Mortality from diabetes mellitus, ischemic heart disease, and cerebrovascular disease among blacks in a higher income area

According to the 1980 census, blacks in Suffolk County on Long Island, NY, had a median family income of almost $20,000 versus $12,618 for blacks in the entire United States, or only 20 percent lower than that for whites in the county. Black-white ratios of age-specific death rates for 1979-83 in Suffolk County were elevated for all causes for men and women in age groups from 35-44 to 55-64 years (but not for those 75 years or older), for ischemic heart disease for women (but not men) for age groups from 35-44 to 55-64 years, for diabetes mellitus for most ages (especially for females), and for cerebrovascular disease for both men and women for all age groups from 35-44 to 65-74 years. The age-specific proportional mortality ratios (PMRs) for ischemic heart disease within educational level (less than 12 years and 12 or more years of school) were lower for black than for white men but more similar for black and white women. For diabetes, the PMRs were higher for black versus white women within both educational levels. PMRs for cerebrovascular disease were higher for black than white men within the group of decedents with less than 12 years of education. The findings are discussed with reference to racial differences in the prevalence of poverty as well as possible differences in risk factors (for example, obesity) or medical care independent of poverty.     

Mortality and coronary heart disease in diabetes mellitus

Abstract: A clinic-based study of 1063 patients with Type 2 diabetes recruited from 1973 to 1982 identified 533 deaths (attributed to coronary heart disease in 268 cases) by 31 December 1989. When compared to the general population of Australia the overall standardised mortality ratio was 1.42 (95 per cent confidence interval (CI) 1.26 to 1.58) for females and 1.19 (CI 1.03 to 1.35) for males. Cox regression analysis showed that having coronary heart disease or absence of foot pulses at the time of entrance to the study were the major independent risk factors for overall mortality after adjustment for initial age. Elevated cholesterol and blood pressure were found to be major independent risk factors for death from coronary heart disease.     

Lipoprotein(a): an independent risk factor for ischemic heart disease that is dependent on triglycerides in subjects with type 2 diabetes mellitus

   

Lipoprotein(a) is an independent risk factor for Ischaemic Heart Disease (IHD) in the general population. There are conflicting reports in the extent of its association with IHD among subjects with Type 2 diabetes mellitus (T2DM).     

2型糖尿病合并冠心病患者脂联素测定及其意义

目的研究脂联素与2型糖尿病合并冠心病相关性,探讨脂联素与2型糖尿病合并冠心病的作用和机制。方法选择正常对照组48例、2型糖尿病组62例和2型糖尿病合并冠心病组68例,测定脂联素、糖化血红蛋白、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、空腹血糖、空腹胰岛素进行观察。结果脂联素、胰岛素抵抗指数存在负相关关系,脂联素与性别、GHbAlc、FINS、BMI、LDL、TG独立相关。结论脂联素水平的降低与2型糖尿病合并冠心病形成有关。     

2型糖尿病合并冠心病患者抵抗素测定及其意义

目的研究抵抗素与2型糖尿病合并冠心病的相关性,探讨抵抗素对2型糖尿病合并冠心病的作用和机制。方法选择正常对照组51例,2型糖尿病组72例和2型糖尿病合并冠心病组75例,测定抵抗素、糖化血红蛋白、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、空腹血糖、空腹胰岛素。结果血清抵抗素浓度与年龄、SBP、DBP、TG呈正相关;与BMI、HOMA—IR等无相关性。结论抵抗素水平的升高与2型糖尿病合并冠心病形成有关。     

Mortality from ischemic heart disease in Iceland, 1951-1985.

The objective of this study was to evaluate mortality rates from ischemic heart disease among Icelanders during the period of 1951 to 1985. In some developed countries, the number of deaths from ischemic heart disease declined markedly in this time period, and it is interesting to study whether the same has occurred in Iceland. The study was based on information obtained from the Statistical Bureau of Iceland, which keeps records of deaths based on death certificates as well as other population records. Nonparametric tests were used to correlate death rates and calendar years. Rates per 100,000 were calculated and plotted. The results indicated that the mortality rates from ischemic heart disease among Icelanders have not yet peaked.     

Mortality from coronary heart disease in the Tecumseh study. Long-term effect of diabetes mellitus, glucose tolerance and other risk factors

The coronary heart disease mortality of participants in the Tecumseh study was examined with particular emphasis on the roles of diabetes and glucose tolerance as risk factors. The cohort consisted of 921 men and 937 women aged 40 years and older who did not have evident coronary heart disease at entry to the study during the period 1959-1965 and whose outcome was determined in the period 1977-1979. Previously diagnosed diabetes was a statistically significant risk factor for coronary heart disease mortality in both sexes even after controlling for systolic blood pressure, serum cholesterol, relative weight, and cigarette smoking. High blood glucose score in nondiabetics was associated with excess coronary heart disease mortality after controlling for other risk factors, but the magnitude of this effect was substantially below that of diabetes. The predictive power of most risk factors except age itself decreased among progressively older segments of the population.     

2型糖尿病与冠心病

1 糖尿病并发心血管病变的危险因素 糖尿病病人中90%～95%是2型糖尿病,2型糖尿病常与代谢综合征伴随发生.代谢综合征表现除血糖增高,糖耐量受损外,还有胰岛素抵抗、高胰岛素血症、腹型肥胖、血脂异常、血压高、血尿酸高和1型纤维蛋白酶原激活物抑制剂(PAI-1)增高等.这些均是2型糖尿病大血管病变发生的原因.     

Mortality from cancer and ischemic heart disease in Danish chimney sweeps: a five-year follow-up

A mortality study of 713 male chimney sweeps in Denmark was performed. The observed number of deaths in 1970-1975 was compared with the expected number, calculated from cohort, period, and cause-specific death rates for employed Danish males. A total of 38 deaths was observed compared with the 18.3 deaths expected (p less than 0.01). Cancer accounted for 12 deaths versus 5.3 expected (p less than 0.05), ischemic heart disease for 12 deaths versus 5.4 expected (p less than 0.05), and residual causes for 14 deaths versus 7.6 expected (p less than 0.05). The excess mortality was exclusively due to cancer and ischemic heart disease among chimney sweeps in the older age group (45-74 years), whereas a high mortality due to other causes was observed among the younger sweeps (15-44 years). It is concluded that heavy inhalation exposure to products from the combustion of fossil fuel leads to an increased individual risk of cancer and ischemic heart disease and substantially reduces the time until occurrence of these diseases.     

Caregiving and risk of coronary heart disease in U.S. women: a prospective study

BACKGROUND: A growing number of women provide care to disabled or ill relatives. Many studies have linked caregiving to psychiatric morbidity, lower perceived health status, elevated blood pressure, and poorer immune function. However, no studies have examined the association between caregiving and cardiovascular disease incidence. METHODS: We conducted the study in 54,412 women from the Nurses' Health Study, a prospective cohort of female registered nurses residing in 11 U.S. states. These women were aged 46 to 71 years and did not have diagnosed coronary heart disease (CHD), stroke, or cancer at baseline (1992). We collected information on caregiving responsibilities in 1992 and coronary heart disease between baseline (June 1, 1992) and return of the 1996 questionnaire. RESULTS: During 4 years of follow-up, we documented 321 incident cases of CHD (231 nonfatal cases of myocardial infarction and 90 CHD deaths). In multivariate analyses controlling for age, smoking, exercise, alcohol intake, body mass index, history of hypertension, diabetes mellitus, and other covariates, caregiving for disabled or ill spouse for > or =9 hours per week was associated with increased risk of CHD (RR, 1.82; 95% confidence interval, 1.08-3.05). However, caregiving for disabled or ill parents or disabled or ill others was not significantly associated with increased risks of CHD. CONCLUSION: These data indicate that high levels of caregiving burden for ill spouses may increase the risk of CHD among women.     

冠心病合并2型糖尿病患者冠状动脉造影分析

目的探讨冠心病合并2型糖尿病患者的冠状动脉（冠脉）造影特点。方法716例冠心病患者，均行冠脉造影检查。其中冠心病合并2型糖尿病患者340例作为观察组，冠心病不合并2型糖尿病患者376例作为对照组。对两组患者的冠脉造影资料进行分析。结果观察组多支病变高于对照组（56．2％比34．6％，P〈0．05），C型病变高于对照组（54．1％比24．5％，P〈0．05）。结论冠心病合并2型糖尿病患者冠脉病变广泛且复杂。     

冠心病合并2型糖尿病患者冠状动脉造影分析

目的 探讨冠心病合并2型糖尿病患者的冠状动脉(冠脉)造影特点.方法 716例冠心病患者,均行冠脉造影检查.其中冠心病合并2型糖尿病患者340例作为观察组,冠心病不合并2型糖尿病患者376例作为对照组.对两组患者的冠脉造影资料进行分析.结果 观察组多支病变高于对照组(56.2%比34.6%,P＜0.05),C型病变高于对照组(54.1%比24.5%,P＜0.05).结论 冠心病合并2型糖尿病患者冠脉病变广泛且复杂.     

Disparities in diabetes management among medicaid recipients with intellectual and developmental disabilities (IDD): Evidence from five U.S. states

BackgroundDiabetes is one of the most common chronic conditions among adults. Little is known about the quality of diabetes care received by adults with intellectual and developmental disabilities (IDD).ObjectiveTo determine the extent to which the diabetes care needs are met for a population with both IDD and diabetes who are solely insured by Medicaid in five states (Iowa, Massachusetts, New York, Oregon and South Carolina).MethodsMedicaid administrative data in 2012 were used to identify Medicaid members (excluding dual eligibles) with diabetes and IDD in five states. Four diabetes care measures were compared between members with and without IDD using bivariate analyses. For those with diabetes and IDD, a logistic regression model was fitted for each state with the following predictors: age, sex, IDD subgroup, and occurrence of a specialist visit in the current or past year. A meta-analysis was then conducted to synthesize cross-state results.ResultsAcross the five states, 6229 (2%) of the 308,804 non-dual adult Medicaid members 18–64 years old with diabetes in 2012 also had IDD. Comparing those with IDD to their non-IDD peers on receipt of all four diabetes care measures showed differences by state, but state rates of overall adherence were very low, ranging from 16.6% to 28.5% of the population.ConclusionsMeta-analysis results identified specialist visits as a strong predictor of adults with diabetes and IDD receiving all four components of diabetes care. This important information should be considered in efforts to improve quality care for this population.     

Protein in optimal health: heart disease and type 2 diabetes

Diets with increased protein and reduced carbohydrates have been shown to improve body composition, lipid and lipoprotein profiles, and glycemic regulations associated with treatment of obesity and weight loss. Derived from these outcomes, high-protein, low-carbohydrate diets are also being examined for treatment of heart disease, metabolic syndrome, and type 2 diabetes. High-protein, low-carbohydrate diets have been found to have positive effects on reducing risk factors for heart disease, including reducing serum triacylglycerol, increasing HDL cholesterol, increasing LDL particle size, and reducing blood pressure. These diets appear particularly attractive for use with individuals exhibiting the atherogenic dyslipidemia of metabolic syndrome. High-protein, low-carbohydrate diets have also been investigated for treatment of type 2 diabetes with positive effects on glycemic regulation, including reducing fasting blood glucose, postprandial glucose and insulin responses, and the percentage of glycated hemoglobin. Specific effects of increasing protein compared with reducing carbohydrates have not been extensively investigated. Additional research is needed to determine specific levels of protein, carbohydrate, and fat for optimum health of individuals who differ in age, physical activity, and metabolic phenotypes.     

静息心率与2型糖尿病发病风险的Meta分析

目的 系统评价静息心率与2型糖尿病发病风险的关系。方法 通过检索中国知网、万方、PubMed和Web of Science数据库,查找关于静息心率与2型糖尿病发病风险的队列研究,按照严格的纳入排除标准筛选文献、提取数据并进行质量评价,运用Stata 11.0软件对纳入的文献进行综合分析,并按种族、静息心率测量方法、随访时间、样本量对文献进行亚组分析。结果 共纳入11篇队列研究文献,总样本量为212 891人。分析结果显示,与静息心率最低分类组相比,静息心率最高分类组人群2型糖尿病发病风险的合并效应值RR=1.54,95% CI:1.29~1.84,亚组分析结果显示,亚洲人和高加索人2型糖尿病发病风险分别为1.67（1.38~2.03）和1.29（1.02~1.62）。Begg's检验（P=0.350）和Egger's检验（P=0.662）未发现发表偏倚。结论 静息心率升高可以增加2型糖尿病发病风险,提示控制静息心率能够降低2型糖尿病的发病风险。     

Mortality related to cardiovascular disease and diabetes mellitus in a modernizing population

Excessive adiposity is associated with elevated rates of middle-aged mortality, particularly that related to cardiovascular disease (CVD) and diabetes mellitus (DM). One purpose of this study was to determine whether the population of American Samoa demonstrated the expected elevation of mortality rates related to these two causes. Accordingly for all American Samoan death records (N = 1588) during the period 1962–74, both crude and age-standardized rates were calculated and interpopulation comparisons of DM and CVD were made. The second purpose of this research was to determine if elevated CVD mortality was associated with the islands' recent trend toward modernization. For this purpose 902 deaths of persons aged 30 or more were analyzed to determine change in CVD mortality over time and differences by degree of participation in modern life.The CVD-related mortality rate for Samoa was 82.1 per 100,000, compared to 368.6 reported for the United States in 1962. After age standardization the Samoan rate increased to 242.5, still below that of the United States. The Samoan DM-related mortality rate was 13.9 per 100,000, compared to a United States rate of 15.9 in 1959. After age adjustment, the respective rates were 32.2 and 13.4 (1957–59), the Samoan rate being more than double that the United States. Female CVD mortality in Samoa increased from 196.2 in the period 1963–66 to 363.0 in 1971–74, while male rates remained essentially unchanged (417.3 and 429.0 respectively). CVD mortality among males living in more modernized areas of the islands was 46.5% higher than that for male residents of more traditional areas (343.5 and 234.5 respectively); among females, however, the rate was highest for those living in traditional areas (398.7). CVD mortality for males classified to the ‘sedentary’ occupational category was 50% greater than that for males in the ‘active’.     

Amaryl (glimepiride) in patients with type 2 diabetes mellitus

The purpose of the present study was to investigate the effect of the first third-generation sulphonylurea drug glimepiride (Amaryl, Aventis) in the treatment of patients with type 2 diabetes mellitus in an open 6-month clinical trial. The study included 19 patients with type 2 diabetes mellitus (7 men and 12 women, aged 53.6 +/- 2.43 years, mean duration of diabetes 7.79 +/- 1.45 years). The body mass index (BMI) of the patients was x = 30.157 +/- 1.63 which is at the borderline between overweight and obesity. The patients started at a baseline dosage of 1 mg which was then it was gradually adjusted according to the blood sugar level. The dosage of the drug varied between 1 and 6 mg (mean daily dosage 2.03 mg). The metabolic control parameters that were calculated included fasting and 2-hour postprandial blood sugar concentration, total cholesterol, serum triglycerides, HbA1c, and microproteinuria. They were measured at baseline, at 3 and 6 months. The results showed that the fasting blood glucose decreased significantly (P<0.05 at 3 months and P<0.001 at 6 months). Statistically significant lower postprandial glycemia was also observed in the patients (the decrease was not significant at 3 months but highly significant at 6 months, P<0.01). The overall evaluation was based on the values of HbA1c--they were statistically significantly lower at 6 months (P<0.01) which suggests the steady improving tendency of the metabolic control in type 2 diabetes patients treated with Amaryl (glimepiride). The improvement of the metabolic control was also manifested by the lower serum triglycerides levels (P<0.05) and the BMI remaining nearly without change. It is concluded that Amaryl (glimepiride) is an efficacious oral sulphonylurea preparation which can be used as an appropriate substitute of the other beta cell stimulators. Glimepiride once daily provides a good compliance of patients which reduces to minimum the skipped doses. It is associated with a reduced risk of hypoglycemia and causes no weight gain.