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

Little comparative data exist for glycoprotein IIb/IIIa inhibitors in acute coronary syndromes (ACS). Two hundred twenty-eight patients were studied: 114 received tirofiban (TI) and 114 received abciximab (AB) for either unstable angina (UA) or myocardial infarction (MI). All patients received aspirin, heparin, and ticlopidine or clopidogrel. Baseline characteristics were similar between the 2 groups for admitting diagnosis (UA vs MI), age, gender, ejection fraction, diabetes mellitus, prior coronary artery disease, prior myocardial infarction (MI), prior bypass surgery, hypertension, congestive heart failure, hyperlipidemia, MI type (Q vs non-Q), or location. Drug administration time (mean) was 13 hours (AB) and 24 hours (TI). All AB was administered in the catheterization laboratory as compared to TI (34% in laboratory and 66% before laboratory). More AB patients received angioplasty or stent (92% vs 80%, p = 0.008) while more TI patients had CABG (10% vs 3%, p = 0.027). In-hospital complications including death, MI, urgent revascularization, cerebrovascular accidents or transient ischemic attacks, and access site bleeding were similar (p = NS). Multivariate predictors of events (odds ratios) were prior coronary artery bypass graft (2.3), diabetes (1.7), and prior percutaneous transluminal coronary angioplasty (1.7), but not the agent used. Over a mean follow-up of 13 months, the individual endpoints of death, MI, revascularization, or hospitalization were similar for both groups. The AB patients had improved freedom from revascularization (100% vs 81%, p = 0.015) in an emergent setting and TI patients had improved freedom from revascularization (93% vs 77%, p = 0.038) with elective procedures. Tirofiban and abciximab appear effective and safe when used for ACS when recommended dosing and precautions are followed. Major adverse outcomes are rare and bleeding complications uncommon.
 ...
PMID:Differential benefits and outcomes of tirofiban vs abciximab for acute coronary syndromes in current clinical practice. 1267 97

Diabetes mellitus affects about 6% of the U.S. population and represents a significant public health challenge, with numbers of those affected increasing every year. The most common cause of death in these patients is macrovascular disease, with coronary disease being the predominant form. The pathophysiology of coronary disease in patients with diabetes is complex and involves elements of hyperglycemia, dyslipidemia, hyperinsulinemia, as well as a procoagulant vascular milieu. First-generation trials looking at revascularization of multivessel disease in patients with diabetes have had long clinical follow-up periods and seem to consistently favor coronary bypass grafting over percutaneous interventions; however, newer trials that include the use of stents and glycoprotein IIb/IIIa inhibitor therapy as part of the latter strategy have raised some interesting questions, so that the issue remains controversial and by no means settled.
 ...
PMID:Diabetes mellitus and coronary artery disease: therapeutic considerations. 1271 79

Atherosclerotic heart disease is the leading cause of death in patients with diabetes mellitus. Platelets play a major role in the clinical manifestations of ischemic heart disease. Diabetic patients have hyperreactive platelets with exaggerated adhesion, aggregation and thrombin generation. Antiplatelet agents, including aspirin, clopidogrel, and glycoprotein IIb/IIIa inhibitors, have shown significant efficacy in reducing recurrent ischemic events in patients with diabetes. Treatment with glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention reduces mortality in diabetic patients.
 ...
PMID:Platelets and antiplatelet therapy in patients with diabetes mellitus. 1273 Jun 35

Currently, an invasive strategy is highly recommended in the management of patients with an acute coronary syndrome without persistent ST segment elevation. This early invasive strategy using angiocoronarography allows the identification of the culprit lesion which can be very frequently treated by stent implantation. The use of glycoprotein IIb/IIIa receptor inhibition is recommended especially for high risk patients, not only for the early benefit during medical treatment but also for the additional protection during percutaneous coronary intervention. Patients with left main or three-vessel disease, especially those with associated left ventricular dysfunction or diabetes, are usually managed with coronary artery bypass graft.
 ...
PMID:[Myocardial revascularization in acute coronary syndrome without ST-segment elevation]. 1274 49

Prior studies have reported significant gender differences in the procedural outcomes after elective percutaneous transluminal coronary angioplasty (PTCA). Many of these differences have been explained by the presence of more comorbidities and worse clinical characteristics such as older age, unstable angina, congestive heart failure, diabetes mellitus, and hypertension in women than in men. Moreover, women have a smaller vessel diameter, more coronary tortuosity and different plaque composition compared to men that can lead to a higher dissection rate and a greater number of procedural complications. Although early data on PTCA suggested worse immediate results in women than in men, more recent data suggest that this difference is less marked. The introduction of stents with a low profile and a higher tractability and pushability has allowed the extensive application of these devices even in small and tortuous vessels improving the outcome of PTCA. This improvement has been higher in women than in men leading to the equalization of the immediate outcome in the two sexes, even if the baseline characteristics remain worse in women. In particular, mortality and the need for urgent surgical revascularization have become extremely low without any differences between sexes. However, some authors have still found a higher incidence of complications in the first period after the procedure due to stent thrombosis in the stenting era. For this reason, meticulous antiplatelet treatment should be prescribed and drugs such as glycoprotein IIb/IIIa inhibitors may also be considered advisable to reduce the excess risk in the female population particularly in women with prothrombotic risk factors such as diabetes. At 6 and 12 months similar rates of death, late myocardial infarction, and repeated revascularization have been shown in the two sexes. Coronary stenting and the use of glycoprotein IIb/IIIa inhibitors have also improved the immediate results in patients with acute myocardial infarction (AMI) undergoing primary PTCA. Studies comparing the outcome differences between women and men with AMI and treated with primary PTCA are limited but all suggest that women benefit more than men from this procedure. The in-hospital mortality in patients with AMI is significantly higher in the female than in the male population with a higher incidence of intracranial hemorrhage in women among tissue-type plasminogen activator-treated patients. Vice versa, women and men have a similar or a slightly higher in-hospital mortality after primary PTCA without intracranial bleeding complications. For this reason, an earlier diagnosis of AMI, an earlier hospital admission and an earlier primary PTCA should be the aims of management in order to improve the outcome in women with AMI and to equalize the procedural results in the two sexes.
 ...
PMID:Gender differences in the outcome of interventional cardiac procedures. 1456 77

Using univariate and multivariate analyses, we evaluated the relation between ischemic and bleeding complications and peak procedural activated clotting time (ACT) in patients undergoing percutaneous coronary intervention whose coronary narrowings were treated with stent implantation. Of the 2,280 patients who qualified for the study, 29% had diabetes mellitus, and 91% received glycoprotein IIb/IIIa inhibitors. The median for ACT was 276 seconds (interquartile range 243 to 317). The incidence of ischemic events by ACT quartiles was 6.3%, 7.5%, 8.1%, and 7.1%, respectively (p=0.71). The incidence of bleeding complications was 6.6%, 5.9%, 6.9%, and 7.3%, respectively (p=0.81). ACT did not independently predict either ischemic or hemorrhagic complications.
 ...
PMID:Revisiting optimal anticoagulation with unfractionated heparin during coronary stent implantation. 1467 90

Patients with diabetes have an increased risk of coronary artery disease, and are at an increased risk of mortality and morbidity with coronary revascularization procedures. This article provides a review of the currently available information on percutaneous coronary intervention (PCI) in the diabetic patient. The effectiveness of PCI in diabetes is discussed, and the factors that may influence outcomes are explored. Recent developments in PCI procedures, such as stents and drug-eluting stents, glycoprotein IIb/IIIa inhibitors and brachytherapy, are evaluated in terms of their ability to improve the prognosis in this patient group.
 ...
PMID:Angioplasty in the diabetic patient. 1469 19

Radiolabeled peptides have been investigated for diagnostic imaging in a variety of non-oncologic diseases. For imaging thromboembolic disease, peptides which bind to various components of thrombi have been tested. For targeting the fibrin component of thrombi, peptide analogues of fibrin or fragments of fibronectin which have a distinct binding domain for fibrin have been studied. For targeting activated platelets within thrombi, linear and cyclic peptide antagonists of the glycoprotein IIb/IIIa receptor on platelets have been studied, as well as naturally occurring antagonists of this receptor which are found in venoms. Analogues of laminin and thrombospondin which bind to other receptors on platelets have also been tested. There is an approach which uses a peptide to target thrombin which is sequestered within a fibrin clot. Another area of investigation has been to develop an improved radiopharmaceutical for imaging sites of infection and/or inflammation. Peptides which would bind to leukocytes in vivo, such as antagonists to the tuftsin receptor, chemotactic peptides, interleukin-8, or a platelet factor 4 analogue, have been radiolabeled for this purpose. These agents would enable imaging of both infection and inflammation. Development of a radiopharmaceutical for specifically imaging infection has focused on antimicrobial peptides such as human neutrophil defensin, ubiquicidin, human lactoferrin and alafosfalin, which are expected to bind selectively to microorganisms and not to leukocytes. Radiolabeled peptides are also being explored as agents for assessing unstable atherosclerotic plaque (endothelin), amyloid deposits (amyloid beta peptides), and the consequences of diabetes mellitus (human C-peptide).
 ...
PMID:Non-oncologic applications of radiolabeled peptides in nuclear medicine. 1497 20

The increasing prevalence of diabetes mellitus and its association with cardiovascular disease have become serious public health issues. Although diabetes and coronary artery disease (CAD) may have different clinical manifestations, their atherosclerotic burden and prognosis are quite similar. However, patients with diabetes who have underlying CAD have a different, more complex pathophysiology and a worse prognosis. Optimal management of these patients requires a comprehensive multifactorial approach to prevent microvascular and macrovascular events. In the setting of an acute myocardial infarction (MI), immediate management should focus on limiting infarct size. This can be achieved by using fibrinolytic agents, primary percutaneous intervention (in ST-segment elevation MI), or glycoprotein IIb/IIIa inhibitors followed by coronary angiography within 24 to 48 hours and, when appropriate, by coronary intervention (in non-ST-segment elevation MI). Drug-eluting stents may have an important role in patients with diabetes, who have a higher rate of postintervention coronary restenosis than do nondiabetic individuals. In addition, all patients with an acute MI (ST- and non-ST-segment elevation) should be given aspirin, nitrates, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors. The long-term pharmacologic management after MI is similar in all patients, regardless of the initial presentation. Antiplatelet agents (aspirin and/or clopidogrel), ACE inhibitors, beta-blockers, lipid-lowering agents, and glycemic control have all been shown to be effective in decreasing long-term mortality. Despite advances in the management of MI, the mortality rates of patients with diabetes remain 1.5- to 2-fold greater than those of persons without diabetes. Maximizing the use of lifesaving therapies proved effective in large randomized clinical trials and tight metabolic control can further decrease mortality rates. However, many of these lifesaving therapies are underused in patients with diabetes because of the misconception that potential adverse effects may outweigh their benefits. New programs aimed at improving postinfarction quality of care in patients with diabetes, based on guidelines and expert recommendations, have shown promise. However, more effort must be devoted to the improvement of outcomes related to these public health problems.
 ...
PMID:Management of the patient with diabetes mellitus and myocardial infarction: clinical trials update. 1501 63

The vast majority of acute coronary syndrome (ACS) trials conducted over the past two decades support the view that women have persistently higher mortality and morbidity despite the introduction of new medical therapies and devices. Even after adjustment for older age, higher prevalence of diabetes, hypertension, heart failure, smaller vessel size, and late presentation, some studies still point to a persistent sex disadvantage. Even in contemporary practice, women continue to have longer delays in presentation and treatment. Selection bias in unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) trials allows inclusion of large numbers of women with clinically insignificant coronary disease and may mistakenly shift results toward apparent benefit of a less aggressive approach. This bias causes further difficulty in determining efficacy and safety of new antithrombotic agents such as direct thrombin inhibitors and glycoprotein IIb/IIa inhibitors across the spectrum of ACS. In trials of UA/NSTEMI, use of objective evidence of ischemia such as elevated troponin levels, would greatly assist the determination of efficacy and benefit in women. Enrollment of more women in clinical trials and timely sex-specific analysis would promote a better understanding of the role of female gender in ACS and would facilitate better care of all patients.
 ...
PMID:Acute coronary syndromes in women: is treatment different? Should it be? 1518 98


<< Previous 1 2 3 4 5 6 7 Next >>