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1.
Medicine (Baltimore) ; 99(4): e18876, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977891

RESUMO

The relationship between monocyte count and mortality seemed to be varied in different diseases, and it remains unclear in type 2 diabetes (T2D). We conducted a prospective study to investigate whether monocyte count predict all-cause mortality in patients with T2D.In this prospective study, a total of 1073 patients with T2D were enrolled at baseline and 880 patients completed the follow up. The median follow-up time was 47 months. At baseline, clinical characteristics including height, weight, waist circumference, blood pressure were recorded. Biochemical parameters including counts of white blood cells (WBCC), neutrophil (NC) and monocyte (MC), lipid profiles, glycated hemoglobin (HbA1c), serum creatinine were measured. Charlson comorbidity index (CCI) was calculated based on age and comorbidities. Participants were stratified into low, median, and high tertiles according to the baseline MC. Regression models were used to analyze the associations of peripheral MC and the all-cause mortality.Compared to the survived subjects, the baseline MC was significantly higher in patients who deceased during the follow-up (0.45 ±â€Š0.16 vs 0.37 ±â€Š0.15 × 10/L, P = .003). In the multivariate Cox hazard models, subjects in higher MC tertile showed higher risks of all-cause mortality (low tertile as the reference, hazard ratio [HR] 95%CI 2.65 [0.84,8.31] and 3.73 [1.14,12.24] for middle and high MC tertile, respectively) after adjusted for gender, body mass index, CCI, duration of T2D, history of hypertension and metabolic syndrome, drugs, levels of high-sensitivity C-reactive protein, systolic blood pressure, HbA1c, WBCC, and NC. In T2D patients with macro-vascular complications at baseline, 1-SD increment of MC resulted in 1.92-fold higher risk of all-cause mortality. However, the relationship disappeared in subjects without macro-vascular complications at baseline (1.13 [0.72, 1.78], P = .591).Peripheral monocyte count is an independent predictor of all-cause mortality in T2D, especially for subjects with macro-vascular complications.


Assuntos
Diabetes Mellitus Tipo 2/mortalidade , Angiopatias Diabéticas/mortalidade , Monócitos/metabolismo , Idoso , Biomarcadores/metabolismo , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/metabolismo , Angiopatias Diabéticas/metabolismo , Humanos , Pessoa de Meia-Idade , Monócitos/patologia , Modelos de Riscos Proporcionais , Estudos Prospectivos
2.
Diabetes Res Clin Pract ; 152: 103-110, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31108137

RESUMO

AIMS: Several insulin secretagogues are widely used to treat diabetes; however, few outcome-based comparative studies have clarified which one of these should be used when indicated. We investigated mortality and cardiovascular event risk associated with optimal forms of insulin secretagogues. METHODS: In this cohort study using real-world data from the diabetes database of Taiwan's National Health Insurance program, patients with diabetes were enrolled if their initial treatment was glimepiride, gliclazide, glipizide, glyburide, or repaglinide from 1999 to 2013. Each group was propensity score-matched to the glimepiride group before comparison. Primary outcomes were all-cause mortality and the combined cardiovascular event risk of acute myocardial infarction and ischemic stroke. Hazard ratios were calculated by Cox proportional hazard regression models. RESULTS: There were 66,790, 97,426, 38,806, 92,970, and 11,468 participants in the glimepiride, gliclazide, glipizide, glyburide, and repaglinide groups, respectively. The median follow-up time was 8 years. Glimepiride was associated with the best clinical outcome, showing the lowest mortality and lowest cardiovascular event risk of the five insulin secretagogues. Using patients on glimepiride as the reference group, the adjusted hazard ratios of all-cause mortality and cardiovascular event risk were 1.52 (p < 0.001) and 1.22 (p = 0.005) for gliclazide, 1.42 (p < 0.001) and 1.19 (p = 0.073) for glipizide, 1.43 (p < 0.001) and 1.32 (p < 0.001) for glyburide, and 1.88 (p < 0.001) and 1.69 (p = 0.001) for repaglinide. CONCLUSIONS: For patients with diabetes taking an insulin secretagogue, glimepiride was associated with the best clinical outcome, showing the lowest mortality and cardiovascular event risk.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/mortalidade , Hipoglicemiantes/uso terapêutico , Secreção de Insulina/efeitos dos fármacos , Secretagogos/uso terapêutico , Idoso , Carbamatos/uso terapêutico , Doenças Cardiovasculares/induzido quimicamente , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/induzido quimicamente , Angiopatias Diabéticas/epidemiologia , Angiopatias Diabéticas/mortalidade , Feminino , Seguimentos , Gliclazida/uso terapêutico , Glipizida/uso terapêutico , Glibureto/uso terapêutico , Humanos , Hipoglicemiantes/farmacologia , Insulina/metabolismo , Masculino , Pessoa de Meia-Idade , Mortalidade , Piperidinas/uso terapêutico , Secretagogos/farmacologia , Compostos de Sulfonilureia/uso terapêutico , Taiwan/epidemiologia
3.
Acta Diabetol ; 56(9): 1051-1060, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30993527

RESUMO

AIMS: Patients with type 2 diabetes (T2D) have an increased risk of cardiovascular disease. Recent cardiovascular outcome trials (CVOTs) with liraglutide, semaglutide, and albiglutide have shown significant reduction in major adverse cardiovascular events. Conversely, the CVOT with exenatide long-acting release (ELAR) confirmed cardiovascular safety of the drug, but did not reached superiority versus placebo. Herein, we systematically evaluated the effect of ELAR versus placebo or active comparators on cardiovascular events and mortality in patients with T2D. METHODS: We screened the literature for randomized controlled trials reporting cardiovascular events and deaths in patients receiving ELAR versus those receiving placebo or any other glucose-lowering medications. Event rates were pooled and compared using the random-effects model. RESULT: We retrieved 16 trials comparing the occurrence of cardiovascular events and mortality in patients treated with ELAR versus placebo or active comparators. The pooled rate ratio for cardiovascular events was similar in the two groups (0.99; 95% CI 0.92-1.06). The rate ratio for all-cause mortality was significantly lower in exenatide group than in comparators (0.87; 95% CI 0.77-0.97). When results of the EXSCEL trial were omitted, the pooled rate ratio for cardiovascular events and mortality was 0.80 (95% CI 0.40-1.63) and 0.75 (95% CI 0.30-1.84), respectively. CONCLUSIONS: Treatment with ELAR does not increase the risk of cardiovascular events and may reduce all-cause mortality.


Assuntos
Preparações de Ação Retardada/farmacologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Exenatida/farmacologia , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Sistema Cardiovascular/efeitos dos fármacos , Causas de Morte , Preparações de Ação Retardada/administração & dosagem , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/mortalidade , Angiopatias Diabéticas/tratamento farmacológico , Angiopatias Diabéticas/mortalidade , Exenatida/administração & dosagem , Feminino , Peptídeos Semelhantes ao Glucagon/uso terapêutico , Humanos , Incidência , Liraglutida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Mortalidade
4.
Diabetologia ; 62(4): 633-643, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30649599

RESUMO

AIMS/HYPOTHESIS: The role of burden and duration of multiple microvascular complications on mortality rate has not been explored in detail in type 1 diabetes. Taking complication burden and time-updated duration into account we aimed to quantify mortality rate in individuals with and without microvascular complications. METHODS: This observational clinical cohort included 3828 individuals with type 1 diabetes attending the Steno Diabetes Center Copenhagen in 2001-2013. We used information on mortality and detailed clinical measures of microvascular complications from electronic patient records. Poisson models were used to model mortality rates according to complication burden. RESULTS: During 26,665 person-years of follow-up, 503 deaths occurred. Compared with individuals without microvascular complications, the mortality rate ratio was 2.20 (95% CI 1.79, 2.69) for individuals with diabetic kidney disease, 1.72 (95% CI 1.39, 2.12) for individuals with neuropathy and 1.02 (95% CI 0.77, 1.37) for individuals with retinopathy, all adjusted for calendar time (year/month/day), age, duration of diabetes, sex, HbA1c, LDL-cholesterol, BMI, smoking status, systolic blood pressure, use of antihypertensive and lipid-lowering medication, and cardiovascular disease status. In individuals with two complications or more, the risk of mortality did not exceed the combined risk from each individual complication. Mortality rate ratios increased immediately after diagnosis of neuropathy and diabetic kidney disease. Mortality rate ratios were independent of the duration of neuropathy and retinopathy, while the mortality rate associated with diabetic kidney disease reached a stable level after approximately 3 years. CONCLUSIONS/INTERPRETATION: Neuropathy and diabetic kidney disease are strong and independent risk markers of mortality in type 1 diabetes, whereas no evidence of higher mortality rate was found for retinopathy. We found no indication that the mortality risk with multiple complications exceeds the risk conferred by each complication separately. The duration spent with microvascular complications had only a marginal effect on mortality.


Assuntos
Diabetes Mellitus Tipo 1/mortalidade , Diabetes Mellitus Tipo 1/terapia , Microcirculação , Adolescente , Adulto , Anti-Hipertensivos/uso terapêutico , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/mortalidade , Dinamarca , Angiopatias Diabéticas/mortalidade , Nefropatias Diabéticas/mortalidade , Neuropatias Diabéticas/mortalidade , Retinopatia Diabética/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
5.
BMC Endocr Disord ; 19(1): 3, 2019 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-30611254

RESUMO

BACKGROUND: Dipeptidyl peptidase-4 (DPP-4) inhibitors could effectively reduce HbA1C and postprandial hyperglycemia and could incur only minimal danger of hypoglycemia. Patients with uncontrolled diabetes might be treated by the complementary action of insulin plus DPP-4 inhibitors. Here, we compared the all-cause mortality risk between DPP-4 inhibitor users and nonusers with underlying insulin therapy. METHODS: Using the population-based National Health Insurance Research Database of Taiwan, we conducted an 11-year retrospective cohort study. A total of 3120 patients undergoing insulin therapy for type 2 diabetes mellitus (T2DM) during 2000-2010 were enrolled. The overall incidence rates for all-cause mortality of 1560 DPP-4 inhibitor users and 1560 matched DPP-4 inhibitor nonusers were compared. RESULTS: No significant difference was found in the baseline demographic and clinical variables of the two groups of patients. Median follow-up period for the matched cohort was 1.67 years. All-cause mortality was observed in 93 (6.0%) of 1560 DPP-4 inhibitor nonusers and 36 (2.3%) of 1560 DPP-4 users. The incidence rate of mortality was 11.72 for DPP-4 inhibitor users and 38.16 per 1000 person-years for DPP-4 inhibitor nonusers. After multivariate adjustment, DPP-4 inhibitor users ran a reduced mortality risk (adjusted hazard ratio 0.32, 95% CI 0.22-0.47; p < 0.0001) than did the nonusers. CONCLUSION: Risk of all-cause mortality may be reduced when using insulin plus DPP-4 inhibitors than when using insulin plus non-DPP-4 inhibitors.


Assuntos
Diabetes Mellitus Tipo 2/mortalidade , Angiopatias Diabéticas/mortalidade , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Adulto , Idoso , Causas de Morte , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/tratamento farmacológico , Angiopatias Diabéticas/fisiopatologia , Dipeptidil Peptidase 4/metabolismo , Inibidores da Dipeptidil Peptidase IV/efeitos adversos , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Hiperglicemia/mortalidade , Hiperglicemia/fisiopatologia , Hipoglicemiantes/efeitos adversos , Insulina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taiwan/epidemiologia , Resultado do Tratamento , Adulto Jovem
6.
Acta Diabetol ; 56(1): 87-96, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30167871

RESUMO

AIM: To evaluate the risk of CVD and all-cause mortality at different BMI levels in conjunction with weight change prior to diagnosis of T2DM in a multi-ethnic population. METHODS: Longitudinal study of 51,455 patients with T2DM and without a history of comorbid diseases at diagnosis. Weight changes prior to diagnosis of T2DM were evaluated, and the risk of CVD and all-cause mortality at different BMI levels among three ethnic groups estimated using treatment effects model. RESULTS: White Europeans (WE), African-Caribbeans (AC), and South Asians (SA) were mean 52, 49, and 47 years with a mean BMI of 33.0, 32.0, and 30.0 kg/m2 at diagnosis, respectively. Among WE, normal weight patients developed CVD significantly earlier by 0.5 years (95% CI 0.1, 0.9 years; p = 0.018) compared to obese patients. Furthermore, those with normal body weight at diagnosis were significantly more likely to die earlier by 0.6 years (95% CI 0.03, 1.2 years; p = 0.037) among WE and by 2.5 years (95% CI 0.3, 4.6 years; p = 0.023) among SA compared to their respective obese patients. However, BMI at diagnosis was not associated with increased risk of CVD and death among AC. CONCLUSIONS: This study suggests a paradoxical association of BMI with cardiovascular and mortality risks in different ethnic groups, which may partially be driven by different cardiovascular and glycaemic risk profiles at diagnosis.


Assuntos
Índice de Massa Corporal , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/mortalidade , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/mortalidade , Grupos Étnicos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Peso Corporal , Causas de Morte , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Angiopatias Diabéticas/etnologia , Angiopatias Diabéticas/mortalidade , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/etnologia , Obesidade/mortalidade , Fatores de Risco , Adulto Jovem
7.
Acta Diabetol ; 56(3): 273-280, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30259114

RESUMO

AIMS: Inflammation plays a role in the development and progression of type 2 diabetes macroangiopathy. Interleukin 33 (IL-33) drives production of Th2-associated cytokines. The soluble form of suppression of tumorigenicity 2 (sST2) acting as a decoy receptor blocks IL-33 and tones down Th2 inflammatory response. We investigated the role of sST2 as a predictor of CV and all-cause mortality in a cohort of patients affected by established atherosclerotic disease. METHODS: 399 patients with atherosclerotic disease from the Tor Vergata Atherosclerosis Registry performed follow-up every year by phone interview. The primary endpoint was cardiovascular death and the secondary endpoint was death for any other disease. RESULTS: sST2 plasma levels were significantly increased from normal glucose-tolerant patients to patients with history of type 2 diabetes (p < 0.00001). Levels of sST2 were significantly correlated with fasting plasma glucose (R = 0.16, p = 0.002), HbA1c (R = 0.17, p = 0.002), and HOMA (R = 0.16, p = 0.004). Dividing patients in tertiles of sST2 levels, those belonging to the highest tertile showed an increased rate of all-cause and cardiovascular mortality, (all-cause mortality p = 0.045 and CVD mortality p = 0.02). A multivariate Cox analysis revealed that sST2 increased the risk in cardiovascular mortality per SD by hazard ratio 1.050 (95% CI 1.006-1.097, p = 0.025) after adjustment for age and hs-CRP while it did not significantly change the risk for all-cause mortality. CONCLUSIONS: High circulating level of sST2 is associated to increased CVD mortality and markers of metabolic dysfunction in subjects with atherosclerotic disease.


Assuntos
Biomarcadores/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/mortalidade , Transtornos do Metabolismo de Glucose/diagnóstico , Proteína 1 Semelhante a Receptor de Interleucina-1/sangue , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/sangue , Aterosclerose/diagnóstico , Aterosclerose/etiologia , Aterosclerose/mortalidade , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Doenças Cardiovasculares/sangue , Causas de Morte , Estudos de Coortes , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Angiopatias Diabéticas/sangue , Progressão da Doença , Feminino , Seguimentos , Transtornos do Metabolismo de Glucose/sangue , Transtornos do Metabolismo de Glucose/etiologia , Transtornos do Metabolismo de Glucose/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco
8.
BJU Int ; 123(3): 519-529, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30216622

RESUMO

OBJECTIVES: To further characterize the beneficial impact of testosterone replacement therapy (TRT) on the association between mortality and hypogonadism (HG) in men with type 2 diabetes (T2DM), by determining, firstly, if changes in cardiovascular disease (CVD) risk factors after TRT play a role, secondly, whether the reduction in mortality is lost when TRT is discontinued and, finally, the presence of subgroups where benefit may be greater. MATERIALS AND METHODS: We studied 857 men with T2DM, screened for the BLAST randomized controlled trial, over 3.8 years of follow-up. The men were stratified first by testosterone levels: group 1: total testosterone (TT) >12 nmol/L and free testosterone (FT) >0.25 nmol/L; Group 2: TT ≤12 nmol/L or FT ≤0.25 nmol/L. Group 2 was further stratified into those not on TRT (Group 2a) and those on TRT (Group 2b). Group 2b was further stratified by whether TRT was discontinued (Group 2b1) or not (Group 2b2). The principal outcome, mortality, was studied using Cox regression. RESULTS: We found that TRT was not associated with improvements in CVD risk factors. CVD risk factors (baseline and changes during follow-up) were not associated with mortality. Men in Group 1 and Group 2b were found to have lower mortality (reference: Group 2a), even with CVD risk factors included in the regression models. Mortality was lower in men in Group 2b1 (6.2%) and Group 2b2 (0%) compared with those in Group 2a (16.9%). The lower mortality associated with Group 1 and Group 2b was observed primarily in older (>64.6 years) and less overweight (≤93.8 kg) men. CONCLUSIONS: The benefits associated with normal testosterone levels and TRT (even after discontinuation) do not appear to be related to improvements in the CVD risk factors studied. In view of TRT having greater impact in men of lower weight, better outcomes may be achieved with concurrent TRT and weight reduction programmes.


Assuntos
Androgênios/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Angiopatias Diabéticas/etiologia , Terapia de Reposição Hormonal , Hipogonadismo/tratamento farmacológico , Obesidade/complicações , Testosterona/uso terapêutico , Idoso , Diabetes Mellitus Tipo 2/mortalidade , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/mortalidade , Angiopatias Diabéticas/fisiopatologia , Método Duplo-Cego , Inglaterra/epidemiologia , Seguimentos , Humanos , Hipogonadismo/mortalidade , Hipogonadismo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Obesidade/mortalidade , Obesidade/fisiopatologia , Resultado do Tratamento
9.
J Am Coll Cardiol ; 73(6): 629-638, 2019 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-30428398

RESUMO

BACKGROUND: The FREEDOM (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease) trial demonstrated that for patients with diabetes mellitus (DM) and multivessel coronary disease (MVD), coronary artery bypass grafting (CABG) is superior to percutaneous coronary intervention with drug-eluting stents (PCI-DES) in reducing the rate of major adverse cardiovascular and cerebrovascular events after a median follow-up of 3.8 years. It is not known, however, whether CABG confers a survival benefit after an extended follow-up period. OBJECTIVES: The purpose of this study was to evaluate the long-term survival of DM patients with MVD undergoing coronary revascularization in the FREEDOM trial. METHODS: The FREEDOM trial randomized 1,900 patients with DM and MVD to undergo either PCI with sirolimus-eluting or paclitaxel-eluting stents or CABG on a background of optimal medical therapy. After completion of the trial, enrolling centers and patients were invited to participate in the FREEDOM Follow-On study. Survival was evaluated using Kaplan-Meier analysis, and Cox proportional hazards models were used for subgroup and multivariate analyses. RESULTS: A total of 25 centers (of 140 original centers) agreed to participate in the FREEDOM Follow-On study and contributed a total of 943 patients (49.6% of the original cohort) with a median follow-up of 7.5 years (range 0 to 13.2 years). Of the 1,900 patients, there were 314 deaths during the entire follow-up period (204 deaths in the original trial and 110 deaths in the FREEDOM Follow-On). The all-cause mortality rate was significantly higher in the PCI-DES group than in the CABG group (24.3% [159 deaths] vs. 18.3% [112 deaths]; hazard ratio: 1.36; 95% confidence interval: 1.07 to 1.74; p = 0.01). Of the 943 patients with extended follow-up, the all-cause mortality rate was 23.7% (99 deaths) in the PCI-DES group and 18.7% (72 deaths) in the CABG group (hazard ratio: 1.32; 95% confidence interval: 0.97 to 1.78; p = 0.076). CONCLUSIONS: In patients with DM and MVD, coronary revascularization with CABG leads to lower all-cause mortality than with PCI-DES in long-term follow-up. (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes [FREEDOM]; NCT00086450).


Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/cirurgia , Angiopatias Diabéticas/mortalidade , Angiopatias Diabéticas/cirurgia , Intervenção Coronária Percutânea , Idoso , Doença da Artéria Coronariana/etiologia , Angiopatias Diabéticas/complicações , Stents Farmacológicos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Taxa de Sobrevida , Resultado do Tratamento
10.
Acta Diabetol ; 56(3): 331-339, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30456728

RESUMO

AIMS: To investigate cardiovascular disease and mortality trends in control arm participants of diabetes cardiovascular outcome trials (CVOTs). METHODS: We electronically searched CVOTs published before October 2017. Data on all-cause mortality, cardiovascular mortality and events, and baseline characteristics were collected, along with study calendar years. Trends were estimated using negative binomial regressions and reported as rate ratio (RR) per 5-year intervals. RESULTS: 26 CVOTs, conducted from 1961 to 2015, included 86788 participants with 6543 all-cause deaths, 3265 cardiovascular deaths, and 7657 3-point major adverse cardiovascular events (3-P MACE; combined endpoint of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke). In unadjusted analysis, there was an increasing trend for 3-P MACE rates over time (5-year RR 1.57; 95% CI 1.34, 1.84); a small increasing trend for cardiovascular disease mortality rates (1.13; 1.01, 1.26); and stable rates for all-cause death. Adjusting for age, sex, previous myocardial infarction, and diabetes duration, there was no evidence of trends for 3-P MACE or cardiovascular disease mortality rates, while reducing rates were observed for nonfatal myocardial infarction (5-year RR: 0.72; 0.54, 0.96), total stroke (0.76; 0.66, 0.88), and nonfatal stroke (0.60; 0.43, 0.82). CONCLUSIONS: In contrast to real-world data, there was no evidence of an improvement in all-cause and cardiovascular mortality in type 2 diabetes participants included in control arms of randomised clinical trials across 5 decades. Further studies should investigate whether and how dissimilarities in populations, procedures, and assessments of exposures and outcomes explain the differences between real-world setting and clinical trials.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Causas de Morte , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/mortalidade , Feminino , Humanos , Masculino , Mortalidade/tendências , Prognóstico , Resultado do Tratamento
11.
Endocrinol Diabetes Nutr ; 66(5): 297-304, 2019 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30509882

RESUMO

INTRODUCTION: Patients with chronic kidney disease (CKD) and diabetes mellitus (DM) have high cardiovascular risk. Both conditions are related to systemic atherosclerosis and vascular calcification. The prevalence and severity of coronary artery calcification (CaC) is higher in patients with DM, regardless of their renal function. Data about the long-term prognostic role of CaC in diabetic patients with CKD are scarce. MATERIAL AND METHODS: We carried out a prospective longitudinal study enrolling 137 patients with advanced CKD. A non-enhanced multislice coronary computed tomography (CT) was performed at baseline. CaC was assessed using Agatston method. Patients were stratified according to their CaC score: severe calcification group (CaCs≥400HU) and mild-moderate calcification group (CaCs<400HU). RESULTS: The median follow-up time was 87.5 months. DM was found in 28% of subjects. The patients with DM showed more severe CaC, lower albumin and higher C-reactive protein serum levels. Serum albumin was correlated with severe CaC (r=-0.45, P=.009). Overall mortality rate reached 58%. Patients with DM also tended to have higher mortality compared to non-diabetic subjects (X2 3.51, P=.061) especially those with severe CaC showed higher mortality than those with severe CaC without DM (93% vs.73%, P=.04). CONCLUSIONS: Patients with advanced CKD and DM have more severe CaC, increased inflammation-malnutrition data and higher mortality compared to those without DM.


Assuntos
Doença da Artéria Coronariana/etiologia , Angiopatias Diabéticas/etiologia , Insuficiência Renal Crônica/complicações , Calcificação Vascular/etiologia , Idoso , Proteína C-Reativa/análise , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/mortalidade , Angiopatias Diabéticas/sangue , Angiopatias Diabéticas/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Estudos Prospectivos , Diálise Renal , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/terapia , Albumina Sérica/análise , Calcificação Vascular/sangue , Calcificação Vascular/mortalidade
12.
J Am Heart Assoc ; 7(20): e009770, 2018 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-30371286

RESUMO

Background The CASTLE - AF (Catheter Ablation versus Standard Conventional Therapy in Patients With Left Ventricular Dysfunction and Atrial Fibrillation) trial recently reported that catheter ablation of atrial fibrillation ( AF ) improves survival in heart failure (HF) with reduced ejection fraction ( HF r EF ). However, established AF was not associated with mortality in trials of contemporary HF r EF pharmacotherapies. We investigated whether HF r EF pathogenesis may influence the conclusions of studies evaluating the prognostic impact of AF . Methods and Results Using a prospective cohort study of 791 patients with HFr EF , with AF determined using 24-hour ambulatory ECG monitoring, univariable and multivariable Cox regression analyses were used to define the association between AF and mode-specific mortality (mean follow-up of 5.4 years). One-year HF-related hospitalization was assessed with binary logistic regression analysis. One-year cardiac remodeling was assessed in a subgroup (n=378) using echocardiography. AF was present in 28.2% of patients, with 9.4% of these being paroxysmal. While AF was associated with increased risk of all-cause mortality (hazard ratio, 1.27; 95% confidence interval 1.03-1.57), with diverging survival curves after 1 year of follow-up, this association was lost in age-sex-adjusted analyses. However, AF was associated with increased risk of age-sex-adjusted all-cause mortality in people with ischemic pathogenesis, with a statistically significant interaction between pathogenesis and AF. This was predominantly attributed to progressive HF deaths. After 1 year, HF hospitalization and cardiac remodeling were not associated with AF , even in people with ischemic pathogenesis. Conclusions AF is associated with increased risk of death in HF r EF of ischemic pathogenesis, predominantly due to progressive HF deaths during long-term follow-up. HF r EF pathogenesis should be considered in trial design and interpretation.


Assuntos
Fibrilação Atrial/complicações , Insuficiência Cardíaca/complicações , Isquemia Miocárdica/complicações , Idoso , Fibrilação Atrial/mortalidade , Causas de Morte , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/mortalidade , Angiopatias Diabéticas/fisiopatologia , Progressão da Doença , Eletrocardiografia Ambulatorial , Feminino , Insuficiência Cardíaca/mortalidade , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Isquemia Miocárdica/mortalidade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Volume Sistólico/fisiologia , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/mortalidade , Remodelação Ventricular/fisiologia
13.
Diab Vasc Dis Res ; 15(6): 504-510, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30246546

RESUMO

BACKGROUND: The prevalence of diabetes mellitus and its associated complications such as peripheral artery disease is increasing worldwide. We aimed to explore the distinct impact of type 1 diabetes mellitus and type 2 diabetes mellitus on treatment and on short- and long-term outcome in patients with peripheral artery disease. METHODS: Retrospective analysis of anonymized data of hospitalized patients covered by a large German health insurance. Assessment of patient's characteristics (comorbidities, complications, etc.) and outcome using multivariable Cox regression and Kaplan-Meier curves. RESULTS: Among 41,702 patients with peripheral artery disease, 339 (0.8%) had type 1 diabetes mellitus and 13,151 (31.5%) had type 2 diabetes mellitus. Patients with diabetes mellitus had more comorbidities and complications than patients without diabetes mellitus ( p < 0.001). Type 1 diabetes mellitus patients exhibited the highest risk for limb amputation at 4-year follow-up (44.6% vs 35.1%, p < 0.001), while type 2 diabetes mellitus patients had higher mortality than type 1 diabetes mellitus (43.6% vs 31.0%, p < 0.001). CONCLUSION: Although the fraction of type 1 diabetes mellitus among patients with peripheral artery disease and diabetes mellitus is low, it represents a subset of patients being at particular high risk for limb amputation. Research focused on elaborating the determinants of limb amputation and mortality in peripheral artery disease patients with diabetes mellitus is warranted to improve the poor prognosis of these patients.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Angiopatias Diabéticas/terapia , Doença Arterial Periférica/terapia , Idoso , Idoso de 80 Anos ou mais , Amputação , Comorbidade , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/mortalidade , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/mortalidade , Feminino , Alemanha/epidemiologia , Hospitalização , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
14.
BMJ ; 362: k3359, 2018 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-30185425

RESUMO

OBJECTIVE: To assess whether statin treatment is associated with a reduction in atherosclerotic cardiovascular disease (CVD) and mortality in old and very old adults with and without diabetes. DESIGN: Retrospective cohort study. SETTING: Database of the Catalan primary care system (SIDIAP), Spain, 2006-15. PARTICIPANTS: 46 864 people aged 75 years or more without clinically recognised atherosclerotic CVD. Participants were stratified by presence of type 2 diabetes mellitus and as statin non-users or new users. MAIN OUTCOME MEASURES: Incidences of atherosclerotic CVD and all cause mortality compared using Cox proportional hazards modelling, adjusted by the propensity score of statin treatment. The relation of age with the effect of statins was assessed using both a categorical approach, stratifying the analysis by old (75-84 years) and very old (≥85 years) age groups, and a continuous analysis, using an additive Cox proportional hazard model. RESULTS: The cohort included 46 864 participants (mean age 77 years; 63% women; median follow-up 5.6 years). In participants without diabetes, the hazard ratios for statin use in 75-84 year olds were 0.94 (95% confidence interval 0.86 to 1.04) for atherosclerotic CVD and 0.98 (0.91 to 1.05) for all cause mortality, and in those aged 85 and older were 0.93 (0.82 to 1.06) and 0.97 (0.90 to 1.05), respectively. In participants with diabetes, the hazard ratio of statin use in 75-84 year olds was 0.76 (0.65 to 0.89) for atherosclerotic CVD and 0.84 (0.75 to 0.94) for all cause mortality, and in those aged 85 and older were 0.82 (0.53 to 1.26) and 1.05 (0.86 to 1.28), respectively. Similarly, effect analysis of age in a continuous scale, using splines, corroborated the lack of beneficial statins effect for atherosclerotic CVD and all cause mortality in participants without diabetes older than 74 years. In participants with diabetes, statins showed a protective effect against atherosclerotic CVD and all cause mortality; this effect was substantially reduced beyond the age of 85 years and disappeared in nonagenarians. CONCLUSIONS: In participants older than 74 years without type 2 diabetes, statin treatment was not associated with a reduction in atherosclerotic CVD or in all cause mortality, even when the incidence of atherosclerotic CVD was statistically significantly higher than the risk thresholds proposed for statin use. In the presence of diabetes, statin use was statistically significantly associated with reductions in the incidence of atherosclerotic CVD and in all cause mortality. This effect decreased after age 85 years and disappeared in nonagenarians.


Assuntos
Aterosclerose/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Angiopatias Diabéticas/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Prevenção Primária , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/mortalidade , Aterosclerose/fisiopatologia , Aterosclerose/prevenção & controle , Diabetes Mellitus Tipo 2/mortalidade , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/mortalidade , Angiopatias Diabéticas/fisiopatologia , Angiopatias Diabéticas/prevenção & controle , Feminino , Seguimentos , Humanos , Masculino , Metanálise como Assunto , Modelos de Riscos Proporcionais , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos
15.
BMC Infect Dis ; 18(1): 428, 2018 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-30153797

RESUMO

BACKGROUND: Chronic diseases, chiefly cancers and circulatory system diseases (CSDs), have become the leading non-AIDS-related causes of death among HIV-infected people, as in the general population. After our previous report of an excess mortality for several non-AIDS-defining cancers, we now aim to assess whether people with AIDS (PWA) experience also an increased mortality for CSDs and diabetes mellitus (DM), as compared to the non-AIDS general population (non-PWA). METHODS: A nationwide, population-based, retrospective cohort study was conducted including 5285 Italians, aged 15-74 years, who were diagnosed with AIDS between 2006 and 2011. Multiple cause-of-death (MCoD) data, i.e. all conditions reported in death certificates, were retrieved through record-linkage with the National Register of Causes of Death up to 2011. Using MCoD data, sex- and age-standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated by dividing the observed number of PWA reporting a specific disease among MCoD to the expected number, estimated on the basis of mortality rates (based on MCoD) of non-PWA. RESULTS: Among 1229 deceased PWA, CSDs were mentioned in 201 (16.4%) certificates and DM in 46 (3.7%) certificates among the various causes of death. These values corresponded to a 13-fold higher mortality related to CSDs (95% CI 10.8-14.4) and DM (95% CI: 9.5-17.4) as compared to 952,019 deceased non-PWA. Among CSDs, statistically significant excess mortality emerged for hypertension (23 deaths, SMR = 6.3, 95% CI: 4.0-9.4), ischemic heart diseases (39 deaths, SMR = 6.1, 95% CI: 4.4-8.4), other forms of heart diseases (88 deaths, SMR = 13.4, 95% CI: 10.8-16.5), and cerebrovascular diseases (42 deaths, SMR = 13.4, 95% CI: 9.7-18.2). The SMRs were particularly elevated among PWA aged < 50 years and those infected through drug injection. CONCLUSIONS: The use of MCoD data disclosed the fairly high mortality excess related to several CSDs and DM among Italian PWA as compared to non-PWA. Study findings also indicate to start preventive strategies for such diseases at a younger age among AIDS patients than in the general population and with focus on drug users.


Assuntos
Síndrome de Imunodeficiência Adquirida/mortalidade , Doenças Cardiovasculares/mortalidade , Diabetes Mellitus/mortalidade , Síndrome de Imunodeficiência Adquirida/complicações , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/complicações , Causas de Morte , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/mortalidade , Estudos de Coortes , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/mortalidade , Feminino , Infecções por HIV/complicações , Infecções por HIV/mortalidade , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
17.
Diabetes Care ; 41(11): 2306-2315, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30131397

RESUMO

OBJECTIVE: Cardiovascular disease (CVD) mortality has declined substantially in the U.S. The aims of this study were to examine trends and demographic disparities in mortality due to CVD and CVD subtypes among adults with and without self-reported diabetes. RESEARCH DESIGN AND METHODS: We used the National Health Interview Survey (NHIS) (1985-2014) with mortality follow-up data through the end of 2015 to estimate nationally representative trends and disparities in major CVD, ischemic heart disease (IHD), stroke, heart failure, and arrhythmia mortality among adults ≥20 years of age by diabetes status. RESULTS: Over a mean follow-up period of 11.8 years from 1988 to 2015 of 677,051 adults, there were significant decreases in major CVD death (all P values <0.05) in adults with and without diabetes except adults 20-54 years of age. Among adults with diabetes, 10-year relative changes in mortality were significant for major CVD (-32.7% [95% CI -37.2, -27.9]), IHD (-40.3% [-44.7, -35.6]), and stroke (-29.2% [-40.0, -16.5]), but not heart failure (-0.5% [-20.7, 24.7]), and arrhythmia (-12.0% [-29.4, 77.5]); the absolute decrease of major CVD among adults with diabetes was higher than among adults without diabetes (P < 0.001). Men with diabetes had larger decreases in CVD death than women with diabetes (P < 0.001). CONCLUSIONS: Major CVD mortality in adults with diabetes has declined, especially in men. Large reductions were observed for IHD and stroke mortality, although heart failure and arrhythmia deaths did not change. All race and education groups benefitted to a similar degree, but significant gaps remained across groups.


Assuntos
Doenças Cardiovasculares/mortalidade , Diabetes Mellitus/mortalidade , Angiopatias Diabéticas/mortalidade , Disparidades nos Níveis de Saúde , Mortalidade/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupos de Populações Continentais/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Autorrelato , Estados Unidos/epidemiologia , Adulto Jovem
18.
BMJ Open ; 8(7): e021382, 2018 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-30002011

RESUMO

OBJECTIVE: The Diabetes Shared Care Program (DSCP) is an integrated care model in Taiwan that has been proven to improve the care quality of patients with diabetes. We aimed to evaluate the efficacy of DSCP in decreasing the hospital mortality of infectious diseases. METHODS: From 1 662 929 patients with type 2 diabetes newly diagnosed between 1999 and 2013, we retrieved a total of 919 patients who participated in the DSCP with the first hospitalisation for an infectious disease as the study cohort and 9190 propensity score-matched patients with type 2 diabetes who did not participate as the comparison.The efficacy of DSCP was evaluated via the following comparisons between the DSCP and non-DSCP cohorts: hospital mortality, 1-year medical cost prior to and during the hospitalisation, and complications, such as receiving mechanical ventilation and intensive care unit admission. The ratio (OR) for hospital mortality of the DSCP participants was calculated by logistical regression. Further stratification analyses were conducted to examine which group of patients with type 2 diabetes benefited the most from the DSCP during hospitalisation for infectious diseases. RESULTS: The DSCP cohort had a lower hospital mortality rate than the non-DSCP participants (2.18% vs 4.82%, p<0.001). The total medical cost during the hospitalisation was lower in the DSCP cohort than in the non-DSCP cohort (NT$72 454±30 429 vs NT$86 385±29 350) (p=0.006). In the logistical regression model, the DSCP participants exhibited a significantly decreased adjusted OR for hospital mortality (adjusted OR=0.42, 95% CI 0.26 to 0.66, p=0.0002). The efficacy of the DSCP was much more prominent in male patients with type 2 diabetes and in patients with lower incomes. CONCLUSION: Participation in the DSCP was associated with a lower risk of hospital mortality for infectious diseases.


Assuntos
Infecções Bacterianas/complicações , Infecções Bacterianas/mortalidade , Prestação Integrada de Cuidados de Saúde , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/mortalidade , Angiopatias Diabéticas/mortalidade , Adulto , Idoso , Infecções Bacterianas/imunologia , Diabetes Mellitus Tipo 2/imunologia , Diabetes Mellitus Tipo 2/microbiologia , Angiopatias Diabéticas/imunologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Taiwan/epidemiologia , Adulto Jovem
19.
J Diabetes Complications ; 32(9): 830-832, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30030011
20.
Med Care ; 56(8): 665-672, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29877955

RESUMO

BACKGROUND: Multiple studies have reported that risk-adjusted rates of 30-day mortality after hospitalization for an acute condition are lower among blacks compared with whites. OBJECTIVE: To examine if previously reported lower mortality for minorities, relative to whites, is accounted for by adjustment for do-not-resuscitate status, potentially unconfirmed admission diagnosis, and differential risk of hospitalization. RESEARCH DESIGN: Using inpatient discharge and vital status data for patients aged 18 and older in California, we examined all admissions from January 1, 2010 to June 30, 2011 for acute myocardial infarction, heart failure, pneumonia, acute stroke, gastrointestinal bleed, and hip fracture and estimated relative risk of mortality for Hispanics, non-Hispanic blacks, non-Hispanic Asians, and non-Hispanic whites. Multiple mortality measures were examined: inpatient, 30-, 90-, and 180 day. Adding census data we estimated population risks of hospitalization and hospitalization with inpatient death. RESULTS: Across all mortality outcomes, blacks had lower mortality rate, relative to whites even after exclusion of patients with do-not-resuscitate status and potentially unconfirmed diagnosis. Compared with whites, the population risk of hospitalization was 80% higher and risk of hospitalization with inpatient mortality was 30% higher among blacks. Among Hispanics and Asians, disparities varied with mortality measure. CONCLUSIONS: Lower risk of posthospitalization mortality among blacks, relative to whites, may be associated with higher rate of hospitalizations and differences in unobserved patient acuity. Disparities for Hispanics and Asians, relative to whites, vary with the mortality measure used.


Assuntos
Afro-Americanos/estatística & dados numéricos , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Adulto , Idoso , California , Angiopatias Diabéticas/mortalidade , Feminino , Humanos , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Acidente Vascular Cerebral/mortalidade , Adulto Jovem
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