Renin-Angiotensin-Aldosterone System, Glucose Metabolism and Incident Type 2 Diabetes Mellitus: MESA.

Background Mechanistic studies suggest that aldosterone impairs glucose metabolism. We investigated the cross-sectional associations of aldosterone and plasma renin activity with fasting plasma glucose, insulin resistance ( IR ), β-cell function, and longitudinal association with incident diabetes mellitus among adults in MESA (the multiethnic study of atherosclerosis) prospective cohort study. Methods and Results Homeostatic model assessment of IR ( HOMA 2- IR ) and HOMA 2-β were used to estimate IR and β-cell function, respectively. Incident diabetes mellitus was defined as fasting plasma glucose ≥126 mg/dL or anti-diabetic medication use at follow-up. Linear regression was used to examine cross-sectional associations of aldosterone with fasting plasma glucose, HOMA 2- IR and HOMA 2-β; Cox regression was used to estimate hazard ratios ( HR ) for incident diabetes mellitus with multivariable adjustment. There were 116 cases of incident diabetes mellitus over 10.5 years among 1570 adults (44% non-Hispanic white, 13% Chinese American, 19% Black, 24% Hispanic American, mean age 64±10 years, 51% female). A 100% increase in log-aldosterone was associated with a 2.6 mg/dL higher fasting plasma glucose, 15% higher HOMA 2- IR and 6% higher HOMA 2-β ( P<0.01). A 1- SD increase in log-aldosterone was associated with a 44% higher risk of incident diabetes mellitus ( P<0.01) with the greatest increase of 142% ( P<0.01) observed in Chinese Americans ( P for interaction=0.09 versus other ethnicities). Similar cross-sectional findings for log-plasma renin activity existed, but log-plasma renin activity was not associated with incident diabetes mellitus after full adjustment. Conclusions Aldosterone is associated with glucose homeostasis and diabetes mellitus risk with graded associations among Chinese Americans and blacks, suggesting that pleiotropic effects of aldosterone may represent a modifiable mechanism in diabetes mellitus pathogenesis with potential racial/ethnic variation

Acculturation is associated with left ventricular mass in a multiethnic sample: the Multi-Ethnic Study of Atherosclerosis.

BackgroundAcculturation involves stress-related processes and health behavioral changes, which may have an effect on left ventricular (LV) mass, a risk factor for cardiovascular disease (CVD). We examined the relationship between acculturation and LV mass in a multiethnic cohort of White, African-American, Hispanic and Chinese subjects.MethodsCardiac magnetic resonance assessment was available for 5004 men and women, free of clinical CVD at baseline. Left ventricular mass index was evaluated as LV mass indexed by body surface area. Acculturation was characterized based on language spoken at home, place of birth and length of stay in the United States (U.S.), and a summary acculturation score ranging from 0 = least acculturated to 5 = most acculturated. Mean LV mass index adjusted for traditional CVD risk factors was compared across acculturation levels.ResultsUnadjusted mean LV mass index was 78.0 ± 16.3 g/m(2). In adjusted analyses, speaking exclusively English at home compared to non-English language was associated with higher LV mass index (81.3 ± 0.4 g/m(2) vs 79.9 ± 0.5 g/m(2), p = 0.02). Among foreign-born participants, having lived in the U.S. for ≥ 20 years compared to < 10 years was associated with greater LV mass index (81.6 ± 0.7 g/m(2) vs 79.5 ± 1.1 g/m(2), p = 0.02). Compared to those with the lowest acculturation score, those with the highest score had greater LV mass index (78.9 ± 1.1 g/m(2) vs 81.1 ± 0.4 g/m(2), p = 0.002). There was heterogeneity in which measure of acculturation was associated with LV mass index across ethnic groups.ConclusionsGreater acculturation is associated with increased LV mass index in this multiethnic cohort. Acculturation may involve stress-related processes as well as behavioral changes with a negative effect on cardiovascular health

Alcohol Use Disorder is Associated with an Increased Risk for Respiratory Failure among Patients with Takotsubo Cardiomyopathy

BACKGROUND: While takotsubo cardiomyopathy (TCM) was initially considered a benign disease, recent studies have demonstrated poor cardiovascular outcomes. It is important to determine the predictors of these outcomes for appropriate risk stratification and to decrease the overall disease burden. Physical stressors (e.g., acute neurologic disorder and lung disorder) and pre-existing heart failure have been associated with worse outcomes. Alcohol abuse has been associated with cardiomyopathy and may also exacerbate pre-existing heart conditions. AIM: We aimed to determine the impact of alcohol abuse on patients with TCM. METHODS: We identified 11,221 patients from the 2009 to 2012 National Inpatient Sample, of which 10,622 had TCM alone and 599 had TCM and alcohol use disorder (AUD). Our outcomes of interest were overall mortality, need for mechanical hemodynamic support (MHS), acute respiratory failure, sudden cardiac arrest, cardiogenic shock, stroke, and atrial fibrillation. All clinical characteristics were defined per the International Classification of Diseases 9th revision codes. Logistic regression was used to estimate the odds ratios of the outcomes in patients with concomitant TCM and AUD, compared to those with TCM without AUD while adjusting for confounders. RESULTS: The mean age of the sample was 60.5 ± 11 for TCM with AUD and 56.0 ± 11 for TCM alone. There was no significant difference between the two groups in the rates of atrial fibrillation (10.4% vs. 8,5%; p = 0.134), cardiogenic shock (5.9% vs. 4.8%; p = 0.3), use of MHS (2.6% vs. 1.7%; p = 0.165), overall in-hospital mortality (4.0% vs. 3.7%; p = 0.691), stroke (1.6% vs. 1.3%; p = 0.593), and sudden cardiac arrest (2.7% vs. 3.5%; p = 0.24). Rates of acute respiratory failure (17.7% vs. 25.2%; p < 0.0001) were significantly higher in patients with TCM with AUD compared to those with TCM alone. After adjusting for significant cofounders, the odds ratio for respiratory failure among patients with concomitant TCM and AUD was 1.36 (95% CI: 1.11–1.66) compared to those with TCM without AUD. CONCLUSION: Pre-existing AUD is associated with an increased risk for respiratory failure in a patient with TCM

Waist circumference does not predict circulating adiponectin levels in sub-Saharan women

<p>Abstract</p> <p>Background</p> <p>Because of previously reported ethnic differences in determinants and markers of obesity and related metabolic disorders, we sought to investigate circulating levels of adiponectin and their correlates in a sub-Saharan African (sSA) population.</p> <p>Subjects and Methods</p> <p>We studied 70 non-diabetic volunteers (33M/37F) living in Yaoundé, Cameroon, aged 24–69 yr, with BMI 20–42 kg/m². In all participants we measured waist circumference and total body fat by bioimpedance, and obtained a fasting venous blood sample for measurement of plasma glucose, serum insulin and adiponectin concentrations. We performed a euglycaemic hyperinsulinaemic clamp in 1/4 subjects, and HOMA_IRwas used as surrogate of fasting insulin sensitivity index since it best correlates to clamp measurements.</p> <p>Results</p> <p>Males had lower adiponectin levels than females (8.8 ± 4.3 vs. 11.8 ± 5.5 μg/L). There was no significant correlation between adiponectin and total body fat (r_s= -0.03; NS), whereas adiponectin was inversely correlated with waist circumference (r_s= -0.39; p = 0.001). Adiponectin correlated negatively with insulin resistance (r_s= -0.35; p = 0.01). In a regression analysis using fasting adiponectin concentration as the dependent variable, and age, HOMA_IR, waist circumference, and fat mass as predictors, waist circumference (β = -3.30; p = 0.002), fat mass (β = -2.68; p = 0.01), and insulin resistance (β = -2.38; p = 0.02) but not age (β = 1.11; p = 0.27) were independent predictors of adiponectin. When considering gender, these relations persisted with the exception of waist circumference in females.</p> <p>Conclusion</p> <p>Adiponectin correlates in this study population are comparable to those observed in Caucasians with the exception of waist circumference in women. The metabolic significance of waist circumference is therefore questioned in sSA women.</p

Étude ethnobotanique des plantes alimentaires utilisées en médecine traditionnelle dans la région Maritime du Togo

Les plantes alimentaires contiennent des principes actifs doués de diverses propriétés médicinales pouvant intervenir dans le traitement de nombreuses maladies. Cette étude est consacrée au recensement des plantes ayant des potentiels nutritionnel et thérapeutique dans la région Maritime du Togo, dans le but de la valorisation de ces plantes. De juin à septembre 2017, une enquête ethnobotanique, basée sur l’utilisation des interviews individuelles à l'aide d'un questionnaire semi-structuré, a été réalisée auprès de 101 Praticiens de la Médecine Traditionnelle. Au total 86 espèces végétales appartenant à 72 genres et 36 familles ont été identifiées. Les Fabaceae et les Solanaceae (7 espèces chacune) ont été les plus représentées. Les espèces les plus citées ont été Ocimum gratissimum L. (10,48%), Vernonia amygdalina Delile (6,71%), Lactuca taraxacifolia (Willd.) Schum. (6,08%) et Heliotropium indicum L. (5,66%). Les feuilles (77,85%), les fruits (5,63%) et les racines (4,26%) sont les organes les plus utilisées sur 799 recettes inventoriées. La principale forme galénique reste la sauce (51,19%) et le mode principal d’administration est la voie orale (90,74%). Concernant les maladies traitées, les affections du tube digestif sont au premier rang (43,80%) suivies par des affections cardiovasculaires (13,52%). Cette étude fournie une base de données sur des plantes ayant des potentiels nutritionnel et thérapeutique au Togo.Mots clés : Alicaments, potentiels nutritionnel et thérapeutique, sécurité alimentaire, Togo. &nbsp; English title: Ethnobotanical study of some food plants used in traditional medicine in the Maritime region of TogoFood plants contain active substances with various medicinal properties that can be used to treat many diseases. This study is devoted to the inventory of plants with nutritional and therapeutic potential in Maritime region of Togo, with the aim of promoting these plants. From June to September 2017, an ethnobotanical survey was conducted among 101 Traditional Medicine Practitioners through individual interviews using a semi-structured questionnaire. A total of 86 plants species belonging to 72 genera and 36 families were identified. Fabaceae and Solanaceae (7 species each) were the most represented. The most cited species were Ocimum gratissimum L. (10.48%), Vernonia amygdalina Delile (6.71%), Lactuca taraxacifolia (Willd.) Schum. (6.08%) and Heliotropium indicum L. (5.66%). The leaves (77.85%), fruits (5.63%) and roots (4.26%) were the most plant parts used out of 799 inventoried recipes. The main dosage form remains the sauce (51.19%) and the main mode of administration is the oral route (90.74%). Regarding the treated diseases, the digestive disorders are in first place (43.80%), followed by cardiovascular diseases (13.52%). This study provides a database of plants with nutritional and therapeutic potential in Togo.Keywords: Food plants, nutritional and therapeutic potentials, food security, Togo

Evaluation In Vitro De L’activité Antimicrobienne Des Extraits De Cassia Alata Linn. (Fabaceae)

Cassia alata (Linn) is a Togolese flora plant traditionally used in the treatment of skin diseases and diarrhea. The objective of this work was to evaluate the in vitro antimicrobial activity and to highlight certain phytochemical total and fractionated extracts of this plant harvested in southern Togo. These extracts were obtained from polar solvents such as water, ethanol and ethanol / water mixture in equal volume. Microbial strains used consisted of bacteria, Staphylococcus aureus, Escherichia coli and Klebsiella oxytoca and yeasts, Candida albicans and Candida krusei. The antimicrobial activity was evaluated by the liquid medium dilution method coupled to spread on solid medium. Highlighting chemical groups was made by a brief qualitative phytochemical analysis from staining tests. The results show that the ethanol leaves crude extract (EBE) was the most active of all the tested microbial strains. This extract completely inhibited the growth of S. aureus (MIC = 1.25mg/ ml.); very strongly C. albicans (PI = 94.34 % ) and C. krusei (PI = 90.67% ) and strongly E. coli ( PI = 80%) and K. oxytoca (PI=79.14 %). The other extracts were active in some organisms with percentage inhibition (PI) of between 68 and 97 %. The phytochemical screening of some extracts revealed the presence of flavonoïdes, tannins and saponins. C. alata seems to contain compounds that interact to inhibit the growth of yeasts and bacteria. These results in part to justify the use of this plant in the Togolese traditional medicines

The American Heart Association Ideal Cardiovascular Health and Incident Type 2 Diabetes Mellitus Among Blacks: The Jackson Heart Study

Background: The concept of ideal cardiovascular health (CVH), defined by the American Heart Association primarily for coronary heart disease and stroke prevention, may apply to diabetes mellitus prevention among blacks. Methods and Results: Our sample included 2668 adults in the Jackson Heart Study with complete baseline data on 6 of 7 American Heart Association CVH metrics (body mass index, healthy diet, smoking, total cholesterol, blood pressure, and physical activity). Incident diabetes mellitus was defined as fasting glucose ≥126 mg/dL, physician diagnosis, use of diabetes mellitus drugs, or glycosylated hemoglobin ≥6.5%. A summary CVH score from 0 to 6, based on presence/absence of ideal CVH metrics, was derived for each participant. Cox regression was used to estimate adjusted hazard ratios. Mean age was 55 years (65% women) with 492 incident diabetes mellitus events over 7.6 years (24.6 cases/1000 person‐years). Three quarters of participants had only 1 or 2 ideal CVH metrics; no participant had all 6. After adjustment for demographic factors (age, sex, education, and income) and high‐sensitivity C‐reactive protein, each additional ideal CVH metric was associated with a 17% diabetes mellitus risk reduction (hazard ratio, 0.83; 95% CI, 0.74–0.93). The association was attenuated with further adjustment for homeostasis model assessment for insulin resistance (hazard ratio, 0.89; 95% CI, 0.79–1.00). Compared with participants with 1 or no ideal CVH metric, diabetes mellitus risk was 15% and 37% lower in those with 2 and ≥3 ideal CVH metrics, respectively. Conclusions: The AHA concept of ideal CVH is applicable to diabetes mellitus prevention among blacks. These associations were largely explained by insulin resistance

Carotid Intima-Media Thickness is Associated With Incident Heart Failure Among Middle-Aged Whites and Blacks: The Atherosclerosis Risk in Communities Study

BackgroundIncreased carotid intima‐media thickness (IMT) is associated with subclinical left ventricular myocardial dysfunction, suggesting a possible role of carotid IMT in heart failure (HF) risk determination.Methods and ResultsMean far wall carotid IMT, measured by B‐mode ultrasound, was available for 13 590 Atherosclerosis Risk in Communities study participants aged 45 to 64 years and free of HF at baseline. HF was defined using ICD‐9 428 and ICD‐10 I‐50 codes from hospitalization records and death certificates. The association between carotid IMT and incident HF was assessed using Cox proportional hazards analysis with models adjusted for demographic variables, major CVD risk factors, and interim CHD. There were 2008 incident HF cases over a median follow‐up of 20.6 years (8.1 cases per 1000 person‐years). Mean IMT was higher in those with HF than in those without (0.81 mm±0.23 versus 0.71 mm±0.17, P<0.001). Unadjusted rate of HF for the fourth compared with the first quartile of IMT was 15.4 versus 3.9 per 1000 person‐years; P<0.001. In multivariable analysis, after adjustment, each standard deviation increase in IMT was associated with incident HF (HR 1.20 [95% CI: 1.16 to 1.25]). After adjustment, the top quartile of IMT was associated with HF (HR 1.60 [95% CI: 1.37 to 1.87]). Results were similar across race and gender groups.ConclusionsIncreasing carotid IMT is associated with incident HF in middle‐aged whites and blacks, beyond risks explained by major CVD risk factors and CHD. This suggests that carotid IMT may be associated with HF through mechanisms different from myocardial ischemia or infarction

Fasting insulin sensitivity indices are not better than routine clinical variables at predicting insulin sensitivity among Black Africans: a clamp study in sub-Saharan Africans

BACKGROUND: We aimed to evaluate the predictive utility of common fasting insulin sensitivity indices, and non-laboratory surrogates [BMI, waist circumference (WC) and waist-to-height ratio (WHtR)] in sub-Saharan Africans without diabetes. METHODS: We measured fasting glucose and insulin, and glucose uptake during 80/mU/m2/min euglycemic clamp in 87 Cameroonians (51 men) aged (SD) 34.6 (11.4) years. We derived insulin sensitivity indices including HOMA-IR, quantitative insulin sensitivity check index (QUICKI), fasting insulin resistance index (FIRI) and glucose-to-insulin ratio (GIR). Indices and clinical predictors were compared to clamp using correlation tests, robust linear regressions and agreement of classification by sex-specific thirds. RESULTS: The mean insulin sensitivity was M =10.5+/-3.2mg/kg/min. Classification across thirds of insulin sensitivity by clamp matched with non-laboratory surrogates in 30-48% of participants, and with fasting indices in 27-51%, with kappa statistics ranging from 0.10 to 0.26. Fasting indices correlated significantly with clamp (/r/=0.23-0.30), with GIR performing less well than fasting insulin and HOMA-IR (both p <0.02). BMI, WC and WHtR were equal or superior to fasting indices (/r/=0.38-0.43). Combinations of fasting indices and clinical predictors explained 25-27% of variation in clamp values. CONCLUSION: Fasting insulin sensitivity indices are modest predictors of insulin sensitivity measured by euglycemic clamp, and do not perform better than clinical surrogates in this population