12 research outputs found
The prognostic role of galectin-3 and endothelial function in patients with heart failure
Background: Heart failure (HF) is nowadays classified as HF with reduced ejection fraction (HFrEF), HF with mildly reduced EF (HFmrEF), and HF with preserved EF (HFpEF). Endothelial dysfunction (assessed by flow-mediated dilatation [FMD]), increased arterial stiffness (assessed by carotid-femoral pulse-wave velocity [PWV]), and galectin-3, a biomarker of myocardial fibrosis, have been linked to major adverse cardiovascular events (MACE) in patients with ischemic HF.
Methods: In this study we prospectively enrolled 340 patients with stable ischemic HF. We assessed the brachial artery FMD, carotid-femoral PWV, and galectin-3 levels, and patients were followed up for MACE according to EF group.
Results: Interestingly, the FMD values exhibited a stepwise improvement according to left ventricular ejection fraction (LVEF) (HFrEF: 4.74 ± 2.35% vs. HFmrEF: 4.97 ± 2.81% vs. HFpEF: 5.94 ± 3.46%, p = 0.01), which remained significant after the evaluation of possible confounders including age, sex, cardiovascular risk factors, and number of significantly stenosed epicardial coronary arteries (b coefficient: 0.990, 95% confidence interval: 0.166–1.814, p = 0.019). Single-vessel coronary artery disease (CAD) was more frequent in the group of HFpEF (HFrEF: 56% vs. HFmrEF: 64% vs. HFpEF: 73%, p = 0.049). PWV did not display any association with LVEF. Patients who presented MACE exhibited worse FMD values (4.51 ± 2.35% vs. 5.32 ± 2.67%, p = 0.02), and the highest tertile of galectin-3 was linked to more MACEs (36% vs. 5.9%, p = 0.01).
Conclusions: Flow-mediated dilatation displayed a linear improvement with LVEF in patients with ischemic HF. Deteriorated values are associated with MACE. Higher levels of galectin-3 might be used for risk stratification of patients with ischemic HF
Antithrombotic Treatment in Diabetes Mellitus: A Review of the Literature about Antiplatelet and Anticoagulation Strategies Used for Diabetic Patients in Primary and Secondary Prevention
Background: Diabetes mellitus (DM) is on the rise globally. Its
prevalence has nearly doubled during the last two decades and it is
estimated to affect 8.8% of the global population. Cardiovascular
disease (CVD) is the leading cause of death in the diabetic population
and despite modem anti-inflammatory and cardiopmtective therapeutic
strategies, diabetic patients have at least a twice fold risk of
cardiovascular events. The prothrombotic state in DM is associated with
multiple determinants such as platelet alterations, oxidative stress,
endothelial changes, circulating mediators. Thus, proper antithrombotic
strategies to reduce the risk of CVD in this population are critical.
Methods: This article reviews the current antiplatelet and anticoagulant
agents in the aspect of primary and secondary prevention of CVD in the
diabetic population.
Results: The use of aspirin may be considered only at high-risk patients
in the absence of contraindications. Cangrelor was not inferior to
clopidogrel in preventing the composite outcome of CV death, myocardial
infarction and revascularization without increasing major bleeding.
Triple therapy in the subpopulation with DM significantly reduced the
composite primary outcome of CV death, myocardial infarction or repeat
target lesion revascularization. That was not the case for stent
thrombosis, which was similar in both groups. importantly, triple
therapy did not result in increased bleeding complications, which were
similar in both groups. However, cilostazol is linked to various adverse
effects (e.g., headache, palpitations, and gastrointestinal
disturbances) that drive many patients to withdrawal.
Conclusion: In conclusion, DM is a rapidly growing disease that
increases the risk of CVD, AF, and CV mortality. Proper antithrombotic
strategies to reduce CVD risk in DM are a necessity. Moreover, new
antithrombotic treatments and combination therapies may play a critical
role to overcome antiplatelet resistance in DM patients and reduce
morbidity and mortality attributed to CVD
Sleep Apnea and Cardiovascular Risk in Patients with Prediabetes and Type 2 Diabetes
Obstructive sleep apnea (OSA) is a common but largely undiagnosed clinical condition, which is turning into a serious public health issue. Of note is that its prevalence is gradually increasing in parallel with the obesity and type 2 diabetes mellitus (T2DM) epidemics. The aim of this article is to comprehensively review the literature in order to evaluate the cardiovascular (CV) risk among patients with OSA and prediabetes or T2DM. OSA seems to be an independent risk factor for the development as well as the progression of T2DM, whereas it is associated with T2DM-related macrovascular and microvascular complications. OSA may also act as a potential risk factor for the presentation and development of CV disease, such as hypertension, coronary artery disease, heart failure, pulmonary hypertension, atrial fibrillation and other cardiac arrythmias, as well as stroke. OSA and T2DM also share common pathophysiological mechanisms leading to atherosclerosis. Considering that the coexistence of OSA and T2DM is an independent and cumulative risk factor for CV mortality, more so than the two diseases separately, clinicians and healthcare professionals should be aware of and screen for OSA in patients with T2DM. Notably, targeted therapy for both conditions seems to substantially improve CV prognosis
Diabetes Mellitus in Acute Coronary Syndrome
The global prevalence of diabetes mellitus (DM) has led to a pandemic, with significant microvascular and macrovascular complications including coronary artery disease (CAD), which worsen clinical outcomes and cardiovascular prognosis. Patients with both acute coronary syndrome (ACS) and DM have worse prognosis and several pathophysiologic mechanisms have been implicated including, insulin resistance, hyperglycemia, endothelial dysfunction, platelet activation and aggregations as well as plaque characteristics and extent of coronary lesions. Therefore, regarding reperfusion strategies in the more complex anatomies coronary artery bypass surgery may be the preferred therapeutic strategy over percutaneous coronary intervention while both hyperglycemia and hypoglycemia should be avoided with closed monitoring of glycemic status during the acute phase of myocardial infraction. However, the best treatment strategy remains undefined. Non-insulin therapies, due to the low risk of hypoglycemia concurrently with the multifactorial CV protective effects, may be proved to be the best treatment option in the future. Nevertheless, evidence for the beneficial effects of glucagon like peptide-1 receptor agonists, dipeptidyl-peptidase 4 inhibitors and sodium glycose cotransporter 2 inhibitors, despite accumulating, is not robust and future randomized control trials may provide more definitive data
Thyroid disorders and cardiovascular manifestations: an update
Cardiovascular disease (CVD) remains the leading cause of death
worldwide, representing a major health, social, and economic issue.
Thyroid disorders are very common and affect >10% of the adult
population in total. The aim of this review is to describe the
physiologic role of thyroid hormones on cardiovascular system, to
present cardiovascular manifestations in patients with thyroid
disorders, emphasizing in molecular mechanisms and biochemical pathways,
and to summarize current knowledge of treatment options. Thyroid hormone
receptors are located both in myocardium and vessels, and changes in
their concentrations affect cardiovascular function. Hyperthyroidism or
hypothyroidism, both clinical and subclinical, without the indicated
therapeutical management, may contribute to the progression of CVD.
According to recent studies, even middle changes in thyroid hormones
levels increase cardiovascular mortality from 20% to 80%. In more
details, thyroid disorders seem to have serious effects on the
cardiovascular system via plenty mechanisms, including dyslipidemia,
hypertension, systolic and diastolic myocardial dysfunction, as well
endothelial dysfunction. On top of clinical thyroid disorders
management, current therapeutics focus on younger patients with
subclinical hypothyroidism and elderly patients with subclinical
hyperthyroidism
TREATMENT OPTIMIZATION WITH SODIUM/GLUCOSE COTRANSPORTER-2 INHIBITORS, DIPEPTIDYL PEPTIDASE-4 INHIBITORS OR GLYCAGONE LIKE PEPTIDE-1 IMPROVES VASCULAR DYSFUNCTION AND ACHIEVES BETTER GLYCEMIC CONTROL IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Endothelial dysfunction and impaired arterial wall properties in patients with retinal vein occlusion
Effects of Newer Antidiabetic Drugs on Endothelial Function and Arterial Stiffness: A Systematic Review and Meta-Analysis
Background. Newer antidiabetic drugs, i.e., dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may exert distinct cardiovascular effects. We sought to explore their impact on vascular function. Methods. Published literature was systematically searched up to January 2018 for clinical studies assessing the effects of DPP-4 inhibitors, GLP-1 RAs, and SGLT-2 inhibitors on endothelial function and arterial stiffness, assessed by flow-mediated dilation (FMD) of the brachial artery and pulse wave velocity (PWV), respectively. For each eligible study, we used the mean difference (MD) with 95% confidence intervals (CIs) for FMD and PWV. The pooled MD for FMD and PWV were calculated by using a random-effect model. The presence of heterogeneity among studies was evaluated by the I2 statistic. Results. A total of 26 eligible studies (n=668 patients) were included in the present meta-analysis. Among newer antidiabetic drugs, only SGLT-2 inhibitors significantly improved FMD (pooled MD 1.14%, 95% CI: 0.18 to 1.73, p=0.016), but not DPP-4 inhibitors (pooled MD = 0.86%, 95% CI: -0.15 to 1.86, p=0.095) or GLP-1 RA (pooled MD = 2.37%, 95% CI: -0.51 to 5.25, p=0.107). Both GLP-1 RA (pooled MD = −1.97, 95% CI: -2.65 to -1.30, p<0.001) and, to a lesser extent, DPP-4 inhibitors (pooled MD = -0.18, 95% CI: -0.30 to -0.07, p=0.002) significantly decreased PWV. Conclusions. Newer antidiabetic drugs differentially affect endothelial function and arterial stiffness, as assessed by FMD and PWV, respectively. These findings could explain the distinct effects of these drugs on cardiovascular risk of patients with type 2 diabetes