Associations between diabetes mellitus and pulmonary hypertension in chronic respiratory disease patients

Takahashi, Tomoko; Yoshihisa, Akiomi; Sugimoto, Koichi; Yokokawa, Tetsuro; Misaka, Tomofumi; Kaneshiro, Takashi; Oikawa, Masayoshi; Kobayashi, Atsushi; Nakazato, Kazuhiko; Ishida, Takafumi; Takeishi, Yasuchika

doi:10.1371/journal.pone.0205008

Cited by 13 publications

(8 citation statements)

References 27 publications

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“…Despite extensive adjustment for potential confounders, residual confounding cannot be fully ruled out. For example subclinical respiratory disease may be important in the association of (pre)diabetes and RA and RV structure and function [39]. Moreover, the use of body surface area to index the RA and LV mass may lead to overcorrection in the more obese (e.g.…”

Section: Confoudingmentioning

confidence: 99%

Associations of (pre)diabetes with right ventricular and atrial structure and function: the Maastricht Study

Linssen

Veugen

Henry

et al. 2020

Cardiovasc Diabetol

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Backgrounds: The role of right ventricular (RV) and atrial (RA) structure and function, in the increased heart failure risk in (pre)diabetes is incompletely understood. The purpose of this study is to investigate the associations between (pre)diabetes and RV and RA structure and function, and whether these are mediated by left ventricular (LV) alterations or pulmonary pressure. Methods: Participants of the Maastricht Study; a population-based cohort study (426 normal glucose metabolism (NGM), 142 prediabetes, 224 diabetes), underwent two-dimensional and tissue Doppler echocardiography. Multiple linear regression analyses with pairwise comparisons of (pre)diabetes versus NGM, adjusted for cardiovascular risk factors, and mediation analyses were used. Results: In general, differences were small. Nevertheless, in individuals with prediabetes and diabetes compared to NGM; RA volume index was lower (both p < 0.01, p trend < 0.01), RV diameter was lower (both p < 0.01, p trend < 0.01) and RV length was significantly smaller in diabetes (p = 0.67 and p = 0.03 respectively, p trend = 0.04), TDI S′RV was lower (p = 0.08 and p < 0.01 respectively, p trend < 0.01), TDI E′RV was lower (p = 0.01 and p = 0.02 respectively, p trend = 0.01) and TDI A′RV was lower (p < 0.01 and p = 0.07 respectively, p trend = 0.04). Only the differences in RA volume index (7.8%) and RV diameter (6.2%) were mediated by the maximum tricuspid gradient, but no other LV structure and function measurements. Conclusions: (Pre)diabetes is associated with structural RA and RV changes, and impaired RV systolic and diastolic function, independent of cardiovascular risk factors. These associations were largely not mediated by indices of LV structure, LV function or pulmonary pressure. This suggests that (pre)diabetes affects RA and RV structure and function due to direct myocardial involvement.

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Section: Confoudingmentioning

confidence: 99%

Associations of (pre)diabetes with right ventricular and atrial structure and function: the Maastricht Study

Linssen

Veugen

Henry

et al. 2020

Cardiovasc Diabetol

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“…Although DM affects arterial function and contributes to systemic arterial hypertension and, in particular, pulmonary hypertension [ 59 ], the effect on veins as part of diabetic vasculopathy is far from being proved. Hyperglycemia and especially fluctuating blood sugar levels seem to contribute to splanchnic hyperemia and elevated portal pressure, increasing the risk of VH [ 60 , 61 ].…”

Section: Discussionmentioning

confidence: 99%

Association between Liver Cirrhosis and Diabetes Mellitus: A Review on Hepatic Outcomes

Coman

Bădărău

et al. 2021

JCM

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Background: Liver cirrhosis (LC) is largely associated with diabetes mellitus (DM). More than 80% of patients with LC manifest glucose intolerance and about 30% have type 2 DM. A particular and yet unrecognized entity is hepatogenous diabetes (HD), defined as impaired glucose regulation caused by altered liver function following LC. Numerous studies have shown that DM could negatively influence liver-related outcomes. Aim: We aimed to investigate whether patients with LC and DM are at higher risk for hepatic encephalopathy (HE), variceal hemorrhage (VH), infections and hepatocellular carcinoma (HCC). The impact of DM on liver transplant (LT) outcomes was also addressed. Methods: Literature search was performed in PubMed, Ovid, and Elsevier databases. Population-based observational studies reporting liver outcomes in patients with LC were included. Results: Diabetics are at higher risk for HE, including post-transjugular intrahepatic portosystemic shunt HE. DM also increases the risk of VH and contributes to elevated portal pressure and variceal re-bleeding, while uncontrolled DM is associated with increased risk of bacterial infections. DM also increases the risk of HCC and contributes to adverse LT outcomes. Conclusions: Patients with DM and LC may benefit from close follow-up in order to reduce readmissions and mortality. Due to the heterogeneity of available research, prospective multicenter clinical trials are needed to further validate these findings.

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“…It is believed that patients with DM are at increased risk of PH and pulmonary embolism [5,44]. It has been shown that DM is an independent factor in PH development in patients with chronic obstructive pulmonary disease and interstitial pneumonia [38,45]. The experimental data generally confirm the existence of such a relationship [17,46].…”

Section: Groupmentioning

confidence: 99%

Influence of type 2 diabetes mellitus on the development of hypoxic pulmonary vasoconstriction

Khromov

Dobrelia

Паршиков

et al. 2020

Фармакологія та лікарська токсикологія

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Hypoxia is currently considered to be an universal factor involved in the development of complications in many diseases including diabetes mellitus (DM). Acute hypoxia causes a systemic reaction with the large circulatory system developing vasodilation and the lesser circulatory system arteries developinghypoxic pulmonary vasoconstriction (HPV), which demonstrates the arteries' ability to regulate pulmonary circulation and maintain normal ventilation-perfusion ratio. Lack of the adequate response to hypoxic effects may be an additional mechanism for the diabetic complications in the cardiovascular system. Despite years of study, the mechanisms of HPV remain largely unclear, as does the effect of diabetes on pulmonary artery reactivity.The aim of the study was to evaluate the effect of high-fat diet and diabetes on the development of the HPV reaction in vivo and in vitro.Studies in rats divided into three groups (control group, a group of rats on a high-fat diet (HFD), and a group of animals with experimental type 2 diabetes mellitus (T2DM)) showed that in rats kept on the high-fat diet, an injection of streptozotocin leads to significant increase in blood glucose levels. In rats kept on the high-fat diet only, this parameter did not differ from the levels in the control animals. In rats kept on HFD and in rats with T2DM model, the right ventricular pressure was significantly higher compared to the control rats.The lung ventilation with a hypoxic gas mixture led to decrease in blood pressure in the systemic circulation in animals of all groups. In the control rats, the pressure in the right ventricular cavity of the heart increased indicating the development of hypoxic pulmonary vasoconstriction. In HFD rats, hypoxic hypoxiahad virtually no effect on the right ventricular pressure. In T2DM rats, an inversion of the hypoxic pulmonary vasoconstriction reaction with decrease in the right ventricular pressure was observed.These results have been confirmed in the in vitro experiments. In lung sections, the responses of the intrapulmonary arteries to hypoxic effects were multi-directional: the pulmonary artery luminal area decreased in the control animals, almost did not change in HFD animals, and increased in T2DM animals.In the rats with experimental diabetes mellitus, the contractile responses of the pulmonary artery ring segments to hypoxia were significantly suppressed compared to the vessels from the control animals.Finding out the exact mechanisms involved in the inversion of the pulmonary vasoconstriction response in diabetes will contribute to a better understanding of the fundamental pathophysiological processes that will promote development of pathogenetically justified approaches to the treatment of this disease and its complications.

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Associations between diabetes mellitus and pulmonary hypertension in chronic respiratory disease patients

Cited by 13 publications

References 27 publications

Associations of (pre)diabetes with right ventricular and atrial structure and function: the Maastricht Study

Associations of (pre)diabetes with right ventricular and atrial structure and function: the Maastricht Study

Association between Liver Cirrhosis and Diabetes Mellitus: A Review on Hepatic Outcomes

Influence of type 2 diabetes mellitus on the development of hypoxic pulmonary vasoconstriction

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