Myocardial dysfunction in type 2 diabetes and arterial hypertension : analysis of insulin resistance, metabolic and cardiovascular parameters

Uvod: Miokardna disfunkcija spada u najveće i najznačajnije probleme savremene civilizacije. Nezavisno od osnovnog uzroka ona predstavlja završnu fazu svih srčanih oboljenja. Tip 2 dijabetesa je jedan od najznačajnijih faktora rizika za nastanak miokardne disfunkcije. Pored toga, insulinska rezistencija i hiperinsulinemija, kao i različiti stepeni poremećaj glikoregulacije, bez klinički ispoljenog dijabetesa predstavljaju značajan faktor rizika za nastanak miokardne disfunkcije. U kliničkoj medicini udruženost arterijske hipertenzije i miokardne disfunkcije je veoma česta i ima veliki dijagnostički i prognostički značaj. Osnovna klinička karakteristika miokardne disfunkcije u arterijskoj hipertenziji je njena neupadljivost i postepena progresija u toku dugog vremenskog perioda. Cilj ove studije je bio određivanjeprevalencije dijastolne i sistolne disfunkcije leve komore, kao i analiza uticaja pojedinačnih faktora rizika na nastanak ovih poremećaja u ispitivanoj grupi bolesnika. Analizirane su metaboličke i kardiovaskularne determinante i upoređivani demografski, ehokardiografski, metabolički i terapijski parametri između ispitivanih grupa. Takodje, ispitani su prediktori nastanka sistolne i dijastolne disfunkcije leve komore, kao i korelacije demografskih, biohemijskih, metaboličkih i ehokardiografskih parametara. Metode: U istraživanje je uključeno 239 bolesnika sa tipom 2 dijabetesa i/ili arterijskom hipertenzijom, bez ishemijske bolesti srca koji su bili podeljeni u tri grupe. Grupu 1 je sačinjavao 101 bolesnik sa tipom 2 dijabetesa, bez arterijske hipertenzije i ishemijske bolesti srca. Grupu 2 je činilo 62 bolesnika koji imaju arterijsku hipertenziju, bez tipa 2 dijabetesa i ishemijske bolesti srca. U Grupu 3 je bilo uključeno 76 bolesnika sa tipom 2 dijabetesa i arterijskom hipertenzijom, kod kojih je isključena ishemijska bolest srca...Background: Myocardial dysfunction is one of the most frequent and most important health problems worldwide. Independently of etiology, myocardial dysfunction and heart failure are end-stage of any progressive myocardial disorder. Type 2 diabetes is one of the most important risk factors for the development of myocardial dysfunction. Also, insulin resistance and hyperinsulinaemia, as well as impaired glycoregulation without frenk diabetes, play an important etiological role in progression of myocardial damage. In addition, arterial hypertension is one of the major cause of this condition, and may be clinically silent over the long period of time. Objectives: The aims of this study was to reveal the prevalence of left ventricular systolic and diastolic dysfunction (LVDD), as well as toassess the role of main risk factors related to the disease development. In this study, demographic, echocardiographic, metabolic and therapeutic determinants among the study groups were compared. In addition, the predictors of LVDD, as well as the correlations of the echocardiographic parameters with laboratory, metabolic and therapeutic variables were investigated. Design and methods: Study population included 239 patients with type 2 diabetes and/or arterial hypertension, without coronary artery disease, divided in three groups. Group 1 consisted of 101 type 2 diabetic patients, with no arterial hypertension and coronary artery disease. Group 2 included 62 patients with arterial hypertension,without type 2 diabetes, and coronary artery disease. In Group 3 there were 76 patients with both type 2 diabetes and arterial hypertension, and no coronary artery disease..

Risk factors for the development of diabetic nephropathy

Introduction. Results of epidemiological analysis show that one third of patients with diabetes mellitus develop diabetic nephropathy (DN). Strategies used until now to slow down the progression of DN were initiated when the symptoms of DN were already present. Objective. Our objective was to analyze the prevalence and characteristics of DN and to determine the factors leading to DN. Methods. Fifty-two patients with diabetes mellitus (DM) - 32 with type 1 aged 32 years and 20 with type 2 aged 59 years - were referred from the Institute of Endocrinology, Diabetes and Metabolic Diseases to the Department of Nephrology for kidney function evaluation. Apart from routine laboratory analyses, glomerular filtration rate was calculated using the MDRD formula (modification of diet in renal disease), the size of the kidney was measured by ultrasound, and kidney volume was calculated using the ellipsoid formula. Results Thirty percent of the patients revealed normal (eight patients with DM type 1) or satisfactory kidney function (eight patients with DM type 1) with physiological proteinuria. Micro-albuminuria (MAU) or pathological proteinuria (PRT) were found in 10 and 9 patients, respectively, with DM type 1, while decreased kidney function was found in one patient without proteinuria. MAU or PRT were found in four and eight patients, respectively, with DM type 2 and decreased kidney function in four patients without proteinuria. Kidney function was significantly lower in patients with DM type 2 in comparison to DM type 1, while the patients with decreased kidney function had a higher PRT. Compared to DM type 2, in DM type 1 patients, the kidney was longer, and parenchymal artery resistance index was lower in DM type 1 patients compared to DM type 2. Factors associated with DN were patient's age, duration of diabetes, systolic blood pressure, HbA1c and kidney volume. Conclusion. The prevalence of DN among the studied patients was 70%. Treatable factors associated with the development of DN are strict control of blood pressure and glycaemia control

Asymptomatic cardiovascular manifestations in diabetes mellitus: Left ventricular diastolic dysfunction and silent myocardial ischemia

Introduction. Several cardiovascular manifestations in patients with diabetes may be asymptomatic. Left ventricular diastolic dysfunction (LVDD) is considered to be the earliest metabolic myocardial lesion in these patients, and can be diagnosed with tissue Doppler echocardiography. Silent myocardial ischemia (SMI) is a characteristic and frequently described form of ischemic heart disease in patients with diabetes. Objective. The aim of the study was to assess the prevalence of LVDD and SMI in patients with type 2 diabetes, as well as to compare demographic, clinical, and metabolic data among defined groups (patients with LVDD, patients with SMI and patients with type 2 diabetes, without LVDD and SMI). Methods. We investigated 104 type 2 diabetic patients (mean age 55.4±9.1 years, 64.4% males) with normal blood pressure, prehypertension and arterial hypertension stage I. Study design included basic laboratory assessment and cardiological workup (transthoracic echocardiography and tissue Doppler, as well as the exercise stress echocardiography). Results. LVDD was diagnosed in twelve patients (11.5%), while SMI was revealed in six patients (5.8%). Less patients with LVDD were using metformin, in comparison to other two groups (χ2 =12.152; p=0.002). Values of HDL cholesterol (F=4.515; p=0.013) and apolipoprotein A1 (F=5.128; p= 0.008) were significantly higher in patients with LVDD. Conclusion. The study confirmed asymptomatic cardiovascular complications in 17.3% patients with type 2 diabetes

Altered Daytime Fluctuation Pattern of Plasminogen Activator Inhibitor 1 in Type 2 Diabetes Patients with Coronary Artery Disease: A Strong Association with Persistently Elevated Plasma Insulin, Increased Insulin Resistance, and Abdominal Obesity

This study was aimed at investigating daily fluctuation of PAI-1 levels in relation to insulin resistance (IR) and daily profile of plasma insulin and glucose levels in 26 type 2 diabetic (T2D) patients with coronary artery disease (CAD) (group A), 10 T2D patients without CAD (group B), 12 nondiabetics with CAD (group C), and 12 healthy controls (group D). The percentage of PAI-1 decrease was lower in group A versus group B (4.4 ± 2.7 versus 35.0 ± 5.4%; P<0.05) and in C versus D (14.0 ± 5.8 versus 44.7 ± 3.1%; P<0.001). HOMA-IR was higher in group A versus group B (P<0.05) and in C versus D (P<0.01). Simultaneously, AUCs of PAI-1 and insulin were higher in group A versus group B (P<0.05) and in C versus D (P<0.01), while AUC of glucose did not differ between groups. In multiple regression analysis waist-to-hip ratio and AUC of insulin were independent determinants of decrease in PAI-1. The altered diurnal fluctuation of PAI-1, especially in T2D with CAD, might be strongly influenced by a prolonged exposure to hyperinsulinemia in the settings of increased IR and abdominal obesity, facilitating altogether an accelerated atherosclerosis