Independent relationship of serum uric acid levels with leukocytes and coronary atherosclerotic burden

Background and AimEpidemiological studies have shown that increased serum uric acid (SUA) level is associated with coronary artery disease (CAD). Leukocytes have been shown to play an important role in the atherosclerotic process. The aim of the study was to investigate whether there is any relationship among SUA, leukocyte counts and coronary atherosclerotic burden in patients who are suspected of having CAD.Method and resultsWe enrolled 690 eligible patients who had undergone coronary angiography between October 2005 and June 2006 in a consecutive manner. The relationship of SUA with total and differential leukocyte counts and CAD was investigated. Serum uric acid levels (5.57 ± 1.64 vs 4.63 ± 1.27 mg/dl, p < 0.001) and leukocytes were higher in patients with CAD than those with normal coronary arteries (NCA). When we divided the patients into four groups according to the quartiles of SUA, we found that the monocyte count was prominently related with SUA (478 ± 165, 553 ± 177, 565 ± 199 and 607 ± 229 mm⁻³, Q1–Q4, p < 0.001). In multivariate analysis, SUA was an independent predictor of CAD (OR, 1.270; 95% CI, 1.087–1.484, p = 0.003). When we performed multiple linear regression analyses to determine the independent predictors of inflammatory cells in blood, we found a strong, positive and independent relationship between SUA with neutrophils (β ± SE: 206 ± 60, p = 0.001) and monocytes (β ± SE: 35 ± 7, p < 0.001).ConclusionOur study results demonstrated that neutrophils and monocytes which play an important role in inflammation and atherosclerosis were independently related with SUA. This finding suggests an important epidemiologic relation and may provide a possible causative mechanism of SUA in atherosclerotic process.     

Serum uric acid concentration is associated with worsening in severity of diabetic retinopathy among type 2 diabetic patients in Taiwan—A 3-year prospective study

AimsTo explore the role of serum uric acid (SUA) concentration in diabetic retinopathy (DR) for patients with type 2 diabetes mellitus (T2DM).MethodsA 3-year prospective study in 749 patients with T2DM and without proliferative diabetic retinopathy (PDR) was conducted at a medical center. Baseline SUA concentration and parameters of glycemic control, blood pressure, kidney disease, and lipid profiles were analyzed to determine their contribution to DR.ResultsFundus examination showed that 184 patients (24.6%) had non-proliferative retinopathy and 565 (75.4%) without DR at baseline. After 3 years, increase in the severity of DR was recognized in 103 patients (13.8%), including 81 patients with newly developed DR. Patients with increase in severity of DR positively associated with duration of DM (11.9 vs. 9.4 years, p = 0.001), HbA1c (7.6 vs. 7.2%, p = 0.001), albuminuria (45.5 vs. 31.0%, p = 0.006), and SUA (6.47 vs. 5.87 mg/dl, p < 0.001) than did those without change in DR stage. Cox regression showed that patients with SUA in the 3rd (5.9–6.9 mg/dl) and 4th (≥7.0 mg/dl) quartiles had hazard ratios for DR worsening of 2.57 and 3.66 (95% C.I. 1.30–5.08 and 1.92–7.00) when compared with patients with SUA in the 1st quartile (<4.9 mg/dl).ConclusionsSUA concentration is associated with the increase in severity of DR over a 3-year period in patients with T2DM. Further study is required to define the exact role of SUA in DR.     

Serum uric acid as an independent predictor of mortality in high-risk patients with obstructive coronary artery disease: A prospective observational cohort study from the ET-CHD registry, 1997–2003

BackgroundSerum uric acid (SUA) has been observed to be highly associated with the development of cardiovascular disease for more than 50 years. Several studies have reported elevated SUA as an independent predictor of mortality in patients with coronary artery disease (CAD) after adjustment for classic risk factors but some studies did not find similar results.MethodsBetween January 1997 and December 2003, a prospective cohort study was performed in 1054 patients with angiographically defined CAD, and their classic risk factors and SUA levels were determined at enrollment. The study cohort was followed for an average of 3.2 years, with a median of 3.1 years. The main outcome measure was death from cardiac disease and any cause.ResultsOf all study patients, 789 (74.9%) were men and 265 (25.1%) were women. The mean age of the male and female patients was 64.8 and 66.9 years, respectively. The mean SUA level of all patients was 410.4 μmol/L. There were grading effects of SUA quartiles on cardiac and all-cause mortality in univariate and multivariate Cox regression analyses. After adjustment, the multivariate analyses revealed that patients in the highest SUA quartile (>487 μmol/L) had 2.08 (95% CI = 1.19–3.62, p = 0.01) fold increased risk of cardiac death, and 1.68 (95% CI = 1.10–2.57, p = 0.017) fold increase risk of overall mortality compared with the lowest quartile (<315 μmol/L).ConclusionsSUA may be a significant predictor of cardiac and overall mortality, independent of classic risk factors in high-risk patients with obstructive CAD.     

Role of diagnostic ultrasonography in detecting gouty arthritis

IntroductionGout is a form of inflammatory arthritis that is characterized by attacks of active synovitis related to the presence of monosodium urate (MSU) crystals in the joints and periarticular soft tissues.Aim of the workTo establish the usefulness of ultrasonography (US) in diagnosing subclinical gouty arthritis and to determine whether there are sonographic features that are characteristic of gout.Patients and methodsWe studied 20 patients known to be gouty (group 1), 20 patients with asymptomatic hyperuricemia (AH) (group 2) and 20 controls (group 3) in a cross sectional study. Demographic, clinical and serological data were evaluated. Knee and 1st MTP joints were assessed by musculoskeletal (US) to detect subclinical gouty arthritis.ResultsClinical gouty arthritis was found in only (20%) in (group 1), but subclinical gouty arthritis had been found in (75%) in (group1) and (25%) in (group 2). There were statistically significant differences between the examined groups regarding the presence of double contour (DC) sign (p < 0.001), joint effusion (p = 0.04), serum uric acid (SUA) level (p < 0.001), diuretics use (p < 0.001), allopurinol use (p < 0.001), also it was found that only SUA was the risk factor for the occurrence of the double contour (DC) sign (p = 0.03) and cut-off value of SUA was 9.1 mg/dl above which DC sign was detected.ConclusionUltrasonography (US) is a useful tool to detect subclinical gouty arthritis; also serves as a non-invasive, bedside and non-ionizing tool.     

Role of asymmetric-dimethyl-l-arginine (ADMA) and nitrite/nitrate (NOx) in the pathogenesis of oxidative stress in female subjects with uncomplicated type 1 diabetes mellitus

AimsTo explore the role of asymmetric-dimethyl-l-arginine (ADMA), an endogenous nitric oxide synthetases (NOS) inhibitor, and nitrite/nitrate (NOx) in the pathogenesis of oxidative stress in early stages of type 1 diabetes mellitus.MethodsWe measured in 99 female subjects with uncomplicated type 1 diabetes (duration disease <10 years) and in 44 sex-matched controls (comparable for age, smoking habit, diet and physical activity) plasma levels of NOx, glycosylated haemoglobin (HbA1c), glucose, uric acid, total cholesterol, high density lipoprotein (HDL) cholesterol, triglycerides and serum ADMA.ResultsType 1 diabetic subjects have higher levels of glycemia, HbA1c, LDL cholesterol and NOx, but lower ADMA and serum uric acid (UA), compared with the control group; no further differences were found. A significant linear and inverse correlation was found between NOx and ADMA levels (R² = 0.237, p < 0.001).ConclusionsThis study suggests a reduced ADMA inhibition of NOS as possible mechanism involved in the pathogenesis of oxidative stress in female subjects with a short duration and uncomplicated type 1 diabetes.     

Presence of coronary artery disease in diabetic and non diabetic South Asian immigrants

IntroductionSouth Asian Immigrants (SAIs) are the second fastest growing Asian immigrant population in the US, and at a higher risk of type 2 diabetes (diabetes) and coronary artery disease (CAD) than the general US population. Objectives: We sought to determine in SAIs the; 1) the prevalence of CAD risk factors in diabetics and non-diabetics; and b) the high possibility of CAD in diabetic SAIs. We also assessed the prevalence of sub-clinical CAD in both diabetics and non-diabetics SAIs using common carotid artery Intima-media thickness (CIMT) as a surrogate marker for atherosclerosis.MethodsIn a cross-sectional study design, 213 first generation SAIs were recruited and based on the history, and fasting glucose levels were divided into two subgroups; 35 diabetics and 178 non-diabetics. 12-hour fasting blood samples were collected for glucose and total cholesterol levels. Exercise Tolerance Test (ETT) was performed to determine the possibility of CAD.ResultsBoth diabetics and non-diabetics SAIs in general, share a significant burden of CAD risk factors. The prevalence of hypertension (p = 0.003), total cholesterol ≥ 200 mg/dl (p < 0.0001) and family history of diabetes (p < 0.0001) was significantly was significantly higher in diabetics compared to non-diabetics. Of the 22/29 diabetic participants without known history of CAD, 45% had positive ETT (p < 0.001). Similarly, 63.1% of diabetics and 51.8 % of non-diabetics were positive for sub-clinical CAD using CIMT as a marker.ConclusionThe susceptibility to diabetes amongst SAIs promotes an adverse CAD risk, as evident by this small study. Further research, including larger longitudinal prospective studies, is required to validate the current small study findings with investigation of the temporal association.     

Serum uric acid and insulin sensitivity in adolescents and adults with and without type 1 diabetes

HypothesisDecreased insulin sensitivity (IS) exists in type 1 diabetes. Serum uric acid (SUA), whose concentration is related to renal clearance, predicts vascular complications in type 1 diabetes. SUA is also inversely associated with IS in non-diabetics, but has not been examined in type 1 diabetes. We hypothesized SUA would be associated with reduced IS in adolescents and adults with type 1 diabetes.MethodsThe cross-sectional and longitudinal associations of SUA with IS were investigated in 254 adolescents with type 1 diabetes and 70 without in the Determinants of Macrovascular Disease in Adolescents with Type 1 Diabetes Study, and in 471 adults with type 1 diabetes and 571 without in the Coronary Artery Calcification in Type 1 diabetes (CACTI) study.ResultsSUA was lower in subjects with type 1 diabetes (p < 0.0001), but still remained inversely associated with IS after multivariable adjustments in adolescents (β ± SE: − 1.99 ± 0.62, p = 0.001, R² = 2%) and adults (β ± SE: − 0.91 ± 0.33, p = 0.006, R² = 6%) with type 1 diabetes, though less strongly than in non-diabetic controls (adolescents: β ± SE: − 2.70 ± 1.19, p = 0.03, R² = 15%, adults: β ± SE: − 5.99 ± 0.75, p < 0.0001, R² = 39%).ConclusionWe demonstrated a significantly weaker relationship between SUA and reduced IS in subjects with type 1 diabetes than non-diabetic controls.     

Circulating irisin levels are lower in patients with either stable coronary artery disease (CAD) or myocardial infarction (MI) versus healthy controls,whereas follistatin and activin A levels are higher and can discriminate MI from CAD with similar to CK-MB accuracy

BackgroundSeveral myokines are produced by cardiac muscle. We investigated changes in myokine levels at the time of acute myocardial infarction (MI) and following reperfusion in relation to controls.MethodsPatients with MI (MI Group, n = 31) treated with percutaneous coronary intervention (PCI) were compared to patients with stable coronary artery disease (CAD) subjected to scheduled PCI (CAD Group, n = 40) and controls with symptoms mimicking CAD without stenosis in angiography (Control Group, n = 43). The number and degree of stenosis were recorded. Irisin, follistatin, follistatin-like 3, activin A and B, ALT, AST, CK and CK-MB were measured at baseline and 6 or 24 h after the intervention.ResultsMI and CAD patients had lower irisin than controls (p < 0.001). MI patients had higher follistatin, activin A, CK, CK-MB and AST than CAD patients and controls (all p ≤ 0.001). None of the myokines changed following reperfusion. Circulating irisin was associated with the degree of stenosis in all patients (p = 0.05). Irisin was not inferior to CK-MB in predicting MI while folistatin and activin A could discriminate MI from CAD patients with similar to CK-MB accuracy. None of these myokines was altered following PCI in contrast to CK-MB.ConclusionsIrisin levels are lower in MI and CAD implying that their production may depend on myocadial blood supply. Follistatin and activin A are higher in MI than in CAD suggesting increased release due to myocardial necrosis. They can predict MI with accuracy similar to CK-MB and their role in the diagnosis of MI remains to be confirmed by prospective large clinical studies.     

Paraoxonase 1 gene (Gln192–Arg) polymorphism and the risk of coronary artery disease in type 2 diabetes mellitus

BackgroundParaoxonase 1 (PON1) is reported to have antioxidant and cardioprotective properties. Recently, an association of glutamine (Gln) or type A/arginine (Arg) or type B polymorphism at position 192 of PON1 gene has been suggested with coronary artery disease (CAD) among patients with diabetes mellitus (DM). However, conflicting results have also been reported.ObjectivesTo investigate the relationship between PON1 gene (Gln¹⁹²–Arg) polymorphism and the presence, extent and severity of CAD in type 2 DM.MethodsThe study comprised 180 patients recruited from those undergoing coronary angiography for suspected CAD, who were divided according to the presence or absence of CAD and DM into four groups: Group I (n = 40 patients) nondiabetic subjects without CAD, Group II (n = 45 patients) diabetic patients without CAD, Group III (n = 47 patients) nondiabetic patients with CAD and Group IV (n = 48 patients) diabetic patients with CAD. PON1(Gln¹⁹²–Arg) genotype was assessed using polymerase chain reaction (PCR) followed by AlwI digestion.ResultsThe frequency of Gln allele (type A) was significantly higher in Group I and Group II compared to Group III and Group IV (62.5%, 60% vs. 38.3%, 31.25%, respectively, p < 0.001) while the frequency of Arg allele (type B + type AB) was significantly higher in ischemic groups (III and IV) compared to nonischemic groups (I and II) (61.7%, 68.75% vs. 37.5%, 40%, respectively, p < 0.001). Patients with CAD and DM (Group IV) have significantly higher severity score and vessel score than those with CAD only (Group III) (9.7 ± 2.97, 2.44 ± 0.56 vs. 6.99 ± 3.71, 1.67 ± 0.89, respectively, p < 0.001) Patients with vessel score 3 had significantly higher severity score and higher Arg allele frequency than patients with vessel score 2, the latter group had also significantly higher severity score and Arg allele frequency than patients with vessel score 1 (8.9 ± 2.79 vs. 5.21 ± 2.13 and 80.49% vs. 67.86%), (5.21 ± 2.13 vs. 3.11 ± 0.89 and 67.86% vs. 53.85%), p < 0.001 for all. In multivariate logistic regression analysis of different variables for prediction of CAD, age [OR 2.99, CI (1.11–10.5), p < 0.01], smoking [OR 4.13, CI (1.37–11.7), p < 0.001], low-density lipoprotein (LDL) cholesterol > 100 mg/dL [OR 4.31, CI (1.25–12.5), p < 0.001], high-density lipoprotein (HDL) cholesterol < 40 mg/dL [OR 5.11, CI (1.79–16.33), p < 0.001] and PON1 192 Arg allele [OR 4.62, CI (1.67–13.57), p < 0.001] were significantly independent predictors of CAD.ConclusionArg allele of PON1 192 gene polymorphism is an independent risk factor for CAD and is associated not only with the presence of CAD but also with its extent and severity and its impact is clearly more pronounced in diabetic patients.     

High-normal serum uric acid predicts the development of chronic kidney disease in patients with type 2 diabetes mellitus and preserved kidney function

AimsWe evaluated whether high-normal serum uric acid (SUA) levels can predict the development of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus and preserved kidney function at baseline.MethodsThis was a retrospective observational longitudinal study of patients presenting at the Department of Endocrinology and Metabolism, Pusan National University Hospital. A total of 512 patients with type 2 diabetes mellitus and preserved kidney function (estimated glomerular filtration rate [eGFR] ≥ 60 mL/min/1.73 m²) and normouricemia were included. The main outcome was development of CKD of stage 3 or greater. The patients were divided into four groups according to quartiles of SUA levels.ResultsDuring the follow-up period, 62 (12.1%) patients had progressed to CKD 3 or greater. The group with the highest-normal range of SUA (Q4) showed a higher cumulative incidence of CKD stage 3 or greater than that of the other lower quartiles (Q4 vs. Q3; P = 0.037, Q4 vs. Q2; P < 0.001, Q4 vs. Q1; P < 0.001). In a univariate analysis, Q4 was significantly associated with the development of CKD 3 or greater (log-rank statistic, 31.93; P < 0.001). In a multivariate analysis, Q4 (hazard ratio, 2.97; 95% confidence interval, 1.15–7.71; P = 0.025) showed a significant association with CKD 3 or greater.ConclusionsHigh-normal SUA may predict the occurrence of CKD stage 3 or greater in patients with type 2 diabetes mellitus and preserved kidney function.     

A study of diabetes complications in an endogamous population: An emerging public health burden

AimThe aims of this study were to determine the prevalence of diabetic complications namely neuropathy, nephropathy, and retinopathy among Qatari's DM patients; and to find associations between these complications and socio-demographic and clinical characteristics in a highly consanguineous population.DesignIt is an observational cohort study.SettingThe survey was carried out at the Hamad General Hospital and Primary Health Care (PHC) centers in the State of Qatar.SubjectsThe study was conducted from May 2011 to January 2013 among Qatari nationals above 20 years of age. Of the 2346 registered with diagnosed diabetes attending Hamad General Hospital and PHC centers, 1633 (69.3%) agreed and gave their consent to take part in this study.MethodsQuestionnaire included socio-demographic variables, body mass index (BMI), consanguinity, lifestyle habits, family history of diabetes, blood pressure and development of diabetes complications such as retinopathy, nephropathy, and neuropathy were collected at regular intervals throughout the follow-up. Univariate and multivariate statistical analysis were performed.ResultsOut of 1633 diabetic patients, 842 (51.6%) were males. The prevalence of diabetic nephropathy 12.4% and retinopathy was 12.5% followed by neuropathy 9.5% among diabetic population. The proportion of diabetic neuropathy and nephropathy were significantly higher among diabetic patients with age 60 years and above as compared to younger age groups (p = 0.010). Nephropathy was significantly higher among male diabetic (p = 0.014) and smokers (p < 0.001) while diabetic neuropathy was more common among diabetic hypertensive patients (p = 0.028). Multivariate logistic regression showed that Age (p = 0.025), being male (p = 0.045), and having high blood pressure (p = 0.006) were significant predictors of diabetic neuropathy. For diabetic retinopathy, family history of DM (p < 0.001), consanguinity (p = 0.010), having high blood pressure (p = 0.042) and physical activity (p < 0.001) were significant predictors of diabetic retinopathy. Meanwhile, for diabetic nephropathy, age (p < 0.001), smoking (p = 0.045), physical activity (p < 0.001) hypertension (p < 0.001) and gender (p = 0.012) were the significant predictors.ConclusionDiabetes exerts a significant burden in Qatar, and this is expected to increase. Many diabetic patients face significant challenges accessing diagnosis and treatment, which contributes to the high morbidity and mortality and prevalence of complications observed. The significant interactions between diabetes and associated complications highlight the need and opportunity for health planners to develop integrated responses to communicable and non-communicable diseases.     

Prognostic value of hyperglycemia on-admission in diabetic versus non-diabetic patients presenting with ST-elevation myocardial infarction in Tunisia

BackgroundHyperglycemia on-admission is a powerful predictor of adverse events in patients presenting for ST-elevation myocardial infarction (STEMI).AimIn this study, we sought to determine the prognostic value of hyperglycemia on-admission in Tunisian patients presenting with STEMI according to their diabetic status.MethodsPatients presenting to our center between January 1998 and September 2014 were enrolled. Hyperglycemia was defined as a glucose level ≥11 mmol/L. In-hospital prognosis was studied in diabetic and non-diabetic patients. The predictive value for mortality of glycemia level on-admission was assessed by mean of the area under receiver operating characteristic (ROC) curve calculation.ResultsA total of 1289 patients were included. Mean age was 60.39 ± 12.8 years and 977 (77.3%) patients were male. Prevalence of diabetes mellitus was 70.2% and 15.2% in patients presenting with and without hyperglycemia, respectively (p < 0.001). In univariate analysis, hyperglycemia was associated to in-hospital death in diabetic (OR: 8.85, 95% CI: 2.11–37.12, p < 0.001) and non-diabetic patients (OR: 2.57, 95% CI: 1.39–4.74, p = 0.002). In multivariate analysis, hyperglycemia was independently predictive of in-hospital death in diabetic patients (OR: 9.6, 95% CI: 2.18–42.22, p = 0.003) but not in non-diabetic patients (OR: 1.93, 95% CI: 0.97–3.86, p = 0.06). Area under ROC curve of glycemia as a predictor of in-hospital death was 0.792 in diabetic and 0.676 in non-diabetic patients.ConclusionIn patients presenting with STEMI, hyperglycemia was associated to hospital death in diabetic and non-diabetic patients in univariate analysis. In multivariate analysis, hyperglycemia was independently associated to in-hospital death in diabetic but not in non-diabetic patients.     

Association of asymptomatic hyperuricemia and endothelial dysfunction in psoriatic arthritis

IntroductionCardiovascular disease is an increasingly recognized contributor to excess morbidity and mortality in psoriatic arthritis (PsA). Traditional cardiovascular risk factors do not adequately account for the extent of cardiovascular disease in PsA.Aim of the workTo examine the prevalence of subclinical atherosclerosis in patients with PsA to emphasize the potential role of serum uric acid on endothelial dysfunction, as an early predictor for atherosclerosis in PsA patients.Patients and methodsThis study included 60 PsA patients as well as 60 age and sex matched healthy controls. Assay of serum uric acid, interleukin-6 (IL-6) and soluble intercellular adhesion molecule-1 (sICAM-1) was done for all patients and controls. Patients were subjected to psoriasis area severity index (PASI) and assessment of disease activity. Patients and controls underwent brachial flow-mediated dilatation (FMD) assessment by color duplex sonography to determine endothelial dysfunction as well as extracranial carotid arteries assessment by high-resolution B-mode ultrasound to measure the common carotid intima-media thickness (CIMT) and the detection of atheromatous plaques.ResultsPsA patients have a high significant difference in CIMT, FMD of the brachial artery and mean levels of serum uric acid compared to healthy controls (p < 0.001). PsA patients with hyperuricemia have a high significant difference in CIMT and FMD of the brachial artery than those with normal serum uric acid. Serum uric acid levels showed a high significant positive correlation with each of CIMT, disease duration, markers of inflammation (ESR, CRP, IL-6, sICAM-1), disease activity score in 28 joints (DAS 28) and PASI (r = 0.71, 0.893, 0.956, 0.858, 0.853, 0.877, 0.907, 0.847, respectively, as p < 0.001). A high significant negative correlation was found between serum uric acid levels and FMD of the brachial artery as r = ?0.634, p < 0.001.ConclusionPatients with PsA have a high prevalence of subclinical atherosclerosis dependent on serum uric acid, suggesting that chronic systemic inflammation and endothelial dysfunction appear to be the link between asymptomatic hyperuricemia and atherosclerosis. Therefore, proper control of serum uric acid may play a preventive role in the development of atherosclerosis in PsA patients.     

Covert dose reduction is a distinct type of medication non-adherence observed across all care settings in Inflammatory Bowel Disease

BackgroundNon-adherence by dose omission is common and deleterious to outcomes in Inflammatory Bowel Disease (IBD), but covert dose reduction (CDR) remains unexplored.AimsTo determine frequency and attitudinal predictors of overall medication non-adherence and of covert dose reduction as separate entities.MethodsA cross sectional questionnaire was undertaken involving IBD patients in three different geographical regions and care settings. Demographics, medication adherence by dose omission, and rate of patient initiated dose reduction of conventional meds without practitioner knowledge (CDR) were assessed, along with attitudes toward IBD medication.ResultsOf 473 respondents (mean age 50.3 years, 60.2% female) frequency of non-adherence was 21.9%, and CDR 26.9% (p < 0.001). By logistic regression, significant independent predictors of non-adherence were dissatisfaction with the patient–doctor relationship (p < 0.001), depression (p = 0.001), anxiety (p = 0.047), and negative views regarding medication efficacy (p < 0.001) or safety (p = 0.017). Independent predictors of covert dose reduction included regular complementary medicine (CAM) use (p < 0.001), experiencing more informative (p < 0.001) and comfortable (p = 0.006) consultations with alternative practitioners, disbelieving doctor delivered information (p = 0.021) and safety concerns regarding conventional medication (p < 0.001). Neither the frequency of non-adherence (p = 0.569) nor CDR (p = 0.914) differed between cohorts by different treatment settings.ConclusionsCovert dose reduction of IBD medication is more common than omission of medication doses, predicted by different factors to usual non-adherence, and has not been previously reported in IBD. The strongest predictor of CDR is regular CAM use.     

Is vitamin D status a predictor glycaemic regulation and cardiac complication in type 2 diabetes mellitus patients?

ObjectiveTo evaluate vitamin D as a predictor of glycaemic regulation in type 2 diabetes mellitus patients.Research design and methodsIn observational study 171 type 2 diabetic patients who are followed for median (range) of 10.15 (3–18) years. Mean ± SD age was 56 ± 10. Plasma 25-hydroxyvitamin D3 levels were determined by high-performance liquid chromatography/tandem mass spectrometry on baseline samples. Vitamin D deficiency was defined as a 25-OHD level of less than 20 ng/ml. Vitamin D levels between 20 and 30 ng/ml are termed ‘insufficient’. Vitamin D levels greater than 30 ng/ml are termed ‘optimal’.Results125 patients have vitamin D deficiency, 14 patients have insufficient and the others have optimal. Vitamin D levels were not associated with sex, age, BMI, HDL, LDL, kreatinin, hypertension and smoking. But vitamin D deficiency patients had more longer duration (p = 0.011), more higher uric acid (p = 0.021), fasting glucose (p = 0.037), postprandial glucose (p = 0.001) and HbA1c (p = 0.026).ConclusionsIn our study type 2 diabetic patients have 73% of vitamin D deficiency. Vitamin D deficiency predicts higher fasting and postprandial blood glucose and diabetes disregulation. Type 2 DM patients and low 25-OH vitamin D levels could increased cardiovascular disease directly or indirectly (low HDL and high uric acid in 25-OH vitamin D <20 ng/ml). Whether vitamin D substitution improves prognosis remains to be investigated.     

Prognostic Significance of Serum Uric Acid in Patients Admitted to the Department of Medicine

BackgroundHyperuricemia has been linked to proatherogenic processes, including increased oxidative stress and leukocyte activation, and was shown to predict adverse prognosis in heart failure, renal failure, and hypertension. Recently, serum uric acid (SUA) was shown to be an independent predictor of long-term mortality in patients with cardiovascular diseases. However, the prognostic significance of SUA for the short-term outcome of admitted medical patients is unknown.MethodsInitial SUA, together with epidemiological, clinical, and laboratory data, was analyzed for a prospective cohort of 650 consecutive adult patients admitted to the department of internal medicine during a 3-month period.ResultsThe mean, median, and range of SUA at admission were 6.1 ± 2.7, 5.6, and 1.2 to 24 mg/dL, respectively. Increased SUA was significantly correlated with age, gender, comorbidities (coronary heart disease, heart failure, hypertension, diabetes, renal failure, and gout), use of diuretics, and current admission for cardiovascular diseases but not with current diagnosis of infection, malignancy, or inflammatory diseases, nor with C-reactive protein. However, SUA significantly correlated with mortality (7.7 versus 6 mg/L, P < 0.025) and was an independent predictor of mortality in a multivariate regression analysis (odds ratio: 1.11; confidence interval: 1.003-1.218; P = 0.04), with a significant difference in mortality between normal SUA (< 6 mg/dL) with 5% mortality and high SUA (> 12 mg/dL) with 27% mortality.ConclusionsInitial SUA is an independent predictor of mortality in admitted medical patients. Whether significant asymptomatic hyperuricemia should be treated remains to be determined in further studies.     

Systemic inflammatory response syndrome in patients with liver cirrhosis

Background and study aimsPatients with liver cirrhosis present an increased susceptibility to the systemic inflammatory response syndrome (SIRS), which is considered the cause of hospital admission in about 10% of patients and is present in about 40% of those admitted for ongoing complications. We tried to assess the prevalence of the SIRS with the possible effects on the course of the disease during hospital stay.Patients and methodsTwo hundred and three patients with liver cirrhosis were examined and investigated with close monitoring during hospital stay. The main clinical endpoints were death and the development of portal hypertension-related complications.ResultsEighty-one patients met the criteria of SIRS (39.9%). We found significant correlations between SIRS and jaundice (p = 0.005), bacterial infection (p = 0.008), white blood cell count (p < 0.001), low haemoglobin concentration (p = 0.004), high serum creatinine levels (p < 0.001), high alanine aminotransferase levels (p < 0.001), serum bilirubin levels (p < 0.001), international normalised ratio (p < 0.001), serum albumin levels (p = 0.033), high Child-Pugh score (p < 0.001). During the follow-up period, 26 patients died (12.8%), 15 developed portal hypertension-related bleeding (7.3%), 30 developed hepatic encephalopathy (14.7%), and 9 developed hepatorenal syndrome type-1 (4.4%). SIRS showed significant correlations both to death (p < 0.001) and to portal hypertension-related complications (p < 0.001).ConclusionThe systemic inflammatory response syndrome occurs in patients with advanced cirrhosis and is associated with a bad prognosis.     

Factors predicting cardiovascular events in statin-treated diabetic and non-diabetic patients with coronary atherosclerosis

ObjectiveWe aimed at identifying which lipid factors drive vascular risk in statin-treated patients with coronary artery disease (CAD).MethodsWe recorded vascular events over 5.6 years in 491 consecutive statin-treated patients with angiographically proven stable CAD, covering 2750 patient-years.ResultsIn the total population, low high-density lipoprotein (HDL) cholesterol (standardized adjusted HR 0.73 [0.60–0.89]; p = 0.001), low apolipoprotein A1 (0.77 [0.65–0.92]; p = 0.003), a small low-density lipoprotein (LDL) particle diameter (0.76 [0.64–0.91]; p = 0.002), and high triglycerides (1.20 [1.05–1.38]; p = 0.007) predicted vascular events, but not total cholesterol, LDL cholesterol, or apolipoprotein B. Factor analysis in the lipid profiles of our patients revealed an HDL-related factor and an LDL-related factor. Concordant with the results for individual lipid parameters, the HDL-related factor (0.69 [0.58–0.83]; p < 0.001) but not the LDL-related factor (p = 0.455) predicted vascular events. Patients with type 2 diabetes (T2DM; n = 116) were at a higher vascular risk than non-diabetic subjects (38.6% vs. 24.1%; p < 0.001), and like in the total population the HDL-related factor (0.59 [0.44–0.77]; p < 0.001) but not the LDL-related factor (p = 0.591) predicted vascular risk in diabetic patients.ConclusionsThe pattern of low HDL cholesterol, low apolipoprotein A1, small LDL particles, and high triglycerides drives vascular risk in statin-treated coronary patients, particularly in those with T2DM.     

Decreased glomerular filtration rate in patients with at least 5 years of type 2 diabetes in Ho Chi Minh City,Vietnam: Prevalence and associated factors

AimsThis study determined the prevalence and associated factors of decreased estimated glomerular filtration rate (eGFR) in patients who had type 2 diabetes for at least 5 years.MethodsA cohort study was conducted in 467 outpatients in a community-based hospital in Ho Chi Minh City, Vietnam. Serum creatinine were tested twice, at two occasions at least 3 months apart. The confirmatory eGFR was the average of the two eGFR of which the difference was ≤20%. The mean urine albumin-to-creatinine ratio was calculated from two consecutive early morning specimens.ResultsMost patients were female with a mean age of 61.7 (8.0) years. Albuminuria was found in 40% of participants, and the prevalence of decreased eGFR was 7.5% (n = 35). Individuals with declined eGFR were older (p < 0.001), had duration of diabetes longer (p = 0.025), higher systolic blood pressure (p = 0.010) and higher acid uric level (p < 0.001), increased albumin excretion (p = 0.009), and more proliferative retinopathy (p = 0.011) than those with non-declined eGFR.ConclusionsAlthough decreased eGFR in type 2 diabetes patients was not prevalent, the strategies to prevent the progressive decline of GFR should be done to prevent patients from progressing to advanced renal disease.     

Impaired systolic blood dipping and nocturnal hypertension: an independent predictor of carotid intima–media thickness in type 1 diabetic patients

ObjectiveType 1 diabetes in children predicts a broad range of later health problems including an increased risk of cardiovascular morbidity and mortality. This study aimed to evaluate whether nocturnal hypertension and impaired nocturnal dipping affect atherosclerosis in children and adolescents with type 1 diabetes and to investigate the relationship between atherogenic risk factors and carotid intima–media thickness (CIMT).MethodsOne hundred fifty-nine type 1 diabetic patients and 100 healthy controls were included in the study. We investigated metabolic and anthropometric parameters such as body mass index (BMI), waist circumference, fasting glucose and insulin, serum lipids, 24 h ambulatory blood pressure monitoring (ABPM), and CIMT and compared these with those in control subjects (CS).ResultsNo difference was found between type 1 diabetic patients and CS in age, weight, waist/hip ratio, triglyceride, HDL-cholesterol level. However in children with type 1 diabetes, total cholesterol (p = 0.016),and LDL-cholesterol (p = 0.002) levels and CIMT (P < 0.001) were greater than those of controls. It was determined that 10% of type 1 diabetic patients had dyslipidemia.In 23.2% of type 1 diabetic patients, ABPM showed arterial hypertension. CIMT was significantly higher in the hypertensive group than in the nonhypertensive group (P = 0.003).Twenty-three (14.4%) diabetic patients had nocturnal hypertension. CIMT was significantly greater in the nocturnal hypertensive group (p = 0.023).Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) dipping was significantly different in diabetic patients (P < 0.001).CIMT was correlated positively with Hba1c (r = 0.220, p = 0.037), and negatively with SBP dipping (r = − 0.362, p = 0.020) in the diabetic patients.In stepwise regression analysis, Hba1c and SBP dipping emerged as a significant predictor of CIMT (β = 0.300, p = 0.044, β = 0.398 p = 0.009) contributing to 15.58% of its variability.ConclusionThese results provide additional evidence for the presence of subclinical cardiovascular disease (CVD) and its relation to hypertension in type 1 diabetic patients. They also indicate a significant relation between nocturnal hypertension, SBP dipping and increased arterial stiffness. It is also important to note that our findings reveal significant relationships between HBA1c cardiovascular changes and underline the importance of glucose control to predict CVD.