Cluster Analysis of Cardiovascular Phenotypes in Patients With Type 2 Diabetes and Established Atherosclerotic Cardiovascular Disease: A Potential Approach to Precision Medicine

OBJECTIVE Phenotypic heterogeneity among patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) is ill defined. We used cluster analysis machine-learning algorithms to identify phenotypes among trial participants with T2DM and ASCVD. RESEARCH DESIGN AND METHODS We used data from the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) study (n = 14,671), a cardiovascular outcome safety trial comparing sitagliptin with placebo in patients with T2DM and ASCVD (median follow-up 3.0 years). Cluster analysis using 40 baseline variables was conducted, with associations between clusters and the primary composite outcome (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina) assessed by Cox proportional hazards models. We replicated the results using the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) trial. RESULTS Four distinct phenotypes were identified: Cluster I included Caucasian men with a high prevalence of coronary artery disease; cluster II included Asian patients with a low BMI; cluster III included women with noncoronary ASCVD disease; and cluster IV included patients with heart failure and kidney dysfunction. The primary outcome occurred, respectively, in 11.6%, 8.6%, 10.3%, and 16.8% of patients in clusters I to IV. The crude difference in cardiovascular risk for the highest versus lowest risk cluster (cluster IV vs. II) was statistically significant (hazard ratio 2.74 [95% CI 2.29–3.29]). Similar phenotypes and outcomes were identified in EXSCEL. CONCLUSIONS In patients with T2DM and ASCVD, cluster analysis identified four clinically distinct groups. Further cardiovascular phenotyping is warranted to inform patient care and optimize clinical trial designs

BOTÂNICA E FISIOLOGIA/ BOTANY AND PHYSIOLOGY ANTIOXIDANT ACTIVITY AND PHYSICOCHEMICAL PARAMETERS IN ‘CUERNAVAQUEÑA’ MEXICAN PLUM (Spondias purpurea L.) AT DIFFERENT RIPENING STAGES

ABSTRACT Mexican plum (Spondias purpurea L.) ‘Cuernavaqueña’ was harvested at four ripening stages, with the aim of evaluating the concentration of bioactive compounds and antioxidant capacity in the pulp and the epicarp. The highest ethylene production (9.43 mL kg h-1) and total soluble solids concentration (23.9 °Brix) was observed in the fully ripe stage. Titratable acidity was higher in green stage compared to other analyzed ripening stages in both pulp (0.48 %) and epicarp (0.32 %). Fully ripe plum epicarp presented the highest content of total phenols (GAE 190 mg g-1), flavonoids (QE 214 mg g-1), and carotenoids (853 mg g-1) compared to other ripening stages. The antioxidant capacity was higher in the epicarp of the fully ripe fruit compared to the other ripening stages: DPPH (1087 µM TE /100 g), ABTS (1534 µM TE/100 g), and FRAP (1764 µM TE/100 g). Significant correlations (r = 0.60 *** to 0.95 **) between bioactive compounds concentrations and antioxidant activity were obtained

Avaliação bioeconômica de estratégias de suplementação de novilhos zebuínos mantidos em pastagens diferidas de capim-marandu no período seco

RESUMO O objetivo com este trabalho foi avaliar estratégias de suplementação sobre o consumo de suplemento, comportamento e desempenho de novilhos zebuínos mantidos em pastagem de capim-marandu (Urochloa brizantha cv. Marandu) diferido. Foi utilizado delineamento inteiramente casualizado para testar cinco estratégias de suplementação: sal mineral (SM), sal proteinado com 25% de ureia (SP) e três multimisturas (45,5% NDT) com 10% (MM10), 15% (MM 15), ou 20% (MM20) de ureia. Foram utilizados vinte novilhos com peso inicial 300±24,9kg, sendo quatro por tratamento, mantidos em cinco piquetes de 3,4ha rotacionados semanalmente, de julho a outubro de 2010. Os dados foram submetidos à ANOVA, usando o Teste de Tukey para comparar as médias (P<0,05); entretanto, a análise econômica determinou a melhor estratégia. A ingestão de suplementos foi alterada (P<0,05) pela estratégia de suplementação, sendo de: 106, 196, 852, 666 e 400 g/animal/dia para SM, SP, MM10, MM15 e MM20, respectivamente. O aumento do consumo de suplementos não alterou o tempo de pastejo ou ruminação/ócio (P>0,05). SM resultou em perda de peso (-137 g/animal/dia). Utilizando-se o SP praticamente manteve o peso dos novilhos. Entretanto, para obtenção de ganho de peso, as multimisturas devem ser utilizadas (P<0,05). Nesses casos, o ganho de peso diário chegou a 324 g/animal (MM10). Baseado nos resultados econômicos, a melhor estratégia foi MM20, seguida de MM10