and Aurum data from 01/09/2008-31/08/2018 linked to Hospital Episode Statistics Admitted Patient Care and Office for National Statistics mortality data from England. We classified cardiovascular risk based on diagnosed hypertension and overall predicted cardiovascular risk estimated using QRISK2 score (≥10% compared with <10%). Using multivariable Poisson regression models, we obtained incidence rate ratios (IRR) for ARI. Among individuals who had an ARI, we then used multivariable Cox regression to obtain hazard ratios (HR) for the risk of major adverse cardiovascular events (MACE) within one year of infection. Findings 4,212,930 individuals were included; 12.5% had hypertension and 14.4% had a QRISK2 score ≥10%. After adjusting for confounders, patients with hypertension (IRR 1.04, 95% CI 1.03-1.05) or QRISK2 score ≥10% (IRR 1.39, 1.37-1.40) had a higher incidence of ARI. Of the 442,408 individuals with an ARI, 4,196 had a MACE within one year of infection. After adjustment, hypertension (HR 1.98, 1.83-2.15) and QRISK2 score ≥10% (HR 3.65, 3.42-3.89) were associated with substantial increased risk of a MACE after infection. Interpretation People without diagnosed CVD but who have raised cardiovascular risk, measured by diagnosed hypertension or, in particular, overall predicted cardiovascular risk, have increased incidence of both ARI and cardiovascular complications following an ARI.

scholarly journals Clinical Features of COVID-19 Patients with Diabetes and Secondary Hyperglycemia

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Wan Zhou ◽  
Shandong Ye ◽  
Wei Wang ◽  
Sumei Li ◽  
Qinggang Hu ◽  
...  
Keyword(s):  
The Other ◽  
Diabetic Patients ◽  
Diabetes Group ◽  
Cell Counts ◽  
Ct Findings ◽  
Cd4 Cell Counts ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Hs Crp ◽  
Cd4 Cell

People with diabetes have higher risks of various infections. Therefore, these diabetic patients might be at increased risk of COVID-19 and have a poorer prognosis. Up until now, little is known about critical role in the pathogenesis. This study aims to investigate the clinical characteristics of COVID-19 patients with diabetes and secondary hyperglycemia, as well as to explore the purported mechanisms. 80 confirmed COVID-19 subjects were classified into the euglycemia group, secondary hyperglycemia group, and diabetes group. Severity of COVID-19 was defined based on the diagnostic and treatment guideline for SARS-CoV-2 issued by Chinese National Health Committee. According to the severity of the disease, patients of the mild type and common type were registered as mild cases (patients with minimal symptoms and negative CT findings), while patients of the severe type and critical type were enrolled as severe cases (patients with positive CT findings and different extent of clinical manifestations). Patients in the diabetes group were older than those in the euglycemia group, and most of them were male. In the diabetes group, the proportion of severe cases was 57.14%, which was significantly higher than those in the other two groups, and 32% of the COVID-19 patients diagnosed as severe cases were with diabetes. The CD4+ cell counts in the diabetes group were lower than those in the other two groups, while the levels of LDH and hs-CRP were higher. Compared with the euglycemia group, the CD3+ cell counts and the CD4+/CD8+ ratio were decreased, whereas the levels of IL-6 were increased in the secondary hyperglycemia group and diabetes group, with the diversities in the diabetes group being especially more significant. The Spearman correlation analysis revealed that the presence of diabetes was positively correlated with age, hs-CRP, LDH, IL-6, CD8+ cells, and severity of COVID-19 and negatively correlated with CD3+ cell counts, CD4+ cell counts, and CD4+/CD8+ ratio. Compared with the other two groups, the diabetes group exhibited more diverse and multifocal features in CT imagings. Diabetes is a risk factor for influence of the progression and prognosis of COVID-19 due to ongoing inflammation and impaired immune response.

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