scholarly journals Epidemiological Research Advances in Vascular Calcification in Diabetes

2021 ◽  
Vol 2021 ◽  
pp. 1-15
Author(s):  
Haipeng Yao ◽  
Zhen Sun ◽  
Guangyao Zang ◽  
Lili Zhang ◽  
Lina Hou ◽  
...  
Keyword(s):  
Vascular Calcification ◽  
Ethnic Differences ◽  
Cardiovascular Events ◽  
Arterial Wall ◽  
Basic Research ◽  
Vascular Wall ◽  
Vascular Bed ◽  
Evaluation Strategies ◽  
Patients With Diabetes ◽  
Clinical Transformation

Vascular calcification is the transformation of arterial wall mesenchymal cells, particularly smooth muscle cells (SMCs), into osteoblast phenotypes by various pathological factors. Additionally, vascular transformation mediates the abnormal deposition of calcium salts in the vascular wall, such as intimal and media calcification. Various pathological types have been described, such as calcification and valve calcification. The incidence of vascular calcification in patients with diabetes is much higher than that in nondiabetic patients, representing a critical cause of cardiovascular events in patients with diabetes. Because basic research on the clinical transformation of vascular calcification has yet to be conducted, this study systematically expounds on the risk factors for vascular calcification, vascular bed differences, sex differences, ethnic differences, diagnosis, severity assessments, and treatments to facilitate the identification of a new entry point for basic research and subsequent clinical transformation regarding vascular calcification and corresponding clinical evaluation strategies.

scholarly journals Vitamin D, phosphate, and vasculotoxicity

2015 ◽  
Vol 93 (12) ◽  
pp. 1077-1082 ◽  
Author(s):  
Ronald B. Brown ◽  
Afrozul Haq ◽  
Charles F. Stanford ◽  
Mohammed S. Razzaque
Keyword(s):  
Vitamin D ◽  
Vascular Calcification ◽  
Serum Levels ◽  
Vascular Wall ◽  
Vascular Pathology ◽  
Vitamin D Metabolites ◽  
Complex Process ◽  
Patients With Diabetes ◽  
Wall Calcification ◽  
Vitamin D Supplements

Vascular calcification is a complex process that results in the ectopic deposition of calcium-phosphate hydroxyapatite. Medial and intimal vascular calcification is frequently present in patients with diabetes mellitus and chronic kidney disease (CKD), and markedly increases the morbidity and mortality of these patients. Increased serum levels of calcium and phosphate, along with the use of active vitamin D metabolites, are commonly implicated in the evolvement of vascular wall mineralization in CKD patients. Because CKD patients have lower serum levels of vitamin D, they are routinely prescribed vitamin D supplements that exert a dualistic role that is both healthful and harmful in these patients, perhaps protecting bone health, but at the expense of promoting vascular pathology. This review briefly explains how reducing the phosphate burden in CKD patients could minimize vitamin-D-associated vascular wall calcification.

Vascular calcification: the role of microRNAs

2017 ◽  
Vol 8 (2) ◽  
pp. 119-123 ◽  
Author(s):  
Stelina Alkagiet ◽  
Konstantinos Tziomalos
Keyword(s):  
Vascular Calcification ◽  
Vascular Wall ◽  
Protective Role ◽  
Left Ventricular ◽  
Coronary Perfusion ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Phosphate Salts

AbstractVascular calcification represents the deposition of calcium phosphate salts in the tunica media of the vascular wall. It occurs during aging but is accelerated and pronounced in patients with diabetes mellitus, chronic kidney disease (CKD) and established cardiovascular disease. Due to the loss of elasticity of the vessel wall, vascular calcification might result in left ventricular hypertrophy and compromise coronary perfusion. Accordingly, several studies showed that vascular calcification is associated with increased risk for cardiovascular morbidity and mortality. Accumulating data suggest that microRNAs (miRs) play an important role in vascular calcification. A variety of miRs have been implicated in the development of vascular calcification, whereas others appear to play a protective role. Accordingly, miRs might represent promising targets for the prevention of vascular calcification and its adverse cardiovascular sequelae. However, given the complexity of regulation of this process and the multitude of miRs involved, more research is needed to identify the optimal candidate miRs for targeting.

Efficacy and cardiovascular safety of SGLT2 Inhibitors

2020 ◽  
Vol 15 ◽  
Author(s):  
Cornelius James Fernandez ◽  
Abisha Graciano Nevins ◽  
Shasta Nawaz ◽  
Tahir Nazir ◽  
Fahmy W F Hanna
Keyword(s):  
Decision Process ◽  
Cardiovascular Events ◽  
Unmet Need ◽  
Clinical Decision ◽  
Sglt2 Inhibitors ◽  
Renal Protection ◽  
Sodium Glucose Cotransporter ◽  
Patients With Diabetes ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

: Patients with diabetes continued to exhibit a high risk for cardiovascular and renal events despite achieving satisfactory glycemic, blood pressure and lipid targets. Studies evaluating new diabetes medications focused on cardiovascular events, largely overlooking heart failure (HF). The latter has recently been recognised as a major cause of morbidity and mortality in patients with diabetes mellitus. There had been an unmet need for drugs with cardiovascular (including HF) and renal protection, with an expectation that an ideal diabetic drug should improve these end points. Moreover, an ideal drug should have weight lowering benefits. Recently published outcome trials have shown that sodium glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 receptor agonists (GLP-1RAs) can reduce cardiovascular and renal events, together with statistically significant weight reduction. As a result, many recently published international guidelines have recommended SGLT2 inhibitors and GLP-1RAs in patients with diabetes and pre-existing cardiovascular disease (CVD). In this review we will critically analyse the efficacy and cardiovascular (CV) safety of SGLT2 inhibitors, based on the available literature to help position them in the clinical decision process.

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

JAMA ◽  
2019 ◽  
Vol 322 (12) ◽  
pp. 1167 ◽  
Author(s):  
Christianne L. Roumie ◽  
Jonathan Chipman ◽  
Jea Young Min ◽  
Amber J. Hackstadt ◽  
Adriana M. Hung ◽  
...  
Keyword(s):  
Kidney Function ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Patients With Diabetes ◽  
Reduced Kidney Function

scholarly journals Control of blood pressure and cardiovascular outcomes in type 2 diabetes

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 304-323 ◽  
Author(s):  
Hernando Vargas-Uricoechea ◽  
Manuel Felipe Cáceres-Acosta
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Events ◽  
Angiotensin Receptor Blockers ◽  
Pharmacological Therapy ◽  
Current Evidence ◽  
Diabetic Patients ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Patients With Diabetes ◽  
The Impact

AbstractHigh blood pressure in patients with diabetes mellitus results in a significant increase in the risk of cardiovascular events and mortality. The current evidence regarding the impact of intervention on blood pressure levels (in accordance with a specific threshold) is not particularly robust. Blood pressure control is more difficult to achieve in patients with diabetes than in non-diabetic patients, and requires using combination therapy in most patients. Different management guidelines recommend initiating pharmacological therapy with values >140/90 mm/Hg; however, an optimal cut point for this population has not been established. Based on the available evidence, it appears that blood pressure targets will probably have to be lower than <140/90mmHg, and that values approaching 130/80mmHg should be recommended. Initial treatment of hypertension in diabetes should include drug classes demonstrated to reduce cardiovascular events; i.e., angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, diuretics, or dihydropyridine calcium channel blockers. The start of therapy must be individualized in accordance with the patient's baseline characteristics, and factors such as associated comorbidities, race, and age, inter alia.

scholarly journals Wnt Signaling in Vascular Calcification

2021 ◽  
Vol 8 ◽  
Author(s):  
Kaylee Bundy ◽  
Jada Boone ◽  
C. LaShan Simpson
Keyword(s):  
Cardiovascular Disease ◽  
Wnt Signaling ◽  
Signaling Pathway ◽  
Vascular Calcification ◽  
Arterial Wall ◽  
Wnt Signaling Pathway ◽  
Phenotypic Switch ◽  
Wnt Ligands ◽  
And Function ◽  
Canonical Wnt

Cardiovascular disease is a worldwide epidemic and considered the leading cause of death globally. Due to its high mortality rates, it is imperative to study the underlying causes and mechanisms of the disease. Vascular calcification, or the buildup of hydroxyapatite within the arterial wall, is one of the greatest contributors to cardiovascular disease. Medial vascular calcification is a predictor of cardiovascular events such as, but not limited to, hypertension, stiffness, and even heart failure. Vascular smooth muscle cells (VSMCs), which line the arterial wall and function to maintain blood pressure, are hypothesized to undergo a phenotypic switch into bone-forming cells during calcification, mimicking the manner by which mesenchymal stem cells differentiate into osteoblast cells throughout osteogenesis. RunX2, a transcription factor necessary for osteoblast differentiation and a target gene of the Wnt signaling pathway, has also shown to be upregulated when calcification is present, implicating that the Wnt cascade may be a key player in the transdifferentiation of VSMCs. It is important to note that the phenotypic switch of VSMCs from a healthy, contractile state to a proliferative, synthetic state is necessary in response to the vascular injury surrounding calcification. The lingering question, however, is if VSMCs acquire this synthetic phenotype through the Wnt pathway, how and why does this signaling occur? This review seeks to highlight the potential role of the canonical Wnt signaling pathway within vascular calcification based on several studies and further discuss the Wnt ligands that specifically aid in VSMC transdifferentiation.

scholarly journals Added prognostic value of plaque burden to computed tomography angiography anatomic assessment and myocardial perfusion imaging in patients with diabetes Mellitus

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Alnabelsi ◽  
A I Ahmed ◽  
Y Han ◽  
M Al Rifai ◽  
F Nabi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Myocardial Imaging ◽  
Plaque Burden ◽  
Emission Computed Tomography ◽  
Patients With Diabetes ◽  
Artery Disease

Abstract Introduction Cardiac computed tomographic angiography (CCTA)-derived measures of coronary artery disease (CAD) burden such as segment involvement score (SIS), which quantifies the number of segments with plaque, have been shown to independently predict incident cardiovascular events. Purpose We aimed to compare the added prognostic value of plaque burden to CCTA anatomic assessment and single photon emission computed tomography (SPECT) physiologic assessment in patients with diabetes undergoing both tests. Methods Consecutive patients with diabetes who underwent clinically indicated CCTA and SPECT myocardial imaging for suspected coronary artery disease at a tertiary care center were retrospectively identified from medical records. Stenosis severity and segment involvement score (SIS) were determined from CCTA, and presence of ischemia was determined from SPECT. Patients were followed from date of imaging for major adverse cardiovascular events (MACE; inclusive of all-cause death, non-fatal myocardial infarction, and percutaneous coronary intervention or coronary artery bypass grafting 90-days after imaging test.) Results A total of 778 patients were included (mean age 60.6±14.4 years, 55% males). Obstructive stenosis (left main ≥50%, all other coronary segments ≥70%) and ischemia were found in 15% and 16% of patients respectively. After a median follow-up of 31 months, 87 (11%) patients experienced a MACE. In multivariable Cox regression models, SIS significantly predicted outcomes in models including obstructive stenosis and ischemia (HR 1.17, 95% CI 1.10 - 1.24, p&lt;0.001; 1.16, 95% CI 1.10 - 1.23, p&lt;0.001). The addition of SIS also significantly improved discrimination (Harrel's C 0.75, p=0.006; 0.76, p=0.006 in models with CCTA obstructive stenosis and SPECT ischemia respectively). Results were consistent using subgroups of summed scores by composition of plaque (calcified vs non-calcified) and alternate definitions of obstructive stenosis. Conclusion Our results suggest that in high-risk patients with diabetes and suspected coronary disease, SIS has incremental prognostic value over ischemia by SPECT or stenosis by CCTA in predicting incident cardiovascular outcomes. FUNDunding Acknowledgement Type of funding sources: None.

Abstract 5825: Association between Patterns of FDG Uptake and Arterial Wall Calcification on PET/CT and Atherogenic Risk Factors in Healthy Subjects

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Hiroya Narumi ◽  
Katsuya Yoshida ◽  
Nobusada Funabashi ◽  
Naotake Hashimoto ◽  
Isao Umehara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vascular Calcification ◽  
Healthy Subjects ◽  
Arterial Wall ◽  
Calcium Score ◽  
The Other ◽  
Fdg Uptake ◽  
Other Hand ◽  
Pet Ct ◽  
Fdg Pet Ct

Background: Augmented metabolic activity of macrophages leads to enough F-18 Fluorodeoxyglucose (FDG) uptake to allow visualization by positron emission tomography (PET). A large body of data, based on computed tomography (CT), has also accumulated concerning the relevance of vascular calcification to the atherosclerotic process. FDG PET/CT can localize both inflammatory changes and vascular calcification. The purpose of this study was to investigate risk factors contributing to these changes in the aorta in healthy subjects. Materials and Methods: A total of 66 consecutive healthy subjects (44 men, 22 women; age range, 30–82 years, mean age, 55.8 years) participating in a health check protocol including FDG PET/CT were evaluated retrospectively. We placed regions of interest on the arterial wall to measure FDG uptake by PET images. To assess arterial calcification, the calcium score of the aorta was measured on CT images. Results: FDG uptake was observed most commonly in proximal, followed by descending, thoracic, and abdominal segments. On the other hand, the most common site of vascular calcification was the descending thoracic aorta, followed by abdominal and, proximal segment. Whole aortic calcification (total calcium score of the whole aorta) was significantly correlated with age (r= 0.353, P= 0.004). On the other hand, FDG uptake (total SUV max of the whole aorta) was significantly correlated with systolic blood pressure (SBP) (r= 0.303, P= 0.013), triglyceride (TG) (r= 0.281, P= 0.022), fasting plasma glucose (FPG) (r= 0.317, P= 0.010), HbA1c (r= 0.433, P< 0.001), visceral abdominal fat area (r= 0.319, P= 0.005), and was negatively correlated with high density lipoprotein (HDL) (r= −0.317, P= 0.010), and adiponectin (r= −0.273, P= 0.029). Conclusions: Aortic calcification was significantly correlated with age. On the other hand, FDG uptake was significantly correlated with the components of metabolic syndrome such as SBP, TG, FPG, HbA1c, visceral adipose fat area and negatively correlated with HDL and adiponectin, but not with age. Our results may suggest that the components of metabolic syndrome and aging affect the progression of atherosclerosis differently.

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