Sex and ethnic differences in the cardiovascular complications of type 2 diabetes

Diabetes mellitus represents a global health concern affecting 463 million adults and is projected to rapidly rise to 700 million people by 2045. Amongst those with type 2 diabetes (T2D), there are recognised differences in the impact of the disease on different sex and ethnic groups. The relative risk of cardiovascular complications between individuals with and without T2D is higher in females than males. People of South Asian heritage are two to four times more likely to develop T2D than white people, but conversely not more likely to experience cardiovascular complications. Differences in the pathophysiological responses in these groups may identify potential areas for intervention beyond glycaemic control. In this review, we highlight key differences of diabetes-associated cardiovascular complications by sex and ethnic background, with a particular emphasis on South Asians. Evidence assessing therapeutic efficacy of new glucose lowering drugs in minority groups is limited and many major cardiovascular outcomes trials do not report ethnic specific data. Conversely, lifestyle intervention and bariatric surgery appear to have similar benefits regardless of sex and ethnic groups. We encourage future studies with better representation of women and ethnic minorities that will provide valuable data to allow better risk stratification and tailored prevention and management strategies to improve cardiovascular outcomes in T2D.

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Impact of type 2 diabetes and microvascular complications on mortality and cardiovascular outcomes in a multiethnic Asian population

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001413 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001413

Author(s):

Jonathan Yap ◽

Kamalesh Anbalakan ◽

Wan Ting Tay ◽

Daniel Ting ◽

Carol Yim Cheung ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Glycemic Control ◽

Microvascular Complications ◽

Population Based ◽

Cardiovascular Outcomes ◽

Microvascular Complication ◽

The Impact ◽

Hba1c Levels

IntroductionDiabetes mellitus is a growing public health epidemic in Asia. We examined the impact of type 2 diabetes, glycemic control and microvascular complications on mortality and cardiovascular outcomes in a multiethnic population-based cohort of Asians without prior cardiovascular disease.Research design and methodsThis was a prospective population-based cohort study in Singapore comprising participants from the three major Asian ethnic groups: Chinese, Malays and Indians, with baseline examination in 2004–2011. Participants with type 1 diabetes and those with cardiovascular disease at baseline were excluded. Type 2 diabetes, Hemoglobin A1c (HbA1c) levels and presence of microvascular complications (diabetic retinopathy and nephropathy) were defined at baseline. The primary outcome was all-cause mortality and major adverse cardiovascular events (MACEs), defined as a composite of cardiovascular mortality, myocardial infarction, stroke and revascularization, collected using a national registry.ResultsA total of 8541 subjects were included, of which 1890 had type 2 diabetes at baseline. Subjects were followed for a median of 6.4 (IQR 4.8–8.8) years. Diabetes was a significant predictor of mortality (adjusted HR 1.74, 95% CI 1.45 to 2.08, p<0.001) and MACE (adjusted HR 1.64, 95% CI 1.39 to 1.93, p<0.001). In those with diabetes, higher HbA1c levels were associated with increased MACE rates (adjusted HR (per 1% increase) 1.18, 95% CI 1.11 to 1.26, p<0.001) but not mortality (p=0.115). Subjects with two microvascular complications had significantly higher mortality and MACE compared with those with only either microvascular complication (adjusted p<0.05) and no microvascular complication (adjusted p<0.05).ConclusionDiabetes is a significant predictor of mortality and cardiovascular morbidity in Asian patients without prior cardiovascular disease. Among patients with type 2 diabetes, poorer glycemic control was associated with increased MACE but not mortality rates. Greater burden of microvascular complications identified a subset of patients with poorer outcomes.

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THE IMPACT OF QUERCETIN ON THE FUNCTIONAL STATE OF CARDIOVASCULAR SYSTEM AND HEMOSTASE IN RATS WITH TYPE 2 DIABETES MELLITUS

PROBLEMS OF ENDOCRINE PATHOLOGY ◽

10.21856/j-pep.2021.3.15 ◽

2021 ◽

Vol 77 (3) ◽

pp. 105-110

Author(s):

Olha Ivanova

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diastolic Dysfunction ◽

Cardiovascular System ◽

Functional State ◽

Cardiovascular Complications ◽

Diabetic Rats ◽

The Impact

Introduction. Type 2 diabetes mellitus (T2DM) increases the risk for atherosclerotic cardiovascular disease and other cardiovascular complications such as cardiac arrhythmias, heart failure, and thrombotic events. Quercetin (Q) possesses a wide range of multiple activities: anti-diabetic, anti-proliferative, anti-atherosclerotic, antioxidant, anti-inflammatory, anti-thrombotic, anti-apoptotic effects and is regarded as a candidate for the role of cardiovascular complications protecting agent. The aim of this study was to assess the effects of Q on the functional state of cardiovascular system and haemostasis in diabetic rats. Materials and Methods. T2DM was induced in Wistar rats by a high-caloric diet during 14 weeks combined with intraperitoneal injections of 25 mg/kg streptozotocin twice per week. All diabetic animals were divided into three groups: treated with solvent and with Q (in dose 10 and 50 mg/kg/day per os) for 8 weeks after diabetes induction. Fibrinogen concentration and induced euglobulin fibrinolysis time were measured in plasma using reagent kits. Electrocardiograms were recorded in leads II. Results. It was established that Q in dose 50 mg/kg b.w. prevents in the formation of sinus tachycardia in experimental animals. In addition, Q in both doses inhibits the development of myocardial diastolic dysfunction, which was confirmed by prolongation of T-P interval and a decrease of duration of the T wave in comparison with diabetic rats. Q in both doses restorated the processes of coagulations and fibrinolysis, as indicated by a decrease of fibrinogen levels and the time of thrombolysis compared to diabetic rats. Conclusions. Q, independently of dose, inhibits the development of myocardial diastolic dysfunction and reduces prothrombotic potential in rats with type 2 diabetes, which may ameliorate diabetic cardiovascular risk. This data justify the perspective of Q for the prevention and management of cardiovascular complications in patients with type 2 diabetes.

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Cardiovascular Outcomes of Antidiabetes Medications by Race/Ethnicity: a systematic review and meta-analysis

10.21203/rs.3.rs-46807/v1 ◽

2020 ◽

Author(s):

Xiaoling Cai ◽

Sam Dagogo-Jack ◽

Chu Lin ◽

Wenjia Yang ◽

Linong Ji

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Risk ◽

Risk Reduction ◽

Ethnic Groups ◽

Meta Analysis ◽

Cardiovascular Outcomes ◽

Control Treatment ◽

Cardiovascular Risk Reduction ◽

Racial Ethnic

Abstract Background: The consistency of cardiovascular risk reduction by antidiabetes medications across racial and ethnic groups remains unclear. The aim of this study was to analyze racial/ethnic patterns in the results of cardiovascular outcomes trials of antidiabetes medications in people with type 2 diabetes.Method: PubMed and Cochrane library databases were searched from the inception dates to December 2019. Cardiovascular outcome trials in type 2 diabetes that randomized participants to active or control treatment and reported results by race/ethnic groups or region were included.Results: A total of 16 studies were included in this meta-analysis. Among White participants, active antidiabetes medication, compared with control treatment, significantly decreased the composite cardiovascular outcomes (OR=0.90, 95% CI 0.86-0.94, p<0.05). Among Asian participants, active antidiabetes medication, compared with control treatment, also significantly decreased the composite cardiovascular outcomes (OR=0.82, 95%CI 0.76-0.90, p<0.05). Among Black participants (OR=0.96, 95% CI 0.69-1.32, p=0.79) and subjects from other groups (mostly Hispanics or Pacific Islanders) (OR=0.92, 95% CI 0.81-1.04, p=0.16), active anti-diabetes medication resulted in nominal but non-significant decreases in the composite cardiovascular outcomes, compared with the control treatment.Conclusions: Antidiabetes drugs demonstrated cardiovascular safety in people with type 2 diabetes from all racial/ethnic groups studied, but achieved significant composite cardiovascular risk reduction only in White and Asian participants, perhaps due to differences in sample size and power.

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Peripheral and Autonomic Neuropathy in South Asians and White Caucasians with Type 2 Diabetes Mellitus: Possible Explanations for Epidemiological Differences

Journal of Diabetes Research ◽

10.1155/2017/1273789 ◽

2017 ◽

Vol 2017 ◽

pp. 1-10 ◽

Cited By ~ 8

Author(s):

Abd A. Tahrani ◽

Q. A. Altaf ◽

Milan K. Piya ◽

Anthony H. Barnett

Keyword(s):

Type 2 Diabetes ◽

Autonomic Neuropathy ◽

South Asians ◽

Clinical Signs ◽

Cross Sectional Study ◽

Cardiac Autonomic Neuropathy ◽

Diabetes Clinic ◽

Cross Sectional ◽

The Impact

Objectives.To compare the prevalence of diabetic peripheral neuropathy (DPN) and that of cardiac autonomic neuropathy (CAN) between South Asians and White Caucasians with type 2 diabetes and to explore reasons for observed differences.Methods.A cross-sectional study of casually selected South Asian and White Caucasian adults attending a hospital-based diabetes clinic in the UK. DPN and CAN were assessed using the Michigan Neuropathy Screening Instrument (MNSI) and heart rate variability testing, respectively.Results.Patients (n=266) were recruited (47.4% South Asians). DPN was more common in White Caucasians compared to South Asians (54.3% versus 38.1%,p=0.008). Foot insensitivity as assessed by 10 g monofilament perception was more common in White Caucasians (43.9% versus 23.8%,p=0.001). After adjustment for confounders, White Caucasians remained twice as likely to have DPN as South Asians, but the impact of ethnicity became nonsignificant after adjusting for adiposity measures or height. No difference in prevalence of standardized CAN test abnormalities was detected between ethnicities. Skin microvascular assessment demonstrated that South Asians had reduced heating flux but preserved acetylcholine response.Conclusions.South Asians with type 2 diabetes have fewer clinical signs of DPN compared to White Caucasians. Differences in adiposity (and its distribution) and height appear to explain these differences.

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Pharmacological Management of Diabetes for Reducing Glucose Levels and Cardiovascular Disease Risk: What Evidence in South Asians?

Current Diabetes Reviews ◽

10.2174/1573399817666201228120725 ◽

2020 ◽

Vol 17 ◽

Author(s):

Nazim Ghouri ◽

Hareem Javed ◽

Naveed Sattar

Keyword(s):

Type 2 Diabetes ◽

South Asian ◽

Disease Risk ◽

South Asians ◽

Cardiovascular Disease Risk ◽

Cardiovascular Outcomes ◽

Renal Outcome ◽

Glucose Lowering ◽

Dipeptidyl Peptidase 4 Inhibitors

Introduction/Aims: South Asians experience more type 2 diabetes, which is earlier in onset and with more rapid glycaemic deterioration, although average body mass indices are lower than in whites. Cardiovascular outcomes from diabetes drug trials are now reported as standard, with data from newer therapies influencing patient management. However, less is known of the effect of such therapies in South Asians. The aim of this narrative review was to extract, wherever possible, the glucose-lowering efficacy and cardiovascular and renal outcome data for these therapies in South Asians. Discussion/Conclusions: Despite the higher prevalence and global burden of type 2 diabetes and adverse outcomes in South Asians, they remain underrepresented in global trials. Even when recruited, the current method of classifying ethnicity does not commonly allow South Asian data to be extracted and reported separately from all Asians. Interrogation of available trial data suggests broadly comparable effects on glycaemia and weight in Asians to other ethnicities with use of glucagon-like peptide 1 receptor agonists (GLP-1RA), but a potentially early, albeit marginally, greater glycaemia benefit with Dipeptidyl peptidase-4 inhibitors (DPP4i) which may not be sustained. Furthermore, there appears a potentially greater glycaemia benefit with use of sodium-glucose transport protein 2 inhibitors (SGLT2i) in Asians compared to whites. Whether such findings are true in all Asians subgroups requires further direct study. For cardiovascular outcomes, available data suggest at least comparable and potentially greater outcome benefits in Asians; point estimates were more favourable for Asians in the vast majority of GLP-1RA and SGLT2i outcome trials. It was, however, impossible to determine whether the effects were similar across all Asian subgroups. We conclude that trialists should be encouraged to record ethnicity with better granularity to allow differing ethnic groups data to be better interrogated. In the meantime, doctors should, where possible, confidently follow newer guidelines for the use of newer glucose lowering agents for treating glycaemia and the prevention of cardiovascular and cardiorenal complications in South Asian people with type 2 diabetes.

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Evidence for fetal programming of obesity with a focus on putative mechanisms

Nutrition Research Reviews ◽

10.1079/nrr200487 ◽

2004 ◽

Vol 17 (2) ◽

pp. 153-162 ◽

Cited By ~ 17

Author(s):

Sarah H. Wild ◽

Christopher D. Byrne

Keyword(s):

Type 2 Diabetes ◽

Metabolic Syndrome ◽

South Asians ◽

Later Life ◽

Individual Risk ◽

The Metabolic Syndrome ◽

Plasma Triacylglycerol ◽

Individual Risk Factors ◽

The Impact

AbstractObesity is associated with insulin resistance, the metabolic syndrome (a clustering of three or more of increased waist circumference, blood pressure, fasting glucose and fasting plasma triacylglycerol levels and reduced HDL levels), and a marked increase in the risk of type 2 diabetes and CHD. The impact of obesity differs between individuals, particularly between men and women and between ethnic groups. For example, in South Asians, although overall obesity is less prevalent, central obesity and the metabolic syndrome are more prevalent than in Europeans and this pattern is associated with the development of type 2 diabetes and CHD at an earlier age. It is important to examine individual risk factors contributing to obesity because they may have a different impact in population subgroups. Many factors contribute to the aetiology of obesity and there is increasing evidence to suggest that altered early development is one such factor and is associated with abnormal fat accumulation, the metabolic syndrome and type 2 diabetes in later life. The present review presents this evidence and discusses some of the mechanisms that may be involved in the pathogenesis of the programming of obesity.

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Exploring the Experiences of West African Immigrants Living with Type 2 Diabetes in the UK

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16193516 ◽

2019 ◽

Vol 16 (19) ◽

pp. 3516

Author(s):

Alloh ◽

Hemingway ◽

Turner-Wilson

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

African Immigrants ◽

West African ◽

Health Concern ◽

Theory Approach ◽

The Uk ◽

West African Immigrants ◽

The Impact

The increasing prevalence and poorer management of Type 2 diabetes among West African immigrants in the UK is a public health concern. This research explored the experiences of West African immigrants in the management of Type 2 diabetes in the UK using a constructivist grounded theory approach. In-depth individual interviews were conducted with thirty-four West African immigrants living with Type 2 diabetes in the London area. Fifteen male and nineteen female adult West African immigrants with age range from 33–82 years participated in the study. Participants were recruited from five diabetes support groups and community settings. Initial, focused and theoretical coding, constant comparison and memos were used to analyse collected data. Three concepts emerged: Changing dietary habits composed of participants’ experiences in meeting dietary recommendations, improving physical activity concerned with the experience of reduced physical activity since moving to the UK and striving to adapt which focus on the impact of migration changes in living with Type 2 diabetes in the UK. These address challenges that West African immigrants experience in the management of Type 2 diabetes in the UK. The findings of this research provide a better understanding of the influencing factors and can be used to improve the support provided for West Africans living with Type 2 diabetes in the UK, presenting a deeper understanding of socio-cultural factors that contribute to supporting individuals from this population.

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The Impact of Obesity on Adverse Cardiovascular Outcomes in the General Population and in patients with Type 2 Diabetes

Clinical medicine Endocrinology and diabetes ◽

10.4137/cmed.s3479 ◽

2009 ◽

Vol 2 ◽

pp. CMED.S3479 ◽

Cited By ~ 2

Author(s):

Jayne Palmer ◽

Anupama Kalsekar ◽

Kristina Boye ◽

Gordon Goodall

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

General Population ◽

Causal Link ◽

Cardiovascular Outcomes ◽

Asia Pacific ◽

Increased Risk ◽

General Populations ◽

The Impact

Objectives There is an established causal link between obesity and cardiovascular outcomes. The aim of this review was to determine whether an independent relationship exists between anthropometric measurements of weight (typically body mass index [BMI]) and cardiovascular outcomes (e.g. angina, myocardial infarction, congestive heart failure, stroke, and mortality due to cardiovascular disease) in the general population and in patients with type 2 diabetes. Methods A review of the medical literature published between 1988 and May 2008 was conducted using the PubMed, EMBASE, Cochrane and Center for Review and Dissemination databases. Studies longer than 12 months, with ≥500 adult subjects and published in English were included. Results In studies conducted in general populations there was an overall trend towards increased risk for adverse cardiovascular outcomes with increasing BMI. The nature and strength of this relationship varied according to the measurement used (e.g. BMI, waist circumference, waist-to-hip ratio) and the population studied, with notable differences observed in Asian/Asia-Pacific compared with European or North American-based studies. However, data from diabetes-specific populations are limited. Conclusions In general, the degree of being overweight or obese was associated with an elevated risk of adverse cardiovascular events and mortality. Although inextricable links exist between obesity, type 2 diabetes and cardiovascular disease in the general population, the extent to which findings can be extrapolated to a diabetes-specific population is limited.

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Cardiovascular complications of type 2 diabetes in youth

Biochemistry and Cell Biology ◽

10.1139/bcb-2014-0118 ◽

2015 ◽

Vol 93 (5) ◽

pp. 496-510 ◽

Cited By ~ 3

Author(s):

D. Scott Kehler ◽

Andrew N. Stammers ◽

Shanel E. Susser ◽

Naomi C. Hamm ◽

Dustin E. Kimber ◽

...

Keyword(s):

Type 2 Diabetes ◽

Treatment Options ◽

Cardiovascular Complications ◽

Health Concern ◽

Cvd Risk ◽

The Past ◽

Microvascular Remodeling ◽

Few Data ◽

Diabetes In Youth

The prevalence of type 2 diabetes mellitus (T2DM) in youth has increased dramatically over the past decades. The literature also suggests that the progression from an impaired glucose tolerance state to established T2DM is more rapid in youth, compared to adults. The presence of significant cardiovascular complications in youth with T2DM, including cardiac, macrovascular, and microvascular remodeling, is another major issue in this younger cohort and poses a significant threat to the healthcare system. However, this issue is only now emerging as a major public health concern, with few data to support optimal treatment targets and strategies to reduce cardiovascular disease (CVD) risk in youth with T2DM. Accordingly, the purpose of this minireview is to better understand the cardiovascular complications in youth with T2DM. We briefly describe the pathophysiology from youth studies, including oxidative stress, inflammation, renin-angiotensin aldosterone system, and epigenetics, which link T2DM and CVD. We also describe the literature concerning the early signs of CVD in youth and potential treatment options to reduce cardiovascular risk.

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Results of the ADVANCE trial and interventional observational program ADVANCE-ON: whether our understanding of the relationship of glycemic factors and the risk of vascular complications in patients with type 2 diabetes has changed?

Diabetes Mellitus ◽

10.14341/dm7696 ◽

2015 ◽

Vol 18 (4) ◽

pp. 119-124 ◽

Cited By ~ 1

Author(s):

Marina Vladimirovna Shestakova ◽

Yuriy Shavkatovich Khalimov

Keyword(s):

Type 2 Diabetes ◽

Glycemic Control ◽

Intervention Program ◽

Vascular Complications ◽

Cardiovascular Complications ◽

Long Term Results ◽

Post Intervention ◽

Intensive Glycemic Control ◽

The Impact

The results from the analysis of the ADVANCE trial and post-intervention program ADVANCE-ON are presented in this article. These studies are dedicated to study the effect of intensive glycemic control on the incidence of micro- and macrovascular events in patients with type 2 diabetes mellitus and evaluation of long-term results of intensive glycemic control. We discuss the progress of views on the impact of glycemic control on the development of cardiovascular complications. According to the analysis of the research results, gliclazide MR is safe in patients with type 2 diabetes at high risk for cardiovascular complications.

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