Abnormalities of glucose metabolism significantly contribute to increase systolic blood pressure and especially diastolic blood pressure in acromegalic patients. Careful control of blood pressure and of risk factors for developing systemic hypertension, with special reference to glucose tolerance, is mandatory to decrease cardiovascular morbidity and mortality in such patients.
BackgroundThe independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre‐DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre‐DM on survival outcomes in the GISSI‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) trial.Methods and ResultsWe assessed the risk of all‐cause death and the composite of all‐cause death or cardiovascular hospitalization over a median follow‐up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI‐HF trial, who were stratified by presence of DM (n=2852), pre‐DM (n=2013), and non‐DM (n=2070) at baseline. Compared with non‐DM patients, those with DM had remarkably higher incidence rates of all‐cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non‐DM patients and those with pre‐DM. Cox regression analysis showed that DM, but not pre‐DM, was associated with an increased risk of all‐cause death (adjusted hazard ratio, 1.43; 95% CI, 1.28–1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI, 1.13–1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all‐cause death: adjusted hazard ratio, 1.21; 95% CI, 1.02–1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI, 1.01–1.29, respectively).ConclusionsPresence of DM was independently associated with poor long‐term survival outcomes in patients with chronic heart failure.Clinical Trial Registration
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00336336.
Background
Previous studies have shown that about 7% of unselected systemic sclerosis (SSc) patients are positive for ANCA1. Some case reports have also described an ANCA–associated vasculitis in SSc patients with progressive renal and lung function deterioration and poor outcome.
Objectives
To evaluate the prevalence of ANCA positivity in a SSc cohort and to study its association with clinical characteristics, major organ involvement and risk of mortality.
Methods
We evaluated the positivity and the levels of p- and c-ANCA in our cohort of 294 SSc patients according with age, immunological characteristics, disease duration and clinical manifestations. Only patients with almost two positive ANCA assessments have been considered ANCA positive. Specifically we evaluated the presence of digital ulcers, glomerulonephritis, myositis and myocarditis. Myocarditis was defined as the presence of increasedcardiac enzymes associated with the presence of enhancement at late gadolinium-enhanced cardiac magnetic resonance imaging and/or myocarditis on myocardial biopsy. The mortality in the last 12 years was also recorded.
Results
17 patients out of 294 (5.8%) of the entire SSc cohort were identified as ANCA-positive. Six patients (35.3%) were c-ANCA positive with a mean level of 70.4±50.7 U/ml, while 11 patients (64.7%) were p-ANCA positive with a mean level of 65.8±47.7 U/ml. Out of the 17 ANCA positive patients, 58.8% presented anti-topoisomerase antibodies, 41.2% anticentromere antibodies. Sixteen patients (5.4%) presented myocarditis which was more frequent in patients with ANCA positivity than in ANCA negative patients (41.7% vs 3.2%, p<0.0001). Overall mortality was 6.8%. Mortality in ANCA positive patients was higher than in ANCA negative patients (29.4% vs 5.4%, p=0.003). There was no association between ANCA positivity and complement consumption, glomerulonephritis, myositis and digital ulcers.
Conclusions
The prevalence of ANCA positivity in our cohort was 5.8% and, as previously reported, the majority of patients was positive for anti-topoisomerase antibodies. ANCA positivity was associated with myocarditis and with an increased risk of mortality. Considering the high mortality associated with cardiac involvement in SSc patients, our preliminary data suggest that ANCA positivity in SSc patients should be a warning biomarker to identify patients at risk of myocarditis and of a poor survival.
References
Akimoto S, Ishikawa O, Tamura T, Miyachi Y. Antineutrophil cytoplasmic autoantibodies in patients with systemic sclerosis. Br J Dermatol 1996;134(3):407-10.
Disclosure of Interest
None Declared
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