Systolic blood pressure as a predictor of incident albuminuria and rapid renal function decline in type 2 diabetic patients

AimsAlbuminuria and a reduced estimated glomerular filtration rate (eGFR) are known risk factors of poor cardiovascular outcomes in diabetic patients. We here aimed to investigate the determinants of incident albuminuria and rapid progression of renal dysfunction in patients with type 2 diabetes.MethodsType 2 diabetic outpatients (n = 215) with a mean baseline eGFR of 87 ± 20 mL min^− 1 1.73 m^− 2 were followed for 12 months. Urinary albuminuria was defined according to the urine albumin-to-creatinine ratio (UACR).ResultsAmong 132 patients with normoalbuminuria at baseline, 20 (15.2%) progressed to a more advanced stage of albuminuria within 1 year, and 20.5% of the 215 patients experienced a rapid decline in eGFR (eGFR reduction > 5 mL min^− 1 1.73 m^− 2 year^− 1). After adjusting for potential confounders, both baseline UACR and systolic blood pressure (SBP) were found to be significant independent factors for incident albuminuria and a rapid decline of eGFR in separate models. Using receiver operating characteristic curves, systolic blood pressures of 132 and 138 mmHg were found to predict incident albuminuria and a rapid decline of eGFR, respectively.ConclusionsIn addition to baseline UACR, SBP is one of the most powerful modifiable independent risk factors for incident albuminuria and a rapid renal function decline in type 2 diabetic patients without symptomatic cardiovascular disease.     

Knowledge of cardiovascular risk factors and awareness of non-pharmacological approach for risk prevention in young survivors of acute myocardial infarction. The cardiovascular risk prevention project "Help Your Heart Stay Young"

Background and aimsKnowledge of cardiovascular disease (CVD) risk factors in young patients who experienced myocardial infarction (MI) is poorly described.Methods and resultsKnowledge of traditional CVD risk factors, non-fatal cardiovascular events and of non-pharmacological factors able to reduce CVD risk and education level were evaluated by questionnaires in subjects who visited their family doctors. Sixty-one participants with history of MI in age <50 years (MI+) were compared with 3749 subjects with age <50 years, from the same population source, but without history of MI (MI−). MI+ were more frequently men (p < 0.01), did not have significantly higher prevalences of family history of CVD, diabetes and hypertension. MI+ individuals reported previous non-fatal stroke (13% vs. 0.5%, p < 0.001), overweight, diabetes, and hypercholesterolemia (all p < 0.001) more frequently than controls, whereas prevalence of arterial hypertension, smoking habit and physical inactivity did not differ between the two groups; MI+ and MI− individuals did not differ in terms of the proportion of those who were unaware of being hypertensive, diabetic or hypercholesterolemic. MI+ participants reported more frequently lower education level than controls (p < 0.05). Knowledge of non-pharmacological approach for CVD risk reduction was similar in MI+ and MI−. In a logistic multivariate analysis, male gender (adjusted odds ratio = 5.8) and high cholesterol level (adjusted odds ratio 2.8, both p < 0.01) were independent correlates of MI+. CVD risk factors distribution was similar between participants with juvenile MI+ and MI in age ≥50 years (n = 167) extracted from the same population source; however, stroke was reported more frequently in juvenile MI+ than in those who had MI at age ≥50 years/old (13% vs. 4%, p < 0.01).ConclusionsJuvenile non-fatal MI was associated with metabolic CVD risk factors, with higher cerebrovascular co-morbidity and lower education level.     

Study of cardiovascular risk factors in Tunisian patients with recent type 2 diabetes

ObjectiveTo study the frequency of silent myocardial ischemia (SMI) in Tunisian patients with recent type 2 diabetes and identify cardiovascular risk factors directly in relation with SMI.Patients and methodsOne hundred and twenty diabetics and sixty healthy people have benefited from blood sampling, electrocardiogram and exercise test.ResultsThe frequency of SMI was 21% in diabetics and 3% in healthy people (P = 0.01). Obesity and hypertension were higher in diabetics than in healthy people (P = 0.001 and P < 10^?4). Using unvaried analysis for risk factors with the presence of SMI in diabetics, we found that age greater than 60 yrs, male sex, sedentary and smoking were significantly correlated with SMI; respectively P = 0.004, 0.01, 0.009 and 0.03. The SMI was found in 37% of diabetics with high blood pressure vs 8% in diabetics with normal blood pressure and was correlated with hypertriglyceridemia, hypoHDLemia and microalbuminuria. Patients with SMI had at least two cardiovascular risk factors apart from diabetes among those: age greater or equal to 60 yrs, male sex, smoking, hypertension, dyslipidemia and family history of early coronaropathy. Chronic inflammation and hyperhomocysteinemia were significantly correlated to SMI; OR = 4.2 and 3.8. In addition, SMI was found in one diabetic over three who had bad glycemic control. Using multivariate analysis, only age greater or equal to 60 yrs, smoking, hypertension, hyperhomocysteinemia and hypertriglyceridemia were risk factors directly in relation with SMI in type 2 diabetes.ConclusionThe assessment of global cardiovascular risk from the moment of discovering type 2 diabetes and the early screening of SMI should be necessary.     

Duration of type 2 diabetes strongly predicts all-cause and cardiovascular mortality in people referred for coronary angiography

ObjectiveType 2 diabetes represents a major cardiovascular risk factor. However, few studies have addressed the impact of the disease duration on mortality. Thus, we aimed to investigate the predictive value of diabetes duration for all-cause and cardiovascular mortality in subjects undergoing coronary angiography.MethodsWe studied 2455 participants of the LUdwigshafen RIsk and Cardiovascular health study (1768 males/687 females). They had a mean ± standard deviation (SD) age of 63.1 ± 9.0 years (range: 40.0–79.9) and a mean ± SD body mass index of 27.7 ± 4.0 kg/m². 704 subjects were newly diagnosed with type 2 diabetes according to the 2010 criteria of the American Diabetes Association and 446 subjects had a known history of type 2 diabetes. The mean ± SD duration of the follow-up for all-cause and cardiovascular mortality was 7.4 ± 2.3 years.ResultsA total of 543 deaths occurred during the follow-up. Among these, 343 were accounted for by cardiovascular diseases. The duration of type 2 diabetes was strongly and positively correlated with all-cause and cardiovascular mortality (both P < 0.001). The multivariate adjusted hazard ratios (95% confidence intervals) for cardiovascular mortality compared to subjects without diabetes were 1.76 (1.34–2.32), 2.86 (2.00–4.08), 2.96 (1.85–4.74), and 4.55 (3.24–6.39) for subjects with new onset type 2 diabetes and subjects with known type 2 diabetes (duration ≤5, >5 and ≤10, >10 years), respectively.ConclusionsThe data emphasise the need to consider the diabetes duration for the prediction of mortality in subjects at intermediate to high cardiovascular risk.     

Chronic inflammation, albuminuria, and functional disability in older adults with cardiovascular disease: the National Health and Nutrition Examination Survey, 1999-2008

ObjectiveAlthough C-reactive protein (CRP) and albuminuria are well-documented cardiovascular risk markers, the functional implications of these biomarkers and their combination on functional disability and metabolic risks in patients with cardiovascular disease (CVD) are unknown.MethodsData were from 1403 adults (≥60 years, mean 73.2 years) with CVD, ascertained by self-reported diagnosis of angina, coronary heart disease, congestive heart failure, myocardial infarction or stroke, in the National Health and Nutrition Examination Survey 1999–2008. Disability in activities of daily living (ADL), instrumental activities of daily living (IADL), leisure and social activities (LSA), general physical activities (GPA), and lower-extremity mobility (LEM) were obtained from self-reports. The urinary albumin-to-creatinine ratio (UACR) was calculated by dividing the urinary albumin value by the urinary creatinine concentration. CRP levels were quantified by latex-enhanced nephelometry.ResultsInflammation and albuminuria were associated with disability. In the full-adjusted models, odds ratios (ORs) (95% confidence intervals [CIs]) of disability in ADL, LSA, and LEM were 1.60 (1.13–2.28), 1.76 (1.22–2.55) and 2.31 (1.62–3.31), respectively, comparing participants in the highest CRP quartile to the lowest (p values for trend across CRP quartiles < 0.01). The corresponding ORs (95% CI) for disability in ADL, IADL, LSA, and LEM were 1.71 (1.20–2.45), 1.72 (1.21–2.45), 1.46 (1.01–2.12) and 2.50 (1.73–3.62), respectively, comparing participants in the highest UACR quartile to the lowest. We found combined association of inflammation and albuminuria with disability and with metabolic risks. Based on medians of both UACR and CRP, subjects with both higher levels of both markers had higher odds of disability and a more unfavorable metabolic profile than those with lower levels.ConclusionsElevated levels of CRP and UACR independently correlate with disability among older adults with CVD. There is a combined association of inflammation and albuminuria on multiple domains of disability and metabolic risks, suggesting the presence of elevated UACR may amplify the association of inflammation with disability and with metabolic risk in older adults living with CVD.     

Hypertension and diabetes mellitus are associated with cardiovascular events in the elderly without cardiovascular disease. Results of a 15-year follow-up in a Mediterranean population

Background and aimsEpidemiological prospective data on cardiovascular (CV) events in elderly subjects from Mediterranean populations are lacking. We aimed to investigate 15-year incidence of CV events and to evaluate the association with CV risk factors in an elderly Mediterranean population.Methods and resultsThe population of a small Sicilian village were enrolled, visited and a blood sample was drawn at baseline. CV events were recorded in the 15 years of follow-up. From 1351 subjects (75% of the resident population); 315 were in the age range 65–85 years; 266 subjects free from CV disease were analysed.Seventy-seven CV events were recorded in 73 out of 266 subjects, with a 19.7% rate (in 10 years). Hypertension (HTN) (hazards ratio = 2.1) and diabetes mellitus (DM) (hazards ratio = 1.8) were independently associated with CV events. Subjects with both DM and HTN showed a lower survival free of CV events compared to those with DM or HTN.ConclusionsIn a 15-year follow-up of an elderly Mediterranean population free from CV disease, diabetes mellitus and hypertension were related to CV events. The control of risk factors in the elderly needs to be reinforced to achieve better results in terms of CV prevention.     

Hypoadiponectinaemia enhances waist circumference as a predictor of glucose intolerance and clustering of risk factors in Chinese men

AimThis study aimed to confirm the hypothesis that adiponectin levels can enhance the discriminative value of waist circumference (WC) in predicting impaired glycaemic status and clustering of risk factors.MethodsWe used receiver operating characteristic (ROC) curve analysis to define the optimal cut-off value of adiponectin to predict diabetes in Chinese men with no relevant past medical history. This value was combined with WC to increase its discriminative power in ascertaining impaired glycaemic status and various cardiovascular risk factors.ResultsIn 360 men (mean ± S.D.; age: 41.3 ± 9.2 years), the mean ± S.D. adiponectin level was 5.2 ± 2.7 μg/mL. Based on oral glucose tolerance tests (OGTTs), 84 men (23.3%) had undiagnosed diabetes, 52 (14.4%) had impaired glucose tolerance (IGT) and 224 (62.3%) had normal glucose tolerance. On ROC analysis, 5.7 μg/mL was the optimal cut-off value of adiponectin in this population to predict diabetes. Compared with subjects who had normal WC (defined as less than 90 cm) and high adiponectin levels (≥ 5.7 μg/mL), the likelihood ratio of diabetes was 2.54 in those with central obesity and hypoadiponectinaemia.ConclusionThe combined use of low adiponectin levels and large WC measures has greater discriminative power than using either index alone to identify subjects at particular risk of glucose intolerance and clustering of risk factors.     

Resistant hypertension in visceral obesity

BackgroundVisceral obesity increases the risk of arterial hypertension (78% of cases of hypertension in men and 65% of cases in women). The aim of the study is to assess the role of visceral obesity in causing resistant hypertension (RH).MethodsThe survey was performed on 5065 hypertensive patients with visceral obesity. BP control was analyzed on the basis of office and home BP measurements. Patients reporting non-compliance were excluded from the study.ResultsThe percentage of RH after excluding undertreated patients (receiving less than 3 drugs or on at least 3-drug regimen without diuretic and without reaching target BP goal) was 13.9%. RH was more frequent only in obese with BMI ≥ 35 and < 40 kg/m² (16.2%) and in morbidly obese individuals (26.5%). Patients with BMI ≥ 35 and < 40 kg/m² and with morbid obesity were receiving three-drug therapy more frequently than patients with visceral obesity and BMI < 30 kg/m². A multiple regression analysis revealed that obesity was associated with RH independent from longer than 5-year period of antihypertensive therapy, diabetes, smoking cigarettes, cardiovascular disease and heart failure. The analysis of home BP measurement revealed that in 11.1% of patients RH was in fact “white coat” hypertension.ConclusionsUndertreatment, underuse of diuretics in multidrug regimens, and the “white-coat” effect are the most common reasons for over-diagnosing resistant hypertension in patients with visceral obesity. Obesity is an independent risk factor for the occurrence of RH.     

Elevated level of C-reactive protein is associated with risk of prediabetes in Indians

BackgroundRelationship of high sensitivity C-reactive protein (hsCRP) with prediabetes has not been explored extensively in Indians. Here we sought to investigate the association of hsCRP levels with prediabetes, as represented by impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), and the influence of risk factors like obesity, decreased HDL cholesterol, hypertension, family history of diabetes and current smoking habit on the relationship.MethodsA cross-sectional study on 1726 Indians, comprising of 1276 individuals with normal glucose tolerance (NGT), 250 IFG and 200 IGT individuals. Subjects were defined according to WHO criteria based on fasting plasma and 2 h glucose levels.ResultsMedian levels of hsCRP were significantly higher in IFG (2.20 mg/l) and IGT (2.32 mg/l) compared to NGT (1.64 mg/l) subjects. Individuals with high risk hsCRP levels (>3 mg/l) had an odds ratio (OR) (95% confidence interval (CI)) of 2.60 (1.56–5.34) [P = 1.3 × 10^?4] for IGT after adjusting the effect of age, sex, medication, body mass index (BMI), waist circumference (WC) and risk factors like decreased high-density lipoprotein cholesterol (HDL-cholesterol), hypertension, family history of diabetes and current smoking. Significant increase in risk of IGT was found with a unit increase in natural log transformed hsCRP levels after adjustment for covariates [OR (95%CI) = 1.57 (1.27–1.94), P = 3.0 × 10^?5]. When subjects were stratified on the basis of risk factors, we found stronger association of elevated hsCRP levels with risk of IFG and IGT in subjects having HDL-cholesterol ≤50 mg/dl and with hypertension.ConclusionsOur study demonstrates that elevated hsCRP levels are independently associated with risk of IFG and IGT in Indians.     

Association between serum uric acid level and peripheral arterial disease

BackgroundHigher serum uric acid levels have been implicated in the development and progression of atherosclerotic cardiovascular disease. However, it is not clear whether serum uric acid levels are related to subclinical measures of cardiovascular disease, including peripheral arterial disease (PAD). We examined the association between increasing serum uric acid levels and PAD in the US general population.MethodsA cross-sectional study was conducted among 3987 National Health and Nutrition Examination Survey 1999–2002 participants aged ≥40 years, without clinical history of cardiovascular disease. Main outcome-of-interest was PAD defined as ankle-brachial index <0.9 (n = 229).ResultsHigher serum uric acid levels were positively associated with PAD, independent of smoking, body mass index (BMI), hypertension, diabetes, serum total cholesterol, serum creatinine, and other confounders. Multivariable odds ratio (OR) [95 percent confidence intervals (CI)] comparing serum uric acid levels ≥75th percentile (≥380.8 μmol/L) to uric acid levels <50th percentile (<315.6 μmol/L) was 1.62 (1.08–2.44), p-trend = 0.015. This association persisted in separate analysis among men and women. Further, the results were consistent in subgroup analyses by categories of age, current smoking, BMI, and diabetes mellitus.ConclusionsHigher serum uric acid levels are associated with PAD in the US general population. These results suggest that PAD may be an important indicator of the reported association between higher serum uric acid levels and clinical cardiovascular disease. Future prospective studies are required to clarify the temporal nature of this relationship.     

The association of tooth scaling and decreased cardiovascular disease: a nationwide population-based study

ObjectivePoor oral hygiene has been associated with an increased risk for cardiovascular disease. However, the association between preventive dentistry and cardiovascular risk reduction has remained undetermined. The aim of this study is to investigate the association between tooth scaling and the risk of cardiovascular events by using a nationwide, population-based study and a prospective cohort design.MethodsOur analyses were conducted using information from a random sample of 1 million persons enrolled in the nationally representative Taiwan National Health Insurance Research Database. Exposed individuals consisted of all subjects who were aged ≥ 50 years and who received at least 1 tooth scaling in 2000. The comparison group of non-exposed persons consisted of persons who did not undergo tooth scaling and were matched to exposed individuals using propensity score matching by the time of enrollment, age, gender, history of coronary artery disease, diabetes, hypertension, and hyperlipidemia.ResultsDuring an average follow-up period of 7 years, 10,887 subjects who had ever received tooth scaling (exposed group) and 10,989 age-, gender-, and comorbidity-matched subjects who had not received tooth scaling (non-exposed group) were enrolled. The exposed group had a lower incidence of acute myocardial infarction (1.6% vs 2.2%, P < .001), stroke (8.9% vs 10%, P = .03), and total cardiovascular events (10% vs 11.6%, P < .001) when compared with the non-exposed group. After multivariate analysis, tooth scaling was an independent factor associated with less risk of developing future myocardial infarction (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.57-0.85), stroke (HR, 0.85; 95% CI, 0.78-0.93), and total cardiovascular events (HR, 0.84; 95% CI, 0.77-0.91). Furthermore, when compared with the non-exposed group, increasing frequency of tooth scaling correlated with a higher risk reduction of acute myocardial infarction, stroke, and total cardiovascular events (P for trend < .001).ConclusionTooth scaling was associated with a decreased risk for future cardiovascular events.     

Low phospholipid transfer protein (PLTP) is a risk factor for peripheral atherosclerosis

ObjectivePhospholipid transfer protein (PLTP) facilitates cholesterol efflux from cells, intravascular HDL remodelling and transfer of vitamin E and endotoxin. In humans, the relationship of PLTP to atherosclerosis is unknown. However, strong coronary risk factors like obesity, diabetes, cigarette smoking and inflammation increase circulating levels of active PLTP. The aim of the present, cross-sectional study was to analyze the relationship of PLTP to peripheral arterial disease, a marker of generalized atherosclerosis, independently of potentially confounding factors like obesity, diabetes and smoking.MethodsWe performed a case control study in 153 patients with symptomatic peripheral arterial disease (PAD) and 208 controls free of vascular disease. Smokers and patients with diabetes mellitus were excluded. A lipoprotein-independent assay was used for measurement of circulating bioactive PLTP and an ELISA utilizing a monoclonal antibody was used to analyze PLTP mass.ResultsPLTP activity was significantly decreased in patients with PAD 5.5 (4.6–6.4)(median (25th–75th percentile)) versus 5.9 (5.1–6.9) μmol/mL/h in controls (p = 0.001). In contrast, PLTP mass was similar in patients with PAD 8.5 μg/mL (7.3–9.5) and in controls 8.3 μg/mL (6.9–9.7) (p = 0.665). Multivariate logistic regression analysis revealed that PLTP activity is independently associated with the presence of PAD. PLTP activity was similar in patients with and without lipid-lowering drugs (p = 0.396).ConclusionOur results show that in non-diabetic, non-smoking subjects low rather than high PLTP activity is a marker for the presence of peripheral arterial disease and that distribution of PLTP between high-activity and low-activity forms may be compromised in atherosclerosis.     

Using brachial-ankle pulse wave velocity to associate arterial stiffness with cardiovascular risks

Background and aimsThis study aimed to elucidate the relationship between brachial-ankle pulse wave velocity (baPWV) and conventional cardiovascular risk factors.Methods and resultsA total of 192 subjects with low to intermediate risk was enrolled in a cardiovascular evaluation program. A multiple regression model was built to find significant cardiovascular biomarkers for predicting baPWV. A logistic regression model was developed to associate baPWV and other biomarkers with the risk of cardiac diastolic dysfunction. A total of 123 men (mean age: 52.6 ± 12.0) and 69 women (mean age: 51.7 ± 10.4) was included. Age, blood pressure, C-reactive protein, serum homocysteine, heart rate, and blood urea nitrogen were positively predictive of increased pulse wave velocity. In turn, baPWV increased the risk (odds ratio: 1.257 for each m/s, 95% CI: 1.105 ∼ 1.430, p < 0.001) and high-density lipoprotein decreased the risk for cardiac diastolic dysfunction (0.962 for each mg/dl, 95% CI: 0.925 ∼ 1.000, p = 0.05). The correlation between baPWV and Framingham 10-year risk was moderate (men: r = 0.306, p = 0.002; women r = 0.548, p < 0.001).ConclusionThe results suggest that baPWV is a composite risk factor for early atherosclerotic change and a predictor for the development of diastolic dysfunction and long-term cardiovascular risk.     

Age- and gender-specific awareness, treatment, and control of cardiovascular risk factors and subclinical vascular lesions in a founder population: The SardiNIA Study

AimWe investigated the gender-specific control of cardiovascular (CV) risk factors and subclinical vascular lesions in a founder population in Italy.Methods and Results6148 subjects were enrolled (aged 14–102 years) from four towns. Hypertension (HT), diabetes mellitus (DM) and dyslipidemia (LIP) were defined in accordance with guidelines. A self-reported diagnosis defined awareness of these conditions, and the current use of specific medications as treatment.Prevalence was HT 29.2%, DM 4.8%, LIP 44.1% and was higher in men than in women. Disease prevalence increased with age for every CV risk factor. Men were less likely than women to take anti-HT drugs and to reach BP control (9.9% vs. 16%). Only 17.6% of HT >65 years had a BP ≤140/90 mmHg, though 48.5% were treated. The use of statins was very low (<1/3 of eligible subjects >65 years, those with the highest treatment rate). The ratio of control-to-treated HT was lower in subjects with, than in those without, thicker carotid arteries (31.5% vs. 38.8%, p < 0.05) or stiffer aortas (26.0% vs. 40.0%, p < 0.05) or carotid plaques (26.3% vs. 41.1%, p < 0.05).ConclusionA large number of subjects at high CV risk are not treated and the management of subclinical vascular lesions is far from optimal.     

A risk score for chronic kidney disease in the general population

BackgroundStratification of individuals at risk for chronic kidney disease may allow optimization of preventive measures to reduce disease incidence and complications. We sought to develop a risk score that estimates an individual's absolute risk of incident chronic kidney disease.MethodsFramingham Heart Study participants free of baseline chronic kidney disease, who attended a baseline examination in 1995-1998 and follow-up in 2005-2008, were included in the analysis (n = 2490). Chronic kidney disease was defined as an estimated glomerular filtration rate <60 mL/min/1.73m² using the Modification of Diet in Renal Disease equation. Participants were assessed for the development of chronic kidney disease at 10 years follow-up. Stepwise logistic regression was used to identify chronic kidney disease risk factors, and these were used to construct a risk score predicting 10-year chronic kidney disease risk. Performance characteristics were assessed using calibration and discrimination measures. The final model was externally validated in the bi-ethnic Atherosclerosis Risk in Communities Study (n = 1777).ResultsThere were 1171 men and 1319 women at baseline, and the mean age was 57.1 years. At follow-up, 9.2% (n = 229) had developed chronic kidney disease. Age, diabetes, hypertension, baseline estimated glomerular filtration rate, and albuminuria were independently associated with incident chronic kidney disease (P <.05), and these covariates were incorporated into a risk function (c-statistic 0.813). In external validation in the ARIC study, the c-statistic was 0.74 in whites (n = 1353) and 0.75 in blacks (n = 424).ConclusionRisk stratification for chronic kidney disease is achievable using a risk score derived from clinical factors that are readily accessible in primary care. The utility of this score in identifying individuals in the community at high risk of chronic kidney disease warrants further investigation.     

Clinical implication of plasma and urine YKL-40, as a proinflammatory biomarker, on early stage of nephropathy in type 2 diabetic patients

ObjectiveChronic inflammation has emerged as being a key pathophysiology in the early stages of diabetic nephropathy. YKL-40 has been established as an inflammatory marker in chronic inflammation. The aim of this study was to evaluate the association of plasma and urine YKL-40 with albuminuria in the early stage of type 2 diabetic nephropathy.Design and methodsA total of 75 type 2 diabetic patients and 22 nondiabetic controls with estimated glomerular filtration (eGFR) ≥ 60 ml/min/1.73 m² were enrolled. Plasma and urine concentrations of YKL-40 were analyzed by ELISA kit.ResultsThe plasma levels of YKL-40 were significantly higher in the normoalbuminuric group with diabetes than in the control group, and increased with increasing severity of albuminuria among diabetes. However, urine YKL-40 was only increased in macroalbuminuric state. Plasma YKL-40 was positively correlated with urine YKL-40 (r = 0.291, P = 0.011). Urinary albumin significantly correlated with both plasma and urine YKL-40 in a univariate analysis. After adjusting for several confounding factors, plasma YKL-40 was significantly correlated with albuminuria (r = 0.359; P = 0.001), whereas urine YKL-40 did not show significant correlation with albuminuria (r = 0.128, P = 0.241).ConclusionsAlthough urine YKL-40 has a limited role, plasma YKL-40, as an proinflammatory marker, was an independent factor associated with albuminuria in early stage of nephropathy in type 2 diabetes and might have an useful role as a noninvasive marker for the early diabetic nephropathy detection.     

The Italian Diabetes and Exercise Study (IDES): design and methods for a prospective Italian multicentre trial of intensive lifestyle intervention in people with type 2 diabetes and the metabolic syndrome

Background and aimsThe IDES is a prospective Italian multicentre randomized controlled trial to evaluate the efficacy of an intensive lifestyle intervention on modifiable cardiovascular disease (CVD) risk factors in a large cohort of people with type 2 diabetes and the metabolic syndrome.Methods and resultsWe recruited 606 subjects with type 2 diabetes and waist circumference >94 cm (M) and >80 cm (F), plus >1 other metabolic syndrome trait (IDF criteria) for both sexes, aged 40–75 years, BMI 27–40 kg/m², diabetes duration >1 year with a sedentary lifestyle of >6 months. Patients were randomized into two groups: a control group, receiving conventional care including exercise counselling and an intervention group, treated with a mixed (aerobic and resistance) exercise programme (150 min/week) prescribed and supervised for 12 months. Primary outcome is HbA1c reduction. Secondary outcomes include other traditional and non-traditional risk factors and their relationship to exercise volume/intensity and fitness; dosage of glucose, lipid and blood pressure-lowering drugs; global CVD 10-year risk; patient well-being; and costs.ConclusionThis trial verifies whether a prescribed and supervised exercise programme, including both aerobic and resistance training, is more effective than conventional exercise counselling in reducing modifiable CVD risk factors in type 2 diabetic subjects with the metabolic syndrome.     

Impact du risque coronarien et de l’hypertension sur le risque rénal en population générale

IntroductionAbnormal albuminuria (≥ 30 mg/g) and low estimated glomerular filtration rate (eGFR < 60 mL/min/1.73m²) not only are renal risk factors, but also cardiovascular and coronarian risk factors. Though, the relation between coronary risk and renal risk, and its interaction with insufficiently controlled brachial pressure (BP) is poorly described in the literature.Subjects and methodsWe realised a cross-sectional study on subjects 40 and older, having attended a medical exam in 11 IRSA centers between 2006 and 2010. Every subject filled a questionnaire, underwent biological analysis, and a clinical examination. eGFR and albuminuria were measured, and the 10-year risk of coronarian event was calculated (Laurier's equation)ResultsWe analysed 118 314 subjects, amongst whom 96 400 had no personal cardiovascular history. Amongst those, 9.1% had a 10-year coronary risk over 10%. There was a continuous relationship between coronary risk and renal risk: subjects with a risk above 15% had a significative risk of pathological albuminuria (OR: 6.87 [5.58–8.44]), and of low eGFR (2.26 [1.82–2.78]) compared to those with a risk under 5%. There was a continuous relationship between BP and renal risk, with a significative risk of pathological albuminuria (OR = 7.75 [6.69–8.96]) and of low eGFR (OR: 1.33 [1.09–1.60]) in subjects with BP greater than or equal to 180/110 mmHg, compared to those with normal BP.ConclusionIn the French population, 9.1% of subjects have a 10-year coronary risk above 10%. This risk is associated to abnormalities of the renal function. The relation between coronary risk and renal risk is continuous and dose-dependent, as is the relation between BP and renal risk.     

Slow heart rate recovery after exercise is associated with carotid atherosclerosis

ObjectiveSlow heart rate recovery (HRR) after exercise is an estimate of impaired parasympathetic tone and predictor of all-cause and cardiovascular mortality. Carotid atherosclerosis is associated with high risk of developing coronary heart disease (CHD) and stroke. We tested the hypothesis that slow HRR is associated with carotid atherosclerosis in a cross-sectional study of 12,712 middle-aged men (age 49.1 ± 8.9 years).MethodsCarotid atherosclerosis was measured using B-mode ultrasonography and defined as stenosis >25% and/or intima–media thickness >1.2 mm. HRR was calculated as the difference between peak heart rate during a graded exercise treadmill test and heart rate 2 min after cessation of exercise.ResultsThe prevalence of carotid atherosclerosis was 8.4%. The prevalence of atherosclerosis was significantly higher among subjects in the lowest (<44 bpm) versus the highest (>61 bpm) quartile of HRR (14.4% versus 4.1%, p < 0.001). In multivariable logistic regression models adjusted for established CHD risk factors, inflammatory markers, and exercise capacity, subjects in the lowest quartile of HRR (<44 bpm) were 1.50 times (95% CI: 1.13–2.00) more likely to have carotid atherosclerosis than subjects in the highest quartile (HRR >61 bpm).ConclusionsSlow heart rate recovery after exercise, an index of decreased parasympathetic activity, is associated with carotid atherosclerosis independent of established risk factors in middle-age men.