Relationship Between Subclinical Cardiovascular Diseases and Cardiac Morpho-Functional Parameters in Preclinical Stage A/B Heart Failure Adults with Type 2 Diabetes.

Purpose: Type 2 diabetes mellitus (T2DM) is a common risk factor for cardiovascular disease which increases the risk of heart failure. This study aimed to determine whether clinical characteristics and subclinical cardiovascular disease (CVD) features are correlated with echocardiographic morpho-functional parameters of T2DM patients. Patients and Methods: Two hundred and fifty-five T2DM patients without a history of coronary heart disease were enrolled in this cross-sectional study. The demographic characteristics, glucose and lipid levels were assessed for each patient. Carotid ultrasonography and peripheral artery examination were performed to measure carotid intima-media thickness (cIMT), carotid plaque, ankle-brachial index (ABI), brachial artery pulse wave velocity (baPWV), and carotid-femoral pulse wave velocity (cfPWV). Furthermore, echocardiography was conducted to evaluate cardiac morphology and systolic and diastolic function. The relationship between clinical characteristics, subclinical cardiovascular diseases, and cardiac morpho-functional parameters was explored with the Pearson and stepwise multivariable linear regression analyses. Results: A total of 255 subjects aged 18-80 years were enrolled in the study. Multiple regression analysis revealed that left ventricular mass index (LVMI) was correlated with age (ß=0.463, p = 0.000) and systolic blood pressure (SBP) (ß=0.179, p = 0.003). Relative wall thickness (RWT) was related to cfPWV (ß=0.006, p = 0.007) and homeostasis model assessment of insulin resistance (HOMA-IR) (ß=0.000, p = 0.036). In contrast, left ventricular ejection fraction (LVEF) was inversely related to cIMT (ß=-0.925, p = 0.019). The ratio of the peak flow velocity of early diastole to atrial contraction (peak E/A) was correlated with age (ß=-0.014, p = 0.000), diastolic blood pressure (DBP) (ß=-0.006, p = 0.001) and cfPWV (ß=-0.025, p = 0.044). Conclusion: In preclinical stage A/B heart failure adults with T2DM, age, BP, HOMA-IR, cfPWV and cIMT are correlated with cardiac morpho-functional parameters.

Obstructive Sleep Apnea Syndrome is Associated with Metabolic Syndrome among Adolescents and Youth in Beijing: data from Beijing Child and Adolescent Metabolic Syndrome Study.

BACKGROUND: Obstructive sleep apnea (OSA) syndrome has a negative impact on the health of millions of adolescents and youth. The aim of this study was to evaluate the associations of OSA syndrome with obesity and cardiometabolic risk factors among adolescents and youth at risk for metabolic syndrome (MS). METHODS: A total of 558 subjects aged 14-28 years were recruited from the Beijing Child and Adolescent Metabolic Syndrome Study. Each underwent a 2-h oral glucose tolerance test (OGTT), echocardiography, and liver ultrasonography. Anthropometric measures, blood levels of glucose, lipids, and liver enzymes were assessed. Subjects with high or low risk for OSA were identified by Berlin Questionnaire (BQ). RESULTS: Among the subjects in obesity, 33.7% of whom were likely to have OSA by BQ. Subjects with high risk for OSA had higher neck and waist circumference and fat mass percentage compared to those with low risk for OSA (P < 0.001). Moreover, significant differences in levels of lipids, glucose after OGTT, and liver enzymes, as well as echocardiographic parameters were found between the two groups with high or low risk for OSA (P < 0.05). The rates of nonalcoholic fatty liver disease (71.0% vs. 24.2%), MS (38.9% vs. 7.0%), and its components in high-risk group were significantly higher than in low-risk group. CONCLUSIONS: The prevalence of OSA by BQ was high in obese adolescents and youth. A high risk for OSA indicates a high cardiometabolic risk. Mechanisms mediating the observed associations require further investigation.

[Correlations of serum alanine aminotransferase and insulin resistance, pancreatic B-cell function].

OBJECTIVE: To explore the correlations of serum alanine aminotransferase (ALT), insulin resistance and pancreatic B-cell function. METHODS: A total of 351 first-degree relatives of type 2 diabetes mellitus received a standard oral glucose tolerance test (OGTT) at our outpatient clinic. All subjects were analyzed for the parameters of body mass index (BMI), waist-hip ratio, blood pressure (BP), serum lipids, ALT, aspartate aminotransferase (AST), plasma glucose (PG), true-insulin and proinsulin. Homeostasis model assessment (HOMA) was applied to assess the status of insulin resistance and pancreatic B-cell function. They were divided into 4 groups according to the quartiles of ALT: ALT1 group (< 12.9 U/L), ALT2 group (12.9 - 17.3 U/L), ALT3 group (17.4 - 24.2 U/L) and ALT4 group (≥ 24.2 U/L). The diagnosis of metabolic syndrome was made according to the definition of Chinese Diabetic Society. RESULTS: With the rising serum ALT levels (ALT4 vs ALT1), the levels of BMI [(26.3 ± 2.9) kg/m(2) vs (23.2 ± 3.7) kg/m(2), P < 0.01], HOMA-IR [1.93 (1.21 - 3.26) vs 1.06 (0.65 - 1.54), P < 0.01] and LnHOMA-beta (2.00 ± 0.32 vs 1.87 ± 0.28, P < 0.05) were elevated; BP, serum lipids, PG, true-insulin and proinsulin also increased (P < 0.05 or P < 0.01). The levels of serum ALT [23.3 (16.3 - 37.6) vs 14.3 (10.3 - 18.5) U/L, P < 0.01] and AST [21.5 (18.3 - 32.8) U/L vs 17.9 (15.5 - 22.1) U/L, P < 0.01] increased with the rising number of metabolic disorders (0 vs 3 - 4 metabolic disorders). After adjustments for gender, age, BMI and waist-hip ratio, serum ALT were still positively correlated with BP, serum lipids, PG, fasting true-insulin, 2 h proinsulin, 2 h proinsulin/true-insulin, HOMA-IR and the numbers of metabolic disorder (r = 0.117 - 0.236, P < 0.05 or P < 0.01). After adjustments for gender, age, BMI, waist-hip ratio and HOMA-IR, the serum ALT level remained positively correlated with the numbers of metabolic disorders (r = 0.120, P < 0.05). Multiple stepwise regression analysis showed that triglyceride, HOMA-IR, total cholesterol and 2 h-proinsulin were the independent risk factors for the level of serum ALT (P < 0.05 or P < 0.01). CONCLUSION: The elevated levels of serum ALT are significantly correlated with metabolic syndrome, insulin resistance and compensatory increases of pancreatic B-cell function. Independently of insulin resistance, the serum ALT level is correlated with metabolic syndrome.