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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cardiac function was examined in 63 asymptomatic Type 1 (insulin-dependent) diabetic patients, aged 30-50 years, using radionuclide ventriculography and exercise electrocardiography to investigate the possible existence of a specific diabetic heart disease. Comparisons were made with 45 age- and sex-matched non-diabetic controls. Radionuclide ventriculography was performed at rest and during the physiological stresses of isometric exercise, cold-pressor testing and dynamic exercise. Scans were technically satisfactory in 56 of the diabetic patients and 38 of the control subjects. The resting left ventricular ejection fractions and the responses to isometric exercise and cold-pressor testing were similar in the diabetic patients and controls. A smaller rise in the left ventricular ejection fraction during dynamic exercise was observed in male diabetic patients compared with male control subjects (9 +/- 1% (mean +/- SEM) vs 14 +/- 1% (p less than 0.005)). A similar trend was observed in female diabetic patients, with a rise of 5 +/- 1% on dynamic exercise compared with a rise of 8 +/- 1% in the control group. Sixteen diabetic patients (29%) demonstrated an abnormal response to dynamic exercise, and 5 of these had an abnormal exercise electrocardiogram. Cardiac catheterisation and coronary arteriography were performed in eight of these 16 patients, and all 8 had normal coronary arteries. Endomyocardial biopsy revealed arteriolar thickening and interstitial fibrosis in 5 patients, and in 2 patients basement membrane thickening was conspicuous. Thus, in diabetic patients cardiac function may be abnormal without evidence of coronary heart disease, and some patients appear to have the histological changes consistent with a diabetic microangiopathy involving the heart.
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PMID:Cardiac function and coronary arteriography in asymptomatic type 1 (insulin-dependent) diabetic patients: evidence for a specific diabetic heart disease. 380 44

The results from studies in which the effects of the extended feeding of sugars such as sucrose and fructose as compared to starch and other glucose-based carbohydrates on metabolic risk factors associated with heart disease have been reviewed. In general, the feeding of the sugars as compared to starch produced undesirable changes in metabolic risk factors such as blood triglycerides, total cholesterol and its lipoprotein distribution, insulin and uric acid. Other dietary components (e.g., saturated fat) can magnify the adverse metabolic effects of the sugars. A finite segment of the population characterized by high levels of triglycerides and insulin may be at a substantially higher risk than is the general population from the present level of intake of sucrose or fructose.
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PMID:Effect of dietary sugars on metabolic risk factors associated with heart disease. 390 52

Forty percent of patients with insulin-dependent diabetes will develop nephropathy during the course of their disease, thus being the most important single disorder leading to end-stage renal failure (ESRF). Intensive metabolic control delays onset of diabetic nephropathy, the first omen of which is appearance of subclinical albuminuria, also termed microalbuminuria. Moreover, it is now established that intensive treatment of hypertension reduces rate of decline in GFR and thus postpones ESRF. When uremia eventually sets in, a range of biochemical and endocrine abnormalities can be included among those characteristics of diabetes mellitus per se. These include elevated plasma levels of growth hormone, glucagon and free fatty acids, which may participate in the uremic insulin resistance superimposed on the preexisting diabetic carbohydrate intolerance. Hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) are two established modalities of renal replacement therapy in diabetes mellitus. Controlled clinical trials for comparison of CAPD versus HD treatment of diabetics are, however, still needed. The survival rate is approximately 80 and 65-95% in insulin-dependent diabetic patients at 1 year during treatment with HD and CAPD, respectively. However, it is general experience that diabetics on CAPD exhibit a glycemic control, superior to that attained during HD. It has not been proved that patient survival after cadaveric renal transplantation is better than on dialysis. The degree of vascular heart disease seems to be the major determinant for survival of kidney-transplanted diabetic patients.
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PMID:End-state renal failure in diabetic nephropathy: pathophysiology and treatment. 391 47

Despite the paucity of epidemiologic work on congestive heart failure (CHF), the salient features of the natural course of cardiac failure are understood. The estimated 1983 incidence of CHF in the United States was 214,000 men and 184,000 women. The estimate of prevalence was 2.3 million persons, with a remarkable increase with advancing age and higher rates in men than women at all ages. Overt heart disease plus age are the principal determinants of the incidence of CHF. Nearly 90% of patients with CHF have systemic hypertension or coronary heart disease, or both, as the antecedent underlying condition. Diabetes mellitus increases the risk of CHF at all ages, particularly in women and those treated with insulin. The prognosis after diagnosis of CHF is grim and is related to the degree of myocardial dysfunction. The challenge is to develop more effective drugs not only for the management of overt CHF, but also for the prevention of its progression.
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PMID:Epidemiology of congestive heart failure. 396 8

Self-limited edema is a well-recognized complication of insulin therapy. However, progression to overt cardiac failure has only recently been reported in one patient with pre-existing heart disease. This report describes the first case of insulin-induced cardiac failure in a patient without underlying heart disease. Current trends toward intensive insulin therapy for rapid near-normalization of blood glucose levels will increase the recognition of this entity. Careful follow-up of so-called "self-limited" insulin edema is encouraged, and the early institution of diuretic therapy is advocated in elderly patients to prevent the development of overt cardiac failure.
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PMID:Insulin-induced cardiac failure. 401 1

To examine the relation of short- and long-term changes in glucose metabolism to cardiac function, radionuclide cineangiography and echocardiography were performed in 10 young insulin-dependent diabetic patients without clinical evidence of heart disease. Cardiac assessments were performed before and after both acute variations in blood glucose, and induction of chronic "tight glucose control" involving normalization of hemoglobin A1 concentrations. In diabetic patients, left ventricular (LV) ejection fraction (EF) at normal blood glucose concentration was indistinguishable from values in 11 normal subjects. However, during hyperglycemia (about 300 mg/dl), the average EF at rest was 61%, significantly higher than that during normoglycemia (56%, p less than 0.001). No significant change in LV diastolic dimension was noted in association with shifts between high and normal blood glucose concentrations. Normalization of hemoglobin A1 was achieved within 6 to 25 weeks. This alteration had no significant effect on LVEF, mitral valve E-F slope, or the response of systolic function to blood glucose levels. In addition, no correlation was found between LVEF and hemoglobin A1 concentrations in 4 of 5 evaluation periods. Thus, in young insulin-dependent diabetic patients without overt heart disease, variation in blood glucose concentration is associated with small but significant variation in EF at rest; normalization of hemoglobin A1 has no significant effect on LVEF or the response of systolic function to blood glucose levels.
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PMID:Relation of hemoglobin A1 and blood glucose to cardiac function in diabetes mellitus. 405 Jul 2

A review of case series of patients with insulin-dependent diabetes mellitus (IDDM) shows an excess frequency of cardiovascular death and probably myocardial infarction. The excess risk is not well quantitated, not clearly associated with poor control of hyperglycemia, and probably not explained by conventional heart disease risk factors. High-density lipoprotein cholesterol levels are not consistently lower in patients with diabetes than in those without diabetes. The relationship of described abnormalities of the coagulation system in diabetes to cardiovascular disease is unknown. Physiologic and pathologic abnormalities are seen in some younger patients without macrovascular disease, but their importance in relation to the excess cardiovascular morbidity and mortality is obscure.
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PMID:Insulin-dependent diabetes mellitus and ischemic heart disease. 405 56

A series of scales was designed to measure perceived control of diabetes and diabetes-related health beliefs with a view to predicting treatment preferences and individual differences in response to the treatments. Scale development is described and the psychometric properties examined with responses from 286 insulin requiring adult diabetic patients. Patients were significantly more likely (p less than 0.001) to attribute responsibility for their diabetes control to themselves rather than to their medical advisors or to other factors. For most of the patients the benefits of treatment were perceived substantially to outweight any barriers (p less than 0.001). Compared with their perceptions of vulnerability to disorders unrelated to diabetes, patients thought that they were more vulnerable to such diabetes related complications as eye, kidney and foot problems (p less than 0.001) but not to heart disease.
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PMID:Development of scales to measure perceived control of diabetes mellitus and diabetes-related health beliefs. 624

Rats were fed ad libitum diets containing a combination of commonly consumed highly palatable snack foods, a commercial stock diet, or had access to both diets for 10-11 weeks. Rats fed snack foods only had elevations in risk factors associated with heart disease and/or diabetes including serum cholesterol, insulin response to glucose, and serum glucose. Triglyceride levels were not affected by diet. Removable fat pad weights (perirenal and epididymal) were greater in rats fed snack foods than in rats fed only stock diet, even though total body weights were less. Liver glucose 6-phosphate dehydrogenase activity was not affected by diet, but malic enzyme activity was greater in rats fed snack foods only than in the other two groups. These results indicate that some risk factors associated with heart disease and/or diabetes can be elevated by feeding a diet containing commonly consumed snack foods.
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PMID:Effects of a combination of common snack foods on some risk factors in heart disease and diabetes in rats. 635 Apr 3

Since the introduction of insulin, heart disease has become a major impediment to survival in persons with diabetes mellitus. Coronary disease has increased severity and accelerated development in diabetic persons compared with an age- and sex-matched nondiabetic population. A peculiar vulnerability of women to the influence of diabetes with loss of premenopausal coronary disease protection has been found. The symptomatology of coronary events may differ and coronary care data show a higher incidence of sudden death in diabetic patients who have a myocardial infarction than in their non-diabetic counterparts. Insulin may play a role in the myocardial adjustment to an ischemic insult by enhancing glucose intake and suppressing lipolysis and ketogenesis. Carbohydrate intolerance in dogs, rhesus monkeys and humans appears associated with similar histologic and compositional changes in the myocardium. Abnormalities in diastolic ventricular function not attributable to large- or small-vessel coronary disease have been found in the diabetic subjects of each species. Studies in humans who have diabetes have assessed single pressure-volume relationships and more exacting measures of ventricular compliance are needed. Abnormalities of myocardial function in patients with diabetes have been found using echo and radionuclide techniques. Many of these findings need to be correlated with invasive data or confirmed in larger populations. Autonomic dysfunction is common in diabetic persons and may imply an associated poor prognosis. Reflex abnormalities in parasympathetic function are most prevalent and occur before sympathetic dysfunction.
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PMID:The heart in diabetes. 637 49


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