Non-insulin-dependent diabetes mellitus and hyperlipoproteinemia in patients with ischemic cardiopathy

Cardiovascular disease (CVD) constitutes the main cause of death in diabetes mellitus (DM): Previous studies at the "Instituto Nacional de Cardiología de México" have investigated the metabolic alterations of survivors of a myocardial infarction (MI), but none of them had focused on the metabolic profile of the diabetic patient. We compared two groups of patients with ischemic heart disease (IHD), one with (DMG) and one without (NDMG) Diabetes Mellitus, to investigate differences in the prevalence and nature of hyperlipoproteinemias (HLP) and other risk factors of atherosclerosis. DMG consisted of 117 patients (75 male, 42 female) and NDMG consisted of 119 patients (91 male y 28 female). (Female NDMG vs female DMG p less than 0.05). The presence of risks factors of atherosclerosis was investigated in all patients, and total cholesterol (chol) triglycerides (TG) and glucose were measured in post-absorptive phase. There were no differences regarding mean age (DMG: 60 +/- 8 years, NDM: 60 +/- 11 years), Quetelet Index (Kg./mt2: DMG: 26.5 +/- 3, NDMG: 26.7 +/- 3), TG: (DMG: 246.2 +/- 125, NDMG: 223.5 +/- 129) or Chol (DMG: 216 +/- 42 mg/dl, NDMG: 225 +/- 45 mg/dl). Hypertriglyceridemia was significantly higher in patients with DM, as a whole and when both sexes were studied separately (p less than 0.05). Hypercholesterolemia was significantly higher in NDMG (p less than 0.05) and without significance, in diabetic women. (p less than 0.05). Type IV phenotype was higher in DMG (p less than 0.05) whereas phenotypes IIa and IIa + IIb were more prevalent among non-diabetics (p less than 0.001, p less than 0.0001, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)     

The impact of diabetes mellitus on cognitive decline in the oldest of the old: a prospective population-based study

Aims/hypothesis Diabetes mellitus is a risk factor for the development of cognitive impairment and dementia in the general population up to 75 years of age. As part of the Leiden 85-plus Study we studied the effects of diabetes on cognition in the oldest old.Subjects and methods The Leiden 85-plus Study is a prospective population-based study of 599 persons from age 85 onward. Cognitive function was assessed each year from ages 85 to 90 by means of four neuropsychological tests. The presence of diabetes and vascular disease was recorded at baseline, HbA_1c was assessed by means of a blood sample at ages 85 and 90. The cross-sectional and prospective associations between diabetes and cognitive function were analysed with linear mixed models, adjusted for sex and level of education.Results At age 85, diabetes was associated with a lower level of cognitive functioning on the Letter Digit Coding test and the Stroop Test. Diabetes was not associated with accelerated cognitive decline during follow-up. Within the group of diabetic patients, macrovascular disease was the most important determinant of cognitive dysfunction.Conclusions/interpretation The association between diabetes and accelerated cognitive decline, which has been documented previously in patients up to 75 years of age, may be less evident after age 85. This suggests that the damage occurs in previous years and that therapies aimed at preventing cognitive decline and dementia should focus on the younger old.     

Hand abnormalities are strongly associated with the duration of diabetes mellitus

Abstract. Objectives. To study the prevalence of hand abnormalities in diabetic patients and to evaluate associations between the hand abnormalities and diabetic variables, ergonomic factors and smoking habits. Design. Cross-sectional study of 100 patients selected at random. Setting. Out-patient clinic, Department of Internal Medicine, Örebro Medical Centre Hospital in Sweden. Main outcome measures. Presence and extent of carpal tunnel syndrome (CTS), Dupuytren's contracture (DC), flexor tenosynovitis (FTS), and limited joint mobility (LJM). Duration of diabetes, metabolic control, chronic diabetic complications, blood pressure, ergonomic factors and smoking habits. Results. Carpal tunnel syndrome, DC, FTS and LJM were each present in about 20% of the patients. Hand abnormalities were observed in 50 patients and more than one abnormality was found in 26 of the patients. The hand abnormalities were associated with the duration of diabetes but not with the metabolic control or with other diabetic complications. However, the diabetic complications were associated with bad metabolic control and with the duration of diabetes. Hand abnormalities correlated with heavy manual work but not with smoking habits. Twenty-five of the 50 patients with hand syndromes were disabled to such an extent that surgery was recommended. Conclusion. The prevalence of hand abnormalities in diabetic patients is high and increases with the duration of diabetes. In many cases patients with hand abnormalities can be helped by surgery.     

Dyslipidemia in type 2 diabetes mellitus

Cardiovascular disease is a significant cause of morbidity and mortality in patients with diabetes mellitus (DM). DM is now recognized as a risk equivalent for coronary heart disease. The lipid profile in patients with type 2 DM is characterized by elevated triglycerides, low levels of high-density lipoprotein cholesterol, and small dense low-density lipoprotein cholesterol (LDLC) particles and is believed to be a key factor promoting atherosclerosis in these patients. Both primary and secondary prevention studies have provided ample evidence that aggressive statin therapy reduces cardiovascular end points in patients with DM. In all persons with DM, current treatment guidelines recommend reduction of LDLC to less than 100 mg/dL, regardless of baseline lipid levels. Lowering LDLC to less than 70 mg/dL may provide even greater benefits, particularly in very high risk patients with DM and coronary heart disease.     

老年2型糖尿病相关指标的临床探讨

目的探讨老年2型糖尿病并发症相关指标的临床意义。方法对住院老年2型糖尿病160例病人随机分组，监测其生化指标（FBG、HbA1C、TC、TG、HDL-C）并作统计学处理。结果相关生化指标测值的比较，糖尿病并发症与无并发症组病例差异有显著性（P〈0．05）。结论对老年2型糖尿病除控制血糖外，更应重视对高血压、血脂异常的治疗，以减少各种并发症的发生。     

Prevalence and factors associated with obesity among the oldest old

PurposeTo determine the prevalence of overweight and obesity, and to identify factors associated with obesity, among the oldest old.MethodsFor this study, data from follow-up (FU) wave 7 and FU wave 8 of the “Study on Needs, Health Service Use, Costs and Health-Related Quality of Life in a Large Sample of Oldest-Old Primary Care Patients (85+)” (AgeQualiDe) were used. At FU wave 7, the mean age was 88.9 years (SD: 2.9; 85–100 years). Body-mass-index (BMI) categories were defined according to the World Health Organization (WHO) thresholds: underweight (BMI < 18.5 kg/m²), normal weight (18.5 kg/m² ≤ BMI < 25 kg/m²), overweight (25 kg/m² ≤ BMI < 30 kg/m²), and obesity (BMI ≥ 30 kg/m²). Longitudinal regression analysis was used to determine factors associated with obesity.ResultsAt FU wave 7, 3.0 % were underweight, 48.9 % were normal weight, 37.9 % were overweight, and 10.2 % were obese. Regressions showed that the probability of obesity decreased with age (OR: 0.77 [95 % CI: .593–.999]) and less chronic conditions (OR: 1.32 [95 % CI: 1.11–1.57]). The probability of obesity was not associated with sex, educational level, marital status, social isolation, visual impairment, hearing impairment, depression, and dementia.ConclusionNearly half of the individuals in very late life had excess weight. Thus, excess weight remains a major challenge, even in very old age. Given the demographic ageing in upcoming decades, this is an issue which we should be aware of.     

Diabetes mellitus and ischemic cardiopathy: potential effects of the use of sulfonylureas]

Morbidity and mortality are increased in diabetic patients with ischemic heart disease. Sulfonylureas are the therapeutic group most frequently used and contributing to this. Patients usually treated with sulfonylureas have increased cardiovascular mortality. This is probably attributed to the action of these drugs on the ATP-sensitive potassium channels via blocking the ischemic preconditioning. This article puts forward evidence on sulfonylureas cellular and molecular pharmacodynamics and the real clinical incidence in the ATP-sensitive potassium channels inhibition in the diabetic patient's ischemic heart.     

Telomere length is associated with left ventricular function in the oldest old: the Newcastle 85+ study.

AIMS: Heart failure is a condition increasingly prevalent at older ages; however, mechanisms by which the ageing process affects cardiac function are largely unknown. Telomere length is a biomarker of ageing that has been suggested to be associated with a variety of diseases of late onset, but its relationship with cardiac function has not previously been studied. We measured telomere length in peripheral blood mononuclear cells and carried out echocardiography in a group of 85-year old subjects recruited from the community as part of the Newcastle 85+ Study. METHODS AND RESULTS: Eighty-nine subjects were recruited through local family practitioners. They were visited in their homes for clinical assessment and echocardiography, which was performed using a handheld device. Telomere length was measured by a real-time PCR method. High sensitivity C-reactive protein was measured using ELISA. Echocardiographic M-mode ejection fraction (EF) was strongly associated with telomere length (P=0.006) in subjects without evidence of previous MI. Sex and telomere length were significant predictors of EF while current smoking, blood pressure, plasma high sensitivity C-reactive protein, and use of cardiovascular medications were not. One standard deviation longer telomeres were associated with a 5% higher EF. Telomere length accounted for 12% of the observed variability in EF. CONCLUSION: These data show influences of the ageing process on myocardial function in the oldest old, apparently independent of other specific disease processes. This may be of importance in the aetiology of heart failure in this age group.     

Fuenlabrada study: lipid and lipoprotein levels in children and adolescents associated with ischemic cardiopathy prevalence among their relatives

The prevalence of coronary heart disease (CHD) was studied in parents and grandparents of 2,419 children surveyed for lipid levels. Children and their families were divided into 3 groups depending on the level of each lipid and lipoprotein studied in children: high greater than or equal to 95 percentile (p), medium 5-95 p, and low less than 5 p. Total cholesterol (Chol) and triglycerides (TG) were determined by enzymatic techniques in autoanalyzer. C-HDL was determined by precipitation method. C-LDL and C-VLDL were obtained by Friedewald-Fredrickson's equation. The prevalence of CHD in parents and grandparents was ascertained from clinical history. Fathers of children in the high groups of Chol, TG, C-LDL/C-HDL, and low group of C-HDL had increased prevalence of CHD compared with those of the low groups of Chol, TG, C-LDL, C-LDL/C-HDL and high group of C-HDL. The strongest association was with C-HDL. Maternal and paternal grandfathers of children in the high groups of Chol had also increased prevalence of CHD compared with those of low group of Chol. There was no association with any other variable. The association was not significant neither in mothers nor in maternal and paternal grandmothers. Childhood lipid and lipoprotein levels could identify families at elevated risk for CHD.     

Regional arterial stiffness associated with ischemic heart disease in type 2 diabetes mellitus

Arterial stiffness is increased in type 2 diabetes mellitus, and diabetes preferentially affects arterial stiffness of the central (elastic, capacitive) over peripheral (muscular, conduit) arteries. We hypothesized that arterial stiffness of the central artery may be more closely associated with ischemic heart disease (IHD) than stiffness of peripheral arteries in type 2 diabetes mellitus. The subjects were 595 type 2 diabetes patients including 70 with IHD. Arterial stiffness was measured as pulse wave velocity (PWV) in the heart-carotid, heart-femoral, heart-brachial, and femoral-ankle regions. The PWV values of the four segments correlated with each other in patients without IHD. However, the correlations were less impressive in those with IHD, suggesting unequal stiffening of regional arteries in IHD. As compared with patients without IHD, the IHD group showed significantly higher PWV values of the four arterial segments, particularly of the heart-femoral region. The presence of IHD was significantly associated with higher heart-femoral PWV, and this association remained significant and independent of other factors in a multiple logistic regression analysis. Pulse pressure was more strongly correlated with PWV of the heart-femoral than other arterial regions. Thus, diabetic patients with IHD have increased stiffness of arteries, particularly of the aorta, supporting the concept that central arterial stiffness plays an important role in the development of IHD.     

Symptoms of depression in the oldest old: a longitudinal study

This study examined depressive symptoms in a population-based, longitudinal sample of people aged 80 and older to determine initial prevalence of depressive symptoms and changes over time. Depressive symptomatology was assessed with the Center for Epidemiologic Studies-Depression scale (CES-D). The sample was drawn from the OCTO-Twin study, which examined 702 Swedish twins over age 80 in which both members of the pair were still surviving. For the present study, one member of each twin pair was randomly selected, resulting in a sample of 351. A comprehensive biobehavioral assessment was conducted at three time points over 4 years. Depressive symptoms were initially relatively low and decreased significantly between Wave 1 and Wave 2. At Wave 3, depressive symptoms increased slightly but not significantly. Participants who received a dementia diagnosis at some point in the study did not differ significantly on initial CES-D scores when compared to those participants who never received such a diagnosis. Lack of well-being, as opposed to negative affect, was the biggest contributor to the overall depression score at each of the three waves of measurement. Predictors of negative affect for this sample included activities of daily living, subjective health, and performance on the cognitive test, block design. None of these predictors were significant for lack of well-being.     

老老年患者缺血性脑白质疏松症与慢性肾功能不全的关系

目的 探讨老老年患者缺血性脑白质疏松症(LA)与慢性肾功能不全(CKD)的关系.方法选择经磁共振成像证实的老老年(≥80岁)缺血性LA患者60例,均为男性,入组后根据慢性肾功能不全诊断标准[由血肌酐水平通过Cockcroft-Gault公式估算肾小球滤过率＜60 ml/( min·1.73m2)]对于是否合并CKD,分...     

Increased aortic stiffness in women with type 1 diabetes mellitus is associated with diabetes duration and autonomic nerve function.

AIMS: The increase in risk for cardiovascular complications in diabetic women is even greater than that in diabetic men. We found arterial stiffness to be increased in women, but not in men, with Type 1 diabetes mellitus (DM). The aims of the present study were to evaluate whether the changes in arterial distensibility are influenced by diabetes duration and to evaluate any association between autonomic neuropathy and decreased arterial distensibility. METHODS: Stiffness of the abdominal aorta was measured noninvasively using echo-tracking sonography and parasympathetic function by heart rate variation during deep breathing (E/I ratio) in 40 women (mean age 33 years, range 20-61) and 38 men (mean age 36 years, range 22-56) with Type 1 DM. RESULTS: There was a significant correlation between aortic stiffness and duration of diabetes in women (r = 0.41, P = 0.008), but not in men (r = 0.15, P = 0.35). There was also a significant correlation between aortic stiffness and the E/I ratio in women (r = -0.49, P = 0.002), but not in men (r = -0.14, P = 0.41). When adjusted for diabetes duration, the significant association between the E/I ratio and aortic stiffness remained in diabetic women (r = -0.44, P = 0.008) and was stronger than the association between diabetes duration and aortic stiffness. There were no significant correlations between aortic stiffness and triglycerides or total cholesterol, respectively. CONCLUSIONS: Increased aortic wall stiffness found in women with Type 1 DM is related to diabetes duration. Further, in women with Type 1 DM there is a correlation between increased aortic stiffness and parasympathetic dysfunction. This may be of importance for the increased susceptibility to cardiovascular complications in diabetic women.     

老年2型糖尿病患者血脂异常状况及其影响因素

目的探讨血脂异常在老年2型糖尿病(T2DM)患者中的发病情况及其影响因素。方法对门诊156例老年T2DM患者进行体格检查及生活习惯和膳食频率调查,收集血样进行血生化检验,分析老年T2DM患者血脂状况及影响因素。结果 60.9%的患者血脂异常,经多因素Logistic回归分析发现,饮酒、体脂量、胰岛素抵抗指数(HOMA-IR)均为老年T2DM患者血脂的危险因素。结论老年T2DM患者血脂控制不理想,建议戒酒,增加适度的运动量,通过健康的方式适度减重,以更好地控制血脂、血糖,降低糖尿病并发症及心血管疾病的发病风险。     

Patterns of comorbidity and multimorbidity in the oldest old: The Octabaix study

BackgroundMultimorbidity is associated with higher mortality, increased disability, a decline in functional status and a lower quality of life. The objective of the study is to explore patterns of multimorbidity in an elderly population.Methods328 community inhabitants aged 85 years were included. Socio-demographic variables and data from the global geriatric assessment were evaluated. Information on the presence of sixteen common chronic conditions was collected: hypertension, diabetes mellitus, dyslipidemia, ischemic cardiomyopathy, heart failure, stroke, chronic obstructive pulmonary disease, (COPD), atrial fibrillation, peripheral arterial disease, Parkinson's disease, cancer, dementia, anemia, chronic kidney disease (CKD), visual impairment and deafness. Hierarchical cluster analysis was performed.ResultsThe rate of multimorbidity (> 1 disease) was 95.1%. Men had a higher percentage of COPD and malignancy. Four main clusters were identified. The highest value of the bivariate correlation matrix was that between heart failure and visual impairment. These two diseases were included in a cluster with atrial fibrillation, CKD, heart failure, stroke, high blood pressure and diabetes mellitus.ConclusionsThe large majority of oldest old subjects had multimorbidity. The results confirm the non-random co-occurrence of certain diseases in this age group.     

Factors associated with microalbuminuria in type 1 diabetes mellitus: a cross-sectional study

In order to determine the prevalence of microalbuminuria in people with Type 1 diabetes mellitus (Type 1 DM) and identify factors associated with microalbuminuria, we studied 312 Type 1 DM patients attending in three hospitals in two Spanish regions over 6 months. Clinical characteristics, micro- and macro-vascular complications, blood pressure, 24-h urine albumin excretion, lipid profile, HbA1(c) levels, smoking habits, and family history of hypertension and diabetic nephropathy were recorded. Univariate analysis and multiple logistic regression were used to examine associations between these variables and the prevalence of microalbuminuria. We detected microalbuminuria in 29% of the patients. The prevalence of microalbuminuria was high during the second decade of diabetes and declined thereafter. Univariate analysis showed dyslipidaemia (P<0. 002), previously diagnosed hypertension (P<0.001), family history of hypertension (sibling alone P<0.006; mother alone P<0.05), family history of diabetic nephropathy (P<0.001), and laser-treated retinopathy (P<0.03) to be factors associated with the presence of microalbuminuria. Multiple logistic regression revealed an association between microalbuminuria and family history of nephropathy (OR 7.6, 3.6-16). In conclusion, in our sample the frequency of microalbuminuria seems to be related to the presence of dyslipidaemia, hypertension, and to a family history of hypertension or nephropathy.