Reasons for Hospitalization Among Australians With Type 1 or Type 2 Diabetes and COVID-19.

OBJECTIVE: Our aim in this study was to determine the reasons for hospitalization in Australian people with diabetes who contract COVID-19. METHODS: All COVID-19 cases reported to the Victorian Department of Health and linked hospitalization data were assessed. We determined reasons for acute (0 to 30 days) and postacute (31 to 365 days) hospitalization among those with type 1 or type 2 diabetes and COVID-19, compared to those with COVID-19 and no diabetes, and to admissions before the COVID-19 pandemic. RESULTS: A total of 13,302 Australians with type 1 or type 2 diabetes were hospitalized in the state of Victoria in the 12 months after COVID-19 diagnosis. Respiratory diseases accounted for 40% of acute admissions among those with diabetes. Viral pneumonia was the leading cause of acute hospitalization among those with diabetes and constituted a larger proportion of admissions in those with compared to those without diabetes (adjusted prevalence ratio 1.87, 95% confidence interval 1.76 to 1.99). The distribution of postacute hospitalizations among those with diabetes aligned with that of people with diabetes before the COVID-19 pandemic. CONCLUSIONS: Respiratory diseases are the leading cause of acute hospitalization in those with type 1 or type 2 diabetes and COVID-19. The reasons for postacute hospitalization resemble those in people with diabetes and no COVID-19. We reinforce the importance of community management of people with diabetes in the ongoing pandemic.

[Benefits of an observatory for myocardial infarction in women under 50 : The WAMIF study]. / Intérêt d'un observatoire de l'infarctus du myocarde des femmes de moins de 50 ans : étude WAMIF.

The WAMIF study was conducted from 2017 to 2019 to include 314 patients in 30 French investigative centers in France. We have systematically collected the clinical, morphological and biological characteristics of cases of myocardial infarction affecting women under 50 years of age and evaluated their short-term (intra-hospital) and mid-term (at 12 months) prognosis. . The main results were: a particularly high incidence of modifiable risk factors affecting 86% of patients with smoking in the first place in 75% of them. The clinical presentation revealed chest pain in more than 90% of cases. The pathophysiological forms of acute coronary syndrome identified the culprit artery in 90% of cases, MI without obstruction (MINOCA) was found in 17.8% of the ST elevation MI (STEMI), spontaneous dissection in 14.6% of STEMI and 16.3% of NSTEMI. Hospital events included 3 strokes, 3 cases of bleeding and no deaths. At 12 months, follow-up showed no cardiovascular deaths. The results of this study allow us to better understand the particularities of cardiovascular diseases in women and thus to develop targeted strategies for prevention and improvement of their management.

Cardiovascular Risk Factors and Adherence to Cardiovascular Protection Practice Guidelines in Adults With Type 1 Diabetes: A BETTER Registry Cross-sectional Analysis.

OBJECTIVES: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in people with type 1 diabetes (PWT1D). We assessed cardiovascular risk factors and pharmacologic treatment in a large Canadian cohort of PWT1D. METHODS: This cross-sectional study used data from adult PWT1D in the BETTER registry (n=974). CVD risk factor status, diabetes complications, and treatments (used as proxy for blood pressure and dyslipidemia) were self-reported through online questionnaires. Objective data were available for a subgroup of PWT1D (23%, n=224). RESULTS: Participants were adults (43.9±14.8 years) with a diabetes duration of 23.3±15.2 years; 34.8% reported glycated hemoglobin (A1C) levels of ≤7%, 67.2% reported a very high cardiovascular risk, and 27.2% reported at least 3 CVD risk factors. Most participants received care for CVD in accordance with the Diabetes Canada Clinical Practice Guidelines (DC-CPG), with a median recommended pharmacologic treatment score of 75.0%. However, 3 subgroups of participants with lower adherence (<70%) to DC-CPG were identified: 1) those with microvascular complications and receiving a statin (60.8%, 208 of 342) or renin-angiotensin axis nephroprotective therapy (52.6%, 180 of 342); 2) those aged ≥40 years and receiving statin therapy (67.1%, 369 of 550); and 3) those aged ≥30 years with a diabetes duration of ≥15 years and receiving statin therapy (58.9%, 344 of 584). Among a subgroup of participants with recent laboratory results, only 24.5% of PWT1D (26 of 106) achieved both A1C and low-density lipoprotein cholesterol targets. CONCLUSIONS: Most PWT1D received recommended pharmacologic cardiovascular protection, but specific subgroups required special attention. Target achievement for key risk factors remains suboptimal.

Thyroid Dysfunction and Cardiovascular Events in Patients With Dysglycemia.

OBJECTIVES: Subclinical thyroid disease is the most common form of thyroid dysfunction and may be associated with adverse cardiovascular outcomes in people at high risk for cardiovascular events. Our objective in this study was to assess the association of thyroid function and thyroid hormone replacement with cardiovascular outcomes in high-risk individuals with dysglycemia and additional cardiovascular risk factors. METHODS: The relationship between baseline thyrotropin (TSH) level and incidence of the composite outcome of nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death; an expanded composite of this outcome plus revascularization or hospitalization for heart failure; and mortality was assessed in 8,401 ORIGIN trial participants with a baseline measurement of TSH. The hazard of each outcome according to either baseline levothyroxine use or TSH-defined hyperthyroidism, euthyroidism, subclinical hypothyroidism, and overt hypothyroidism was estimated before and after adjustment for baseline demographic and clinical characteristics and treatment allocation. RESULTS: Of all participants, 91.5% were euthyroid, 0.8% were hyperthyroid, 5.5% had subclinical hypothyroidism, and 2.2% had overt hypothyroidism. Subclinical hypothyroidism predicted both the expanded cardiovascular outcome (hazard ratio [HR]=1.24, 95% confidence interval [CI] 1.06 to 1.46) and mortality (HR=1.37, 95% CI 1.12 to 1.67), whereas levothyroxine use predicted fewer deaths (HR=0.72, 95% CI 0.56 to 0.94). CONCLUSION: Subclinical hypothyroidism predicts future cardiovascular events and mortality in people with dysglycemia and other cardiovascular risk factors.

[A Family History of Hypercholesterolemia - the Role of Genetics]. / Une histoire familiale d'hypercholestérolémie ­ le rôle de la génétique.

A Family History of Hypercholesterolemia - the Role of Genetics Abstract. Genetic testing is rarely used in Switzerland to confirm the clinical diagnosis of familial hypercholesterolemia. However, cascade genetic testing from an index case is recommended by the guidelines. By describing a patient and his family with severe hypercholesterolemia, we discuss the benefits, risks and barriers regarding the implementation of genetics for familial hypercholesterolemia. Family screening with genetic testing could become a standard of care for severe hypercholesterolemia.

Résumé. La génétique est encore peu utilisée en Suisse pour confirmer le diagnostic clinique d'une hypercholestérolémie familiale. Pourtant le dépistage génétique familial en cascade à partir d'un cas index est recommandé par les experts. En décrivant un patient et sa famille avec une hypercholestérolémie sévère, nous discutons les bénéfices, les risques et les barrières à l'implémentation du test la génétique pour l'hypercholestérolémie familiale. Le dépistage familial à l'aide du test génétique pourrait devenir un standard de soin pour l'hypercholestérolémie sévère.

A single dose of dietary nitrate supplementation protects against endothelial ischemia-reperfusion injury in early postmenopausal women.

The onset of menopause and accompanying changes to ovarian hormones often precedes endothelial dysfunction in women. In particular, accelerated impairments in macrovascular and microvascular function coincide with the loss of estrogen, as does impaired endothelial responses to ischemia-reperfusion (IR) injury. In healthy, early postmenopausal women (n = 12; 3.9 ± 1.5 years since menopause) we tested the hypothesis that acute dietary nitrate (NO3-) supplementation would improve endothelial function and attenuate the magnitude of endothelial dysfunction following whole-arm IR in comparison with placebo. In this randomized, double-blind, placebo-controlled, crossover study we tested participants before and after NO3--rich (BRnitrate) and NO3--depleted (BRplacebo) beetroot juice (BR) consumption, as well as following IR injury, and 15 min after IR to assess recovery. Analyses with repeated-measures general linear models revealed a condition × time interaction for brachial artery flow-mediated dilation (FMD; P = 0.04), and no interaction effect was found for the near-infrared spectroscopy-derived reperfusion slope (P = 0.86). Follow-up analysis showed a significant decline in FMD following IR injury with BRplacebo in comparison with all other timepoints (all, P < 0.05), while this decline was not present with BRnitrate (all, P > 0.05). Our findings demonstrate that a single dose of dietary NO3- minimizes IR-induced macrovascular endothelial dysfunction in healthy, early postmenopausal women, but does not improve resting macrovascular and microvascular function. Trial registration number: NCT03644472. Novelty: In healthy, early postmenopausal women, a single dose of NO3--rich BR can protect against IR-induced endothelial dysfunction. This protection may be due to nitric oxide bioactivity during IR rather than improved endothelial function prior to the IR protocol per se.

Development of machine learning prediction models to explore nutrients predictive of cardiovascular disease using Canadian linked population-based data.

Machine learning may improve use of observational data to understand the nutritional epidemiology of cardiovascular disease (CVD) through better modelling of non-linearity, non-additivity, and dietary complexity. Our objective was to develop machine learning prediction models for exploring how nutrients are related to CVD risk and to evaluate their predictive performance. We established a population-based cohort from the Canadian Community Health Survey and measured CVD incidence and mortality from 2004 to 2018 using administrative databases of national hospital discharges and deaths. Predictors included 61 nutrition variables and fourteen socioeconomic, demographic, psychological, and behavioural variables. Conditional inference forest models were interpreted and evaluated by permutation feature importance, accumulated local effects, and predictive discrimination and calibration. A total of 12 130 individuals were included in the study. Use of supplements, caffeine, and alcohol were the most important nutrition variables for prediction of CVD. Supplement use was associated with decreased risk, caffeine was associated with increasing risk, and alcohol had a u-shaped association with risk. The model had an out-of-sample c-statistic of 0.821 (95% confidence interval = 0.801-0.842). Exploratory findings included both known and novel associations and predictive performance was competitive, suggesting that further application of machine learning to nutritional epidemiology may help elucidate risks and improve predictive models. Novelty: Machine learning prediction models were developed for CVD using dietary data. Models were interpreted with interpretable machine learning techniques, revealing diverse associations between diet and CVD. Models achieved comparable or superior predictive performance to existing CVD risk prediction models.

IL-6 induced enhanced clearance of proANP and ANP by insulin-degrading enzyme in T1DM mice.

Cardiovascular disease (CVD) is a prevalent cause of morbidity and mortality in type I diabetes mellitus (T1DM). However, the pathophysiological mechanisms underlying the relationship between CVD, CVD risk factors, and T1DM have not yet been sufficiently explored. Here, we report that insulin-degrading enzyme (IDE) effectively degrades the precursor of atrial natriuretic peptide (proANP) in HEK293T cells. The pro-inflammatory cytokine IL-6 elicited a significant dose-dependent increase in IDE protein expression. Inhibition of the ERK/MAPK signaling pathway with selumetinib abolished the IL-6-stimulated increase in IDE protein levels and decreased ANP secretion in H9C2 cells. Importantly, the T1DM mouse model displayed lower proANP in the heart and ANP in serum, due to increased IDE expression and activity. Our results suggest a novel role of IL-6 in ANP metabolism via IDE and provide possibilities for new potential therapeutic strategies for diabetes-related cardiovascular complications.

Prevalence of severe cardiovascular disease in patients with schizophrenia.

OBJECTIVES: We assessed the prevalence of severe cardiovascular (CV) disease requiring hospitalization among patients with schizophrenia in France. METHOD: We included patients hospitalized with schizophrenia or psychotic disorder during 2015, in five French psychiatric hospitals. Patients with CV disease were defined as those with a correspondent ICD-10 code during a hospital stay in any general hospital, five years before or three years after the psychiatric hospitalization. CV disease included myocardial infarction (MI), stroke, heart failure (HF), coronary artery disease (CAD) or peripheral artery disease. Risk factors such as hypertension, obesity and diabetes were recorded. RESULTS: In total, 4424 patients with schizophrenia were included. Overall, 203 (4,6%) patients were diagnosed with CV disease, 93 (2.1%) with CAD, 86 (1.9%) with HF and 49 (1.1%) with stroke. The prevalence of hypertension, obesity and diabetes was 11.3%, 9.7% and 7.8%. The median (interquartile range) age of patients with MI and diabetes was 57 (49-70) and 56 (48-66) years. CONCLUSION: Patients with schizophrenia develop severe CV disease requiring hospitalization at an early age. These severe events are associated with a high prevalence of risk factors. Early screening and treatment of CV disease and risk factors is important to improve life expectancy and quality of life of these patients.

[Retinal vascular network: Changes with aging and systemic vascular disease (cardiac and cerebral)]. / Caractéristiques vasculaires rétiniennes : modifications lors du vieillissement et en pathologie vasculaire systémique (cardiaque et cérébrale).

For over 10 years, the description of the retinal microvascular network has benefited from the development of new imaging techniques. Automated retinal image analysis software, as well as OCT angiography (OCT-A), are able to highlight subtle, early changes in the retinal vascular network thanks to a large amount of microvascular quantitative data. The challenge of current research is to demonstrate the association between these microvascular changes, the systemic vascular aging process, and cerebrovascular and cardiovascular disease. Indeed, a pathophysiological continuum exists between retinal microvascular changes and systemic vascular diseases. In the Montrachet study, we found that a suboptimal retinal vascular network, as identified by the Singapore I Vessel Assessment (SIVA) software, was significantly associated with treated diabetes and an increased risk of cardiovascular mortality. In addition, we supplemented our research on the retinal vascular network with the use of OCT-A. In the EYE-MI study, we showed the potential role of quantitative characterization of the retinal microvascular network by OCT-A in order to assess the cardiovascular risk profile of patients with a history of myocardial infarction. A high AHA (American Heart Association) risk score was associated with low retinal vascular density independently of hemodynamic changes. Thus, a better understanding of the association between the retinal microvasculature and macrovascular disease might make its use conceivable for early identification of at-risk patients and to suggest a personalized program of preventative care. The retinal vascular network could therefore represent an indicator of systemic vascular disease as well as an interesting predictive biomarker for vascular events.

[Social representations of cardiovascular disease in the Tanvè Health Study (TAHES) cohort in Benin]. / Représentations sociales des maladies cardio-vasculaires dans la cohorte Tanvè Health Study (TAHES) au Bénin.

OBJECTIVE: To describe the social representations associated with cardiovascular diseases (CVD) in the village of Tanvè in Benin. METHODS: Focus groups discussions and semi-structured interviews were conducted among participants of Tanvè Health Study (TAHES) cohort. Audio recordings were made during the interviews, as well as some note-taking. Data were organized by themes and analyzed to identify key representations that underlie attitudes and health care practices. RESULTS: A total of 19 subjects (including 11 women) participated in 2 focus groups and 17 (including 5 women) in individual interviews. Etymologies of CVD's names evoke either clinical signs (example: ''tesisi glô mɛ'' [can't stand up]), guessed etiology (example: ''kuvitɔ zɔn'' [ghosts' disease]) or a local adaptation of a biomedical name (example: ''a'tension'' [from hypertension]), to cite the example of stroke. According to beliefs about etiology, diseases were classed as ''simple'' or "organic" diseases ("azɔn yaya") and ''supernatural'' or ''induced'' diseases linked to "azé" [immaterial witchcraft] or "bô" [material bewitchment]. Chronic or recurrent diseases usually end up in the ''supranatural'' category and induce the consultation of "bokɔnɔ᷉" (diviner) or other religious for diagnosis. Health care seeking refer to modern medicine, "amanɔn" (leaf-based care), "bokɔnɔ᷉" or traditional religious (various rites) and Christians (prayers). CONCLUSION: Social representations of CVD in this community are based on ancestral beliefs, but are also influenced by modern knowledge. Taking them into account could improve quality of health to fulfill communities' care needs.

[Care and follow-up of cardiovascular disease in women]. / Prise en charge et suivi de la pathologie cardio-vasculaire chez la femme.

The condition of women has vastly improved over recent decades: respect of equality, better salary conditions and health status. Although women, like men, are living longer, certain differences in care are emerging. This survey studies the characteristics of women's cardiovascular health, especially in terms of treatment and follow-up.

COVID-19 pandemic - Inequities and inequalities to exercise and their consequences on the physical and mental health of women with cardiovascular disease: recommendations on how to address the needs of women.

The coronavirus disease (COVID-19) pandemic disproportionately affects those with pre-existing conditions and has exacerbated gender inequalities. Cardiovascular disease (CVD) is the leading cause of death among Canadian women. Exercise improves physical and mental health and CVD management. Amid the pandemic, women are experiencing an increase in caregiving responsibilities, job insecurities, and domestic violence creating competing demands for prioritizing their health. Recommendations on how to meet the unique needs of Canadian women with CVD through exercise are provided. Novelty: Exercise recommendations amid the pandemic for women with CVD need to be flexible, feasible, and fun.

Association Between Soluble Receptor for Advanced Glycation End Product and Endogenous Secretory Soluble Receptor for Advanced Glycation End Product Levels and Carotid Atherosclerosis in Diabetes: A Systematic Review and Meta-Analysis.

BACKGROUND: The soluble receptor for advanced glycation end product (sRAGE) and endogenous secretory RAGE (esRAGE) are novel biomarkers that are associated with vascular disease. We carried out a systematic review to provide a more complete picture of sRAGE, esRAGE, carotid atherosclerosis and cardiovascular disease (CVD) in patients with diabetes. METHODS: We searched the Cochrane Library, PubMed and Embase databases. Systematic review best practices were followed, and study quality was assessed. RESULTS: Ultimately, 11 studies met all the inclusion criteria. Meta-analysis indicated that esRAGE was not significantly lower in patients with type 1 diabetes (T1D) (standardized mean difference [SMD], -0.76; 95% confidence interval [CI], -1.57 to 0.05; I2=90%; p=0.002), whereas it was significantly lower in patients with type 2 diabetes (T2D) (SMD, -1.08; 95% CI, -1.53 to -0.62; I2=80%; p=0.006). Meta-analysis suggested that sRAGE levels were not significantly lower or higher in T1D (SMD, 0.06; 95% CI, -0.14 to 0.26; I2=38%; p=0.20) or T2D (SMD, 0.00; 95% CI, -0.26 to 0.26; I2=0.00%; p=1.00) patients. The level of esRAGE was inversely correlated with carotid intima-media thickness (IMT) in T2D patients, whereas there was a contrasting relationship between sRAGE and carotid IMT in T1D patients. Higher sRAGE was associated with cardiovascular events. CONCLUSION: Our meta-analysis showed that circulating esRAGE was lower and inversely correlated with IMT in T2D patients.

Dietary Reference Intakes based on chronic disease endpoints: outcomes from a case study workshop for omega 3's EPA and DHA.

Given the focus on developing Dietary Reference Intakes (DRIs) based on chronic disease risk reduction and recent research for omega-3 long chain PUFA since the last DRI review, the Canadian Nutrition Society convened a panel of stakeholders for a 1-day workshop in late 2019. Attendees discussed the new NASEM guidelines for establishing DRI values based on chronic disease risk endpoints and the strength of current evidence for EPA and DHA as it relates to the new guidelines. Novelty: Summarizes evidence and expert opinions regarding the potential for reviewing DRI values for EPA and DHA and cardiovascular disease risk and early development.

Aerobic training, resistance training, or their combination as a means to fight against excess weight and metabolic syndrome in obese students - which is the most effective modality? A randomized controlled trial.

This study aimed to determine the effects of either aerobic training (AT) or resistance training (RT) or both (A+RT) on obesity and its comorbidities in young adults. A total of 61 participants, aged 21.74 ± 1.42 years and with a body mass (BM) index (BMI) of 36.21 ± 2.43 kg/m2, were randomized for 12 weeks into control (CONT, n = 15), AT (n = 15), RT (n = 16), and A+RT (n = 15) groups. BM, body composition, and cardiovascular disease risk factors were assessed before and after intervention. BM did not change in the CONT and RT groups but decreased significantly by 7.5 kg in the AT (p ≤ 0.05) and 8.82 kg in the A+RT (p ≤ 0.05) groups, respectively. Significant reductions were also noted in waist circumference, BMI, and body fat percentage in the exercising groups. The most significant variations were in the A+RT group. High-density lipoprotein cholesterol (HDL-C) concentrations were increased after A+RT by 2.39 mg/dL. Significant reductions were also noted in very-low-density lipoprotein cholesterol (VLDL-C) concentrations (-2.84 mg/dL) in the A+RT group. AT alone is effective in improving BM and body composition, while RT alone improves the body composition and A+RT ensures better outcomes concerning BM, body composition, HDL-C, and VLDL-C. Novelty: Aerobic training alone is effective in improving BM and body composition. Resistance training alone improves the body composition. The combination of aerobic and resistance exercises ensures better outcomes for BM, body composition, HDL-C, and VLDL-C.

[Evaluation of a woman's care program after pre-eclampsia]. / Évaluation d'un parcours de soin chez la femme au décours d'une prééclampsie.

INTRODUCTION: The medical treatment of preeclampsia is well structured in its acute phase but the required follow-up with patients in post-partum is discussed. However, preeclampsia is associated with an increased risk of cardiovascular morbi-mortality in the long term. In order to optimize the post-partum treatment, a care program has been developed for these patients in the city of Nantes, France. This includes a check-up of the cardiovascular risks at a day hospital. Our study presents the first results of this program. METHODS: The study included 134 patients who were diagnosed with preeclampsia between October 2016 and January 2019 in the Nantes area, France, and took part in the program within the year following their childbirth. A descriptive analysis was first carried out and then a multivariate logistic regression model was used to investigate the risk factors for persistent high blood pressure after preeclampsia. RESULTS: The study detected 28 cases of persistent hypertension (20.9%), 34 cases of obesity (25.3%) and 1 case of diabetes. Hypertension was predominantly diastolic, mild and sometimes masked (35.7%). In a third of the cases (32.1%), the hypertension was secondary. High blood pressure was found to be more frequent in older patients (OR: 2.26; 95% CI: 1.25-4.11, p=0.072), patients from sub-Saharan Africa (OR: 11.52; 95% CI: 2.67-49.86, p=0.01) and multiparous patients (OR: 7.82; 95% CI: 1.15-53.21, p=0.035). CONCLUSION: The study confirmed that this care program enables an earlier detection and therefore treatment of the cardiovascular risk factors of these young women.

Unexpected challenges for the translation of research on food interventions to applications in the food industry: using flaxseed research as an example.

One of the primary purposes of the studies that life science researchers carry out is to translate their findings into demonstrable impacts in the lives of the general population. If we study the mechanism of heart disease, for example, it is our hope that new therapies or preventative strategies can be created from these mechanistic data. In the field of nutrition, it is the ultimate goal to translate research findings on the health benefits of functional foods and nutraceuticals into products consumed by the public that will benefit their health, improve quality of life, prevent disease, and prolong life. However, the pathway from research on the health benefits of specific foods or food products into industry applications is often a pathway with multiple, unexpected roadblocks for the unsuspecting scientist. The purpose of this article, therefore, is to identify these obstacles that have confronted industry translation in the past by using flaxseed research as an example. The ultimate goal of the review is to alert those in research and in the food industry of these translational hindrances to avoid them in the future and promote a more rapid and effective translation of food/health research into marketing success.