Primary Prevention of Major Cardiovascular and Cerebrovascular Events with Statins in Diabetic Patients

Drugs ◽  
2012 ◽  
Vol 72 (18) ◽  
pp. 2365-2373 ◽  
Author(s):  
Folgerdiena M. de Vries ◽  
Petra Denig ◽  
Koen B. Pouwels ◽  
Maarten J. Postma ◽  
Eelko Hak
Keyword(s):  
Primary Prevention ◽  
Diabetic Patients ◽  
Cerebrovascular Events

scholarly journals Statins for Primary Prevention of Cardiovascular and Cerebrovascular Events in Diabetic Patients without Established Cardiovascular Diseases: A Meta-Analysis

2011 ◽  
Vol 120 (02) ◽  
pp. 116-120 ◽  
Author(s):  
Y.-H. Chen ◽  
B. Feng ◽  
Z.-W. Chen
Keyword(s):  
Primary Prevention ◽  
Statin Therapy ◽  
Therapy Group ◽  
Coronary Revascularization ◽  
Meta Analysis ◽  
Diabetic Patients ◽  
Cerebrovascular Events ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Control Therapy

AbstractLipid-lowering medications could lead to a significant reduction in major cardiovascular events in patients with diabetes. However, there was still controversy regarding the use of statins in patients with diabetes for primary prevention. The meta-analysis was performed to evaluate the outcomes of statin-therapy in diabetic patients without established cardiovascular diseases.7 randomized controlled trials of statin- vs. control-therapy in patients with diabetes were included. A total number of 12 711 patients were involved. The outcomes of interest were major adverse cardiovascular and cerebrovascular events (MACCE), including myocardial infarction, stroke, all-cause mortality and coronary revascularization.A total of 1 376 MACCE occurred during follow-up, with 9.54% (605 patients) in the statin therapy group and 12.10% (771 patients) in control group. Statin therapy was associated with a significant reduction in the incidence of MACCE (0.79, 95%CI 0.66–0.95; P=0.01). Meanwhile, the risk of stroke and coronary revascularization were reduced 29 and 26% in statin therapy group. However, there was no statistical difference of all-cause mortality between statin- and control-therapy group (3.73 vs. 4.65%, P=0.13).For primary prevention in patients with diabetes without established cardiovascular disease, statin therapy could reduce the cardiovascular and cerebrovascular events, but not all-cause mortality.

scholarly journals Using biomarkers to identify diabetic patients with multiple silent cardiac abnormalities

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V.H Chong ◽  
J.S.S Singh ◽  
E Dow ◽  
R.J McCrimmon ◽  
C.C Lang ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Cardiac Troponin ◽  
Cardiovascular Events ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Public Institution ◽  
Diabetic Patients ◽  
Funding Source ◽  
Cardiac Abnormality ◽  
Cardiac Abnormalities

Abstract Background Primary prevention of cardiovascular events in people with Type 2 diabetes mellitus (T2DM) needs to improve due to risk of cardiovascular events. A major problem in T2DM is the high incidence of silent yet potentially lethal cardiac abnormalities, namely myocardial ischaemia (MI), left ventricular hypertrophy (LVH), left ventricular systolic dysfunction (LVSD), left ventricular diastolic dysfunction (LVDD), and left atrial enlargement (LAE). All these independently predict cardiovascular events and mortality. There is not a single study with comprehensive enough cardiac phenotyping to document the prevalence of all the aforementioned 5 cardiac abnormalities. To improve primary prevention of cardiovascular disease in diabetes, we need to first identify the type of silent cardiac abnormality and treat accordingly. However cardiac phenotyping in all people with T2DM would be prohibitively expensive. Purpose Our study examines the prevalence of all 5 cardiac abnormalities, and the accuracy of biomarkers in identifying them in a cohort of patients with well-controlled T2DM and blood pressure (BP) with no known cardiovascular symptom or disease. Methods This is a cross-sectional study of randomly selected patients with T2DM with no known cardiovascular symptom or disease, clinic BP or average 24-hour BP ≤140/80mmHg, and HbA1c ≤64mmol/mol. Patients with renal impairment, atrial fibrillation, moderate to severe valvular heart disease were excluded. All participants underwent transthoracic echocardiogram, electrocardiogram and dobutamine stress echocardiogram (DSE). Those who did not tolerate DSE or whose DSE was inconclusive, a myocardial perfusion scan or computed tomography coronary angiogram was done. Biomarkers such as BNP, NT-proBNP, high-sensitivity cardiac Troponin I (hs-cTnI), and high sensitivity cardiac Troponin T (hs-cTnT) were measured. Results Of 246 participants (mean age 66 years, 63% male), 141 (57.3%) had silent cardiac abnormalities. 90 (36.6%) had 1 cardiac abnormality, 44 (17.9%) had 2 cardiac abnormalities and 7 (2.8%) had 3 cardiac abnormalities. The most prevalent abnormality was LAE, n=106 (43.1%); followed by LVH, n=71 (28.9%); LVDD, n=13 (5.3%); MI, n=8 (3.3%); LVSD, n=1 (0.4%). Both NT-proBNP and hs-cTnI performed best in detecting silent cardiac abnormalities with p-values of 0.02 and 0.0004, and AUC 0.66 and 0.68 respectively. Increasing NT-proBNP (p=0.002) and hs-cTnI (p=0.002) levels correlated to increasing number of concomitant cardiac abnormalities. Our key new finding is that biomarkers identify those with multiple silent cardiac abnormalities. Conclusion BNP and high-sensitivity cardiac Troponin appear to identify those with multiple silent cardiac abnormalities which may make them useful screening tests so that cardiac investigations are focused on this high-risk subset, with a view to intensifying potential therapies on this subset to reduce the cardiotoxic effect of diabetes. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Chief Scientist Office

scholarly journals Effect of Low-Dose Aspirin on Primary Prevention of Cardiovascular Events in Japanese Diabetic Patients at High Risk

2013 ◽  
Vol 77 (12) ◽  
pp. 3023-3028 ◽  
Author(s):  
Sadanori Okada ◽  
Takeshi Morimoto ◽  
Hisao Ogawa ◽  
Mio Sakuma ◽  
Hirofumi Soejima ◽  
...  
Keyword(s):  
Primary Prevention ◽  
High Risk ◽  
Cardiovascular Events ◽  
Low Dose ◽  
Diabetic Patients ◽  
Dose Aspirin ◽  
Low Dose Aspirin

scholarly journals Role of Aspirin for primary prevention of cardiovascular and all-cause mortality events in diabetes: An updated meta-analysis of randomized controlled trials.

2021 ◽  
Author(s):  
Hua Ma ◽  
QIng Gu ◽  
Huining Niu ◽  
Xiaohua Li ◽  
Rong Wang
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Meta Analysis ◽  
Significant Risk ◽  
Diabetic Patients ◽  
Primary Endpoints ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Rule Out

Background: The use of Aspirin in the primary prevention of cardiovascular disease (CVD) is still a topic of debate, especially in patients with diabetes. The present meta-analysis aims to rule out the efficacy of Aspirin in patients with diabetes and to compare the effectiveness of Aspirin with a placebo (or no treatment) for the primary prevention of CVD and all-cause mortality events in people with diabetes. Materials and Methods: An extensive and systematic search was conducted in Medline (via PubMed), Cinahl (via Ebsco), Scopus, and Web of Sciences from 1988 to December 2020. A detailed literature search was conducted using Aspirin, cardiovascular disease (CVD), diabetes, and efficacy to identify trials of patients with diabetes who received Aspirin for primary prevention of CVD. Demographic details with the primary outcome of events and bleeding outcomes were analyzed. The risk of bias (RoB) in included studies was evaluated using the QUADAS-2 tool. Results: A total of 5 studies out of 13 were included with 23,570 diabetic patients; 11,738 allocated to Aspirin and 11,832 allocated to the placebo group. In patients with diabetes, there was no difference between Aspirin and placebo with respect to the risk of all-cause death with a confidence interval (CI) varying 0.63 to 1.17. In addition, there were no differences in the bleeding outcomes with an odds ratio of 1.4411 (CI 0.47 to 4.34). Conclusion: Aspirin has no significant risk on primary endpoints of cardiovascular events and the bleeding outcomes in diabetic patients compared to placebo. More research on the use of Aspirin alone or in combination with other antiplatelet drugs is required in patients with diabetes to supplement currently available research.

Primary Prevention of Cerebropathy in Diabetic Patients

2010 ◽  
Vol 11 (4) ◽  
pp. 281
Author(s):  
Kyung Sun Park ◽  
Yong Wook Cho
Keyword(s):  
Primary Prevention ◽  
Diabetic Patients

scholarly journals Sex differences in long-term outcomes of patients with percutaneous coronary intervention: the Armenian experience

2013 ◽  
Vol 1 (2) ◽  
pp. 17
Author(s):  
Yeva Sahakyan ◽  
Michael E. Thompson ◽  
Lusine Abrahamyan
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Sex Differences ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Event Free Survival ◽  
Free Survival ◽  
Cerebrovascular Events ◽  
Percutaneous Coronary

The present study aimed at assessing sex differences in perioperative characteristics and 3-year event-free survival from major adverse cardiac and cerebrovascular events (MACCE) in patients with percutaneous coronary intervention (PCI) in Armenia. The study utilized an observational, retrospective cohort design enrolling patients who underwent PCI from 2006 to 2008 at a single center in Yerevan, Armenia. Major adverse cardiac and cerebrovascular events included all-cause mortality, myocardial infarction (MI), repeat revascularization, or stroke/transient ischemic attack. Among 485 participants included in the analysis, 419 (86%) were men. Women were older, more hypertensive, more obese, and had significantly higher rates of diabetes. At the end of follow-up, the incidence of MACCE was 37% for men and 33% for women (P=0.9). Based on the results from the adjusted Cox proportional hazards model, the independent predictors of MACCE included acute MI [hazard ratio (HR)=1.43, 95% confidence interval (CI): 1.02-2.00], arrhythmia (HR=1.64, 95% CI: 1.07-2.50), sex (HR=2.46, 95% CI: 1.08- 5.61), diabetes (HR=5.65, 95% CI: 2.14-14.95), and the interaction between sex and diabetes (HR=0.16; 95% CI: 0.05-0.47). Among diabetic patients, men had better event-free survival from MACCE (HR=0.40, 95% CI: 0.19-0.85) than women, whereas in patients without diabetes men had worse outcomes than women (95% CI: 1.08-5.62). In Armenia, the baseline profile of women undergoing PCI differed considerably from that of men. In patients with diabetes, women had worse outcomes at long-term follow-up, while the opposite was noted in patients without diabetes.

The role of metformin for primary prevention in non-elderly diabetic colorectal cancer patients.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 406-406
Author(s):  
Amikar Sehdev ◽  
Ya-Chen T. Shih ◽  
Benjamin Vekhter ◽  
Christopher Lyttle ◽  
Blase N. Polite
Keyword(s):  
Colorectal Cancer ◽  
Primary Prevention ◽  
Polycystic Ovary ◽  
Conditional Logistic Regression ◽  
Primary Objective ◽  
Multivariate Model ◽  
Exposed Group ◽  
Diabetic Patients ◽  
Incident Cases

406 Background: There is growing evidence for the beneficial effect of metformin in reducing the incidence of colorectal cancer (CRC) in diabetic patients. However, no such studies are done in the US population. We conducted a case control study (N=8,046) in non-elderly diabetic adult US population (age 18-64 years) to investigate the role of metformin for the primary prevention of CRC. Methods: MarketScan claims database was used to identify diabetic patients with CRC using ICD-9 codes. Only incident cases of CRC in diabetic patients were included in the study. Two matched controls (matched for age, sex, and geographical region) were selected per case. The exposure to metformin was assessed from prescriptions in the 12 months prior to the earliest date of CRC diagnosis. The primary objective was to assess the odds of having CRC in metformin users as compared nonusers. Adjusted odds ratios (AOR) were calculated by adjusting for multiple potential confounders using conditional logistic regression. Results: The mean age of CRC patients was 56 years, 60% were males. Metformin was prescribed to 38.13% patients. A total of 37% (995/2,682) patients developed CRC in metformin exposed group compared to 62.9% (1,687/2,682) patients in non-metformin exposed group. In a multivariate model, any metformin use was associated with a statistically significant 12% reduced risk of developing CRC (AOR 0.88, 95% CI, 0.79-0.98, p<0.026). Prescribed NSAIDs were also associated with decreased incidence of CRC (AOR 0.84, 95% CI, 0.73-0.97, p=0.019). Variables associated with increased incidence of CRC in the multivariate model were IBD (AOR 1.94, 95% CI, 1.13-3.33, p<0.015); use of insulin (AOR 1.45, 95% CI, 1.27-1.65, p<0.001); coronary artery disease (AOR 1.66, 95% CI, 1.43-1.93, p<0.001). There was no significant relationship between CRC incidence and obesity (AOR 1.19, 95% CI, 0.93-1.53, p=0.158); polycystic ovary disease (AOR 0.32, 95% CI, 0.03-2.76, p=0.3); sulfonylureas (AOR 1.09, 95% CI, 0.96-1.24, p=0.15); thiazolidinediones (AOR 0.94, 95% CI, 0.82-1.08, p=0.41); statins (AOR 0.914, 95% CI, 0.82-1.01, p=0.108). Conclusions: The use of metformin appears to reduce the incidence of CRC in non-elderly diabetic adult US population.

scholarly journals A study of the influence of lipid profile in diabetic patients on the incidence of cerebrovascular events

2019 ◽  
Vol 6 (3) ◽  
pp. 816
Author(s):  
Taha Mahboob Ali Khalid ◽  
Rahul Gandhi G.
Keyword(s):  
Lipid Profile ◽  
Plasma Concentrations ◽  
Elevated Serum ◽  
Rapid Onset ◽  
Diabetic Patients ◽  
Mean Values ◽  
Cerebrovascular Events ◽  
Serum Lipid Concentration ◽  
Increased Risk ◽  
The Difference

Background: The relationship between elevated serum lipids and atherosclerosis is well established. Recent studies have demonstrated not only that the serum lipid concentration but also the distribution of TG and cholesterol within major lipoprotein classes are of importance for the development of atherosclerosis. Elevated plasma concentrations of LDL and decreased HDL are associated with increased risk of atherosclerosis. To study the influence of lipid profile in diabetic patients on the incidence of cerebrovascular events.Methods: The study was based on 60 patients meeting the inclusion criteria from those who were admitted at Shadan Institute of Medical Sciences, Hyderabad, India from Feb 2013-May 2014. Detailed history was taken and thorough physical examination done pertaining to the involved condition. Patients who were conscious, slow progression of neurological deficit, rapid onset of lateralizing signs with variable blood pressure were considered to be suffering from infarction.Results: The mean values of lipid profile were significantly different among the gender. There were more females with medium and high TC values as compared to females and this difference was found to be significant. Though the number of females with high HDL values was more than males, the difference was not found to be significant. The number of females with high LDL values was far more than males and this difference was found to be significant. Though the number of females was more with high TG values, the difference was not found to be significant.Conclusions: In conclusion, our study gives evidence that poor glycemic control is a strong risk factor for stroke in patients with NIDDM.

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