P4663Hyperinsulinemia, hypertension and two clusters of biomarkers predict aortic stenosis in 10,144 Finnish men

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Ojanen ◽  
R Jauhiainen ◽  
J Vangipurapu ◽  
T Kuulasmaa ◽  
J Kuusisto ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Regression Analysis ◽  
Glucose Tolerance ◽  
Systolic Blood Pressure ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Plasma Insulin ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Fasting Plasma

Abstract BACKROUND Recent studies show that hypertension predicts aortic stenosis (AS). Other predictors of AS are not established. Purpose To investigate a large panel of biomarkers as predictors of AS in the population-based METSIM cohort. Methods Anthropometric, metabolic and inflammatory biomarkers were measured at baseline in the cohort of 10,197 Finnish men. Subjects with AS at baseline (n=53) were excluded from the analyses. Cases of AS were identified from the medical records. Cox regression analysis was used to identify variables predicting AS. Principal components analysis was applied to investigate clustering of variables predicting AS. Uni- and multivariate logistic regression analysis were used to investigate the clusters of biomarkers as predictors of AS. Results Over a mean follow-up time of 10.8 years, incident AS was diagnosed in 116 (1.1%) men. In Cox regression analysis, fasting plasma insulin (9.8±12.8 in men without AS vs. 14.5±18.2 mU/l in men with incident AS; P=6.13 x 10–6) and systolic blood pressure (138.2±16.7 vs. 146.3±19.4 mmHg; P=3.8 x 10–7) were associated with higher risk of AS (HR 1.44 (95% CI 1.23–1.68); P=4.04 x 10–5 and HR 1.54 (1.30–1.83); P=3.01 x 10–7, respectively). Other biomarkers, which significantly predicted AS were age, body mass index, waist, waist/hip ratio, body fat mass percentage, urine albumin, CRP, blood GHbA1C, fasting plasma glucose and proinsulin, oral glucose tolerance test (OGTT) 30 min plasma insulin and proinsulin, OGTT 120 min plasma insulin and proinsulin, and serum C-peptide. Glucose tolerance (ADA 2003), and insulin resistance and insulin secretion indices based on HOMA were significant predictors of AS. After adjusting for age, the same biomarkers except for OGTT 120 min plasma proinsulin, blood GHbA1C and fasting plasma glucose significantly predicted AS. After exclusion of diabetic subjects, all biomarkers mentioned above except for GHbA1C, fasting plasma glucose and glucose tolerance predicted AS in unadjusted Cox models. Two clusters of risk factors were found in principal components analysis, one consisting of fasting plasma insulin, HOMA insulin resistance index, waist/hip ratio, GHbA1c and CRP, and another consisting of age, systolic blood pressure and urine albumin, explaining 38.33 and 15.37% of the total variance, respectively. In univariate logistic regression analysis both clusters predicted AS (HR 1.35 (1.15–1.59); P=2.47 x 10–4 and HR 1.73 (1.46–2.04); P=1.53 x 10–10, respectively), and were statistically significant when entered in the multivariate model (HR 1.30 (1.11–1.52); P=1.01 x 10–3 and HR 1.69 (1.43–1.99); P=5.84 x 10–10, respectively). Conclusion In the present large-scale population-based study, several biomarkers, particularly hyperinsulinemia and systolic blood pressure, predicted AS. In addition, two clusters of biomarkers, one with high loading on insulin and another on systolic blood pressure, independently predicted AS. Acknowledgement/Funding Kuopio University Hospital ja Academy of Finland

scholarly journals Pulmonary hypertension: state of problem and analysis of referential center work (results of first Ukrainian Register)

2019 ◽  
Vol 26 (4) ◽  
pp. 56-72
Author(s):  
G. D. Radchenko ◽  
I. O. Zhyvylo ◽  
Yu. M. Sirenko
Keyword(s):  
Blood Pressure ◽  
Pulmonary Hypertension ◽  
Regression Analysis ◽  
Survival Rate ◽  
Connective Tissue ◽  
Systolic Blood Pressure ◽  
Right Ventricular ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
The Right

The aim – to analyze the structure of patients who were treated in specialized referential center; to evaluate Ukrainian reality of survival of patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) who were treated at the referential center and to determine the predictors of death. Materials and methods. Data of 359 patients with pulmonary hypertension were included in the study. To assess survival, 281 patients (52 (18.5 %) with CTEPH and 229 (81.5 %)) with PAH were examined who were treated at the center of pulmonary hypertension of M.D. Strazhesko Institute of Cardiology of NAMS of Ukraine. The diagnosis of pulmonary hypertension was based on the data of the catheterization of the right heart. Survival was determined by the method of constructing the Kaplan – Meier curves. The observation period was 51 months. Predictors were determined using binary logistic regression and Cox regression analysis. Results and discussion. The survival rate of the overall patient cohort was 93.3 %, 86.8 % and 81.5 % at stages one, two, and three, respectively. The best survival rate was in patients with PAH associated with congenital heart diseases – CHD (92.7 %) compared to patients with idiopathic PAH (67.5 %, long rank р=0.002), PAH associated with connective tissue diseases (49.7 %, long rank р=0.001) and CTEPH (83.2 %, long rank р=0.04). According to the univariate Cox analysis, the predictors of death were: functional class IV according to the WHO (OR=4.94, 95 % CI 2.12–11.48), presence of ascites (OR=4.52, 95 % CI 2.21–9.24), PAH associated with connective tissue disease (OR=3.07, 95 % CI 1.07–8.87), PAH associated with CHD (OR=0.28, 95 % CI 0.11–0.68), heart rate at the background of treatment > 105 beats per minute (OR=7.85, 95 % CI 1.83–33.69), office systolic blood pressure < 100 mm Hg (OR=2.78, 95 % CI 1.26–6.1), the distance of the 6-minute test at the background of treatment < 340 m (OR=3.47, 95 % CI 1.01–12.35), NT-proBNP level > 300 pg/ml (OR=4.98, 95 % CI 1.49–16.6), right atrial area > 22 cm2 (OR=14.2, 95 % CI 1.92–104.89), right ventricular area in diastole (OR=1.08, 95 % CI 1.03–1.14), right ventricular area in systole (OR=1.08, 95 % CI 1.02–1.11), 1 mm Hg increase of mean pressure in the right atrium (OR=1.02, 95 % CI 1.02–1.19). In multivariate Cox regression analysis, independent predictors of death were ascites, office systolic blood pressure < 100 mm Hg, and NT-proBNP level > 300 pg/ml. PAH associated with CHD reduced the likelihood of death. Conclusions. These are the first results of the study that was conducted at the only Ukrainian center for the diagnosis and treatment of pulmonary hypertension. They show that the structure of patients with PAH in Ukraine is significantly different from that in centers of other countries, though the survival rates are comparable. Quite simple indicators are found which can be evaluated in routine practice and which are independent predictors of death.

scholarly journals Impact of Prior Cerebrovascular Disease and Glucose Status on Incident Cerebrovascular Disease in Japanese

2021 ◽  
Author(s):  
Momoko Oe ◽  
Kazuya Fujihara ◽  
Mayuko Harada Yamada ◽  
Taeko Osawa ◽  
Masaru Kitazawa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Glucose Tolerance ◽  
Cerebrovascular Disease ◽  
Systolic Blood Pressure ◽  
Cox Regression ◽  
Drug Prescription ◽  
Cvd Risk ◽  
Cox Regression Analysis ◽  
The Impact ◽  
Glucose Status

Abstract Background: Although both a history of cerebrovascular disease (CVD) and glucose abnormality are risk factors for CVD, few large studies have examined their association with subsequent CVD in the same cohort. Thus, we compared the impact of prior CVD, glucose status, and their combinations on subsequent CVD using real-world data. Methods: This is a retrospective cohort study including 363,627 men aged 18-72 years followed for ≥3 years between 2008 and 2016. Participants were classified as normoglycemia, borderline glycemia, or diabetes defined by fasting plasma glucose, HbA1c, and antidiabetic drug prescription. Prior and subsequent CVD (i.e. ischemic stroke, transient ischemic attack, and non-traumatic intracerebral hemorrhage) were identified according to claims using ICD-10 codes, medical procedures, and questionnaires. Results: The subjects’ mean age was 46.1 ± 9.3, and median follow up was 5.2 (4.2, 6.7) years. Cox regression analysis showed that prior CVD+ conferred excess risk for CVD regardless of glucose status (normoglycemia: hazard ratio (HR) , 8.77; 95% CI, 6.96-11.05; borderline glycemia: HR, 7.40, 95% CI, 5.97-9.17; diabetes: HR, 5.73, 95% CI, 4.52-7.25). Compared with the normoglycemia, borderline glycemia did not influence risk of CVD, whereas diabetes affected subsequent CVD in those with CVD- (HR, 1.50, 95% CI, 1.34-1.68). In CVD-/diabetes, age, current smoking, systolic blood pressure, HDL cholesterol, and HbA1c were associated with risk of CVD, but only systolic blood pressure was related to CVD risk in CVD+/diabetes.Conclusions: Prior CVD had a greater impact on risk of CVD than glucose tolerance and glycemic control. In diabetes with prior CVD, systolic blood pressure was a stronger risk factor than HbA1c. Individualized treatment strategy should consider glucose tolerance status and prior CVD.

scholarly journals Impaired Clinical Efficacy of Aspirin in Hypoalbuminemic Patients With Diabetes Mellitus

2021 ◽  
Vol 12 ◽  
Author(s):  
Angela Sciacqua ◽  
Francesco Andreozzi ◽  
Elena Succurro ◽  
Daniele Pastori ◽  
Vittoria Cammisotto ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Serum Albumin ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Cox Regression ◽  
Coronary Revascularization ◽  
Cox Regression Analysis ◽  
Fasting Plasma ◽  
Increased Risk ◽  
The Impact

Objective: To investigate the impact of albumin levels on the aspirin efficacy, since aspirin inhibits platelet aggregation (PA) by cyclooxygenase one irreversible acetylation that is less effective in patients with type 2 diabetes mellitus (T2DM).Patients and Methods: A total of 612 aspirin (100 mg/day)-treated T2DM patients were followed-up for 54.4 ± 7.3 months. The primary endpoint, a composite of cardiovascular events (CVEs) including CV death, myocardial infarction, ischemic stroke and coronary revascularization, was analysed according to baseline values of serum albumin (≥ or &lt; 3.5 g/dL). Serum thromboxane (Tx)B2 was also measured.Results: 250 (40.8%) patients had serum albumin &lt; 3.5 g/dL; these patients were overweight and had higher values of fibrinogen (p = 0.009), high sensitivity C-reactive protein (p = 0.001) and fasting plasma glucose (p &lt; 0.0001) compared to those with albumin ≥ 3.5 g/dL. During follow-up, 86 CVEs were recorded, 49 and 37 in patients with serum albumin &lt; or ≥3.5 g/dL, respectively (p = 0.001). At multivariable Cox regression analysis, serum albumin &lt; 3.5 g/dL (hazard ratio [HR] 1.887, 95% confidence interval [CI] 1.136–3.135, p = 0.014), age (HR 1.552 for every 10 years, 95%CI 1.157–2.081, p = 0.003), fasting plasma glucose (HR 1.063, 95%CI 1.022–1.105, p = 0.002) and beta-blocker use (HR 0.440, 95%CI 0.270–0.717, p = 0.001) were associated to CVEs. Serum TxB2 levels (n = 377) were 0.32 ± 0.12 and 0.24 ± 0.12 ng/ml in patients with albumin &lt; or ≥ 3.5 g/dL, respectively (p &lt; 0.001).Conclusion: In T2DM patients, the efficacy of aspirin varies according to albumin levels. Hypoalbuminemia associated with impaired TxB2 inhibition and an increased risk of long-term CVEs.

scholarly journals Comparative efficacy of once-weekly semaglutide versus SGLT-2 inhibitors in patients inadequately controlled with one to two oral antidiabetic drugs: a systematic literature review and network meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e023458 ◽  
Author(s):  
Steve Kanters ◽  
Lars Wilkinson ◽  
Hrvoje Vrazic ◽  
Rohini Sharma ◽  
Sandra Lopes ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Glucose ◽  
North America ◽  
Systolic Blood Pressure ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Meta Analysis ◽  
Postprandial Blood Glucose ◽  
Comparative Efficacy ◽  
Fasting Plasma

ObjectiveTo determine the comparative efficacy of once-weekly semaglutide relative to sodium-glucose cotransporter 2 inhibitors (SGLT-2is) licensed in Europe and North America among patients with type 2 diabetes (T2D) inadequately controlled with 1–2 oral antidiabetics (OADs), using a network meta-analysis (NMA). Design systematic review and network meta-analysis. Data Sources EMBASE, MEDLINE and CENTRAL were searched from January 1994 to August 2017.MethodsRandomised controlled trials with ≥20 weeks of treatment evaluating once-weekly semaglutide or SGLT-2is. Primary outcomes included change from baseline in: HbA1c, weight, systolic blood pressure, postprandial blood glucose and fasting plasma glucose. Fixed-effect and random-effect Bayesian NMA were used to indirectly compare treatment effects at 26 (±4) weeks. Metaregression and sensitivity analyses were conducted. Model selection was performed using the deviance information criterion and consistency was assessed by comparing indirect (edge-splitting) to direct evidence.ResultsForty-eight publications representing 21 trials were included. The mean differences (MD) in change from baseline in HbA1c of once-weekly semaglutide 1.0 mg versus SGLT-2is ranged from −0.56% for canagliflozin 300 mg (95% credible interval (CrI): −0.76 to −0.33%), to −0.95% for dapagliflozin 5 mg (95% CrI: −1.20 to −0.69%). The MD in change from baseline in weight of once-weekly semaglutide 1.0 mg versus SGLT-2is ranged from −1.35 kg for canagliflozin 300 mg to −2.48 kg for dapagliflozin 5 mg, while change from baseline in fasting plasma glucose ranged from −0.41 mmol/L for canagliflozin 300 mg to −1.37 mmol/L for dapagliflozin 5 mg. Once-weekly semaglutide was not statistically differentiable than all SGLT-2is in reducing systolic blood pressure. NMA was not feasible for postprandial blood glucose and safety outcomes.ConclusionOnce-weekly semaglutide demonstrated statistically significant and clinically meaningful reductions in HbA1c and body weight in T2D patients inadequately controlled with 1–2 OADs compared to all SGLT-2is licensed in Europe and North America.

scholarly journals Impact of prior cerebrovascular disease and glucose status on incident cerebrovascular disease in Japanese

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Momoko Oe ◽  
Kazuya Fujihara ◽  
Mayuko Harada-Yamada ◽  
Taeko Osawa ◽  
Masaru Kitazawa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Glucose Tolerance ◽  
Cerebrovascular Disease ◽  
Systolic Blood Pressure ◽  
Cox Regression ◽  
Drug Prescription ◽  
Cvd Risk ◽  
Cox Regression Analysis ◽  
The Impact ◽  
Glucose Status

Abstract Background Although both a history of cerebrovascular disease (CVD) and glucose abnormality are risk factors for CVD, few large studies have examined their association with subsequent CVD in the same cohort. Thus, we compared the impact of prior CVD, glucose status, and their combinations on subsequent CVD using real-world data. Methods This is a retrospective cohort study including 363,627 men aged 18–72 years followed for ≥ 3 years between 2008 and 2016. Participants were classified as normoglycemia, borderline glycemia, or diabetes defined by fasting plasma glucose, HbA1c, and antidiabetic drug prescription. Prior and subsequent CVD (i.e. ischemic stroke, transient ischemic attack, and non-traumatic intracerebral hemorrhage) were identified according to claims using ICD-10 codes, medical procedures, and questionnaires. Results Participants’ mean age was 46.1 ± 9.3, and median follow up was 5.2 (4.2, 6.7) years. Cox regression analysis showed that prior CVD + conferred excess risk for CVD regardless of glucose status (normoglycemia: hazard ratio (HR), 8.77; 95% CI 6.96–11.05; borderline glycemia: HR, 7.40, 95% CI 5.97–9.17; diabetes: HR, 5.73, 95% CI 4.52–7.25). Compared with normoglycemia, borderline glycemia did not influence risk of CVD, whereas diabetes affected subsequent CVD in those with CVD- (HR, 1.50, 95% CI 1.34–1.68). In CVD-/diabetes, age, current smoking, systolic blood pressure, high-density lipoprotein cholesterol, and HbA1c were associated with risk of CVD, but only systolic blood pressure was related to CVD risk in CVD + /diabetes. Conclusions Prior CVD had a greater impact on the risk of CVD than glucose tolerance and glycemic control. In participants with diabetes and prior CVD, systolic blood pressure was a stronger risk factor than HbA1c. Individualized treatment strategies should consider glucose tolerance status and prior CVD.

scholarly journals Effect of a 4 week physical training program on plasma concentrations of inflammatory markers in patients with abnormal glucose tolerance

2006 ◽  
Vol 154 (4) ◽  
pp. 577-585 ◽  
Author(s):  
Andreas Oberbach ◽  
Anke Tönjes ◽  
Nora Klöting ◽  
Mathias Fasshauer ◽  
Jürgen Kratzsch ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Insulin Sensitivity ◽  
Glucose Tolerance ◽  
Body Fat ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Physical Training ◽  
Plasma Concentrations ◽  
Percentage Body Fat ◽  
Fasting Plasma

Objective: Subclinical chronic inflammation could be a unifying factor linking type 2 diabetes (T2D) and atherosclerosis. The beneficial effects of physical activity on a reduced risk of coronary heart disease could at least in part be mediated by improved markers of inflammation. Research design and methods: The aim of this study was to determine the effect of 4 weeks of physical training on plasma concentrations of interleukin (IL)-6, C-reactive protein (CRP), adiponectin and IL-10 in 60 individuals with normal glucose tolerance, impaired glucose tolerance (IGT) or T2D. Results: In patients with IGT and T2D, significant improvement in body fat, fitness level, glucose metabolism and insulin sensitivity after 4 weeks of physical training was associated with significantly improved plasma concentrations of adiponectin and CRP, but not IL-6. Regression analysis demonstrated only for the anti-inflammatory parameters adiponectin and IL-10 a significant relationship with the decrease in fasting plasma glucose, whereas changes in IL-6 and CRP were not significantly related to changes in fasting plasma glucose, body fat, maximal oxygen uptake, or insulin sensitivity. In a multivariate linear regression analysis, only changes in circulating adiponectin, fasting plasma glucose and percentage body fat were determinants of changes in insulin sensitivity. Conclusions: Physical training was associated with a near normalization of adiponectin and CRP plasma concentrations in subjects with IGT and T2D. Increased insulin sensitivity after training was most strongly related to changes in adiponectin plasma concentrations, in fasting plasma glucose and percentage body fat, whereas changes in IL-6, IL-10 and CRP plasma concentrations did not significantly contribute to improved insulin sensitivity.

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