Among patients with diabetes and stable ischemic heart disease, higher SYNTAX scores predict higher rates of major cardiovascular events and were associated with more favorable outcomes of revascularization compared with medical therapy among patients suitable for CABG. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes; NCT00006305).

Fibrinolytic system proteins in blood and arterial walls [1±6] have been implicated in atherogenesis and in the macroangiopathy typical of non-insulindependent diabetes mellitus (NIDDM). Impairment of fibrinolysis may lead to accumulation of microthrombi that may induce or exacerbate atherogenesis. High concentrations of plasminogen activator inhibitor type-1 (PAI-1) and attenuated fibrinolytic activity are seen in human subjects with obesity, NID-DM, or both [7±10]. Obesity and particularly early stage NIDDM are also characterized by increased concentrations of immunoreactive insulin (IRI) evident in plasma. Several observations suggest a causal connection between hyperinsulinaemia, insulin resistance and impaired fibrinolysis in blood [7±10]. However, the temporal relationships between hyperinsulinaemia, hypertriglyceridaemia, and impaired fibrinolytic system capacity secondary to increased PAI-1 in blood and the onset of macroangiopathy have not yet been elucidated. Accordingly, we studied JCR:LA-cp (corpulent) rats, animals genetically predisposed to develop severe insulin resistance with hyperinsulinaemia, hyperlipidaemia, obesity, and subsequent macroangiopathy [11±14].The JCR:LA-cp atherosclerosis-prone rat strain is one in which many aspects of early NIDDM and atherogenesis are simulated [11±14]. This strain incorporates an autosomal recessive cp (corpulent) gene and JCR:LA-cp rats homozygous for the cp gene (cp/ cp) are obese, insulin resistant, and hypertriglyceridaemic [13]. Heterozygous ( + /cp) and homozygous Diabetologia (1998) Summary Increased concentrations of plasminogen activator inhibitor type-1 (PAI-1) in blood and attenuated fibrinolytic activity, hypertriglyceridaemia, and insulin resistance are common in subjects with obesity and non-insulin-dependent diabetes mellitus who are at markedly increased risk for coronary artery disease. To clarify potentially causal relationships between these phenomena, we studied JCR:LA-cp rats, animals that are insulin resistant and prone to vasculopathy. Blood and aortas were obtained from lean and corpulent animals at 1, 2, 4, 6, and 9 months of age. The homozygous corpulent rats were hyperinsulinaemic and hypertriglyceridaemic at all ages tested. Increased activity of PAI-1 was present in blood from corpulent animals at 1, 6, and 9 months of age. Positive correlations were observed between blood PAI-1 and both insulin and triglycerides. As judged from results with aortic rings in in vitro culture, the increased PAI-1 in blood was anteceded by increased expression of PAI-1 in arterial walls. Thus, changes indicative of inhibition of the fibrinolytic system capacity precede gross atherosclerosis.[ Diabetologia (1998) 41: 141±147]Keywords Atherosclerosis, diabetes, hyperinsulinaemia, hypertriglyceridaemia, plasminogen activator inhibitor-1.Received: 8 July 1997 and in revised form: 23 September 1997Corresponding author: Dr. P. M. Absher, Department of Medicine, Given Building, Room C-323, University of Vermont College of Medicine, Burlington, VT 05405,...

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The magnitude of autophagy in the heart after infarction is of very modest extent and is not modulated by diabetes. Thus, diminution of autophagy is not likely to reduce infarct size or attenuate late negative remodeling after MI in patients with diabetes.

Background. Research has shown less aggressive treatment and poorer control of cardiovascular disease (CVD) risk factors in women than men. Methods. We analyzed sex differences in pharmacotherapy strategies and attainment of goals for hemoglobin A1c (HbA1c), blood pressure (BP), and low density lipoprotein cholesterol (LDL-C) in patients with type 2 diabetes and established coronary artery disease enrolled into the BARI 2D trial. Results. Similar numbers of drugs were prescribed in both women and men. Women were less frequent on metformin or sulfonylurea and more likely to take insulin and to be on higher doses of hydroxymethylglutaryl-CoA reductase inhibitors (statins) than men. After adjusting for baseline differences and treatment prescribed, women were less likely to achieve goals for HbA1c (OR = 0.71, 95% CI 0.57, 0.88) and LDL-C (OR = 0.64, 95% CI 0.53, 0.78). More antihypertensives were prescribed to women, and yet BP ≤ 130/80 mmHg did not differ by sex. Conclusions. Women entering the BARI 2D trial were as aggressively treated with drugs as men. Despite equivalent treatment, women less frequently met targets for HbA1c and LDL-C. Our findings suggest that there may be sex differences in response to drug therapies used to treat diabetes, hypertension, and hyperlipidemia.