Triple threat: diabetes, hypertension, and heart disease

Review care specifics for prediabetes, including details of hypertension and metabolic syndrome.     

Lowering the risks of diabetes, hypertension, and heart disease

Review care specifics for prediabetes, including details of hypertension and metabolic syndrome.     

Interrelation of diabetes mellitus, atherosclerosis and ischemic heart disease

In patients with diabetes mellitus, the processes of lipid peroxidation are activated and the system of antioxidants is disturbed (the content of reduced glutathione and red cell glutathione reductase is lowered and red cell glutathione peroxidase activity is heightened). At the same time the patients demonstrate high concentration of sterols bound by fibrinogen, a considerable lowering of cholesterol content in high density lipoproteins having an antiiatrogenic action. The alterations found underlie the development of atherosclerosis and coronary heart disease.     

Taking hypoglycaemia seriously: diabetes, dementia and heart disease

Hypoglycaemia is a common and potentially deadly problem for people with diabetes who are prescribed insulin secretagogues and/or insulin as part of their treatment regimen. This article focuses mainly on type 2 diabetes and considers the incidence, pharmacological causes and definition of hypoglycaemia. It discusses the recently defined relationships between hypoglycaemia and the onset and development of dementia and cardiovascular disease. Hypoglycaemia risk factors are identified and linked to specific characteristics found in the elderly, and information is offered on how to treat hypoglycaemia effectively and avoid repeated episodes.     

The potential of embryonic stem cells to treat heart disease

Cell therapy is currently receiving growing interest as a new means of repairing infarcted myocardium. Despite the encouraging experimental results yielded by autologous skeletal myoblasts and bone marrow-derived hematopoietic and mesenchymal stem cells, there is increasing evidence that the plasticity of these adult cells is more limited than initially thought and that, consequently, their conversion into cardiomyocytes is unlikely or, at best, quantitatively very limited. As the engrafted cells should electromechanically interact with host cardiac cells to form a functional syncytium, attention is now increasingly focused on cells that feature a true cardiomyogenic differentiation potential, enabling them to connect with the neighboring cardiomyocytes. In this setting, embryonic stem cells are particularly attractive, since they can be precommitted towards a cardiac lineage and complete their full maturation in vivo, possibly under the influence of host tissue-associated paracrine signaling pathways. Although a potential clinical use of embryonic stem cells is still fraught with difficulty (amplification, purification and immunogenicity), available experimental data suggest a consistent efficacy in repairing infarcted myocardium, which has stimulated efforts to address these issues.     

Coronary heart disease in patients with diabetes mellitus

Diabetes mellitus is a well-recognized risk-factor for coronary artery disease. It is known that diabetic patients have a two-to fourfold increased risk of mortality or morbidity for cardiovascular diseases compared with the general population. Further, many diabetic patients with coronary heart disease have severe diseased coronary arteries: multi-vessel disease and/or severe stenosed vessel(s). In Japan, the prevalence of diabetic patients is rapidly increasing in these days. This article will review the evaluation for risk of coronary heart disease by measuring glucose level, the prognosis of diabetic patients, and the prevention of cardiovascular event in the patients with diabetes mellitus.     

In utero ultrasound diagnosis of congenital heart disease

Two hundred and one pregnancies considered at high risk for congenital heart disease (CHD) underwent fetal cross-sectional echocardiographic (CSE) examination. In 190 cases a structurally normal heart was correctly predicted; seven cases of CHD were identified, but in two of them the specific diagnosis was inaccurate. One false positive diagnosis of a small ventricular septal defect was made. There were three false negative diagnoses: two of ventricular septal defects and one of aortic coarctation. We conclude that severe heart malformations can be reliably identified or excluded by CSE in utero, but important anatomical details may be missed. Therefore, prognosis should be based only on the structures identified to multiple-scan planes.     

Prevention of coronary heart disease in type 2 diabetes

Patients with diabetes without a prior myocardial infarction are at a similar risk of coronary heart disease (CHD) events as non-diabetic subjects with a prior myocardial infarction. Furthermore, prognosis after the first myocardial infarction is worse in diabetic compared to non-diabetic patients. Therefore, management of cardiovascular risk factors in subjects with diabetes should be as vigorous as in patients with known CHD who have had a myocardial infarction. Randomised controlled trials have shown that efficacy of cholesterol lowering and antihypertensive therapy in type 2 diabetes is at least as effective as in non-diabetic subjects in preventing macrovascular disease. Antiplatelet therapy with aspirin reduces the risk of CHD events in high-risk patients and the benefit is similar in subjects with and without diabetes. Improved glycaemic control has a modest beneficial effect on CHD risk. There is residual excess risk of CHD in type 2 diabetes, which is not explained by traditional cardiovascular risk factors. Insulin resistance may partly mediate this. Prediabetic subjects who are insulin resistant have more adverse levels of triglycerides, high density lipoprotein (HDL)-cholesterol and blood pressure than those who are insulin sensitive. Moreover, factors associated with insulin resistance are significant predictors of CHD events in subjects with diabetes, in addition to conventional risk factors. The thiazolidinedione, pioglitazone, improves glycaemia and insulin sensitivity in hyperglycaemic patients. It also improves insulin and triglyceride levels and lowers blood pressure. Thiazolidinediones have been found to have vasculo-protective effects in both acute and chronic vascular injury in animal models. For prevention of CHD in type 2 diabetes a multi-factorial approach should be considered, including improved glycaemic control, aggressive management of dyslipidaemia and hypertension, anti-platelet therapy, reduction of insulin resistance and use of agents that improve insulin sensitivity.     

Using BNP to diagnose,manage, and treat heart failure

A rapid assay for B-type natriuretic peptide (BNP) not only can be used to diagnose heart failure, it can help the clinician evaluate effectiveness of therapy, determine when discharge from the hospital is appropriate, and estimate prognosis. A synthetic formulation of BNP (nesiritide) is used to treat decompensated heart failure, resulting in improved hemodynamics and symptoms.     

黛力新治疗老年冠心病伴抑郁症的临床研究

目的．观察黛力新（氟哌噻吨美利曲辛片）治疗军队离退休干部（军队休干）冠心病伴发抑郁症的疗效。方法将2010-2011年在院的军队休干明确诊断为冠心病合并抑郁症52例患者随机分为两组,A组为治疗组,B为组对照组,两组均常规给以拜阿司匹林、单硝酸异山梨酯、他汀类等药物口服,A组同时加服黛力新片。采用动态心电图观察用药前后心绞痛发生情况;并用汉密顿抑郁量表（HAMD）观察其抑郁变化程度。结果A组总有效率92．0％,B组总有效率55．5％,P〈0．05。HAMD评分：A组明显好转,差异有统计学意义,P〈0．05。结论黛力新可以同时改善老年冠心病伴发抑郁症患者的缺血症状以及抑郁程度。     

DNA vaccination to treat autoimmune diabetes

In numerous animal models, DNA immunization has been shown to induce protective immunity against infectious diseases (viral, bacterial and protozoan) and cancers (1, 2). In these situations it is desirable to induce a strong immune response to the DNA-encoded antigen in order to generate an immune memory that enables the vaccine to respond more rapidly to subsequent challenge. The success of DNA vaccination in this regard has led to its rapid introduction into several human clinical trials (3, 4). However, in autoimmunity, undesirable immune responses to autoantigens are thought to lead to the destruction of target cells or organs, resulting in diseases such as myasthenia gravis, diabetes or multiple sclerosis. Thus, at first sight, it appears that immunization would more likely trigger autoimmunity than ameliorate it. Nevertheless, clinical experience has shown that certain immune-mediated diseases may be countered by low-dose antigen administration (‘desensitization’), although the underlying mechanisms remain somewhat conjectural. Here, we will describe an intriguing approach to the prevention of autoimmune disease, in which we use a DNA vaccine encoding a self-antigen to abrogate autoimmune diabetes. The success of this strategy relies on the nature of the immune response induced by the DNA vaccine.     

Type-2 diabetes and coronary heart disease: common physiopathology,viewed from autoimmunity

Two highly prevalent diseases, Type-2 diabetes mellitus and coronary heart disease (CHD), share risk factors. Excess levels of LDL-cholesterol have been overemphasized to uniformly encompass the development of CHD, and the origin of insulin resistance underlying Type-2 diabetes has not been fully elucidated. Autoimmune response has been recognized to be responsible only of a small minority of diabetes. The increasing trend in the worldwide prevalence of diabetes and the risk factors for both diseases are reviewed, the independent mediation for CHD of (central) adiposity in both diseases and the ‘hypertriglyceridemic waist’ phenotype are outlined. Evidence is described that serum lipoprotein (Lp)(a) concentrations, not only in excess, but also in apparently ‘reduced’ levels, as a result of autoimmune response, underlie both disorders and are closely related to insulin resistance.     

DNA vaccination to treat autoimmune diabetes

In numerous animal models, DNA immunization has been shown to induce protective immunity against infectious diseases (viral, bacterial and protozoan) and cancers (1, 2). In these situations it is desirable to induce a strong immune response to the DNA-encoded antigen in order to generate an immune memory that enables the vaccine to respond more rapidly to subsequent challenge. The success of DNA vaccination in this regard has led to its rapid introduction into several human clinical trials (3, 4). However, in autoimmunity, undesirable immune responses to autoantigens are thought to lead to the destruction of target cells or organs, resulting in diseases such as myasthenia gravis, diabetes or multiple sclerosis. Thus, at first sight, it appears that immunization would more likely trigger autoimmunity than ameliorate it. Nevertheless, clinical experience has shown that certain immune-mediated diseases may be countered by low-dose antigen administration ('desensitization'), although the underlying mechanisms remain somewhat conjectural. Here, we will describe an intriguing approach to the prevention of autoimmune disease, in which we use a DNA vaccine encoding a self-antigen to abrogate autoimmune diabetes. The success of this strategy relies on the nature of the immune response induced by the DNA vaccine.     

抑郁症伴发高血压糖尿病冠心病患者临床特征分析

目的探讨抑郁症伴发高血压、糖尿病、冠心病患者的临床特征,为临床干预提供依据。方法将50例伴有高血压、糖尿病、冠心病的抑郁症患者设为共病组,抽取同期住院的50例单纯抑郁症患者设为对照组,两组均口服舍曲林治疗,观察12周。于治疗前及治疗12周末采用汉密顿焦虑量表、汉密顿抑郁量表评定焦虑抑郁状况,采用社会功能缺陷筛选量表评定社会功能状况。结果治疗前共病组汉密顿焦虑量表,汉密顿抑郁量表及社会功能缺陷筛选量表总分均显著高于对照组（P〈0．01）;治疗12周末,各量表评分均较治疗前显著下降,但共病组仍显著高于对照组（P〈0．05或0．01）。结论抑郁症伴发高血压、糖尿病、冠心病患者较单纯抑郁症患者的焦虑、抑郁症状严重,社会功能缺陷明显,治疗效果较差。     

Prediction of coronary heart disease in middle-aged adults with diabetes

OBJECTIVE: To determine the 10-year probability of coronary heart disease (CHD) in diabetic adults and how well basic and novel risk factors predict CHD risk. RESEARCH DESIGN AND METHODS: We measured risk factors in 14054 participants (1500 with diabetes) initially free of CHD in the Atherosclerosis Risk in Communities study from 1987 to 1989 and followed them prospectively for CHD incidence through 1998. We used proportional hazards regression models and receiver operating characteristic (ROC) curves for CHD risk prediction. RESULTS: Based on our model using basic risk factors (age, race, total and HDL cholesterol, systolic blood pressure, antihypertensives, and smoking status), approximately 61% of diabetic women and 86% of diabetic men had a predicted 10-year CHD probability >or=10%. This CHD risk-prediction model had an area under the ROC curve of 0.72 in diabetic women and 0.67 in diabetic men. Novel risk factors or subclinical disease markers individually added only modest predictivity, but the addition of multiple markers (BMI, waist-to-hip ratio, Keys dietary score, serum albumin and creatinine, factor VIII, white blood cell count, left ventricular hypertrophy determined by electrocardiogram, and carotid intima-media thickness) increased the area under the curve by approximately 10%. CONCLUSIONS: Although all diabetic adults are at high risk for CHD, their variation in CHD risk can be predicted moderately well by basic risk factors. No single novel risk marker greatly enhanced absolute CHD risk assessment, but a battery of novel markers did. Our model can provide estimates of CHD risk for the primary prevention of this disease in people with type 2 diabetes.