Although the 1-y intervention did not change CCA-IMT or BP, clinically relevant improvements in arterial stiffness were observed; equol producers were particularly responsive. Flavonoids may augment existing therapeutic strategies to reduce cardiovascular disease risk in postmenopausal T2DM patients, and longer studies are needed to examine the effects on atherosclerosis progression. This trial was registered at clinicaltrials.gov as NCT00677599.
Type 2 diabetes (T2DM) increases cardiovascular disease (CVD) risk, adversely increasing common carotid artery intima-media thickness (CCA-IMT) (1) and endothelial dysfunction (2) . Previously, higher intakes of some flavonoid sub-classes (specifically flavan-3-ols) have been associated with reduced atherosclerosis progression (3) , with animal and in vitro studies supporting benefits of this sub-class on Nitric Oxide (NO) (4) and NADPH oxidase activity (5) and of another sub-class, isoflavones, on vascular inflammation (6) . The ability to metabolise the isoflavone equol, from its precursor, daidzein, has also been associated with improved vascular function (7) . Despite these previous findings, the longer-term vascular effects of combined flavan-3-ol and isoflavone intakes remain under-studied and few studies have examined if these flavonoids augment standard therapies in controlling CVD risk in 'at-risk' populations, such as T2DM patients.In a randomised double-blind, parallel-design, placebo controlled study which was conducted in accordance with the Declaration of Helsinki guidelines, postmenopausal women with T2DM consumed 27 g/d (split-dose) flavonoid-enriched chocolate (850 mg flavan-3-ols (90 mg epicatechin) + 100 mg isoflavones (aglycone equivalents)/d), or matched placebo for 1-year. CCA-IMT, vascular biomarkers and measures of arterial stiffness (pulse wave velocity (PWV), augmentation Index (AIx)) and blood pressure (BP) were assessed. Changes from baseline (0 M) to 1-year (12M) were assessed with univariate ANCOVA.
In the last decade ultrasound has become the gold standard for evaluating symptomatic patients with suspected deep vein thrombosis (DVT). As well as reliably confirming or excluding DVT, ultrasound can diagnose alternative or coexistent pathologies, which may be contributing to the patient's symptoms. We present a series of patients who were all referred through the fast-track DVT service in whom other unsuspected pathologies were found at the original ultrasound examination.
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