3 research outputs found
Klinefelter syndrome, insulin resistance, metabolic syndrome, and diabetes: review of literature and clinical perspectives
Klinefelter syndrome (KS), the most frequent chromosomic abnormality in males, is associated with hypergonadotropic hypogonadism and an increased risk of cardiovascular diseases (CVD). The mechanisms involved in increasing risk of cardiovascular morbidity and mortality are
not completely understood. Insulin resistance, metabolic syndrome, and type 2 diabetes are more frequently diagnosed in KS than in the general population; however, the contribution of hypogonadism to metabolic derangement is highly controversial. Whether this dangerous
combination of risk factors fully explains the CVD burden of KS patients remains unclear. In addition, testosterone replacement therapy only exerts a marginal action on the CVD system. This review summaries the current understandings of the complex relationship between KS, metabolic syndrome and cardiovascular risk in order to plan future studies and improve current strategies to reduce mortality in this high-risk population. Since fat accumulation and distribution seem to play a relevant role in triggering metabolic abnormalities, an early diagnosis and a tailored intervention
strategy with drugs aimed at targeting excessive visceral fat deposition appear necessary in patients with KS
Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry
BackgroundÂ
Findings from the T.O.S.CA. Registry recently reported that patients with concomitant chronic heart failure (CHF) and impairment of insulin axis (either insulin resistance—IR or diabetes mellitus—T2D) display increased morbidity and mortality. However, little information is available on the relative impact of IR and T2D on cardiac structure and function, cardiopulmonary performance, and their longitudinal changes in CHF.Â
MethodsÂ
Patients enrolled in the T.O.S.CA. Registry performed echocardiography and cardiopulmonary exercise test at baseline and at a patient-average follow-up of 36Â months. Patients were divided into three groups based on the degree of insulin impairment: euglycemic without IR (EU), euglycemic with IR (IR), and T2D.Â
ResultsÂ
Compared with EU and IR, T2D was associated with increased filling pressures (E/e′ratio: 15.9 ± 8.9, 12.0 ± 6.5, and 14.5 ± 8.1 respectively, p 
Trial registration ClinicalTrials.gov identifier: NCT023358017</p
Multiple hormonal and metabolic deficiency syndrome predicts outcome in heart failure: the T.O.S.CA. registry
Aims Recent evidence supports the occurrence of multiple hormonal and metabolic deficiency syndrome (MHDS) in
chronic heart failure (CHF). However, no large observational study has unequivocally demonstrated its impact on
CHF progression and outcome. The T.O.S.CA. (Trattamento Ormonale nello Scompenso CArdiaco; Hormone
Treatment in Heart Failure) Registry has been specifically designed to test the hypothesis that MHDS affects
morbidity and mortality in CHF patients. Methods
and Results
The T.O.S.CA. Registry is a prospective, multicentre, observational study involving 19 Italian centres. Thyroid
hormones, insulin-like growth factor-1, total testosterone, dehydropianoandrosterone sulfate, insulin resistance,
and the presence of diabetes were evaluated. A MHDS was defined as the presence of >_2 hormone deficiencies
(HDs). Primary endpoint was a composite of all-cause mortality and cardiovascular hospitalizations. Four hundred
and eighty heart failure patients with ejection fraction <_45% were enrolled. MHDS or diabetes was diagnosed in
372 patients (77.5%). A total of 271 events (97 deaths and 174 cardiovascular hospitalizations) were recorded,
41% in NO-MHDS and 62% in MHDS (P < 0.001). Median follow-up was of 36 months. MHDS was independently
associated with the occurrence of the primary endpoint [hazard ratio 95% (confidence interval), 1.93 (1.37–2.73),
P < 0.001] and identified a group of patients with a higher mortality [2.2 (1.28–3.83), P = 0.01], with a graded
relation between HDs and cumulative events (P Conclusion MHDS is common in CHF and independently associated with increased all-cause mortality and cardiovascular
hospitalization, representing a promising therapeutic target