In this population of patients with diabetes and hypertension, we found a significantly higher incidence of fatal and nonfatal myocardial infarction among those assigned to therapy with the calcium-channel blocker nisoldipine than among those assigned to receive enalapril. Since our findings are based on a secondary end point, they will require confirmation.

Serum levels of TBARS were strongly predictive of cardiovascular events in patients with stable CAD, independently of traditional risk factors and inflammatory markers.

U ntrained people with type 2 diabetes have been shown to have a re d u c e d VO 2 m a x c o m p a red with nondiabetic people, even in the absence of card i o v a scular disease (1). In addition, it has been re p o rted that VO 2 kinetics are impaired in women with type 2 diabetes (2). The causes of the exercise impairment are unknown, and thus the physiological and clinical significance of these findings warrants further study.VO 2 m a x is the classic measure of overall c a rd i o re s p i r a t o ry fitness and describes the highest oxygen uptake obtainable by an individual for a given form of exerc i s e despite increased eff o rt and increased work rate. In contrast, VO 2 kinetics measure the e fficiency of the card i o re s p i r a t o ry re s p o n s e to an imposed work demand. Specific a l l y, VO 2 kinetics describe the rate at which the c a rd i o re s p i r a t o ry system is able to deliver oxygen to skeletal muscle and the rate at which oxygen is consumed by skeletal muscle at the beginning of exercise. VO 2 k i n e t i c s a re measured during repeated submaximal constant-load exercise bouts. The rise to steady state is described by a time constant, .is determined by fitting an exponential c u rve to VO 2 kinetics data ( Fig. 1). A slowed is a marker of impaired oxygen delivery and/or extraction. It takes longer for an individual with a slowed to reach steady state.Although the exercise impairments in diabetes have been described, the eff e c t s of e x e rcise training on VO 2 kinetics in untrained women with diabetes and the baseline impairments discussed above are not well described. Although many studies have examined the metabolic effects of e x e rcise training in subjects with diabetes (3-5), fewer investigators have studied the e ffects of exercise training on card i o v a s c ular parameters such as VO 2 m a x in subjects with diabetes (3,4). In addition, the impact of exercise training on VO 2 kinetics in subjects with type 2 diabetes has not been well characterized. It appears that the exerc i s e e ff o rt expended by people with diabetes may be greater for a given workload (even at very low workloads) than for nondiabetic patients (2). Studying the card i o v a scular response to exercise training in diabetes may provide insight into tre a tment recommendations, such as optimal e x e rcise prescriptions, for this common disease with a significantly increased risk of c a rdiovascular morbidity and mort a l i t y.We hypothesized that VO 2 m a x and VO 2 kinetics would improve with exercise training in women with type 2 diabetes. To A b b re v i a t i o n s : A N O VA, analysis of variance; ECG, electro c a rdiogram; FFM, fat-free mass; FSH, folliclestimulating hormone; LOPAR, Low Level Physical Activity Recall Questionnaire; LV, left ventricular; MET, metabolic equivalent; RER, re s p i r a t o ry exchange ratio. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. O B J E C T I V E-Women with uncomplicated t...

Thus, increasing UAE in this large NIDDM population in the U.S. was associated with an increased prevalence of diabetic retinopathy, neuropathy, and cardiovascular disease. This suggests that UAE may be more than an indicator of renal disease in NIDDM patients and, in fact, may reflect a state of generalized vascular damage occurring throughout the body. Prospective studies in NIDDM patients are needed to determine the predictive effect of UAE and the effect of decreasing UAE on future diabetic micro- and macrovascular complications.

In the present study of NIDDM subjects, a significant independent association was demonstrated between diabetic nephropathy and retinopathy with exercise capacity. These results were obtained controlling for age, sex, length of diagnosed diabetes, hypertension, race, and BMI. Thus the findings in this large NIDDM population without a history of coronary artery disease indicate a potential pathogenic relationship between microvascular disease and exercise capacity.