Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim was to determine if certain risk factors in the general population are more strongly related to peripheral arterial disease than to ischemic heart disease. Arterial disease in the lower limbs was measured by means of the World Health Organization questionnaire on intermittent claudication, the ankle brachial pressure index, and a reactive hyperemia test in 1,592 men and women aged 55-74 years selected randomly in 1988 from the age-sex registers of 10 general practices in Edinburgh, Scotland. Peripheral arterial disease was strongly related to lifetime cigarette smoking, with additional risks in current and exsmokers of less than 5 years. Multiple regression of risk factors on measures of peripheral arterial disease showed associations with diabetes mellitus (but not impaired glucose tolerance), systolic blood pressure, and serum cholesterol; inverse association with high-density lipoprotein cholesterol; and only univariate association with triglycerides. In multiple logistic regressions of risk factors on six separate indicators of cardiovascular disease, the only consistent difference was that smoking increased the risk of peripheral arterial disease (range of odds ratios, 1.8-5.6) more than heart disease (range of odds ratios, 1.1-1.6). Diabetes mellitus was not a stronger risk factor for peripheral arterial disease.
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PMID:Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh Artery Study. 155 87

The prevalence and prognostic significance of silent myocardial ischemia were prospectively assessed in 217 patients (mean age 57 +/- 9 years, 83% male) recovering from a first uncomplicated acute myocardial infarction and undergoing a dipyridamole echocardiography test before hospital discharge. Clinical, angiographic, exercise electrocardiographic (ECG) and dipyridamole echocardiographic variables were also examined. Of the 217 patients, 89 had no echocardiographically proved dyssynergy after dipyridamole, whereas 128 had dipyridamole-induced wall motion abnormalities that were silent in 94 (Group I) and symptomatic in 34 (Group II). There was no intergroup difference with respect to dipyridamole time (i.e., the time from onset of the test to frank dyssynergy: 7 +/- 3 vs. 8 +/- 3 min; p = NS); prevalence of inferior myocardial infarction (69% vs. 71%; p = NS); ischemic ECG changes during the test (83% vs. 71%; p = NS); diabetes (8.5% vs. 6%; p = NS); ongoing medical therapy; multivessel disease (57% vs. 56%; p = NS); and baseline left ventricular ejection fraction (57 +/- 13% vs. 57 +/- 10%; p = NS). There was also no significant difference between Group I and Group II with respect to wall motion score index at peak dipyridamole effect (1.77 +/- 0.39 vs. 1.78 +/- 0.36; p = NS). Patients were followed up for 24 +/- 4 and 25 +/- 5 months, respectively (p = NS). Life table analysis revealed no difference in unstable angina, reinfarction and death between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Silent versus symptomatic dipyridamole-induced ischemia after myocardial infarction: clinical and prognostic significance. 155 19

Recent reports of the risk of asymptomatic carotid stenosis have been compromised by flawed patient selection or the performance of a large number of carotid endarterectomies during follow-up. We report the natural history of a randomly selected group of asymptomatic patients (n = 188; 114 males and 74 females) with documented carotid artery disease who were prospectively followed without intervention for up to 8 years. Risk factors included ischaemic heart disease in 17%, diabetes in 10%, hypertension in 46% and 88% were smokers. The degree of internal carotid stenosis was classified by duplex scanning and a total of 259 vessels had evidence of atherosclerosis. Study end-points included TIA, CVA and death. At mean follow-up of 4 years 3% of the 96 patients with internal carotid artery stenosis of less than 50% had died and 2% suffered a stroke. Six per cent of patients with a stenosis of 50-79% had died and 4% and 2% had suffered a CVA and TIA, respectively. In the 59 patients with greater than 80% stenosis 7% had suffered a TIA and an additional 7% a CVA, while 2% had died. None of the patients suffering a stroke had an antecedent TIA. Though the incidence of ischaemic events is significantly higher in patients with greater than 80% stenosis the incidence of unheralded stroke remains low. We therefore continue to recommend a conservative approach to the management of asymptomatic carotid stenosis.
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PMID:Asymptomatic carotid stenosis: a benign lesion? 155 61

This study examines the relationship between cardiovascular risk factors and regional variation in IHD incidence among white males 55-74 years of age from the NHANES I Epidemiologic Followup Study. The age-adjusted IHD incidence rate was lowest in the west (31.3 per 1000 persons years of followup). The rates in the northeast, midwest, and south were similar and so they were combined into one region, the non-west, with a rate of 42.4. Differences in risk factors (smoking, educational level, hypertension, serum cholesterol, diabetes mellitus, and body mass index) did not explain the regional differences in IHD incidence. After adjusting for baseline risk factors using proportional hazards model, the risk of IHD incidence was still 38% higher in the non-west compared to the west. However, the effect of hypertension, diabetes, and body mass index on IHD incidence varied by region.
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PMID:Regional variation in ischemic heart disease incidence. 157 31

Despite a marked reduction in cardiovascular morbidity and mortality, treated hypertensive patients remain at increased risk of coronary artery disease and its complications compared with untreated normotensive subjects. Mild hypertension is often associated with other, usually chronic, diseases. The failure of first-line antihypertensive therapy to deal adequately with concomitant disease and associated therapy might account for the poor improvement in the cardiovascular prognosis. This possibility has been addressed in an ongoing trial of novel design, the Perindopril Therapeutic Safety Study, a multicenter, double-blind, randomized and placebo-controlled trial to determine the safety, efficacy, and interaction of angiotensin-converting enzyme (ACE) inhibition with eight of the most common concomitant diseases and their therapies. A total of 480 male and female patients (60 per disease group) aged 30-70 years, with a diastolic pressure of 90-104 mm Hg, were included after a 3-week placebo run-in if they satisfied standard criteria for any of the following: hyperlipidemia, type II diabetes, ischemic heart disease, cardiac arrhythmia, peripheral arterial disease, nephropathy with proteinuria, chronic obstructive lung disease, or rheumatoid arthritis. Of these, 460 patients have completed the 6-week double-blind phase (comprising two assessments, at 3 and 6 weeks), and are currently undergoing assessments every 3 months over a 1-year follow-up period. The end points include the incidence of progression or improvement in concomitant disease, the incidence of positive or negative interaction between ACE inhibition and concomitant therapy, change in blood pressure, adverse biochemical and hemodynamic reactions, self-reported side effects, and quality of life indices. Interim results for the 6-week double blind phase will shortly be available. However, the desirability and feasibility of conducting a study according to this novel design have already been proved.
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PMID:Angiotensin-converting enzyme inhibition in mild hypertension with concomitant diseases and therapies: an efficacy, safety, and compatibility study of novel design, the Perindopril Therapeutic Safety Study. 158 Feb 90

Two cases of symptomatic extracranial carotid artery stenosis associated with ischemic heart disease are reported. The first case was 72-year-old male, who was admitted because of transient ischemic attack due to the stenosis of left internal carotid artery. He had a history of myocardial infarction and coronary angiography revealed three vessel disease. The second case was 74-year-old female with diabetes mellitus. She was admitted because of cerebral infarction. The carotid angiography revealed critical stenosis of bilateral internal carotid arteries. Her coronary angiography revealed three vessel disease. Her chest symptom became unstable after her admission. In both cases, simultaneous carotid endarterectomy and coronary bypass grafting were performed with successful outcome. In the patients with symptomatic extracranial carotid occlusive disease associated with severe ischemic heart diseases, we advocate simultaneous operation both for carotid and coronary artery occlusive disease.
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PMID:[Surgical results of two cases of simultaneous surgery of carotid and coronary occlusive disease]. 158 67

The Copenhagen City Heart Study is a prospective ischaemic heart disease population study designed to evaluate incidence of, and risk factors for, ischaemic heart disease. A random population sample of approximately 20,000 men and women was invited to participate in a health survey, which was carried out in 1976-78. The participation rate was 74%. Systolic (SBP) and diastolic blood pressure (DBP) was measured with the London School of Hygiene sphygmomanometer after 5 minutes in the sitting position. Risk factors were assessed by a questionnaire and non-fasting plasma cholesterol was measured. Information about subsequent death and causes of death was obtained from the Danish Death Register. Follow-up was virtually complete over an observation time of 10 years. Analysis of the independent effect of SBP and DBP measured at entry on the 10 year total and cause-specific mortality was performed using the Cox regression model. Antihypertensive medication and/or diuretic therapy, physical activity during leisure time, economic and educational status, tobacco and alcohol consumption, diabetes mellitus, body mass index, plasma cholesterol levels, age and sex were entered as confounders. Total mortality was increased only in the higher quintiles of SBP. Concerning ischaemic heart disease mortality and cerebrovascular mortality, the risk increased in a graded manner with increasing quintile of SBP and DBP. With regard to cancer mortality, a U-shaped association was observed between quintile of SBP (and DBP) and death rate. With advancing age, the predictive power of SBP on total and cause-specific mortality changed, especially in males, as a pronounced U-shape of the association between BP and mortality appeared. The reasons for this are discussed. The relative risk in subjects receiving antihypertensive medication was 1.7 (CL 1.5-2.0) regarding total mortality, 2.0 (CL 1.5-2.7) regarding ischaemic heart disease mortality, 0.8 (CL 0.5-1.4) regarding cerebrovascular mortality, and 1.3 (CL 1.0-1.7) regarding cancer mortality. This finding is in agreement with clinical trials experiences, and may have an impact on management of high blood pressure.
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PMID:Blood pressure and mortality: an epidemiological survey with 10 years follow-up. 158 31

An elevated peripheral leucocyte count is associated with an increased risk of myocardial infarction and progression of coronary artery disease. The aim of this study was to determine neutrophil count and activation, measured as an increase in plasma neutrophil elastase, in patients with stable ischaemic heart disease, insulin-dependent diabetes mellitus and essential hypertension compared with a comparable group of control subjects. Neutrophil count and neutrophil elastase were raised significantly for patients with ischaemic heart disease (p less than 0.005; p less than 0.002), diabetes mellitus (p less than 0.001; p less than 0.01) and hypertension (p less than 0.05; p less than 0.0001) respectively compared to the control subjects. Neutrophil elastase did not correlate with subject age or leucocyte count. This study confirms the association between leucocyte count and vascular disease, and is consistent with neutrophil activation contributing to the progression of vascular disease.
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PMID:Neutrophil count and activation in vascular disease. 160 64

Trends in diabetes-related mortality in England and Wales between 1975-6 and 1985-6, and regional and ethnic differences in diabetes-related mortality in 1985-6, have been examined. Data from death certificates mentioning diabetes in 1975-6 were compared with those for 1985-6 for different age groups. Data for 1985-6 were also analysed for different regions of England and Wales, and for country of birth. Between 1975-6 and 1985-6, the age-standardized rate of mentioning diabetes rose by 2.7% (95% confidence interval 1.4%, 4.1%) in men of all ages, and fell by 11.7% (10.6, 12.8) in women of all ages. By contrast, the rate of mentioning diabetes in those below 45 years fell by 30.7% (23.0, 37.7) in men and by 26.7% (16.5, 35.6) in women. Deaths in which the underlying cause was ischaemic heart disease (IHD), and where diabetes was also mentioned on the death certificate, rose by 14.4% (11.5, 16.8) in men and did not change significantly in women of all ages, but fell by 18.4% (-35.1, +2.6) in men, and 23.5% (-49.1, +15.2) in women below age 45. This was less favourable than the trend in the general population, where IHD mortality fell by 9.7% in men and 8.3% in women of all ages, and by 31.1% (28.6, 33.5) in men and 40.5% (35.0, 45.5) in women under 45 years.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Recent trends in diabetes mortality in England and Wales. 161 27

Positron emission tomography (PET) allows, in combination with multiple radiopharmaceuticals, unique physiological and biochemical tissue characterization. Tracers of blood flow, metabolism and neuronal function have been employed with this technique for research application. More recently, PET has emerged in cardiology as a useful tool for the detection of coronary artery disease and the evaluation of tissue viability. Metabolic tracers such as fluorine-18 deoxyglucose (FDG) permit the specific delineation of ischaemically compromised myocardium. Clinical studies have indicated that the metabolic imaging is helpful in selecting patients for coronary artery bypass surgery or coronary angioplasty. More recent research work has concentrated on the use of carbon-11 acetate as a marker of myocardial oxygen consumption. Together with measurements of left ventricular performance, estimates of cardiac efficiency can be derived from dynamic 11C-acetate studies. The non-invasive evaluation of the autonomic nervous system of the heart was limited in the past. With the introduction of radiopharmaceuticals which specifically bind to neuronal structures, the regional integrity of the autonomic nervous system of the heart can be evaluated with PET. Numerous tracers for pre- and postsynaptic binding sites have been synthesized. 11C-hydroxyephedrine represents a new catecholamine analogue which is stored in cardiac presynaptic sympathetic nerve terminals. Initial clinical studies with it suggest a promising role for PET in the study of the sympathetic nervous system in various cardiac diseases such as cardiomyopathy, ischaemic heart disease and diabetes mellitus. The specificity of the radio-pharmaceuticals and the quantitative measurements of tissue tracer distribution provided by PET make this technology a very attractive research tool in the cardiovascular sciences with great promise in the area of cardiac metabolism and neurocardiology.
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PMID:Imaging of metabolism and autonomic innervation of the heart by positron emission tomography. 161 39


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