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

1. The aim of the present study was to evaluate whether metabolic factors are linked to the steady component and the pulsatile component of blood pressure, evaluated as mean arterial pressure and pulse pressure respectively, in a sex-specific manner. 2. A cohort of 299 subjects (152 males, 147 females; 25-80 years of age) was studied. Patients presenting congestive heart failure, coronary insufficiency, severe valvular heart disease, neurological accident in the last 6 months, renal or respiratory failure, cancer, diabetes mellitus or acute infectious disease were excluded. None of the women was taking oral contraceptives or oestrogen supplementation. All cardioactive drugs were withdrawn at least 2 weeks before the subjects entered the study. 3. Men presented higher mean arterial pressure (120 +/- 15 compared with 115 +/- 16 mmHg, P < 0.01) and lower pulse pressure values (63 +/- 16 compared with 67 +/- 18 mmHg, P < 0.05) than women. In men, no significant relation between mean arterial pressure and the tested variables was detected; multiple regression analysis demonstrated that age contributed independently to the model for pulse pressure with a multiple r2 of 0.10 (P < 0.01). In women, body mass index contributed independently to the model for mean arterial pressure, with a multiple of 0.12 (P < 0.005); age and, to a lesser extent, body mass index, glycaemia and triglyceridaemia persisted as independent determinants of pulse pressure at the multiple regression analysis, with a multiple r2 of 0.20 (P < 0.001). 4. Our findings suggest that metabolic risk factors are associated differently with pulse pressure and mean arterial pressure values in the two sexes.
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PMID:Sex differences in correlates of steady state and pulsatile component of blood pressure. 898 63

Diabetic cardiopathy represents a cardiac disorder with involvement of myocardial, interstitial, coronary, and neural structures. One of the main manifestations refers to coronary microangiopathy, which has not yet been clearly identified. Coronary hemodynamics, including the determination of coronary flow reserve, were therefore analyzed in normal subjects and in nine patients with NIDDM and clinically suspected coronary heart disease but normal coronary arteriogram. Coronary flow reserve was determined as the quotient of baseline and minimal coronary resistance after dipyridamole (0.5 mg/kg i.v.). Coronary blood flow was measured quantitatively by the argon method. Systolic left ventricular function was analyzed by ventriculography and diastolic function by M-mode and Doppler echocardiography. Twelve healthy normotensive subjects served as the control group (CON). In the diabetic patients, maximal coronary flow was significantly reduced (172 +/- 50 vs. 395 +/- 103 ml/min x 100 g; P < 0.001), and minimal coronary resistance was increased (0.60 +/- 0.19 vs. 0.24 +/- 0.06 mmHg x min x 100 g/ml; P < 0.001). Coronary reserve in the diabetic subjects was markedly reduced (1.84 +/- 0.39 vs. 4.23 +/- 0.52; P < 0.001). No difference existed with respect to myocardial oxygen consumption (12.4 +/- 2.3 vs. 11.8 +/- 2.8 ml O2/100 g x min; NS). Global systolic function was normal in all patients (ejection fraction: NIDDM 72 +/- 13 vs. CON 77 +/- 12%, NS; CI: NIDDM 3.2 +/- 0.8 vs. CON 3.3 +/- 1.2 l/min x m2, NS). Diastolic function was impaired in diabetic patients with an increase in relaxation time index (97 +/- 23 vs. 45 +/- 18 ms; P < 0.01) and an impaired diastolic inflow pattern, indicated by the ratio between early and late transmitral flow (0.75 +/- 0.14 vs. 1.66 +/- 0.13; P < 0.05). We conclude that the markedly reduced coronary flow reserve in diabetic patients may play a key role in the induction and perpetuation of coronary insufficiency in myocardial ischemia, in diastolic and systolic dysfunction, and in the initiation of diabetic cardiopathy.
Diabetes 1997 Sep
PMID:Impaired coronary flow reserve in NIDDM: a possible role for diabetic cardiopathy in humans. 928 13

It is not easy to define a plan for the preoperative assessment of the coronary circulation: some studies carried out in the context of vascular surgery are contradictory and no method has a sensitivity and specificity of 100%. Nevertheless, it is essential to select patients with a high risk of perioperative cardiac complications so that their medical treatment can be reinforced or anatomical correction envisaged. A first assessment is obtained from the history, the clinical examination and simple investigations (resting ECG, chest X-ray). Surgical operations which do not impose a major strain on the cardiovascular system do not require further investigations. The risk of postoperative cardiac complications is low in the absence of the nine risk factors defined by Goldman and/or an ischemic syndrome (residual angina after mild physical activity, unstable angina, myocardial infarct). The problem arises in patients with the Goldman risk factors and/or a history of coronary insufficiency and/or coronary insufficiency risk factors (diabetes, tobacco, hypercholesterolemia, age > 70 years, arterial hypertension), who require an operation likely to cause a particularly serious strain on the cardiovascular system. An exercise ECG, by the Holter method, is helpful, particularly in known or potential coronary arteriopaths who cannot exercise. Echocardiography under dobutamine has good sensitivity and good specificity when exercise is impossible. Thallium-dipyridamole scanning has not been shown to be helpful in vascular surgery. This method could be refined by a quantitative analysis of the number of areas and segments involved. Finally, patients showing ischaemic changes on continuous ECG recording, abnormalities on echocardiography under dobutamine, abnormalities on thallium-dipyridamole myocardial scanning or on exercise ECG, should be considered for coronary angiography with a view to a preliminary anatomical correction.
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PMID:[Preoperative evaluation of coronary circulation]. 955 52

We sought to determine the rate of target vessel revascularization (TVR) after percutaneous transluminal coronary angioplasty (PTCA) and to determine factors that predispose to its occurrence. The 10-year outcome of 2,262 patients in the National Heart, Lung, and Blood institute PTCA Registry was analyzed to determine the incidence and characterize predictors of TVR. TVR was performed in 30.4% of patients. Male gender (relative risk [RR] 1.26; p <0.05), diabetes (RR 1.57; p <0.001), multiple discrete lesions (RR 1.38, p <0.01), diffuse lesions (RR 1.27; p <0.05), and calcium at the lesion site (RR 1.25; p <0.05) were predictors for TVR. TVR was performed early (< or = 1 year) in 18.3% and late (> 1 year) in 12.2%. Age > or = 65 years (RR 1.24; p <0.05), congestive heart failure (RR 1.70; p <0.05), acute coronary insufficiency (RR 1.28; p <0.05), and left anterior descending lesion location (RR 1.34, p <0.01) were significant predictors of early versus late TVR by multivariate analysis. Coronary artery bypass grafting (CABG) rather than PTCA was the TVR procedure in 21% of patients undergoing early TVR and 58% of those undergoing late TVR. Significant independent predictors of CABG as the TVR procedure were multivessel disease (RR 1.97; p <0.001), presence of collateral vessels (RR 1.81; p <0.05), diffuse (RR 1.89; p <0.01), or occluded (RR 1.82; p <0.05) target lesions, and a greater residual stenosis after the initial PTCA (RR 1.19; p <0.001). Age > or = 65 years (RR 0.65; p <0.05) conferred a lower risk for CABG.
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PMID:Incidence and predictors of target vessel revascularization following percutaneous transluminal coronary angioplasty: a report from the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. 1042 35

We describe the case of a young HIV-positive patient undergoing three-drug antiretroviral therapy that included a protease inhibitor for 9 months, who was admitted to the hospital with an acute myocardial infarction. A coronary angiogram revealed occlusion caused by a thrombus in the proximal third of the anterior descending artery. Complete recanalization was obtained after an angioplasty was performed. At the time of the infarction, only the triglyceride levels were found to be high. Metabolic alterations associated with the prolonged use of protease inhibitors have been described such as an increase in the triglyceride and cholesterol serum levels, diabetes, resistance to insulin, lipodystrophy, and pancreatitis. The consequences of chronic hyperlipidemia are well known in the medical literature, especially premature coronary artery disease. No family history of coronary artery disease was identified in this patient. Whether the genesis of this localized coronary thrombosis was due to a change in the metabolism of the vascular endothelium caused by the protease inhibitors, or by related dyslipidemia, is still to be determined. In this case, the data suggest a strong link between coronary insufficiency and prolonged use of the protease inhibitor.
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PMID:Acute Myocardial Infarction in a 34-Year-Old HIV-Positive Female Patient While Undergoing Active Antiretroviral Therapy Containing a Protease Inhibitor. 1108 68

An angiographic study of coronary bed status and relationships of insulin, cortisol, somatotropin (ST), T3, T4, glucose in 109 Q-wave myocardial infarction (MI) patients aged 47 +/- 0.8 years was performed at rest and during veloergometric stress-test ischemia modelling of exercise tolerance in early (21-26 days) and late (> 5 years) follow-up. The hormones level was found to be significantly related to coronary insufficiency as a result of coronary atherosclerosis both at rest and during muscular stress-test. Coronary failure limiting activity of metabolic processes in the myocardium by chronic hypoxia induces changed proportion of hormones regulating energy metabolism processes. In MI hypometabolic syndrome is developing with specific hormonal "ischemic profile" in which during exercise insulin and thyroxin become leading hormones regulating intracellular exchange of energy; the level of cortisol and ST decreases. Increased need in glucose as a main energy substrate during ischemia and therefore in insulin leads to disturbed carbohydrate metabolism in 33% of patients recorded 3-5 years after MI. The above metabolic changes manifest with increased glucose tolerance and/or clinical signs of diabetes mellitus.
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PMID:[Coronary insufficiency and metabolic hormone ratio in patients with myocardial infarction in the course of a long prospective study]. 1121 Mar 45

Combined oral contraceptives (OCs) raise the blood pressure of all women using them. In most cases the elevation is minimal, 4 mm Hg for systolic pressure and 1 mm Hg for diastolic pressure on average, but it is statistically significant and correlated with age and personal history of hypertension. In 4-5% of women the hypertensive effect is frankly pathological. The decline during the 1970s of the estrogen dose from 100 to 50 mcg reduced the hypertensive effect of OCs, but the decline from 50 to 30 mcg did not produce a parallel decline in hypertensive effect. 3 times as many OC users as women in the general population have blood pressures in excess of 160/90. The hypertensive effect of OCs was initially exclusively attributed to estrogens, but evidence has been accumulating of a hypertensive effect of at least the more estrogenic progestins, and there is also evidence that the dose is significant. The limited available data suggest that estrogen replacement therapy at menopause has the same hypertensive effect. The main cardiac risk is coronary insufficiency, which is rare in young women and only increases slightly for OC users in the absence of other vascular risk factors. Data on the effect on cardiac risks of postmenopausal estrogen therapy have been contradictory, with some suggesting that estrogen therapy results in increased rates of coronary insufficiency and others suggesting some protective effect. All studies were agreed that smoking during estrogen therapy presented a significant risk. The coronary risks could be almost eliminated if the classic contraindications of OCs were rigorously respected. Age over 35, hypertension, diabetes, and hyperlipidemia should preclude use of OCs. Natural hormones administered parenterally, such as 17-beta-estradiol and natural progesterone, do not seem to have the same secondary effects as orally administered synthetic hormones. Confirmation of their vascular innocuity will require longterm prospective studies on samples of sufficient size.
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PMID:[Hypertension, heart disease and combined oral contraceptives]. 1228 Jan 98

Treatment of acute coronary insufficiency in diabetics--recent myocardial infarction (MI--unstable angina--uses the same modalities as in the absence of diabetes. Thrombolytics improve the prognosis of MI, although the hospital mortality remains about two fold in the presence of diabetes. Primary angioplasty has an identical success rate, but restenoses are significantly more frequent in diabetics. Systematic use of stents allows a reduction of the restenosis rate to the level observed in the absence of diabetes. In unstable angina, low molecular weight heparins have an efficacy and a safety identical to those observed in non-diabetic patients. There is therefore no limitation to their use. Diabetics present permanent activation of blood platelets which promotes their adhesion and aggregation. Aspirin must therefore be systematically prescribed to diabetic patients, except in the presence of a contraindication, especially gastrointestinal, in which case, ticlopidine can be used. Platelet glycoprotein IIB-IIIA receptor inhibitors have the same indications and provide the same results as in the absence of diabetes. Contrary to a widely held belief, beta-blockers, especially cardioselective, can be widely used in diabetics. The same applies to angiotensin converting enzyme inhibitors. Finally, during the acute phase of coronary insufficiency, continuous insulin infusion via a pump ensures better control of diabetes and also decreases the mortality of MI. Permanent collaboration between cardiologists and diabetologists is therefore essential to increase the efficacy of treatment and to improve the prognosis of acute coronary insufficiency in diabetic patients.
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PMID:[Treatment of coronary insufficiency in diabetics: Part 2: acute coronary insufficiency]. 1255 36

Coronary insufficiency affects 55% of insulin-dependant diabetics and is responsible for 60% of deaths in this population. Its particular severity is essentially due to the severity of coronary atherosclerosis, which is usually multi-vessel, involves both large trunks and microcirculation, is made of frequently lipid-rich and therefore fragile plaques, and is accompanied by abnormal but specific reactions of the arterial wall (tendency to vasoconstriction and increased neointimal proliferation after trauma). Coronary atherosclerosis is also often associated with HT, lower limb arteriopathy or cerebral atherosclerosis. Quality of blood glucose control, other organic lesions of diabetes (nephropathy, retinopathy), disturbances of platelet function and dyslipidaemias (hypercholesterolaemia, hypertriglyceridaemia, increased levels of highly atherogenic small LDL particles) are also involved in the development of coronary insufficiency. A precise knowledge of the diseases to be treated and their particularly rigorous prevention and treatment can improve the prognosis of coronary insufficiency in diabetics.
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PMID:[Treatment of coronary insufficiency in diabetics. Part 1: objectives and targets]. 1255 54

The drug treatment of chronic coronary insufficiency in diabetic patients is now well defined. Platelet antiaggregants, especially aspirin, must be prescribed in the long-term or even indefinitely. Other drugs (beta-blockers, calcium channel blockers, nitrates, etc.) can be used in the same way as in the absence of diabetes. Angioplasty gives immediate favourable results in diabetics, very similar to those obtained in the absence of diabetes. In contrast, the longer term prognosis is less favourable, as the mortability, myocardial infarction, restenosis and bypass graft rates are significantly higher. First-line stenting lowers the restenosis rate to a level comparable to that observed in non-diabetics. However, instrumental revascularization is less complete than surgical revascularization and the number of redilatations and/or secondary bypass grafts remains high. The indications, mortality and early complications of coronary surgery are now identical to those observed in the absence of diabetes. Its long-term results are significantly more favourable than those of medical treatment or even angioplasty, although this issue is still controversial. The improved prognosis observed in operated diabetic coronary patients is due to the more frequent use of arterial bypass grafts. The maintenance of blood glucose control and correction of the frequently associated cardiovascular risk factors (obesity, sedentary lifestyle, smoking, HT, dyslipidaemia) increase the efficacy of treatment of coronary insufficiency in diabetic patients. This goal can only be achieved by permanent, unfailing collaboration between cardiologists and diabetologists.
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PMID:[Treatment of coronary insufficiency in diabetics. Part 3: chronic coronary insufficiency]. 1255 83


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