Familial aggregation of non-insulin dependent diabetes and coronary heart disease are accompanied by different effects on serum lipids, lipoproteins and apolipoproteins

This study was designed to investigate whether the presence of non-insulin-dependent diabetes mellitus (NIDDM) or coronary heart disease (CHD) in probands have different effects on serum lipid, lipoprotein and apolipoprotein concentrations in the first-degree relatives. Altogether 161 probands (114 men, 47 women) and 788 first-degree relatives of these probands (174 brothers, 246 sisters, 180 sons, 188 daughters) were included in the analyses. The presence of NIDDM in the proband was associated with lowered total, LDL and HDL cholesterol and apolipoprotein A1 and elevated total triglyceride levels in the brothers (P less than 0.05) and elevated total and LDL cholesterol levels in the sisters (P less than 0.05). Total LDL and VLDL cholesterol and apolipoprotein B were higher (P less than 0.05) and HDL/total cholesterol ratio and apolipoprotein A1/B ratio lower (P less than 0.05) in the daughters of the nondiabetic and diabetic probands were pooled, CHD in the proband was associated particularly with low apolipoprotein A1/B ratio. In conclusion, (1) the presence of NIDDM in the proband appears to be associated in siblings with more profound lipid and lipoprotein changes (especially low HDL cholesterol and high total triglycerides) than a history of CHD in the proband, (2) a history of CHD in the proband is associated in children with apolipoprotein changes favouring atherosclerosis (low apolipoprotein A1, high apolipoprotein B, low apolipoprotein A1/B ratio). Different effects of a history of NIDDM and CHD in the proband on lipid, lipoprotein and apolipoprotein levels in the first-degree relatives warrants more population-based studies.     

Two-hour glucose is a better risk predictor for incident coronary heart disease and cardiovascular mortality than fasting glucose.

AIMS: To assess the predictive value of fasting and 2-h glucose after a 75 g glucose load, with regard to incidence of coronary heart disease and cardiovascular mortality. METHODS AND RESULTS: 6766 subjects from five Finnish cohorts aged 30-89 years were followed up for 7-10 years. Hazards ratios associated with increasing glucose concentrations were homogeneous over studies. Multivariate Cox regression analyses showed that the hazards ratio for one standard deviation increase in 2-h glucose after logarithmic transformation was 1.17 (95% CI 1.05-1.30) for coronary heart disease incidence and 1.22 (1.09-1.37) for cardiovascular mortality. For fasting glucose, they were 1.05 (0.94-1.17) and 1.13 (1.01-1.25), respectively. Inclusion of 2-h glucose in the model based on fasting glucose significantly improved the prediction (P<0.005 for coronary heart disease incidence and P<0.025 for cardiovascular mortality), whereas fasting glucose did not add significant information to the model initially based on 2-h glucose (P>0.10 for both events). CONCLUSION: In subjects without a prior history of diabetes the association of 2-h glucose with coronary heart disease incidence and cardiovascular morality is graded and independent. The results of our study indicate that 2-h glucose is superior to fasting glucose in assessing the risk of future cardiovascular disease events.     

Streptozotocin-induced diabetes decreases rat sarcolemmal lactate transport

Impaired lactate metabolism is a metabolic disorder, which is not fully understood in the diabetic state including streptozotocin (STZ)-induced diabetes. We investigated whether STZ-induced diabetes results in altered lactate exchanges using the rat muscle sarcolemmal vesicles (SV) model. Fifteen days after diabetes onset (1 STZ-injection, 65 mg/kg, intraperitoneal [IP]), rats had higher blood and muscle lactate concentrations compared with normal rats (1.50 +/- 0.09 v 1.95 +/- 0.21 mmol/L (not significant [NS]) and 21.02 +/- 1.26 v 25.53 +/- 0.98 mmol/kg wet weight (ww); P < .05). The initial rate of lactate uptake was measured at various external lactate concentrations using SV of both group in zero-trans conditions. STZ-induced diabetes decreased the initial rate of total lactate influx at external lactate concentrations from 1 to 100 mmol/L (P < .05). This decrease in lactate transport was found in addition to an increased free radical production, as indicated by a significant increase in malonedialdehyde (MDA) concentration (64.3 +/- 8.7 v 100.3 +/- 13.5 nmol. g(-1) ww, P < .05), coupled with a higher glutathione peroxidase (Gpx) activity (48.03 +/- 3.13 v 84.7 +/- 15.01 micromol. min(-1). mg(-1) protein, P < .05) in red gastrocnemius. We concluded that STZ-induced diabetes decreases total lactate transport activity in rat SV and is associated with increased muscular oxidative stress.     

Current status and future perspectives in the prevention of coronary heart disease

The causal role of the three major coronary heart disease (CHD) risk factors - elevated plasma cholesterol, elevated blood pressure, and smoking - has become established by a wealth of scientific information which has become importantly expanded during the last decade with regard to prevention and treatment of elevated blood pressure and cholesterol lowering. A comprehensive action for CHD prevention has to include a population strategy for the reduction of risk factor levels in the entire population, and high-risk strategy for the reduction of risk factor levels in asymptomatic high-risk individuals, as well as a risk factor intervention as part of secondary prevention and good clinical care of patients with symptomatic CHD. There is no conflict between population and high-risk strategies, but instead these two different strategies are complementary to each other.     

Low-risk patients with chest pain and without evidence of myocardial infarction may be safely discharged from emergency department.

AIMS: This study is an audit of the risk stratification of patients admitted to a university hospital emergency department with a suspected acute coronary syndrome (ACS). The main aim of the study was to investigate the prognosis of those patients who were discharged to home from the emergency room (ER) or adjacent chest pain observation unit (CPU). METHODS AND RESULTS: Three thousand one hundred and seven consecutive patients admitted to the ER with a suspected ACS were retrospectively identified. Seven hundred and sixty-four (25%) patients were discharged from the ER and 417 (13%) from the CPU after observation and ruling out myocardial infarction (MI) and high-risk ACS. One thousand seven hundred and two patients were hospitalized. Follow-up end-points were cardiovascular mortality, hospitalization for ACS and incidence of any cardiovascular disease event during 6 months. During 4 weeks after the discharge from the ER and CPU cardiovascular mortality was 0.1% and 0.5% and during 6 months 0.8% and 1.7%, respectively. Within 6 months 4.2% and 8.4% of the patients were hospitalized for ACS and 9.3% and 11.5% had a cardiovascular disease event. CONCLUSIONS: Patients admitted with chest pain may be safely discharged from the emergency department, if there is no evidence of MI or high-risk ACS. However, further examination and appropriate treatment must be arranged.     

Quantitative electrocardiographic and vectorcardiographic study on newly-diagnosed non-insulin-dependent diabetic and non-diabetic control subjects

Quantitative electrocardiographic (ECG) and vectorcardiographic (VCG) analysis was carried out in 113 newly diagnosed, middle-aged, non-insulin-dependent diabetics (61 men, 52 women) and 125 non-diabetic control subjects (56 men, 69 women) in order to explore changes attributable to non-coronary heart disease (diabetic cardiomyopathy) in diabetics. Diabetic men had a prolonged PQ interval and women a more negative P-terminal force and a more leftward frontal QRS axis than their non-diabetic counterparts, but no other significant differences we found between diabetic and non-diabetic subjects in various quantitative ECG and VCG variables when the effect of confounding factors (age, obesity, coronary heart disease, hypertension, drugs) was taken into account. The more negative P-terminal force and left axis deviation in diabetic women could be explained by a concomitant left ventricular hypertrophy among them. Non-insulin-dependent (type 2) diabetes, which is commonly preceded by a long duration of asymptomatic hyperglycaemia, is not associated, early in its clinical course, with major ECG and VCG abnormalities suggestive of diabetic cardiomyopathy.