Low-grade inflammation as a risk factor for cardiovascular events and all-cause mortality in patients with type 2 diabetes

Background Type 2 diabetes is a condition associated with a state of low-grade inflammation caused by adipose tissue dysfunction and insulin resistance. High sensitive-CRP (hs-CRP) is a marker for systemic low-grade inflammation and higher plasma levels have been associated with cardiovascular events in various populations. The aim of the current study is to evaluate the relation between hs-CRP and incident cardiovascular events and all-cause mortality in high-risk type 2 diabetes patients. Methods Prospective cohort study of 1679 type 2 diabetes patients included in the Second Manifestations of ARTerial disease (SMART). Cox proportional hazard models were used to evaluate the risk of hs-CRP on cardiovascular events (composite of myocardial infarction, stroke and vascular mortality) and all-cause mortality. Hs-CRP was log-transformed for continuous analyses. Findings were adjusted for age, sex, BMI, current smoking and alcohol use, non-HDL-cholesterol and micro-albuminuria. Results 307 new cardiovascular events and 343 deaths occurred during a median follow-up of 7.8 years (IQR 4.2–11.1). A one unit increase in log(hs-CRP) was related to an increased vascular- and all-cause mortality risk (HR 1.21, 95% CI 1.01–1.46 and HR 1.26, 95% CI 1.10–1.45 respectively). No relation was found between log(hs-CRP) and myocardial infarction or stroke. The relations were similar in patients with and without previous vascular disease. Conclusion Low grade inflammation, as measured by hs-CRP, is an independent risk factor for vascular- and all-cause mortality but not for cardiovascular events in high-risk type 2 diabetes patients. Chronic low-grade inflammation may be a treatment target to lower residual cardiovascular risk in type 2 diabetes patients.

Effect On Cardiac Function Among Patients With Type 2 Diabetes Following High-Dose Mineralocorticoid Receptor Antagonist Using Echocardiography; Data From The MIRAD Randomized Clinical Trial

Background: Early heart failure (HF)-prevention is central in patients with type 2 diabetes, and mineralocorticoid receptor antagonists (MRAs) have shown to improve prognosis. We investigated the effect of high-dose MRA, eplerenone, on cardiac function and structure in patients with type 2 diabetes and established or increased risk of cardiovascular disease but without HF. Methods: In the current randomized, placebo-controlled clinical trial, 140 patients with high-risk type 2 diabetes were randomized to high-dose eplerenone (100-200 mg daily) or placebo as add-on to standard care for 26 weeks. Left ventricular (LV) systolic and diastolic function, indexed LV mass (LVMi), and global longitudinal strain (GLS) were assessed using echocardiography at baseline and after 26 weeks of treatment. Results: Of the included patients, 138 (99%) had an echocardiography performed at least once. Baseline early diastolic in-flow velocity (E-wave) indexed by mitral annulus velocity (e’) was mean (SD) 11.1 (0.5), with 31% of patients reaching above 12. No effect of treatment on diastolic function was observed measured by E/e’ (0.0, 95%CI [-1.2 to 1.2], P=0.992) or E/A (-0.1, 95%CI [-0.2 to 0.0], P=0.191). Mean LV ejection fraction (LVEF) at baseline was 59.0% (8.0). No improvement in systolic function was observed when comparing groups after 26 weeks (LVEF: 0.9, 95%CI [-1.1 to 2.8], P=0.382; GLS: -0.4%, 95%CI [-1.5 to 0.6], P=0.422), nor in LVMi (-3.8 g/m2 95%CI [-10.2 to 2.7], P=0.246). Conclusion: In the present echo sub-study, no change in cardiac function was observed following high-dose MRA therapy in patients with high-risk type 2 diabetes.Trial registration: Date of registration 25/08/2015 (EudraCT number: 2015-002519-14)

Targeting Alcohol Septal Ablation in Patients with Obstructive Hypertrophic Cardiomyopathy Candidates for Surgical Myectomy: Added Value of Three-Dimensional Intracoronary Myocardial Contrast Echocardiography

Background: Myocardial contrast two-dimensional echocardiography (MC-2DE) is widely used to address alcohol septal ablation (ASA) in obstructive hypertrophic cardiomyopathy (HCM). Owing to its limited cut-planes, MC-2DE may inaccurately identify the contrast misplacement associated with an unsuccessful or complicated ASA outcome. Objective: The aim of this study was to assess the added value of myocardial contrast three-dimensional echocardiography (MC-3DE) compared with MC-2DE to identify the appropriate matching between the target septal zone (TSZ) and coronary artery branch for safe and long-term effective ASA in HCM patients. Methods: A consecutive series of 52 symptomatic obstructive HCM patients referred for isolated surgical myectomy (SM) was analyzed with MC-2DE and MC-3DE following injection of echocontrast into one or more septal branches. MC-2DE and MC-3DE patterns were categorized according to complete (Type 1) or incomplete (Type 2) TSZ covering, high-risk (Type 3) exceeding TSZ, or life-threatening outside TSZ distribution (Type 4). Results: MC-2DE per patient analysis showed a Type 1 pattern in 32 patients and Types 2–4 in the remaining 20 patients; subsequent MC-3DE analysis provided a re-phenotyping of MC-2DE findings in 22 of the 52 patients (42%), showing a high-risk Type 2 pattern in 17 of the 32 patients with Type 1, and a new life-threatening Type 4 in three patients with Type 2, respectively. All patients with MC-3DE Type 1 pattern underwent safe and effective ASA with a long-term uneventful follow-up, while the remaining patients underwent SM. Conclusions: Refining high risk or life-threatening contrast misplacement, MC-3DE is more accurate than conventional MC-2DE to target safe and long-term effective septal reduction with ASA in obstructive HCM patients referred for isolated SM.

HPV infection and high - risk behaviours among men who have sex with men in the two biggest cities of Vietnam

The objective of a cross sectional study is to describe the situation of human papillomavirus (HPV) infection and risk behaviours among 800 men who have sex with men (MSM) in Hanoi and Ho Chi Minh City (HCMC) from December 2017 to May 2018 using respondent - driven sampling method (RDS). The results showed that the prevalence of any type of HPV infection was 29.8% (33% in HCMC, 26.5% in Hanoi) and the prevalence of any high - risk type of HPV infection was 24.0% (29.0% in HCMC, 19.0% in Hanoi). The risk behaviours to HPV among MSM in both cities included: Alcohol use (69.9%), smoking (30.7%), drug use (8.5%), having frst sexual intercourse under 18 years old (31.8%), having group sex (10.5%), having sex with both men and women (21.7%). The factors which had statistically signifcant differences with HPV status in MSM group included: City, age group, and marital status. These results showed that there is a need for medical interventions for MSM to improve individual health as well as to minimize the transmission of HPV in this population.

Effect of Various Types of Intermittent Fasting (IF) on Weight Loss and Improvement of Diabetic Parameters in Human

Purpose of Review A number of recent studies have suggested that intermittent fasting is as effective as traditional calorie restriction (CR) for weight loss and for cardioprotection. However, it is still unclear whether IF improves diabetes risk indicators as does CR. This review provides an overview of various patterns of intermittent fasting and shows the effect of intermittent fasting on human anthropometric such as excess body weight and biochemical parameters for example high glucose and fasting insulin, which are risk factors for diabetes. Recent Findings There is a growing body of evidence pointing to the benefits of intermittent fasting for glucose and insulin homeostasis, but this should be confirmed by further studies in population groups with (or at high risk) type II diabetes and insulin resistance. Long-term studies are also needed that could reveal potential negative health effects that some studies report. Summary Eleven studies in overweight/obese adult people that included changes in weight, body composition, and diabetic parameters (fasting glucose, fasting insulin, HbA1c concentration, and HOMA-IR index) were published between 2012 and 2020. Seven studies concerning the effects of alternate day fasting (ADF) on weight loss and diabetic parameters were analyzed. All of them have shown the effects of ADF on weight loss and slight improvement in diabetic parameters. For time-restricted feeding (TRF), a significant improvement in the HOMA-IR index was observed in 2 studies. One study saw an increase in fasting glucose. An analysis of 2 studies using a complete alternate day fasting (CADF) was performed. One study showed decrease in fasting glucose and insulin, and in one a decrease in glycosylated hemoglobin (HbA1c) was observed. Conclusion Different types of intermittent fasting reduce body weight and reduce diabetes parameters such as fasting glucose, fasting insulin, HOMA-IR index, and glycated hemoglobin (HbA1c).