8 research outputs found
Cardiovascular disease management in people with diabetes outside North America and Western Europe in 2006 and 2015
Aim: Optimal treatment of cardiovascular disease is essential to decrease mortality among people with diabetes, but information is limited on how actual treatment relates to guidelines. We analysed changes in therapeutic approaches to anti-hypertensive and lipid-lowering medications in people with Type 2 diabetes from 2006 and 2015.
Methods: Summary data from clinical services in seven countries outside North America and Western Europe were collected for 39 684 people. Each site summarized individual-level data from outpatient medical records for 2006 and 2015. Data included: demographic information, blood pressure (BP), total cholesterol levels and percentage of people taking statins, anti-hypertensive medication (angiotensin-converting enzyme inhibitors, calcium channel blockers, angiotensin II receptor blockers, thiazide diuretics) and antiplatelet drugs.
Results: From 2006 to 2015, mean cholesterol levels decreased in six of eight sites (range: −0.5 to −0.2), whereas the proportion with BP levels > 140/90 mmHg increased in seven of eight sites. Decreases in cholesterol paralleled increases in statin use (range: 3.1 to 47.0 percentage points). Overall, utilization of anti-hypertensive medication did not change. However, there was an increase in the use of angiotensin II receptor blockers and a decrease in angiotensin-converting enzyme inhibitors. The percentage of individuals receiving calcium channel blockers and aspirin remained unchanged.
Conclusions: Our findings indicate that control of cholesterol levels improved and coincided with increased use of statins. The percentage of people with BP > 140/90 mmHg was higher in 2015 than in 2006. Hypertension treatment shifted from using angiotensin-converting enzyme inhibitors to angiotensin II receptor blockers. Despite the potentially greater tolerability of angiotensin II receptor blockers, there was no associated improvement in BP levels.Centro de Endocrinología Experimental y Aplicad
Cardiovascular disease management in people with diabetes outside North America and Western Europe in 2006 and 2015
Aim: Optimal treatment of cardiovascular disease is essential to decrease mortality among people with diabetes, but information is limited on how actual treatment relates to guidelines. We analysed changes in therapeutic approaches to anti-hypertensive and lipid-lowering medications in people with Type 2 diabetes from 2006 and 2015.
Methods: Summary data from clinical services in seven countries outside North America and Western Europe were collected for 39 684 people. Each site summarized individual-level data from outpatient medical records for 2006 and 2015. Data included: demographic information, blood pressure (BP), total cholesterol levels and percentage of people taking statins, anti-hypertensive medication (angiotensin-converting enzyme inhibitors, calcium channel blockers, angiotensin II receptor blockers, thiazide diuretics) and antiplatelet drugs.
Results: From 2006 to 2015, mean cholesterol levels decreased in six of eight sites (range: −0.5 to −0.2), whereas the proportion with BP levels > 140/90 mmHg increased in seven of eight sites. Decreases in cholesterol paralleled increases in statin use (range: 3.1 to 47.0 percentage points). Overall, utilization of anti-hypertensive medication did not change. However, there was an increase in the use of angiotensin II receptor blockers and a decrease in angiotensin-converting enzyme inhibitors. The percentage of individuals receiving calcium channel blockers and aspirin remained unchanged.
Conclusions: Our findings indicate that control of cholesterol levels improved and coincided with increased use of statins. The percentage of people with BP > 140/90 mmHg was higher in 2015 than in 2006. Hypertension treatment shifted from using angiotensin-converting enzyme inhibitors to angiotensin II receptor blockers. Despite the potentially greater tolerability of angiotensin II receptor blockers, there was no associated improvement in BP levels.Centro de Endocrinología Experimental y Aplicad
Supplementary Material for: Association of Serum Amyloid A with Kidney Outcomes and All-Cause Mortality in American Indians with Type 2 Diabetes
<p><b><i>Background:</i></b> Serum amyloid A (SAA) induces inflammation
and apoptosis in kidney cells and is found to be causing the pathologic
changes that are associated with diabetic kidney disease (DKD). Higher
serum SAA concentrations were previously associated with increased risk
of end-stage renal disease (ESRD) and death in persons with type 2
diabetes and advanced DKD. We explored the prognostic value of SAA in
American Indians with type 2 diabetes without DKD or with early DKD. <b><i>Methods:</i></b>
SAA concentration was measured in serum samples obtained at the start
of follow-up. Multivariate proportional hazards models were employed to
examine the magnitude of the risk of ESRD or death across tertiles of
SAA concentration after adjustment for traditional risk factors. The C
statistic was used to assess the additional predictive value of SAA
relative to traditional risk factors. <b><i>Results:</i></b> Of 256
participants (mean ± SD glomerular filtration rate [iothalamate] = 148 ±
45 mL/min, and median [interquartile range] urine albumin/creatinine =
39 [14-221] mg/g), 76 developed ESRD and 125 died during a median
follow-up period of 15.2 and 15.7 years, respectively. After
multivariable proportional hazards regression, participants in the 2
highest SAA tertiles together exhibited a 53% lower risk of ESRD (hazard
ratio [HR] 0.47, 95% CI 0.29-0.78), and a 30% lower risk of death (HR
0.70, 95% CI 0.48-1.02), compared with participants in the lowest SAA
tertile, although the lower risk of death was not statistically
significant. Addition of SAA to the ESRD model increased the C statistic
from 0.814 to 0.815 (<i>p </i>= 0.005). <b><i>Conclusions:</i></b> Higher circulating SAA concentration is associated with a reduced risk of ESRD in American Indians with type 2 diabetes.</p