Hyperglycemia and Inflammation in older individuals.

OBJECTIVE - The objective of this study was to assess the association of inflammation with hyperglycemia (impaired fasting glucose [IFG]/impaired glucose tolerance [IGT]) and diabetes in older individuals. RESEARCH DESIGN AND METHODS - Baseline data from the Health, Aging and Body Composition study included 3,075 well-functioning black and white participants, aged 70-79 years. RESULTS - Of the participants, 24% had diabetes and 29% had IFG/IGT at baseline. C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) levels (P < 0.001) were significantly higher among diabetic participants and those with IFG/IGT. Odds of elevated IL-6 and TNF-α (>75th percentile) were, respectively, 1.95 (95% CI 1.56 -2.44) and 1.88 (1.51-2.35) for diabetic participants and 1.51 (1.21-1.87) and 1.14 (0.92-1.42) for those with IFG/IGT after adjustment for age, sex, race, smoking, alcohol intake, education, and study site. Odds ratios for elevated CRP were 2.90 (2.13-3.95) and 1.45 (1.03-2.04) for diabetic women and men and 1.33 (1.07-1.69) for those with IFG/IGT regardless of sex. After adjustment for obesity, fat distribution, and inflammation-related conditions, IL-6 remained signifi-cantly related to both diabetes and IFG/IGT. CRP in women and TNF-α in both sexes were significantly related to diabetes, respectively, whereas risk estimates for IFG/IGT were decreased by adjustment for adiposity. Among diabetic participants, higher levels of Hb

Pharmacologic management of patients with both heart failure and diabetes

Diabetes and heart failure often occur together in patients, with each condition influencing the treatment of the other. Each disease has its own well-documented impact on prognosis, but when they are present in the same patient, the risk of morbidity and mortality increases substantially. Some therapies used in the treatment of diabetes are contraindicated in patients with heart failure, and some therapies for treating heart failure are often mistakenly believed to be contraindicated in patients with diabetes. This article aims to clarify the evidence behind treating these conditions simultaneously and dispel the myths surrounding the pharmacologic management of diabetes in heart failure and vice vers

Central blood pressure, arterial stiffness, and wave reflection: New targets of treatment in essential hypertension

Central blood pressure is dependent on the stiffness of large arteries and pulse wave reflection. These parameters are very important in the development of hypertensive target organ disease. Moreover, recent clinical studies have shown their independent predictive value for cardiovascular morbidity and mortality. Therefore, 2007 guidelines for the management of hypertension inserted the evaluation of central arterial stiffness as an important component for assessing total cardiovascular risk. Differences in the way various antihypertensive drugs affect arterial stiffness and central hemodynamics may explain the greater cardio-vascular protection provided by newer drugs (eg, renin-angiotensin system blockers or calcium channel blockers) independent of peripheral blood pressure reduction, as shown by recent clinical studies. However, the predictive value of the attenuation of arterial stiffness, wave reflections, and central blood pressure still needs to be confirmed in prospective, long-term, large-scale therapeutic trials. Thus, whether these measurements should be routinely performed as a diagnostic or therapeutic indicator remains debatable