Effects of Physical Activity and Exercise Training on Cardiovascular Risk in Coronary Artery Disease Patients With and Without Type 2 Diabetes

Background: Adipose tissue produces pro-inflammatory mediators involved in the atherosclerotic process. We investigated whether 12-month exercise training in patients with type 2 diabetes mellitus and coronary artery disease would reduce circulating levels and genetic expression of mediators in the interleukin-18, Caspase-1 and NLR pyrin domain containing 3 pathways. Correlations to glucometabolic variables; fasting glucose, HbA1c, duration of diabetes, insulin, C-peptide, insulin resistance (measured by homeostatic model assessment indexes – insulin resistance) and body mass index at baseline were further assessed. Methods: 137 patients (aged 41–81 years, 17.2% female participants) were included and randomized to a 12-month exercise programme or to a control group. Fasting blood and adipose tissue samples were taken at inclusion and after 12 months. Results: No statistically significant difference in changes of any variable between the intervention and the control group was found. At baseline, a positive correlation between insulin and homeostatic model assessment indexes – insulin resistance, interleukin-18 expression in adipose tissue and an inverse correlation between some glucometabolic variables and leukocyte expression of NLR pyrin domain containing 3 and Caspase-1 were observed. Conclusion: No significant effects of long-term exercise training were observed on the inflammasome-related mediators in our patients with combined coronary artery disease and type 2 diabetes mellitus. The observed correlations may indicate a pro-inflammatory state in adipose tissue by overweight and a compensatory downregulation of these mediators in circulating leucocytes.

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Elevated levels of circulating microvesicles in coronary artery disease patients with type 2 diabetes and albuminuria: Effects of exercise training

Diabetes and Vascular Disease Research ◽

10.1177/1479164119843094 ◽

2019 ◽

Vol 16 (5) ◽

pp. 431-439 ◽

Cited By ~ 3

Author(s):

Vibeke Bratseth ◽

Gemma Chiva-Blanch ◽

Rune Byrkjeland ◽

Svein Solheim ◽

Harald Arnesen ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Coronary Artery Disease ◽

Type 2 Diabetes Mellitus ◽

Coronary Artery ◽

Exercise Training ◽

Characteristic Curve ◽

Vascular Complications ◽

Artery Disease

Objective:Circulating microvesicles, released from activated/apoptotic cells, are involved in vascular complications and may be looked upon as biomarkers. Albuminuria is characteristic of disease progression in type 2 diabetes mellitus. We aimed to investigate quantitative and qualitative differences of circulating microvesicles in type 2 diabetes mellitus with and without albuminuria and whether 12-month exercise training influenced expression of circulating microvesicles.Methods:Coronary artery disease patients with type 2 diabetes mellitus (n = 75), of which 25 had albuminuria, were included. Annexin V+(AV+) circulating microvesicles were analysed by flow cytometry in citrated plasma. The exercise volume was 150 min per week.Results:In albuminuria patients, circulating microvesicles from endothelial-(CD146+/CD62E+/AV+) and endothelial-progenitor-(CD309+/CD34+/AV+) cells were significantly higher compared to those without ( p ⩽ 0.01, both). Receiver operating characteristic curve analysis of the endothelial circulating microvesicles shows an area under the curve of 0.704 (95% confidence interval: 0.57–0.84; p = 0.004). Albuminuria patients had more circulating microvesicles derived from activated leukocytes and monocytes and monocytes carrying tissue factor (CD11b+/AV+, CD11b+/CD14+/AV+, CD142+/CD14+/AV+, respectively, p ⩽ 0.05, all) and higher number of circulating microvesicles from activated platelets (CD62P+/AV+). Within exercising patients, circulating microvesicles from progenitor cells increased ( p = 0.023), however, not significantly different from controls.Conclusion:Coronary artery disease patients with type 2 diabetes mellitus and albuminuria had elevated number of circulating microvesicles from activated blood and vascular cells, rendering them as potential predictors of disease severity. The circulating microvesicles were limitedly affected by long-term exercise training in our population.

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The concurrence of Microalbuminuria and Retinopathy with Cardiovascular Risk Factors; reliable predictors of Asymptomatic Coronary Artery Disease in Type 2 Diabetes

HORMONES ◽

10.14310/horm.2002.11127 ◽

2004 ◽

Vol 3 (3) ◽

pp. 198-203 ◽

Cited By ~ 6

Author(s):

George Ioannidis ◽

Melpomeni Peppa ◽

Phivi Rontogianni ◽

Michael Callifronas ◽

Christos Papadimitriou ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Coronary Artery Disease ◽

Cardiovascular Risk ◽

Coronary Artery ◽

Cardiovascular Risk Factors ◽

Artery Disease ◽

Asymptomatic Coronary Artery Disease

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Effects Of Exercise Training In Patients With Type 2-diabetes And Coronary Artery Disease

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000493684.39276.a4 ◽

2014 ◽

Vol 46 ◽

pp. 169

Author(s):

Rune Byrkjeland ◽

Ida U. Njerve ◽

Harald Arnesen ◽

Sigmund Anderssen ◽

Ingebjørg Seljeflot ◽

...

Keyword(s):

Type 2 Diabetes ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Exercise Training ◽

Artery Disease

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Effects of exercise training on HbA1c and VO2peak in patients with type 2 diabetes and coronary artery disease: A randomised clinical trial

Diabetes and Vascular Disease Research ◽

10.1177/1479164115590552 ◽

2015 ◽

Vol 12 (5) ◽

pp. 325-333 ◽

Cited By ~ 23

Author(s):

Rune Byrkjeland ◽

Ida U Njerve ◽

Sigmund Anderssen ◽

Harald Arnesen ◽

Ingebjørg Seljeflot ◽

...

Keyword(s):

Type 2 Diabetes ◽

Coronary Artery Disease ◽

Clinical Trial ◽

Coronary Artery ◽

Exercise Training ◽

Randomised Clinical Trial ◽

Artery Disease

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Type 2 diabetes and the risk of cardiovascular events in peripheral artery disease versus coronary artery disease

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2021-002407 ◽

2021 ◽

Vol 9 (2) ◽

pp. e002407

Author(s):

Lukas Sprenger ◽

Arthur Mader ◽

Barbara Larcher ◽

Maximilian Mächler ◽

Alexander Vonbank ◽

...

Keyword(s):

Type 2 Diabetes ◽

Coronary Artery Disease ◽

Cardiovascular Risk ◽

Coronary Artery ◽

Peripheral Artery Disease ◽

Cardiovascular Events ◽

Peripheral Artery ◽

Artery Disease ◽

Mutually Independent

IntroductionThe prevalence of type 2 diabetes mellitus (T2DM) is higher in peripheral artery disease (PAD) than in coronary artery disease (CAD) patients, and PAD overall confers higher cardiovascular risk than CAD. How cardiovascular risk compares between PAD and CAD patients when analyses are stratified by the presence of type 2 diabetes is unclear and is addressed in the present study.Research design and methodsWe prospectively recorded major cardiovascular events (MACE; ie, cardiovascular death, myocardial infarction or stroke) over 10.0±4.7 years in 923 patients with stable CAD, of whom 26.7% had T2DM and in 292 patients with PAD, of whom 42.1% had T2DM. Four groups were analyzed: CAD patients without diabetes (CAD/T2DM−; n=677), CAD patients with T2DM (CAD/T2DM+; n=246), PAD patients without diabetes (PAD/T2DM−; n=169) and PAD patients with T2DM (PAD/T2DM+; n=123).ResultsThe event rate for MACE increased over our four investigated groups: it was lowest in CAD/T2DM− patients (2.52 events per 100 person-years). It was significantly higher in CAD/T2DM+ patients (3.96 events per 100 person-years; p<0.001), in PAD/T2DM− patients (3.68 events per 100 person-years; p=0.022), and in PAD/T2DM+ patients (7.10 events per 100 person-years; p<0.001), who in turn were at a higher risk than CAD/T2DM+ or PAD/T2DM− patients (p=0.001 and p<0.001, respectively). Cox regression analysis after multivariate adjustment showed that the presence of T2DM (HR=1.44 (95% CI 1.09 to 1.92); p=0.012) and the presence of PAD versus CAD (HR=1.48 (95% CI 1.15 to 1.91); p=0.002) were mutually independent predictors of cardiovascular events.ConclusionsIn conclusion, our data show that T2DM as well as the presence of PAD versus CAD are mutually independent predictors of MACE. Patients with both PAD and T2DM are at an exceedingly high risk of cardiovascular events.

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Gut related inflammation and cardiorespiratory fitness in patients with CAD and type 2 diabetes: a sub-study of a randomized controlled trial on exercise training

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-021-00655-2 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Susanne Kristine Aune ◽

Rune Byrkjeland ◽

Svein Solheim ◽

Harald Arnesen ◽

Marius Trøseid ◽

...

Keyword(s):

Type 2 Diabetes ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Exercise Training ◽

Cardiorespiratory Fitness ◽

Binding Protein ◽

Gut Leakage ◽

Artery Disease

Abstract Aim Gut leakage has been shown to associate with low-grade inflammation and lower cardiorespiratory fitness in diabetic subjects. We aimed to investigate whether gut leakage markers related to cardiorespiratory fitness in patients with both coronary artery disease and type 2 diabetes, and whether these were affected by long-term exercise training. Methods Patients with angiographically verified coronary artery disease and type 2 diabetes mellitus (n = 137) were randomized to either 12 months exercise intervention or conventional follow-up. A cardiopulmonary exercise test and fasting blood samples were obtained before and after intervention to assess VO2peak and the biomarkers soluble CD14, lipopolysaccharide-binding protein and intestinal fatty-acid binding protein as markers of gut leakage. Results 114 patients completed the intervention satisfactory. VO2peak correlated inversely to sCD14 (r = − 0.248, p = 0.004) at baseline. Dividing sCD14 into quartiles (Q), VO2peak was significantly higher in Q1 vs. Q2–4 (p = 0.001), and patients in Q2-4 (sCD14 > 1300 ng/mL) had an OR of 2.9 (95% CI 1.2–7.0) of having VO2peak below median (< 23.8 ml/kg/min) at baseline. There were no statistically significant differences in changes in gut leakage markers between the two randomized groups (all p > 0.05) after 12 months. Conclusions Cardiorespiratory fitness related inversely to sCD14, suggesting physical capacity to be associated with gut leakage in patients with CAD and T2DM. Long-term exercise training did not affect circulating gut leakage markers in our population. Trial registration NCT01232608, Registered 02 November 2010—Retrospectively registered at https://clinicaltrials.gov/ct2/show/NCT01232608?term=NCT01232608&draw=2&rank=1

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Cost-effectiveness of screening of coronary artery disease in patients with type 2 DIABetes at a very high cardiovascular risk (SCADIAB study) rational and design

Cardiovascular Diabetology ◽

10.1186/s12933-021-01253-2 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Kamel Mohammedi ◽

Nathalie Préaubert ◽

Tanguy Cariou ◽

Vincent Rigalleau ◽

Ninon Foussard ◽

...

Keyword(s):

Type 2 Diabetes ◽

Coronary Artery Disease ◽

Cardiovascular Risk ◽

Coronary Artery ◽

Lower Limb ◽

High Cardiovascular Risk ◽

Coronary Syndrome ◽

Artery Disease ◽

Very High

Abstract Background Screening for coronary artery disease (CAD) remains broadly performed in patients with type 2 diabetes (T2DM), although the lack of evidence. We conduct a real-world evidence (RWE) study to assess the risk of major clinical outcomes and economic impact of routine CAD screening in T2DM individuals at a very high cardiovascular risk. Methods SCADIAB is a comparative nationwide cohort study using data from the French National Health Data System. The main inclusion criteria are: age ≥ 40 years, DT2 diagnosed for ≥ 7 years, with ≥ 2 additional cardiovascular risk factors plus a history of microvascular or macrovascular disease, except CAD. We estimated ≥ 90,000 eligible participants for our study. Data will be extracted from 01/01/2008 to 31/12/2019. Eligible participants will be identified during a first 7-year selection period (2008–2015). Each participant will be assigned either in experimental (CAD screening procedure during the selection period) or control group (no CAD screening) on 01/01/2015, and followed for 5 years. The primary endpoint is the incremental cost per life year saved over 5 years in CAD screening group versus no CAD screening. The main secondary endpoints are: total 5-year direct costs of each strategy; incidence of major cardiovascular (acute coronary syndrome, hospitalization for heart failure, coronary revascularization or all-cause death), cerebrovascular (hospitalization for transient ischemic attack, stroke, or carotid revascularization) and lower-limb events (peripheral artery disease, ischemic diabetic foot, lower-limb revascularization or amputation); and the budget impact for the French Insurance system to promote the cost-effective strategy. Analyses will be adjusted for a high-dimension propensity score taking into account known and unknown confounders. SCADIAB has been funded by the French Ministry of Health and the protocol has been approved by the French ethic authorities. Data management and analyses will start in the second half of 2021. Discussion SCADIAB is a large and contemporary RWE study that will assess the economic and clinical impacts of routine CAD screening in T2DM people at a very high cardiovascular risk. It will also evaluate the clinical practice regarding CAD screening and help to make future recommendations and optimize the use of health care resources. Trial registration ClinicalTrials.gov Identifier: NCT04534530 (https://clinicaltrials.gov/ct2/show/NCT04534530)

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