Cardiovascular Events and Their Reduction With Pravastatin in Diabetic and Glucose-Intolerant Myocardial Infarction Survivors With Average Cholesterol Levels

Goldberg, Ronald; Mellies, Margot J.; Sacks, Frank M.; Moyé, Lemuel A.; Howard, Barbara V.; Howard, W.J.; Davis, Barry R.; Cole, Thomas G.; Pfeffer, Marc A.; Braunwald, Eugene

doi:10.1161/01.cir.98.23.2513

Cited by 879 publications

(442 citation statements)

References 19 publications

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“…Although there were no differences in CVD events (myocardial infarction, stroke, and coronary revascularization) after 3 years between treatment arms in the Diabetes Prevention Program, there were significant reductions in cardiometabolic risk factors in the lifestyle arm, including high triglyceride levels, hypertension, low high‐density lipoprotein, and small dense low‐density lipoprotein 36. In other clinical trials with longer durations of follow‐up, such cardiometabolic risk factor reductions have resulted in reductions in both fatal and nonfatal CVD events 37, 38…”

Section: Discussionmentioning

confidence: 99%

The American Heart Association Ideal Cardiovascular Health and Incident Type 2 Diabetes Mellitus Among Blacks: The Jackson Heart Study

Effoe

Carnethon

Echouffo‐Tcheugui

et al. 2017

JAHA

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BackgroundThe concept of ideal cardiovascular health (CVH), defined by the American Heart Association primarily for coronary heart disease and stroke prevention, may apply to diabetes mellitus prevention among blacks.Methods and ResultsOur sample included 2668 adults in the Jackson Heart Study with complete baseline data on 6 of 7 American Heart Association CVH metrics (body mass index, healthy diet, smoking, total cholesterol, blood pressure, and physical activity). Incident diabetes mellitus was defined as fasting glucose ≥126 mg/dL, physician diagnosis, use of diabetes mellitus drugs, or glycosylated hemoglobin ≥6.5%. A summary CVH score from 0 to 6, based on presence/absence of ideal CVH metrics, was derived for each participant. Cox regression was used to estimate adjusted hazard ratios. Mean age was 55 years (65% women) with 492 incident diabetes mellitus events over 7.6 years (24.6 cases/1000 person‐years). Three quarters of participants had only 1 or 2 ideal CVH metrics; no participant had all 6. After adjustment for demographic factors (age, sex, education, and income) and high‐sensitivity C‐reactive protein, each additional ideal CVH metric was associated with a 17% diabetes mellitus risk reduction (hazard ratio, 0.83; 95% CI, 0.74–0.93). The association was attenuated with further adjustment for homeostasis model assessment for insulin resistance (hazard ratio, 0.89; 95% CI, 0.79–1.00). Compared with participants with 1 or no ideal CVH metric, diabetes mellitus risk was 15% and 37% lower in those with 2 and ≥3 ideal CVH metrics, respectively.ConclusionsThe AHA concept of ideal CVH is applicable to diabetes mellitus prevention among blacks. These associations were largely explained by insulin resistance.

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Section: Discussionmentioning

confidence: 99%

The American Heart Association Ideal Cardiovascular Health and Incident Type 2 Diabetes Mellitus Among Blacks: The Jackson Heart Study

Effoe

Carnethon

Echouffo‐Tcheugui

et al. 2017

JAHA

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“…The Dubbo Study in the Australian elderly failed to confirm prediction of incident ischemic stroke by diabetes [24]. Moreover, several studies have found that subjects with impaired fasting glucose levels have an increased risk of stroke [3,20,42,43].…”

Section: Discussionmentioning

confidence: 99%

“…The UKPDS demonstrated the importance of maintaining good glycaemic control for prevention of the development and progression of complications among patients with type 2 diabetes [44]. Clinical trials have shown that pharmacological treatment of hypertension [45][46][47] and cholesterol reduction with a statin therapy [42,43,[48][49][50] are efficient ways of preventing stroke and other cardiovascular events in patients with diabetes or impaired fasting glucose.…”

Section: Menmentioning

confidence: 99%

The effect of diabetes and stroke at baseline and during follow-up on stroke mortality

Jousilahti

Sarti

et al. 2006

Diabetologia

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Aims/hypothesis The aim of this study was to compare the magnitude of the effect of diabetes and stroke at baseline and during follow-up on risk of stroke mortality. Materials and methods Study cohorts included 25,155 Finnish men and 26,423 women aged 25-74 years. Data on diabetes and stroke history at baseline, their incidence during follow-up, and stroke death were obtained from national registers. Results During a mean follow-up of 18.9 years, 838 stroke deaths were recorded. In the baseline study, hazard ratios (HRs) for stroke mortality were 5.26 for men with prior diabetes only, 4.76 for men with prior stroke only, and 13.4 for men with both prior diabetes and stroke compared with men without diabetes and stroke at baseline and during follow-up. In women, the corresponding hazard ratios were 7.29, 5.27 and 5.52, respectively. When only diabetes and stroke status during the follow-up were considered, the hazard ratios for stroke mortality were 1.41 for men and 1.56 for women with incident diabetes only, 5.62 for men and 5.58 for women with incident stroke only, and 5.59 for men and 4.48 for women with both incident diabetes and stroke compared with men and women without diabetes and stroke at baseline and during follow-up. Conclusions/interpretation Diabetes and stroke, present either at baseline or during follow-up, markedly increase the risk of stroke death. Prior stroke at baseline carries a similar risk of stroke mortality as prior diabetes. There is a greater risk of stroke mortality associated with incident stroke during follow-up than with incident diabetes.

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“…Landmark secondary prevention studies (4S, CARE, LIPID) have provided strong evidence of the clinical benefits of LDL-lowering in people with diabetes [157,158,159]. The Heart Protection study (HPS) included 5348 people with diabetes and 2279 with no previous CHD [160].…”

Section: Consequences Of the Increase Of Vldl 1 Particlesmentioning

confidence: 99%

Diabetic dyslipidaemia: from basic research to clinical practice*

2003

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The recognition that the increase of plasma triglyceride rich lipoproteins (TRLs) is associated with multiple alterations of other lipoproteins species that are potentially atherogenic has expanded the picture of diabetic dyslipidaemia. The discovery of heterogeneity within major lipoprotein classes VLDL, LDL and HDL opened new avenues to reveal the specific pertubations of diabetic dyslipidaemia. The increase of large VLDL 1 particles in Type 2 diabetes initiates a sequence of events that generates atherogenic remnants, small dense LDL and small dense HDL particles. Together these components comprise the atherogenic lipid triad. Notably the malignant nature of diabetic dyslipidaemia is not completely shown by the lipid measures used in clinical practice. The key question is what are the mechanisms behind the increase of VLDL 1 particles in diabetic dyslipidaemia? Despite the advances of recent years, our understanding of VLDL assembly and secretion is still surprisingly incomplete. To date it is still unclear how the liver is able to regulate the amount of triglycerides incorporated into VLDL particles to produce either VLDL 1 or VLDL 2 particles. The current evidence suggests that the machinery driving VLDL assembly in the liver includes (i) low insulin signalling via PI-3 kinase pathway that enhances lipid accumulation into "nascent" VLDL particles (ii) up-regulation of SREBP-1C that stimulates de novo lipogenesis and (iii) excess availability of "polar molecules" in hepatocytes that stabilizes apo B 100. Recent data suggest that all these steps could be fundamentally altered in Type 2 diabetes explaining the overproduction of VLDL apo B as well as the ability of insulin to suppress VLDL 1 apo B production in Type 2 diabetes.Recent discoveries have established the transcription factors including PPARs, SREBP-1 and LXRs as the key regulators of lipid assembly in the liver. These observations suggest these factors as a new target to tailor more efficient drugs to treat diabetic dyslipidaemia. [Diabetologia (2003) 46:733-749]

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Cardiovascular Events and Their Reduction With Pravastatin in Diabetic and Glucose-Intolerant Myocardial Infarction Survivors With Average Cholesterol Levels

Abstract: Diabetic patients and nondiabetic patients with impaired fasting glucose are at high risk of recurrent coronary events that can be substantially reduced by pravastatin treatment.

Cited by 879 publications

References 19 publications

The American Heart Association Ideal Cardiovascular Health and Incident Type 2 Diabetes Mellitus Among Blacks: The Jackson Heart Study

The American Heart Association Ideal Cardiovascular Health and Incident Type 2 Diabetes Mellitus Among Blacks: The Jackson Heart Study

The effect of diabetes and stroke at baseline and during follow-up on stroke mortality

Diabetic dyslipidaemia: from basic research to clinical practice*

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