scholarly journals The effect of preventative cardiovascular therapies on coronary artery disease in people with and without type 2 diabetes: a propensity-matched score study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Katerina V. Kiburg ◽  
Andrew I. MacIsaac ◽  
Georgia E. McCluskey ◽  
Vijaya Sundararajan ◽  
Richard J. MacIsaac
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Logistic Regression ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Medication Use ◽  
Patients With Diabetes ◽  
Artery Disease ◽  
Ras Inhibitors

Abstract Background Although it is known that patients with Type 2 Diabetes Mellitus (T2DM) are at an increased risk of coronary artery disease (CAD), the actual coronary artery burden of atherosclerotic disease in patients with and without T2DM in a real-world setting and its possible modification by preventative therapies has not been extensively documented. Methods Merged coronary angiography and hospital discharge data between 2013 and 2019 were obtained for analysis and a random sub-sample of patient charts were reviewed for medication use. Propensity scores were estimated using logistic regression models and used to match patients, looking at the effect of severity of CAD over time in years in an ordinal logistic regression model. A separate propensity score was estimated and used to inverse probability weight the ordinal logistic regression looking at the effect of medication use on CAD severity in patients with and without T2DM. Results From 3,016 patients in the coronary angiography database, 1421 with T2DM and 1421 without T2DM were matched on propensity score. T2DM patients had more extensive CAD in 2018 compared to 2013 ((adjusted odds ratio) adjOR: 2.06 95% C.I. 1.38, 2.07), but this risk appeared to be attenuated in 2019. In contrast, there was no effect of time on CAD burden in patients without diabetes. In the sub-sample of 760 patients who underwent a chart review of their medication use, there were 367 (48%) with T2DM. For patients with T2DM 69.8% reported taking statins, 64.0% RAS inhibitors and 64.0% anti-platelet drugs. This was significantly higher than patients without diabetes of whom 46.6% reported taking statins, 49.0% RAS inhibitors and 49.9% anti-platelet drugs. As in the full matched sample, patients with diabetes had more extensive CAD (adjOR: 1.32 95% CI: 1.01, 1.74). However, after adjustment for the use of RAS inhibitors, statins and anticoagulants there was no difference in extent of CAD between patients with and without diabetes (adjOR: 1.14 95% CI: 0.85, 1.53). Conclusions Although patients with diabetes have a greater extent of CAD in comparison to those without T2DM, preventative medication use decreases this CAD burden significantly.

scholarly journals The influence of cardiac rehabilitation on heart rate variability indices in men with type 2 diabetes and coronary artery disease

2021 ◽  
Vol 18 (3) ◽  
pp. 147916412110201
Author(s):  
Katarzyna Szmigielska ◽  
Anna Jegier
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Coronary Artery ◽  
Cardiac Rehabilitation ◽  
Interval Training ◽  
Patients With Diabetes ◽  
Artery Disease

The study evaluated the influence of cardiac rehabilitation (CR) on heart rate variability (HRV) in men with coronary artery disease (CAD) with and without diabetes. Method: The study population included 141 male CAD patients prospectively and consecutively admitted to an outpatient comprehensive CR program. Twenty-seven patients with type-2 diabetes were compared with 114 males without diabetes. The participants performed a 45-min cycle ergometer interval training alternating 4-min workload and a 2-min active restitution three times a week for 8 weeks. The training intensity was adjusted so that the patient’s heart rate achieved the training heart rate calculated according to the Karvonen formula. At the baseline and after 8 weeks, all the patients underwent the HRV assessment. Results: HRV indices in the patients with diabetes were significantly lower as compared to the patients without diabetes in SDNN, TP, LF parameters, both at the baseline and after 8 weeks of CR. After 8 weeks of CR, a significant improvement of TP, SDNN, pNN50% and HF occurred in the patients without diabetes, whereas in the patients with diabetes only HF component improved significantly. Conclusions: As regards HRV indices, CR seems to be less effective in patients with CAD and type-2 diabetes.

scholarly journals Could osteoprotegerin serve as a marker of metabolic syndrome?

2013 ◽  
Vol 26 (3) ◽  
pp. 309-312
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Metabolic Syndrome ◽  
Coronary Artery ◽  
Cardiovascular Diseases ◽  
Urinary Calcium ◽  
Syndrome Type ◽  
Patients With Diabetes ◽  
Artery Disease

There has been a dramatic increase in the worldwide prevalence of obesity, which is associated with the development of several chronic diseases such as metabolic syndrome, type 2 diabetes and cardiovascular diseases. Osteoprotegerin is a glycoprotein mainly secreted by bone but produced also by heart muscle and blood vessels. It inhibits the recruitment, proliferation, and activation of osteoclasts. The role of osteoprotegerin in the pathogenesis of metabolic syndrome, type 2 diabetes and cardiovascular diseases is still discussed. The study was carried out on 62 patients with metabolic syndrome aged 35-83 (34F and 28M). Type 2 diabetes was diagnosed in 76% of subjects and 62% of them suffered from coronary artery disease as a macrovascular complication. Determinations of biochemical parameters and anthropometric measurements were performed in the studied group. The relationships between serum osteoprotegerin concentrations and components of metabolic syndrome and total cholesterol, LDL-cholesterol, HbA1C, BMI, levels of calcium and phosphate in the blood and 24-hour urinary calcium have been analysed. Diabetics had higher osteoprotegerin concentrations than patients without diabetes (5.570 pmol/l vs 4.690 pmol/l). Osteoprotegerin levels in patients with diabetes and coronary artery disease were significantly higher (6.640pmol/l) than in those without macrovascular complications (5.295 pmol/l) (Z=1.986; p=0.047). Furthermore, the associations between osteoprotegerin and calcium and phosphate levels in the blood and 24-hour urinary calcium have been shown. A lower calcium level in the blood was negative but a lower phosphate level was positive correlated with OPG serum concentration (respectively: 6.825 pmol/l vs 5.195 pmol/l, Z=2.656, p=0.008; 4.250pmol/l vs 5.640 pmol/l, Z=2.718, p=0.007). What’s more, the inverse correlations between OPG concentrations and 24-hour urinary calcium and diastolic blood pressure have been observed. No associations between osteoprotegerin and waist circumference, BMI, cholesterol levels and HbA1C, were found. In summary, osteoprotegerin is not a use ful marker of all components of metabolic syndrome. It is level depends on the presence of hypertension, type 2 diabetes and coronary artery disease. This glycoprotein may serve a a marker of calcium and phosphate homeostasis. We concluded that the relationship between osteoprotegerin concentrations and calcification of atherosclerotic plaques in patients with metabolic syndrome and type 2 diabetes should be analysed in further investigations.

Pulmonary function in patients with type 2 diabetes and coronary artery disease

2016 ◽  
Vol 94 (5) ◽  
pp. 366-373 ◽  
Author(s):  
Evgeniy D. Bazdyrev ◽  
O. M. Polikutina ◽  
N. A. Kalichenko ◽  
Yu. S. Slepynina ◽  
O. L. Barbarash
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Respiratory Failure ◽  
Coronary Artery ◽  
Pulmonary Function ◽  
Diabetic Patients ◽  
Carbohydrate And Lipid Metabolism ◽  
Patients With Diabetes ◽  
Artery Disease

Currently, there is no convincing evidence of respiratory failure in patients with diabetes mellitus (DM) and coronary artery disease (CAD). Aim: To evaluate the differences in the main parameters of pulmonary function in patients with isolated type 2 diabetes and diabetic patients with CAD. Materials and methods: Patients with diabetes were allocated to two groups depending to the presence of CAD. The assessment of carbohydrate and lipid metabolism, as well as the measurement of inflammatory markers were performed using standard methods of clinical and biochemical analysis. Respiratory function and diffusion capacity of the lungs (DLCO) were assessed using a body plethysmograph Elite Dl-220v. Results. Main pulmonary functional test parameters were within normal values, except residual volume in diabetic patients. Patients with concomitant CAD demonstrated lower values of the studied parameters compared to non-diabetic ones. A number of volume and flow rate parameters as well as DLCO correlated with systemic inflammation, decompensation of carbohydrate and lipid metabolism, and duration of diabetes. Conclusion. Diabetic patients with CAD suffered from respiratory failure, manifested as decline in pulmonary function and DLCO. Blood glucose levels, inflammation symptoms, dyslipidemia and myocardial dysfunction are among suspected causes contributing to the development and acceleration of this decline.

scholarly journals Oral diabetes medication monotherapy and short-term mortality in individuals with type 2 diabetes and coronary artery disease

2018 ◽  
Vol 6 (1) ◽  
pp. e000516 ◽  
Author(s):  
Sridharan Raghavan ◽  
Wenhui G Liu ◽  
David R Saxon ◽  
Gary K Grunwald ◽  
Thomas M Maddox ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Proportional Hazards ◽  
Medication Use ◽  
Mortality Rates ◽  
Cox Proportional Hazards ◽  
Diabetes Medication ◽  
Artery Disease

ObjectiveTo determine whether sulfonylurea use, compared with non-sulfonylurea oral diabetes medication use, was associated with 2-year mortality in individuals with well-controlled diabetes and coronary artery disease (CAD).Research design and methodsWe studied 5352 US veterans with type 2 diabetes, obstructive CAD on coronary angiography, hemoglobin A1c ≤7.5% at the time of catheterization, and taking zero or one oral diabetes medication (categorized as no medications, non-sulfonylurea medication, or sulfonylurea). We estimated the association between medication category and 2-year mortality using inverse probability of treatment-weighted (IPW) standardized mortality differences and IPW multivariable Cox proportional hazards regression.Results49%, 35%, and 16% of the participants were on no diabetes medications, non-sulfonylurea medications, and sulfonylureas, respectively. In individuals on no medications, non-sulfonylurea medications, and sulfonylureas, the unadjusted mortality rates were 6.6%, 5.2%, and 11.9%, respectively, and the IPW-standardized mortality rates were 5.9%, 6.5%, and 9.7%, respectively. The standardized absolute 2-year mortality difference between non-sulfonylurea and sulfonylurea groups was 3.2% (95% CI 0.7 to 5.7) (p=0.01). In Cox proportional hazards models, the point estimate suggested that sulfonylurea use might be associated with greater hazard of mortality than non-sulfonylurea medication use, but this finding was not statistically significant (HR 1.38 (95% CI 1.00 to 1.93), p=0.05). We did not observe significant mortality differences between individuals on no diabetes medications and non-sulfonylurea users.ConclusionsSulfonylurea use was common (nearly one-third of those taking medications) and was associated with increased 2-year mortality in individuals with obstructive CAD. The significance of the association between sulfonylurea use and mortality was attenuated in fully adjusted survival models. Caution with sulfonylurea use may be warranted for patients with well-controlled diabetes and CAD, and metformin or newer diabetes medications with cardiovascular safety data could be considered as alternatives when individualizing therapy.

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