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1.
Purpose of Review
In this review, we examine the interaction between the metabolic syndrome (MS) and non-alcoholic fatty liver disease (NAFLD) and describe the impact of the features of MS on the most worrisome complications of non-alcoholic steatohepatitis (NASH), (cirrhosis, hepatocellular carcinoma) and, ultimately, on liver-related, cardiovascular, and overall mortality.Recent Findings
Insulin resistance, obesity, and dyslipidemia in a pro-inflammatory environment have a causal role in hepatic fibrogenesis and oncogenesis in NAFLD patients. Natural history, longitudinal studies confirm the conditions linked to MS as independent predictors of overall-, cardiovascular-, and liver-related mortality.Summary
Dysmetabolic factors stemming from insulin resistance play a key role in liver damage progression. Obesity, type 2 diabetes (T2DM), dyslipidemia, and arterial hypertension are independent predictors of liver fibrosis and cirrhosis; furthermore, obesity and T2DM play a key role in the development of hepatocellular carcinoma both in cirrhotic and non-cirrhotic NASH patients.2.
Purpose of the Review
Cellular circadian clocks regulate physiological functions during day and night. It has been convincingly demonstrated that hypertension in patients suffering from diabetes mellitus or metabolic syndrome is characterized in most cases by a disturbed 24-h profile resulting in a nondipper pattern. We consider possible correlation between biological clocks and symptoms of the metabolic syndrome.Recent Findings
Changes in circadian clock function have been linked to metabolic disorders in genome-wide association studies. Epidemiological studies have shown that a loss of nocturnal decline in blood pressure increases the risk of cardiovascular morbidity and mortality and end-organ damage. Looking at clock genes, however, there is no obvious association between symptoms of diabetes or metabolic syndrome and clock gene expression.Summary
Emerging data suggest that circadian rhythm disruption is a risk factor for metabolic and cardiovascular disorders, while disease feedback on clock function is limited.3.
Background and objectives
Patients with diabetes mellitus are at increased cardiovascular risk. While arteriosclerotic lesions have long been recognized as the underlying cause, more recent studies suggest alterations in the coagulation system to be equally important in this context.Materials and methods
A systematic PubMed search was performed.Results
In patients with diabetes mellitus, alterations in the coagulation system play a pivotal role. This not only contributes to the increased cardiovascular risk but also explains the low or nonresponse to antiplatelet therapy. These alterations in the coagulation system include changes in platelet and fibrin clot function. This is reflected by the recommendation of the 2013 ESC guidelines on antiplatelet therapy in diabetes.Conclusions
This article provides an overview of pathophysiological alterations in coagulation of patients with diabetes mellitus and the recommended antiplatelet therapy in the presence of coronary artery disease.4.
Revathy Carnagarin Vance B. Matthews Lakshini Y. Herat Jan K. Ho Markus P. Schlaich 《Current diabetes reports》2018,18(11):107
Purpose of Review
Cardiometabolic disorders such as obesity, metabolic syndrome and diabetes are increasingly common and associated with adverse cardiovascular outcomes. The mechanisms driving these developments are incompletely understood but likely to include autonomic dysregulation. The latest evidence for such a role is briefly reviewed here.Recent Findings
Recent findings highlight the relevance of autonomic regulation in glucose metabolism and identify sympathetic activation, in concert with parasympathetic withdrawal, as a major contributor to the development of metabolic disorders and an important mediator of the associated adverse cardiovascular consequences.Summary
Methods targeting sympathetic overactivity using pharmacological and device-based approaches are available and appear as logical additional approaches to curb the burden of metabolic disorders and alleviate the associated morbidity from cardiovascular causes. While the available data are encouraging, the role of therapeutic inhibition of sympathetic overdrive in the prevention of the metabolic disorders and the associated adverse outcomes requires adequate testing in properly sized randomised controlled trials.5.
Lane B. Benes Daniel J. Brandt Eric J. Brandt Michael H. Davidson 《Current cardiology reports》2018,20(12):138
Purpose of the Review
To summarize advances in genomic medicine and anticipated future directions to improve cardiovascular risk reduction.Recent Findings
Mendelian randomization and genome-wide association studies have given significant insights into the role of genetics in dyslipidemia and cardiovascular disease (CVD), with over 160 gene loci found to be associated with coronary artery disease to date. This has enabled the creation of genetic risk scores that have demonstrated improved risk prediction when added to clinical markers of CVD risk.Summary
Incorporation of genomic data into clinical patient care is on the horizon. Genomic medicine is expected to offer improved risk assessment, determination of targeted treatment strategies, and improved detection of lipid disorders causal to CVD development.6.
Ah Reum Khang Eu Jeong Ku Ye An Kim Eun Roh Jae hyun Bae Tae Jung Oh Sang Wan Kim Chan Soo Shin Seong Yeon Kim Jung Hee Kim 《Pituitary》2016,19(6):573-581
Purpose
Hypopituitary patients have a reduced life expectancy owing to cardiovascular events. We investigated the prevalence of metabolic syndrome in hypopituitary patients for a follow-up period of at least 1 year in comparison with an age- and sex-matched nationwide control group.Methods
A total of 515 patients with hypopituitarism who visited Seoul National University Hospital between January 2000 and December 2010 were included. Data for an age- and sex-matched control group were obtained from the Korean National Health and Nutrition Examination Surveys (KNHANES) (n = 1545). Metabolic syndrome was defined according to the modified National Cholesterol Education Program (NCEP-ATPIII).Results
The prevalence of metabolic syndrome did not differ significantly between the hypopituitary and control groups for men (34.9 versus 30.3 %), but the risk of metabolic syndrome was higher in hypopituitary women than in controls (39.8 versus 28.5 %). In both sexes, the risks of central obesity and dyslipidemia were higher in the hypopituitary group than in the control group. Men had lower risks of hypertension and hyperglycemia in the hypopituitary group, which attenuated the risk of metabolic syndrome. Age greater than 40 years and obesity (BMI ≥25 kg/m2) contributed to a higher risk of metabolic syndrome.Conclusions
The metabolic syndrome prevalence was higher in the hypopituitry group than in the control group in Korean women, and this was attributed to an increased risk of central obesity and dyslipidemia. Accordingly, early intervention to reduce metabolic syndrome needed in hypopituitary patients, i.e. women.7.
Background
Diabetes mellitus is a disease which leads to vascular damage resulting in subsequent severe cardiovascular complications, such as myocardial infarction and stroke. This process is aggravated by coexisting hypertension.Objective
This analysis gives a review of the latest study results on prognosis, blood pressure targets, drug therapy and interventional therapy in patients with diabetes and hypertension. Selected studies published in recent years with practical relevance for patients with diabetes and hypertension are presented.Summary
Patients with simultaneous diabetes and hypertension have a poorer prognosis and a higher cardiovascular risk compared to patients with diabetes but without hypertension. Patients with diabetes and hypertension benefit from interventional blood pressure therapy8.
M. Lehrke 《Der Diabetologe》2016,12(5):328-334
Background
Diabetes remains a leading risk factor for cardiovascular events.Current diabetes therapies
For the therapy of type 2 diabetes mellitus metformin is available as the first choice treatment. The decision which anti-diabetic drug should be used for second line therapy is left up to the treating physician. The decision-making process is largely influenced by the results of new cardiovascular outcome trials, which are carried for newly introduced diabetes medications.Diabetes therapy and cardiovascular risk
Outcome studies for three classes of drugs were presented in the previous year, which are discussed in this article. Furthermore, this article presents recent advances in the possibilities for coronary interventions in patients with diabetes and mechanisms of diabetic cardiomyopathy are discussed.9.
Angela Pirillo Fabrizia Bonacina Giuseppe Danilo Norata Alberico Luigi Catapano 《Current atherosclerosis reports》2018,20(3):12
Purpose of Review
Atherosclerosis is an inflammatory disorder of the arterial wall, in which several players contribute to the onset and progression of the disease. Besides the well-established role of lipids, specifically cholesterol, and immune cell activation, new insights on the molecular mechanisms underlying the atherogenic process have emerged.Recent Findings
Meta-inflammation, a condition of low-grade immune response caused by metabolic dysregulation, immunological memory of innate immune cells (referred to as “trained immunity”), cholesterol homeostasis in dendritic cells, and immunometabolism, i.e., the interplay between immunological and metabolic processes, have all emerged as new actors during atherogenesis. These observations reinforced the interest in directly targeting inflammation to reduce cardiovascular disease.Summary
The novel acquisitions in pathophysiology of atherosclerosis reinforce the tight link between lipids, inflammation, and immune response, and support the benefit of targeting LDL-C as well as inflammation to decrease the CVD burden. How this will translate into the clinic will depend on the balance between costs (monoclonal antibodies either to PCSK9 or to IL-1ß), side effects (increased incidence of death due to infections for anti-IL-1ß antibody), and the benefits for patients at high CVD risk.10.
Deepu David Anantharam Raghavendran Ashish Goel C. Bharath Kumar Thomas Alex Kodiatte Deepak Burad Priya Abraham Banumathi Ramakrishna Philip Joseph Jeyamani Ramachandran C. E. Eapen 《Indian journal of gastroenterology》2017,36(5):373-379
Aim of the study
The aim of the study was to analyze the prevalence of risk factors for non-alcoholic fatty liver disease (NAFLD) in patients with non-B non-C hepatocellular carcinoma (HCC).Methods
Between June 2012 and November 2014, patients with HCC, negative for hepatitis B surface antigen and hepatitis C virus antibody, were included in this study. All patients were assessed for risk factors for NAFLD such as diabetes mellitus (DM), hypertension, dyslipidemia, metabolic syndrome, and obesity.Results
Forty-seven patients with non-B non-C HCC (males, 37; age, 60±10 years; mean±SD) were studied. Model for end-stage liver disease score was 11±4. Twenty-five patients were in Child’s class A. History of significant alcohol intake was noted in 11 (23%) patients. Prevalence of risk factors for NAFLD were obesity 24 (51%), DM 22 (47%), metabolic syndrome 21 (45%), hypertension 16 (34%), and dyslipidemia 13 (28%). Forty (85%) patients had at least one risk factor for NAFLD. The mean duration of at least one NAFLD risk factor was 7.5 years, prior to diagnosis of HCC. Thirteen (28%) patients were positive for anti-HBc; however, none of the study patients had detectable HBV DNA in blood.Conclusions
Eighty-five percent of the patients with non-B non-C HCC had at least one risk factor for NAFLD. None of the study patients had occult hepatitis B infection. NAFLD is emerging as the major etiological contributing factor for non-B non-C HCC in India.11.
Silvio Romano Elisa Salustri Piero Ruscitti Francesco Carubbi Maria Penco Roberto Giacomelli 《Current rheumatology reports》2018,20(12):81
Purpose of the Review
An increased prevalence of cardiovascular risk factors in rheumatoid arthritis (RA) is reported. The absolute cardiovascular risk in RA patients is higher than in the general population, and although the RA prognosis has gradually improved, premature cardiovascular (CV) mortality remains a matter of fact. The purpose of this review is to shed light on CV and metabolic involvement in RA, with the aim of defining its best management.Recent Findings
Multiple lines of evidence have revealed common mechanisms behind inflammatory and CV diseases and clarified the metabolic and CV pathways involved in RA and the effects of different pharmacological treatments.Summary
CV risk assessment should be mandatory in all RA patients, taking into account the impact of both diseases on patient’s prognosis. Therefore, a multidisciplinary approach is the best management, and rheumatologists, cardiologists, and general practitioners must work together to significantly improve outcome and quality of life in RA patients. Future research could investigate the potential beneficial effects of a more aggressive pharmacological treatment of CV and metabolic risk factors.12.
Purpose of Review
Assessing the cardiovascular risk associated with hypertriglyceridemia can be challenging due to frequent confounding conditions such as hypertension, diabetes mellitus, and hyperlipidemia. We sought to quantify this risk by examining several meta-analyses as well as subgroup analyses of previously published major randomized controlled trials that focused on the treatment of hyperlipidemia.Recent Findings
Recent trials measuring the effects of PCSK9 inhibitors such as evolocumab and alirocumab on cardiovascular outcomes have demonstrated a high degree of residual cardiovascular risk even after profound reductions in low-density-lipoprotein cholesterol (LDL-C).Summary
Despite optimization of LDL-C through the use of statins, PCSK9 inhibitors and adjunctive therapies such as ezetimibe, bile acid sequestrants and niacin, residual cardiovascular risk remains significant. Several ongoing trials are assessing the efficacy of pemafibrate and omega-3 fatty acids for the treatment of hypertriglyceridemia and their effects on major cardiovascular outcomes.13.
Elliott J. Goytia David W. Lounsbury Mary S. McCabe Elisa Weiss Meghan Newcomer Deena J. Nelson Debra Brennessel Bruce D. Rapkin M. Margaret Kemeny 《Journal of general internal medicine》2009,24(2):451
INTRODUCTION
Many cancer centers and community hospitals are developing novel models of survivorship care. However, few are specifically focused on services for socio-economically disadvantaged cancer survivors.AIMS
To describe a new model of survivorship care serving culturally diverse, urban adult cancer patients and to present findings from a feasibility evaluation.SETTING
Adult cancer patients treated at a public city hospital cancer center.PROGRAM DESCRIPTION
The clinic provides comprehensive medical and psychosocial services for patients within a public hospital cancer center where they receive their oncology care.PROGRAM EVALUATION
Longitudinal data collected over a 3-year period were used to describe patient demographics, patient needs, and services delivered. Since inception, 410 cancer patients have been served. Demand for services has grown steadily. Hypertension was the most frequent comorbid condition treated. Pain, depression, cardiovascular disease, hyperlipidemia, and bowel dysfunction were the most common post-treatment problems experienced by the patients. Financial counseling was an important patient resource.DISCUSSION
This new clinical service has been well-integrated into its public urban hospital setting and constitutes an innovative model of health-care delivery for socio-economically challenged, culturally diverse adult cancer survivors.14.
Angelos D. Karagiannis Martin Liu Peter P. Toth Shijia Zhao Devendra K. Agrawal Peter Libby Yiannis S. Chatzizisis 《Current atherosclerosis reports》2018,20(4):20
Purpose of Review
Clinical trials with PCSK9 inhibitors have shown a robust decrease in plasma LDL levels and a significant reduction in the incidence of cardiovascular atherosclerotic events. However, the role of PCSK9 in atherosclerosis is not well investigated and it remains unclear whether PCSK9 inhibition has direct, LDL-independent, anti-atherosclerotic effects. This review outlines the molecular pathways and targets of PCSK9 in atherosclerosis and summarizes the experimental and clinical data supporting the anti-atherosclerotic (pleiotropic) actions of PCSK9 inhibitors.Recent Findings
PCSK9 is expressed by various cell types that are involved in atherosclerosis (e.g., endothelial cell, smooth muscle cell, and macrophage) and is detected inside human atherosclerotic plaque. Preclinical studies have shown that inhibition of PCSK9 can attenuate atherogenesis and plaque inflammation.Summary
Besides increasing plasma LDL, PCSK9 appears to promote the initiation and progression of atherosclerosis. Inhibition of PCSK9 may confer atheroprotection that extends beyond its lipid-lowering effects.15.
Anne H. Blaes G. J. van Londen Nicole Sandhu Amir Lerman Daniel A. Duprez 《Current treatment options in cardiovascular medicine》2018,20(6):48
Purpose of review
The purpose of this review is to summarize the current literature on estrogen and progesterone antagonists and their effects on the cardiovascular system.Recent findings
Estrogen and progesterone antagonists reduce cancer-related recurrence and mortality in women with ER-positive breast cancer. Recent studies, however, suggest that women with early stage breast cancer are more likely to die of cardiovascular disease than recurrent breast cancer. Estrogen antagonists have been shown to reduce endothelial function, to increase lipid profiles and to alter body composition accelerating atherosclerotic changes.Summary
While clinical trial data demonstrates mixed results of the impact of estrogen antagonists on cardiovascular risk, there is a growing body of evidence that estrogen suppression and estrogen antagonists result in biologic effects on the endothelium, altering lipid profiles and accelerating the risk of atherosclerosis. Further longitudinal work however is needed.16.
Purpose
It remains unclear whether there is a pathogenic link between chronic obstructive pulmonary disease (COPD) and cardiovascular diseases. Subclinical carotid atherosclerosis is a predictor of future cardiovascular events. Exacerbations increase all-cause mortality in COPD, and exacerbation-like episodes have been described in subjects without COPD. Our objectives were as follows: (1) to confirm the independent association between COPD and carotid atherosclerosis and (2) to asses the possible relationship between COPD exacerbations or exacerbation-like episodes and a higher risk of atherosclerosis.Methods
127 COPD subjects and 80 control subjects with smoking history were studied. Carotid ultrasound examination was carried out in all subjects. Univariate and multivariate logistic regression analyses were performed in order to assess the relationship between both COPD diagnosis and previous COPD exacerbations (or exacerbation-like episodes in non-COPD subjects) and the presence of carotid atherosclerosis.Results
The prevalence of carotid atherosclerosis was higher in COPD group (65.3 vs. 47.5%, p?=?0.01; OR?2.18, 95% CI 1.23–3.88, p?<?0.01). Diagnosis of COPD was not independently associated with atherosclerosis, after adjusting for potential confounders. Neither COPD exacerbations nor exacerbation-like episodes in control subjects were associated with a higher risk of atherosclerosis.Conclusion
There is a higher prevalence of carotid atherosclerosis in COPD than in control smokers or ex-smokers, but the differences seem to be related to shared risk factors. We have not found evidence for an increased risk of atherosclerosis associated with COPD exacerbations or exacerbation-like events. Further longitudinal studies should be carried out to confirm these findings.17.
Ming-Sheng Teng Semon Wu Leay-Kiaw Er Lung-An Hsu Hsin-Hua Chou Yu-Lin Ko 《Diabetology & metabolic syndrome》2018,10(1):79
Background
Visceral adiposity indicators and the product of triglyceride and fasting plasma glucose (TyG) index-related parameters are effective surrogate markers for insulin resistance (IR) and are predictors of metabolic syndrome and diabetes mellitus. However, their genetic determinants have not been previously reported. Pleiotropic associations of LIPC variants have been observed in lipid profiles and atherosclerotic cardiovascular diseases. We aimed to investigate LIPC polymorphisms as the genetic determinants of adiposity status, visceral adiposity indicators and TyG index-related parameters.Methods
A total of 592 participants from Taiwan were genotyped for three LIPC single nucleotide polymorphisms (SNPs).Results
The LIPC SNPs rs2043085 and rs1532085 were significantly associated with body mass index (BMI), waist circumference (WC), lipid accumulation product, visceral adiposity index, and TyG index-related parameters [including the TyG index, TyG with adiposity status (TyG-BMI), and TyG-WC index], whereas the rs1800588 SNP was only significantly associated with the TyG index. The associations became nonsignificant after further adjustment for serum TG levels. No significant association was observed between any the studied LIPC SNPs and IR status.Conclusion
Our data revealed a pleiotropic association between the LIPC variants and visceral adiposity indicators and TyG index-related parameters, which are mediated by serum TG levels.18.
Ilaria Cavallari Alessia Delli Veneri Ernesto Maddaloni Rosetta Melfi Giuseppe Patti Nicola Napoli Paolo Pozzilli Germano Di Sciascio 《Current diabetes reports》2018,18(12):138
Purpose of the Review
To summarize available evidence regarding lipid-lowering interventions for the prevention of cardiovascular disease in patients with diabetes.Recent Findings
Statins and non-statin therapies that act through upregulation of LDL receptor expression are associated with similar cardiovascular risk reduction per decrease in LDL cholesterol.Summary
In subjects with diabetes, with or without established cardiovascular disease, each 39 mg/dl reduction in LDL cholesterol observed with statins is associated with a 21% relative reduction in the risk of major coronary events at 5 years. Statins remain the first-line lipid-lowering agents for the management of dyslipidemia in individuals with diabetes; however, the addition of non-statin therapies to lower LDL cholesterol, such as ezetimibe and PCSK-9 inhibitors, to maximally tolerated statin therapy is recommended in patients with atherosclerotic cardiovascular disease and baseline LDL cholesterol over 70 mg/dl. Recent data support even lower LDL cholesterol targets (<?55 mg/dl) to further reduce the risk of cardiovascular events especially in subjects with diabetes and documented cardiovascular disease.19.
Purpose of Review
South Asians (SA) are at a higher risk for stroke and vascular dementia due to the disproportionate burden of diabetes, hypertension, and dyslipidemia. This review summarizes the rationale for screening, early detection, and aggressive control of metabolic factors, and critically examines the published literature on primary and secondary stroke prevention.Recent Findings
South Asians have a higher prevalence of diabetes than non-SA. SA with diabetes are at a higher risk of recurrent ischemic stroke and have a higher incidence of stroke-related dementia compared to non-South Asians.Summary
South Asians are one of the fastest-growing ethnic groups worldwide with an unusually increased risk of heart disease and stroke. An accurate assessment of those at risk of stroke and cognitive impairment is urgently needed to plan preventive strategies.20.