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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The composition of atherosclerotic plaques in 331 five-mm segments of the 4 major (left main, left anterior descending, left circumflex, and right) epicardial coronary arteries of 8 patients with juvenile (mean age at onset, 9 years; mean age at death, 29 years) diabetes mellitus was determined by computerized planimetric analysis. Analysis of all coronary segments disclosed that the plaques consisted primarily of dense (53%) and cellular (38%) fibrous tissue. Pultaceous debris (7%), foam cells (1.2%) and calcific deposits (0.7%) occupied a small percentage of the plaques. Thus, 91% of the coronary plaques in these young diabetic patients consisted of fibrous tissue and nearly all of the remaining 9% consisted of lipid deposits. Analysis of composition according to degrees of cross-sectional luminal narrowing revealed marked increases in dense fibrous tissue (from 31 to 74%), pultaceous debris (from 3 to 12%), and calcific deposits (from 0% to 3%) as the cross-sectional area narrowing increased from < or = 25% to > 75%. Compared with older patients with fatal coronary artery disease, the patients with juvenile diabetes had more dense fibrous tissue and pultaceous debris and less calcific deposits.
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PMID:Composition of atherosclerotic plaques in the epicardial coronary arteries in juvenile (type I) diabetes mellitus. 144 76

The percent distribution of selected comorbid conditions from a national sample of 3,399 Medicare patients starting maintenance hemodialysis in 1986-87 is described. Using the Cox proportional hazards model, the relative mortality risk (RR) was assessed for comorbid conditions at time of ESRD while adjusting for the other comorbid and demographic covariates. Coronary artery disease and congestive heart failure, each present in 41 percent of patients, were associated with RR of 1.22 and 1.26 respectively (p < 0.0005 each). Fifty percent of patients had a serum albumin concentration at onset of ESRD of less than 3.5 gm/dl, and an increased risk of dying. Additionally, patients recorded as undernourished had an elevated risk (RR = 1.34, without adjustment for serum albumin, p < 0.0001). Other factors associated with a statistically significant increased mortality risk (p < 0.005) included older age, diabetes as cause of ESRD (particularly if insulin dependent), history of neoplasm, active smoker, and relatively low serum creatinine concentration. By describing the magnitude of risk associated with comorbid conditions, this study emphasizes the need for preventive efforts during the pre-ESRD stages of renal impairment. Studies are needed to document whether improvement in serum albumin or other comorbid factors before ESRD leads to reduction in mortality risk for ESRD patients.
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PMID:Comorbid conditions and correlations with mortality risk among 3,399 incident hemodialysis patients. 144 73

From available studies, there appears to be a racial preponderance of coronary artery disease (CAD) among Indians when compared to other ethnic groups. We found that this racial difference exists even in a young Asian population with premature atherosclerosis. In this small series, these racial differences could not be explained by the commonly known risk factors for coronary artery disease--smoking, hypertension, diabetes and hypercholesterolaemia, findings similar to those found in older patients elsewhere. Only fasting triglyceride levels were significantly higher among young Indians compared to non Indians (p less than 0.02) although the importance of this finding as a risk factor for CAD remains controversial. The majority of these young patients were treated medically and their one year survival was good.
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PMID:Coronary artery disease in Asians. 144 22

Plasma low density lipoprotein (LDL) comprises multiple discrete subclasses differing in size, density, and chemical composition. A common, heritable phenotype characterized by the predominance of small, dense LDL particles (LDL subclass phenotype B) is associated with relatively increased concentrations of plasma triglycerides, reduced levels of high density lipoprotein, and increased risk of coronary artery disease in comparison with subjects with larger LDL (LDL subclass phenotype A). Population studies have indicated that approximately 20-30% of adult men have phenotype B, and another 15-20% have LDL of intermediate size. The lipid changes in phenotype B are similar to those that have been observed in patients with non-insulin-dependent diabetes mellitus (NIDDM). In the present study, we have assessed LDL subclass phenotypes in normolipidemic men with NIDDM and in age-matched control subjects who had similar lipid levels. There was a greater than twofold increase in the percentage of individuals with the LDL B phenotype in the NIDDM subjects. The LDL B phenotype was associated with higher plasma triglyceride levels and a trend toward lower high density lipoprotein cholesterol levels compared with the LDL A phenotype in the NIDDM subjects, as has been previously observed in control groups. Indices of diabetic control, such as fasting and hemoglobin A1 levels, were similar regardless of LDL phenotype pattern, suggesting that glycemic control was not likely to account for the increase in the LDL B phenotype. In both control and NIDDM subjects, the clearance of triglyceride-rich lipoproteins was slowed in the subjects with the LDL phenotype B compared with those with the A phenotype.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:LDL subclass phenotypes and triglyceride metabolism in non-insulin-dependent diabetes. 145 Jan 81

BACKGROUND--Thirty-five percent of type I-diabetic patients are dead of coronary artery disease by age 55 years, and the risk of death is increased eightfold to 15-fold in patients with nephropathy. However, the prevalence of coronary artery disease with respect to age is unknown and few risk factors have been identified. METHODS--One hundred ten insulin-dependent diabetic patients underwent routine pretransplant coronary angiography and cardiac risk factor assessment. Angiograms were evaluated by two angiographers for presence or absence of coronary artery disease (CAD, defined as one or more coronary artery stenoses of 50% or greater in diameter, and no CAD, defined as no stenosis of 25% or greater in diameter, respectively). Prevalence of CAD by age was determined, and associated risk factors were defined. RESULTS--Fifty-two of 110 patients had CAD. Coronary artery disease prevalence increased significantly with age; 13 of 16 patients older than 45 years of age had CAD. For patients 35 years of age or younger, associated risk factors included a family history of premature myocardial infarction, higher hemoglobin A1c level, hypertension for more than 5 years, lower high-density lipoprotein level, and smoking for more than 5 pack-years. For patients between 35 and 45 years of age, associated risk factors included number of years of diabetes, higher hemoglobin A1c levels, and smoking more than 5 pack-years. CONCLUSIONS--In type I-diabetic patients with nephropathy, CAD prevalence increased significantly with age and was found in the majority of patients older than 45 years of age. Coronary artery disease risk factors operative in the general population were significantly associated with CAD in this high-risk group. In addition, a role for hyperglycemia in accelerated atherogenesis was supported by the association of both higher hemoglobin A1c levels and number of years of diabetes with CAD.
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PMID:Prevalence of, and risk factors for, angiographically determined coronary artery disease in type I-diabetic patients with nephropathy. 145 56

The goal of this review was to assess the magnitude of coronary artery disease (CAD) mortality and its determinants in insulin-dependent diabetes mellitus (IDDM) patients with persistent proteinuria. By reanalyzing data from two previously published studies of patients with nephropathy, it was found that these patients had extremely high CAD mortality rates in comparison with IDDM patients without proteinuria, but only after the age of 35 yr. In addition, the risk of CAD death was associated with high serum cholesterol levels but was unrelated to systemic blood pressure, smoking habits, and obesity. Further studies of the determinants of CAD in patients with IDDM and proteinuria are urgently needed. Except for efforts to lower serum cholesterol, it is not known whether any other measure can be undertaken to reduce the extremely high mortality due to CAD that afflicts IDDM patients with persistent proteinuria, in particular those patients whose renal failure might have been "successfully" postponed by antihypertensive therapy.
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PMID:Coronary artery disease is the major determinant of excess mortality in patients with insulin-dependent diabetes mellitus and persistent proteinuria. 145 52

We have developed a particle-concentration fluorescence immunoassay (PCFIA) for estimating apolipoprotein (apo) B concentrations in plasma. A two-step antigen-detection system with a polyclonal antibody to apo B bound to carboxyl-polystyrene particles binds the antigen, and a fluorescein-labeled monoclonal antibody detects the bound apo B. Narrow-cut low-density lipoproteins (d = 1.03-1.05 kg/L) were used as the primary standard. The assay compares well with the enzyme-linked immunosorbent assay. The PCFIA gives parallel responses with low-density lipoprotein, very-low-density lipoproteins, and plasma samples, and can be fully automated and completed in 3 h. In a pilot study of patients with diabetes, coronary artery disease (CAD), or both, we found statistically significant differences in apo B concentrations for patients with both CAD and diabetes compared with those for patients with diabetes alone or for control subjects (P < 0.01).
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PMID:Apolipoprotein B quantified by particle-concentration fluorescence immunoassay. 145 72

The natural history of peripheral arterial occlusive disease is discussed. Severe limb-threatening ischemia is the most serious consequence of chronic arterial occlusive disease. Severe ischemia and amputation can be considered as an endpoint in peripheral vascular disease. Severe limb ischemia is relatively uncommon in isolated aortoiliac disease and this is more than twice in patients with either femoropopliteal or multisegmental disease. Subsequent studies have also demonstrated that both smoking and diabetes are associated with a substantial risk for sudden ischemia. A clear majority of about 50% deaths are caused by associated coronary artery disease, 15% to stroke and 10% to vascular disease in the abdomen. Ankle systolic blood pressure is one of the most significant factors in the progression of peripheral arterial occlusive disease and also for cardiovascular mortality. In the future, men need to know how therapies as exercise, during regimens would influence the most frequent complications besides severe limb ischemia, namely brain infarction and coronary artery disease.
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PMID:Natural history and evolution of peripheral obstructive arterial disease. 146 Mar 49

A prospective study of cardiovascular disease in elderly Australians commenced in 1988 in Dubbo, New South Wales. The study population comprised 1,237 men and 1,568 women aged > or = 60 years. The prevalence rates of coronary artery disease (CAD) and putative risk factors were examined cross-sectionally in the baseline data. The age-standardized rate of CAD was 23.8/100 men and 18.1/100 women. In a univariate analysis, the major risk factors for CAD were hypertension, diabetes, family history, reduced high-density lipoprotein (HDL) cholesterol levels, and increased triglyceride levels. The prevalence rate of CAD was examined in those with low-density lipoprotein (LDL):HDL ratios < 5.0 or > 5.0. Most notably in women, the CAD rate was 16/100 with an LDL.HDL ratio < or = 5.0 and 28/100 with an LDL.HDL ratio > 5.0. In the latter group, the rate was 21/100 in those with triglycerides < or = 2.3 mmol/liter and 36/100 in those with triglycerides > 2.3 mmol/liter. In a multiple logistic model that controlled for many potential risk factors or confounding variables, CAD in men was significantly predicted by age, hypertension (odds ratio = 1.40), family history (odds ratio = 2.05), and low HDL cholesterol (odds ratio = 0.78). Significant predictors in women were age, years of education (odds ratio = 0.82), hypertension (odds ratio = 1.45), family history (odds ratio = 1.77), serum triglycerides (odds ratio = 1.30), and low HDL cholesterol (odds ratio = 0.73). An independent gradient of CAD risk with increasing triglyceride levels and a similar gradient with decreasing HDL cholesterol levels were found in women.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Triglyceride levels and the risk of coronary artery disease: a view from Australia. 146 12

Enhanced and non-enhanced computed tomography (CT) were performed in 405 subjects (222 men; 183 women; mean age 57 years). Intimal atherosclerotic changes of the aorta were quantified by enhanced CT, revealing the atheromatous intima to be projecting and thick-walled, while non-enhanced CT demonstrated aortic calcification. We measured the degree of aortic intimal changes at various segments of the aorta. In 224 cases, CT was performed from the aortic root to the bifurcation of the abdominal aorta. Intimal changes were found predominantly at the aortic arch, the middle descending thoracic and the infrarenal abdominal aorta. As for the intimal changes, aortic calcification and aortic pulse wave velocity were significant atherosclerotic characteristics. The aortic diameter did not show a significant association with intimal change. Among the various atherosclerotic risk factors, intimal change was significantly associated with age, systolic blood pressure, serum total cholesterol and diabetes mellitus, whereas gender, diastolic blood pressure, relative weight and cigarette use were not significantly related. For coronary artery disease and arteriosclerosis obliterans, aortic intimal changes constituted a significant atherosclerotic feature. In cerebrovascular disease, however, aortic intimal change did not play a significant role.
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PMID:Evaluation of morphological changes of the atherosclerotic aorta by enhanced computed tomography. 146 58


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