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

Every physician providing care to diabetics will at some time be asked whether driving is allowed. The answer is often determined by the type of sequela that may develop, in particular diabetic retinopathy. Among the metabolic conditions, hypoglycemia is important. But the fitness of a diabetic to drive may be impaired more by such associated conditions as CHD or hypertension than by the diabetes as possible to drive, near-normal glucose levels and intensive counseling are necessary, to ensure not only that the patient can carry out the required control measures, and self-medicate, but also is able to recognize threatening hypoglycemia in good time. Good documentation of the physician's surveillance is the basis for the determination of fitness to drive by an independent expert.
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PMID:[Hypoglycemic and vision impaired. When is a diabetic patient unfit to drive?]. 1285 22

The aim of the present study was to investigate the prognostic value of plasma interleukin-8 (IL-8) for early complications after percutaneous coronary intervention (PCI). The pre- and postprocedural plasma levels of IL-8 and serum C-reactive protein (CRP) were examined by immunoassay, and the expression of CD11b/CD18 on neutrophils was assessed by flow cytometry. Early complications (abrupt occlusion, threatened abrupt occlusion, early recurrence of ischemia, myocardial infarction, cardiac sudden death, and target vessel revascularization) occurred intra-procedure and 30 days after PCI and were observed in 121 consecutive patients with coronary heart disease. Sixteen patients with early complications had high preprocedural levels and high postprocedural differentials of IL-8, CRP, and CD11b/CD18 compared to those without complications (all P < 0.05). The occurrence of complications showed a significant increase in the patients according to the tertiles of IL-8, CRP, and CD11b/CD18. Preprocedural levels of IL-8 (RR = 5.864, CI = 1.658-20.734, P = 0.006) and diabetes (RR = 1.587, CI = 1.246-2.132, P = 0.038) were independent predictors of early complications. There were significant correlations in the postprocedural differential between IL-8 and CD11b/CD18 (r = 0.776, P = 0.002) in patients with complications. The results reveal that the early complications after PCI contribute to preprocedural inflammatory responses. Normal levels of IL-8 may be powerful negative predictors of early complications in patients with CHD following PCI.
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PMID:Plasma levels of IL-8 predict early complications in patients with coronary heart disease after percutaneous coronary intervention. 1290 27

The ATP III report represents an important advance from previous ATP reports dating back to the late 1980s. The guidelines are more tightly evidence-based than previous reports, partly because of evolution of the guideline process, requiring clearly delineated links between evidence and recommendations and also because of the robust evidence base published over the last decade. An important change in ATP III is the expansion of the high-risk category to include patients without evident vascular disease, but with a level of risk equivalent to those patients with established CHD. This group termed "coronary heart disease equivalents" now includes patients with diabetes, and those with a 10-year absolute risk of over 20 percent for CHD events. With the ATP III report, the Framingham risk score is formally introduced into the guideline process. The scoring system allows for easy calculation of the absolute risk for an individual of having a "hard" CHD event (myocardial infarction, or CHD death). The report also discusses in detail concepts of lifetime or long-term risk. ATP III has broadened recommendations for lifestyle change termed "therapeutic lifestyle change (TLC)," and eliminated the step 1 and step 2 diet approach. Finally, the report details established approaches to improve adherence and provides patients and clinicians with a set of implementation tools to enhance use of the guidelines and compliance with the guidelines' recommendations. It is hoped that by improved understanding, recognition of a firm evidence base, and education through multiple channels, that adherence with the new ATP III guidelines will improve the care of our population by more effectively targeting lipid factors that lead to the development and progression of atherosclerotic cardiovascular disease.
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PMID:Report of the Adult Treatment Panel III: the 2001 National Cholesterol Education Program guidelines on the detection, evaluation and treatment of elevated cholesterol in adults. 1462 53

Light to moderate drinking is associated with lower risk of coronary heart (CHD) than non-drinkers. We have examined the relationships between total alcohol intake and type of alcoholic beverage and several potential biological mechanisms. We carried out the study in 3158 men aged 60-79 years drawn from general practices in 24 British towns with no history of myocardial infarction, stroke or diabetes and who were not on warfarin. Total alcohol consumption showed a significant positive dose-response relationship with high density lipoprotein cholesterol (HDL-C), coagulation factor IX, haematocrit, blood viscosity, and tissue plasminogen (t-PA) antigen, and an inverse dose-response relationship with insulin, fibrinogen, von Willebrand factor (vWF) and triglycerides after adjustment for possible confounders. Total alcohol consumption showed weak associations with plasma viscosity and fibrin D-dimer, and no association with factors VII, VIII, or C-reactive protein (CRP). Wine was specifically associated with lower CRP, plasma viscosity, factor VIII and triglycerides. The findings are consistent with the suggestion that HDL-C in particular but also insulin and haemostatic factors may contribute to the beneficial effect of light to moderate drinking on risk of CHD. Wine has effects that may confer greater protection than other alcoholic beverages.
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PMID:The effects of different alcoholic drinks on lipids, insulin and haemostatic and inflammatory markers in older men. 1465 40

The major message from this discussion is that the end points from hypertensive disease (stroke, CHD, and hypertensive emergencies) are now preventable. Cardiac failure and ESRD, however, two exceedingly common end points from long-standing hypertension, remain as major disabilities and causes of death. The former is the most common cause of hospitalization in industrialized societies; hypertension and diabetes mellitus are the most common causes of the latter. The mechanisms of risk of these target organ diseases is not LVH per se, or the elevated arterial pressure alone in the kidney, but the coronary and renal ischemia, organ fibrosis, and, perhaps, apoptosis. Present day therapy now can effectively reverse these costly (economically and by human suffering) complications. Recent experimental studies suggest that, when used early enough, these newer pharmacologic agents may even prevent their occurrences and consequences. The very practical lesson from these experiences is that early detection and treatment of hypertension, effective control of arterial pressure, and the suppression of the underlying disease mechanisms markedly reduce the now increasing prevalence of both cardiac and renal failure.
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PMID:Target organ involvement in hypertension: a realistic promise of prevention and reversal. 1487 Oct 60

The association between scandium status and risk of acute myocardial infarction (MI) was examined in a multicentre case control study in 10 centres from Europe and Israel. Scandium in toenails was assessed in 684 cases and 724 controls less than 70 years of age. Mean concentrations of toenail scandium were 6.74 micro/kg in cases and 7.75 microg/kg in controls. Scandium among controls, adjusted for age and centre was positively associated with concentrations of lycopene and oleic acid in adipose tissue (P = 0.002 for both nutrients). Pearson correlations adjusted for age and centre were significant (P < 0.05) between scandium and lycopene (r = 0.08), zinc (r = 0.08), mercury (r = 0.18) and oleic acid (r = 0.21). Overall, cases had lower levels of scandium than controls after adjustment for age and centre (case control ratio, 0.87; 95% CI 0.79-0.96). This association persisted after adjustment for other cardiovascular risk factors (case-control ratio 0.88; 95% CI, 0.79-0.98). The risk of MI at high scandium levels was reduced after adjustment for age and centre (P-trend = 0.04). Further adjustments for BMI, history of hypertension, smoking, alcohol intake, diabetes, family history of CHD, alpha-tocopherol, beta-carotene, lycopene, selenium and mercury slightly attenuated this trend (P = 0.055). Our results suggest that toenail scandium level is associated with a reduced risk of acute MI, but we are uncertain whether this element can really play a protective role in the development of CHD. Without an identified plausible mechanism, these results should be regarded as preliminary and should be tested in future studies.
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PMID:Association between toenail scandium levels and risk of acute myocardial infarction in European men: the EURAMIC and Heavy Metals Study. 1506 35

The target group for "secondary prevention"--better "risk-adapted prevention"--of CHD are individuals who have suffered a myocardial infarction or have indicator diseases or other risk factor constellations with a cardiovascular risk of > 20% in ten years. The indisputably effective measures include cessation of smoking, blood pressure control with appropriate medications, a Mediterranean diet, maritime omega-3 fatty acids, endurance sports, statin-based lipid management (LDL < 100 mg/dl, triglycerides < 200 mg/dl), a target BMI of 18.5-25, optimized diabetes management, use of platelet aggregation inhibitors, beta blockers and ACE inhibitors. Hormone replacement therapy or vitamin supplementation has been identified as ineffective or mildly dangerous. Other measures have either not become established, or only poorly so. Currently, implementation of the effective measures leaves much to be desired. Quality-controlled close cooperation by the family doctor and cardiologist arguably provides the best long-term care in the area of secondary prevention, but still remains utopian.
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PMID:[Secondary prevention of coronary heart disease]. 1510 29

Type 2 diabetes plays significant roles in pathogenesis of metabolic syndrome. The Japan Diabetes Complications Study(JDCS) is an ongoing trial with 2,205 patients with type 2 diabetes. It is clarified that the frequencies of CHD and stroke events in type 2 diabetic patients are three or more times greater than non-diabetic subjects. Gender, LDL cholesterol, glycohemoglobin A1c and triglycerides are significant age-adjusted risk factors for CHD in patients with type 2 diabetes, while systolic blood pressure and glycohemoglobin A1c are those for stroke. We can conclude from these results that the control of risk factors like LDL cholesterol and blood pressure, together with glycemic control, is essential for preventing CHD and stroke also in Japanese patients with type 2 diabetes.
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PMID:[Prevention and therapeutic strategy of metabolic syndrome--implications from the interim results of Japan Diabetes Complications Study(JDCS)]. 1520 56

Endothelial dysfunction is a feature of atherosclerosis and is associated with CHD (coronary heart disease) risk factors. This study aimed to determine the relationship between the degree of endothelial dysfunction and calculated cardiovascular risk. Endothelial function, as determined by the ACh/NP (acetycholine/sodium nitroprusside response) ratio on brachial plethysmography, was compared with cardiovascular risk as calculated from the Framingham, PROCAM (Prospective Cardiovascular Munster) and MRFIT (Multiple Risk Factor Intervention Trial) algorithms in 246 (187 male) patients, including 44 (22%) with established CHD. Endothelial dysfunction correlated with the total number of risk factors (r2=0.22; P=0.002) and was related to LDL (low-density lipoprotein)-cholesterol in men and triacylglycerols (triglycerides) in women. The ACh/NP ratio correlated with the occurrence of diabetes, CHD and the LDL-cholesterol concentration (r2=0.58; P<0.001). Endothelial dysfunction was associated with presence of CHD on receiver-operating characteristic plot analysis (area=0.706+/-0.04; P=0.001). There was no correlation between ACh/NP ratio and CHD risk calculated with the Framingham algorithm in men, although both ACh and NP response correlated separately with risk in women. The endothelial ACh/NP ratio correlated with absolute risk in the PROCAM algorithm (r2=0.41; P<0.005). Intermediate results were obtained with MRFIT. Individual risk factors make different contributions to endothelial dysfunction compared with their role in risk calculators. The stronger relationship of endothelial dysfunction with PROCAM risk reflects the contribution of male sex, LDL-cholesterol and triacylglycerols to risk calculated by this algorithm.
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PMID:Cardiovascular risk factors and endothelial dysfunction. 1545 2

To elucidate the health effects of air pollution, the short-term association of criteria pollutants (particles <10 microm in diameter [PM(10)], O(3), CO, NO(2), and SO(2)) with hemostatic and inflammatory markers were examined using a population-based sample of 10,208 middle-age males and females of the biracial cohort of Atherosclerosis Risk in Communities (ARIC) study. For each participant, we calculated the following pollutant exposures 1-3 days prior to the randomly allocated cohort examination date: PM(10), CO, NO(2), and SO(2) as 24-h averages, and O(3) as an 8-h average of the hourly measures. The hemostatic/inflammatory factors included fibrinogen, factor VIII-C, von Willebrand factor (vWF), albumin, and white blood cell count (WBC). Linear regression models were used to adjust for cardiovascular disease (CVD) risk factors, demographic and socioeconomic variables, and relevant meteorological variables. One standard deviation (SD) increment of PM(10) (12.8 microg/m(3)) was significantly (P < 0.05) associated with 3.93% higher of vWF among diabetics and 0.006 g/dl lower of serum albumin among persons with a history of CVD. One SD increment of CO (0.60 p.p.m.) was significantly (P < 0.01) associated with 0.018 g/dl lower of serum albumin. Significant curvilinear associations, indicative of threshold effects, for PM(10) with factor VIII-C, O(3) with fibrinogen and vWF, and SO(2) with factor VIII-C, WBC, and serum albumin were found. This population-based study suggest that the hemostasis/inmflammation markers analyzed, which are linked to higher risk of CHD, are associated adversely with environmentally relevant ambient pollutants, with the strongest associations in the upper range of the pollutant distributions, and in persons with a positive history of diabetes and CHD.
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PMID:Association of criteria pollutants with plasma hemostatic/inflammatory markers: a population-based study. 1553 89


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