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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The contribution from lipoproteins, blood pressure, albuminuria and demographic variables to coronary heart disease in 90 adult subjects with and 172 without Type 1 diabetes mellitus was examined in order to investigate whether risk factors were of equivalent importance in diabetic and non-diabetic coronary heart disease. Coronary heart disease (CHD) was present in roughly 25% of subjects in each group. In Type 1 diabetes those with CHD had significantly higher levels of systolic blood pressure, albumin excretion, serum creatinine, triglycerides, VLDL cholesterol and C-peptide, and reductions in serum concentrations of HDL and HDL2 cholesterol, in comparison to those without. However, the prevalence of smokers, and concentrations of Lp(a), ApoB and fibrinogen were comparable. Blood pressure and HDL cholesterol were higher in the CHD group with Type 1 diabetes in comparison to the nondiabetic group with CHD, although LDL concentrations and the prevalence of Lp(a) concentrations > 200 mg/l were lower. Logistic regression analysis revealed the strongest independent predictors of CHD in Type 1 diabetes were serum triglycerides, systolic blood pressure, age, serum LDL cholesterol, and the daily insulin dosage, whereas in the non-diabetic control group HDL2 cholesterol, Lp(a), ApoA1 and ApoB, total serum cholesterol and body mass index were additional predictors. CHD in Type 1 diabetes appears to be most closely associated with increasing age and levels of blood pressure and total serum lipids. Apolipoproteins and albuminuria did not seem to be important independent predictors of CHD in Type 1 diabetes, whereas the former were more clearly associated with CHD in non-diabetic controls.
Diabetes Res Clin Pract 1992 Dec
PMID:A cross-sectional evaluation of cardiovascular risk factors in coronary heart disease associated with type 1 (insulin-dependent) diabetes mellitus. 128 18

Treadmill stress tests provide useful noninvasive prognostic information in patients with coronary heart disease (CHD). The present study has prospectively analysed the long term prognostic value of exercise tolerance as measured by exercise time during treadmill stress test in 335 consecutive patients with stable CHD. 161 had exercise time of 6 minutes or less (mean 4.58 +/- 1.54 minutes) on a modified protocol (Group A) and 174 had exercise time of more than 6 minutes (mean 9.30 +/- 0.74 minutes)(Group B). Both groups were matched for major coronary risk factors (hypertension, smoking, diabetes and cholesterol levels) and type of drug therapy (betablockers, nifedipine, diuretics and aspirin). The patients have been followed up for upto 9 years with a mean of 6.28 +/- 2.99 years (Group A) and 7.87 +/- 1.98 years (Group B). Actuarial analysis shows that the overall survival after dropout due to death or coronary artery bypass surgery was significantly lower in group A [dropouts = 66 (41.0%)] than in Group B [dropouts = 19 (10.9%)] (Logrank test = 39.94, p < 0.001). The mortality was significantly higher in Group A with 58 deaths (36.0%) as compared to Group B with 16 deaths (9.2%) (x2 = 34.98, p < 0.001). The crude death rate was 5.73% per year in Group A as compared to 1.17% per year in Group B. The incidence of sudden deaths was also higher in Group A with 28(17.4%) instances as compared to 5(2.9%) in Group B (x2 = 19.85, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long term follow up study of prognostic significance of exercise duration during treadmill stress test in patients with stable coronary heart disease. 128 17

Diabetes mellitus (DM)-linked metabolic alterations and hypertension concomitantly accelerate or precipitate cerebrovascular and coronary heart disease, nephropathy, retinopathy and widespread macroangiopathy, thereby conferring to diabetic patients a very high risk of morbidity, disability and early death. Therefore, the long-term care for diabetic patients should be aimed at concomitant metabolic and blood pressure (BP) control. Dietary measures are indispensable; a high fibre, low fat, low salt diet is recommended, complemented with caloric restriction and physical exercise when body weight is above the ideal. Antidiabetic pharmacotherapy involves an unresolved dilemma. The desired achievement of euglycemia necessitates effective levels of insulin, but hyperinsulinemia (due to parenteral [over]treatment in insulin-dependent DM) is suspected to promote atherogenesis and represents a coronary risk factor and perhaps even facilitates hypertension. Considering antihypertensive pharmacotherapy, thiazide-type or loop diuretics are problematic drugs in DM because they can aggravate metabolic alterations. These agents also seem to exert only a limited preventive or regressive effect on left ventricular hypertrophy (LVH); beta-blockers are also not considered ideal, since they decrease the awareness of hypoglycemia and tend to promote glucose intolerance. Unselective beta-blockers in particular promote peripheral ischemia and insulin-induced hypoglycemia, while beta-blockers without intrinsic sympathomimetic activity lower serum HDL-cholesterol. Calcium antagonists and ACE inhibitors have equivalent antihypertensive efficacy, do not impair carbohydrate and lipid homeostasis or peripheral perfusion and can effectively improve LVH. Certain ACE inhibitors may even slightly ameliorate abnormal insulin sensitivity and plasma glucose levels. While alpha-blockers share most of these desirable properties, these agents are more prone to precipitate orthostatic hypotension in the diabetic patient. The non-thiazide diuretic indapamide and the serotonin2-antagonist ketanserin also combine antihypertensive efficacy with metabolic neutrality. The ultimate goal of therapy is to improve life prognosis. In essential hypertension, conventional drug treatment based on diuretics in high dosage satisfactorily reduced cerebrovascular but not coronary complications or sudden death. In diabetic patients, the influence of antihypertensive therapy on prognosis has not been assessed prospectively. Based on retrospective analyses, Warram et al reported a 3.8 times higher mortality in diabetics treated with diuretics alone, than in diabetics with untreated hypertension (Arch Intern Med. 1991;151:1350). H. H. Parving calculated that effective BP control in patients with diabetic nephropathy might reduce 10 year-mortality from about 65 to 20 percent (J Hypertension. 1990; 8[Suppl 7]:187).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Antihypertensive therapy in diabetic patients. 128 10

In order to evaluate whether and to what extent elevated blood lipid concentrations and clinical expressions of coronary heart disease (CHD) are associated in the elderly, we studied the risk of CHD (myocardial infarction and angina pectoris) in a population of elderly hospitalized patients (210 subjects, 126 men and 84 women, average age 76 +/- 6 years) exposed to risk factors. 210 patients, free from current and previous cardiovascular diseases, age and sex matched, were recruited as the control group. Advanced senile decline, severe hepatic or renal failure and malignancies were considered exclusion criteria for both groups. The following dichotomic variables (familial history of CHD, cigarette smoking, clinical history of arterial hypertension or diabetes mellitus, hypercholesterolemia, hypertriglyceridemia) and continuous variables (total, LDL and HDL cholesterol, triglycerides, total/HDL cholesterol ratio, body mass index (BMI), years of exposure to risk factors) were considered. Using a stepwise multiple logistic regression forward method, the following variables resulted significantly associated with the risk of CHD: total/HDL cholesterol ratio (OR 1,89), BMI (OR 1,04), period of hypertension (OR 1,04) and cigarette smoke exposure (OR 1,007). We conclude that in the elderly the total/HDL cholesterol ratio can be a more predictive and reliable index of coronary risk than blood total cholesterol concentration.
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PMID:[Lipid parameters and cardiovascular risks in elderly patients hospitalized for ischemic cardiopathy. A case-control study]. 129 23

The relationship between cardiovascular risk factors and the prevalence of coronary heart disease was examined in 152 Type 2 diabetic patients (65 men, 87 women) aged 35-54 years and in 105 randomly selected control subjects (46 men, 59 women). Coronary heart disease, defined by symptoms and ECG abnormalities, was 1.2 times higher in male and 3.4 times higher in female diabetic patients than in the controls. In logistic regression analysis (including diabetes, age, body mass index, triglycerides, HDL-cholesterol, non-HDL-cholesterol and hypertension) diabetes showed an independent, significant association to coronary heart disease in women, whereas hypertension was independently related to coronary heart disease in men.
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PMID:Cardiovascular risk factors and prevalence of coronary heart disease in type 2 (non-insulin-dependent) diabetes. 129 82

Recent developments in diabetes epidemiology in Europe have included the completion of the European Community sponsored Concerted Action on the Epidemiology and Prevention of Diabetes (Eurodiab), further studies of diabetes and coronary heart disease prevalence in ethnic minority groups in the United Kingdom, and studies of the effect of poor fetal and early post-natal nutrition on the risk of developing non-insulin dependent diabetes (NIDDM). The EURODIAB Concerted Action Programme has provided valuable new information on the incidence of insulin-dependent diabetes mellitus (IDDM) throughout Europe and has drawn attention to an unexpectedly high incidence in Sardinia. In the EURODIAB IDDM complications study, the prevalence of both large- and small-vessel complications of diabetes has been examined, using standardized methods, in 3,279 IDDM patients from 31 centres throughout Europe. The data on risk factors for complications obtained from this study will have significant health policy implications for diabetes in Europe which will be utilized by the current St. Vincent Declaration Action Programme for Diabetes Care and Research in Europe. In another part of the EURODIAB Concerted Action Programme, important information has been obtained on the validity of routinely-collected diabetes health information, such as mortality statistics based on death certificates, and estimates of diabetes prevalence obtained from drug-utilization data.
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PMID:Recent developments in diabetes epidemiology in Europe. 129 76

We have retrospectively studied 814 diabetic outpatients, 407 hypertensives and 407 normotensives. The aim of the study was to investigate on possible associations between macroangiopathic complications (coronary heart disease, peripheral and cerebral arteriopathy) and well recognized risk factors for atherosclerosis. Macroangiopathy was present in 27% of males and 24% of females (p = NS), and in 32% of hypertensives and 18% of normotensives (p < 0.0001). Macroangiopathy associated, in both sexes, with age and duration of diabetes, but did not correlate, instead, with metabolic control, obesity, serum cholesterol and triglycerides. High triglyceride levels were associated strictly with arterial hypertension, in both sexes, but are more elevated in men. Risk factors for atherosclerosis seem not to be simply considered in the same way in diabetic and non diabetic populations.
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PMID:[Arterial hypertension and macroangiopathic complications in a group of diabetic out-patients]. 130 Apr 64

We prospectively conducted a hospital based study to determine the prevalence of vascular complications in NIDDM and their risk factors. Using standard protocol for interviewing, physical examination and laboratory investigations, we studied 207 patients from the diabetic clinic and medical outpatient department (ratio 3.9:1) by systematic sampling. The prevalence of hypertension, coronary heart disease cerebrovascular disease, peripheral and large vessel disease was 22.2, 22.2, 8.2, 21.3 and 34.8 per cent respectively. We found that the prevalence of small vessel disease, retinopathy and nephropathy was 34.3, 25.1 and 12.5 per cent respectively. The complications were slightly higher in females and increased with duration of diabetes. By univariate and logistic regression analysis, we found that the risk factors of large vessel disease were body mass index, diastolic blood pressure, duration of diabetes and for small vessel disease were duration of diabetes and high uric acid.
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PMID:Vascular complications in noninsulin dependent diabetes mellitus (NIDDM) in Srinagarind Hospital, Khon Kaen. 130 93

It is well known that excessive weight is associated with resistance to insulin-mediated glucose uptake and predisposition to the development of type II diabetes. It has been shown more recently that excessive weight and insulin resistance tend to be associated to android fat distribution, arterial hypertension, elevated levels of triglycerides, low concentration of HDL cholesterol and defective fibrinolysis. The terms syndrome of insulin resistance, metabolic syndrome or syndrome X have been proposed to describe this cluster of abnormalities. The pathophysiological mechanisms which could explain the interrelations between these different parameters are still only partly understood. Epidemiological prospective studies have demonstrated that the metabolic syndrome is a risk factor for coronary heart disease and type II diabetes. The mechanisms involved in the development of diabetes are relatively well established, but those which are implicated in the atherothrombotic process are far from being clearly described. Anyway, sufficient presumption exists to attempt at decreasing insulin resistance when it exists. Physical training and, if indicated, weight reduction are the simplest means.
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PMID:The syndrome of insulin resistance. 130 11

Mexican Americans have a high prevalence of diabetes relative to non-Hispanic whites, but paradoxically experience a lower prevalence of myocardial infarction and lower cardiovascular mortality (at least in men). To determine whether Mexican Americans might be more resistant to the atherogenic effects of diabetes than non-Hispanic whites, we examined the associations between diabetes and myocardial infarction and selected coronary heart disease (CHD) risk factors in these two ethnic groups. The study population consisted of 5149 Mexican Americans and non-Hispanic whites who were 25 to 64 years old and recruited from the San Antonio Heart Study, a population-based study of cardiovascular risk factors and diabetes conducted between 1979 and 1988. Diabetic men were more than twice as likely to have an electrocardiography (ECG)-documented myocardial infarction than were nondiabetic men, while diabetic women were more than three times as likely to have a myocardial infarction than were nondiabetic women. In both sexes the association between myocardial infarction and diabetes was nearly identical between the two ethnic groups. In both ethnic groups diabetes was also more strongly associated with conventional CHD risk factors (e.g., triglycerides, systolic blood pressure, and high-density-lipoprotein cholesterol) in women than in men. Furthermore, these associations were at least as strong, if not stronger, in Mexican Americans as in non-Hispanic whites. Thus, these data provide no evidence to suggest that Mexican Americans are resistant to the lipid-altering effects of diabetes. We conclude that the protective effect against CHD conferred by Mexican American ethnicity may be obscured in part by the high prevalence of diabetes in this ethnic group.
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PMID:Diabetes and coronary heart disease risk in Mexican Americans. 828 49


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