The Role of Circulating Glucose and Triglyceride Concentrations and Their Interactions with Other “Risk Factors” as Determinants of Arterial Disease in Nine Diabetic Population Samples from the WHO Multinational Study

Km, West; Mm, Ahuja; Ph, Bennett; Czyźyk, A; Om, De Acosta; Fuller, JH; Grab, B.; Grabauskas,; Rj, Jarrett; Kosaka, Kinori

doi:10.2337/diacare.6.4.361

Cited by 424 publications

(153 citation statements)

References 2 publications

Supporting

Mentioning

131

Contrasting

Unclassified

Order By: Relevance

“…In a subset of 9 of the original 14 centres, 8 of them included in the follow-up, fasting venous blood was collected at the baseline examination and glucose estimated by the local`true glucose' method. The methods used have been described elsewhere [11]. The geometric mean fasting glucose values are shown by centre in Table 2.…”

Section: Resultsmentioning

confidence: 99%

Follow-up of the WHO multinational study of vascular disease in diabetes: general description and morbidity

et al. 2001

View full text Add to dashboard Cite

Aims. The incidence of retinal, renal and cardiovascular complications and their relation to baseline risk factors was documented in this follow-up study of 10 of the 14 original centres of the WHO Multinational Study of Vascular Disease in Diabetes (WHO MSVDD). Methods. The incidence of specified items of vascular disease and some associated risk factors was ascertained after 7 to 9 years (11±12 years in Oklahoma, USA) follow-up, re-using baseline examination methodology in 3165 patients (66.9 %) and, through secondary information in 717 (15.2 %) of the 4729 original patients, of whom 540 (11.4 %) had died and 307 (6.5 %) were untraceable. Results. During follow-up, approximately one third of the patients developed hypertension and one third started insulin. Coronary heart disease incidence varied 10 to 20-fold among centres as did limb amputation rates. Inter-centre differences in incident retinopathy and severe visual impairment were smaller but incident clinical proteinuria and renal failure varied markedly. Vascular disease incidence of all categories was high in Native Americans though coronary heart disease incidence was relatively low in Pima Indians and absolutely low in Hong Kong and Tokyo patients. Specific vascular events and their relation with baseline risk factors are analysed in accompanying papers, summarised in the Epilogue. Conclusion/interpretation. These 10 centres reported very different incidence rates of vascular complications. Observer variation, selection biases and competing causes of mortality contributed to these differences but their validity is supported by the more objective outcome indicators. The following papers also suggest that baseline factors such as raised arterial pressure, cholesterol and fasting glucose (in the centres where it was measured) were important and potentially reversible predictors of risk. [Diabetologia (2001)

show abstract

Section: Resultsmentioning

confidence: 99%

Follow-up of the WHO multinational study of vascular disease in diabetes: general description and morbidity

et al. 2001

View full text Add to dashboard Cite

show abstract

“…There is considerable evidence indicating that plasma triglyceride concentrations are higher than normal in patients with NIDDM [32], and that this change is associated with increased risk of CHD in these patients [33,34]. However, the link between a high plasma triglyceride concentration and CHD is far from obvious.…”

Section: Discussionmentioning

confidence: 96%

Effect of glipizide treatment on postprandial lipaemia in patients with NIDDM

et al. 1994

View full text Add to dashboard Cite

SummaryThe primary goal of the present study was to examine the effects of improved glycaemic control associated with glipizide treatment on postprandial lipaemia in non-insulin-dependent diabetic patients. The metabolism of triglyceride-rich lipoproteins of intestinal origin was assessed by measuring the retinyl palmitate content in plasma and the Svedberg flotation index (Sf) > 400 and Sf 20-400 lipoprotein fractions. Fasting plasma glucose concentrations (14.5 + 0.5 vs 9.0 + 0.5 mmol/1), glycated haemoglobin levels (13.1 + 0.6 vs 9.7 _+ 0.6 %), and daylong plasma glucose concentrations were all significantly lower after glipizide treatment (p < 0.001). The improvement in glycaemic control was associated with increases in insulin-mediated glucose uptake (p < 0.001) and plasma post-heparin lipoprotein and hepatic lipolytic activities Go < 0.02). Both fasting plasma triglyceride (3.09 + 0.51 vs 2.37 + 0.34 mmol/1), and postprandial triglyceride concentrations (p < 0.05-0.001) were lower following glipizide treatment, associated with a significant fall in retinyl palmitate content in all three lipoprotein fractions (p < 0.02-0.001), with the most substantial decrease seen in the Sf 20-400 fraction. These data indicate that glipizide-induced improvement in glycaemic control was associated with changes in the metabolism of triglyceride-rich lipoproteins of intestinal origin that would be anticipated to reduce risk of coronary heart disease in non-insulin-dependent diabetic patients. [Diabetologia (1994) proteins of intestinal origin were higher in patients with NIDDM [2]. In 1979 Zilversmit [3] suggested that triglyceride-rich lipoproteins of intestinal origin, especially the cholesteryl ester-rich chylomicron remnants, could play a very important role in atherogenesis, and since then, several reports have been published supporting this hypothesis [4][5][6][7][8][9][10]. Thus, our observation that postprandial lipaemia was increased in NIDDM raised the possibility that abnormalities in the metabolism of intestinally-derived lipoproteins may contribute to the increased risk of CHD in these patients. Although we could not detect any correlation in our earlier paper between the magnitude of postprandial lipaemia and the level of glycaemic control, the crosssectional nature of the study protocol was not designed to carefully explore such a relationship. Consequently, we initiated the current study to see if improved glycaemic control associated with glipizide

show abstract

“…65 In this cross-sectional study, triglyceride levels were significantly higher among subjects with major Q-wave abnormalities compared with subjects without such abnormalities. Multivariate analysis using logistic regression revealed that the triglyceride association remained significant, independently of age, adiposity, cholesterol, and systolic blood pressure.…”

Section: Studies In Diabeticsmentioning

confidence: 90%

Plasma triglyceride and coronary heart disease.

Austin

1991

Arterioscler Thromb

598

View full text Add to dashboard Cite

Although the literature on epidemiological associations between plasma triglyceride and CHD is not completely consistent, trends do emerge from the studies described here. First, the majority of observational studies demonstrate a significant univariate relation, although the results of case-control and cross-sectional studies are more uniform than those from prospective study designs. In many but not all studies, triglyceride remains a significant predictor of CHD in multivariate statistical analyses after controlling for TC or LDL-C. Perhaps the least consistent result is that the triglyceride association does not persist in some analyses controlling for HDL-C, while in other studies, the association remains significant. Although most studies have been conducted in men, the studies providing data on women, normocholesterolemic subjects, and diabetic subjects have generally found triglyceride to be, at the very least, a univariate risk factor. The results of intervention trials differ considerably, but no such study to date has been specifically designed to evaluate triglyceride-lowering effects on primary prevention of CHD. Important statistical properties must be taken into consideration in evaluating triglyceride as a risk factor for CHD. The large variability of triglyceride measurements and the correlation of triglyceride values with other lipid measures appears to result in the underestimation of the association between triglyceride and disease in multivariate analyses. Finally, individual genetic susceptibility may play an important role in the relation between plasma triglyceride levels and CHD. For example, risk of CHD clearly varies among the well-established familial forms of hypertriglyceridemia. A predominance of small, dense, LDL particles (LDL subclass pattern B) also appears to be a genetic trait associated with both increased risk of MI and increases in plasma triglyceride levels.

show abstract

The Role of Circulating Glucose and Triglyceride Concentrations and Their Interactions with Other “Risk Factors” as Determinants of Arterial Disease in Nine Diabetic Population Samples from the WHO Multinational Study

Cited by 424 publications

References 2 publications

Follow-up of the WHO multinational study of vascular disease in diabetes: general description and morbidity

Follow-up of the WHO multinational study of vascular disease in diabetes: general description and morbidity

Effect of glipizide treatment on postprandial lipaemia in patients with NIDDM

Plasma triglyceride and coronary heart disease.

Contact Info

Product

Resources

About