Diabetes Mellitus

Kuller, Lewis H.; Velentgas, Priscilla; Barzilay, Joshua I.; Beauchamp, Norman J.; O’Leary, Daniel H.; Savage, Peter J.

doi:10.1161/01.atv.20.3.823

Cited by 156 publications

(56 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recently, we have shown that subclinical CVD is the primary determinant of incident clinical CVD in individuals with glucose disorders (2). Considering the high prevalence of isolated subclinical CVD among participants with glucose disorders, efforts at CVD risk factor reduction in those without clinical CVD seem warranted.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence of Clinical and Isolated Subclinical Cardiovascular Disease in Older Adults With Glucose Disorders

et al. 2001

Self Cite

View full text Add to dashboard Cite

OBJECTIVE -Clinical cardiovascular disease (CVD) is highly prevalent among people with diabetes. However, there is little information regarding the prevalence of subclinical CVD and its relation to clinical CVD in diabetes and in the glucose disorders that precede diabetes. RESEARCH DESIGN AND METHODS -Participants in the Cardiovascular HealthStudy, aged Ն65 years (n ϭ 5,888), underwent vascular and metabolic testing. Individuals with known disease in the coronary, cerebral, or peripheral circulations were considered to have clinical disease. Those without any clinical disease in whom CVD was detected by ultrasonography, electrocardiography, or ankle arm index in any of the three vascular beds were considered to have isolated subclinical disease.RESULTS -Approximately 30% of the cohort had clinical disease, and ϳ60% of the remainder had isolated subclinical disease. In those with normal glucose status, isolated subclinical disease made up most of the total CVD. With increasing glucose severity, the proportion of total CVD that was clinical disease increased; 75% of men and 66% of women with normal fasting glucose status had either clinical or subclinical CVD. Among those with known diabetes, the prevalence was ϳ88% (odds ratio [OR] 2.46 for men and 4.22 for women, P Ͻ 0.0001). There were intermediate prevalences and ORs for those with impaired fasting glucose status and newly diagnosed diabetes.CONCLUSIONS -Isolated subclinical CVD is common among older adults. Glucose disorders are associated with an increased prevalence of total CVD and an increased proportion of clinical disease relative to subclinical disease.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Subclinical disease is a strong risk factor for clinical CVD (1)(2)(3)(4). Knowledge of the prevalence of subclinical disease in asymptomatic patients is therefore of interest to the clinician for the purposes of risk stratification.…”

mentioning

confidence: 99%

Prevalence of Clinical and Isolated Subclinical Cardiovascular Disease in Older Adults With Glucose Disorders

et al. 2001

Self Cite

View full text Add to dashboard Cite

show abstract

“…Moreover, in uncomplicated well-controlled type 2 diabetes, LV dysfunction detected by echocardiography has been associated with impaired functional capacity observed in these patients [2]. A follow-up study over 6.4 years demonstrated that diabetic subjects had a higher prevalence of clinical and subclinical cardiovascular disease at baseline, and the presence of subclinical cardiovascular disease and diabetes was associated with significantly increased adjusted relative risk of death, relative risk of incident coronary heart disease, and incident myocardial infarction [3]. Thus, subclinical cardiovascular disease is an important determinant of clinical cardiovascular disease among diabetic patients, and the detection of subclinical cardiovascular disease in these patients may provide an approach for identifying high-risk individuals who may benefit from earlier and more active intervention to prevent clinical disease.…”

Section: Introductionmentioning

confidence: 99%

Determinants of subclinical diabetic heart disease

et al. 2005

View full text Add to dashboard Cite

Aims/hypothesis: Subclinical left ventricular (LV) dysfunction has been shown by tissue Doppler and strain imaging in diabetic patients in the absence of coronary disease or LV hypertrophy, but the prevalence and aetiology of this finding remain unclear. This study sought to identify the prevalence and the determinants of subclinical diabetic heart disease. Methods: A group of 219 unselected patients with type 2 diabetes without known cardiac disease underwent resting and stress echocardiography. After exclusion of coronary artery disease or LV hypertrophy, the remaining 120 patients (age 57±10 years, 73 male) were studied with tissue Doppler imaging. Peak systolic strain of each wall and systolic (Sm) and diastolic (Em) velocity of each basal segment were measured from the three apical views and averaged for each patient. Significant subclinical LV dysfunction was identified according to Sm and Em normal ranges adjusted by age and sex. Strain and Em were correlated with clinical, therapeutic, echocardiographic and biochemical variables, and significant independent associations were sought using a multiple linear regression model. Results: Significant subclinical LV dysfunction was present in 27% diabetic patients. Myocardial systolic dysfunction by peak strain was independently associated with glycosylated haemoglobin level (p<0.001) and lack of angiotensin-converting enzyme inhibitor treatment (p=0.003). Myocardial diastolic function (Em) was independently predicted by age (p=0.013), hypertension (p=0.001), insulin (p=0.008) and metformin (p=0.01) treatment. Conclusions/interpretation: In patients with diabetes mellitus, subclinical LV dysfunction is common and associated with poor diabetic control, advancing age, hypertension and metformin treatment; ACE inhibitor and insulin therapies appear to be protective.

show abstract

“…Even subjects with milder disturbances in glucose metabolism, such as IGT, are at an increased risk of cardiovascular disease [3,4].…”

Section: Introductionmentioning

confidence: 99%

Improved fibrinolysis by an intensive lifestyle intervention in subjects with impaired glucose tolerance. The Finnish Diabetes Prevention Study

et al. 2005

View full text Add to dashboard Cite

Aims/hypothesis: The aim of this study was to investigate the effects of lifestyle intervention on the levels of plasminogen activator inhibitor (PAI-1) and fibrinogen in subjects participating in the Finnish Diabetes Prevention Study (DPS). Methods: In five DPS centres, 321 subjects with impaired glucose tolerance (intervention group, n= 163; control group, n=158) had their PAI-1 and fibrinogen levels measured at baseline and at the 1-year follow-up. Additional 3-year follow-up assessments were carried out in a sample of 97 subjects in one of the DPS centres (Turku). The intervention programme included an intensive lifestyle intervention aiming at weight reduction, healthy diet and increased physical activity. Results: During the first intervention year, PAI-1 decreased by 31% in the intervention group but showed no change in the control group (p<0.0001). In the Turku subgroup, the decrease in PAI-1 persisted throughout the 3-year follow-up. Changes in PAI-1 were associated with the number of lifestyle changes made during the first year (p=0.008). Weight reduction was the most important factor explaining the decrease in PAI-1. Changes in fibrinogen levels did not differ between the groups. Conclusions/interpretation: In addition to the previously reported reduction in the risk of type 2 diabetes in DPS participants with impaired glucose tolerance, the intensive dietary and exercise intervention had beneficial long-term effects on fibrinolysis as indicated by the reduced levels of PAI-1. These results suggest that elevated PAI-1 levels in obese subjects with impaired glucose tolerance are mostly reversible by lifestyle changes, especially those geared to weight reduction.

show abstract

Diabetes Mellitus

Cited by 156 publications

References 44 publications

Prevalence of Clinical and Isolated Subclinical Cardiovascular Disease in Older Adults With Glucose Disorders

Prevalence of Clinical and Isolated Subclinical Cardiovascular Disease in Older Adults With Glucose Disorders

Determinants of subclinical diabetic heart disease

Improved fibrinolysis by an intensive lifestyle intervention in subjects with impaired glucose tolerance. The Finnish Diabetes Prevention Study

Contact Info

Product

Resources

About