Lipoprotein(a) concentration is associated with risk of type 2 diabetes and cardiovascular events in a Chinese population with very high cardiovascular risk

Endocrine ◽  
2020 ◽  
Vol 69 (1) ◽  
pp. 63-72
Author(s):  
Dilidaer Muhanhali ◽  
Tianyu Zhai ◽  
Zhenqin Cai ◽  
Yan Ling
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
Chinese Population ◽  
Cardiovascular Events ◽  
High Cardiovascular Risk ◽  
Lipoprotein A ◽  
Very High

scholarly journals Clinical profiles and quality of care of subjects with type 2 diabetes according to their cardiovascular risk: an observational, retrospective study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Basilio Pintaudi ◽  
Alessia Scatena ◽  
Gabriella Piscitelli ◽  
Vera Frison ◽  
Salvatore Corrao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Quality Of Care ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Cardiovascular Risk Factors ◽  
High Cardiovascular Risk ◽  
Very High

Abstract Background The European Society of Cardiology (ESC) recently defined cardiovascular risk classes for subjects with diabetes. Aim of this study was to explore the distribution of subjects with type 2 diabetes (T2D) by cardiovascular risk groups according to the ESC classification and to describe the quality indicators of care, with particular regard to cardiovascular risk factors. Methods The study is based on data extracted from electronic medical records of patients treated at the 258 Italian diabetes centers participating in the AMD Annals initiative. Patients with T2D were stratified by cardiovascular risk. General descriptive indicators, measures of intermediate outcomes, intensity/appropriateness of pharmacological treatment for diabetes and cardiovascular risk factors, presence of other complications and overall quality of care were evaluated. Results Overall, 473,740 subjects with type 2 diabetes (78.5% at very high cardiovascular risk, 20.9% at high risk and 0.6% at moderate risk) were evaluated. Among people with T2D at very high risk: 26.4% had retinopathy, 39.5% had albuminuria, 18.7% had a previous major cardiovascular event, 39.0% had organ damage, 89.1% had three or more risk factors. The use of DPP4-i markedly increased as cardiovascular risk increased. The prescription of secretagogues also increased and that of GLP1-RAs tended to increase. The use of SGLT2-i was still limited, and only slightly higher in subjects with very high cardiovascular risk. The overall quality of care, as summarized by the Q score, tended to be lower as the level of cardiovascular risk increased. Conclusions A large proportion of subjects with T2D is at high or very high risk. Glucose-lowering drug therapies seem not to be adequately used with respect to their potential advantages in terms of cardiovascular risk reduction. Several actions are necessary to improve the quality of care.

scholarly journals Disease overarching mechanisms that explain and predict outcome of patients with high cardiovascular risk: rationale and design of the Berlin Long-term Observation of Vascular Events (BeLOVE) study

2019 ◽  
Author(s):  
Bob Siegerink ◽  
Joachim Weber ◽  
Michael Ahmadi ◽  
Kai-Uwe Eckardt ◽  
Frank Edelmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Cardiovascular Events ◽  
Target Organ Damage ◽  
Organ Damage ◽  
High Cardiovascular Risk

AbstractBackgroundCardiovascular disease (CVD) is the leading cause of premature death worldwide. Effective and individualized treatment requires exact knowledge about both risk factors and risk estimation. Most evidence for risk prediction currently comes from population-based studies on first incident cardiovascular events. In contrast, little is known about the relevance of risk factors for the outcome of patients with established CVD or those who are at high risk of CVD, including patients with type 2 diabetes. In addition, most studies focus on individual diseases, whereas less is known about disease overarching risk factors and cross-over risk.AimThe aim of BeLOVE is to improve short- and long-term prediction and mechanistic understanding of cardiovascular disease progression and outcomes in very high-risk patients, both in the acute as well as in the chronic phase, in order to provide the basis for improved, individualized management.Study designBeLOVE is an observational prospective cohort study of patients of both sexes aged >18 in selected Berlin hospitals, who have a high risk of future cardiovascular events, including patients with a history of acute coronary syndrome (ACS), acute stroke (AS), acute heart failure (AHF), acute kidney injury (AKI) or type 2 diabetes with manifest target-organ damage. BeLOVE includes 2 subcohorts: The acute subcohort includes 6500 patients with ACS, AS, AHF, or AKI within 2-8 days after their qualifying event, who undergo a structured interview about medical history as well as blood sample collection. The chronic subcohort includes 6000 patients with ACS, AS, AHF, or AKI 90 days after event, and patients with type 2 diabetes (T2DM) and target-organ damage. These patients undergo a 6-8 hour deep phenotyping program, including detailed clinical phenotyping from a cardiological, neurological and metabolic perspective, questionnaires including patient-reported outcome measures (PROMs)as well as magnetic resonance imaging. Several biological samples are collected (i.e. blood, urine, saliva, stool) with blood samples collected in a fasting state, as well as after a metabolic challenge (either nutritional or cardiopulmonary exercise stress test). Ascertainment of major adverse cardiovascular events (MACE) will be performed in all patients using a combination of active and passive follow-up procedures, such as on-site visits (if applicable), telephone interviews, review of medical charts, and links to local health authorities. Additional phenotyping visits are planned at 2, 5 and 10 years after inclusion into the chronic subcohort.Future perspectiveBeLOVE provides a unique opportunity to study both the short- and long-term disease course of patients at high cardiovascular risk through innovative and extensive deep phenotyping. Moreover, the unique study design provides opportunities for acute and post-acute inclusion and allows us to derive two non-nested yet overlapping sub-cohorts, tailored for upcoming research questions. Thereby, we aim to study disease-overarching research questions, to understand crossover risk, and to find similarities and differences between clinical phenotypes of patients at high cardiovascular risk.

scholarly journals Effects of dapagliflozin of the markers of fibrosis and inflammation in type 2 diabetes and very high cardiovascular risk

2021 ◽  
Vol 5 (4) ◽  
pp. 185-188
Author(s):  
D.A. Lebedev ◽  
◽  
A.Yu. Babenko ◽  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
Randomized Clinical Trials ◽  
High Sensitivity ◽  
Type I ◽  
High Cardiovascular Risk ◽  
Renal Outcomes ◽  
Positive Effects ◽  
Very High

Background: several randomized clinical trials have demonstrated that dapagliflozin, like other inhibitors of sodium-glucose cotransporter 2 (SGLT2), significantly improves cardiovascular and renal outcomes in type 2 diabetes (T2D). However, underlying mechanisms remain unclear. Aim: to assess changes in the levels of serum markers associated with fibrosis and inflammation in patients with T2D receiving dapagliflozin. Patients and Methods: this prospective single-center study included 27 patients aged 40–65 years with T2D that lasts more than 1 year and without verified atherosclerosis but multiple cardiovascular risk factors (i.e., dyslipidemia, obesity, hypertension). In addition to basic treatment for T2D, all patients received dapagliflozin 10 mg daily for 6 months. Before and 6 months after treatment, the levels of the markers of fibrosis (including procollagen type I carboxy-terminal propeptide/PICP) and inflammation were measured. Results: the median age was 56 [49; 61] years and the median duration of T2D was 7 [4; 12] years. After 6-month treatment with dapagliflozin, significant reduction in the concentration of PICP from 136.8 [100,4; 200,6] ng/ml to 104.8 [79.7; 162.0] ng/ml (р = 0.019). The levels of galectin-3, matrix metalloproteinase (MMP) 9, tissue inhibitor of MMP-1, growth stimulating expressed gene 2, high-sensitivity C-reactive protein, and N-terminal pro-atrial natriuretic peptide were similar at baseline and after 6-month treatment. Conclusions: 6-month treatment with dapagliflozin reduced the levels of PICP. Together with other mechanisms, this phenomenon illustrates the positive effects of dapagliflozin on cardiovascular and renal outcomes in T2D. KEYWORDS: type 2 diabetes, fibrosis, chronic inflammation, dapagliflozin, cardiovascular diseases. FOR CITATION: Lebedev D.A., Babenko A.Yu. Effects of dapagliflozin of the markers of fibrosis and inflammation in type 2 diabetes and very high cardiovascular risk. Russian Medical Inquiry. 2021;5(4):185–188 (in Russ.). DOI: 10.32364/2587-6821-2021-5-4-185-188.

scholarly journals Cost-effectiveness of screening of coronary artery disease in patients with type 2 DIABetes at a very high cardiovascular risk (SCADIAB study) rational and design

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Kamel Mohammedi ◽  
Nathalie Préaubert ◽  
Tanguy Cariou ◽  
Vincent Rigalleau ◽  
Ninon Foussard ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Lower Limb ◽  
High Cardiovascular Risk ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
Very High

Abstract Background Screening for coronary artery disease (CAD) remains broadly performed in patients with type 2 diabetes (T2DM), although the lack of evidence. We conduct a real-world evidence (RWE) study to assess the risk of major clinical outcomes and economic impact of routine CAD screening in T2DM individuals at a very high cardiovascular risk. Methods SCADIAB is a comparative nationwide cohort study using data from the French National Health Data System. The main inclusion criteria are: age ≥ 40 years, DT2 diagnosed for ≥ 7 years, with ≥ 2 additional cardiovascular risk factors plus a history of microvascular or macrovascular disease, except CAD. We estimated ≥ 90,000 eligible participants for our study. Data will be extracted from 01/01/2008 to 31/12/2019. Eligible participants will be identified during a first 7-year selection period (2008–2015). Each participant will be assigned either in experimental (CAD screening procedure during the selection period) or control group (no CAD screening) on 01/01/2015, and followed for 5 years. The primary endpoint is the incremental cost per life year saved over 5 years in CAD screening group versus no CAD screening. The main secondary endpoints are: total 5-year direct costs of each strategy; incidence of major cardiovascular (acute coronary syndrome, hospitalization for heart failure, coronary revascularization or all-cause death), cerebrovascular (hospitalization for transient ischemic attack, stroke, or carotid revascularization) and lower-limb events (peripheral artery disease, ischemic diabetic foot, lower-limb revascularization or amputation); and the budget impact for the French Insurance system to promote the cost-effective strategy. Analyses will be adjusted for a high-dimension propensity score taking into account known and unknown confounders. SCADIAB has been funded by the French Ministry of Health and the protocol has been approved by the French ethic authorities. Data management and analyses will start in the second half of 2021. Discussion SCADIAB is a large and contemporary RWE study that will assess the economic and clinical impacts of routine CAD screening in T2DM people at a very high cardiovascular risk. It will also evaluate the clinical practice regarding CAD screening and help to make future recommendations and optimize the use of health care resources. Trial registration ClinicalTrials.gov Identifier: NCT04534530 (https://clinicaltrials.gov/ct2/show/NCT04534530)

scholarly journals Disease overarching mechanisms that explain and predict outcome of patients with high cardiovascular risk: rationale and design of the Berlin Long-term Observation of Vascular Events (BeLOVE) study

2019 ◽  
Author(s):  
Bob Siegerink ◽  
Joachim Weber ◽  
Michael Ahmadi ◽  
Kai-Uwe Eckardt ◽  
Frank Edelmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Cardiovascular Events ◽  
Target Organ Damage ◽  
Organ Damage ◽  
High Cardiovascular Risk

Background: Cardiovascular disease (CVD) is the leading cause of premature death worldwide. Effective and individualized treatment requires exact knowledge about both risk factors and risk estimation. Most evidence for risk prediction currently comes from population-based studies on first incident cardiovascular events. In contrast, little is known about the relevance of risk factors for the outcome of patients with established CVD or those who are at high risk of CVD, including patients with type 2 diabetes. In addition, most studies focus on individual diseases, whereas less is known about disease overarching risk factors and cross-over risk. Aim: The aim of BeLOVE is to improve short- and long-term prediction and mechanistic understanding of cardiovascular disease progression and outcomes in very high-risk patients, both in the acute as well as in the chronic phase, in order to provide the basis for improved, individualized management. Study design: BeLOVE is an observational prospective cohort study of patients of both sexes aged >18 in selected Berlin hospitals, who have a high risk of future cardiovascular events, including patients with a history of acute coronary syndrome (ACS), acute stroke (AS), acute heart failure (AHF), acute kidney injury (AKI) or type 2 diabetes with manifest target-organ damage. BeLOVE includes 2 subcohorts: The acute subcohort includes 6500 patients with ACS, AS, AHF, or AKI within 2-8 days after their qualifying event, who undergo a structured interview about medical history as well as blood sample collection. The chronic subcohort includes 6000 patients with ACS, AS, AHF, or AKI 90 days after event, and patients with type 2 diabetes (T2DM) and target-organ damage. These patients undergo a 6-8 hour deep phenotyping program, including detailed clinical phenotyping from a cardiological, neurological and metabolic perspective, questionnaires including patient-reported outcome measures (PROMs)as well as magnetic resonance imaging. Several biological samples are collected (i.e. blood, urine, saliva, stool) with blood samples collected in a fasting state, as well as after a metabolic challenge (either nutritional or cardiopulmonary exercise stress test). Ascertainment of major adverse cardiovascular events (MACE) will be performed in all patients using a combination of active and passive follow-up procedures, such as on-site visits (if applicable), telephone interviews, review of medical charts, and links to local health authorities. Additional phenotyping visits are planned at 2, 5 and 10 years after inclusion into the chronic subcohort. Future perspective: BeLOVE provides a unique opportunity to study both the short- and long-term disease course of patients at high cardiovascular risk through innovative and extensive deep phenotyping. Moreover, the unique study design provides opportunities for acute and post-acute inclusion and allows us to derive two non-nested yet overlapping sub-cohorts, tailored for upcoming research questions. Thereby, we aim to study disease-overarching research questions, to understand crossover risk, and to find similarities and differences between clinical phenotypes of patients at high cardiovascular risk.

scholarly journals Cardiovascular events and effectiveness of hypolipidemic therapy in patients with familial hypercholesterolemia and patients of very high cardiovascular risk: 3-year follow-up of the RENAISSANCE Registry

2020 ◽  
pp. 27-36
Author(s):  
У.В. Чубыкина ◽  
М.В. Ежов
Keyword(s):  
Cardiovascular Risk ◽  
Familial Hypercholesterolemia ◽  
Cardiovascular Events ◽  
Density Lipoprotein ◽  
High Cardiovascular Risk ◽  
Lipoprotein A ◽  
History Of ◽  
Male Sex ◽  
Very High

Цель. Целью исследования явилась оценка эффективности и приверженности гиполипидемической терапии, частоты развития сердечно<со< судистых осложнений в течение 3<летнего периода наблюдения в рамках регистра РЕНЕССАНС (Регистр пациентов с СГХС и пациентов очень высокого сЕрдечно<Сосудистого риска с недоСтАточной эффективНоСтью проводимой гиполипидемической терапии). Материал и методы. РЕНЕССАНС является открытым национальным наблюдательным исследованием и включает больных с семейной ги< перхолестеринемией (СГХС), а также пациентов очень высокого сердечно<сосудистого риска (ОВССР). Учитывали наличие факторов риска атеросклероза, анамнез сердечно<сосудистых заболеваний, гиполипидемическую терапию. В каждом центре выполняли определение концен< трации: общего холестерина (ОХС), триглицеридов (ТГ), холестерина липопротеидов высокой плотности (ХС ЛВП) в сыворотке крови. Содер< жание холестерина липопротеидов низкой плотности (ХС ЛНП) рассчитывали по формуле Фридвальда. Уровень липопротеида(а) измеряли методом иммуноферментного анализа в некоторых центрах. При оценке частоты конечной точки, включавшей фатальные и нефатальные сердечно<сосудистых осложнения (ССО), проводили анализ Каплана — Майера. Результаты. В регистр включено 1570 (средний возраст 54,0±14,6 лет) пациентов с СГХС и 121 (63,5±10,9 лет) больной с ОВССР. В группе СГХС динамическое наблюдение проведено у 594 пациентов (38%) в течение 23,6±14,6 месяцев, конечная точка зарегистрирована у 9% больных. Мужской пол (относительный риск 2,1; 95% доверительный интервал 1,13–3,66; p<0,01), гипертония (2,8; 1,4–5,2; p<0,01), ишеми< ческая болезнь сердца (6,8; 3,5–13,2; p<0,0001), отягощенный анамнез по сердечно<сосудистым заболеваниям (ССЗ) (2,1; 1,1–3,9; p<0,05) и концентрация липопротеида(а) ≥ 30 мг/дл (2,8; 1,1–7,7; p<0,05) явились предикторами развития ССО. В группе СГХС отмечено снижение уровня ОХС от исходного на 19%, ХС ЛНП на 25% (р<0,001 для обоих), целевых значений ХС ЛНП достигли 2% больных. В группе ОВССР динамическое наблюдение проведено у 72 (60%) пациентов в течение 19,7±5,8 месяцев. Ни один больной не достиг целевого уровня ХС ЛНП менее 1,4 ммоль/л. Заключение. Трехлетнее наблюдение за участниками регистра РЕНЕССАНС демонстрирует усиление приверженности гиполипидемической терапии. С увеличением риска развития сердечно<сосудистых осложнений при СГХС ассоциированы мужской пол, наличие гипертонии, ише< мической болезни сердца, отягощенного анамнеза по ССЗ и высокий уровень липопротеида(а). The aim of the study was to evaluate the effectiveness and adherence to hypolipidemic therapy, the frequency of cardiovascular events (CVE) during the 3!year follow!up in the RENAISSANCE registry (Registry of patients with familial hypercholesterolemia and very high cardiovascular risk with insufficient effect of hypolipidemic therapy). Methods. The RENAISSANCE registry is an open, national, observational study and includes patients with familial hypercholesterolemia (FH), as well as patients of very high cardiovascular risk (VHR). We took into consideration atherosclerosis risk factors and history of cardiovascular diseases (CVD), adherence to hypolipidemic therapy. Concentrations of total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL!C) were measured in blood serum in all centers. Low density lipoprotein cholesterol (LDL!C) level was defined according to Friedewald formula. The concentration of lipoprotein(a) was measured by enzyme!linked immunosorbent assay in serum in some centers. Kaplan!Mayer analysis was performed to assess the frequency of fatal and nonfatal CVE. Results. The Registry consisted of 1570 (mean age 54.0±14.6 years) FH patients and 121 (63.5±10.9 years) VHR patients. Data of 594 patients (38%) who had follow!up visits were obtained in FH patients, follow!up duration 23.6±14.6 months, 54 (9%) patients experienced CVE. Male sex (hazard ratio 2.1; 95% confidence interval 1.13!3.66, p<0.01), hypertension (2.8;1.4–5.2; p<0.01), ischemic heart disease (6.8;3.5!13.2; p<0.0001), family history of CVD (2.1;1.1–3.9, p<0.05) and lipoprotein(a) level ≥30 mg/dl (2.8;1.1–7.7; p<0.05) were predictors of CVE. In FH patients the level of TC decreased by 19%, LDL!C by 25% (p<0.001 for both). Data on 72 VHR patients (60%) were obtained with follow!up duration of 19.7±5.8 months. No patient achieved the target LDL!C level of less than 1.4 mmol/L. Conclusion. Three!year follow!up of participants in the RENAISSANCE registry shows an enhanced adherence to hypolipidemic therapy. In FH patients the increased risk of new CVE is associated with male sex, hypertension, CHD, family history of CVD and lipoprotein(a) level ≥30 mg/dl

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