Risk of Vascular Disease in Premenopausal Women With Diabetes Mellitus

García, Néstor H.; Perez, Hernan A; Spence, J. David; Armando, Luís

doi:10.1016/j.clinthera.2014.06.011

Cited by 9 publications

(7 citation statements)

References 60 publications

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“…The post-test probability TPA (Ptp-TPA) was then used as a surrogate marker for the combined outcome of fatal myocardial infarction and stroke, calculated by using the Bayes formula and risk calculator designed by Romanens et al . [ 17 , 18 ] ( http://www.scopri.ch/posttestcalculators1.html ). Then, to compare both methods we calculated the Pearson coefficient.…”

Section: Methodsmentioning

confidence: 99%

Adding carotid total plaque area to the Framingham risk score improves cardiovascular risk classification

Perez¹,

García²,

Spence³

et al. 2016

aoms

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IntroductionCardiovascular events (CE) due to atherosclerosis are preventable. Identification of high-risk patients helps to focus resources on those most likely to benefit from expensive therapy. Atherosclerosis is not considered for patient risk categorization, even though a fraction of CE are predicted by Framingham risk factors. Our objective was to assess the incremental value of combining total plaque area (TPA) with the Framingham risk score (FramSc) using post-test probability (Ptp) in order to categorize risk in patients without CE and identify those at high risk and requiring intensive treatment.Material and methodsA descriptive cross-sectional study was performed in the primary care setting in an Argentine population aged 22–90 years without CE. Both FramSc based on body mass index and Ptp-TPA were employed in 2035 patients for risk stratification and the resulting reclassification was compared. Total plaque area was measured with a high-resolution duplex ultrasound scanner.Results57% male, 35% hypertensive, 27% hypercholesterolemia, 14% diabetes. 20.1% were low, 28.5% moderate, and 51.5% high risk. When patients were reclassified, 36% of them changed status; 24.1% migrated to a higher and 13.6% to a lower risk level (κ index = 0.360, SE κ = 0.16, p < 0.05, FramSc vs. Ptp-TPA). With this reclassification, 19.3% were low, 18.9% moderate and 61.8% high risk.ConclusionsQuantification of Ptp-TPA leads to higher risk estimation than FramSc, suggesting that Ptp-TPA may be more sensitive than FramSc as a screening tool. If our observation is confirmed with a prospective study, this reclassification would improve the long-term benefits related to CE prevention.

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Section: Methodsmentioning

confidence: 99%

Adding carotid total plaque area to the Framingham risk score improves cardiovascular risk classification

Perez¹,

García²,

Spence³

et al. 2016

aoms

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“…DM is widely regarded as an important risk factor for CVD pathogenesis, and contributes to cardiovascular morbidity and mortality (18). Even in premenopausal women with DM, cardiovascular risk is increased compared with in age-matched women without DM, thus suggesting that DM may increase the CVD risk in young premenopausal women due to certain underlying mechanisms (19). Previously, numerous studies indicated that the number and functional ability of circulating EPCs were reduced and weakened, due to the effects of impaired endothelial repair capacity during DM development or DM-associated vascular dysfunction (11,13,14,(31)(32)(33).…”

Section: Discussionmentioning

confidence: 99%

“…Patients with T2DM have a two-to four-fold increased risk of CVD (18). In addition, the deleterious effects of DM on CVD risk also occur in premenopausal women, in spite of their relatively high estrogen levels (19). Our previous studies indicated that, although the number and activity of circulating EPCs is preserved in prehypertensive premenopausal women compared with in those without prehypertension (20), DM concomitantly diminishes their EPC advantages in terms of vascular protection, thus resulting in a reduced number and impaired activity of EPCs, and even damaged endothelial function (21).…”

Section: Attenuated Endothelial Function Is Associated With Decreasedmentioning

confidence: 99%

Attenuated endothelial function is associated with decreased endothelial progenitor cells and nitric oxide in premenopausal diabetic women

Liu

Yan³

et al. 2018

Mol Med Report

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Previous studies have demonstrated that the deleterious effect of diabetes mellitus (DM) on the risk of cardiovascular disease also occurs in premenopausal women, in spite of their relatively high estrogen levels; however, the underlying mechanism remains unclear. The present study aimed to investigate the sex‑related differences in circulating endothelial progenitor cells (EPCs) in a relatively young population with type 2 DM (T2DM) and its underlying mechanism. The number and functional activity of circulating EPCs, and vascular endothelial function assessed using flow‑mediated dilation (FMD), were compared in premenopausal women and age‑matched men with or without T2DM. Nitric oxide (NO) in the plasma or NO secreted by EPCs was also measured. The number and activity of circulating EPCs, and NO levels in the plasma or culture medium, were lower in premenopausal women with T2DM compared with those without T2DM. In addition, the number and activity of circulating EPCs and NO levels were decreased in men with T2DM compared with in age‑matched premenopausal women with T2DM. FMD was positively correlated with the number and activity of circulating EPCs, and NO levels. In conclusion, DM in premenopausal women may significantly impair the repair capability of EPCs and lead to endothelial dysfunction, which may be associated with reduced NO production. In patients with both DM and normal glucose tolerance, sex‑related differences of EPCs are presented in a young population.

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“…Body mass index (BMI) was calculated from height and weight measurements obtained in the clinic. Blood pressure was assessed as the mean of three measurements performed on the left arm in the sitting position, after a 5-minute period of rest, with the OMRON Hem 705 sphygmomanometer [44]. Personal history of CVD was defined by prior myocardial infarction, coronary/ peripheral revascularization, stroke, or any self-reports of chest pain, chest pressure, or chest tightness.…”

Section: Methodsmentioning

confidence: 99%

“…The FRS sex-specific risk equations that substitute BMI for lipid profile (BMI-FRS) were used to predict the risk of developing CVD over the next 10 years, as previously described [44]. This traditional risk assessment score was estimated based on the subject’s reported smoking, age, sex, diabetes status, BMI, systolic blood pressure, and use of antihypertensive therapy.…”

Section: Methodsmentioning

confidence: 99%

Increased carotid plaque burden in patients with family medical history of premature cardiovascular events in the absence of classical risk factors

Atkins¹,

Perez²,

Spence³

et al. 2019

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IntroductionThe hypothesis that relates atherosclerosis to traditional risk factors (TRF) seems to be not as adequate as previously thought; other risk factors (RF) need to be considered to prevent atherosclerosis progression. Although a family medical history of premature cardiovascular events (FHx) has been considered the putative RF for decades, it has not been incorporated routinely into cardiovascular risk evaluation along with another RF. The objective of this study was to investigate whether FHx is associated with a higher atherosclerotic burden, measured as carotid total plaque area (TPA) in a population having no traditional RF.Material and methodsThe study included 4,351 primary care patients in Argentina. After excluding a personal history of cardiovascular disease (CVD) and TRF: hypertension, diabetes mellitus, hypercholesterolemia, smoking history, and body mass index (BMI) > 25 kg/cm2, 34 patients with FHx were identified. Compared to 56 matched controls TPA was 86% higher in FHx patients (p < 0.05). A second analysis performed in hypertensive patients but no other TRF; 32 patients with FHx were identified.ResultsCompared with 44 matched controls, TPA was 77% higher in FHx patients (p < 0.05). A final analysis using a generalized linear model with TPA progression as the response variable suggests that TPA progresses more rapidly in FHx patients compared to controls.ConclusionsThe FHx was associated with increased TPA burden and progression in the absence of other TRF. This supports ultrasound screening in FHx patients in order to detect high-risk patients who may benefit from early intervention.

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Risk of Vascular Disease in Premenopausal Women With Diabetes Mellitus

Cited by 9 publications

References 60 publications

Adding carotid total plaque area to the Framingham risk score improves cardiovascular risk classification

Adding carotid total plaque area to the Framingham risk score improves cardiovascular risk classification

Attenuated endothelial function is associated with decreased endothelial progenitor cells and nitric oxide in premenopausal diabetic women

Increased carotid plaque burden in patients with family medical history of premature cardiovascular events in the absence of classical risk factors

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