Global cardiovascular disease risk assessment in United States adults with diabetes

Wong, Nathan D.; Glovaci, Diana; Wong, Kalina; Malik, Shaista; Franklin, Stanley S.; Wygant, Gail; Iloeje, Uchenna H.

doi:10.1177/1479164112436403

Cited by 64 publications

(35 citation statements)

References 20 publications

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“…For example, hypertension (62) and inflammation (63), both more frequently associated with T2DM than T1DM (64, 65), are associated with distinct placental pathological abnormalities which may predominate in T2DM relative to T1DM placentas (26). In fact, one study reported that placentas of pregnancies complicated by T2DM had a significant increase in placental infarcts compared to T1DM (15), a vascular abnormality that has also been found in studies of hypertension in pregnancy (66).…”

Section: Discussionmentioning

confidence: 99%

A systematic review of placental pathology in maternal diabetes mellitus

et al. 2015

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During a pregnancy complicated by diabetes, the human placenta undergoes a number of functional and structural pathologic changes, such as increased placental weight and increased incidence of placental lesions including villous maturational defects and fibrinoid necrosis. The pathologic findings reported have differed among studies, potentially reflecting differences in type of diabetes, study methodology, or glycemic control of study participants. Alternatively, these discrepancies may represent different biologic adaptations to distinct metabolic diseases. In order to clarify these distinctions, we conducted a comprehensive review of English language citations in Pubmed and Embase using the keywords “diabetes”, “placenta”, AND “pathology”. Abstracts were reviewed for relevance then full-text articles were reviewed in order to extract a comprehensive summary of current pathological findings associated with pregestational and gestational diabetes mellitus, as well as an understanding of the impact of glycemic control on placental pathology. Placental abnormalities most consistently associated with maternal diabetes are an increased incidence of villous immaturity, increased measures of angiogenesis, and increased placental weight. The literature suggests that, despite similarities in placental abnormalities, differences in placental pathology may reflect differences in pathophysiology among different types of diabetes. Consequently, standardization of terminology used to define placental lesions is warranted. Moreover, further research is needed to investigate the impact of pathophysiology, glycemic control and clinical factors, such as infant sex, weight and race, on placental structure and function.

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Section: Discussionmentioning

confidence: 99%

A systematic review of placental pathology in maternal diabetes mellitus

et al. 2015

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“…Recent publications indicate that significant progress has been made in improving glycaemic control among US T2DM patients, a likely result of increased awareness for screening and treatment. 9,18,19 However, the proportion of patients in control for several other risk factors including weight remains dismal. In these current analyses, we were interested in understanding the trends in control of some key risk factors for CVD among diabetic patients, stratified by CVD status in the United States over a 12-year period.…”

Section: Discussionmentioning

confidence: 99%

Trends in control of cardiovascular risk factors among US adults with type 2 diabetes from 1999 to 2010: Comparison by prevalent cardiovascular disease status

Wong

Patao

Wong

et al. 2013

Diabetes and Vascular Disease Research

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Background Most patients with type 2 diabetes mellitus (T2DM) suffer from cardiovascular disease (CVD). Whether CVD risk factors have improved in those with DM with and without CVD is not established. We compared risk factor levels and goal attainment in US adults with diabetes with and without CVD. Methods We examined 2403 adults (aged ≥ 18 years) in the United States with T2DM (n = 654, 27% with CVD) across 1999–2010 using the US National Health and Nutrition Examination Survey (NHANES) and evaluated control of hemoglobin A1c (HbA1c), blood pressure (BP), low-density lipoprotein cholesterol (LDL-C) and body mass index (BMI) in those with DM with versus without CVD. Results The proportions controlled for HbA1c, BP and LDL-C have improved (p < 0.001) overall between 1999 and 2010, but only 24% were at goal for all three factors in 2009–2010. There were improvements in BP, triglycerides and LDL-C in those with CVD, and in those without CVD, there were also improvements in control of all parameters, although changes in mean levels of risk factors were less impressive. Conclusion Despite modest improvement over time, in most CVD risk factors, only one-fourth of those with T2DM are at goal for HbA1c, BP and LDL-C, with improvements seen in those without CVD more often than those with CVD.

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“…Based on 2003–2006 NHANES data, many patients with type 2 diabetes did not appear to be at high Framingham risk, with about 23% at low risk, 17% at intermediate risk, and 60% at high risk. In the low risk group, over 50% filled the criteria for metabolic syndrome and 7% suffered from chronic kidney disease, raising the high risk total to 87% 448. Again, less than 13% of all diabetics achieved all three risk goals: HbA 1c (less than two thirds under control), blood pressure (about 30% under control), and LDL cholesterol (less than 50% under control), regardless of risk group 448.…”

Section: Adherence and Performance In Risk Reductionmentioning

confidence: 99%

Molecular sources of residual cardiovascular risk, clinical signals, and innovative solutions: relationship with subclinical disease, undertreatment, and poor adherence: implications of new evidence upon optimizing cardiovascular patient outcomes

Kones¹

2013

VHRM

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Residual risk, the ongoing appreciable risk of major cardiovascular events (MCVE) in statin-treated patients who have achieved evidence-based lipid goals, remains a concern among cardiologists. Factors that contribute to this continuing risk are atherogenic non-low-density lipoprotein (LDL) particles and atherogenic processes unrelated to LDL cholesterol, including other risk factors, the inherent properties of statin drugs, and patient characteristics, ie, genetics and behaviors. In addition, providers, health care systems, the community, public policies, and the environment play a role. Major statin studies suggest an average 28% reduction in LDL cholesterol and a 31% reduction in relative risk, leaving a residual risk of about 69%. Incomplete reductions in risk, and failure to improve conditions that create risk, may result in ongoing progression of atherosclerosis, with new and recurring lesions in original and distant culprit sites, remodeling, arrhythmias, rehospitalizations, invasive procedures, and terminal disability. As a result, identification of additional agents to reduce residual risk, particularly administered together with statin drugs, has been an ongoing quest. The current model of atherosclerosis involves many steps during which disease may progress independently of guideline-defined elevations in LDL cholesterol. Differences in genetic responsiveness to statin therapy, differences in ability of the endothelium to regenerate and repair, and differences in susceptibility to nonlipid risk factors, such as tobacco smoking, hypertension, and molecular changes associated with obesity and diabetes, may all create residual risk. A large number of inflammatory and metabolic processes may also provide eventual therapeutic targets to lower residual risk. Classically, epidemiologic and other evidence suggested that raising high-density lipoprotein (HDL) cholesterol would be cardioprotective. When LDL cholesterol is aggressively lowered to targets, low HDL cholesterol levels are still inversely related to MCVE. The efflux capacity, or ability to relocate cholesterol out of macrophages, is believed to be a major antiatherogenic mechanism responsible for reduction in MCVE mediated in part by healthy HDL. HDL cholesterol is a complex molecule with antioxidative, anti-inflammatory, anti-thrombotic, antiplatelet, and vasodilatory properties, among which is protection of LDL from oxidation. HDL-associated paraoxonase-1 has a major effect on endothelial function. Further, HDL promotes endothelial repair and progenitor cell health, and supports production of nitric oxide. HDL from patients with cardiovascular disease, diabetes, and autoimmune disease may fail to protect or even become proinflammatory or pro-oxidant. Mendelian randomization and other clinical studies in which raising HDL cholesterol has not been beneficial suggest that high plasma levels do not necessarily reduce cardiovascular risk. These data, coupled with extensive preclinical information about the functional heterogeneity of HDL, challenge the ...

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Global cardiovascular disease risk assessment in United States adults with diabetes

Cited by 64 publications

References 20 publications

A systematic review of placental pathology in maternal diabetes mellitus

A systematic review of placental pathology in maternal diabetes mellitus

Trends in control of cardiovascular risk factors among US adults with type 2 diabetes from 1999 to 2010: Comparison by prevalent cardiovascular disease status

Molecular sources of residual cardiovascular risk, clinical signals, and innovative solutions: relationship with subclinical disease, undertreatment, and poor adherence: implications of new evidence upon optimizing cardiovascular patient outcomes

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