scholarly journals The importance of three-stage cardiac rehabilitation in patients with acute coronary syndrome and type 2 diabetes mellitus

2020 ◽  
pp. 12-18
Author(s):  
E. A. Nikitina ◽  
E. N. Chicherina ◽  
O. S. Elsukova ◽  
I. S. Metelev
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Myocardial Revascularization ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Long Term Prognosis

Introduction. Acute coronary syndrome (ACS) patients with type 2 diabetes mellitus (T2DM) have worse prognosis than those without diabetes. Risk of adverse outcome in this cohort remains high despite the introduction of new methods of invasive treatment of ACS. The use of all-inclusive cardiac rehabilitation (CR) programs allows improving prognosis in patients with ACS and T2DM. Aim. The aim of the study was to evaluate impact of two- or three-stage CR on long-term prognosis in patients with ACS and T2DM. Methods. The study included 251 ACS patients hospitalized in the department of cardiology, of which 120 patients with T2DM. Management of ACS was carried out in accordance with the clinical recommendations of the European Society of Cardiology (2015, 2017). All patients underwent standard laboratory and instrumental examination. We analyzed prognostic parameters (myocardial revascularization, myocardial infarction and mortality) during 12 months of follow-up in diabetic and non-diabetic patients with ACS who underwent two or a three-stage CR. Additionally, the achievement of the combined endpoint, which include at least one of the ACE, was analyzed. Results. Long-term prognosis in ACS patients who underwent three-stage CR in diabetic and non-diabetic groups did not differ significantly. However, the frequency of repeated myocardial revascularization was higher in patients with T2DM in comparison with non-diabetic patients inside the two-stage CR subgroup. Conclusion. Three-stage CR should be recommended in diabetic patients with ACS to improve long-term prognosis.

scholarly journals The clinical burden of type 2 diabetes in patients with acute coronary syndromes: Prognosis and implications for short- and long-term management

2014 ◽  
Vol 11 (6) ◽  
pp. 395-409 ◽  
Author(s):  
Pamela Katz ◽  
Lawrence A Leiter ◽  
Linda Mellbin ◽  
Lars Rydén
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Acute Coronary Syndromes ◽  
Coronary Syndrome ◽  
Review Management ◽  
Coronary Syndromes

Type 2 diabetes mellitus (T2DM) is associated with increased morbidity and mortality in patients with acute coronary syndromes (ACS). Cardiometabolic risk factors, including hyperglycaemia, insulin resistance, atherogenic dyslipidaemia, increased visceral fat and inflammation, are associated with increased risk in this population and represent potential targets for treatment. In this review, management strategies for patients with T2DM post-ACS, both in the acute-care setting and in the long-term, are discussed. Although the benefits of long-term, aggressive, multifactorial risk factor modification are well established, a significant burden of recurrent events remains and the search for novel strategies continues. Several studies are assessing the potential cardiovascular (CV) benefits and safety of various classes of newer agents. Of these, AleCardio (aleglitazar), Examination of Cardiovascular Outcomes With Alogliptin versus Standard of Care in Patients With Type 2 Diabetes Mellitus and Acute Coronary Syndrome (EXAMINE; alogliptin) and Evaluation of LIXisenatide in Acute Coronary Syndrome (ELIXA; lixisenatide) specifically address patients with type 2 diabetes post-ACS. The mechanisms of action of these new therapies and aims of the CV outcome studies are briefly reviewed. The prevalence of type 2 diabetes continues to increase worldwide highlighting the need for new strategies that address the complex underlying processes that drive atherosclerosis and CV events in this high-risk patient population.

scholarly journals Impact of timing of randomization after an acute coronary syndrome and subsequent events in patients with type 2 diabetes mellitus: an analysis of the EXAMINE trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Elharram ◽  
A Sharma ◽  
W White ◽  
G Bakris ◽  
P Rossignol ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Clinical Trials ◽  
Type 2 Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Primary Outcome ◽  
Funding Source ◽  
Coronary Syndrome ◽  
The Impact

Abstract Background The timing of enrolment following an acute coronary syndrome (ACS) may influence cardiovascular (CV) outcomes and potentially treatment effect in clinical trials. Using a large contemporary trial in patients with type 2 diabetes mellitus (T2DM) post-ACS, we examined the impact of timing of enrolment on subsequent CV outcomes. Methods EXAMINE was a randomized trial of alogliptin versus placebo in 5380 patients with T2DM and a recent ACS. The primary outcome was a composite of CV death, non-fatal myocardial infarction [MI], or non-fatal stroke. The median follow-up was 18 months. In this post hoc analysis, we examined the occurrence of subsequent CV events by timing of enrollment divided by tertiles of time from ACS to randomization: 8–34, 35–56, and 57–141 days. Results Patients randomized early (compared to the latest times) had less comorbidities at baseline including a history of heart failure (HF; 24.7% vs. 33.0%), prior coronary artery bypass graft (9.6% vs. 15.9%), or atrial fibrillation (5.9% vs. 9.4%). Despite the reduced comorbidity burden, the risk of the primary outcome was highest in patients randomized early compared to the latest time (adjusted hazard ratio [aHR] 1.47; 95% CI 1.21–1.74) (Figure 1). Similarly, patients randomized early had an increased risk of recurrent MI (aHR 1.51; 95% CI 1.17–1.96) and HF hospitalization (1.49; 95% CI 1.05–2.10). Conclusion In a contemporary cohort of T2DM with a recent ACS, early randomization following the ACS increases the risk of CV events including recurrent MI and HF hospitalization. This should be taken into account when designing future clinical trials. Figure 1 Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Takeda Pharmaceutical

scholarly journals The 14 bp Del/Ins HLA-G Polymorphism Is Related with High Blood Pressure in Acute Coronary Syndrome and Type 2 Diabetes Mellitus

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Ilian Janet García-González ◽  
Yeminia Valle ◽  
Fernando Rivas ◽  
Luis Eduardo Figuera-Villanueva ◽  
José Francisco Muñoz-Valle ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
High Blood Pressure ◽  
Negative Regulator ◽  
Native Page ◽  
Coronary Syndrome

Immunologic and inflammatory processes are involved in the pathogenesis of acute coronary syndrome (ACS) and type 2 diabetes mellitus (DM2). Human leukocyte antigen-G (HLA-G) is a negative regulator of the immune response. This study evaluates the 14 bp Del/Ins HLA-G polymorphism in ACS and DM2. Three hundred and seventy individuals from Western Mexico were recruited and categorized into three groups: ACS (86), DM2 without coronary complications (70), and healthy subjects (214). Genotyping of the 14 bp Del/Ins HLA-G polymorphism was performed by PCR and Native-PAGE. The most common risk factors were hypertension and overweight in ACS and DM2, respectively. The genetic distribution of the 14 bp Del/Ins HLA-G polymorphism showed no significant differences between groups (P≥0.23). Nonetheless, the Ins/Ins genotype was associated with high blood pressure (HBP) in the DM2 group (ORc = 1.65,P=0.02). The genetic recessive model showed similar findings (ORc = 3.03,P=0.04). No association was found in ACS, with aPof 0.05; nevertheless, the prevalence of Ins/Ins carriers was quite similar to that found in the DM2-HBP group. The 14 bp Del/Ins HLA-G polymorphism was not a susceptibility factor for ACS or DM2; however, the Ins/Ins genotype might have contributed to the development of HBP in the studied groups.

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