Cardiovascular disease (CVD) and cancer are leading causes of mortality and morbidity worldwide. Strategies to improve their treatment and prevention are global priorities and major focus of World Health Organization’s joint prevention programs. Emerging evidence suggests that modifiable risk factors including diet, sedentary lifestyle, obesity and tobacco use are central to the pathogenesis of both diseases and are reflected in common genetic, cellular, and signaling mechanisms. Understanding this important biological overlap is critical and may help identify novel therapeutic and preventative strategies for both disorders. In this review, we will discuss the shared genetic and molecular factors central to CVD and cancer and how the strategies commonly used for the prevention of atherosclerotic vascular disease can be applied to cancer prevention.
BackgroundDiabetes has been shown to be independent predictor of restenosis after percutaneous coronary intervention (PCI). The aim of the present study was to investigate whether a pre- and post-procedural glycaemic control in diabetic patients was related to major advance cardiovascular events (MACE) during follow up.MethodsWe evaluated 2884 consecutive patients including 2181 non-diabetic patients and 703 diabetics who underwent coronary stenting. Diabetes mellitus was defined as the fasting blood sugar concentration ≥ 126 mg/dL, or the use of an oral hypoglycemic agent or insulin at the time of admission. Diabetic patients were categorized into two groups based on their mean HbA1c levels for three measurements (at 0, 1, and 6 months following procedure): 291 (41.4%) diabetics with good glycaemic control (HbA1c ≤ 7%) and 412 (58.6%) diabetics with poor glycaemic control (HbA1c > 7%).ResultsThe adjusted risk of MACE in diabetic patients with poor glycaemic control (HbA1c > 7%) was 2.1 times of the risk in non-diabetics (adjusted HR = 2.1, 95% CI: 1.10 to 3.95, p = 0.02). However, the risk of MACE in diabetics with good glycaemic control (HbA1c ≤ 7%) was not significantly different from that of non-diabetics (adjusted HR = 1.33, 95% CI: 0.38 to 4.68, p = 0.66).ConclusionsOur data suggest that there is an association between good glycaemic control to obtain HbA1c levels ≤7% (both pre-procedural glycaemic control and post-procedural) with a better clinical outcome after PCI.
Opium is the second-most-commonly abused substance (after tobacco) in developing countries of the Middle East region, and in many Asian nations. One of the reasons for the high prevalence of opium abuse in these countries is a traditional belief among Eastern people, even including some medical staff, that opium might have beneficial effects on cardiovascular health and in the control of diabetes mellitus, hypertension, and dyslipidaemia. In this Perspectives article, we summarize the current understanding of the pharmacotoxicology of opium and its specific effects on glycaemic control, blood pressure, lipid profile, and atherosclerosis. On the basis of the available evidence, we believe not only that opium has no ameliorating effect on cardiovascular diseases, but also that the use of this drug might have adverse effects on these conditions. Therefore, people should be educated about the hazardous effects of opium consumption on cardiometabolic diseases.
There is a traditional belief among Eastern people that opium may have ameliorating effects on cardiovascular risk factors, especially diabetes; thus, it is widely used among diabetic patients. We attempted to investigate the association of opium consumption with coronary artery disease (CAD) in diabetic patients. A cross-sectional study was conducted on diabetic patients undergoing coronary angiography in our center. Out of 1925 diabetic patients included in the study, 228 were opium users, and the remaining 1697 non-opium users were used as a pool of potential comparators. Propensity scores were used to match the 228 opium consumers with 228 matched comparators for age, sex, and smoking status. The Gensini score and extent score were respectively used to assess the angiographic severity and extent of CAD. The mean Gensini score (86.9 ± 62.7 vs. 59.6 ± 43.4, p < 0.0001) and extent score (7.1 ± 2.9 vs. 5.9 ± 2.9, p < 0.0001) were significantly higher in opium user diabetic patients than in non-opium users. After adjustment for potential confounders, a dose-response relationship was observed between dose of opium and the Gensini score ( β = 0.27, p = 0.04). There were no significant differences between the routes of opium administration (inhalation vs. oral) regarding the severity and extent of CAD. In conclusion, exposure to opium in diabetic patients may be positively associated with the risk of CAD, and with the angiographically determined severity and extent of the disease. Furthermore, dosage of opium consumption may correlate with severity of CAD.
Opioids have the highest rate of illicit drug consumption after cannabis worldwide. Opium, after tobacco, is still the most commonly abused substance in the Middle East. In addition to the ease of availability, one reason for the high consumption of opium in Asian countries might be a traditional belief among Eastern people and even medical staff that opium may have ameliorating effects on cardiovascular diseases (CVDs) as well as diabetes mellitus, hypertension, and dyslipidemia. Over the last decade, many studies have been performed on humans and animals to evaluate the interplay between opium consumption and stable coronary artery disease, acute coronary syndromes, and atherosclerosis. In this review, we conclude that opium consumption should be considered a risk factor for CVDs. Healthy individuals, as well as cardiac and diabetic patients, should be informed and educated about the hazardous effects of opium consumption on cardiovascular and other chronic diseases.
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