Coronary heart disease (CHD) is the leading cause of morbidity and mortality in patients with diabetes. Asymptomatic CHD in these patients is elusive and carries a poor prognosis given the fact that an unheralded acute myocardial infarction or sudden cardiac death frequently constitutes its first presentation. Because effective screening for asymptomatic patients with type 2 diabetes for both the presence and severity of CHD is intuitively appealing, we have summarized the utility and prognostic value of various diagnostic modalities (both functionally and anatomically) in enhancing risk stratification and leading to improved and more aggressive management of the risk factors. There exist some evidence and recommendations for screening of asymptomatic persons with diabetes using certain modalities. More research is needed to define potential subsets of patients with diabetes who may benefit from additional testing for asymptomatic CHD.
"Should every diabetic undergo a diagnostic test? The answer is most probably no even if the question is still open . Let's use a Bayesian approach: according to the UKPDS risk calculator , my pre-test probability fell in the range of 20–25%; almost the same results were obtained using the Mayo Clinic instrument which purported similar results (I had a score of 18, therefore falling at the border between average and elevated risk) . "
[Show abstract][Hide abstract] ABSTRACT: Considering the reduced ability of cardiac fibroblasts to release adenosine and increased ability of interstitial adenosine uptake during diabetes mellitus, the present study investigated the effect of adenosine preconditioning and the existence of cross-talk with opioid receptor activation in the diabetic rat heart subjected to ischemia-reperfusion (I/R). Langendorff-perfused normal and streptozotocin (65 mg/kg, i.p., once)-administered diabetic (after 8-weeks) rat hearts were subjected to 30-min global ischemia and 120-min reperfusion. Myocardial infarct size using triphenyltetrazolium chloride staining, markers of cardiac injury such as lactate dehydrogenase (LDH) and creatine kinase (CK-MB) release, coronary flow rate (CFR) and myocardial oxidative stress were assessed. The diabetic rat heart showed high degree of I/R injury with increased LDH and CK-MB release, high oxidative stress and reduced CFR as compared to the normal rat heart. The adenosine preconditioning (10 μM) afforded cardioprotection against I/R injury in the normal rat heart that was prevented by naloxone (100 μM) pre-treatment. Conversely, adenosine preconditioning-induced cardioprotection was abolished in the diabetic rat heart. However, co-administration of dipyridamole (100 μM), adenosine reuptake inhibitor, markedly restored the cardioprotective effect of adenosine preconditioning in the diabetic rat heart, and this effect was also abolished by naloxone pre-treatment. The reduced myocardial availability of extracellular adenosine might explain the inability of adenosine preconditioning to protect the diabetic myocardium. The pharmacological elevation of extracellular adenosine restores adenosine preconditioning-mediated cardioprotection in the diabetic myocardium by possibly involving opioid receptor activation.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the impact of a steroid-free regimen with tacrolimus and mycophenolate mofetil (modified therapy) versus a standard regimen of tacrolimus and steroids on the cardiovascular risk score of liver transplant recipients. Patients who received a liver transplant were randomized to a modified therapy (n=58) or a standard regimen (n=59). Both groups were balanced at baseline, except for a higher prevalence of diabetes mellitus (DM) (p<0.01) and a higher serum creatinine concentration (p <0.05) in the modified therapy group. After 12-months, the prevalence of new-onset DM, arterial hypertension, hypercholesterolemia, hypertriglyceridemia and changes in cardiovascular risk factors were similar in both groups. The increase in serum creatinine (mg/dL) compared to baseline at 1 year post-transplantation was numerically lower in the modified therapy group (0.22±0.42) than in the standard regimen group (0.41±0.67) (p=0.068). Although estimated cardiovascular risk score did not vary significantly compared to baseline in either group, there was a slight reduction in the modified regimen (-0.27±2.87), versus a mild increase (0.17±2.94) in the standard regimen (p=0.566). In conclusion, a steroid-free regimen with tacrolimus and mycophenolate mofetil was associated with a trend towards better preservation of kidney function and reduction of cardiovascular risk score. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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