Impact of Diabetes on Long-Term Prognosis in Patients With Unstable Angina and Non–Q-Wave Myocardial Infarction

Malmberg, Klas; Yusuf, Salim; Gerstein, Hertzel C.; Brown, Joanne; Zhao, Feng; Hunt, David; Piegas, Leopoldo Soares; Calvin, James E.; Keltai, Mátyás; Budaj, Andrzej

doi:10.1161/01.cir.102.9.1014

Cited by 675 publications

(340 citation statements)

References 16 publications

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“…DM is associated with a higher incidence of myocardial infarction or cardiac death,2 and worse prognosis after ACS,37 percutaneous coronary intervention,38 and coronary artery bypass graft surgery 39. Panvascular inflammation in patients with DM presenting with ACS explains an increased risk for future nonculprit lesion‐related major adverse cardiovascular events in patients with DM 36.…”

Section: Discussionmentioning

confidence: 99%

Coronary Plaque Characteristics in Patients With Diabetes Mellitus Who Presented With Acute Coronary Syndromes

Sugiyama

Yamamoto

Bryniarski

et al. 2018

JAHA

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BackgroundDiabetes mellitus (DM) is a major risk factor for cardiovascular events. We aimed to investigate the coronary plaque phenotype of diabetic patients who presented with acute coronary syndromes by optical coherence tomography.Methods and ResultsA total of 322 patients with acute coronary syndromes who underwent preintervention optical coherence tomography imaging of the culprit lesion were included. Culprit plaque characteristics were compared between patients with DM (n=95) and those without DM (n=227). In the subgroup of 250 patients in whom sufficient length of nonculprit region in the culprit vessel was imaged by optical coherence tomography, the characteristics of nonculprit plaques were also evaluated. Patients with DM had a higher prevalence of lipid‐rich plaque (58.9% versus 44.9%, P=0.030) and macrophage accumulation (60.0% versus 44.9%, P=0.019) in the culprit lesion compared with patients without DM. The prevalence of plaque rupture (33.7% versus 30.4%, P=0.896) and plaque erosion (21.1% versus 22.0%, P=0.458) was similar. In the nonculprit lesions, the DM group had greater maximal lipid arc (248.9°±83.9° versus 179.9°±58.3°, P=0.006), thinner fibrous cap thickness (103.3±56.2 μm versus 140.7±70.0 μm, P=0.013), and a higher prevalence of thin‐cap fibroatheroma (17.2% versus 6.3%, P=0.031), compared with the non‐DM group.ConclusionsCompared with patients without DM, those with DM had more vulnerable features in both culprit and nonculprit lesions, thus indicating a higher level of panvascular instability.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01110538.

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Section: Discussionmentioning

confidence: 99%

Coronary Plaque Characteristics in Patients With Diabetes Mellitus Who Presented With Acute Coronary Syndromes

Sugiyama

Yamamoto

Bryniarski

et al. 2018

JAHA

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“…The reason for this fundamental step was the undisputed evidence that Type 2 diabetic subjects without a prior history of myocardial infarction (MI) have as a high risk of CHD as non-diabetic patients who have had a previous MI [4,5] as well as the extremely poor short-term prognosis of Type 2 diabetic subjects after their first MI [154,155]. ATP III and ADA guidelines identified LDL cholesterol as the first priority of lipid lowering and the optimal level was set <2.6 mmol/l [6,156].…”

Section: Consequences Of the Increase Of Vldl 1 Particlesmentioning

confidence: 99%

“…The International Diabetes Federation (IDF) foresees a rise of epidemic proportions in Type 2 diabetes that portends a daunting increase in CHD [3]. Solid evidence has confirmed that people with Type 2 diabetes have a similar risk of heart attack as people without diabetes who have already had a heart attack [4,5]. Adult Treatment panel III (ATP III) designated diabetes as a CHD risk equivalent and LDL was identified the first priority of lipid lowering [6].…”

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confidence: 99%

Diabetic dyslipidaemia: from basic research to clinical practice*

2003

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The recognition that the increase of plasma triglyceride rich lipoproteins (TRLs) is associated with multiple alterations of other lipoproteins species that are potentially atherogenic has expanded the picture of diabetic dyslipidaemia. The discovery of heterogeneity within major lipoprotein classes VLDL, LDL and HDL opened new avenues to reveal the specific pertubations of diabetic dyslipidaemia. The increase of large VLDL 1 particles in Type 2 diabetes initiates a sequence of events that generates atherogenic remnants, small dense LDL and small dense HDL particles. Together these components comprise the atherogenic lipid triad. Notably the malignant nature of diabetic dyslipidaemia is not completely shown by the lipid measures used in clinical practice. The key question is what are the mechanisms behind the increase of VLDL 1 particles in diabetic dyslipidaemia? Despite the advances of recent years, our understanding of VLDL assembly and secretion is still surprisingly incomplete. To date it is still unclear how the liver is able to regulate the amount of triglycerides incorporated into VLDL particles to produce either VLDL 1 or VLDL 2 particles. The current evidence suggests that the machinery driving VLDL assembly in the liver includes (i) low insulin signalling via PI-3 kinase pathway that enhances lipid accumulation into "nascent" VLDL particles (ii) up-regulation of SREBP-1C that stimulates de novo lipogenesis and (iii) excess availability of "polar molecules" in hepatocytes that stabilizes apo B 100. Recent data suggest that all these steps could be fundamentally altered in Type 2 diabetes explaining the overproduction of VLDL apo B as well as the ability of insulin to suppress VLDL 1 apo B production in Type 2 diabetes.Recent discoveries have established the transcription factors including PPARs, SREBP-1 and LXRs as the key regulators of lipid assembly in the liver. These observations suggest these factors as a new target to tailor more efficient drugs to treat diabetic dyslipidaemia. [Diabetologia (2003) 46:733-749]

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“…Previously, published studies showed that the cardiovascular prognosis of patients with diabetes without acute myocardial infarction (AMI) was similar to patients without diabetes but with a history of AMI (2)(3)(4). Consequently, the third National Cholesterol Education Program (NCEP) expert panel report on elevated blood cholesterol detection, assessment and treatment in adults (Adult Treatment Panel III -ATP III), considered the patient with diabetes as "coronary equivalent" (5).…”

Section: Introductionmentioning

confidence: 99%

Estimation of cardiovascular risk and detection of subclinical carotid atheromatosis in patients with diabetes without a history of cardiovascular disease

Masson¹,

Francesca²,

Molinero³

et al. 2017

Arch. Endocrinol. Metab.

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Objectives: Cardiovascular risk estimated by several scores in patients with diabetes mellitus without a cardiovascular disease history and the association with carotid atherosclerotic plaque (CAP) were the aims of this study. Materials and methods: Cardiovascular risk was calculate using United Kingdom Prospective Diabetes Study (UKPDS) risk engine, Framingham risk score for cardiovascular (FSCV) and coronary disease (FSCD), and the new score (NS) proposed by the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol. Ultrasound was used to assess CAP occurrence. A receiver operating characteristic (ROC) analysis was performed. Results: One hundred seventy patients (mean age 61.4 ± 11 years, 58.8% men) were included. Average FSCV, FSCD and NS values were 33.6% ± 21%, 20.6% ± 12% and 24.8% ± 18%, respectively. According to the UKPDS score, average risk of coronary disease and stroke were 22.1% ± 16% and 14.3% ± 19% respectively. Comparing the risks estimated by the different scores a significant correlation was found. The prevalence of CAP was 51%, in patients with the higher scores this prevalence was increased. ROC analysis showed a good discrimination power between subjects with or without CAP. Conclusion: The cardiovascular risk estimated was high but heterogenic. The prevalence of CAP increased according to the strata of risk. Understanding the relationship between CAP and scores could improve the risk estimation in subjects with diabetes. Arch Endocrinol Metab. 2017;61(2):122-9.

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Impact of Diabetes on Long-Term Prognosis in Patients With Unstable Angina and Non–Q-Wave Myocardial Infarction

Cited by 675 publications

References 16 publications

Coronary Plaque Characteristics in Patients With Diabetes Mellitus Who Presented With Acute Coronary Syndromes

Coronary Plaque Characteristics in Patients With Diabetes Mellitus Who Presented With Acute Coronary Syndromes

Diabetic dyslipidaemia: from basic research to clinical practice*

Estimation of cardiovascular risk and detection of subclinical carotid atheromatosis in patients with diabetes without a history of cardiovascular disease

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