A Roadmap on the Prevention of Cardiovascular Disease Among People Living
                        With Diabetes

Mitchell, Sharon; Malanda, Belma; Damasceno, Albertino; Eckel, Robert H.; Gaiță, Dan; Kotseva, Kornelia; Januzzi, James L.; Mensah, George A.; Plutzky, Jorge; Prystupiuk, Maksym; Rydén, Lars; Thierer, Jorge; Virani, Salim S.; Sperling, Laurence

doi:10.1016/j.gheart.2019.07.009

Cited by 26 publications

(25 citation statements)

References 111 publications

(110 reference statements)

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“…We searched Medline, Embase, Global Health, and Global Index Medicus from inception up to 14 November 2020 to identify systematic reviews of observational studies on the association between diabetes and CVD, CKD, dengue, depression, pneumonia, and TB. CVD encompassed coronary heart disease, myocardial infarction, angina, stroke and transient ischaemic attack, since diabetes has been shown to be associated with a markedly higher risk of these conditions [ 15 ]. The search included variations of the following as MeSH terms or keywords: diabetes, CVD, CKD, dengue, depression, pneumonia, and TB, as well as terms for LMICs, including individual country names (Appendix S1 in the Online Supplementary Document ) [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

Diabetes comorbidities in low- and middle-income countries: An umbrella review

2021

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Background Diabetes mellitus, particularly type 2 diabetes, is a major public health burden globally. Diabetes is known to be associated with several comorbidities in high-income countries. However, our understanding of these associations in low- and middle-income countries (LMICs), where the epidemiological transition is leading to a growing dual burden of non-communicable and communicable disease, is less clear. We therefore conducted an umbrella review to systematically identify, appraise and synthesise reviews reporting the association between diabetes and multiple key comorbidities in LMICs. Methods We searched Medline, Embase, Global Health, and Global Index Medicus from inception to 14 November 2020 for systematic reviews, with or without meta-analyses, of cohort, case-control or cross-sectional studies investigating the associations between diabetes and cardiovascular disease (CVD), chronic kidney disease (CKD), depression, dengue, pneumonia, and tuberculosis within LMICs. We sought reviews of studies focused on LMICs, but also included reviews with a mixture of high-income and at least two LMIC studies, extracting data from LMIC studies only. We conducted quality assessment of identified reviews using an adapted AMSTAR 2 checklist. Where appropriate, we re-ran meta-analyses to pool LMIC study estimates and conduct subgroup analyses. Results From 11 001 articles, we identified 14 systematic reviews on the association between diabetes and CVD, CKD, depression, or tuberculosis. We did not identify any eligible systematic reviews on diabetes and pneumonia or dengue. We included 269 studies from 29 LMICs representing over 3 943 083 participants. Diabetes was positively associated with all comorbidities, with tuberculosis having the most robust evidence (16 of 26 cohort studies identified in total) and depression being the most studied (186 of 269 studies). The majority (81%) of studies included were cross-sectional. Heterogeneity was substantial for almost all secondary meta-analyses conducted, and there were too few studies for many subgroup analyses. Conclusions Diabetes has been shown to be associated with several comorbidities in LMICs, but the nature of the associations is uncertain because of the large proportion of cross-sectional study designs. This demonstrates the need to conduct further primary research in LMICs, to improve, and address current gaps in, our understanding of diabetes comorbidities and complications in LMICs.

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Section: Methodsmentioning

confidence: 99%

Diabetes comorbidities in low- and middle-income countries: An umbrella review

2021

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“…The Roadmap on CD sheds light on the barriers to patients accessing care, and proposes evidence-based practical solutions for healthcare professionals, health authorities and governments to help overcome these barriers. As part of the WHF Roadmap series, it complements existing Roadmaps on rheumatic heart disease [1], tobacco control [2], hypertension [3], the use of secondary prevention for CVD [4], atrial fibrillation [5], heart failure, and prevention of cardiovascular disease among people living with diabetes [6]. Figure 2 outlines the design and methodology of the WHF Roadmap series.…”

Section: Introductionmentioning

confidence: 99%

WHF IASC Roadmap on Chagas Disease

et al. 2020

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Background: Chagas Disease is a neglected tropical disease caused by the protozoan Trypanosoma cruzi, with some of the most serious manifestations affecting the cardiovascular system. It is a chronic, stigmatizing condition, closely associated with poverty and affecting close to 6 million people globally. Although historically the disease was limited to endemic areas of Latin America recent years have seen an increasing global spread. In addition to the morbidity and mortality associated with the disease, the social and economic burdens on individuals and society are substantial. Often called the 'silent killer', Chagas disease is characterized by a long, asymptomatic phase in affected indivi duals. A pproximately 30% then go on develop chronic Chagas cardiomyopathy and other serious cardiac complications such as stroke, rhythm disturbances and severe heart failure. Methods: In a collaboration of the World Hearth Federation (WHF) and the Inter-American S ociety of Cardiology (IASC) a writing group consisting of 20 diverse experts on Chagas disease (CD) was convened. The group provided up to date expert knowledge based on their area of expertise. An extensive review of the literature describing obstacles to diagnosis and treatment Echeverría et al: WHF IASC Roadmap on Chagas Disease Art. 26, page 2 of 31 of CD along with proposed solutions was conducted. A survey was sent to all WHF Members and, using snowball sampling to widen the consultation, to a variety of health care professionals working in the CD global health community. The results were analyzed, open comments were reviewed and consolidated, and the findings were incorporated into this document, thus ensuring a consensus representation. Results: The WHF IASC Roadmap on Chagas Disease offers a comprehensive summary of current knowledge on prevention, diagnosis and management of the disease. In providing an analysis of 'roadblocks' in access to comprehensive care for Chagas disease patients, the document serves as a framework from which strategies for implementation such as national plans can be formulated. Several dimensions are considered in the analysis: healthcare system capabilities, governance, financing, community awareness and advocacy. Conclusion: The WHF IASC Roadmap proposes strategies and evidence-based solutions for healthcare professionals, health authorities and governments to help overcome the barriers to comprehensive care for Chagas disease patients. This roadmap describes an ideal patient care pathway, and explores the roadblocks along the way, offering potential solutions based on available research and examples in practice. It represents a call to action to decision-makers and health care professionals to step up efforts to eradicate Chagas disease.

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“…Type-2 diabetes mellitus (T2DM) is one of the most important cardiovascular risk factors [1], and death rates in diabetic people are twice those of nondiabetics [2]. T2DM and prediabetes have been associated with the development of subclinical direct myocardial damage, microvascular inflammation, and endothelial dysfunction, which contribute to a higher cardiovascular risk in these patients [3].…”

Section: Introductionmentioning

confidence: 99%

Galectin-3 is Associated with Cardiovascular Events in Post-Acute Coronary Syndrome Patients with Type-2 Diabetes

Lorenzo-Almorós

Pello

Aceña

et al. 2020

JCM

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Introduction: Type-2 diabetes mellitus (T2DM) is associated with early and severe atherosclerosis. However, few biomarkers can predict cardiovascular events in this population. Methods: We followed 964 patients with coronary artery disease (CAD), assessing plasma levels of galectin-3, monocyte chemoattractant protein-1 (MCP-1), and N-terminal fragment of brain natriuretic peptide (NT-proBNP) at baseline. The secondary outcomes were acute ischemia and heart failure or death. The primary outcome was the combination of the secondary outcomes. Results. Two hundred thirty-two patients had T2DM. Patients with T2DM showed higher MCP-1 (144 (113–195) vs. 133 (105–173) pg/mL, p = 0.006) and galectin-3 (8.3 (6.5–10.5) vs. 7.8 (5.9–9.8) ng/mL, p = 0.049) levels as compared to patients without diabetes. Median follow-up was 5.39 years (2.81–6.92). Galectin-3 levels were associated with increased risk of the primary outcome in T2DM patients (Hazard ratio (HR) 1.57 (1.07–2.30); p = 0.022), along with a history of cerebrovascular events. Treatment with clopidogrel was associated with lower risk. In contrast, NT-proBNP and MCP-1, but not galectin-3, were related to increased risk of the event in nondiabetic patients (HR 1.21 (1.04–1.42); p = 0.017 and HR 1.23 (1.05–1.44); p = 0.012, respectively), along with male sex and age. Galectin-3 was also the only biomarker associated with the development of acute ischemic events and heart failure or death in T2DM patients, while, in nondiabetics, MCP-1 and NT-proBNP, respectively, were related to these events. Conclusion: In CAD patients, galectin-3 plasma levels are associated with cardiovascular events in patients with T2DM, and MCP-1 and NT-proBNP in those without T2DM.

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A Roadmap on the Prevention of Cardiovascular Disease Among People Living With Diabetes

Cited by 26 publications

References 111 publications

Diabetes comorbidities in low- and middle-income countries: An umbrella review

Diabetes comorbidities in low- and middle-income countries: An umbrella review

WHF IASC Roadmap on Chagas Disease

Galectin-3 is Associated with Cardiovascular Events in Post-Acute Coronary Syndrome Patients with Type-2 Diabetes

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