Effect of valsartan on left ventricular anatomy and systolic function and aortic elasticity

Khaodhiar, Lalita; Brennan, Aoife M.; Lima, Christina; Chan, Jean L.; Mantzoros, Christos S.; Manning, Warren J.; Danias, Peter G.; Veves, Aristidis

doi:10.1016/j.metabol.2009.01.009

Metabolism

2009

DOI: 10.1016/j.metabol.2009.01.009

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Effect of valsartan on left ventricular anatomy and systolic function and aortic elasticity

Lalita Khaodhiar

Aoife M. Brennan

Christina Lima

et al.

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“…Obesity is a causal risk factor for both type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA), such that the presence of OSA in those with T2DM is extremely common with estimates as high as 87% (2). Although both conditions are independently recognized as risk factors for cardiovascular disease (3)(4)(5), few studies have addressed their interaction (6,7). If such an interaction exists, then OSA may represent a plausible treatment target to lower cardiovascular complication rates in patients with T2DM.…”

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The Effect of Continuous Positive Airway Pressure on Vascular Function and Cardiac Structure in Diabetes and Sleep Apnea. A Randomized Controlled Trial

et al. 2020

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Rationale: Although both type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) are independently recognized as risk factors for cardiovascular disease, little is known about their interaction.Objectives: We hypothesized that T2DM and OSA act synergistically to increase vascular risk, and that treatment of OSA would improve vascular reactivity in patients with T2DM plus OSA.Methods: Cross-sectional study of 141 adults with T2DM, OSA, T2DM plus OSA, and control subjects, followed by a 3-month, parallel-arm, randomized, placebo-controlled trial comparing active and sham continuous positive airway pressure (CPAP) in 53 adults with T2DM plus OSA. Endothelium-dependent macro-and microvascular reactivity (flow-mediated dilation [FMD] of the brachial artery and acetylcholine-induced dilation of forearm microvasculature, respectively) and cardiovascular magnetic resonance to assess left-and right-ventricular mass/volume.Results: Mean (6SD) FMD was 6.1 (64.0)%, 7.3 (63.6)%, 6.8 (64.5)%, and 4.8 (62.9)% in control subjects, T2DM only, OSA only, and T2DM plus OSA, respectively. We observed a significant T2DM 3 OSA interaction on FMD, such that the mean effect of OSA in those with T2DM was 3.1% (95% confidence interval [CI], 0.6 to 5.6) greater than the effect of OSA in those without T2DM. A total of 3 months of CPAP resulted in a mean absolute increase in FMD of 0.3% (95% CI, 21.9 to 2.5; primary endpoint), with a net improvement of 1.1% (95% CI, 21.4 to 3.6) among those with adherence of 4 h/night or greater. A significant T2DM 3 OSA interaction was found for both left ventricular (LV) and right ventricular end-diastolic volume, such that OSA was associated with a 22.4 ml (95% CI, 3.2 to 41.6) greater LV end-diastolic volume and 23.2 ml (95% CI, 2.6 to 43.8) greater right ventricular end-diastolic volume in those with T2DM compared with the impact of OSA in those without T2DM. We observed a net improvement in LV enddiastolic volume of 8.7 ml (95% CI, 27.0 to 24.4). Conclusions:The combination of T2DM plus OSA is associated with macrovascular endothelial dysfunction beyond that observed with either disease alone. CPAP for 3 months did not significantly improve macrovascular endothelial function in the intent-to-treat analysis; however, cardiovascular magnetic resonance results suggest that there may be a beneficial effect of CPAP on LV diastolic volume.Clinical trial registered with www.clinicaltrials.gov (NCT01629862).

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The Effect of Continuous Positive Airway Pressure on Vascular Function and Cardiac Structure in Diabetes and Sleep Apnea. A Randomized Controlled Trial

et al. 2020

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Effect of valsartan on left ventricular anatomy and systolic function and aortic elasticity

Cited by 3 publications

References 35 publications

The Effect of Continuous Positive Airway Pressure on Vascular Function and Cardiac Structure in Diabetes and Sleep Apnea. A Randomized Controlled Trial

The Effect of Continuous Positive Airway Pressure on Vascular Function and Cardiac Structure in Diabetes and Sleep Apnea. A Randomized Controlled Trial

Recent Publications on Medications and Pharmacy

Recent Publications on Medications and Pharmacy

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