Lean versus obese diabetes mellitus patients in the United States minority population

ObjectiveTo identify special characteristics in large group of lean diabetes minority patients in comparison to obese type 2 diabetes.Methods1784 lean (BMI < 25) diabetes patients were identified and compared with 8630 obese (BMI ≥ 30) patients. Patients with Type 1 Diabetes (N = 523) were excluded. Patient data, including demographics, psychosocial factors, insulin use, and complications was analyzed.ResultsIn lean compared to obese, there was male predominance (62% vs 48%, p < 0.001), higher prevalence of insulin use (49% vs 44%, p = 0.001), lower TG/HDL (2.28 vs 3.4, p < 0.001), and higher prevalence of alcoholism (5.7% vs 2.4%, p < 0.001) and pancreatitis (3.6% vs 0.9%, p < 0.001). In both groups, African Americans and Latinos were the prevalent ethnicities (38%, 34% vs. 53%,31%).When comparing patients within the lean group who were on insulin (49%) to those on oral medications, there were more males (65% vs. 59%, p < 0.001), earlier age of onset (40 ± 14 vs. 47 ± 12, p < 0.001), lower BMI (22.1 ± 2 vs.22.6 ± 1.7, p < 0.001) and lower TG/HDL (2.18 vs. 2.42, p = 0.021).ConclusionsA subset of diabetes patients in the United States minority population are lean and may have rapid beta cell failure. The etiology is not clear and acquired factors, genetics, and autoimmunity may be contributory.     

Social determinants status and hypertension: A Nationwide Cross‐sectional Study in China

To explore the association between unbalanced social determinants status and hypertension (HTN) in China, we conducted a cross‐sectional survey in a sample of 299 220 Chinese in 2012 to 2015. Social determinants status were measured with: (a) district‐level:Per capita GDP (Per_GDP), the number of hospital beds per 1000 residents (Per 1000_bed) and tertiary industry added value (TIAV); (b) individual‐level: education and employment conditions. Compared with the poorest level of Per_GDP, the middle and richest group had higher risk of HTN [OR, 95%CI: 1.12 (1.09‐1.14) and 0.99 (0.96‐1.02)] and higher possibility of HTN awareness, treatment, and control. Higher risk of HTN and lower possibility of awareness, treatment, and control were associated with elevated Per 1000_bed in rural area. Higher possibility of HTN control was associated with the higher TIAV (P _trend < .001). Those with middle (OR, 95%CI: 0.86, 0.84‐0.88) and senior (OR, 95%CI: 0.72, 0.69‐0.76) education had a decreased risk of HTN and higher HTN control possibility compared to primary. And participants in retirement/unemployment conditions had a higher risk of HTN and higher possibility of HTN awareness, treatment, and control compared with the job‐holders. This study provides evidence from China that social determinants status has a detectable association with HTN. People with a higher economic area living, lower level of education, or retirement/ unemployment conditions has a higher risk of HTN, especially for male or rural residents. And lower possibility of HTN awareness, treatment, and control were associated with worse economic development and social circumstances environment, lower education level, and employment/student conditions.     

The lowest VE/VCO2 ratio best identifies chronic thromboembolic pulmonary hypertension

Introduction

The natural history of acute pulmonary embolism (PE) under treatment is about a gradual resolution of the thrombi, and uncommonly, the development of chronic thromboembolic pulmonary hypertension (CTEPH). We hypothesized that ventilatory efficiency parameters during cardiopulmonary exercise testing (CPET) may be able to monitor the process and predict CTEPH.

Methods

15 patients rehabilitated from acute PE (total resolution of thrombi), 44 patients with chronic PE (with residual thrombi), 66 patients with CTEPH, and 36 sedentary healthy controls performed incremental CPET.

Results

The lowest VE/VCO₂ was higher in CTEPH patients than that in chronic PE and rehabilitated patients (43.4 L/min vs 29.9 L/min vs 27.1 L/min, p < 0.005). The VE/VCO₂ slope (48.4 L/min/L/min vs 29.9 L/min/L/min vs 28.0 L/min/L/min, p < 0.005) and oxygen uptake efficiency plateau (OUEP) (37.1 L/min vs 27.0 L/min vs 25.2 L/min, p < 0.005) had the similar changes. In logistic regression analysis, the lowest VE/VCO₂ ≥ 34.35 L/min was the best predictor of CTEPH (OR 159.0, 95% CI 36.0-702.3, p < 0.001). The lowest VE/VCO₂ was higher in chronic PE patients compared with the controls (29.9 L/min vs 26.5 L/min, p < 0.05), but there was no difference between the rehabilitated patients and the controls. In multiple linear regression analysis, the percentage of vascular obstruction by ventilation-perfusion lung scanning (PVO) was the most significant independent predictor for indices of ventilatory efficiency in chronic PE and rehabilitated patients.

Conclusions

CTEPH is associated with weakened ventilatory efficiency. The lowest VE/VCO2 ratio has the best capability to predict CTEPH. Ventilatory inefficiency improves along with recovery of acute PE.     

Smoking status on outcomes after percutaneous coronary intervention

Background:

The effect of smoking on prognosis among patients undergoing percutaneous coronary intervention (PCI) is controversial, and data on the importance of smoking cessation or reductions were lacking.

Hypothesis:

Smoking cessation or reductions could reduce the risk of adverse outcomes in patient after PCI.

Methods:

There were 19 506 consecutive patients who had undergone successful PCI between April 2004 and January 2010 followed. Extensive data, including self‐reported smoking habits, were obtained at baseline and during follow‐up.

Results:

Compared with post‐PCI quitters and persistent smokers, the nonsmokers and pre‐PCI quitters were older and had a higher prevalence of comorbid factors such as hypertension and impaired left ventricle function. The adjusted hazard ratios for mortality were 2.52 (95% confidence interval [CI]: 1.92–3.30) for nonsmokers, 0.52 (95% CI: 0.32–0.84) for pre‐PCI quitters, and 0.11 (95% CI: 0.06–0.22) for post‐PCI quitters, compared to persistent smokers. With respect to additional revascularizations, a higher risk was observed among the quitters (1.70 [95% CI: 1.40–2.08] for pre‐PCI quitters and 1.59 [95% CI: 1.36–1.85] for post‐PCI quitters) as well as the nonsmokers (1.40 [95% CI: 1.20–1.64]). Among persistent smokers, each reduction of 5 cigarettes/day was associated with a 72% decline in mortality risk (P < 0.001) but did not reach statistical significant for repeated revascularizations (0.80 [95% CI: 0.46–1.37], P = 0.4132).

Conclusions:

Despite a higher risk of revascularization, the cessation of smoking either before or after PCI is beneficial in all‐cause mortality. The apparent smoker's paradox may be explained by the differences in baseline risk or the reduced sensitivity to adverse outcomes as well as the reluctance to seek medical help among smokers. This study received an unrestricted grant from Pfizer Investment Co., China. The authors have no other funding, financial relationships, or conflicts of interest to disclose.