Type 2 diabetes as a "coronary heart disease equivalent" - An 18-year prospective population-based study in Finnish subjects
ABSTRACT The purpose of this study was to investigate the hypothesis that coronary heart disease (CHD) mortality in diabetic subjects without prior evidence of CHD is equal to that in nondiabetic subjects with prior myocardial infarction or any prior evidence of CHD.
During an 18-year follow-up total, cardiovascular disease (CVD) and CHD deaths were registered in a Finnish population-based study of 1,373 nondiabetic and 1,059 diabetic subjects.
Adjusted multivariate Cox hazard models indicated that diabetic subjects without prior myocardial infarction, compared with nondiabetic subjects with prior myocardial infarction, had a hazard ratio (HR) of 0.9 (95% CI 0.6-1.5) for the risk of CHD death. The corresponding HR was 0.9 (0.5-1.4) in men and 1.9 (0.6 -6.1) in women. Diabetic subjects without any prior evidence of CHD (myocardial infarction or ischemic electrocardiogram [ECG] changes or angina pectoris), compared with nondiabetic subjects with prior evidence of CHD, had an HR of 1.9 (1.4-2.6) for CHD death (men 1.5 [1.0-2.2]; women 3.5 [1.8-6.8]). The results for CVD and total mortality were quite similar to those for CHD mortality.
Diabetes without prior myocardial infarction and prior myocardial infarction without diabetes indicate similar risk for CHD death in men and women. However, diabetes without any prior evidence of CHD (myocardial infarction or angina pectoris or ischemic ECG changes) indicates a higher risk than prior evidence of CHD in nondiabetic subjects, especially in women.
SourceAvailable from: Luis Alberto Garcia-Rodriguez[Show abstract] [Hide abstract]
ABSTRACT: Objective To assess the risk of nonfatal ischaemic stroke associated with NSAIDs and paracetamol. The effects of dose, duration of treatment, background cardiovascular (CV) risk and use of concomitant aspirin were studied.Methods We performed a population-based case-control study. Patients were considered exposed if they were on treatment within a 30-day window before the index date. We estimated adjusted odds ratios (ORs) and their 95% CI using logistic regression.Results2888 cases and 20000 controls were included. No increased risk was observed with traditional NSAIDs as a group (OR= 1.03; 0.90-1.19), but results varied across individual agents and conditions of use. An increased risk was found with diclofenac (OR=1.53; 95%CI: 1.19-1.97), in particular when used at high doses (OR=1.62; 1.06-2.46), over long-term periods (>365 days; OR=2.39; 1.52-3.76) and in patients at high background CV risk (OR=1.78; 1.23-2.58), as well as with aceclofenac when used at high doses (OR=1.67; 1.05-2.67), long-term treatments (OR=2.00; 1.14-3.53) and in patients with CV risk factors (OR=2.33; 1.40-3.87). No association was found with ibuprofen (OR=0.94; 0.76-1.17) or naproxen (OR=0.68; 0.36-1.29). The concomitant use of aspirin did not show a significant effect modification. Paracetamol did not increase the risk overall (OR= 0.97; 0.85-1.10), or in patients at high CV risk (OR=0.94; 0.78-1.14).Conclusions Diclofenac and aceclofenac increase the risk of ischaemic stroke while ibuprofen and naproxen do not. Dose, duration and baseline CV risk, but not aspirin use, appear to modulate the risk. Paracetamol does not increase the risk, even in patients at high background CV risk.This article is protected by copyright. All rights reserved.Journal of Thrombosis and Haemostasis 01/2015; DOI:10.1111/jth.12855 · 5.55 Impact Factor
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ABSTRACT: In patients with diabetic kidney disease, it is well documented that RAS blockade is associated with an improved outcome. This observational, multicenter study examined the "real-world" use of ACEI/ARB in patients with type 2 diabetes (T2DM) in China. Data from the China Cardiometabolic Registries on blood pressure, blood lipid and blood glucose in Chinese T2DM patients (CCMR-3B) were used for the present study. Consecutive outpatients with T2DM for more than 6 months were recruited to this non-interventional, observational, cross-sectional study. Albuminuria was defined as urine albumin creatinine ratio (ACR) ≥ 30mg/g. A total of 25,454 outpatients with T2DM from 6 regions in China were enrolled, 47.0% were male, and 59.8% had hypertension. ACR was measured in 6,383 of these patients and 3,231 of them ≥ 30mg/L. Among patients with hypertension, 73.0% were on antihypertensives, and 39.7% used ACEI/ARB. Of the 2,157 patients with hypertension and albuminuria, only 48.3% used ACEI/ARB. Among the non-hypertensive patients with albuminuria, ACEI/ARB usage was < 1%. Multivariate analysis revealed that comorbidities, region, hospital tier, physician specialty and patient's educational level were associated with ACEI/ARB use. In T2DM with hypertension and albuminuria in China, more than half of them were not treated with ACEI/ARB. This real world evidence suggests that the current treatment for patients with diabetes coexisting with hypertension and albuminuria in China is sub-optimal.PLoS ONE 02/2015; 10(2):e0116970. DOI:10.1371/journal.pone.0116970 · 3.53 Impact Factor
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ABSTRACT: Individually, diabetes mellitus, hypertension, and dyslipidemia have been shown to increase the risk of cardiovascular disease. While traditional management of Type 2 diabetes has focused mainly on glycemic control, robust evidence supports the integration of hypertension and dyslipidemia management to reduce the risk of cardiovascular disease. The primary objective of this study was to assess the level of control of blood glucose, blood pressure, and blood lipids (3Bs) among patients with type 2 diabetes. An additional objective was to investigate the impact of hospital type, physician specialty, treatment pattern, and patient profile on clinical outcomes.The American Journal of Medicine 10/2013; 126(10):925.e11-925.e22. DOI:10.1016/j.amjmed.2013.02.035 · 5.30 Impact Factor