Can We Decrease Epicardial and Pericardial Fat in Patients With Diabetes?

2021 ◽  
pp. 107424842110069
Author(s):  
Emir M. Muzurović ◽  
Snežana Vujošević ◽  
Dimitri P. Mikhailidis
Keyword(s):  
Myocardial Dysfunction ◽  
Biologically Active ◽  
Therapeutic Interventions ◽  
Cvd Risk ◽  
Fat Deposits ◽  
Patients With Diabetes ◽  
Calorie Diet ◽  
Cv Disease ◽  
Secretory Pattern

Diabetes mellitus (DM) is a chronic and complex metabolic disorder and also an important cause of cardiovascular (CV) disease (CVD). Patients with type 2 DM (T2DM) and obesity show a greater propensity for visceral fat deposition (and excessive fat deposits elsewhere) and the link between adiposity and CVD risk is greater for visceral than for subcutaneous (SC) adipose tissue (AT). There is growing evidence that epicardial AT (EAT) and pericardial AT (PAT) play a role in the development of DM-related atherosclerosis, atrial fibrillation (AF), myocardial dysfunction, and heart failure (HF). In this review, we will highlight the importance of PAT and EAT in patients with DM. We also consider therapeutic interventions that could have a beneficial effect in terms of reducing the amount of AT and thus CV risk. EAT is biologically active and a likely determinant of CV morbidity and mortality in patients with DM, given its anatomical characteristics and proinflammatory secretory pattern. Consequently, modification of EAT/PAT may become a therapeutic target to reduce the CV burden. In patients with DM, a low calorie diet, exercise, antidiabetics and statins may change the quantity of EAT, PAT or both, alter the secretory pattern of EAT, improve the metabolic profile, and reduce inflammation. However, well-designed studies are needed to clearly define CV benefits and a therapeutic approach to EAT/PAT in patients with DM.

scholarly journals Cardiovascular Event Risk in Rheumatoid Arthritis Compared with Type 2 Diabetes: A 15-year Longitudinal Study

2019 ◽  
Vol 47 (3) ◽  
pp. 316-324 ◽  
Author(s):  
Rabia Agca ◽  
Luuk H.G.A. Hopman ◽  
Koen J.C. Laan ◽  
Vokko P. van Halm ◽  
Mike J.L. Peters ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Incidence Rate ◽  
Cvd Risk ◽  
Cardiovascular Research ◽  
Number Of Patients ◽  
Cv Disease ◽  
Reference Cohort

Objective.Cardiovascular (CV) disease (CVD) risk is increased in rheumatoid arthritis (RA). However, longterm followup studies investigating this risk are scarce.Methods.The CARRÉ (CARdiovascular research and RhEumatoid arthritis) study is a prospective cohort study investigating CVD and its risk factors in 353 patients with longstanding RA. CV endpoints were assessed at baseline and 3, 10, and 15 years after the start of the study and are compared to a reference cohort (n = 2540), including a large number of patients with type 2 diabetes (DM).Results.Ninety-five patients with RA developed a CV event over 2973 person-years, resulting in an incidence rate of 3.20 per 100 person-years. Two hundred fifty-seven CV events were reported in the reference cohort during 18,874 person-years, resulting in an incidence rate of 1.36 per 100 person-years. Age- and sex-adjusted HR for CV events were increased for RA (HR 2.07, 95% CI 1.57–2.72, p < 0.01) and DM (HR 1.51, 95% CI 1.02–2.22, p = 0.04) compared to the nondiabetic participants. HR was still increased in RA (HR 1.82, 95% CI 1.32–2.50, p < 0.01) after additional adjustment for CV risk factors. Patients with both RA and DM or insulin resistance had the highest HR for developing CVD (2.21, 95% CI 1.01–4.80, p = 0.046 and 2.67, 95% CI 1.30–5.46, p < 0.01, respectively).Conclusion.The incidence rate of CV events in established RA was more than double that of the general population. Patients with RA have an even higher risk of CVD than patients with DM. This risk remained after adjustment for traditional CV risk factors, suggesting that systemic inflammation is an independent contributor to CV risk.

Hypertriglyceridaemia in type 2 diabetes: prevalence, risk and primary care management

2012 ◽  
Vol 12 (2) ◽  
pp. 65-70
Author(s):  
Alan Sinclair
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Clinical Excellence ◽  
Lifestyle Changes ◽  
Omega 3 ◽  
Cvd Risk ◽  
Reinforcing Factors ◽  
Patients With Diabetes ◽  
Secondary Causes

Cardiovascular disease (CVD) associated with type 2 diabetes will impose an increasing burden on primary care over the next few decades. Several mutually reinforcing factors account for the increased CVD risk among patients with diabetes, including hypertriglyceridaemia, the importance of which has been generally underestimated. A consensus from the literature suggests that fasting triglyceride levels of 1.7 mmol/L or above may be a cause for cardiovascular concern and warrant further investigation. Apart from CVD, hypertriglyceridaemia can increase the risk of pancreatitis. Clinicians in primary care should become active in identifying and managing secondary causes of hypertriglyceridaemia and encourage patients with diabetes to implement lifestyle changes. Statins are the mainstay of treatment for diabetic dyslipidaemia that remains inadequately controlled. However, the National Institute for Health and Clinical Excellence (NICE) suggests prescribing a fibrate if triglyceride levels remain >4.5 mmol/L after addressing secondary causes. Clinicians could consider adding a fibrate if triglyceride levels remain between 2.3 and 4.5 mmol/L despite statin monotherapy for patients at high CVD risk. NICE advocates a trial of highly concentrated, licensed omega-3 fish oils if lifestyle measures and fibrate fail to adequately reduce hypertriglyceridaemia.

scholarly journals An explainable XGBoost–based approach towards assessing the risk of cardiovascular disease in patients with Type 2 Diabetes Mellitus

2020 ◽  
Author(s):  
Maria Athanasiou ◽  
Konstantina Sfrintzeri ◽  
Konstantia Zarkogianni ◽  
Anastasia Thanopoulou ◽  
Konstantina S. Nikita
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Disease ◽  
Risk Prediction ◽  
Prediction Models ◽  
Therapeutic Interventions ◽  
Gradient Boosting ◽  
Cvd Risk ◽  
Medical Visits ◽  
Extreme Gradient Boosting

<div> <div> <div> <p>Cardiovascular Disease (CVD) is an important cause of disability and death among individuals with Diabetes Mellitus (DM). International clinical guidelines for the management of Type 2 DM (T2DM) are founded on primary and secondary prevention and favor the evaluation of CVD related risk factors towards appropriate treatment initiation. CVD risk prediction models can provide valuable tools for optimizing the frequency of medical visits and performing timely preventive and therapeutic interventions against CVD events. The integration of explainability modalities in these models can enhance human understanding on the reasoning process, maximize transparency and embellish trust towards the models’ adoption in clinical practice. The aim of the present study is to develop and evaluate an explainable personalized risk prediction model for the fatal or non-fatal CVD incidence in T2DM individuals. An explainable approach based on the eXtreme Gradient Boosting (XGBoost) and the Tree SHAP (SHapley Additive exPlanations) method is deployed for the calculation of the 5-year CVD risk and the generation of individual explanations on the model’s decisions. Data from the 5- year follow up of 560 patients with T2DM are used for development and evaluation purposes. The obtained results (AUC=71.13%) indicate the potential of the proposed approach to handle the unbalanced nature of the used dataset, while providing clinically meaningful insights about the ensemble model’s decision process. </p> </div> </div> </div>

scholarly journals An explainable XGBoost–based approach towards assessing the risk of cardiovascular disease in patients with Type 2 Diabetes Mellitus

2020 ◽  
Author(s):  
Maria Athanasiou ◽  
Konstantina Sfrintzeri ◽  
Konstantia Zarkogianni ◽  
Anastasia Thanopoulou ◽  
Konstantina S. Nikita
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Disease ◽  
Risk Prediction ◽  
Prediction Models ◽  
Therapeutic Interventions ◽  
Gradient Boosting ◽  
Cvd Risk ◽  
Medical Visits ◽  
Extreme Gradient Boosting

<div> <div> <div> <p>Cardiovascular Disease (CVD) is an important cause of disability and death among individuals with Diabetes Mellitus (DM). International clinical guidelines for the management of Type 2 DM (T2DM) are founded on primary and secondary prevention and favor the evaluation of CVD related risk factors towards appropriate treatment initiation. CVD risk prediction models can provide valuable tools for optimizing the frequency of medical visits and performing timely preventive and therapeutic interventions against CVD events. The integration of explainability modalities in these models can enhance human understanding on the reasoning process, maximize transparency and embellish trust towards the models’ adoption in clinical practice. The aim of the present study is to develop and evaluate an explainable personalized risk prediction model for the fatal or non-fatal CVD incidence in T2DM individuals. An explainable approach based on the eXtreme Gradient Boosting (XGBoost) and the Tree SHAP (SHapley Additive exPlanations) method is deployed for the calculation of the 5-year CVD risk and the generation of individual explanations on the model’s decisions. Data from the 5- year follow up of 560 patients with T2DM are used for development and evaluation purposes. The obtained results (AUC=71.13%) indicate the potential of the proposed approach to handle the unbalanced nature of the used dataset, while providing clinically meaningful insights about the ensemble model’s decision process. </p> </div> </div> </div>

Diabetes Mellitus, Arterial Stiffness and Cardiovascular Disease: Clinical Implications and the Influence of SGLT2i

2020 ◽  
Vol 19 (2) ◽  
pp. 233-240 ◽  
Author(s):  
Olga Lamacchia ◽  
Maria Rosaria Sorrentino
Keyword(s):  
Diabetes Mellitus ◽  
Arterial Stiffness ◽  
Vascular Endothelial ◽  
Beneficial Effects ◽  
Sodium Glucose Cotransporter ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Global Health Issue ◽  
Cv Disease

: Type 2 diabetes mellitus (T2DM) is a rapidly evolving global health issue associated with a markedly increased risk of cardiovascular (CV) morbidity and mortality. The hyperglycaemic milieu contributes to the development of CV complications via several pathological pathways, leading to increased arterial stiffness (AS), that can be considered as a predictor of CV events in patients with diabetes. The measurement of AS is increasingly used for the clinical assessment of patients. Several methodologies were used in extensive population studies to assess AS; the most commonly used is the pulse wave velocity (PWV). The cardio-ankle vascular index (CAVI) was developed to measure AS; it is not affected by blood pressure at the time of measurement and shows stable values in healthy persons for years. There are several potential pharmacological and non-pharmacological interventions aiming to reduce AS. Recent evidence from clinical trials suggests that newer antidiabetic drugs do not only exert glycaemic-lowering properties but also decrease CV risk. In this context, sodium glucose cotransporter- 2 inhibitors (SGLT2i) ( empagliflozin, canagliflozin and dapagliflozin) significantly reduced the risk of CV and all-cause mortality (only EMPA-REG OUTCOME study) and hospitalization for heart failure in patients with T2DM with established CV disease and/or with CV risk factors. Improved endothelial function and AS probably represents one of the mechanisms by which these drugs exert their beneficial effects. The present review aimed both to describe the association between AS and T2DM and to discuss the effectiveness of SGLT2i on vascular endothelial dysfunction and AS.

Abstract #789: Type 2 Diabetes-Related Intermediate Phenotypic Traits in North Indian Patients with Diabetes

2005 ◽  
Vol 11 ◽  
pp. 16
Author(s):  
Sandeep Kumar Mathur ◽  
Piyush Chandra ◽  
Sandhya Mishra ◽  
Piyush Ajmera ◽  
Praveen Sharma
Keyword(s):  
Type 2 Diabetes ◽  
Phenotypic Traits ◽  
Indian Patients ◽  
Patients With Diabetes

Model estimates of the results of diabetes patients using modern glucometers with tri-color technology for displaying test results

2019 ◽  
pp. 81-89
Author(s):  
Larisa Dmitrievna Popovich ◽  
Svetlana Valentinovna Svetlichnaya ◽  
Aleksandr Alekseevich Moiseev
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Economic Benefits ◽  
Test Results ◽  
Self Monitoring ◽  
Patients With Diabetes ◽  
The Impact

Diabetes – a disease in which the effect of the treatment substantially depends on the patient. Known a study showed that the use of glucometers with the technology of three-color display of test results facilitates self-monitoring of blood sugar and leads to a decrease in glycated hemoglobin (HbAlc). Purpose of the study: to modeling the impact of using of a glucometer with a color-coded display on the clinical outcomes of diabetes mellitus and calculating, the potential economic benefits of reducing the hospitalization rate of patients with diabetes. Material and methods. Based on data from two studies (O. Schnell et al. and M. Baxter et al.) simulation of the reduction in the number of complications with the use of a glucometer with a color indication. In a study by O. Schnell et al. a decrease of HbA1c by 0.69 percent is shown when using the considered type of glucometers, which was the basis of the model. Results. In the model, the use of a glucometer with a color-coded display for type 1 diabetes led to a decrease in the total number of complications by 9.2 thousand over 5 years per a cohort of 40 thousand patients with different initial levels of HbA1c. In a cohort of 40 thousand patients with type 2 diabetes, the simulated number of prevented complications was 1.7 thousand over 5 years. When extrapolating these data to all patients with diabetes included in the federal register of diabetes mellitus (FRD), the number of prevented complications was 55.4 thousand cases for type 1 diabetes and 67.1 thousand cases for type 2 diabetes. The possible economic effect from the use of the device by all patients with a diagnosis of diabetes, which are included in the FRD, estimated at 1.5 billion rubles for a cohort of patients with type 1 diabetes and 5.3 billion rubles for patients with type 2 diabetes. Conclusion. Improving the effectiveness of self-monitoring, which is the result of the use of glucometers with color indicators, can potentially significantly reduce the incidence of complications in diabetes and thereby provide significant economic benefits to society.

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