scholarly journals All-Cause Mortality And Cardiovascular Events In A Spanish Nonagenarian Cohort According To Type 2 Diabetes Mellitus Status And Established Cardiovascular Disease

2021 ◽  
Author(s):  
MA Salinero-Fort ◽  
J Mostaza-Prieto ◽  
C Lahoz-Rallo ◽  
J Cárdenas-Valladolid ◽  
JI Vicente-Díez ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Type 2 Diabetes Mellitus ◽  
Primary Outcome ◽  
P Values ◽  
Group 4 ◽  
All Cause Mortality

Abstract Background: To analyze all-cause mortality and cardiovascular events in nonagenarians from a Mediterranean population.Methods: Primary Health Care (265 health centres)Participants: Primary health records of all the nonagenarians living in the Community of Madrid (N=59,423). We defined 4 groups according to prevalent type 2 diabetes mellitus and established cardiovascular disease: (1) type 2 diabetes mellitus (-), cardiovascular disease (-); (2) type 2 diabetes mellitus (-), cardiovascular disease (+); (3) type 2 diabetes mellitus (+), cardiovascular disease (-); and (4) type 2 diabetes mellitus (+), cardiovascular disease (+). Follow-up time was 2.5 years. Primary outcome: Cumulative incidence and the density incidence rates of all-cause mortality, non-fatal myocardial infarction, non-fatal stroke (combined they constituted the first composite primary outcome (CPO1)), and heart failure (similarly, combined with the previous they constituted CPO2). We evaluated the adjusted effect of groups classification on all-cause mortality (Cox regression). Results. Mean age was 93.3±2.8 years; 74.2% were women. Hypertension, dyslipidemia, heart failure, albuminuria and estimated glomerular filtration rate <60 mL/min/1.73m2 were significantly more prevalent in group 4 (type 2 diabetes mellitus (+), cardiovascular disease (+)) than in the other groups (all p values <0.001). We observed significantly higher rates of cumulative incidence of all-cause mortality, CPO1 and CPO2 in participants belonging to group 4 (all p values ≤0.001). People in group 2 (type 2 diabetes mellitus (-), cardiovascular disease (+)) presented higher rates of all-cause mortality, heart failure, CPO1 and CPO2 than people in group 3 (type 2 diabetes mellitus (+), cardiovascular disease (-)) (all p values ≤0.001). In the fully-adjusted model, prevalent type 2 diabetes mellitus plus established cardiovascular disease (group 4) independently predicted all-cause mortality (HR=1.48 (95% CI, 1.40 to 1.57) as compared to reference group 1 (type 2 diabetes mellitus (-), cardiovascular disease (-)) (p <0.01). Also, cardiovascular disease and type 2 diabetes mellitus alone showed significant HRs (1.13 and 1.14, respectively; both p values <0.01)).Conclusions. In Spanish nonagenarians, established cardiovascular disease and type 2 diabetes mellitus conferred modest all-cause mortality risks. The concurrent presence of both conditions conferred the highest all-cause mortality risk.

scholarly journals Chronic heart failure in patients with type 2 diabetes mellitus: prevalence, prognosis

2015 ◽  
Vol 6 (1) ◽  
pp. 16-23
Author(s):  
S. V Kakorin ◽  
I. A Averkova ◽  
A. M Mkrtumyan
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Type 2 Diabetes Mellitus ◽  
Chronic Heart Failure ◽  
Carbohydrate Metabolism ◽  
The Status ◽  
Treatment Prognosis

The article presents a literature review of prevalence, prognosis and treatment of overt tactics of chronic heart failure (CHF) in patients with type 2 diabetes mellitus (T2DM). Diabetes and heart failure acquire the status of the epidemic of the XXI century and require health care costs for prevention and treatment of these diseases. Application of modern pharmacological preparations and instrumental treatment of cardiovascular disease (CVD) increases life expectancy and improves the quality of life of patients with CHF as with normal carbohydrate metabolism (UO), and with type 2 diabetes. However, the risk of cardiovascular mortality (CAS) in patients with type 2 diabetes, compared to having a normal carbohydrate metabolism remains unchanged. The rapidly growing population of patients with type 2 diabetes will soon change this in recent years to improve representation treatment prognosis of cardiovascular disease. Violation of myocardial remodeling in type 2 diabetes is caused by a combination of factors associated with diabetic cardiomyopathy. Reduction of the metabolic activity of cardiomyocytes insufficient glucose transport into cells, endothelial dysfunction, diabetic macro and microangiopathy myocardial fibrosis leading to disruption of filling the left ventricle (LV) and the development of chronic heart failure.Insulin resistance (IR) and compensatory hyperinsulinemia (GI) play a key role in the pathogenesis of type 2 diabetes. With effective treatment of chronic heart failure by cardiologists in patients with type 2 diabetes, affecting therapy with insulin resistance should be mandatory.

scholarly journals Prognostic Value of Secreted Frizzled-Related Protein 5 in Heart Failure Patients With and Without Type 2 Diabetes Mellitus

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Jiandi Wu ◽  
Haoxiao Zheng ◽  
Xinyue Liu ◽  
Peisong Chen ◽  
Yunlong Zhang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Prognostic Value ◽  
Primary Outcome ◽  
Related Protein

Background: Patients with heart failure (HF) with diabetes mellitus have distinct biomarker profiles compared with those without diabetes mellitus. SFRP5 (secreted frizzled-related protein 5) is an anti-inflammatory adipokine with an important suppressing role on the development of type 2 diabetes mellitus (T2DM). This study aimed to evaluate the prognostic value of SFRP5 in patients with HF with and without T2DM. Methods: The study included 833 consecutive patients with HF, 312 (37.5%) of whom had T2DM. Blood samples were collected at presentation, and SFRP5 levels were measured. The primary outcome was the composite end points of first occurrence of HF rehospitalization or all-cause mortality during follow-up. Results: During median follow-up of 2.1 years, 335 (40.2%) patients in the cohort experienced the composite primary outcome. After adjustment for multiple risk factors, each doubling of SFRP5 level was associated with a 21% decreased risk of primary outcomes in the overall study population ( P <0.001). Subgroup analyses showed that the association between level of SFPR5 and primary outcomes may be stronger in patients with T2DM (hazard ratio, 0.69 [95% CI, 0.61–0.79]) than in patients without T2DM (hazard ratio, 0.89 [95% CI, 0.79–1.01]; interaction P =0.006). Similar associations were observed when taking SFRP5 as a categorical variable. Addition of SFRP5 significantly improved discrimination and reclassification of the incident primary outcomes beyond clinical risk factors and N-terminal pro-B-type natriuretic peptide in all patients with HF and those with T2DM (all P <0.01). Conclusions: SFRP5 is an independent novel biomarker for risk stratification in HF, especially in HF with T2DM.

scholarly journals Type 2 Diabetes Mellitus and Chronic Heart Failure with Midrange and Preserved Ejection Fraction: A Focus on Serum Biomarkers of Fibrosis

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
D. A. Lebedev ◽  
E. A. Lyasnikova ◽  
E. Yu Vasilyeva ◽  
A. Yu Babenko ◽  
E. V. Shlyakhto
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Type 2 Diabetes Mellitus ◽  
Clinical Manifestations ◽  
Type I ◽  
Procollagen Type ◽  
Galectin 3

As myocardial fibrosis might be an important contributor to the association of diabetes mellitus with left ventricular (LV) dysfunction and chronic heart failure (HF), we investigated the profile of some proinflammatory, profibrotic biomarkers in patients with type 2 diabetes mellitus (T2DM) at various stages of the cardiovascular disease continuum from absence of clinic since and symptoms to HF with preserved (HFpEF) and midrange ejection fraction (HFmrEF). Material and Methods. Sixty-two patients with T2DM (age 60 [55; 61]), 20 patients without clinical manifestations of HF and 2 groups with clinical manifestations of stable HF, 29 patients with HFpEF, and 13 patients with HFmrEF, were included in the study. The control group consisted of 13 healthy subjects and normal BMI. All patients underwent transthoracic echocardiography, laboratory assessment of N-terminal fragment of the brain natriuretic peptide (Nt-proBNP), highly sensitive C-reactive protein (hsCRP), soluble suppression of tumorigenesis-2 (sST2), galectin-3, C-terminal propeptide of procollagen type I (PICP), N-terminal propeptide of procollagen type III (PIIINP), matrix metalloproteinase-9 (MMP-9), and tissue inhibitor of matrix proteinase-1 (TIMP-1). Results. Patients with HFmrEF had higher values of LV volumetric parameters, indexed parameters of LV myocardial mass (LVMM), and higher concentrations of Nt-proBNP (all p < 0.05 ). The concentrations of galectin-3 were greater in patients with HFpEF and HFmrEF compared to patients without HF ( p = 0.01 and p = 0.03 , respectively). PICP and PICP/PIIINP ratio were greater in patients with HFmrEF compared to patients with HFpEF ( p = 0.043 and p = 0.033 , respectively). In patients with T2DM and HF, a relationship was found between galectin-3 and LVMM/body surface area ( r = − 0.58 , p = 0.001 ), PIIINP, TIMP-1, and LV end-diastolic volume ( r = − 0.68 and p = 0.042 and r = 0.38 and p = 0.02 , respectively). Conclusion. The dynamics at various stages of the cardiovascular disease continuum in the serum fibrosis markers may reflect an increase in fibrotic and decrease in antifibrotic processes already at the preclinical stage of HF. At the same time, the changes found in the circulating procollagen levels may indicate a shift in balance towards type I collagen synthesis in HFmrEF compared with HFpEF.

scholarly journals Bias Implications of Outcome Misclassification in Observational Studies Evaluating Association Between Treatments and All‐Cause or Cardiovascular Mortality Using Administrative Claims

2020 ◽  
Vol 9 (17) ◽  
Author(s):  
Rishi J. Desai ◽  
Raisa Levin ◽  
Kueiyu Joshua Lin ◽  
Elisabetta Patorno
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cardiovascular Mortality ◽  
Administrative Claims ◽  
National Death Index ◽  
All Cause Mortality ◽  
Predicted Values

Background The bias implications of outcome misclassification arising from imperfect capture of mortality in claims‐based studies are not well understood. Methods and Results We identified 2 cohorts of patients: (1) type 2 diabetes mellitus (n=8.6 million), and (2) heart failure (n=3.1 million), from Medicare claims (2012–2016). Within the 2 cohorts, mortality was identified from claims using the following approaches: (1) all‐place all‐cause mortality, (2) in‐hospital all‐cause mortality, (3) all‐place cardiovascular mortality (based on diagnosis codes for a major cardiovascular event within 30 days of death date), or (4) in‐hospital cardiovascular mortality, and compared against National Death Index identified mortality. Empirically identified sensitivity and specificity based on observed values in the 2 cohorts were used to conduct Monte Carlo simulations for treatment effect estimation under differential and nondifferential misclassification scenarios. From National Death Index, 1 544 805 deaths (549 996 [35.6%] cardiovascular deaths) in the type 2 diabetes mellitus cohort and 1 175 202 deaths (523 430 [44.5%] cardiovascular deaths) in the heart failure cohort were included. Sensitivity was 99.997% and 99.207% for the all‐place all‐cause mortality approach, whereas it was 27.71% and 33.71% for the in‐hospital all‐cause mortality approach in the type 2 diabetes mellitus and heart failure cohorts, respectively, with perfect positive predicted values. For all‐place cardiovascular mortality, sensitivity was 52.01% in the type 2 diabetes mellitus cohort and 53.83% in the heart failure cohort with positive predicted values of 49.98% and 54.45%, respectively. Simulations suggested a possibility for substantial bias in treatment effects. Conclusions Approaches to identify mortality from claims had variable performance compared with the National Death Index. Investigators should anticipate the potential for bias from outcome misclassification when using administrative claims to capture mortality.

Renal impairment and all-cause mortality in cardiovascular disease: effect modification by type 2 diabetes mellitus

2013 ◽  
Vol 43 (2) ◽  
pp. 198-207 ◽  
Author(s):  
Sharmini Selvarajah ◽  
Cuno S. P. M. Uiterwaal ◽  
Jamaiyah Haniff ◽  
Yolanda van der Graaf ◽  
Frank L. J. Visseren ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Type 2 Diabetes Mellitus ◽  
Renal Impairment ◽  
Effect Modification ◽  
All Cause Mortality ◽  
Disease Effect

scholarly journals The Association Between Metformin Treatment and Outcomes in Type 2 Diabetes Mellitus Patients With Heart Failure With Preserved Ejection Fraction: A Retrospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Jianfang Wang ◽  
Yi Lu ◽  
Xinjia Min ◽  
Tan Yuan ◽  
Jia Wei ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Preserved Ejection Fraction ◽  
Metformin Group ◽  
Patients With Heart Failure ◽  
All Cause Mortality

Background: Metformin is the first-line antidiabetic medication for type 2 diabetes mellitus (T2DM). However, the association between metformin and outcomes in T2DM patients with heart failure with preserved ejection fraction (HFpEF) is still unknown. We aimed to explore the association between metformin and adverse outcome in T2DM patients with HFpEF.Methods: A total of 372 T2DM patients with HFpEF hospitalized from January 1, 2013, to December 31, 2017, were included in this retrospective cohort study. There were 113 and 259 subjects in metformin and non-metformin group, respectively. Subjects were followed up for all-cause mortality, cardiovascular death, all-cause hospitalization, and heart failure hospitalization.Results: The median follow-up period was 47 months. Eleven patients (2.49% per patient-year) in the metformin group and 56 patients (5.52% per patient-year) in the non-metformin group deceased during follow-up (P = 0.031). However, a multivariable Cox regression failed to show that metformin was an independent factor of all-cause mortality [HR (95% CI) = 0.682 (0.346–1.345); P = 0.269]. A subgroup analysis revealed a significant association between metformin and all-cause mortality in patients with a higher hemoglobin A1c (HbA1c) level (HbA1c ≥7%) [HR (95% CI) = 0.339 (0.117–0.997); P = 0.045]. The 4-year estimated number needed to treat (NNT) with metformin compared with non-metformin for all-cause mortality was 12 in all populations and 8 in the HbA1c ≥7% subgroup.Conclusions: Metformin was not independently associated with clinical outcomes in patients with T2DM and HFpEF, but was associated with lower all-cause mortality in the subgroup of patients with poor glycemic control. Prospective, randomized controlled trials are needed to further verify these findings.

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