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)

The National Cholesterol Education Program NCEP has recently updated their Adult Treatment Panel (ATP) III guidelines and called for more intensive cholesterol treatment, especially in patients at high risk for coronary heart disease CHD. The message from the updated report is that lower is better for high risk patients, with the NCEP expert panel calling for low-density lipoprotein LDL- cholesterol treatment targets of <100 mg/dL in patients at high risk for CHD. In very high risk patients, however, aggressively lowering LDL-cholesterol to <70 mg/dL is now a therapeutic option for clinicians. Very high risk individuals are those with cardiovascular disease plus diabetes, persistent cigarette smoking, poorly controlled hypertension, or multiple risk factors of the metabolic syndrome, and those who recently had a myocardial infarction MI. Despite the strong clinical evidence and widely publicized treatment guidelines, many hyperlipidemic patients receive inadequate lipid-lowering treatment or leave the hospital after having a MI without a statin. Intensive therapy should be considered for all patients admitted to the hospital for acute coronary syndrome. Achieving very low levels of LDL-cholesterol often requires high doses of a statin or a combination therapy. The coadministration of ezetimibe, a new cholesterol-absorption inhibitor, further reduced LDL-cholesterol by 23% compared with those patients who remained on statin therapy alone. Recent trials with statin therapy are discussed in this review.
 ...
PMID:Cholesterol. How low should we go? 1575 46

This paper describes a paper and pencil questionnaire that measures heart disease risk knowledge in people with diabetes. The Heart Disease Fact Questionnaire (HDFQ) is a 25-item questionnaire that was developed to tap into respondents' knowledge of major risk factors for the development of CHD. Approximately half of these items specifically address diabetes-related CHD risk factors. Based on extensive pilot data, the current study analyzed responses from 524 people with diabetes to assess the psychometric properties. The HDFQ is readable to an average 13-year old and imposes little burden. It shows good content and face validity. It demonstrates adequate internal consistency, with Kuder-Richardson-20 formula = 0.77 and good item-total correlations. Item analysis showed a desirable range in P-values. In discriminant function analyses, HDFQ scores differentiated respondents by knowledge of their own cardiovascular health, use of lipid lowering medications, health insurance status, and educational attainment, thus indicating good criterion related validity. This measure of heart disease risk knowledge is brief, understandable to respondents, and easy to administer and score. Its potential for use in research and practice is discussed. Future research should establish norms as well as investigate its test-retest reliability and predictive validity.
 ...
PMID:Development of a questionnaire to measure heart disease risk knowledge in people with diabetes: the Heart Disease Fact Questionnaire. 1595 Aug 40

Cardiovascular disease (especially coronary heart disease ) is the most common complication and cause of death in patients with type 2 diabetes. CHD prevention should be the major focus in preventive care of diabetes patients. There is a solid evidence base from which to recommend aggressive control of elevated blood pressure and lipids to reduce CHD events in diabetes. Aggressive glycemic control alone will not reduce CHD events, but will prevent diabetes-specific microvascular complications. Blood pressure should be treated to a goal of at least 130/80 mm Hg, and possibly lower, using angiotensin-converting enzyme inhibitors, thiazide diuretics, or beta blockers as first-line agents. Low-density lipoprotein cholesterol should be treated with a statin to reduce the level by 30% to 40%, regardless of pretreatment level, to a goal of less than 100 mg/dL for most patients or a goal of less than 70 mg/dL in diabetes patients with CHD. Patients with high-density lipoprotein levels less than 40 mg/dL may benefit from fibrate therapy. Cigarette smoking should be actively discouraged, and prophylactic aspirin therapy should be prescribed for most patients. A regular program of physical activity and weight control should be prescribed to improve insulin sensitivity. Use of thiazolidinediones may be considered early in the course of hypoglycemic therapy, but additional research is needed to define the role of insulin sensitization as a primary means to reduce CHD risk in type 2 diabetes.
 ...
PMID:Prevention of coronary heart disease in diabetes. 1600 57

The polyol isomalt (Palatinit) is a well established sugar replacer. The impact of regular isomalt consumption on metabolism and parameters of gut function in nineteen healthy volunteers was examined in a randomised, double-blind, cross-over trial with two 4-week test periods. Volunteers received 30 g isomalt or 30 g sucrose daily as part of a controlled diet. In addition to clinical standard diagnostics, biomarkers and parameters currently discussed as risk factors for CHD, diabetes or obesity were analysed. Urine and stool Ca and phosphate excretions were measured. In addition, mean transit time, defecation frequency, stool consistency and weight were determined. Consumption of test products was affirmed by the urinary excretion of mannitol. Blood lipids were comparable in both phases, especially in volunteers with hyperlipidaemia, apart from lower apo A-1 (P=0.03) for all subjects. Remnant-like particles, oxidised LDL, NEFA, fructosamine and leptin were comparable and not influenced by isomalt. Ca and phosphate homeostasis was not affected. Stool frequency was moderately increased in the isomalt phase (P=0.006) without changes in stool consistency and stool water. This suggests that isomalt is well tolerated and that consumption of isomalt does not impair metabolic function or induce hypercalciuria. In addition, the study data indicate that isomalt could be useful in improving bowel function.
 ...
PMID:Effects of isomalt consumption on gastrointestinal and metabolic parameters in healthy volunteers. 1619 83

The aim is to assess socio-occupational (SO) class differences in incident coronary and stroke. Methods. In a prospective fixed-cohort study 2959 35-74 year old men free from coronary (CHD) and stroke events were recruited in four population-based cohorts from 1986 to 1994 and followed-up until the end of 2002 to ascertain first CHD and stroke events. At baseline, major cardiovascular risk factors were investigated according to a standardised protocol. SO classes were based on current or last employment. Age-adjusted and multi-factors-adjusted risk ratios (RR) and 95% CI were calculated from Poisson regression models. Results. In 11-year median follow-up, the cohorts accumulated 33,926 person-years and generated 168 first major CHD events and 56 stroke events. Non-manual workers showed the lowest incident rates of both endpoints, and were considered as the reference category. Higher relative risks of CHD events were foundfor lower administrators and professionals, unskilled manual workers (UMW) and self-employed. Higher relative risks of stroke were found for skilled manual workers and UMW. Higher relative risks of CVD (either CHD or stroke) were found for lower administrators and professionals, skilled and unskilled manual workers and self-employed. Adjustments for major risk factors (cholesterol, systolic blood pressure, cigarette smoking, diabetes) did not modify the RRs. Conclusion. The higher risk of major cardiovascular events among lower SO classes is confirmed. Higher relative risks of CHD among lower administrators and professionals, and self-employers were also found. Further studies are needed to assess the etiologic role of job stress conditions.
 ...
PMID:[Incidence risk of major cardiovascular events among socio-occupational classes. 11-year follow-up of the MONICA Brianza and PAMELA cohorts]. 1624 May 72

Statins have a good overall safety profile to date, with no increase in haemorrhagic stroke or cancer. They have favourable effects in the primary prevention of cardiovascular disease in high-risk young as well as elderly populations. Statins reduce the incidence of stroke in high-risk populations (mainly CHD patients, diabetics and hypertensives) even with a normal baseline blood cholesterol level, which argues for a global cardiovascular risk-based treatment strategy. As for CHD, stroke reduction was mainly observed in studies with large between-group LDL cholesterol difference. In patients with prior strokes, statins reduce the incidence of coronary events, but it is not yet proven that they actually reduce the incidence of recurrent strokes in secondary prevention. From a practical point of view, since there was a favourable treatment effect overall in stroke and TIA patients in HPS, it seems reasonable to treat stroke patients with a statin and total cholesterol >135 mg/dL (3.5 mmol/dL). On-going research is aiming to refine patient selection. As anticipated by current US recommendations, patients who are likely to benefit most are those with carotid atherosclerosis, diabetes mellitus, previous coronary heart disease, hypertension, hypercholesterolaemia, or cigarette smoking and LDL cholesterol > 100 mg/dL.
 ...
PMID:Stroke prevention, blood cholesterol and statins. 1625 11

We measured the content of lipid peroxides in plasma LDL from patients with chronic CHD not accompanied by hypercholesterolemia; CHD and hypercholesterolemia; type 2 diabetes mellitus and decompensation of carbohydrate metabolism; and CHD, circulatory insufficiency, and type 2 diabetes mellitus (without hypercholesterolemia). The content of lipid peroxides in LDL isolated from blood plasma by differential ultracentrifugation in a density gradient was estimated by a highly specific method with modifications (reagent Fe(2+) xylene orange and triphenylphosphine as a reducing agent for organic peroxides). The content of lipid peroxides in LDL from patients was much higher than in controls (patients without coronary heart disease and diabetes). Hypercholesterolemia and diabetes can be considered as factors promoting LDL oxidation in vivo. Our results suggest that stimulation of lipid peroxidation in low-density lipoproteins during hypercholesterolemia and diabetes is associated with strong autooxidation of cholesterol and glucose during oxidative and carbonyl (aldehyde) stress, respectively. These data illustrate a possible mechanism of the progression of atherosclerosis in patients with diabetes mellitus.
 ...
PMID:Oxidative stress in atherosclerosis and diabetes. 1625 16

The association between cerium status and risk of first acute myocardial infarction (AMI) was examined in a case-control study in 10 centres from Europe and Israel. Cerium in toenails was assessed by neutron activation analysis in 684 cases and 724 controls aged 70 years or younger. Mean concentrations of cerium were 186 and 173 microg/kg in cases and controls, respectively. Cerium was positively associated with low socio-economic status, smoking, mercury, zinc and scandium (p0.001). Cases had significantly higher levels of cerium than controls after adjustment for age and centre (case-control ratio 1.074; 95% CI 1.002-1.151) and increased in further adjustment for other cardiovascular risk factors 1.085; 95% CI 1.025-1.149. The risk after adjustment for age and centre was higher with increasing cerium levels (p for trend=0.02). After adjustment for BMI, history of hypertension, smoking, alcohol intake, diabetes, family history of CHD, beta-carotene, lycopene, alpha-tocopherol, selenium, mercury and scandium, the OR for the highest quintile was 1.43 (95% CI 0.85-2.41; p-trend 0.08). When we applied this same model in non-smokers the odds ratios in the 4th and 5th quintiles of cerium as compared with the lowest were 2.09 (95% CI 1.05-4.16) and 2.81 (95% CI 1.21-6.52), respectively, p-trend 0.011. Our results suggest that toenail cerium levels may be associated with an increased risk of AMI, but more research is warranted to shed further light and fully understand the plausibility and public health implications of these findings.
 ...
PMID:Toenail cerium levels and risk of a first acute myocardial infarction: the EURAMIC and heavy metals study. 1634 93

It is well known that subjects with type 1 diabetes are at an increased risk of death from coronary heart disease in comparison to non-diabetic age-matched individuals because hyperglycaemia is believed to be a key risk factor for the development of micro- and macrovascular complications. On the other hand there is increasing evidence about the role of inflammatory mediators in the pathogenesis of atherosclerosis and the development of acute coronary syndromes. It has been recently suggested that IL-18 and sICAM-1 have a strong predictive value for cardiovascular diseases and deaths in patients with coronary artery disease and/or in apparently healthy men. The aim of our study was to estimate the serum levels of IL-18 and sICAM-1 in subjects with type 1 diabetes and their relatives, who share HLA diabetic susceptibility genes (with or without pancreatic autoantibodies), but still without glucose level disturbances, as an evaluation of the possible role of genetic predisposition to the presence of IL-18 in diabetic families. The study was carried out in 35 type 1 diabetic subjects, their 101 healthy first-degree relatives: 36 siblings and 65 parents and the control group consisted of 31 healthy volunteers. We have found increased IL-18 and sICAM-1 levels in subjects with type 1 diabetes and their first degree relatives, who share diabetic HLA haplotypes: DRB1*03/DRB1*04 or DRB1*03/*04/DQB1*02 independently of their autoimmune status. There was a strong positive correlation between IL-18 and sICAM-1 levels in diabetic subjects and their first degree relatives without glucose level disturbances. To our knowledge this is the first study, which suggests that sICAM-1 elevations could be a result of IL-18 overproduction in type 1 diabetic subjects and their first degree relatives. Since in previous studies IL-18 and sICAM-1 were found to be predictors of death in subjects with CHD, one could speculate that high levels of IL-18 observed in subjects with genetic predisposition, but still with normal glucose levels, are an in addition to hyperglycaemia, pathogenic factors responsible for a higher risk of acute coronary events in subjects with diabetes type 1.
 ...
PMID:Interleukin 18 and sICAM-1 serum levels in families with type 1 diabetes mellitus. 1635 56

The environment encountered in fetal and neonatal life exerts a profound influence on physiological function and risk of disease in adult life. Epidemiological evidence suggests that impaired fetal growth followed by rapid catch-up in infancy is a strong predictor of obesity, hypertension, non-insulin-dependent diabetes and CHD. Whilst these associations have been widely accepted to be the product of nutritional factors operating in pregnancy, evidence from human populations to support this assertion is scarce. Animal studies clearly demonstrate that there is a direct association between nutrient imbalance in fetal life and later disease states, including hypertension, diabetes, obesity and renal disease. These associations are independent of changes in fetal growth rates. Experimental studies examining the impact of micro- or macronutrient restriction and excess in rodent pregnancy provide clues to the mechanisms that link fetal nutrition to permanent physiological changes that promote disease. Exposure to glucocorticoids in early life appears to be an important consequence of nutrient imbalance and may lead to alterations in gene expression that have major effects on tissue development and function. Epigenetic mechanisms, including DNA methylation, may also be important processes in early-life programming.
 ...
PMID:Developmental programming of health and disease. 1644 49


<< Previous 1 2 3 4 5 6 7 8 9 10