Detection of subclinical atherosclerosis in peripheral arterial beds with B-mode ultrasound: a proposal for guiding the decision for medical intervention and an artifact-corrected volumetric scoring index.

OBJECTIVES: To assess subclinical atherosclerotic cardiovascular disease (ASCVD) using B-mode ultrasound, with special emphasis on the incremental value of performing imaging in multiple peripheral arteries, and to compare imaging findings with traditional risk factors for medical intervention eligibility. METHODS: Data from 2 asymptomatic cohorts from India with unknown ASCVD risk factors were compared to 2 cohorts from North America with known ASCVD risk factors. Carotid and iliofemoral arteries of the Indian cohorts were examined with automated ultrasound in a high-pace environment by non-experts. A simplified metric of atherosclerotic disease burden (FUster-Narula or FUN Score) was developed from 3D imaging data by summing intima-media volume (IMV) over 5-cm arterial segments. Effectiveness of ASCVD prevention guidelines to direct therapy was compared to results from direct imaging. RESULTS: Of the 941 (mean age 44.27 ± 13.76 years, 34% female) enrollees from India, 224 (24%) demonstrated plaques in at least 1 of the 4 arterial sites examined; 107 (11%) had plaques in only the carotids, 70 (7%) in both the carotids and iliofemoral arteries, and 47 (5%) had plaques in only the iliofemoral arteries. Older age and male sex were associated with the presence of plaque, but association with systolic blood pressure was not observed. Data from 2 North American clinics (n = 481, mean age 59.68 ± 11.95 years, 39% female) showed that 203 subjects (42%) had carotid plaque; 82% of whom would not have qualified for lipid-lowering therapy under the Adult Treatment Panel (ATP) III Guidelines. Using the recently published ATP IV Guidelines, 33% of the individuals with carotid plaque would also have failed to qualify for treatment. CONCLUSIONS: B-mode ultrasound examination of bilateral iliofemoral arteries provided an incremental yield in identifying subclinical atherosclerotic disease compared to carotid evaluation alone. Ultrasound examination allowed improved identification of individuals who could be targeted for prophylactic medical intervention compared to ATP III and ATP IV Guidelines.

Proton pump inhibitor therapy associated with lower glycosylated hemoglobin levels in type 2 diabetes.

INTRODUCTION: Oral hypoglycemic medications sometimes do not control type 2 diabetes well. Proton pump inhibitors (PPIs) as adjunctive therapy might improve diabetes control through increasing serum gastrin and fasting insulin levels. METHODS: Electronic medical records in a family medicine residency program office practice were reviewed for 73 individuals with type 2 diabetes (not taking insulin), for whom PPIs were prescribed. Values for glycosylated hemoglobin (HbA1c) for periods of time when a PPI had been prescribed were compared with HbA1c levels for periods of time with no record of PPI prescribing or over-the-counter PPI use. RESULTS: The mean HbA1c for patients not taking insulin was 7.11 during periods with recorded prescribing or over-the-counter use of PPIs, compared with 7.70 during periods without recorded PPI therapy (P = .001). Mean HbA1c for metformin monotherapy was not significantly different (6.81 with PPI vs. 7.10 without PPI; n = 16; P = .25). Mean HbA1c was significantly different for combination therapy that included metformin and/or sulfonylurea and/or giltazone (7.26 vs. 7.80; n = 27; P = .002). CONCLUSION: The observed association between PPI therapy and lower HbA1c levels suggests that PPIs may be useful as adjunctive therapy for type 2 diabetes.

Proton pump inhibitors as a treatment method for type II diabetes.

Recent reports have hypothesized a role for exogenously administered gastrin in regulating beta cell function or activity. We surmised that a class of agents, proton pump inhibitors (omeprazole, esomeprazole, pantoprazole, rabeprazole, lansoprazole), known to increase serum gastrin levels could have such an effect, and that data might be available in our database which could address such an effect. We examined our electronic database to obtain glycohemoglobin (HgbA1c) levels measured in the past two years from all type II diabetics and extracted from those diabetics who were concurrently taking a proton pump inhibitor. A comparison of these groups showed an average HgbA1c of 7.6% for type II diabetics not taking a proton pump inhibitor (n=282) and an average HgbA1c of 7.0% for type II diabetics concurrently taking a proton pump inhibitor (n=65), T=-3.61, p=0.002. These data support the hypothesis that proton pump inhibitors can be used to treat type II diabetes.