Meta-Analysis of the Quantitative Relation Between Pulse Pressure and Mean Arterial Pressure and Cardiovascular Risk in Patients With Diabetes Mellitus

Kodama, Satoru; Horikawa, Chika; Fujihara, Kazuya; Yoshizawa, Shunsuke; Yachi, Yoko; Tanaka, Shiro; Ohara, Nobumasa; Matsunaga, Satoshi; Yamada, Takaho; Hanyu, Osamu; Sone, Hirohito

doi:10.1016/j.amjcard.2013.12.005

Cited by 48 publications

(44 citation statements)

References 29 publications

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“…Dekker and colleagues did not report similar metabolic changes in their T2DM cohort. We also observed a decrease in mean arterial pressure [48]. These observations indicate that elevated bilirubin levels may exert therapeutic benefits on cardiovascular health by diminishing diabetic dysmetabolism and improving hemodynamic parameters rather than through endothelial function.…”

Section: Discussionmentioning

confidence: 63%

Atazanavir improves cardiometabolic measures but not vascular function in patients with long-standing type 1 diabetes mellitus

et al. 2015

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Aims Vascular disease is the leading cause of morbidity and mortality in type 1 diabetes mellitus (T1DM). We previously demonstrated that patients with T1DM have impaired endothelial function, a forme fruste of atherosclerosis, as a result of increased oxidative stress. Bilirubin has emerged as a potent endogenous antioxidant with higher concentrations associated with lower rates of myocardial infarction and stroke. Methods We tested the hypothesis that increasing endogenous bilirubin using atazanavir would improve cardiometabolic risk factors and vascular function in patients with T1DM to determine whether targeting bilirubin may be a novel therapeutic approach to reduce cardiovascular disease risk in this population. In this single-arm, open-label study, we evaluated blood pressure, lipid profile, and conduit artery function in fifteen subjects (mean age 45 ± 9 years) with T1DM following a 4-day treatment with atazanavir. Results As anticipated, atazanavir significantly increased both serum total bilirubin levels (p < 0.0001) and plasma total antioxidant capacity (p < 0.0001). Reductions in total cholesterol (p = 0.04), LDL cholesterol (p = 0.04), and mean arterial pressure (p = 0.04) were also observed following atazanavir treatment. No changes were seen in either flow-mediated endothelium-dependent (p = 0.92) or nitroglycerine-mediated endothelium-independent (p = 0.68) vasodilation, measured by high-resolution B-mode ultrasonography at baseline and post-treatment. Conclusion Increasing serum bilirubin levels with atazanavir in subjects with T1DM over 4 days favorably reduces LDL and blood pressure but is not associated with improvements in endothelial function of conduit arteries.

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Section: Discussionmentioning

confidence: 63%

Atazanavir improves cardiometabolic measures but not vascular function in patients with long-standing type 1 diabetes mellitus

et al. 2015

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“…PP is determined by cardiac output and the stiffness of elastic central arteries, such as the aorta, and may be calculated as the difference between systolic BP (SBP) and diastolic BP (DBP) [13]. Increased peripheral PP is an independent predictor of CV disease in patients with T2DM [14][15][16], and a meta-analysis showed that the relative risks of CV events were similar for an increase in central SBP and central PP to those for their peripheral (brachial) counterparts [17]. Another marker of arterial stiffness is the ambulatory arterial stiffness index [AASI: 1 minus the regression slope of DBP and SBP values derived from 24-h ambulatory BP monitoring (ABPM) [18]].…”

Section: Introductionmentioning

confidence: 99%

“…Mean arterial pressure (MAP) is a measure of central haemodynamics that reflects the cardiac cycle and is determined by cardiac output, systemic vascular resistance and [16] and has been shown to be predictive of CV events in patients with T2DM.…”

Section: Introductionmentioning

confidence: 99%

“…MAP is calculated as 2/3 DBP + 1/3 SBP [16] and has been shown to be predictive of CV events in patients with T2DM.…”

Section: Introductionmentioning

confidence: 99%

“…Another marker of arterial stiffness is the ambulatory arterial stiffness index [AASI: 1 minus the regression slope of DBP and SBP values derived from 24-h ambulatory BP monitoring (ABPM) [18]]. The AASI represents the dynamic relationship between SBP and DBP, as defined by haemodynamic arterio-ventricular properties, and has been reported to be an independent predictor of CV mortality [19].Mean arterial pressure (MAP) is a measure of central haemodynamics that reflects the cardiac cycle and is determined by cardiac output, systemic vascular resistance and [16] and has been shown to be predictive of CV events in patients with T2DM.DIABETES, OBESITY AND METABOLISM original article central venous pressure. MAP is calculated as 2/3 DBP + 1/3 SBP…”

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confidence: 99%

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Effects of empagliflozin on blood pressure and markers of arterial stiffness and vascular resistance in patients with type 2 diabetes

Chilton

Tikkanen

Cannon

et al. 2015

Diabetes Obesity Metabolism

417

283

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Aims:To determine the effects of empagliflozin on blood pressure (BP) and markers of arterial stiffness and vascular resistance in patients with type 2 diabetes mellitus (T2DM). Methods:We conducted a post hoc analysis of data from a phase III trial in patients with T2DM and hypertension receiving 12 weeks' empagliflozin and four phase III trials in patients with T2DM receiving 24 weeks' empagliflozin (cohort 1, n = 823; cohort 2, n = 2477). BP was measured using 24-h BP monitoring (cohort 1) or seated office measurements (cohort 2).Results: Empagliflozin reduced systolic BP (SBP) and diastolic BP in both cohorts (p < 0.001 vs placebo), without increasing heart rate. Empagliflozin reduced pulse pressure (PP; adjusted mean difference vs placebo cohort 1: −2.3 mmHg; cohort 2: −2.3 mmHg), mean arterial pressure (MAP; cohort 1, −2.3 mmHg; cohort 2, −2.1 mmHg) and double product (cohort 1, −385 mmHg × bpm; cohort 2, −369 mmHg × bpm) all p < 0.001 vs placebo. There was a trend towards a reduction in the ambulatory arterial stiffness index (AASI) with empagliflozin in cohort 1 (p = 0.059 vs placebo). AASI was not measured in cohort 2. Subgroup analyses showed that there were greater reductions in PP with increasing baseline SBP in cohort 1 (p = 0.092). In cohort 2, greater reductions in MAP were achieved in patients with higher baseline SBP (p = 0.027) and greater reductions in PP were observed in older patients (p = 0.011). Conclusions IntroductionCardiovascular (CV) disease is the major cause of morbidity and mortality in patients with type 2 diabetes (T2DM) [1]. The risk of CV disease in adults with diabetes is double that in adults without diabetes, and diabetes is estimated to account for 10-12% of all vascular deaths [2]. Patients with T2DM often have numerous CV risk factors and a multifactorial approach to addressing CV risk, including controlling glycaemia, blood pressure (BP) and body weight, is recommended in these patients [1,3].The metabolic abnormalities that are characteristic of diabetes, such as hyperglycaemia, excess free fatty acids and insulin resistance, can lead to suppression of nitric oxide production and activation of the renin-angiotensin system, leading to oxidative stress, endothelial dysfunction and activation of the receptor for advanced glycation end products (RAGE) [4][5][6]. These may contribute to hypertension [7] or to increased arterial stiffness related to vascular calcification or accumulation ofCorrespondence to: Odd Erik Johansen, Boehringer Ingelheim Norway KS, Asker, Norway. E-mail: odd_erik.johansen@boehringer-ingelheim.com This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.collagen [8,9] that could partly explain the increased risk of vascular complications associated with T2DM [4].Arterial stiffness is a strong predictor of CV events, heart failure and death [10][11][12]...

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Associations between the levels of circulating inflammatory adipokines and the risk of type 2 diabetes in Chinese male individuals: A case–control study

Sun

Qiu

et al. 2023

Clinical Laboratory Analysis

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Background Whether the levels of circulating inflammatory adipokines affect the progression of type 2 diabetes (T2D) remains unclear. This study aimed to assess the association between circulating inflammatory adipokine levels and risk of T2D. Methods This case–control study involved 130 individuals consisting of 66 healthy controls (Control group) and 64 patients with T2D (T2D group) in Lishui Municipal Central Hospital from January 2017 to June 2017. Multivariate logistic regression analysis was applied to assess the associations between circulating inflammatory adipokine levels and the risk of T2D. Results There were significant differences in the levels of adiponectin ( p = 0.013) and visfatin ( p < 0.001) between the T2D and Control groups. In contrast, no significant differences in leptin ( p = 0.113), TNF‐α ( p = 0.632), and IL‐6 ( p = 0.156) levels were found between the groups. Multivariate logistic regression indicated that elevated visfatin level was associated with an increased risk of T2D (OR: 3.543; 95% CI: 1.771–7.088; p < 0.001), while adiponectin (OR: 1.946; 95% CI: 0.925–4.094; p = 0.079), leptin (OR: 3.723; 95% CI: 0.788–17.583; p = 0.097), TNF‐α (OR: 1.081; 95% CI: 0.911–1.281; p = 0.373), and IL‐6 (OR: 0.878; 95% CI: 0.657–1.173; p = 0.379) were not associated with the risk of T2D. Conclusions This study found elevated visfatin levels are associated with an increased risk of T2D, while adiponectin, leptin, TNF‐α, and IL‐6 are not. These findings should be further verified by a large‐scale prospective study.

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Meta-Analysis of the Quantitative Relation Between Pulse Pressure and Mean Arterial Pressure and Cardiovascular Risk in Patients With Diabetes Mellitus

Cited by 48 publications

References 29 publications

Atazanavir improves cardiometabolic measures but not vascular function in patients with long-standing type 1 diabetes mellitus

Atazanavir improves cardiometabolic measures but not vascular function in patients with long-standing type 1 diabetes mellitus

Effects of empagliflozin on blood pressure and markers of arterial stiffness and vascular resistance in patients with type 2 diabetes

Associations between the levels of circulating inflammatory adipokines and the risk of type 2 diabetes in Chinese male individuals: A case–control study

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