Association of Treatment With Metformin vs Sulfonylurea With Major Adverse Cardiovascular Events Among Patients With Diabetes and Reduced Kidney Function

Abstract Background and Aims The association of lipid parameters with cardiovascular outcomes and the impact of kidney function on this association have not been thoroughly evaluated in chronic kidney disease (CKD) patients with diabetes. Method We reviewed the National Health Insurance Database of Korea, containing the data of 10,505,818 subjects who received routine check-ups in 2009. We analyzed the association of lipid profile parameters with major adverse cardiovascular events (MACEs) risk and all-cause mortality in a nationally representative cohort of 51,757 lipid-lowering medication-naïve patients who had CKD and diabetes. Results Advanced CKD patients with eGFR <30 mL/min/1.73 m2 (n=10,775) had lower serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c) but higher non-HDL-c levels and triglyceride (TG) to HDL-c ratios. There was a positive linear association between serum LDL-c and MACE risk in both early and advanced CKD patients (P <0.001 for trend). A U-shaped relationship was observed between serum LDL-c and all-cause mortality (the 4th and 8th octile groups; lowest hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.87-1.05 and highest HR 1.14, 95% CI 1.04-1.26, respectively). A similar pattern remained in both early and advanced CKD patients. The TG/HDL-c ratio categories showed a positive linear association for MACE risk in early CKD (P <0.001 for trend), but this correlation disappeared in advanced CKD patients. There was no correlation between the serum TG/HDL-c ratio and all-cause mortality in the study patients. Conclusion The LDL-c level predicted the risk for MACEs and all-cause mortality in both early and advanced CKD patients with diabetes, although the patterns of the association differed from each other. However, the TG/HDL-c ratio categories could not predict the risk for either MACEs or all-cause mortality in advanced CKD patients with diabetes, except that the TG/HDL-c ratio predicted MACE risk in early CKD patients with diabetes.

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Aspirin effect on the incidence of major adverse cardiovascular events in patients with diabetes mellitus: a systematic review and meta-analysis

Cardiovascular Diabetology ◽

10.1186/1475-2840-10-25 ◽

2011 ◽

Vol 10 (1) ◽

pp. 25 ◽

Cited By ~ 37

Author(s):

Sonia Butalia ◽

Alexander A Leung ◽

William A Ghali ◽

Doreen M Rabi

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Cardiovascular Events ◽

Meta Analysis ◽

Major Adverse Cardiovascular Events ◽

Patients With Diabetes

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Benefits and Risks Associated With Aspirin Use in Patients With Diabetes for the Primary Prevention of Cardiovascular Events and Mortality: A Meta-Analysis

Frontiers in Endocrinology ◽

10.3389/fendo.2021.741374 ◽

2021 ◽

Vol 12 ◽

Author(s):

Hua Ma ◽

Qing Gu ◽

Huining Niu ◽

Xiaohua Li ◽

Rong Wang

Keyword(s):

Cardiovascular Disease ◽

Primary Prevention ◽

Cardiovascular Events ◽

Meta Analysis ◽

Significant Risk ◽

Major Adverse Cardiovascular Events ◽

Control Group ◽

All Cause Mortality ◽

Patients With Diabetes ◽

Aspirin Group

PurposeA meta-analysis was conducted to assess the benefits and risks of aspirin for the primary prevention of cardiovascular disease and all-cause mortality events in adults with diabetes.MethodsAn extensive and systematic search was conducted in MEDLINE (via PubMed), Cinahl (via Ebsco), Scopus, and Web of Sciences from 1988 to December 2020. A detailed literature search was conducted using aspirin, cardiovascular disease (CVD), diabetes, and efficacy to identify trials of patients with diabetes who received aspirin for primary prevention of CVD. Demographic details with the primary outcome of events and bleeding outcomes were analyzed. The Cochrane Collaboration’s risk of bias tool was used to assess the methodological quality of the included studies. Random-effects meta-analysis was used to calculate the pooled odds ratio for outcomes of cardiovascular events, death, and adverse events.FindingsA total of 8 studies were included with 32,024 patients with diabetes; 16,001 allocated to aspirin, and 16,023 allocated to the control group. There was no difference between aspirin and control groups with respect to all-cause mortality, cardiovascular mortality, or bleeding events. However, MACE was significantly lower in the aspirin group.ImplicationsAlthough aspirin has no significant risk on primary endpoints of cardiovascular events and bleeding outcomes in patients with diabetes compared to control, major adverse cardiovascular events (MACE) were significantly lower in the aspirin group. Further research on the use of aspirin alone or in combination with other antiplatelet drugs is required in patients with diabetes to supplement currently available research. Systematic Review Registrationidentifier [XU#/IRB/2020/1005].

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Association of UBE3C Variants with Reduced Kidney Function in Patients with Diabetic Kidney Disease

Journal of Personalized Medicine ◽

10.3390/jpm10040210 ◽

2020 ◽

Vol 10 (4) ◽

pp. 210

Author(s):

Ying-Chun Chen ◽

Mei-Yi Wu ◽

Zhi-Lei Yu ◽

Wan-Hsuan Chou ◽

Yi-Ting Lai ◽

...

Keyword(s):

Kidney Disease ◽

Kidney Function ◽

Diabetic Kidney Disease ◽

Clinical Role ◽

Diabetic Kidney ◽

Factors Affecting ◽

Patients With Diabetes ◽

Stage Renal Disease ◽

End Stage ◽

Reduced Kidney Function

Diabetic kidney disease (DKD) is the leading cause of morbidity and mortality in patients with diabetes mellitus (DM) and the most common variant of end-stage renal disease (ESRD) globally. The economic burden of ESRD treatment with dialysis is substantial. The incidence and prevalence of ESRD in Taiwan remain the highest worldwide. Therefore, identifying genetic factors affecting kidney function would have valuable clinical implications. We performed microarray experiments and identified that ubiquitin protein ligase E3C (UBE3C) is differentially expressed in two DKD patient groups with extreme (low and high) urine protein-to-creatinine ratios. A follow-up genotyping study was performed in a larger group to investigate any specific variants of UBE3C associated with DKD. A total of 263 patients were included in the study, comprising 172 patients with DKD and 91 control subjects (patients with DM without chronic kidney disease (CKD)). Two UBE3C variants (rs3802129(AA) and rs7807(CC)) were determined to be associated with reduced kidney function. The haplotype analysis revealed that rs3802129/rs3815217 (block 1) with A/G haplotype and rs8101/rs7807 (block 2) with T/C haplotype were associated with higher risks of CKD phenotypes. These findings suggest a clinical role of UBE3C variants in DKD risk.

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Triglyceride-glucose index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome

10.21203/rs.3.rs-16318/v1 ◽

2020 ◽

Author(s):

Le Wang ◽

Hongliang Cong ◽

Jing-xia Zhang ◽

Yue-cheng Hu ◽

Ao Wei ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cardiovascular Events ◽

Independent Predictor ◽

Survival Rates ◽

Major Adverse Cardiovascular Events ◽

Coronary Syndrome ◽

Tyg Index ◽

Net Reclassification Improvement ◽

Triglyceride Glucose Index ◽

Patients With Diabetes

Abstract Background: Triglyceride-glucose index (TyG index) has been regarded as a reliable alternative marker of insulin resistance and an independent predictor of cardiovascular outcomes. Whether TyG index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome (ACS) remains uncertain. The aim of the present study was to investigate the prognostic value of TyG index in patients with diabetes and ACS.Methods: A total of 2531 consecutive patients with diabetes who underwent coronary angiography for ACS were enrolled in the study. Patients were divided into 3 tertiles according to TyG index. The primary outcomes included the occurrence of major adverse cardiovascular events (MACE), defined as all-cause death, non-fatal myocardial infarction and non-fatal stroke. The TyG index was calculated as ln (fasting triglyceride level (mg/dL) ×fasting glucose level (mg/dL)/2). Results: The incidence of MACE increased with TyG index tertiles after 3-year follow-up. Kaplan-Meier curves showed significant differences in event-free survival rates among TyG index tertiles (P=0.005). Multivariate Cox hazards regression analysis revealed that TyG index was an independent predictor of MACE (95% CI 1.201-1.746; P<0.001). The optimal TyG index cut-off for predicting MACE was 9.323 (sensitivity 46.0% ; specificity 63.6%; area under the curve 0.560; P=0.001 ).Furthermore, adding TyG index to the prognostic model for MACE improved the C-statistic value (P=0.010), the integrated discrimination improvement value(P=0.001) and the net reclassification improvement value(P=0.019).Conclusions TyG index predicts future recurrent cardiovascular events in patients with diabetes and ACS, independently of known cardiovascular risk factors，suggesting that TyG index may be a useful marker for risk stratification and prognosis in patients with diabetes and ACS.

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Cardiovascular risk in patients with and without diabetes presenting with chronic coronary syndrome in 2004–2016

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02312-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Esben Skov Jensen ◽

Kevin Kris Warnakula Olesen ◽

Christine Gyldenkerne ◽

Pernille Gro Thrane ◽

Lisette Okkels Jensen ◽

...

Keyword(s):

Cardiovascular Risk ◽

Coronary Angiography ◽

Cardiovascular Events ◽

Major Adverse Cardiovascular Events ◽

Coronary Syndrome ◽

Patients With Diabetes ◽

Adjusted Incidence Rate ◽

Artery Disease ◽

Rate Ratios ◽

Diabetes Patients

Abstract Background It was recently shown that new-onset diabetes patients without previous cardiovascular disease have experienced a markedly reduced risk of adverse cardiovascular events from 1996 to 2011. However, it remains unknown if similar improvements are present following the diagnosis of chronic coronary syndrome. The purpose of this study was to examine the change in cardiovascular risk among diabetes patients with chronic coronary syndrome from 2004 to 2016. Methods We included patients with documentation of coronary artery disease by coronary angiography between 2004 and 2016 in Western Denmark. Patients were stratified by year of index coronary angiography (2004–2006, 2007–2009, 2010–2012, and 2013–2016) and followed for two years. The main outcome was major adverse cardiovascular events (MACE) defined as myocardial infarction, ischemic stroke, or death. Analyses were performed separately in patients with and without diabetes. We estimated two-year risk of each outcome and adjusted incidence rate ratios (aIRR) using patients examined in 2004-2006 as reference. Results Among 5931 patients with diabetes, two-year MACE risks were 8.4% in 2004–2006, 8.5% in 2007–2009, and then decreased to 6.2% in 2010–2012 and 6.7% in 2013–2016 (2013–2016 vs 2004–2006: aIRR 0.70, 95% CI 0.53–0.93). In comparison, 23,540 patients without diabetes had event rates of 6.3%, 5.2%, 4.2%, and 3.9% for the study intervals (2013–2016 vs 2004–2006: aIRR 0.57, 95% CI 0.48–0.68). Conclusions Between 2004 and 2016, the two-year relative risk of MACE decreased by 30% in patients with diabetes and chronic coronary syndrome, but slightly larger absolute and relative reductions were observed in patients without diabetes.

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