Do angiotensin converting enzyme inhibitors or angiotensin receptor blockers prevent diabetes mellitus? A meta-analysis

Background: The prevalence of diabetes mellitus (DM) has increased exponentially in recent years, with 100 million people expected to develop diabetes in the coming 15 years. The impact of medical therapy on the incidence of new onset DM is not clear. We performed a systematic review and meta-analysis to study the impact of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) on the incidence of new onset DM. Methods: MEDLINE, EMBASE, BIOSIS, Cochrane databases from inception until February 2009 for randomized controlled trials (RCT) that reported new incident DM with ACEI or ARB therapy. A total of 18 RCT are included in this meta-analysis. A random-effect model was used and between-studies heterogeneity was estimated with I2. Results: There were 50,451 patients randomized to ACEI or ARB and 50,397 patients randomized to other therapies. ACEI/ARB use was associated with a decrease in new onset DM (RR 0.78, 95% CI 0.70-0.88, p = 0.003 for ACEI and RR 0.8, 95% CI 0.75-0.86, p < 0.0001 for ARB). Treating 100 patients with ACEI or 50 patients with ARB prevents one case of new onset DM. Conclusions: The cumulative evidence suggests that the use of ACEI/ARB prevents diabetes mellitus. This finding may be of special clinical benefit in patients with hypertension and prediabetes or metabolic syndrome. (Cardiol J 2010; 17, 5: 448-456

Low admission triglyceride and mortality in acute coronary syndrome patients

Background: The relationship between admission triglyceride (TG) levels and long-term outcomes has not been established in patients with acute coronary syndrome. We tested the hypothesis that patients who develop non-ST segment elevation myocardial infarction (NSTEMI) despite low TG have a worse cardiovascular outcome in the long term. Methods: Patients admitted with NSTEMI between 1 January 1997 and 31 December 2000 and with fasting lipid profiles measured within 24 hours of admission were included for analysis. Baseline characteristics and three-year all-cause mortality were compared between the patients with TG above and below the median. Multivariate analysis was used to determine the predictors of all-cause mortality and adjusted survival was analyzed using the Cox proportional hazard model. Results: Of 517 patients, 395 had TG &#163; 200 mg/dL and 124 had TG > 200 mg/dL. Patients with low TG were more often Caucasian, with no significant differences in gender or severity of coronary artery disease between the two groups. There was a trend for increased all-cause mortality at six months (9% vs 3%, p = 0.045) and three years (13.4% vs 5.6%, p = 0.016) in patients with low TG. In multivariate analysis, low TG level at admission was an independent predictor of increased mortality at three years (adjusted OR 2.5, 95% CI = 1.04&#8211;5.9, p = 0.04). Conclusions: In our cohort, lower TG at admission is associated with increased three-year mortality in patients with NSTEMI. Whether this is a result of current therapy, or a marker for worse baseline characteristics, needs to be studied further. (Cardiol J 2011; 18, 3: 297&#8211;303

Czy inhibitory konwertazy angiotensyny lub blokery receptora dla angiotensyny zapobiegają wystąpieniu cukrzycy? Metaanaliza

Wstęp: Zapadalność na cukrzycę w ciągu ostatnich lat gwałtownie wzrosła, przy czym szacuje się, że w ciągu kolejnych 15 lat choroba ta rozwinie się u 100 milionów osób. Wpływ leczenia na rozwój cukrzycy de novo nie jest jasny. Autorzy badania przeprowadzili systematyczny przegląd i metaanalizę w celu zbadania wpływu inhibitorów konwertazy angiotensyny (ACEI) i blokerów receptora dla angiotensyny (ARB) na wystąpienie cukrzycy de novo. Materiał i metody: Przeszukano bazy danych MEDLINE, EMBASE, BIOSIS, Cochrane od dnia ich powstania aż do lutego 2009 roku. Poszukiwano badań z randomizacją dotyczących świeżych zachorowań na cukrzycę w grupie pacjentów leczonych ACEI lub ARB. Do metaanalizy włączono 18 badań. Zastosowano model efektów losowych i różnice między badaniami oszacowano za pomocą I2. Wyniki: Losowo wybrano 50 451 pacjentów leczonych ACEI lub ARB i 50 397 osób poddanych terapii innymi preparatami. Stosowanie ACEI lub ARB wiązało się ze zmniejszeniem liczby nowych przypadków cukrzycy (RR 0,78, 95% CI 0,70-0,88, p = 0,003 dla ACEI i RR 0,8, 95% CI 0,75-0,86, p < 0,0001 dla ARB). Liczba osób, które należało leczyć, aby zapobiec jednemu nowemu przypadkowi cukrzycy, wyniosła 100 w przypadku ACEI i 50 w przypadku ARB. Wnioski: Zgromadzone dowody wskazują, że stosowanie ACEI/ARB zapobiega rozwojowi cukrzycy. Może to przynieść szczególne korzyści kliniczne pacjentom z nadciśnieniem tętniczym i stanem przedcukrzycowym lub zespołem metabolicznym. (Folia Cardiologica Excerpta 2010; 5, 5: 247-256

Mechanobehavior and Ontogenesis of the Temporomandibular Joint

Craniofacial secondary cartilages of the mandibular condyle and temporomandibular joint (TMJ) eminence grow in response to the local mechanical environment. The intervening TMJ disc distributes normal loads over the cartilage surfaces and provides lubrication. A better understanding of the mechanical environment and its effects on growth, development, and degeneration of the TMJ may improve treatments aimed at modifying jaw growth and preventing or reversing degenerative joint disease (DJD). This review highlights data recorded in human subjects and from computer modeling that elucidate the role of mechanics in TMJ ontogeny. Presented data provide an approximation of the age-related changes in jaw-loading behaviors and TMJ contact mechanics. The cells of the mandibular condyle, eminence, and disc respond to the mechanical environment associated with behaviors and ultimately determine the TMJ components' mature morphologies and susceptibility to precocious development of DJD compared to postcranial joints. The TMJ disc may be especially prone to degenerative change due to its avascularity and steep oxygen and glucose gradients consequent to high cell density and rate of nutrient consumption, as well as low solute diffusivities. The combined effects of strain-related hypoxia and limited glucose concentrations dramatically affect synthesis of the extracellular matrix (ECM), which limit repair capabilities. Magnitude and frequency of jaw loading influence this localized in situ environment, including stem and fibrocartilage cell chemistry, as well as the rate of ECM mechanical fatigue. Key in vivo measurements to characterize the mechanical environment include the concentration of work input to articulating tissues, known as energy density, and the percentage of time that muscles are used to load the jaws out of a total recording time, known as duty factor. Combining these measurements into a mechanobehavioral score and linking these to results of computer models of strain-regulated biochemical events may elucidate the mechanisms responsible for growth, maintenance, and deterioration of TMJ tissues