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Query: UMLS:C0042373 (vascular disease)
 17,070 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 1985, an assessment of arterial hypertension treatment in insulin-treated diabetic patient gave disappointing results. In 1988, we carried out another study in order to assess the impact of new antihypertensive drugs (angiotensin converting enzyme inhibitors and calcium antagonists) on the management of arterial hypertension and to identify patients in whom strict normal blood pressure control is mandatory. Seven hundred and fifty four patients were selected. The prevalence of arterial hypertension was 38.4 p. 100 (n = 290). Two hundred and thirty five patients (31.2 p. 100) were on antihypertensive treatment: monotherapy: 60.4 p. 100 (n = 142), bitherapy: 30.6 p. 100 (n = 72), tritherapy: 9 p. 100 (n = 21). In descending order of frequency, the following drugs were used: angiotensin converting enzyme inhibitors, calcium antagonists, diuretics, cardio-selective beta-blockers, central acting agents. Blood pressure values significantly decreased (148/83 mmHg, in 1988, vs 157/85 mmHg, in 1985, p less than 0.05). However, 20 p. 100 of the patients still had blood pressure values greater than or equal to 160 and/or 95 mmHg with or without antihypertensive treatment, and on average, blood pressure values remained higher in patients with antihypertensive treatment than in those without (148/83 mmHg vs 131/77 mmHg, p less than 0.001). Patients with urinary albumin excretion above or equal 30 mg/24 h compared to those with normal albuminuria had significant higher values of blood pressure, glycosylated haemoglobin and blood lipids (p less than 0.01). Only 51 p. 100 of these patients, received an antihypertensive treatment. This study emphasizes the difficulty of antihypertensive treatment in insulin-treated diabetic patients and the necessity to improve education in patients with high risk for widespread angiopathy, and particularly those with increased urinary albumin excretion.
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PMID:[Treatment of arterial hypertension in insulin-treated diabetic patients. Change over 3 years (1985-1988)]. 167 85

The frequency of all forms of atherosclerotic vascular disease is much greater in diabetics than in nondiabetics. Abnormalities in both the quantity and the quality of lipoproteins are among the many factors that can contribute to this. The most frequent quantitative lipoprotein abnormality in diabetics is hypertriglyceridemia. High-density lipoprotein (HDL) levels may be reduced, normal, or increased depending on the type of diabetes, its treatment, and the presence or absence of obesity. Low-density lipoprotein (LDL) levels in diabetics generally are not different from those in nondiabetics. The qualitative changes in lipoprotein composition may include alterations in the C apolipoproteins that could retard very low-density lipoproteins (VLDL) catabolism, enrichment of LDL and HDL with triglyceride, and modifications of LDL (e.g., glycosylation or oxidation) that makes it more atherogenic. The present rationale for the treatment of LDL abnormalities in diabetics is based on extrapolation from intervention trials in nondiabetics. These trials have suggested targets for plasma and LDL cholesterol levels. To date, no similar trials have been conducted in diabetics. Hence, it is not known whether the same or even lower LDL targets should apply to diabetics. Primary intervention trials have also shown the benefits, at least in nondiabetics, of increasing HDL levels. There is increasing evidence to support a cardiovascular risk effect of hypertriglyceridemia and one secondary intervention trial has demonstrated benefit associated with the correction of this. An added benefit of triglyceride reduction, at least in the milder diabetics, appears to be an improvement in insulin sensitivity. Fibrates are the drugs of choice for the correction of hypertriglyceridemia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of various lipid-lowering treatments in diabetics. 171 Jul 44

Plasma endothelin-1 (ET-1) concentrations were measured in 25 patients with non-insulin-dependent diabetes mellitus (11 with angiopathy and 14 without angiopathy) and 21 normal subjects using radioimmunoassay specific to ET-1. Basal plasma immunoreactive (ir) ET-1 levels in diabetic patients with and without angiopathy were 1.73 +/- 0.29 and 1.68 +/- 0.20 pg/ml, respectively. Although high glucose levels may stimulate ET-1 release from vascular endothelial cells in vitro, our data suggest that circulating ET-1 may not be elevated in most diabetic patients with or without angiopathy.
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PMID:Plasma endothelin-1 levels in patients with diabetes mellitus with or without vascular complication. 172 17

Although the pathogenesis of obesity in OZR is unknown, the association among hyperinsulinemia, insulin resistance, and hyperlipidemia suggests that investigations using OZR may help define how a number of vascular disease risk factors interact to cause end-organ damage. Like other rat strains, OZR do not develop atherosclerosis spontaneously. Nevertheless, in an endothelial injury model, atherosclerosis was worse in OZR than in LZR. Perhaps more intriguing is the fact that OZR develop spontaneous glomerular injury. Although the mechanisms important in the development and progression of glomerular injury in OZR remain to be clarified, both lipid abnormalities and glomerular hemodynamic alterations could play a role.
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PMID:The Zucker rat model of obesity, insulin resistance, hyperlipidemia, and renal injury. 173 Apr 47

We review the epidemiology of hypertension in diabetic patients and discuss the implications for treatment. The relationship between coronary heart disease (CHD) mortality and blood pressure (BP) in the World Health Organization Multinational Study of Vascular Disease in Diabetics (WHO MSVDD) is evaluated. One thousand two hundred seventy-seven patients with insulin-dependent diabetes mellitus (IDDM) and 3463 patients with non-insulin-dependent diabetes mellitus (NIDDM), aged 35-55 yr at baseline, from 10 centers throughout the world were evaluated. CHD mortality after a follow-up of 6-7 yr was measured. Estimates of usual diastolic BP were made with data from the Framingham study. The relative risk (RR) of CHD death was plotted against usual diastolic BP for IDDM and NIDDM, and the shapes of the relationship were compared with a meta-analysis of nine prospective studies in nondiabetic populations. For the NIDDM group, the CHD RRs were significantly greater than 1.0 only for the uppermost diastolic BP category (RR 2.23, 95% confidence interval 1.14-4.40). For the IDDM group, the shape of the diastolic BP-CHD relationship was difficult to assess in view of the small number of events. In neither diabetic group was the evidence for a J-shaped relationship. Elevated BP is associated with increased cardiovascular/renal mortality in both types of diabetes. However, the efficacy of antihypertensive therapy in the prevention of these outcomes remains unclear. Prospective data from the WHO MSVDD do not provide clear evidence of benefit from treating diastolic BP less than 95-100 mmHg in NIDDM patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Epidemiology of hypertension in diabetic patients and implications for treatment. 174 58

Using measurements of fibrin fibre thickness (microT) derived from turbidity and permeability (tau) of clotted plasma, it has been found that glucose in vitro added to plasma decreases permeability of the network despite unaltered fibrinogen conversion. Fibrin fibre thickness (microT) in uncontrolled diabetes is found significantly reduced. In diabetic plasma the degree of conversion to fibrin is similar to that in age and sex matched plasma from non-diabetics: the effect on fibrin network and fibre thickness probably arises from glycosylation of fibrinogen. Studies with Gliclazide, Metformin, Glibenclamide and insulin have shown that while all other drugs tested have no effect, Gliclazide increases fibrin fibre thickness (microT) significantly, diminishes tensile strength and reduces permeability. In separate experiments lysability of 125I-labelled fibrin networks developed in the presence of all four hypoglycaemic agents by tissue activator was tested. Networks developed in the presence of Metformin were found to lyse more quickly, followed by insulin and Gliclazide. Alterations induced in fibrin networks in diabetes may be nullified by some oral hypoglycaemic agents such as Gliclazide and not by others. Whether nullification of such changes has long-term effects in reducing the incidence of vascular disease in diabetics remains to be established.
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PMID:Studies on fibrin network structure in human plasma. Part II--Clinical application: diabetes and antidiabetic drugs. 178 32

Three prospective population studies on non-diabetic subjects--the Helsinki Policemen Study, the Busselton Study, and the Paris Prospective Study--have shown that high plasma insulin levels, fasting or after oral glucose load, are associated with an increased risk of coronary heart disease (CHD). The excess of CHD events accumulating in the highest quintiles or deciles for plasma insulin and multivariate analyses suggests that the predictive value of plasma insulin with regard to CHD risk would be independent of blood glucose levels and other major CHD risk factors. Interpretation of the results of multivariate analyses including plasma insulin is, however, complex owing to relatively strong correlations between plasma insulin and several other risk factors. Interaction of the predictive value of plasma insulin with other risk factors, such as obesity, plasma lipids and lipoproteins, and blood pressure also deserves consideration. Analyses of the follow-up data from the Paris Prospective Study have in fact shown that such interaction exists with regard to obesity, high plasma insulin levels being predictive of increased risk of CHD in obese subjects but not in lean subjects. No information is available about the possible relationship between plasma free-insulin levels and atherosclerotic vascular disease (ASVD) in patients with insulin-dependent type diabetes receiving insulin treatment. Information concerning the relationship of plasma insulin to ASVD in subjects with impaired glucose tolerance (IGT) or non-insulin-dependent diabetes (NIDD) is so far fragmentary but suggests that elevated plasma insulin levels would be predictive of increased risk of ASVD in NIDD and its precursor stage, IGT.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hyperinsulinaemia as predictor of atherosclerotic vascular disease: epidemiological evidence. 183 87

Glucose tolerance is determined by the balance of insulin secretion and insulin action and deteriorates with age. Insulin secretion does not appear to be reduced with increasing age, but many recent studies have demonstrated insulin resistance in healthy elderly subjects. However, this has not been a universal finding and the reasons for the discrepant results probably include general health, physical training, changes of liver size and delays in carbohydrate absorption. When confounding factors, particularly physical activity, are taken into account there appears to be little or no change in insulin action with age. Delays in monosacharride absorption may play a role. Maintaining physical fitness throughout middle and older age and so reducing hyperinsulinaemia may have benefits on reducing vascular disease.
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PMID:Review: deterioration of glucose tolerance with age: the role of insulin resistance. 185 96

Type II (non-insulin dependent) diabetes is associated with a high incidence of vascular disease that causes morbidity and mortality. The principal organs affected by this process are the heart, brain and lower limbs. For many years it has been proposed that depression of the fibrinolytic system, which acts to maintain patency of blood vessels, may contribute to the development of vascular disease. A number of pharmacological agents have been shown to enhance circulating fibrinolytic activity of which metformin is perhaps the most interesting because of its low incidence of serious side effects. Early studies with metformin demonstrated an increase in global fibrinolytic activity in patients with coronary artery disease, peripheral vascular disease and diabetes. Recent studies using assays specific for the components of the fibrinolytic system have shown that the effects of metformin are to cause a fall in plasma levels of the fibrinolytic inhibitor, plasminogen activator inhibitor-1 (PAI-1). There is evidence to suggest that the relationship between depressed fibrinolysis and vascular disease is due to high levels of PAI-1, and reasons to believe that a lowering of PAI-1 may be beneficial in this respect. Further studies are warranted to evaluate the long term effects of metformin warranted to evaluate the long term effects of metformin on the incidence of vascular disease in diabetic patients.
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PMID:The effects of metformin on the fibrinolytic system in diabetic and non-diabetic subjects. 193 71

The Paris Prospective Study is a long term investigation of the incidence of coronary heart disease in a large population of working men. The first follow-up examination involved 7,038 men, aged 43-54 years, and free from cardiovascular disease. A 0-2 h 75 g oral glucose tolerance test with measurement of plasma insulin and glucose levels was performed, and the major coronary heart disease risk factors were determined. Subjects with impaired glucose tolerance or diabetes at baseline (n = 943) were selected from the total population for a separate analysis of coronary heart disease mortality risk factors. After a mean follow-up of 11 years, 26 of these 943 subjects with abnormal glucose tolerance had died from coronary heart disease. In multivariate regression analysis using the Cox model, triglyceride plasma level was the only factor positively and significantly associated with death from coronary heart disease (p less than 0.006). After a mean follow-up of 15 years, 37 of the 943 had died from coronary heart disease. Significant multivariate predictors of coronary heart disease death with the Cox model were triglyceride plasma level (p less than 0.03), systolic blood pressure (p less than 0.03), and number of cigarettes per day (p less than 0.05). This epidemiological evidence of the consistency of hypertriglyceridaemia as an important predictor of CHD mortality in subjects with impaired glucose tolerance or diabetes suggests a possible role of dyslipidaemia in the excessive occurrence of atherosclerotic vascular disease in this category of subjects. It remains speculative how this dyslipidaemia can be related to arterial damage, whether by itself or as part of the insulin resistance syndrome.
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PMID:Insulin-resistance, hypertriglyceridaemia and cardiovascular risk: the Paris Prospective Study. 193 89


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