scholarly journals Triglyceride glucose index for the detection of asymptomatic coronary artery stenosis in patients with type 2 diabetes

2020 ◽  
Author(s):  
Pham Viet Thai ◽  
Hoang Anh Tien ◽  
Huynh Van Minh ◽  
Paul Valensi
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Coronary Artery ◽  
Epidemiologic Transition ◽  
Asymptomatic Patients ◽  
Triglyceride Glucose Index ◽  
Increased Risk ◽  
Coronary Stenoses

Abstract Background Triglyceride Glucose index (TyG) was associated with an increased risk of cardiovascular events. Silent coronary disease is common in patients with type 2 diabetes. In Vietnam, a low-middle income country, the burden of cardiovascular disease is growing in parallel to the epidemiologic transition. The aim was in patients with type 2 diabetes and no history or symptom of cardiovascular disease, to assess the prevalence of coronary stenoses (CS) and investigate the association between TyG and cardiovascular risk factors and the presence and severity of CS. Methods We recruited 166 patients at Ninh Thuan General Hospital, Vietnam. TyG and HOMA-IR were calculated, and a coronary computed tomography angiography (CCTA) was performed. Results The population was separated according to tertiles of TyG. Patients with highest TyG had higher BMI, waist circumference, total cholesterol, LDL-cholesterol, triglycerides, plasma glucose and HbA1c levels, lower HDL-cholesterol; more of them had a metabolic syndrome and less practiced physical activity (p<0.05 to <0.001). TyG correlated with HOMA-IR (p<0.001). CS ≥50% were present in 60 patients, with a coronary artery narrowing ≥70% in 32 of them. The patients with CS had higher TyG (p<0.05). The association of TyG with CS remained significant in a multivariate analysis including confounding risk factors. The number of narrowed vessels and the degree of stenosis were associated with higher TyG levels (p=0.04 and <0.005). TyG was significant in identifying patients with CS with an area under the ROC curve of 0.678 (95%CI: 0.582-0.775, p=0.002), a cut-off point of 9.63 offering 75% sensitivity and 44% specificity. In subgroup analysis the association TyG-CS was stronger in patients ≥60 yrs, with HbA1c≥7%, on statin or anti-platelet therapy. The AROC was higher with the triple criterion age-HbA1c-TyG than with age or HbA1c alone (p<0.001 for both comparisons). Conclusion More than one third of asymptomatic patients with type 2 diabetes had CS on CCTA. TyG may be considered as a marker of insulin resistance and allows to identify patients with high risk of coronary stenoses, particularly in those ≥ 60 yrs with poor glycemic control, and is associated with the number and the severity of narrowed branches.

scholarly journals Triglyceride Glucose Index for the Detection of Asymptomatic Coronary Artery Stenosis in Patients With Type 2 Diabetes

2020 ◽  
Author(s):  
Pham Viet Thai ◽  
Hoang Anh Tien ◽  
Huynh Van Minh ◽  
Paul Valensi
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Coronary Artery ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
Epidemiologic Transition ◽  
Tyg Index ◽  
Asymptomatic Patients ◽  
Increased Risk

Abstract Background: Triglyceride Glucose (TyG) index has been associated with an increased risk in cardiovascular events. Silent coronary disease is common in patients with type 2 diabetes. In Vietnam, a low-middle income country, the burden of cardiovascular disease is growing simultaneously with the epidemiologic transition. Our aim was to assess the prevalence of coronary stenoses (CS) in patients with type 2 diabetes and no history or symptom of cardiovascular disease and to investigate the association between TyG index and cardiovascular risk factors and both the presence and severity of CS. Futhermore, we assessed the value of TyG index in predicting subclinical CS. Methods: This was a cross-sectional observational study. We recruited 166 patients at Ninh Thuan General Hospital, Vietnam. TyG index and HOMA-IR were calculated, and a coronary computed tomography angiography (CCTA) was performed.Results: The population was classified according to tertiles of TyG index. The highest TyG values were associated with higher BMI, waist circumference, total cholesterol, LDL-cholesterol, triglycerides, plasma glucose, HbA1c levels and HOMA-IR, lower HDL-cholesterol, a higher incidence of metabolic syndrome and less frequent physical activity (p<0.05 to <0.0001). TyG index correlated with logHOMA-IR (p<0.0001). CS ≥50% were present in 60 participants and 32 had coronary artery stenosis ≥70%. TyG index and HOMA-IR were significantly higher in patients with CS ≥70%. The number of narrowed coronary arteries and the degree of stenosis were associated with higher TyG index levels (p=0.04 and <0.005 respectively). A TyG index ≥ 10 was significantly associated with an increased risk of multiple coronary artery disease and of more severe CS. After adjusting for confounding factors, including logHOMA-IR, these risks remained mostly significant. A TyG index threshold at 10 resulted in 57% sensitivity and 75% specificity for predicting the presence of CS ≥ 70%. In subgroup analysis TyG index ≥ 10 was associated with an increased risk in CS ≥ 70% in patients treated with statin or antiplatelet therapy.Conclusion: More than one third of asymptomatic patients with type 2 diabetes had significant CS on CCTA. TyG index may be considered as a marker for insulin resistance and increased TyG index could identify patients with high risk of coronary artery stenoses and is associated with the number and the severity of artery stenoses.

scholarly journals Triglyceride glucose index for the detection of asymptomatic coronary artery stenosis in patients with type 2 diabetes

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Pham Viet Thai ◽  
Hoang Anh Tien ◽  
Huynh Van Minh ◽  
Paul Valensi
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Coronary Artery ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
Epidemiologic Transition ◽  
Tyg Index ◽  
Asymptomatic Patients ◽  
Increased Risk

Abstract Background Triglyceride Glucose (TyG) index has been associated with an increased risk in cardiovascular events. Silent coronary disease is common in patients with type 2 diabetes. In Vietnam, a low-middle income country, the burden of cardiovascular disease is growing simultaneously with the epidemiologic transition. Our aim was to assess the prevalence of coronary stenoses (CS) in patients with type 2 diabetes and no history or symptom of cardiovascular disease and to investigate the association between TyG index and cardiovascular risk factors and both the presence and severity of CS. Futhermore, we assessed the value of TyG index in predicting subclinical CS. Methods This was a cross-sectional observational study. We recruited 166 patients at Ninh Thuan General Hospital, Vietnam. TyG index and HOMA-IR were calculated, and a coronary computed tomography angiography (CCTA) was performed. Results The population was classified according to tertiles of TyG index. The highest TyG values were associated with higher BMI, waist circumference, total cholesterol, LDL-cholesterol, triglycerides, plasma glucose, HbA1c levels and HOMA-IR, lower HDL-cholesterol, a higher incidence of metabolic syndrome and less frequent physical activity (p < 0.05 to < 0.0001). TyG index correlated with logHOMA-IR (p < 0.0001). CS ≥ 50% were present in 60 participants and 32 had coronary artery stenosis ≥ 70%. TyG index and HOMA-IR were significantly higher in patients with CS ≥ 70%. The number of narrowed coronary arteries and the degree of stenosis were associated with higher TyG index levels (p = 0.04 and < 0.005 respectively). A TyG index ≥ 10 was significantly associated with an increased risk of multiple coronary artery disease and of more severe CS. After adjusting for confounding factors, including logHOMA-IR, these risks remained mostly significant. A TyG index threshold at 10 resulted in 57% sensitivity and 75% specificity for predicting the presence of CS ≥ 70%. In subgroup analysis TyG index ≥ 10 was associated with an increased risk in CS ≥ 70% in patients treated with statin or antiplatelet therapy. Conclusion More than one third of asymptomatic patients with type 2 diabetes had significant CS on CCTA. TyG index may be considered as a marker for insulin resistance and increased TyG index could identify patients with high risk of coronary artery stenoses and is associated with the number and the severity of artery stenoses.

Abstract P191: Does ApoB/A1 Ratio Explain the Increased Risk of Cardiovascular Disease in Indian Asians Compared to Europeans?

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Sian-Tsung Tan ◽  
Abtehale Al-Hussaini ◽  
Sunaina Yadav ◽  
Joban Sehmi ◽  
Mika Ala-Korpela ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Hdl Cholesterol ◽  
Cholesterol Ratio ◽  
Chd Risk ◽  
Increased Risk ◽  
Chd Risk Factors

Introduction Coronary heart disease (CHD) mortality is ∼2-fold higher in Indian Asians (IA) than in European Whites (EW). This is not accounted for by conventional CHD risk factors (type-2 diabetes, cigarette smoking, hypertension, obesity, total or HDL cholesterol). The INTERHEART Study has reported that ApoB/A1 ratio is the single strongest risk factor for CHD accounting for ∼50% of CHD risk; the contribution of ApoB/A1 ratio to the excess CHD risk in IA is not known. Hypothesis We tested the hypothesis that ApoB/A1 ratio is higher in IA than EW and accounts for the ∼2-fold excess CHD risk in IA, independent of conventional CHD risk factors. Methodology We studied 1361 IA and 1028 EW men and women aged 35-75 years, participating in the London Life Sciences Population Study. All participants completed a structured health questionnaire and had blood pressure, height, weight, waist-hip ratio, fasting biochemistry measured. Coronary artery calcium (CAC) was measured by electron beam CT; Agatston score >0 was considered to indicate the presence of coronary atherosclerosis. Results Compared to EW, IA were younger, had higher prevalence of diabetes and hypertension, had higher WHR, and were less likely to smoke. Total and HDL cholesterol were lower, but Total-HDL cholesterol ratio was higher in IA ( table ). ApoB/A1 ratio was higher in IA compared to EW [0.71±0.15 vs. 0.67±0.16, p<0.001], and was independent of conventional CHD risk factors (p<0.001). In univariate analysis, ApoB/A1 ratio was associated with CAC in both populations [Odds ratio (OR) for CAC per 1 SD increase in ApoB/A1 ratio: IA 1.17 (1.05-1.30), p=0.006; EW 1.40 (1.23-1.59), p<0.001]. After adjustment for age, gender, and total-HDL cholesterol ratio, there was no association between ApoB/A1 ratio and CAC [OR: IA 0.95 (0.74-1.21), p=0.66; EW 0.98 (0.72-1.33), p=0.88]. Conclusions ApoB/A1 is higher in IA compared to EW, but not independently associated with coronary calcification in either population. ApoB/A1 ratio does not explain the ∼2-fold increased risk of CHD in IA. Europeans Indian Asians P-value N 1028 1361 Age (years) 55.5 54.2 0.002 Male gender (%) 70.3 62.0 <0.0001 Ever Smoked (%) 54.8 15.1 <0.0001 ApoB/A1 ratio 0.67 (0.16) 0.71 (0.15) <0.0001 Total: HDL Cholesterol Ratio 4.12 (1.10) 4.23 (1.03) <0.0001 HDL cholesterol (mmol/L) 1.37 (0.39) 1.24 (0.32) <0.0001 Type-2 Diabetes (%) 8.2 20.1 <0.0001 Treated Hypertension (%) 19.2 31.3 <0.0001 Waist-Hip Ratio 0.92 (0.08) 0.94 (0.08) <0.0001 Coronary artery calcium score greater than 0 (%) 54.1 51.1 0.15 Table: Characteristics of study participants

scholarly journals Incidence and risk factors for end-stage kidney disease in patients with clinically manifest vascular disease; results from the UCC-SMART cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H.B Oestergaard ◽  
M.C Verhaar ◽  
M.L Bots ◽  
F.W Asselbergs ◽  
G.J De Borst ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Kidney Disease ◽  
Vascular Disease ◽  
Hdl Cholesterol ◽  
Incidence Rates ◽  
Increased Risk ◽  
Kidney Length

Abstract Background Patients with cardiovascular disease are at increased risk of developing chronic kidney disease, potentially leading to end-stage kidney disease (ESKD). On the other hand, kidney disease is associated with an increased risk of adverse cardiovascular outcomes and mortality. Previous studies have identified several risk factors for ESKD in the general population. However, little is known about the impact of these risk factors for ESKD in patients with clinically manifest cardiovascular disease. Purpose The aim of this study was to determine the incidence rates of ESKD in patients with clinically manifest cardiovascular disease and to assess the relation between risk of ESKD and risk factors, including systolic blood pressure (SBP), type 2 diabetes mellitus, estimated glomerular filtration rate (eGFR) and albuminuria (urinary albumin/creatinine ratio (uACR)), body mass index (BMI), dyslipidemia (non-HDL cholesterol), smoking, kidney length and exercise, in this high-risk population. Methods Patients (n=8402) from the ongoing UCC-SMART cohort (1996–2018) with clinically manifest cardiovascular disease were included. Occurrence of ESKD during follow up was defined as kidney transplantation, chronic dialysis or chronic kidney disease stage 5 (persistent eGFR &lt;15 mL/min/1.73m2). Incidence rates for ESKD were determined and stratified according to vascular disease location. Cox proportional hazard models were used to assess the risk of ESKD for every determinant adjusted for potential confounders. Results A total of 65 events of ESKD were observed in 75,282 person-years (median follow-up time 8.6 years, IQR 4.7–12.8 years). The overall incidence rate for ESKD was 0.9 per 1000 person-years and was lower in patients with only cerebrovascular (0.6 per 1000 person-years) or cardiovascular disease (0.6 per 1000 person-years). A higher incidence rate was observed in patients with polyvascular disease (1.8 per 1000 person-years) (Figure 1A). Presence of type 2 diabetes (HR 1.83; 95% CI 1.06–3.16) and higher SBP (HR 1.37; 95% CI 1.24–1.52 per 10 mmHg) were associated with an elevated risk of ESKD. Lower eGFR and higher uACR were associated with a higher risk of ESKD (Figure 1B). Kidney length was inversely associated with risk of ESKD. Smoking, physical exercise, BMI and non-HDL cholesterol were not related to ESKD. Conclusions The incidence of ESKD is higher in patients with polyvascular disease compared to patients with cerebrovascular or cardiovascular disease. Type 2 diabetes, SBP, eGFR, uACR and kidney length are associated with a higher risk of ESKD. In patients with symptomatic vascular disease, secondary cardiovascular prevention focused at these risk factors may also reduce the risk of ESKD. Figure 1 Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): University Medical Center Utrecht

scholarly journals Cost-effectiveness of screening for coronary artery disease in asymptomatic patients with type 2 diabetes and additional atherogenic risk factors

2004 ◽  
Vol 19 (12) ◽  
pp. 1181-1191 ◽  
Author(s):  
Yasuaki Hayashino ◽  
Sizuko Nagata-Kobayashi ◽  
Takeshi Morimoto ◽  
Kenji Maeda ◽  
Takuro Shimbo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Cost Effectiveness ◽  
Coronary Artery ◽  
Asymptomatic Patients ◽  
Artery Disease

scholarly journals High-risk coronary artery plaque in asymptomatic patients with type 2 diabetes: clinical risk factors and coronary artery calcium score

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Laurits Juhl Heinsen ◽  
Gokulan Pararajasingam ◽  
Thomas Rueskov Andersen ◽  
Søren Auscher ◽  
Hussam Mahmoud Sheta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Coronary Artery ◽  
High Risk ◽  
Coronary Artery Calcium ◽  
Coronary Artery Calcium Score ◽  
Calcium Score ◽  
Coronary Artery Plaque ◽  
Asymptomatic Patients

Abstract Background High-risk coronary artery plaque (HRP) is associated with increased risk of acute coronary syndrome. We aimed to investigate the prevalence of HRP in asymptomatic patients with type 2 diabetes (T2D), and its relation to patient characteristics including cardiovascular risk factors, diabetes profile, and coronary artery calcium score (CACS). Methods Asymptomatic patients with T2D and no previous coronary artery disease (CAD) were studied using coronary computed tomography angiography (CCTA) in this descriptive study. Plaques with two or more high-risk features (HRP) defined by low attenuation, positive remodeling, spotty calcification, and napkin-ring sign were considered HRP. In addition, total atheroma volume (TAV), proportions of dense calcium, fibrous, fibrous-fatty and necrotic core volumes were assessed. The CACS was obtained from non-enhanced images by the Agatston method. Cardiovascular and diabetic profiles were assessed in all patients. Results In 230 patients CCTA was diagnostic and 161 HRP were detected in 86 patients (37%). Male gender (OR 4.19, 95% CI 1.99–8.87; p < 0.01), tobacco exposure in pack years (OR 1.02, 95% CI 1.00–1.03; p = 0.03), and glycated hemoglobin (HbA1c) (OR 1.04, 95% CI 1.02–1.07; p < 0.01) were independent predictors of HRP. No relationship was found to other risk factors. HRP was not associated with increased CACS, and 13 (23%) patients with zero CACS had at least one HRP. Conclusion A high prevalence of HRP was detected in this population of asymptomatic T2D. The presence of HRP was associated with a particular patient profile, but was not ruled out by the absence of coronary artery calcium. CCTA provides important information on plaque morphology, which may be used to risk stratify this high-risk population. Trial registration This trial was retrospectively registered at clinical trials.gov January 11, 2017 trial identifier NCT03016910.

Physical health and attendance at primary care in people with schizophrenia

2008 ◽  
Vol 25 (2) ◽  
pp. 57-60 ◽  
Author(s):  
Caragh Behan ◽  
Nicola McGlade ◽  
Farhan Haq ◽  
Anthony Kinsella ◽  
Michael Gill ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Physical Health ◽  
Physical Illness ◽  
National Guidelines ◽  
Endocrine Disease ◽  
Increased Risk

AbstractObjectives: People with schizophrenia are at increased risk of cardiovascular and endocrine disease. National guidelines recommend the physical health of people with schizophrenia be monitored by primary care, but little is known about whether such people attend primary care. We sought to examine the prevalence of cardiovascular and endocrine disease in a stable population with schizophrenia, and factors associated with attending primary care.Method: A cross sectional survey of people with a diagnosis of schizophrenia/schizoaffective disorder was taken from a larger cohort participating in the Resource for Psychoses and Genomics in Ireland (RPGI) study. Participants were interviewed using standardised clinical assessments, and underwent anthropometric measurements, and further information was collected by medical record review and contacting the general practitioner (GP).Results: Thirteen percent (n = 14) had established cardiovascular disease and 4.3% (n = 4) had type 2 diabetes. Risk factors for cardiovascular disease and type 2 diabetes were higher than the general population. Sixty-eight point five percent (n = 63) had attended their GP at least once in the previous year. Only 35% self reported a physical illness. Females (p = 0.03), those with both self-reported presence of physical illness (p = 0.007), and diagnosed physical illness (p = 0.001) were more likely to attend their GP. Other psychosocial, psychological and illness related variables did not predict attendance at primary care.Conclusion: While established patients attend their GP, they had significant unidentified risk factors for cardiovascular disease and type 2 diabetes. It is likely that non-attendees at secondary care would fare worse yet.

scholarly journals Separating the direct effects of risk factors for atherosclerotic cardiovascular disease from those mediated by type 2 diabetes

2021 ◽  
Author(s):  
Venexia Walker ◽  
Marijana Vujkovic ◽  
Alice R Carter ◽  
Neil M Davies ◽  
Miriam Udler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Mendelian Randomization ◽  
Atherosclerotic Cardiovascular Disease ◽  
Peripheral Artery ◽  
Artery Disease

Background: Type 2 diabetes and atherosclerotic cardiovascular disease share several risk factors. However, it is unclear whether the effect of these risk factors on liability to atherosclerotic cardiovascular disease is independent of their effect on liability to type 2 diabetes. Methods: We performed univariate Mendelian randomization to quantify the effects of continuous risk factors from the IEU OpenGWAS database on liability to three outcomes: type 2 diabetes, coronary artery disease, and peripheral artery disease, as well as the effects of liability to type 2 diabetes on the risk factors. We also performed two-step Mendelian randomization for mediation to estimate the mediating pathways between the risk factors, liability to type 2 diabetes, and liability to the atherosclerotic cardiovascular disease outcomes where possible. Results: We found evidence for 53 risk factors as causes of liability to coronary artery disease, including eight which were causes of liability to type 2 diabetes only and four which were consequences only. Except for fasting insulin and hip circumference, the direct and total effects from the two-step Mendelian randomization were similar. This suggests that the combination of these risk factors with liability to type 2 diabetes was unlikely to alter liability to coronary artery disease beyond their individual effects. We also found 13 risk factors that were causes of liability peripheral artery disease, including six which were causes of liability to type 2 diabetes only and four which were consequences only. Again, the direct and total effects were similar for these ten risk factors apart from fasting insulin. Conclusions: Most risk factors were likely to affect liability to atherosclerotic cardiovascular disease independently of their relationship with liability to type 2 diabetes. Control of modifiable risk factors therefore remains important for reducing atherosclerotic cardiovascular disease risk regardless of patient liability to type 2 diabetes.

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