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Khavandi K.,Kings College London | Amer H.,St. Georges Hospital | Ibrahim B.,Foundation Medicine | Brownrigg J.,Vascular Research Institute
Therapeutic Advances in Chronic Disease | Year: 2013

Diabetes is a major and growing public health challenge which threatens to overwhelm medical services in the future. Type 2 diabetes confers significant morbidity and mortality, most notably with target organ damage to the eyes, kidneys, nerves and heart. The magnitude of cardiovascular risk associated with diabetes is best illustrated by its position as a coronary heart disease risk equivalent. Complications related to neuropathy are also vast, often working in concert with vascular abnormalities and resulting in serious clinical consequences such as foot ulceration. Increased understanding of the natural history of this disorder has generated the potential to intervene and halt pathological progression before overt disease ensues, after which point management becomes increasingly challenging. The concept of prediabetes as a formal diagnosis has begun to be translated from the research setting to clinical practice, but with continually updated guidelines, varied nomenclature, emerging pharmacotherapies and an ever-changing evidence base, clinicians may be left uncertain of best practice in identifying and managing patients at the prediabetic stage. This review aims to summarize the epidemiological data, new concepts in disease pathogenesis and guideline recommendations in addition to lifestyle, pharmacological and surgical therapies targeted at stopping progression of prediabetes to diabetes. While antidiabetic medications, with newer anti-obesity medications and interventional bariatric procedures have shown some promising benefits, diet and therapeutic lifestyle change remains the mainstay of management to improve the metabolic profile of individuals with glucose dysregulation. New risk stratification tools to identify at-risk individuals, coupled with unselected population level intervention hold promise in future practice. © The Author(s), 2013. Source

Kim S.-K.,Korea University | Kim D.-J.,Ajou University | Kim S.-H.,Catholic Kwandong University | Lee Y.-K.,Korea University | And 3 more authors.
Diabetes Research and Clinical Practice | Year: 2010

Objective: To investigate whether alanine aminotransferase (ALT), even within the reference range, is associated with atherosclerotic burden in apparently healthy adults. Methods: This was an observational study performed on 830 healthy individuals with normal ALT concentration (≤40 U/L). Atherosclerotic burden was assessed by carotid arterial intima-media thickness (IMT). All subjects were divided according to the quartile based on their ALT concentrations. Results: Despite all subjects having a normal ALT concentration, ultrasonographic liver steatosis was observed in 48.4% and 36.7% of men and women, respectively. In both genders, subjects in the highest quartile of ALT concentration had a significantly higher waist circumference, triglyceride concentration, HOMA-IR, a higher prevalence of metabolic syndrome, and a greater severity of ultrasonographic liver steatosis than did those in the lower quartiles. In women, the carotid IMT increased significantly with increasing quartiles of ALT concentration (0.62 ± 0.14 mm, 0.66 ± 0.15 mm, 0.69 ± 0.15 mm, vs. 0.72 ± 0.24 mm; P for trend < 0.001). Based on multivariate regression analysis, the serum ALT, even within the normal range, was associated with the carotid IMT in both men and women, and independently of traditional cardiovascular risk factors. Conclusions: ALT concentrations, albeit within the reference range, were associated with atherosclerotic burden in healthy adults. © 2010 Elsevier Ireland Ltd. All rights reserved. Source

Riccio P.M.,University of Buenos Aires | Klein F.R.,University of Buenos Aires | Cassara F.P.,University of Buenos Aires | Giacomelli F.M.,University of Buenos Aires | And 8 more authors.
Neurology | Year: 2013

Background: Based on the higher frequency of paroxysmal atrial fibrillation during night and early morning hours, we sought to analyze the association between newly diagnosed atrial fibrillation and wake-up ischemic cerebrovascular events. Methods: We prospectively assessed every acute ischemic stroke and TIA patient admitted to our hospital between 2008 and 2011. We used a forward step-by-step multiple logistic regression analysis to assess the relationship between newly diagnosed atrial fibrillation and wake-up ischemic stroke or TIA, after adjusting for significant covariates. Results: The study population comprised 356 patients, 274 (77.0%) with a diagnosis of acute ischemic stroke and 82 (23.0%) with TIA. A total of 41 (11.5%) of these events occurred during night sleep. A newly diagnosed atrial fibrillation was detected in 27 patients of 272 without known atrial fibrillation (9.9%). We found an independent association between newly diagnosed atrial fibrillation and wake-up ischemic stroke and TIA (odds ratio 3.6, 95% confidence interval 1.2-7.7, p = 0.019). Conclusions: The odds of detecting a newly diagnosed atrial fibrillation were 3-fold higher among wake-up cerebrovascular events than among non-wake-up events. The significance of this independent association between newly diagnosed atrial fibrillation and wake-up ischemic stroke and TIA and the role of other comorbidities should be investigated in future studies. © 2013 American Academy of Neurology. Source

Sposato L.A.,Favaloro University | Sposato L.A.,Vascular Research Institute | Sposato L.A.,Diego Portales University | Suarez A.,Favaloro University | And 11 more authors.
Journal of the Neurological Sciences | Year: 2011

Background: Information regarding predisposing factors, frequency, and prognostic implications of new onset atrial fibrillation (NOAF) after carotid endarterectomy (CEA) is scarce. We assessed the frequency, risk factors, and the prognostic impact of NOAF after CEA. Methods: We assessed every patient undergoing CEA (n = 186) at our academic hospital between 2006 and 2009. Patients underwent continuous electrocardiographic monitoring during surgery and during the rest of hospital stay. We performed univariate and multivariate analyses for identifying variables associated with NOAF and for individualizing variables related to four perioperative adverse outcome measures: a) ischemic stroke; b) ischemic stroke and myocardial infarction, c) ischemic stroke and death, and d) ischemic stroke, myocardial infarction, and death. Results: The study cohort comprised 186 patients. Overall, NOAF was detected in 7 cases (3.8%). The only variable associated with NOAF was intraoperative hypotension (OR 9.6, 95% CI 1.9-47.4, P =.006). There were no perioperative deaths. NOAF was associated with perioperative ischemic stroke and with the combined outcome of ischemic stroke and myocardial infarction. Conclusions: We found a low frequency of NOAF after CEA. Intraoperative hypotension was associated to a higher risk of NOAF. In turn, NOAF was related to adverse postoperative outcome. Further research is needed to clarify the pathophysiological relation between intraoperative hypotension, NOAF, and adverse CEA outcome. © 2011 Elsevier B.V. All rights reserved. Source

Kim S.-K.,CHA Medical University | Choi Y.J.,Vascular Research Institute | Huh B.W.,Vascular Research Institute | Park S.W.,CHA Medical University | And 3 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2014

Context: The association between nonalcoholic fatty liver disease (NAFLD) and subclinical atherosclerosis in type 2 diabetes is controversial. Objective: The objective of the study was to investigate the participation of insulin resistance in the association of NAFLD and the carotid atherosclerotic burden in a large cohort of patients with type 2 diabetes. Design, Setting, and Patients: This was an observational study performed in 4437 consecutively enrolled patients with type 2 diabetes. Main Outcomes Measures: Hepatic steatosis and mean carotid intima-media thickness (C-IMT) were measured using ultrasonography. Insulin resistance was assessed using the short insulin tolerance test. Results: The prevalence of NAFLD was 72.7% in the whole study population. Among subjects with NAFLD, 23.2% were not insulin resistant. There were significant differences in C-IMT and the frequency of carotid atherosclerosisbetweengroups classified by insulin resistance within thesame NAFLD strata. C-IMT was highest in subjects with both NAFLD and insulin resistance [0.844±0.004 (mean ± SE) mm vs 0.786 ± 0.008, 0.821 ± 0.007, and 0.807 ± 0.006 mm, P for trend <.001, respectively, in insulin sensitive subjects without NAFLD, insulin resistant subjects without NAFLD, andinsulin sensitive subjects with NAFLD]. These differences remained after adjusting for potential confounders. However, C-IMT in subjects having only NAFLD or insulin resistance was not higher than that in those with neither NAFLD nor insulin resistance. Conclusions: NAFLD is very common in subjects with type 2 diabetes, but NAFLD not accompanied by insulin resistance is not associated with a carotid atherosclerotic burden. However, having both NAFLD and insulin resistance seemed to be an independent predictor of increased C-IMT. © 2014 by the Endocrine Society. Source

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