‘Warm-up’ phenomenon in diabetic patients with stable angina treated with diet or sulfonylureas

Bilińska, Maria; Potocka, J; Korzeniowska−Kubacka, Iwona; Piotrowicz, Ryszard

doi:10.1097/mca.0b013e3282a30676

Cited by 23 publications

(17 citation statements)

References 36 publications

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“…However, these medications continue to be prescribed in diabetic patients, which is a serious concern. In contrast, Gliclazide did not significantly affect warm-up angina in Bilinska et al ,58 which is reassuring and is consistent with its higher selectivity for pancreatic K ATP channels 59…”

Section: Mechanismmentioning

confidence: 52%

“…This applies in diabetics and non-diabetics 54–56. A significant reduction in maximal ST-segment depression on second exercise was demonstrated in four control groups 43 55 57 58. This protection was abolished with glibenclamide 43 55 57 58.…”

Section: Mechanismmentioning

confidence: 88%

“…A significant reduction in maximal ST-segment depression on second exercise was demonstrated in four control groups 43 55 57 58. This protection was abolished with glibenclamide 43 55 57 58. It is difficult to assess the effects of glibenclamide in Ferreira et al , as they failed to show a significant reduction in maximal ST-segment depression on second exercise in their control group 56…”

Section: Mechanismmentioning

confidence: 97%

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‘Warm-up Angina’: harnessing the benefits of exercise and myocardial ischaemia

Williams

Manou‐Stathopoulou

Redwood

et al. 2013

Heart

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The phenomenon of warm-up angina was first noted over 200 years ago. It describes the curious observation whereby exercise-induced ischaemia on second effort is significantly reduced or even abolished if separated from first effort by a brief rest period. However, the precise mechanism via which this cardio-protection occurs remains uncertain. Three possible explanations for reduced myocardial ischaemia on second effort include: first, an improvement in myocardial perfusion; second, increased myocardial resistance to ischaemia similar to ischaemic preconditioning; and third, reduced cardiac work through better ventricular-vascular coupling. Obtaining accurate coronary physiological measurements in the catheter laboratory throughout exercise demands a complex research protocol. In the 1980s, studies into warm-up angina relied on great cardiac vein thermo-dilution to estimate coronary blood flow. This technique has subsequently been shown to be inaccurate. However exercise physiology in the catheter laboratory has recently been resurrected with the advent of coronary artery wires that allow continuous measurement of distal coronary artery pressure and blood flow velocity. This review summarises the intriguing historical background to warm-up angina, and provides a concise critique of the important studies investigating mechanisms behind this captivating cardio-protective phenomenon.

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Section: Mechanismmentioning

confidence: 52%

Section: Mechanismmentioning

confidence: 88%

Section: Mechanismmentioning

confidence: 97%

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‘Warm-up Angina’: harnessing the benefits of exercise and myocardial ischaemia

Williams

Manou‐Stathopoulou

Redwood

et al. 2013

Heart

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“…19 Furthermore, such binding varies among sulfonylureas, with glibenclamide having potentially larger effects than the comparatively benign gliclazide and glimepiride. 20,21 Rapid glucose concentration lowering occurs with clinical use of sulfonylureas, much more so than with metformin or thiazolidinediones. 13 Much of this early rapid effect is, however, lost, such that by 8 months glucose level lowering is equivalent, whereafter the glucose-lowering effect gradually becomes less effective compared with the other classes over 3-5 years.…”

Section: Mechanistic Considerations and Surrogate Outcomesmentioning

confidence: 99%

Cardiovascular Disease and Oral Agent Glucose-Lowering Therapies in the Management of Type 2 Diabetes

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2012

Diabetes Technology & Therapeutics

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Although glucose-lowering oral agents have been available for clinical use for over 60 years, the formal evidence base supporting their advantage and safety in regard of cardiovascular (CV) outcomes remains less than optimal. However, a synthesis of the evidence results in a high probability of benefit. For metformin, the United Kingdom Prospective Diabetes Study (UKPDS) substudy is convincing for a definite effect in reducing myocardial infarction (MI), but the quantitative extent of that is uncertain. For sulfonylureas, support for reduction in MI comes from the UKPDS extension study, where the central estimate for risk reduction remains the same as in the original planned end to the study, but the greater number of events was statistically significant for the sulfonylurea/insulin arm. Other studies do not support the view that metformin and sulfonylureas differ with respect to MI or indeed CV outcomes more generally. The data available for acarbose, an α-glucosidase inhibitor, are weak but not of concern, although some positive substudy data are available for people with impaired glucose tolerance. For peroxisome proliferator-activated receptor-γ agonists the CV data are more controversial, but the purpose-designed randomized controlled trials are clear that pioglitazone is advantageous to placebo (except for heart failure [HF]), whereas rosiglitazone is indistinguishable from metformin/sulfonylureas (even when including HF data). Lower-quality data do, however, lead to significant concerns for MI with rosiglitazone. Early and somewhat low-quality data for the dipeptidyl peptidase inhibitors show they are safe and hold promise for cardiovascular advantage, with major randomized controlled trials being underway. Preliminary CV data are available for one sodium/glucose cotransporter 2 inhibitor and look reassuring.

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“…Mesmo que alguns trabalhos demonstrem que o diabetes não interfere substancialmente no PI (40,41) , muitos sugerem influência negativa (42)(43)(44) . (17,18,45) . Assim, estes estudos não apresentam resultados definitivos sobre o tema.…”

Section: Dados Internacionais De Catalogação Na Publicação (Cip)unclassified

Expressão do precondicionamento isquêmico em pacientes com diabetes mellitus tipo 2 e doença arterial coronariana

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‘Warm-up’ phenomenon in diabetic patients with stable angina treated with diet or sulfonylureas

Abstract: Warm-up effect is preserved in diabetic patients with stable angina treated with diet, partially preserved in gliclazide-treated and abolished in glibenclamide-treated patients.

Cited by 23 publications

References 36 publications

‘Warm-up Angina’: harnessing the benefits of exercise and myocardial ischaemia

‘Warm-up Angina’: harnessing the benefits of exercise and myocardial ischaemia

Cardiovascular Disease and Oral Agent Glucose-Lowering Therapies in the Management of Type 2 Diabetes

Expressão do precondicionamento isquêmico em pacientes com diabetes mellitus tipo 2 e doença arterial coronariana

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