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

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

Impact of Medical Therapy on Atheroma Volume Measured by Different Cardiovascular Imaging Modalities

Atherosclerosis is a systemic disease that affects most vascular beds. The gold standard of atherosclerosis imaging has been invasive intravascular ultrasound (IVUS). Newer noninvasive imaging modalities like B-mode ultrasound, cardiac computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI) have been used to assess these vascular territories with high accuracy and reproducibility. These imaging modalities have lately been used for the assessment of the atherosclerotic plaque and the response of its volume to several medical therapies used in the treatment of patients with cardiovascular disease. To study the impact of these medications on atheroma volume progression or regression, imaging modalities have been used on a serial basis providing a unique opportunity to monitor the effect these antiatherosclerotic strategies exert on plaque burden. As a result, studies incorporating serial IVUS imaging, quantitative coronary angiography (QCA), B-mode ultrasound, electron beam computed tomography (EBCT), and dynamic contrast-enhanced magnetic resonance imaging have all been used to evaluate the impact of therapeutic strategies that modify cholesterol and blood pressure on the progression/regression of atherosclerotic plaque. In this review, we intend to summarize the impact of different therapies aimed at halting the progression or even result in regression of atherosclerotic cardiovascular disease evaluated by different imaging modalities

Incidence and Risk Factors of Uterine Scar Dehiscence Identified at Elective Repeat Cesarean Delivery: A Case-Control Study

info:eu-repo/semantics/publishe

Galectin-3 Regulates Atrial Fibrillation Remodeling and Predicts Catheter Ablation Outcomes

Atrial fibrillation (AF) usually starts as paroxysmal but can evolve relentlessly to the persistent and permanent forms. However, the mechanisms governing such a transition are unknown. The authors show that intracardiac serum levels of galectin (Gal)-3 are greater in patients with persistent than paroxysmal AF and that Gal-3 independently predicts atrial tachyarrhythmia recurrences after a single ablation procedure. Using a sheep model of persistent AF the authors further demonstrate that upstream therapy targeting Gal-3 diminishes both electrical remodeling and fibrosis by impairing transforming growth factor beta–mediated signaling and reducing myofibroblast activation. Accordingly, Gal-3 inhibition therapy increases the probability of AF termination and reduces the overall burden of AF. Therefore the authors postulate that Gal-3 inhibition is a potential new upstream therapy to prevent AF progression