Prognostic value of myocardial perfusion scintigraphy in type 2 diabetic patients with mild, stable angina pectoris

Aim: To determine the prognostic value of reversible myocardial perfusion defects on myocardial perfusion scintigraphy (MPS) in patients with type 2 diabetes mellitus and mild anginal complaints. Methods and results: In the MERIDIAN trial, patients with diabetes mellitus type 2, stable, mild anginal symptoms (Canadian Cardiovascular Society classification (CCS) I-II/IV) and reversible perfusion defects were randomized to either continued pharmacological treatment or early invasive treatment. In this sub analysis, the severity of the myocardial perfusion defect was related to the occurrence of cardiac death and non-fatal myocardial infarction, in 319 patients (63% male, 65 ± 9 years). During follow-up (2.2 ± 0.6 years), 14 patients had a cardiac event: 3 in 171 patients without myocardial ischemia and 11 in 148 patients with myocardial ischemia. Annual event rates rose from 0.8% to 5.8% with increasing severity of myocardial ischemia. Multivariable analysis identified the presence of severe myocardial ischemia (hazard ratio (HR) 5.45, 95%CI 1.89-15.71) and insulin use (HR 4.00, 95%CI 1.25-12.75) as independent predictors of cardiac events. Conclusions: Type 2 diabetics with mild anginal symptoms with no or moderate myocardial ischemia have a low annual cardiac event rate. In patients with severe myocardial ischemia event rate increased 3-6 fold

Diabetes mellitus type 2 is associated with higher levels of myeloperoxidase

BACKGROUND: Diabetes mellitus type 2 is linked to augmented endothelial dysfunction and accelerated atherosclerosis. Myeloperoxidase plays an important role in the initiation, progression, and the complications of atherosclerosis. We investigated whether myeloperoxidase levels are increased in diabetic patients. MATERIAL/METHODS: We compared baseline plasma myeloperoxidase levels in diabetic and nondiabetic patients with mild, stable anginal complaints (Canadian Cardiovascular Society I-II/IV) and performed multivariate linear regression analyses to adjust for possible confounding factors. RESULTS: A total of 440 patients were recruited from the outpatient clinic of cardiology, 268 patients with and 172 without diabetes mellitus type 2. Levels of myeloperoxidase were significantly higher in diabetic patients (median, 141 pM; interquartile range, 115-171 pM) than in nondiabetic patients (median, 126 pM; interquartile range, 105-167 pM) (P=0.01). Diabetes mellitus type 2, age in years, current smoking status, presence of hypercholesterolemia, and use of calcium antagonists and ACE inhibitors were associated with logarithmically transformed myeloperoxidase levels. Of these variables, diabetes mellitus type 2 (beta 0.096, SE 0.038, P=0.01); age (beta 0.01, SE 0.002, P <0.001), and current smoking (beta 0.166, SE 0.05, P=0.001) remained independently associated with myeloperoxidase levels in multivariate analysis. The linear regression coefficient of diabetes mellitus type 2 in relation to myeloperoxidase was 0.092 in univariate linear regression and 0.078 after adjusting for age, current smoking, and use of ACE inhibitors and calcium antagonists. CONCLUSIONS: Diabetes mellitus type 2 is associated with mildly increased levels of myeloperoxidase, independent of other clinical variables. This association may contribute to the accelerated progression of atherosclerosis in diabetic

Alirocumab and cardiovascular outcomes after acute coronary syndrome

BACKGROUN

Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome

BACKGROUN