Prevalence of silent myocardial ischaemia in new‐onset middle‐aged Type 2 diabetic patients without other cardiovascular risk factors

Fornengo, Paolo; Bosio, Albino Claudio; Epifani, Giuseppe; Pallisco, O.; Mancuso, Andrea; Pascale, Claudio

doi:10.1111/j.1464-5491.2006.01910.x

Cited by 32 publications

(24 citation statements)

References 47 publications

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“…The alarming increase in type 2 diabetes in children and young adults and the fact that a substantial proportion of patients with type 2 diabetes have coronary artery disease at presentation makes understanding the mechanisms underlying accelerated atherosclerosis in insulin resistance of particular importance (13).…”

Section: Discussionmentioning

confidence: 99%

“…Insulin resistance per se is now well established as an independent risk factor for the development of cardiovascular atherosclerosis (18,20,21) and type 2 diabetes (57). As a result of this relationship, a significant proportion of patients with type 2 diabetes have evidence of myocardial ischemia at presentation (13). This suggests that future therapies should be targeted earlier at the mild end of the spectrum of insulin resistance.…”

mentioning

confidence: 99%

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Accelerated endothelial dysfunction in mild prediabetic insulin resistance: the early role of reactive oxygen species

Duncan¹,

Walker²,

Ezzat³

et al. 2007

American Journal of Physiology-Endocrinology and Metabolism

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AM, Kearney MT. Accelerated endothelial dysfunction in mild prediabetic insulin resistance: the early role of reactive oxygen species. Am J Physiol Endocrinol Metab 293: E1311-E1319, 2007. First published August 28, 2007; doi:10.1152/ajpendo.00299.2007.-Insulin resistance is well established as an independent risk factor for the development of type 2 diabetes and cardiovascular atherosclerosis. Most studies have examined atherogenesis in models of severe insulin resistance or diabetes. However, by the time of diagnosis, individuals with type 2 diabetes already demonstrate a significant atheroma burden. Furthermore, recent studies suggest that, even in adolescence, insulin resistance is a progressive disorder that increases cardiovascular risk. In the present report, we studied early mechanisms of reduction in the bioavailability of the antiatheroscerotic molecule nitric oxide (NO) in very mild insulin resistance. Mice with haploinsufficiency for the insulin receptor (IRKO) are a model of mild insulin resistance with preserved glycemic control. We previously demonstrated that 2-moold (Young) IRKO mice have preserved vasorelaxation responses to ACh. This remained the case at 4 mo of age. However, by 6 mo, despite no significant deterioration in glucose homeostasis (Adult), IRKO mice had marked blunting of ACh-mediated vasorelaxation [IRKO maximum contraction response (Emax) 66 Ϯ 5% vs. wild type 87 Ϯ 4%, P Ͻ 0.01]. Despite the endothelial dysfunction demonstrated, aortic endothelial nitric oxide synthase (eNOS) mRNA levels were similar in Adult IRKO and wild-type mice, and, interestingly, aortic eNOS protein levels were increased, suggesting a compensatory upregulation in the IRKO. We then examined the potential role of reactive oxygen species in mediating early endothelial dysfunction. The superoxide dismutase mimetic Mn(III)tetrakis(1-methyl-4-pyridyl) porphyrin pentachloride (MnTMPyP) restored ACh relaxation responses in the Adult IRKO (Emax to ACh with MnTMPyP 85 Ϯ 5%). Dihydroethidium fluorescence of aortas and isolated coronary microvascular endothelial cells confirmed a substantial increase in endothelium-derived reactive oxygen species in IRKO mice. These data demonstrate that mild insulin resistance is a potent substrate for accelerated endothelial dysfunction and support a role for endothelial cell superoxide production as a mechanism underlying the early reduction in NO bioavailability. insulin resistance; endothelial function; superoxide; enos INSULIN RESISTANCE is a central pathogenic feature of type 2 diabetes mellitus (42), the incidence of which is rising substantially (24). The principal cause of death in type 2 diabetes is premature cardiovascular atherosclerosis (23), and patients with type 2 diabetes have a similar risk of fatal cardiovascular events as nondiabetic patients who have sustained a myocardial infarction (19). We recently demonstrated that, despite contemporary therapies, patients with type 2 diabetes who have sustained an acute myocardial infarction have not benefited from the impr...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Accelerated endothelial dysfunction in mild prediabetic insulin resistance: the early role of reactive oxygen species

Duncan¹,

Walker²,

Ezzat³

et al. 2007

American Journal of Physiology-Endocrinology and Metabolism

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show abstract

“…401 The positive predictive value for detecting CAD using coronary angiography as the gold standard ranges between 60% and 94% and was higher in men than women. 401,416 Recommendations for exercise stress testing for risk assessment do not appear to be different in patients with diabetes and patients without diabetes.…”

Section: Electrocardiographic Stress Testing For Silent Myocardial Ismentioning

confidence: 99%

“…[411][412][413][414][415][416] ECG stress testing has an approximate 50% sensitivity and 80% specificity. 401 The positive predictive value for detecting CAD using coronary angiography as the gold standard ranges between 60% and 94% and was higher in men than women.…”

Section: Electrocardiographic Stress Testing For Silent Myocardial Ismentioning

confidence: 99%

2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults

Greenland

Alpert²,

Beller³

et al. 2010

Circulation

1,028

319

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“…The prevalence of SMI in diabetic patients is reported to be 7.6-12.6% (Koistinen 1990;Janand-Delenneet al1999;Gokcelet al 2003;Fornengo et al 2006). The aim of this study was to investigate the frequency of SMI in diabetic patients with retinopathy and to explore the risk factors for SMI in these patients.…”

mentioning

confidence: 99%

Silent myocardial ischaemia in patients with diabetic retinopathy

Ohtomo

Shigeeda

Hirose

et al. 2014

Acta Ophthalmologica

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Prevalence of silent myocardial ischaemia in new‐onset middle‐aged Type 2 diabetic patients without other cardiovascular risk factors

Cited by 32 publications

References 47 publications

Accelerated endothelial dysfunction in mild prediabetic insulin resistance: the early role of reactive oxygen species

Accelerated endothelial dysfunction in mild prediabetic insulin resistance: the early role of reactive oxygen species

2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults

Silent myocardial ischaemia in patients with diabetic retinopathy

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