Diabetes without Manifest Cardiovascular Disease: A Novel Approach in Risk Stratification and Treatment Selection

2020 ◽  
Vol 16 (8) ◽  
pp. 869-873 ◽  
Author(s):  
Emile Andari ◽  
Samir Arnaout ◽  
Sami T. Azar ◽  
Elie Chammas ◽  
Selim Jambart ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
Risk Stratification ◽  
Vascular Complication ◽  
Cvd Risk ◽  
Risk Of Death ◽  
Asymptomatic Patients ◽  
Novel Approach ◽  
Risk Patients

Background: Cardiovascular disease (CVD), the main macro vascular complication of type 2 diabetes (T2D), increases the risk of death significantly in patients with T2D. Introduction: Most of the patients with T2D do not have obvious CVD symptoms. Due to the paucity of data, CVD screening in asymptomatic patients with T2D remains highly controversial. Methods: This has driven a panel of experts to establish a novel consensus on how to approach patients with T2D at high CVD risk. The panel formulated a stepwise algorithm by which patients with T2D undergo initial risk stratification into low, intermediate and high risk using the ASCVD calculator. In patients with intermediate risk, coronary artery calcium measurement is used to further stratify those patients into new low and high-risk categories. Results and Conclusion: The panel recommends using standard diabetes care in low risk patients and using SGLT2 inhibitors and GLP1 agonists with cardio protective effect, on top of standard care, in high risk individuals.

Using mHealth tools to improve access, coverage and treatment of uninsured people with high cardiovascular disease risk in Argentina: a study protocol for a pragmatic cluster randomised trial

2018 ◽  
Vol 4 (3) ◽  
pp. 135-141 ◽  
Author(s):  
Shafika Abrahams-Gessel ◽  
Andrea Beratarrechea ◽  
Vilma Irazola ◽  
Laura Gutierrez ◽  
Daniela Moyano ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
High Risk ◽  
Randomised Trial ◽  
Text Messages ◽  
Cluster Randomised Trial ◽  
Cvd Risk ◽  
High Risk Patients ◽  
Cluster Randomised ◽  
Risk Patients

IntroductionCardiovascular disease (CVD) accounts for approximately one-third of Argentina’s deaths. Despite government provision of free primary care health services to the uninsured population, with a focus on non-communicable diseases, screening and management of those with high CVD risk at primary care clinics (PCCs) remain low.Methods and analysisThis pragmatic cluster randomised trial will take place in two provinces of Argentina and will recruit 740 participants. Eight PCCs will be randomised to either the intervention or current practice arm. Community health workers (CHWs) in the intervention arm will be trained to use a set of integrated mHealth tools (a validated risk screening tool mobile application; electronic scheduling system using wireless access to PCCs; and educational text messages) to screen for CVD and to schedule appointments with primary care providers for persons with high CVD risk (≥10%). The primary aims of this study are to determine if the use of mHealth tools will (1) increase attendance of first appointments scheduled by CHWs for persons determined to have high risk for CVD during screening and, (2) lead to an increase in follow-up visits at PCCs by high risk patients. Secondary outcomes include assessing the proportion of high-risk patients receiving appropriate medications and a cost-effective analysis of the intervention.Ethics and disseminationThis study has been approved by the Institutional Review Boards at Partners/Brigham and Women’s Hospital (USA) and the Hospital Italiano de Buenos Aires (Argentina). The open-source software for the mHealth tools will be made publicly available at the end of the study.Trial registration numberNCT02913339.

Abstract P177: Potential Value of Intensive Blood-Pressure Treatment Based on Predicted Lifetime Cardiovascular Disease at Age 40: Computer Simulation Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Anusorn Thanataveerat ◽  
Sonia Singh ◽  
Ciaran Kohli-Lynch ◽  
Yiyi Zhang ◽  
Eric Vittinghoff ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Computer Simulation ◽  
High Risk ◽  
Cost Effective ◽  
Intensive Treatment ◽  
Lifetime Risk ◽  
Cvd Risk ◽  
Risk Patients ◽  
Intensive Blood Pressure

Introduction: In the SPRINT trial, intensive blood pressure (BP) treatment saved lives and was cost-effective in high-risk older adults. It is unclear if intensive BP treatment should be extended to high-risk adults aged 40-49 years. Objectives: We used individual patient computer simulation to assess the incremental value of extending intensive BP treatment to adults as young as age 40 with high cardiovascular disease (CVD) risk. We selected patients aged <60 years with high lifetime risk because few have high ten-year risk. Methods: Male and female cohorts of 100,000 individuals were assembled from NHANES surveys 1999-2010 using sampling weights. BP and other risk factor trajectories were projected for ages 40 to 69 years based on Framingham Offspring Cohort analyses. The “standard of care” treatment scenario simulated treating BP <140/90 mmHg in all patients ≥140/90 mmHg. Two alternative scenarios were simulated: add intensive treatment (goal <130/90 mmHg) from age 40-69 or from age 50-59 in patients with high lifetime risk. The lifetime risk thresholds (Table 1) were chosen in order to capture patients with forecasted ten-year CVD risk ≥ 10% at age 60. Costs included added treatment and side-effect costs and avoided CVD costs; indexed to 2016. Incremental cost-effectiveness ratios (ICERs) assessed changes in costs and quality-adjusted life years due to adding intensive BP goals. Results: Over a 30-year time horizon, adding intensive treatment in high lifetime risk patients at age 40 would prevent 2,880 additional CVD events in males and 2,958 in females compared to treating only BP <140/90 mmHg. Intensive treatment in high lifetime risk patients before age 60 appeared generally cost-effective except in females aged 40 years (ICER $59,000). Conclusion: Our results suggest that over the long term, intensive BP treatment may be cost-effective in high-risk men as young as 40 and high-risk women as young as 50. Lifetime cardiovascular disease risk might be used to select high risk middle-aged adults for intensive BP treatment.

scholarly journals Long-Term Effects of Intensive Glycemic and Blood Pressure Control and Fenofibrate Use on Kidney Outcomes

2018 ◽  
Vol 13 (11) ◽  
pp. 1693-1702 ◽  
Author(s):  
Amy K. Mottl ◽  
John B. Buse ◽  
Faramarz Ismail-Beigi ◽  
Ronald J. Sigal ◽  
Carolyn F. Pedley ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
High Risk ◽  
Glycemic Control ◽  
Secondary Outcome ◽  
Composite Outcome ◽  
Intensive Glycemic Control ◽  
Risk Of Death

Background and objectivesIn people with type 2 diabetes, aggressive control of glycemia, BP, and lipids have resulted in conflicting short-term (<5 years) kidney outcomes. We aimed to determine the long-term kidney effects of these interventions.Design, setting, participants, & measurementsThe Action to Control Cardiovascular Risk in Diabetes (ACCORD) was a multifactorial intervention study in people with type 2 diabetes at high risk for cardiovascular disease (n=10,251), to examine the effects of intensive glycemic control (hemoglobin A1c <6.0% versus 7%–7.9%), BP control (systolic BP <120 mm Hg versus <140 mm Hg) or fenofibrate versus placebo added to simvastatin on cardiovascular events and death. The glycemia trial lasted 3.7 years and participants were followed for another 6.5 years in ACCORDION, the ACCORD Follow-On Study. The post hoc primary composite kidney outcome was defined as incident macroalbuminuria, creatinine doubling, need for dialysis, or death by any cause. Cox proportional hazards regression estimated the effect of each intervention on the composite outcome and individual components. In secondary outcome analyses, competing risk regression was used to account for the risk of death in incident kidney outcomes. Analyses were adjusted for sociodemographics, randomization groups, and clinical factors.ResultsThere were 988 cases of incident macroalbuminuria, 954 with doubling of creatinine, 351 requiring dialysis, and 1905 deaths. Hazard ratios (HRs) for the composite outcome with intensive glycemic, BP control, and fenofibrate use compared with standard therapy were 0.92 (95% confidence interval [95% CI], 0.86 to 0.98), 1.16 (95% CI, 1.05 to 1.28), and 1.16 (95% CI, 1.06 to 1.27). Multivariable, secondary outcome analyses showed that in the glycemia trial, only macroalbuminuria was significantly decreased (HR, 0.68; 95% CI, 0.59 to 0.77). In the BP and lipid trials, only creatinine doubling was affected (HR, 1.64; 95% CI, 1.30 to 2.06 and HR, 2.00; 95% CI, 1.61 to 2.49, respectively).ConclusionsIn people with type 2 diabetes at high risk for cardiovascular disease, intensive glycemic control may result in a long-term reduction in macroalbuminuria; however, intensive BP control and fenofibrates may increase the risk for adverse kidney events.

scholarly journals DYNAMICS OF MORPHOLOGICAL CHANGES IN BRACHIOCEPHALIC TRUNK ARTERIES INFLUENCED OF ATORVASTATIN THERAPY IN PATIENTS OF HIGH RISK

2018 ◽  
Vol 3 (3) ◽  
pp. 35-38
Author(s):  
OA A Rubanenko
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
Morphological Changes ◽  
High Risk Patients ◽  
Risk Of Death ◽  
Brachiocephalic Trunk ◽  
Atorvastatin Therapy ◽  
Risk Patients

Aim - to assess the morphological changes in the extracranial arteries of the brachiocephalic trunk in high-risk patients during atorvastatin therapy. Materials and methods. The study included 78 patients with a high risk of death from cardiovascular disease (mean age 54.8 ± 4.4 years), according to SCORE > 5% and

scholarly journals The prediction and assessment of cardiovascular and renal disease in type 2 diabetes. A current review

2013 ◽  
Vol 20 (4) ◽  
pp. 427-434
Author(s):  
Loredana Mădălina Popa ◽  
Amorin Remus Popa ◽  
Gabriela Florina Dale ◽  
Mircea Ioachim Popescu
Keyword(s):  
Type 2 Diabetes ◽  
High Risk ◽  
Risk Stratification ◽  
Prediction Models ◽  
Cost Effective ◽  
Risk Scores ◽  
Risk Patients ◽  
Novel Biomarkers ◽  
Current Guidelines

Abstract According to the current guidelines all type 2 diabetes (T2DM) subjects are at high cardiovascular (CV) risk. Scientists are researching the issue of further risk stratification among already high-risk patients, improved cost-effective risk stratification tools being under development. The assessment of the CV risk with the help of prediction models developed for the general population is considered to be not accurately enough for high risk individuals, therefore the current interest for identifying novel biomarkers and the development of specifically designed risk-scores for individuals with diabetes.

Identification of a spliceosome-associated fingerprint with potential to predict development of type 2 diabetes in high-risk patients

2016 ◽  
Author(s):  
Raul M. Luque ◽  
Manuel D. Gahete ◽  
Mercedes del Rio-Moreno ◽  
Sergio Pedraza-Arevalo ◽  
Antonio Camargo ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
High Risk ◽  
High Risk Patients ◽  
Risk Patients

TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy Versus Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing Percutaneous Coronary Intervention

2020 ◽  
Vol 14 ◽  
Author(s):  
Johny Nicolas ◽  
Usman Baber ◽  
Roxana Mehran
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Bleeding Events ◽  
High Risk Patients ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Risk Patients

A P2Y12 inhibitor-based monotherapy after a short period of dual antiplatelet therapy is emerging as a plausible strategy to decrease bleeding events in high-risk patients receiving dual antiplatelet therapy after percutaneous coronary intervention. Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention (TWILIGHT), a randomized double-blind trial, tested this approach by dropping aspirin at 3 months and continuing with ticagrelor monotherapy for an additional 12 months. The study enrolled 9,006 patients, of whom 7,119 who tolerated 3 months of dual antiplatelet therapy were randomized after 3 months into two arms: ticagrelor plus placebo and ticagrelor plus aspirin. The primary endpoint of interest, Bleeding Academic Research Consortium type 2, 3, or 5 bleeding, occurred less frequently in the experimental arm (HR 0.56; 95% CI [0.45–0.68]; p<0.001), whereas the secondary endpoint of ischemic events was similar between the two arms (HR 0.99; 95% CI [0.78–1.25]). Transition from dual antiplatelet therapy consisting of ticagrelor plus aspirin to ticagrelor-based monotherapy in high-risk patients at 3 months after percutaneous coronary intervention resulted in a lower risk of bleeding events without an increase in risk of death, MI, or stroke.

2-OR: Impact of N Terminal Pro B-Type Natriuretic Peptide and High Sensitivity Cardiac Troponin on the Prediction of Death and Cardiovascular Events in High-Risk Patients with Type 2 Diabetes

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 2-OR
Author(s):  
MARCUS V.B. MALACHIAS ◽  
PARDEEP JHUND ◽  
BRIAN CLAGGETT ◽  
MAGNUS O. WIJKMAN ◽  
RHONDA BENTLEY-LEWIS ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
High Risk ◽  
Natriuretic Peptide ◽  
Cardiac Troponin ◽  
Cardiovascular Events ◽  
High Sensitivity ◽  
High Risk Patients ◽  
Risk Patients
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