Background Lipid levels during pregnancy in women with gestational diabetes mellitus (GDM) have been extensively studied; however, it remains unclear whether dyslipidaemia is a potential marker of preexisting insulin resistance.Objective To evaluate the relationship between lipid measures throughout pregnancy and GDM.Search strategy We searched PubMed-MedLine and SCOPUS (inception until January 2014) and reference lists of relevant studies.Selection criteria Publications describing original data with at least one raw lipid (total cholesterol, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], or triglyceride) measurement during pregnancy in women with GDM and healthy pregnant controls were retained.Data collection and analysis Data extracted from 60 studies were pooled and weighted mean difference (WMD) in lipid levels was calculated using random effects models. Meta-regression was also performed to identify sources of heterogeneity.Main results Triglyceride levels were significantly elevated in women with GDM compared with those without GDM (WMD 30.9, 95% confidence interval [95% CI] 25.4-36.4). This finding was consistent in the first, second and third trimesters of pregnancy. HDL-C levels were significantly lower in women with GDM compared with those without GDM in the second (WMD À4.6, 95% CI À6.2 to À3.1) and third (WMD À4.1, 95% CI À6.5 to À1.7) trimesters of pregnancy. There were no differences in aggregate total cholesterol or LDL-C levels between women with GDM and those without insulin resistance.Author's conclusions Our meta-analysis shows that triglycerides are significantly elevated among women with GDM compared with women without insulin resistance and this finding persists across all three trimesters of pregnancy.
Dalcetrapib similarly decreased CETP activity and increased HDL-C levels in patients with and without T2DM or metabolic syndrome; the ongoing Phase III dal-OUTCOMES study will help to determine if dalcetrapib's improvement in lipid levels also reduces cardiovascular morbidity and mortality.
The acute technical success was reported as 94% for AVNRT, 88% for AVRT, 75% for atrial tachycardia, 97% for atrial flutter, and 97% for atrial fibrillation. The overall complication rate of any severity was 10%. Most of the complications related to atrial fibrillation ablation were captured later during the follow up visits. In AVRT, ventricular tachycardia and atrial flutter, complications developed mainly during the peri-procedural period. The chronic success (reported as success at last follow-up visit) was 92% for AVNRT, 92% for AVRT, 67% for atrial tachycardia, 80% for atrial flutter and 70% for atrial fibrillation. The operational cost of the project was 20,000 CAD which represented 1% of ablation program funding. CONCLUSION: This pilot run of CQI project demonstrated that an operator-driven approach is feasible and economical; it may become a useful tool to track outcomes within cooperating physicians group. The individual operators are motivated by periodic feedback on their own data and groups procedural outcomes. It seems that there is a correlation between specific ablation procedures and timing of complications; hence, different follow up strategies could be implemented according to different ablation procedures for CQI purposes.
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