RESUMEN
The Global Lung Function Initiative (GLI) has recently published international reference values for diffusing capacity of the lung for carbon monoxide (D LCO). Lower limit of normal (LLN), i.e. the 5th percentile, usually defines impaired D LCO We examined if the GLI LLN for D LCO differs from the LLN in a Swedish population of healthy, never-smoking individuals and how any such differences affect identification of subjects with respiratory burden.Spirometry, D LCO, chest high-resolution computed tomography (HRCT) and questionnaires were obtained from the first 15â040 participants, aged 50-64â
years, of the Swedish CArdioPulmonary bioImage Study (SCAPIS). Both GLI reference values and the lambda-mu-sigma (LMS) method were used to define the LLN in asymptomatic never-smokers without respiratory disease (n=4903, of which 2329 were women).Both the median and LLN for D LCO from SCAPIS were above the median and LLN from the GLI (p<0.05). The prevalence of D LCO
Asunto(s)
Pulmón , Adulto , Femenino , Volumen Espiratorio Forzado , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Valores de Referencia , Espirometría , Suecia/epidemiología , Capacidad VitalAsunto(s)
Cardiología , Enfermedades Cardiovasculares/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Guías de Práctica Clínica como Asunto , Estado Prediabético/diagnóstico , Sociedades Médicas , Enfermedades Cardiovasculares/etiología , Diabetes Mellitus Tipo 2/complicaciones , Europa (Continente) , Humanos , Estado Prediabético/complicacionesRESUMEN
BACKGROUND: Anthropometric measurements are useful in clinical practice since they are non-invasive and cheap. Previous studies suggest that sagittal abdominal diameter (SAD) may be a better measure of visceral fat depots. The aim of this study was to prospectively explore and compare how laboratory and anthropometric risk markers predicted subclinical organ damage in 255 patients, with type 2 diabetes, after four years. METHODS: Baseline investigations were performed in 2006 and were repeated at follow-up in 2010. Carotid intima-media thickness (IMT) was evaluated by ultrasonography and aortic pulse wave velocity (PWV) was measured with applanation tonometry over the carotid and femoral arteries at baseline and at follow-up in a cohort of subjects with type 2 diabetes aged 55-65 years old. RESULTS: There were significant correlations between apolipoprotein B (apoB) (r = 0.144, p = 0.03), C - reactive protein (CRP) (r = 0.172, p = 0.009) at baseline and IMT measured at follow-up. After adjustment for sex, age, treatment with statins and Hba1c, the associations remained statistically significant. HbA1c, total cholesterol or LDL-cholesterol did not correlate to IMT at follow-up. Baseline body mass index (BMI) (r = 0.130, p = 0.049), waist circumference (WC) (r = 0.147, p = 0.027) and sagittal Abdominal Diameter (SAD) (r = 0.184, p = 0.007) correlated to PWV at follow-up. Challenged with sex, SBP and HbA1c, the association between SAD, not WC nor BMI, and PWV remained statistically significant (p = 0.036). In a stepwise linear regression, entering both SAD and WC, the association between SAD and PWV was stronger than the association between WC and PWV. CONCLUSIONS: We conclude that apoB and CRP, but not LDL-cholesterol predicted subclinical atherosclerosis. Furthermore, SAD was more independent in predicting arterial stiffness over time, compared with WC, in middle-aged men and women with type 2 diabetes.
Asunto(s)
Aterosclerosis/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Angiopatías Diabéticas/complicaciones , Obesidad Abdominal/diagnóstico , Rigidez Vascular , Abdomen , Anciano , Apolipoproteínas B , Aterosclerosis/diagnóstico por imagen , Índice de Masa Corporal , Tamaño Corporal , Proteína C-Reactiva/metabolismo , Grosor Intima-Media Carotídeo , LDL-Colesterol/sangre , Estudios de Cohortes , Angiopatías Diabéticas/diagnóstico por imagen , Femenino , Hemoglobina Glucada , Humanos , Grasa Intraabdominal , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Obesidad Abdominal/complicaciones , Estudios Prospectivos , Análisis de la Onda del Pulso , Circunferencia de la CinturaRESUMEN
BACKGROUND: It is not clear if the European Systematic Coronary Risk Evaluation algorithm is useful for identifying prevalent subclinical atherosclerosis in a population of apparently healthy individuals. Our aim was to explore the association between the risk estimates from Systematic Coronary Risk Evaluation and prevalent subclinical atherosclerosis. DESIGN: The design of this study was as a cross-sectional analysis from a population-based study cohort. METHODS: From the general population, the Swedish Cardiopulmonary Bioimage Study randomly invited individuals aged 50-64 years and enrolled 13,411 participants mean age 57 (standard deviation 4.3) years; 46% males between November 2013-December 2016. Associations between Systematic Coronary Risk Evaluation risk estimates and coronary artery calcification and plaques in the carotid arteries by using imaging data from a computed tomography of the heart and ultrasonography of the carotid arteries were examined. RESULTS: Coronary calcification was present in 39.5% and carotid plaque in 56.0%. In men, coronary artery calcium score >0 ranged from 40.7-65.9% and presence of carotid plaques from 54.5% to 72.8% in the age group 50-54 and 60-65 years, respectively. In women, the corresponding difference was from 17.1-38.9% and from 41.0-58.4%. A doubling of Systematic Coronary Risk Evaluation was associated with an increased probability to have coronary artery calcium score >0 (odds ratio: 2.18 (95% confidence interval 2.07-2.30)) and to have >1 carotid plaques (1.67 (1.61-1.74)). CONCLUSION: Systematic Coronary Risk Evaluation estimated risk is associated with prevalent subclinical atherosclerosis in two major vascular beds in a general population sample without established cardiovascular disease or diabetes mellitus. Thus, the Systematic Coronary Risk Evaluation risk chart may be of use for estimating the risk of subclinical atherosclerosis.
Asunto(s)
Aterosclerosis , Enfermedades de las Arterias Carótidas , Enfermedad de la Arteria Coronaria , Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/epidemiología , Estudios de Cohortes , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Suecia/epidemiologíaRESUMEN
[This corrects the article DOI: 10.1371/journal.pone.0194084.].
RESUMEN
OBJECTIVE: Blood pressure variability (BPV) has been associated with risk of cardiovascular events in observational studies, independently of mean BP levels. In states with higher autonomic imbalance, such as in diabetes, the importance of BP variability may theoretically be even greater. We aimed to investigate the incremental value of BPV for prediction of cardiovascular and all-cause mortality in patients with type 2 diabetes. METHODS: We identified 9,855 patients without pre-existing cardiovascular disease who did not change BP-lowering treatment during the observation period from a Swedish primary health care cohort of patients with type 2 diabetes. BPV was summarized as the standard deviation (SD), coefficient of variation (CV), or variation independent of mean (VIM). Patients were followed for a median of 4 years and associations with cardiovascular and all-cause mortality were investigated using Cox proportional hazards models. RESULTS: BPV was not associated with cardiovascular specific or all-cause mortality in the total sample. In patients who were not on BP-lowering drugs during the observation period (n = 2,949), variability measures were associated with all-cause mortality: hazard ratios were 1.05, 1.04 and 1.05 for 50% increases in SD, CV and VIM, respectively, adjusted for Framingham risk score risk factors, including mean BP. However, the addition of the variability measures in this subgroup only led to very minimal improvement in discrimination, indicating they may have limited clinical usefulness (change in C-statistic ranged from 0.000-0.003 in all models). CONCLUSIONS: Although BPV was independently associated with all-cause mortality in diabetes patients in primary care who did not have pre-existing cardiovascular disease or BP-lowering drugs, it may be of minimal clinical usefulness above and beyond that of other routinely measured predictors, including mean BP.
Asunto(s)
Presión Sanguínea/fisiología , Enfermedades Cardiovasculares/mortalidad , Diabetes Mellitus Tipo 2/fisiopatología , Hipertensión/mortalidad , Anciano , Determinación de la Presión Sanguínea , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/fisiopatología , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Humanos , Hipertensión/etiología , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
OBJECTIVE: This study explored whether the Pro12Ala polymorphism in the peroxisome proliferator-activated receptor-gamma (PPARgamma) is associated with blood pressure in subjects with type 2 diabetes. DESIGN: A community-based, cross-sectional observation study. SETTING: Primary care. PATIENTS: One hundred and ninety-two men and 192 women with type 2 diabetes who consecutively underwent annual follow-up. MAIN OUTCOME MEASURE: The PPARgammaPro12Ala genotype was determined by polymerase chain reaction-based techniques. Associations between genotype and blood pressure were analysed by linear regression and expressed as differences in blood pressure (delta) with 95% confidence interval (CI). RESULTS: The mean systolic blood pressure and the diastolic blood pressure were 160 mmHg (standard deviation = 22.8) and 84 mmHg (standard deviation = 9.6), respectively. Subjects with Pro/Ala (24%) or Ala/Ala (2%) had lower diastolic blood pressure (delta = 2.8; 95% CI, 0.6-5.0) when adjusted for age and gender compared with Pro/Pro subjects (74%). This association was restricted to men (delta = 4.4; 95% CI, 1.3-7.4), who also had a borderline significant difference in systolic blood pressure (delta = 6.9; 95% CI, -0.8 to 13.8). In men the difference in diastolic blood pressure remained after adjustment for age, body mass index, serum triglycerides, serum insulin and haemoglobin A(1c) (delta = 4.6; 95% CI, 1.1-8.1). A subanalysis of normotensive men (n = 100) confirmed the difference associated with the Pro12Ala polymorphism in diastolic blood pressure (delta = 5.2; 95% CI, 0.6-10.0). CONCLUSIONS: The common Pro12Ala polymorphism in PPARgamma is associated with lower diastolic blood pressure in male subjects with type 2 diabetes.
Asunto(s)
Presión Sanguínea/genética , Diabetes Mellitus Tipo 2/genética , Hipertensión/genética , Polimorfismo Genético , Receptores Citoplasmáticos y Nucleares/genética , Factores de Transcripción/genética , Anciano , Estudios Transversales , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Genotipo , Humanos , Hipertensión/fisiopatología , Modelos Lineales , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: The optimal blood pressure (BP) in persons with type-2 diabetes is debated. We investigated shapes of the associations of SBP and DBP levels with risk of cardiovascular events and mortality in a large primary care-based sample of diabetic patients. METHODS: We investigated all 34â009 consecutive cardiovascular disease-free type-2 diabetes patients aged 35 years or older (mean age 64 years) at 84 primary care centers in central Sweden between 1999 and 2008. We followed this cohort until the end of 2009 in national registries for the incidence of major cardiovascular events (a composite endpoint of myocardial infarction, stroke, heart failure, or cardiovascular mortality) or total mortality. RESULTS: During up to 11 years of follow-up, 6344 patients (18.7%) had a first cardiovascular event, and 6235 died (18.3%). The associations of annually updated SBP and DBP with risk of major cardiovascular events were U-shaped. The lowest risk of cardiovascular events was observed at a SBP of 135-139âmmHg and a DBP of 74-76âmmHg, and the lowest mortality risk at a SBP of 142-150âmmHg and a DBP of 78-79âmmHg, in both antihypertensive drug-untreated and drug-treated persons. CONCLUSION: In a large primary care-based sample of patients with type-2 diabetes, associations of SBP and DBP with risk of major cardiovascular events and mortality were U-shaped. This may have implications for risk stratification of persons with diabetes.
Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/fisiopatología , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatología , Hipertensión/complicaciones , Adulto , Anciano , Antihipertensivos/química , Presión Sanguínea , Determinación de la Presión Sanguínea , Estudios de Cohortes , Complicaciones de la Diabetes/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Atención Primaria de Salud/organización & administración , Sistema de Registros , Estudios Retrospectivos , Riesgo , SueciaRESUMEN
AIMS: To explore the association between nocturnal blood pressure (BP) dipper status and macro- and microvascular organ damage in type 2 diabetes. METHODS: Cross-sectional data from 663 patients with type 2 diabetes, aged 55-66 years, were analysed. Nurses measured office BP and ambulatory BP during 24h. Individuals with ≥ 10% difference in nocturnal systolic blood pressure (SBP) relative to daytime values were defined as dippers. Non-dippers were defined as <10% nocturnal decrease in SBP. Estimated glomerular filtration rate (GFR) was calculated and microalbuminuria was measured by albumin:creatinine ratio (ACR). Aortic pulse wave velocity (PWV) was measured with applanation tonometry over the carotid and femoral arteries. RESULTS: We identified 433 dippers and 230 subjects with a nocturnal non-dipping pattern. Nocturnal SBP dipping was independently of office SBP associated with decreased PWV (p = 0.008), lower ACR (p = 0.001) and NT-proBNP (p = 0.001) and increased GFR (p<0.001). CONCLUSIONS: We conclude that diurnal BP variation provides further information about early macro- and microvascular subclinical organ damage that goes beyond standardized office BP measurements in patients with type 2 diabetes.
Asunto(s)
Presión Sanguínea , Ritmo Circadiano , Diabetes Mellitus Tipo 2/complicaciones , Angiopatías Diabéticas/etiología , Hipertensión/etiología , Microcirculación , Anciano , Albuminuria/etiología , Albuminuria/fisiopatología , Aorta/fisiopatología , Monitoreo Ambulatorio de la Presión Arterial , Arterias Carótidas/fisiopatología , Estudios Transversales , Diabetes Mellitus Tipo 2/fisiopatología , Angiopatías Diabéticas/diagnóstico , Angiopatías Diabéticas/fisiopatología , Nefropatías Diabéticas/etiología , Nefropatías Diabéticas/fisiopatología , Diagnóstico Precoz , Ecocardiografía Doppler , Femenino , Arteria Femoral/fisiopatología , Tasa de Filtración Glomerular , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Riñón/fisiopatología , Modelos Lineales , Masculino , Manometría , Persona de Mediana Edad , Visita a Consultorio Médico , Valor Predictivo de las Pruebas , Estudios Prospectivos , Flujo Pulsátil , Medición de Riesgo , Factores de Riesgo , SueciaRESUMEN
OBJECTIVE: To compare the microcirculatory velocity distribution in type 2 diabetic patients and nondiabetic control subjects at baseline and after local heating. RESEARCH DESIGN AND METHODS: The skin blood flow response to local heating (44 degrees C for 20 min) was assessed in 28 diabetic patients and 29 control subjects using a new velocity-resolved quantitative laser Doppler flowmetry technique (qLDF). The qLDF estimates erythrocyte (RBC) perfusion (velocity x concentration), in a physiologically relevant unit (grams RBC per 100 g tissue x millimeters per second) in a fixed output volume, separated into three velocity regions: v <1 mm/s, v 1-10 mm/s, and v >10 mm/s. RESULTS: The increased blood flow occurs in vessels with a velocity >1 mm/s. A significantly lower response in qLDF total perfusion was found in diabetic patients than in control subjects after heat provocation because of less high-velocity blood flow (v >10 mm/s). The RBC concentration in diabetic patients increased sevenfold for v between 1 and 10 mm/s, and 15-fold for v >10 mm/s, whereas no significant increase was found for v <1 mm/s. The mean velocity increased from 0.94 to 7.3 mm/s in diabetic patients and from 0.83 to 9.7 mm/s in control subjects. CONCLUSIONS: The perfusion increase occurs in larger shunting vessels and not as an increase in capillary flow. Baseline diabetic patient data indicated a redistribution of flow to higher velocity regions, associated with longer duration of diabetes. A lower perfusion was associated with a higher BMI and a lower toe-to-brachial systolic blood pressure ratio.
Asunto(s)
Velocidad del Flujo Sanguíneo , Diabetes Mellitus Tipo 2/fisiopatología , Flujo Sanguíneo Regional , Piel/irrigación sanguínea , Anciano , Capilares/fisiopatología , Femenino , Calor , Humanos , Flujometría por Láser-Doppler , Masculino , Microcirculación , Persona de Mediana Edad , Estudios Prospectivos , Piel/fisiopatologíaRESUMEN
AIM: To explore the feasibility of withdrawal of diabetes medication in elderly patients with HbA1cAsunto(s)
Diabetes Mellitus/sangre
, Diabetes Mellitus/tratamiento farmacológico
, Hipoglucemiantes/administración & dosificación
, Casas de Salud
, Anciano
, Anciano de 80 o más Años
, Glucemia/metabolismo
, Esquema de Medicación
, Femenino
, Hemoglobina Glucada/metabolismo
, Humanos
, Masculino
, Persona de Mediana Edad