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

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 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.

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 Diabetes mellitus, platelet function and acetylsalicylic acid

2021 ◽  
Vol 17 (3) ◽  
pp. 250-257
Author(s):  
G.F. Gendeleka ◽  
A.N. Gendeleka
Keyword(s):  
Diabetes Mellitus ◽  
Primary Prevention ◽  
Acetylsalicylic Acid ◽  
Platelet Function ◽  
Cardiovascular Events ◽  
Coronary Calcification ◽  
Aspirin Resistance ◽  
Diabetic Patients ◽  
Low Grade ◽  
Level Of Evidence

Diabetes mellitus is an independent risk factor for cardiovascular disease (CVD). Accelerated development of atherosclerosis in patients with diabetes is a consequence of endothelial dysfunction, low-grade inflammation, oxidative stress, dyslipidemia, and platelet dysfunction. The results of studies have shown that among diabetic patients there is a high percentage of no effect when using both acetylsalicylic acid (ASA) and clopidogrel. It is necessary to distinguish between patients with a weak response and people with no effect — resistant to aspirin. The frequency of the so-called aspirin resistance, according to modern research, is different and depends on the methods used to study platelet function. In diabetic patients, it ranges from 5 to 45 % when taking ASA and from 4 to 30 % when taking clopidogrel. Recent studies show an even higher proportion of such individuals among people with diabetes. The appropriateness of lifelong ASA for secondary prevention in people diagnosed with CVD is indisputable (level of evidence A). At the same time, approaches to primary prevention vary in different countries. It is emphasized that the primary prevention with ASA in modern conditions maintains a favorable balance of benefits/risks. The new guidelines state that the calculated 10-year risk of cardiovascular events should not be considered when deciding whether to prescribe ASA to patients without CVD. Instead, all risk factors present in each patient should be considered, including burdensome family history, inability to achieve lipid and glycemic levels, and coronary calcification. The conclusion that ASA has evidence-based efficacy in secondary prophylaxis in patients with CVD has been confirmed. Regarding the primary prevention of cardiovascular events, including healthy individuals, the appropriateness, duration of administration, and choice of ASA should be determined taking into account the 10-year development of serious events, the presence of comorbidities, and the risk of bleeding.

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