Cardio-protective effects of carnitine in streptozotocin-induced diabetic rats

BACKGROUND: Streptozotocin-induced diabetes (STZ-D) in rats has been associated with carnitine deficiency, bradycardia and left ventricular enlargement. AIM: The purpose of this study was to determine whether oral carnitine supplementation would normalize carnitine levels and cardiac function in STZ-D rats. METHODS: Wistar rats (48) were made hyperglycemic by STZ at 26 weeks of age. Same age normal Wistar rats (24) were used for comparison. Echocardiograms were performed at baseline 2, 6, 10, and 18 weeks after STZ administration in all animals. HbA1c, serum carnitine and free fatty acids (FFA) were measured at the same times. Since STZ-D rats become carnitine deficient, 15 STZ-D rats received supplemental oral carnitine for 16 weeks. RESULTS: The heart rates for the STZ-D rats (290 ± 19 bpm) were less than control rats (324 ± 20 bpm) (p < 0.05). After 4 weeks of oral carnitine supplementation, the serum carnitine and heart rates of the STZ-D rats returned to normal. Dobutamine stress increased the heart rates of all study animals, but the increase in STZ-D rats (141 ± 8 bpm) was greater than controls (79 ± 8 bpm) (p < 0.05). The heart rates of STZ-D rats given oral carnitine, however, were no different than controls (94 ± 9 bpm). The left ventricular mass/body weight ratio (LVM/BW) in the diabetic animals (2.7 ± 0.5) was greater than control animals (2.2 ± 0.3) (p < 0.05) after 18 weeks of diabetes. In contrast, the LVM/BW (2.3 ± .2) of the STZ-D animals receiving supplemental carnitine was the same as the control animals at 18 weeks. CONCLUSION: Thus, supplemental oral carnitine in STZ-D rats normalized serum carnitine, heart rate regulation and left ventricular size. These findings suggest a metabolic mechanism for the cardiac dysfunction noted in this diabetic animal model

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents

This document was written with the intent to be a complete reference at the time of publication on the topic of managing hypertension in the elderly. This document has been developed as an expert consensus document by the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA), in collaboration with the American Academy of Neurology (AAN), the American College of Physicians (ACP), the American Geriatrics Society (AGS), the American Society of Hypertension (ASH), the American Society of Nephrology (ASN), the American Society for Preventive Cardiology (ASPC), the Association of Black Cardiologists (ABC), and the European Society of Hypertension (ESH). Expert consensus documents are intended to inform practitioners, payers, and other interested parties of the opinion of ACCF and document cosponsors concerning evolving areas of clinical practice and/or technologies that are widely available or new to the practice community

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents

This document was written with the intent to be a complete reference at the time of publication on the topic of managing hypertension in the elderly. This document has been developed as an expert consensus document by the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA), in collaboration with the American Academy of Neurology (AAN), the American College of Physicians (ACP), the American Geriatrics Society (AGS), the American Society of Hypertension (ASH), the American Society of Nephrology (ASN), the American Society for Preventive Cardiology (ASPC), the Association of Black Cardiologists (ABC), and the European Society of Hypertension (ESH). Expert consensus documents are intended to inform practitioners, payers, and other interested parties of the opinion of ACCF and document cosponsors concerning evolving areas of clinical practice and/or technologies that are widely available or new to the practice community

Exercise and Pharmacological Treatment of Depressive Symptoms in Patients with Coronary Heart Disease: Results from the UPBEAT Study

To assess the efficacy of exercise and antidepressant medication in reducing depressive symptoms and improving cardiovascular biomarkers in depressed patients with coronary heart disease (CHD)

Measuring Quality of Life at the End of Life

For patients near the end of life, quality of life becomes an even more central goal of care than for patients for whom recovery is expected. While patient quality of life is essentially an individual matter and a reflection of a particular patient’s goals, experiences, values and preferences for treatment, there is considerable agreement about what domains are relevant. Domains that comprise patient quality of life at the end of life generally include: trusting one’s physician, avoiding a prolonged dying experience, attaining a sense of closure, avoiding being a burden to family members, managing pain and other symptoms, and maintaining open communication. The characteristics of quality of life measures useful in this context are described, and seven quality of life measures with demonstrated reliability and validity in the end of life context are discussed. The domains that comprise quality of care at the end of life overlap the domains of quality of life; thus three measures of quality of care at the end of life are also described. Since patients nearing the end of life are often debilitated and unable to respond to measurement instruments, the benefits and risks of using proxy data for patient quality of life measurements are summarized. The influence of hospice care on patient quality of life is summarized, as well as the difficulties of conducting research in this patient population. The chapter concludes with suggested directions for future research

Measuring Quality of Life at the End of Life

For patients near the end of life, quality of life becomes an even more central goal of care than for patients for whom recovery is expected. While patient quality of life is essentially an individual matter and a reflection of a particular patient’s goals, experiences, values and preferences for treatment, there is considerable agreement about what domains are relevant. Domains that comprise patient quality of life at the end of life generally include: trusting one’s physician, avoiding a prolonged dying experience, attaining a sense of closure, avoiding being a burden to family members, managing pain and other symptoms, and maintaining open communication. The characteristics of quality of life measures useful in this context are described, and seven quality of life measures with demonstrated reliability and validity in the end of life context are discussed. The domains that comprise quality of care at the end of life overlap the domains of quality of life; thus three measures of quality of care at the end of life are also described. Since patients nearing the end of life are often debilitated and unable to respond to measurement instruments, the benefits and risks of using proxy data for patient quality of life measurements are summarized. The influence of hospice care on patient quality of life is summarized, as well as the difficulties of conducting research in this patient population. The chapter concludes with suggested directions for future research

Longitudinal blood glucose level and increased silent myocardial infarction: a pooled analysis of four cohort studies

Abstract Background Fasting glucose (FG) demonstrates dynamic fluctuations over time and is associated with cardiovascular outcomes, yet current research is limited by small sample sizes and relies solely on baseline glycemic levels. Our research aims to investigate the longitudinal association between FG and silent myocardial infarction (SMI) and also delves into the nuanced aspect of dose response in a large pooled dataset of four cohort studies. Methods We analyzed data from 24,732 individuals from four prospective cohort studies who were free of myocardial infarction history at baseline. We calculated average FG and intra-individual FG variability (coefficient of variation), while SMI cases were identified using 12-lead ECG exams with the Minnesota codes and medical history. FG was measured for each subject during the study’s follow-up period. We applied a Cox regression model with time-dependent variables to assess the association between FG and SMI with adjustment for age, gender, race, Study, smoking, longitudinal BMI, low-density lipoprotein level, blood pressure, and serum creatinine. Results The average mean age of the study population was 60.5 (sd: 10.3) years with median fasting glucose of 97.3 mg/dL at baseline. During an average of 9 years of follow-up, 357 SMI events were observed (incidence rate, 1.3 per 1000 person-years). The association between FG and SMI was linear and each 25 mg/dL increment in FG was associated with a 15% increase in the risk of SMI. This association remained significant after adjusting for the use of lipid-lowering medication, antihypertensive medication, antidiabetic medication, and insulin treatment (HR 1.08, 95% CI 1.01–1.16). Higher average FG (HR per 25 mg/dL increase: 1.17, 95% CI 1.08–1.26) and variability of FG (HR per 1 sd increase: 1.23, 95% CI 1.12–1.34) over visits were also correlated with increased SMI risk. Conclusions Higher longitudinal FG and larger intra-individual variability in FG over time were associated in a dose–response manner with a higher SMI risk. These findings support the significance of routine cardiac screening for subjects with elevated FG, with and without diabetes

Additional file 1 of Longitudinal blood glucose level and increased silent myocardial infarction: a pooled analysis of four cohort studies

Additional file 1. Time points of measurement of fasting glucose and ECG in the ARIC, MESA, Health ABC, and CHS cohorts