Prevalence of residual inflammatory risk and associated clinical variables in patients with type 2 diabetes

Residual inflammatory risk (RIR) is defined as persistent circulating levels of high sensitivity C-reactive protein (hs-CRP) >2 mg/L despite an optimal (<70 mg/dL) control of LDL-cholesterol (LDL-C) and represents an emerging risk factor for the development of cardiovascular events in patients at high risk of atherosclerosis. Sparse data are available regarding the prevalence of RIR in patients with type 2 diabetes (T2D) and the clinical variables associated with hs-CRP elevation. Here, we report data from a well-characterized cohort of patients with T2D (n = 511) stratified for statins use, LDL-C goal attainment and prevalent T2D complications. Statins use and having at-target LDL-C partially affect the number of patients with inflammatory risk when compared with the whole T2D population, with an RIR prevalence of 39.2%. Among the spectra of complications, only patients with nephropathy had a higher prevalence of inflammatory risk. Total cholesterol, non-HDL-cholesterol, triglycerides, body mass index and waist-hip ratio were associated with hs-CRP, with an increased magnitude in at-target patients. Conversely, glucose-related variables were strongly associated with hs-CRP only in at-target patients, overall suggesting glycaemic control, insulin resistance, non-LDL-C lipid variables and especially central obesity as possible contributors to RIR in patients with T2D and LDL-C <70 mg/dL.     

1677例老干部向心性肥胖和心血管病危险因素的关系

目的　调查分析军队退休老干部群体向心性肥胖及其与心血管病危险因素的关系。方法　根据计划方案对成都地区 6 0岁以上军队退休老干部进行病史询问和体格检查 ,获得完整资料 16 77份。对腰围和体重指数 (BMI)、高血压、糖尿病、高胆固醇血症、高甘油三酯血症等心血管病危险因素进行分析。结果　BMI在男性和女性分别为2 4 .4 2± 3.0 4和 2 3.97± 3.12 (P >0 .0 5 )。腰围在男性和女性分别为 (83.79± 8.34)cm和 (78.4 3± 7.89)cm(P <0 .0 0 1) ,并呈现随年龄增长而增大的趋势。腰围过大者占总体的 4 7.88% ;腰围与BMI正相关 ,但 2 9.5 2 %的腰围过大者其BMI<2 5 ;对腰围进行分层处理后 ,可见除高胆固醇以外 ,各危险因素及危险因素聚集 (具有 2个及以上危险因素 )的检出率随腰围的增大而逐渐上升 ,呈密切的正相关。结论　军队退休老干部反映向心性肥胖的指标———腰围与心血管病危险因素及其分布情况密切相关     

同型半胱氨酸与糖尿病及心脑血管疾病关系

流行病学资料表明,高同型半胱氨酸血症与糖尿病及心脑血管疾病关系密切;但大型临床试验却显示降低血同型半胱氨酸浓度的治疗对这些疾病无益。文章对已有的资料进行综述,探讨同型半胱氨酸与糖尿病及心脑血管疾病的关系,以期对临床及今后的研究提供线索。     

Visfatin in overweight/obesity, type 2 diabetes mellitus, insulin resistance, metabolic syndrome and cardiovascular diseases: a meta-analysis and systemic review

There are controversies regarding the association of visfatin with overweight/obesity, type 2 diabetes mellitus, insulin resistance (IR), metabolic syndrome and cardiovascular disease in published articles. A meta-analysis was performed to identify the significance of visfatin in these diseases. We searched for relevant articles in Pubmed, Scopus and SCIE. A total of 1035 articles were surveyed and 46 articles were identified, with 14 reports reporting more than one of our investigated diseases. A total of 13 (n = 644), 19 (n = 2405), 20 (n = 2249), 5 (n = 527) and 5 (n = 851) articles/(participants) were included in each meta-analysis regarding the association of visfatin and overweight/obesity, type 2 diabetes mellitus, insulin resistance, metabolic syndrome and cardiovascular diseases, respectively. Plasma visfatin concentrations were increased in participants diagnosed with overweight/obesity, type 2 diabetes mellitus, metabolic syndrome and cardiovascular diseases, with pooled log odds ratios of 1.164 [95% confidence interval (CI): 0.348 to 1.981, p = 0.005], 1.981 (95% CI: 1.377 to 2.584, p < 0.001), 1.094 (95% CI: 0.678 to 1.511, p < 0.001), and 2.902 (95% CI: 0.924 to 4.879, p < 0.005), respectively. The circulating visfatin level was positively associated with insulin resistance, with a Fisher's z of 0.089 (95% CI: 0.013 to 0.165, p = 0.022). No single study was found to affect the overall result of each analysis by sensitivity testing. No publication bias was found by the Egger test. Our study suggests that the use of visfatin may be promising for predicting obesity, diabetes status, insulin resistance, metabolic syndrome and cardiovascular disease.     

Improved cardiovascular health following a progressive walking and dietary intervention for type 2 diabetes

Aim: To examine the impact of two different lifestyle programmes on cardiovascular health and glycaemic control among people with type 2 diabetes.
Methods: A two-phase 24-week randomized trial. During the first phase, participants were to increase daily steps using a pedometer. At week 12, participants were randomly allocated to either an enhanced lifestyle programme (ELP) targeting walking speed or a basic lifestyle programme (BLP) targeting total daily steps. Both programmes focused on increasing the intake of low glycaemic index foods but utilized different goal setting strategies. Clinical measurements were completed at baseline, week 12 and week 24. Principal outcomes were change in resting pulse rate (PR) and glycated haemoglobin A1c (A1c) between week 12 and week 24 compared between groups using analysis of covariance.
Results: Forty-one participants [mean ± s.d. : age = 56.5 ± 7.2 years, body mass index (BMI) = 32.7 ± 6.1 kg/m²] were randomized. After 12 weeks, we observed an increase in average total daily steps of 1562 (95% confidence interval: 303–2821, p = 0.02). Weight, BMI and systolic and diastolic blood pressure improved (p < 0.01 for all). No changes were observed for energy intake. At week 24, those in the ELP had a lower resting PR (71 ± 12 b.p.m.) compared with those in the BLP (78 ± 12 b.p.m.) (adjusted p = 0.03), while no group differences for total daily steps or glycaemic control were observed.
Conclusions: Improvements in cardiovascular health can be expected following a pedometer-based lifestyle modification programme that progresses from walking more to walking faster.     

心血管高危患者踝臂指数与血尿酸水平的相关性分析

目的探讨心血管高危患者踝臂指数与血尿酸水平的相关性。方法选取高血压和(或)糖尿病患者363例,将单纯原发性高血压189例作为高血压组、原发性高血压合并2型糖尿病123例作为合并组和单纯2型糖尿病51例作为糖尿病组,均常规治疗,检测患者踝臂指数(ABI)、血尿酸和其他心血管疾病危险因素,并应用偏相关分析血尿酸、ABI与其他临床指标相关性。结果 3组收缩压、舒张压、TG、HDL-C、糖化血红蛋白(HbA1c)比较,差异有统计学意义(P<0.05)。高血压组和糖尿病组ABI高于合并组(1.12±0.09和1.11±0.07 vs 0.93±0.11,P=0.012)。校正高血压、糖尿病病史、年龄、性别、体质量指数、TG、TC、HDL-C、LDL-C、HbA1c、收缩压、舒张压等的影响因素后,ABI与血尿酸呈负相关(r=-0.235,P=0.012)。结论心血管高危患者的ABI与血尿酸可能存在相关性。     

The 30-year cardiovascular risk profile of South Africans with diagnosed diabetes, undiagnosed diabetes, pre-diabetes or normoglycaemia: the Bellville, South Africa pilot study

The aim of this pilot study was to assess the 30-year risk for cardiovascular disease (CVD) in the South Africa population of mixed-ancestry in individuals with non-diabetic hyperglycaemia, and undiagnosed and self-reported diabetes. Participants were drawn from an urban community of the Bellville South suburb of Cape Town. In total, 583 subjects without a history of CVD were eligible for lifetime CVD risk estimation. Gender-specific prediction for CVD risk was calculated using the 30-year CVD interactive risk calculator. High CVD risk (> 20%) was evident in normoglycaemic and younger subjects (under 35 years). The significant predictors of CVD were sibling history of diabetes, and triglyceride, low-density lipoprotein cholesterol and glycated haemoglobin levels (p < 0.001). The high lifetime risk in normoglycaemic and younger subjects may be considered a warning that CVD might take on epidemic proportions in the near future in this country. We recommend the inclusion of education on CVD in school and university curricula.     

Obesity and cardiovascular risk factors in type 2 diabetes: results from the Swedish National Diabetes Register

OBJECTIVES: To compare obese with normal and overweight type 2 diabetic patients regarding body mass index (BMI) and cardiovascular risk factors, and to analyse changes in weight versus risk factors. DESIGN AND SETTING: A cross-sectional study of 44 042 type 2 patients, and a 6-year prospective study of 4468 type 2 patients. RESULTS: Obese patients (BMI > or = 30 kg m(-2)), 37% of all patients, had high frequencies of hypertension (88%), hyperlipidaemia (81%) and microalbuminuria (29%). Only 11% had blood pressure <130/80 mmHg. Their ratio of triglycerides to HDL cholesterol was considerably elevated, whilst the mean total and LDL cholesterol were similar as in normal weight subjects. Obese patients had elevated odds ratios for hypertension, hyperlipidaemia and microalbuminuria: 2.1, 1.8 and 1.4 in the cross-sectional study, similarly confirmed in the prospective 6-year study. BMI was an independent predictor of these risk factors (P < 0.001), although only slightly associated with HbA1c and not with total or LDL cholesterol. A change in BMI during the prospective study was related to a change in HbA1c in patients treated with diet and oral hypoglycaemic agents (OHAs) but not with insulin. In all patients, an increase in BMI was related to the development of hypertension, and a change in BMI to change in blood pressure, also mostly confirmed when treated with diet, OHAs or insulin. CONCLUSIONS: The high frequencies of risk factors in obese type 2 patients implies an increased risk of cardiovascular disease and the need for therapeutic measures. The paradox that hypoglycaemic treatment accompanied by weight gain may increase cardiovascular risk factors seems to be verified here concerning hypertension but not concerning microalbuminuria.     

老年2型糖尿病患者合并心脑血管疾病的危险因素分析

目的　探讨老年 2型糖尿病 (diabetesmellitus ,DM)患者心脑血管病变的特点及相关危险因素。方法　通过回顾性分析方法 ,将 2 12例老年 2型DM患者分为心脑血管病变组 (病变组 )和无血管病变组 (无病变组 )各 10 6例。病变组含缺血性心脏病 (ischemicheartdisease ,IHD)患者组 72例和 (或 )脑血管病变 (cerebrovasculardisease,CVD)患者 5 0例。其中 ,两者并存者 16例。对两组间患者的临床数据进行比较及回归分析。结果　病变组的年龄、高血压患病比率、DM病程、尿微量白蛋白排泄率异常比无病变组明显增高 ;各亚组与无病变组的比较也有相似的趋势。回归分析显示 ,年龄、高血压是老年 2型DM患者总的心脑血管病变的独立危险因素 ,同时也分别是IHD和CVD的独立危险因素 ;另外 ,高甘油三酯血症与病变组和IHD分别独立相关 ;吸烟史是IHD的独立危险因素。结论　对于老年2型DM患者 ,除了年龄、高血压外 ,高甘油三酯血症是心脑血管病变的独立危险因子     

A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1‐year prospective randomized intervention study

Background: The appropriate dietary intervention for overweight persons with type 2 diabetes mellitus (DM2) is unclear. Trials comparing the effectiveness of diets are frequently limited by short follow‐up times and high dropout rates. Aim: The effects of a low carbohydrate Mediterranean (LCM), a traditional Mediterranean (TM), and the 2003 American Diabetic Association (ADA) diet were compared, on health parameters during a 12‐month period. Methods: In this 12‐month trial, 259 overweight diabetic patients (mean age 55 years, mean body mass index 31.4 kg/m²) were randomly assigned to one of the three diets. The primary end‐points were reduction of fasting plasma glucose, HbA1c and triglyceride (TG) levels. Results: 194 patients out of 259 (74.9%) completed follow‐up. After 12 months, the mean weight loss for all patients was 8.3 kg: 7.7 kg for ADA, 7.4 kg for TM and 10.1 kg for LCM diets. The reduction in HbA1c was significantly greater in the LCM diet than in the ADA diet (?2.0 and ?1.6%, respectively, p < 0.022). HDL cholesterol increased (0.1 mmol/l ± 0.02) only on the LCM (p < 0.002). The reduction in serum TG was greater in the LCM (?1.3 mmol/l) and TM (?1.5 mmol/l) than in the ADA (?0.7 mmol/l), p = 0.001. Conclusions: An intensive 12‐month dietary intervention in a community‐based setting was effective in improving most modifiable cardiovascular risk factors in all the dietary groups. Only the LCM improved HDL levels and was superior to both the ADA and TM in improving glycaemic control.     

Clustering of cardiovascular risk factors in type 2 diabetes mellitus: prognostic significance and tracking

Summary
Aim   Little attention has been paid to the prognostic significance and tracking effect of risk factor clusters characteristic of type 2 diabetes mellitus. We studied the clustering of eight cardiovascular risk factors (smoking, high body mass index, elevated systolic blood pressure, high serum, low density lipoprotein (LDL) cholesterol, high serum LDL triglycerides, low serum, high density lipoprotein (HDL) cholesterol, high fasting blood glucose and high plasma insulin concentration) and their effect on the prognosis and the tracking effect.
Methods   This study is a population-based prospective follow-up of newly diagnosed type 2 diabetic subjects (n = 133, aged 45–64 years) in Eastern Finland. The following end points were used: all-cause mortality, cardiovascular mortality, and incidences of first myocardial infarction and first stroke. Furthermore, we studied the 'tracking effect' of the risk factor clusters during the 10-year follow-up period.
Results   When the clustering of risk factors typical of type 2 diabetes mellitus was taken into account, all-cause mortality increased from 28.6% to 50.0% (p < 0.05) and cardiovascular disease mortality increased from 14.3% to 50.0% (p < 0.01) depending on the number of risk factors present. The incidence of first myocardial infarction increased from 0% to 40.0% (p < 0.05) as the number of risk factors increased from 0 to 5. In survivors, the proportion of individuals with no risk factors decreased and the proportion on individuals with three to four risk factors increased during the 10-year follow-up period despite the high mortality among the group with many risk factors.
Conclusions   The risk factor clusters among type 2 diabetic subjects are of great predictive value and when not aggressively treated, show a relentless increase despite selective mortality.     

Familial (shared environmental and genetic) factors and the foetal origins of cardiovascular diseases and type 2 diabetes: a review of the literature

Several researchers have argued that observed associations between birth weight and cardiovascular diseases, and type 2 diabetes, may be confounded by familial (shared environmental and genetic) factors. However, most studies have found that shared environmental factors, including socio-economic factors, do not influence the foetal origins of adult diseases. Results from two twin studies suggest that genetic factors may be of importance for the association between birth weight and risks of coronary heart disease, but findings from intergenerational studies are not consistent with genetic confounding. More studies have assessed the importance of genetic factors with respect to risk factors of coronary heart, including raised blood pressure and lipid levels. Recent findings suggest that the association between birth weight and hypertension is independent of genetic factors. In contrast, recent twin and intergenerational studies favour the hypothesis that the association between birth weight and risk of type 2 diabetes is confounded by genetic factors.     

2型糖尿病患者校正QT间期延长与多种心血管危险因素的相关性

目的分析QTc延长与多种心血管危险因素的关系。方法除外影响QTc因素的患者后,收集完成糖尿病并发症筛查和12导联心电图检查的数据。根据QTc正常与否（QTc〈0．44S为正常,QTc≥0．44s为延长）,将患者分为正常组和延长组。比较和分析两组患者的多种心血管危险因素。结果人选2型糖尿病患者3426例,其中37％的患者合并有QTc延长。与正常组相比,延长组患者年龄大、糖尿病病程长、女性比例高、腰围和腰臀比大、血压高、心率快,糖化血红蛋白（HbAlc）、餐后2小时血糖、空腹胰岛素、血胆固醇和甘油三酯以及尿白蛋白／肌酐比值高。Logistic回归分析显示,年龄、性别、体质量指数、腰围、腰臀比、心率和血肌酐与QTc延长明显相关。结论略多于1／3的2型糖尿病患者合并QTc延长,并有更多更严重的多种心血管疾病危险因素。     

单中心老年心血管病危险因素控制现状分析

目的了解老年患者心血管病危险因素控制现状。方法选择我院老年内科住院治疗的疑诊冠心病的老年患者256例,测定血糖、血脂水平,进行24h动态血压监测,根据相关指南推荐的血压、血糖及血脂达标值判断达标情况。根据冠状动脉造影结果将入选者分为冠心病组208例与非冠心病组48例,比较2组上述危险因素控制情况。结果 256例患者中,209例(81.6%)合并高血压,24h、昼间及夜间平均血压达标率分别为75.1%、82.8%和59.3%;99例(38.7%)合并糖尿病,血糖达标率70.7%;154例(60.2%)合并血脂异常,LDL-C达标率41.4%。冠心病组与非冠心病组血压、血糖达标率比较,差异无统计学意义(P>0.05),冠心病组LDL-C达标率低于非冠心病组,差异有统计学意义(38.5%vs 54.2%,P<0.05)。结论老年心血管病高危患者中,血压、血糖达标率高,LDL-C达标率较低,尤其心血管病极高危的冠心病患者LDL-C达标率更低,应重视老年患者心血管病风险评估,并进一步加强对血脂的干预力度。     

Smoking, diabetes and cardiovascular diseases in men in the Asia Pacific region

Background: To assess whether there is a statistical interaction between smoking and diabetes that is related to the risk of cardiovascular disease (CVD) in men in the Asia Pacific region. Methods: An individual participant data meta‐analysis was conducted on 34 cohort studies, involving 16 492 participants with diabetes (47.4% smokers) and 188 897 without (47.6% smokers). Hazard ratios (HR) and 95% confidence intervals (CI) were calculated for smoking (stratified by study and adjusted for age) for those with and without diabetes. Results: In men with diabetes, the HR (95% CI) comparing current smokers with non‐smokers was 1.42 (1.10–1.83) for coronary heart disease, 1.10 (0.88–1.37) for total stroke and 1.15 (0.98–1.35) for total CVD. The corresponding figures for men without diabetes were 1.47 (1.33–1.61), 1.27 (1.16–1.39) and 1.35 (1.27–1.44), respectively. There was no evidence of a statistical interaction between diabetes and current smoking, the number of cigarettes smoked per day or quitting smoking. Smoking cessation was associated with a 19% reduction in CVD risk, irrespective of diabetes status. Conclusions: The effects of cigarette smoking and smoking cessation are broadly similar in men with and without diabetes. In Asia, where there are high rates of smoking and a rapidly increasing prevalence of diabetes, strategies that encourage smokers to quit are likely to have huge benefits in terms of reducing the burden of CVD in men with diabetes.     

Levels of cardiovascular risk factors in type 2 diabetes mellitus are dependent on the stage of proteinuria.

Levels of cardiovascular risk factors were determined in 75 patients with Type 2 diabetes mellitus. The patients were divided into three groups according to their urinary protein excretion (UPE): (a) normal proteinuria (less than or equal to 70 mg d-1); (b) microproteinuria (70-500 mg d-1); and (c) macroproteinuria (greater than 500 mg d-1). A significant stepwise increase in mean systolic blood pressure, LDL-cholesterol and fibrinogen levels was observed from the first to the third investigated group of patients. Mean apoprotein B levels were significantly increased in the group with macroproteinuria compared to the other two groups. Significant linear correlations were found between UPE and LDL-cholesterol, total cholesterol, apoprotein B, creatinine, systolic blood pressure and diabetes duration. In summary, it is concluded that the levels of some cardiovascular risk factors increase with the stage of proteinuria in Type 2 diabetes mellitus.