Effects of exercise training on left ventricular function and exercise capacity in patients with coronary artery disease and varying degrees of left ventricular dysfunction

The medical profession has increased its acceptance of the benefits of exercise training for patients with uncomplicated coronary artery disease. Access to more modem technology and better management of this condition has led to an increase in the number of patients surviving acute coronary episodes . Some of these patients may have developed chronic asymptomatic left ventricular dysfunction and/or residual myocardial ischaemia, and could become potential candidates for cardiac rehabilitation if exercise training could induce physiological benefits without further deteriorating their condition. Over the last 10 years, several patients at moderate to high risk of future cardiovascular events because of the presence of left ventricular dysfunction and/or myocardial ischaemia have been accepted for cardiac rehabilitation at the Johannesburg Cardiac Rehabilitation Center. The purpose of the study was to evaluate the effects of exercise training on left ventricular function and exercise capacity in patients with coronary artery disease and varying degrees of left ventricular dysfunction and/or myocardial ischaemia attending the Johannesburg Cardiac Rehabilitation Center

Adding rapid-acting insulin or GLP-1 receptor agonist to basal insulin: outcomes in a community setting

Onur Başer (MEF Author)##nofulltext##To evaluate real-world outcomes in patients with type 2 diabetes mellitus (T2DM)receiving basal insulin, who initiate add-on therapy with a rapid-acting insulin (RAI) or aglucagon-like peptide 1 (GLP-1) receptor agonist.Data were extracted retrospectively from a U.S. health claims database. Adults withT2DM on basal insulin who added an RAI (basal+RAI) or GLP-1 receptor agonist (basal+GLP-1) were included. Propensity score matching (1 up to 3 ratio) was used to control for differencesin baseline demographics, clinical characteristics, and health resource utilization. Endpointsincluded prevalence of hypoglycemia, pancreatic events, all-cause and diabetes-relatedresource utilization, and costs at 1 year follow-up. Overall, 6,718 matched patients were included: 5,013 basal+RAI and 1,705basal+GLP1. Patients in both groups experienced a similar proportion of any hypoglycemicevent (P = .4079). Hypoglycemic events leading to hospitalization were higher in the basal+RAIcohort (2.7% vs. 1.8%; P = .0444). The basal+GLP-1 cohort experienced fewer all-cause(13.55% vs. 18.61%; P<.0001) and diabetes-related hospitalizations (11.79% vs. 15.68%;P<.0001). The basal+GLP-1 cohort had lower total all-cause health care costs ($18,413 vs.$20,821; P = .0002), but similar diabetes-related costs ($9,134 vs.$8,985; P<.0001) comparedwith the basal+RAI cohort. Add-on therapy with a GLP-1 receptor agonist in T2DM patients receiving basalinsulin was associated with fewer hospitalizations and lower total all-cause costs compared withadd-on therapy using a RAI, and could be considered an alternative to a RAI in certain patientswith T2DM, who do not achieve effective glycemic control with basal insulin.WOS:000350032700012Scopus - Affiliation ID: 60105072PMID: 25148821Science Citation Index ExpandedQ2ArticleUluslararası işbirliği ile yapılan - EVETOcak2015YÖK - 2014-1

Physiological benefits of a prolonged moderate intensity endurance training programme in patients with coronary artery disease

Objectives. To assess the physiological changes that take place in patients with  coronary artery disease after 6 and 18 months of moderate-intensity endurance  training.Design. Prospective non-randomised controlled study.Setting. Joharmesburg Cardiac Rehabilitation Centre, a community-based phase ill cardiac rehabilitation programme.Subjects. The 93 patients who completed 18 months of training form  the'experimental or 'complier' group, while the 18 patients who discontinued the programme form the comparison or 'dropout' group.Outcome measures. Haemodynamic, electrocardiographic and metabolic  measurements at rest and at submaximal and peak exercise levels on admission and after 6 a.,d 18 months of endurance training.Results. Among the compliers several significant changes took place. Resting heart rate and blood pressure decreased at 6 months (P &lt; 0.(05). Submaximal heart rate, blood pressure, rate-pressure product and ventilation decreased at 6 months (P &lt; 0.0001, P &lt; 0.01, P &lt; 0.001, P &lt; 0.01 respectively), and the .rate-pressure product decreased further at 18 months (P &lt; 0.05). Ventilat~ry threshold increased  at 6 months (P &lt; 0.00(1). Peak oxygen uptake, heart rate and ventilation increased at 6 months (P &lt; 0.0001, P &lt; 0.005 and P &lt; 0.0001, respectively), with no further changes at 18 months. Treadmill time increased at 6 months and again at 18 months (P &lt; 0.00(1). The only Significant change in the dropout group was an increase in ST-segment depression on the exercise ECG from 0.2 to 0.6 mm (P &lt; 0.05).Conclusion. The study confirms that cardiac rehabilitation is beneficial. Most changes occurred in the first 6 months, the longer period of 18 months serving mostly as reinforcement of these and other lifestyle changes

Lixisenatide reduces glycaemic variability in insulin-treated patients with type 2 diabetes

International audienceChronic hyperglycaemia and glucose variability are associated with the development of chronic diabetes-related complications. We conducted a pooled analysis of patient-level data from three 24-week, randomized, phase III clinical trials to evaluate the impact of lixisenatide (LIXI) on glycaemic variability (GV) vs placebo as add-on to basal insulin. The main outcome GV measures were standard deviation (s.d.), mean amplitude of glycaemic excursions (MAGE), mean absolute glucose (MAG) level, area under the curve for fasting glucose (AUC-F), and high (HBGI) and low blood glucose index (LBGI). The change in GV metrics over 24 weeks and relationships among baseline GV, patient characteristics and outcomes were assessed. Data were pooled from 1198 patients (665 LIXI, 533 placebo). Values for s.d., MAG level, MAGE, HBGI, and AUC-F significantly decreased with LIXI vs placebo, while LBGI values were unchanged. Higher baseline GV measures correlated with older age, longer type 2 diabetes duration, lower body mass index, higher baseline glycated/haemogobin, greater reduction in postprandial glucose (PPG) level, and higher rates of symptomatic hypoglycaemia. These data show that LIXI added to basal insulin significantly reduced GV and PPG excursions vs placebo, without increasing the risk of hypoglycaemia (LBGI)

Reduction in lipoprotein-associated apoC-III levels following volanesorsen therapy: phase 2 randomized trial results.

Elevated apoC-III levels predict increased cardiovascular risk when present on LDL and HDL particles. We developed novel high-throughput chemiluminescent ELISAs that capture apoB, lipoprotein (a) [Lp(a)], and apoA-I in plasma and then detect apoC-III on these individual lipoproteins as apoCIII-apoB, apoCIII-Lp(a), and apoCIII-apoAI complexes, respectively. We assessed the effects on these complexes of placebo or 100-300 mg volanesorsen, a generation 2.0+ antisense drug that targets apoC3 mRNA in patients with hypertriglyceridemia, including familial chylomicronemia syndrome (n = 3), volanesorsen monotherapy (n = 51), and as add-on to fibrate (n = 26), treated for 85 days and followed for 176 days. Compared with placebo, volanesorsen was associated with an 82.3 ± 11.7%, 81.3 ± 15.7%, and 80.8 ± 13.6% reduction in apoCIII-apoB, apoCIII-Lp(a), and apoCIII-apoA-I, respectively (300 mg dose;P&lt; 0.001 for all), at day 92. Strong correlations in all assay measures were noted with total plasma apoC-III, chylomicron-apoC-III, and VLDL-apoC-III. In conclusion, novel high-throughput ELISAs were developed to detect lipoprotein-associated apoC-III, including for the first time on Lp(a). Volanesorsen uniformly lowers apoC-III on apoB-100, Lp(a), and apoA-I lipoproteins, and may be a potent agent to reduce triglycerides and cardiovascular risk mediated by apoC-III