Combined Effects of Hemoglobin A1c and C-Reactive Protein on the Progression of Subclinical Carotid Atherosclerosis The INVADE Study
ABSTRACT Glycohemoglobin (hemoglobin A1c [HbA1c]) and high-sensitivity C-reactive protein (hsCRP) are risk indicators for atherosclerosis. Limited information exists regarding the combined effects of inflammation and hyperglycemia. We investigated the joint effects of both parameters on early carotid atherosclerosis progression and major vascular events in diabetic and nondiabetic subjects.
We analyzed the data of INVADE (Intervention Project on Cerebrovascular Diseases and Dementia in the Community of Ebersberg, Bavaria), a prospective, population-based study conducted in 3534 subjects (mean age, 69 years). In addition to common risk factors, measurements of carotid intima-media thickness (IMT), hsCRP, and HbA1c were performed at baseline and after 2 years of follow-up.
For the entire population, IMT progression was significantly related to HbA1c (P=0.003) but not to hsCRP (P=0.06) after risk factor adjustment. The interaction hsCRPxHbA1c was highly significant (P=0.001), and the most pronounced IMT progression was seen in subjects with both parameters in the fourth quartiles compared with subjects with both parameters in the first quartiles (0.028 [0.025, 0.031] versus 0.012 mm/year [0.007, 0.019]; P=0.0013). We observed a significant joint effect of HbA1c and hsCRP on IMT progression in the diabetic (n=882) as well as the nondiabetic subgroup (n=2652). Subjects with HbA1c and hsCRP in the upper 2 quartiles had an increased risk for new vascular events (adjusted hazard ratio in diabetics: 4.3 [1.8, 7.3]; P=0.001; nondiabetics: 2.9 [1.6, 4.7]; P=0.001).
The combination of hyperglycemia and inflammation is associated with an advanced early carotid atherosclerosis progression and an increased risk of new vascular events in diabetic as well as nondiabetic subjects.
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ABSTRACT: Background: Obese youth demonstrate the same obesity-associated morbidities observed in obese adults, including poor cardiorespiratory fitness, poor quality of life, and reports of musculoskeletal pain. The purposes of this study were to compare the prevalence of cardiovascular risk factors and evaluate the odds of metabolic syndrome in obese youth based on measures of cardiorespiratory fitness, quality of life, and pain. Methods: A medical chart review of 183 obese youth in a medical weight management program was conducted. Measures of cardiovascular risk and metabolic syndrome were recorded. Groups were categorized based on Progressive Aerobic Cardiovascular Endurance Run (PACER) score, Pediatric Quality of Life (PedsQL)-Physical Function score, PedsQL-Psychosocial Health score, and reports of musculoskeletal pain. Statistical analysis included independent t-tests, Mann-Whitney U-test, chi-squared test, and logistic regression. Results: Thirty-three percent of the entire sample had C-reactive protein (CRP) levels >3.0 mg/dL and 30% were categorized as having metabolic syndrome. Patients with lower PACER scores demonstrated a greater prevalence of CRP levels >3.0 mg/dL versus those with higher PACER scores (45% vs. 12%; P=0.01). There were no other differences in the prevalence of cardiovascular risk factors or metabolic syndrome when categorized by PACER, PedsQL, or pain. Those with CRP levels >3.0 mg/dL demonstrated increased odds of metabolic syndrome-[odds (95% confidence interval, CI): 4.93 (1.24-19.61); P=0.02]. Conclusions: Overall, results do not show differences in cardiovascular risk in obese youth when categorized by PACER, PedsQL, or reports of MSK pain. Elevated CRP may be a useful predictor of metabolic syndrome in obese youth and warrants further investigation.Metabolic Syndrome and Related Disorders 01/2015; 13(3). DOI:10.1089/met.2014.0107 · 1.92 Impact Factor
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ABSTRACT: Väitekirja elektroonilisest versioonist puuduvad väitekirja aluseks olevate artiklite täistekstid Cardiovascular disease (CVD) is the leading cause of death in people with type 1 diabetes (DM1). In this study we looked at biochemical risk markers of CVD, as well as atherosclerosis-related structural and functional chan¬ges of the arterial wall in children with DM1. Compared to healthy controls, children with DM1 had elevated markers of systemic inflammation (high-sensitivity C-reactive protein), endothelial activation (intercellular cell adhesion molecule-1) and cellular inflammation and oxidative stress (myeloperoxidase). Children with diabetes had higher levels of adiponectin and lower levels of novel atherosclerotic metabolite risk markers (asymmetric dimethylarginine, homocysteine). Systemic oxidative stress (measured by urinary 8-iso-prostaglandin F2a levels) did not differ between children with diabetes and healthy controls. The levels of traditional markers of dyslipidemia did not differ between the diabetes and control groups. Children with DM1 had increased carotid intima-media thickness (IMT) and arterial stiffness. Increased IMT was associated with poor glycaemic control in children with DM1. These results suggest that children with diabetes have atherosclerosis-related changes of the arterial wall as early as five years after the diagnosis. An association has been reported between CVD and osteoporosis. Previous studies have shown that patients with DM1 are also at risk of decreased bone mineral density (BMD) and bone fractures. This study evaluated different BMD parameters in children with DM1. Compared to healthy children, children with DM1 had lower BMD, which was particularly seen in the boys. Poor glycaemic control, elevated markers of inflammation (intercellular cell adhesion molecule-1) and oxidative stress (8-iso-prostaglandin F2a) were associated with lower BMD in patients with DM1. Therefore it is important to pay early attention also to BMD in those patients in addition to classical vascular complications. Südame-veresoonkonna haigused on 1. tüüpi suhkurtõve (DM1) patsientide peamine surma põhjus täis¬kasvanueas. Käesolevas uurimustöös hinnati DM1 põde¬vatel lastel arterite funktsionaalset ja struktuurset seisundit koos bio¬keemiliste südame-veresoonkonna haiguste riskimarkeritega. Võrreldes tervetega oli DM1 grupi lastel kõrgem süsteemse põletiku (kõrgtundlik C-reaktiivne valk), endoteeli aktivatsiooni (intertsellulaarne adhesioonimolekul-1), rakulise põletiku ning oksüdatiivse stressi (müeloperoksidaas) näitajate tase veres. Suhkruhaigetel lastel esines kõrgem adiponektiini ning madalam uute biokeemilis-metaboolsete ateroskleroosi riskimarkerite (asümmeetriline dimetüülarginiin, homotsüsteiin) tase plasmas. Süsteemse oksüdatiivse stressi markeri (8-isoprostaglandiin F2a) tase uriinis ei olnud suhkurtõvega lastel erinev tervetest. Klassikaliste düslipideemia markerite tase seerumis ei erinenud suhkru¬¬haigetel lastel kontrollgrupi omast. DM1 põdevatel lastel esines suurenenud unearteri sise- ja keskkesta paksus (IMT) ning arterite jäikus. Puudulik glükeemiline kontroll oli seotud IMT suurenemisega. Antud tulemused näitavad, et veresoonkonna varased aterosklerootilised muutused esinevad lastel juba viie aasta möödudes suhkurtõve diagnoosimisest. Eelnevad uuringud on näidanud, et südame-veresoonkonna haigused esine¬vad sageli koos osteoporoosiga. Täis¬kasvanu¬eas on DM1 põdevad inimesed ohustatud osteoporoosist ning seeläbi on neil ka suurenenud luumurdude tekke risk. Käesolevas uuringus määrati luutiheduse erinevaid parameetreid DM1 lastel. Suhkruhaigust põdevatel lastel oli luutihedus madalam võrreldes konrollgrupiga. Muutused olid eriti väljendunud poistel. Halb suhkurtõve glükeemiline kontroll, kõrgenenud oksüdatiivse stressi (8-isoprostaglandiin F2a) ning põletiku- ja endoteeli aktivatsioonimarkeri (intertsellulaarne adhesioonimolekul-1) tase olid seotud madalama luutihedusega. Antud tulemustest võib järeldada, et lisaks vaskulaarsetele tüsistustele peab varakult pöörama tähelepanu ka suhkruhaigete laste luutihedusele.
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ABSTRACT: Purpose Metabolic syndrome (MS) is a clinical condition that shares many common characteristics with diabetes. However, unlike diabetes, the usefulness of MS as a prognostic entity in peripheral arterial disease is uncertain. This study evaluated the prognostic usefulness of MS in critical lower limb ischemia (CLI) patients. Materials and Methods We compared the 2-year clinical outcomes in 101 consecutive CLI patients (66±14 years; 78% men) with 118 affected limbs treated with percutaneous transluminal angioplasty (PTA) according to the presence of MS and diabetes. Results The number of MS patients was 53 (52%), of which 45 (85%) had diabetes. During a 2-year follow-up, the incidence of clinical outcomes, including reintervention, major amputation, minor amputation, and survival, was not significantly different between MS and non-MS patients; however, the incidence of minor amputation was significantly higher in diabetic than in non-diabetic patients (42% vs. 17%; p=0.011). Cox regression analysis for the 2-year primary patency demonstrated no association between MS and 2-year primary patency [hazard ratio (HR), 1.02; 95% confidence interval (CI), 0.45-2.30; p=0.961], whereas there was a significant association between diabetes and 2-year primary patency (HR, 2.81; 95% CI, 1.02-7.72; p=0.046). Kaplan-Meier analysis revealed no significant difference in the 2-year primary patency between MS and non-MS patients; however, the 2-year primary patency was lower in diabetic than in non-diabetic patients (p=0.038). Conclusion As a prognostic concept, MS might conceal the adverse impact of diabetes on the prognosis of CLI patients treated with PTA.Yonsei medical journal 01/2014; 55(1):46-52. DOI:10.3349/ymj.2014.55.1.46 · 1.26 Impact Factor