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The Role of Echocardiography in Evaluating Cardiovascular Diseases in Patients with Diabetes Mellitus
Sun Hwa Lee, Jae-Hyeong Park
Diabetes Metab J. 2023;47(4):470-483.   Published online July 27, 2023
DOI: https://doi.org/10.4093/dmj.2023.0036
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AbstractAbstract PDFPubReader   ePub   
Patients with diabetes mellitus are highly susceptible to cardiovascular complications, which are directly correlated with cardiovascular morbidity and mortality. In addition to coronary artery disease, there is growing awareness of the risk and prevalence of heart failure (HF) in patients with diabetes. Echocardiography is an essential diagnostic modality commonly performed in patients with symptoms suggestive of cardiovascular diseases (CVD), such as dyspnea or chest pain, to establish or rule out the cause of symptoms. Conventional echocardiographic parameters, such as left ventricular ejection fraction, are helpful not only for diagnosing CVD but also for determining severity, treatment strategy, prognosis, and response to treatment. Echocardiographic myocardial strain, a novel echocardiographic technique, enables the detection of early changes in ventricular dysfunction before HF symptoms develop. This article aims to review the role of echocardiography in evaluating CVD in patients with diabetes mellitus and how to use it in patients with suspected cardiac diseases.

Citations

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  • Biomarkers and subclinical left ventricular dysfunction in patients with type 2 diabetes without clinical manifestations of cardiovascular diseases
    T. G. Utina, D. U. Akasheva, D. V. Korsunsky, O. N. Dzhioeva, O. M. Drapkina
    Cardiovascular Therapy and Prevention.2024; 23(1): 3914.     CrossRef
  • Cardiovascular risk assessment in inflammatory bowel disease with coronary calcium score
    Waqar Arif Rasool Chaudhry, Muhammad Ashfaq, Parvinder Kaur, Mahendra Kumar, Maria Faraz, Jahanzeb Malik, Amin Mehmoodi
    Annals of Medicine & Surgery.2024; 86(3): 1496.     CrossRef
  • Increased Blood Pressure Variability Over a 16-Year Period Is Associated With Left Ventricular Diastolic Dysfunction in a Population-Based Cohort
    Jae-Hyeong Park, Soon-Ki Ahn, Goo-Yeong Cho, Ki-Chul Sung, Seung Ku Lee, Seong Hwan Kim, Chol Shin
    American Journal of Hypertension.2023;[Epub]     CrossRef
Original Articles
Cardiovascular Risk/Epidemiology
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Clinical Significance of Body Fat Distribution in Coronary Artery Calcification Progression in Korean Population
Heesun Lee, Hyo Eun Park, Ji Won Yoon, Su-Yeon Choi
Diabetes Metab J. 2021;45(2):219-230.   Published online October 28, 2020
DOI: https://doi.org/10.4093/dmj.2019.0161
Correction in: Diabetes Metab J 2021;45(6):974
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  • 9 Web of Science
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Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Although obesity differs according to ethnicity, it is globally established as a solid risk factor for cardiovascular disease. However, it is not fully understood how obesity parameters affect the progression of coronary artery calcification (CAC) in Korean population. We sought to evaluate the association of obesity-related parameters including visceral adipose tissue (VAT) measurement and CAC progression.
Methods
This retrospective observational cohort study investigated 1,015 asymptomatic Korean subjects who underwent serial CAC scoring by computed tomography (CT) with at least 1-year interval and adipose tissue measurement using non-contrast CT at baseline for a routine checkup between 2003 and 2015. CAC progression, the main outcome, was defined as a difference of ≥2.5 between the square roots of the baseline and follow-up CAC scores using Agatston units.
Results
During follow-up (median 39 months), 37.5% of subjects showed CAC progression of a total population (56.4 years, 80.6% male). Body mass index (BMI) ≥25 kg/m2, increasing waist circumferences (WC), and higher VAT/subcutaneous adipose tissue (SAT) area ratio were independently associated with CAC progression. Particularly, predominance of VAT over SAT at ≥30% showed the strongest prediction for CAC progression (adjusted hazard ratio, 2.20; P<0.001) and remained of prognostic value regardless of BMI or WC status. Further, it provided improved risk stratification of CAC progression beyond known prognosticators.
Conclusion
Predominant VAT area on CT is the strongest predictor of CAC progression regardless of BMI or WC in apparently healthy Korean population. Assessment of body fat distribution may be helpful to identify subjects at higher risk.

Citations

Citations to this article as recorded by  
  • Gender-specific abdominal fat distribution and insulin resistance associated with organophosphate esters and phthalate metabolites exposure
    Xiaoliu Shi, Wanyue Wang, Jiafan Feng, Xiaochun Ma, Mengting Xu, Cui Wang
    Environmental Pollution.2024; 349: 123959.     CrossRef
  • The association between C-reactive protein and coronary artery calcification: a systematic review and meta-analysis
    Amirhossein Tajani, Masoumeh Sadeghi, Navid Omidkhoda, Amir Hooshang Mohammadpour, Sara Samadi, Vahid Jomehzadeh
    BMC Cardiovascular Disorders.2024;[Epub]     CrossRef
  • Visceral adipose tissue is an independent predictor and mediator of the progression of coronary calcification: a prospective sub-analysis of the GEA study
    Neftali Eduardo Antonio-Villa, Juan Gabriel Juárez-Rojas, Rosalinda Posadas-Sánchez, Juan Reyes-Barrera, Aida Medina-Urrutia
    Cardiovascular Diabetology.2023;[Epub]     CrossRef
  • Deep learning-based prediction for significant coronary artery stenosis on coronary computed tomography angiography in asymptomatic populations
    Heesun Lee, Bong Gyun Kang, Jeonghee Jo, Hyo Eun Park, Sungroh Yoon, Su-Yeon Choi, Min Joo Kim
    Frontiers in Cardiovascular Medicine.2023;[Epub]     CrossRef
  • Relationship between a novel non–insulin-based metabolic score for insulin resistance (METS‐IR) and coronary artery calcification
    Zhenwei Wang, Xiaofang Hui, Xu Huang, Jingjie Li, Naifeng Liu
    BMC Endocrine Disorders.2022;[Epub]     CrossRef
  • Association Between Abdominal Adipose Tissue Distribution and Risk of Endometrial Cancer: A Case-Control Study
    Yuan Cheng, Zhongyu Wang, Xiaoxuan Jia, Rong Zhou, Jianliu Wang
    Clinical Medicine Insights: Oncology.2022; 16: 117955492211407.     CrossRef
  • Sex differences in cardiovascular risk may be related to sex differences in diet patterns: a narrative review
    A. M. Tindall, V. A. Stallings
    Annals of Human Biology.2021; 48(6): 517.     CrossRef
Cardiovascular Risk/Epidemiology
Impact of Diabetes Control on Subclinical Atherosclerosis: Analysis from Coronary Computed Tomographic Angiography Registry
Gyung-Min Park, Chang Hoon Lee, Seung-Whan Lee, Sung-Cheol Yun, Young-Hak Kim, Yong-Giun Kim, Ki-Bum Won, Soe Hee Ann, Shin-Jae Kim, Dong Hyun Yang, Joon-Won Kang, Tae-Hwan Lim, Eun Hee Koh, Woo Je Lee, Min-Seon Kim, Joong-Yeol Park, Hong-Kyu Kim, Jaewon Choe, Sang-Gon Lee
Diabetes Metab J. 2020;44(3):470-479.   Published online November 22, 2019
DOI: https://doi.org/10.4093/dmj.2019.0073
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AbstractAbstract PDFSupplementary MaterialPubReader   
Background

There are limited data on the impact of diabetes control on the risk of subclinical coronary atherosclerosis.

Methods

We analyzed 6,434 consecutive asymptomatic individuals without previous history of coronary artery disease who underwent coronary computed tomographic angiography (CCTA) (mean age, 53.7±7.6 years and 4,694 men [73.0%]). The degree and extent of subclinical coronary atherosclerosis were assessed by CCTA, and ≥50% diameter stenosis was defined as significant. A cardiac event was defined as a composite of all-cause death, myocardial infarction, unstable angina, or coronary revascularization. Study participants were categorized as normal (n=5,319), controlled diabetes (glycosylated hemoglobin [HbA1c] <7%, n=747), or uncontrolled diabetes (HbA1c ≥7%, n=368), respectively.

Results

Compared with normal individuals, there were no statistically significant differences in the risk of for any atherosclerotic plaque (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.98 to 1.38; P=0.086) and significant coronary artery stenosis (OR, 1.08; 95% CI, 0.82 to 1.42; P=0.583) in controlled diabetic individuals. In contrast, uncontrolled diabetic individuals had consistently higher risks of any atherosclerotic plaque (OR, 2.16; 95% CI, 1.70 to 2.75; P<0.001) and significant coronary artery stenosis (OR, 3.34; 95% CI, 2.52 to 4.43; P<0.001) than normal individuals. During a follow-up of median 5.4 years, there was no significant difference in cardiac events between normal and controlled diabetic individuals (P=0.365). However, uncontrolled diabetes was associated with an increased risk of cardiac events compared with normal individuals (P<0.001) and controlled diabetic individuals (P=0.023).

Conclusion

Asymptomatic uncontrolled diabetes was associated with significant subclinical coronary atherosclerosis with subsequent high risk for cardiac events.

Citations

Citations to this article as recorded by  
  • Carotid Ultrasound Abnormalities of People Living With HIV in Kunming, China: Multiple Correspondence Analysis Approach to Identify Influencing Factors
    Shuishui Pan, Haiyan Fu, Zhiqiong Ai, Chongxi Li, Jinsong Bai
    International Journal of STD & AIDS.2023; 34(10): 710.     CrossRef
  • Differential Impact of Degree of Hypertension on Subclinical Coronary Atherosclerosis in Asymptomatic Subjects With and Without Diabetes Mellitus
    Hyun Woo Park, Sangyong Jo, Kyung Sun Park, Hyeji Lee, Young-Jee Jeon, Sangwoo Park, Soe Hee Ann, Yong-Giun Kim, Seong Hoon Choi, Woon Jung Kwon, Young-Rak Cho, Jon Suh, Gyung-Min Park
    The American Journal of Cardiology.2023; 203: 343.     CrossRef
  • Exosomal MALAT1 Derived from High Glucose-Treated Macrophages Up-Regulates Resistin Expression via miR-150-5p Downregulation
    Kou-Gi Shyu, Bao-Wei Wang, Wei-Jen Fang, Chun-Ming Pan, Chiu-Mei Lin
    International Journal of Molecular Sciences.2022; 23(3): 1095.     CrossRef
  • Comparison of Framingham risk score and pooled cohort equations for the prediction of coronary atherosclerosis in patients who meet the target LDL-C level of Korean dyslipidemia guideline
    Su Bin Kim, Hae Won Jung
    Medicine.2022; 101(47): e31816.     CrossRef
  • Time to Reach Target Glycosylated Hemoglobin Is Associated with Long-Term Durable Glycemic Control and Risk of Diabetic Complications in Patients with Newly Diagnosed Type 2 Diabetes Mellitus: A 6-Year Observational Study
    Kyoung Jin Kim, Jimi Choi, Jae Hyun Bae, Kyeong Jin Kim, Hye Jin Yoo, Ji A Seo, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Sin Gon Kim, Nam Hoon Kim
    Diabetes & Metabolism Journal.2021; 45(3): 368.     CrossRef
  • Frequency and Significance of Right Bundle Branch Block and Subclinical Coronary Atherosclerosis in Asymptomatic Individuals
    Hyeji Lee, Young-Jee Jeon, Byung Ju Kang, Tae Young Lee, Eun Ji Park, Sangwoo Park, Soe Hee Ann, Yong-Giun Kim, Yongjik Lee, Seong Hoon Choi, Gyung-Min Park
    The American Journal of Cardiology.2021; 158: 30.     CrossRef
  • The association between glucose-related variables and plaque morphology in patients with ST-segment elevated myocardial infarction
    Jinxin Liu, Shanjie Wang, Can Cui, Hengxuan Cai, Rong Sun, Weili Pan, Shaohong Fang, Bo Yu
    Cardiovascular Diabetology.2020;[Epub]     CrossRef
  • Choosing Antithrombotic Therapy in Patients with Coronary Heart Disease and Type 2 Diabetes Mellitus: How to Reduce the Risk of Death
    N. A. Koziolova, P. G. Karavaev, A. S. Veklich
    Kardiologiia.2020; 60(4): 109.     CrossRef
Complications
Serum Total Bilirubin Levels Provide Additive Risk Information over the Framingham Risk Score for Identifying Asymptomatic Diabetic Patients at Higher Risk for Coronary Artery Stenosis
Jaechan Leem, Eun Hee Koh, Jung Eun Jang, Chang-Yun Woo, Jin Sun Oh, Min Jung Lee, Joon-Won Kang, Tae-Hwan Lim, Chang Hee Jung, Woo Je Lee, Joong-Yeol Park, Ki-Up Lee
Diabetes Metab J. 2015;39(5):414-423.   Published online October 22, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.5.414
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AbstractAbstract PDFPubReader   
Background

The diagnosis of coronary artery disease (CAD) is often delayed in patients with type 2 diabetes. Serum total bilirubin levels are inversely associated with CAD. However, no studies have examined whether this can be used as a biochemical marker for identifying asymptomatic diabetic patients at higher risk for having obstructive CAD.

Methods

We performed a cross-sectional study of 460 consecutive asymptomatic patients with type 2 diabetes. All patients underwent coronary computed tomographic angiography, and their serum total bilirubin levels were measured. Obstructive CAD was defined as ≥50% diameter stenosis in at least one coronary artery.

Results

Serum total bilirubin tertiles showed an inverse association with the prevalence of obstructive CAD. In multivariate logistic regression analysis, the odds ratio for the highest versus the lowest tertile of total bilirubin was 0.227 (95% confidence interval [CI], 0.130 to 0.398), and an increment of 1 µmol/L in serum total bilirubin level was associated with a 14.6% decrease in obstructive CAD after adjustment for confounding variables. Receiver operating characteristic curve analysis showed that the area under the curve for the Framingham Risk Score (FRS) plus serum total bilirubin level was 0.712 (95% CI, 0.668 to 0.753), which is significantly greater than that of the FRS alone (P=0.0028).

Conclusion

Serum total bilirubin level is inversely associated with obstructive CAD and provides additive risk information over the FRS. Serum total bilirubin may be helpful for identifying asymptomatic patients with type 2 diabetes who are at higher risk for obstructive CAD.

Citations

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  • Association between bilirubin and biomarkers of metabolic health and oxidative stress in the MARK-AGE cohort
    Vanessa Schoissengeier, Lina Maqboul, Daniela Weber, Tilman Grune, Alexander Bürkle, Maria Moreno-Villaneuva, Claudio Franceschi, Miriam Capri, Jürgen Bernhard, Olivier Toussaint, Florence Debacq-Chainiaux, Birgit Weinberger, Efstathios S. Gonos, Ewa Siko
    iScience.2024; 27(7): 110234.     CrossRef
  • DECREASE IN SERUM BILIRUBIN AS AN UNFAVORABLE MARKER OF CARDIOVASCULAR DISORDERS
    L. M. Strilchuk, O. O. Zimba, I. B. Zhakun
    Eastern Ukrainian Medical Journal.2020; 8(3): 268.     CrossRef
  • Contemporary diagnostic algorithm for coronary artery disease: achievements and prospects
    A. S. Akselrod, D. Yu. Shchekochikhin, E. S. Tebenkova, A. V. Zhelankin, D. A. Stonogina, E. A. Syrkina, S. K. Ternovoy
    Kardiologiya i serdechno-sosudistaya khirurgiya.2019; 12(5): 418.     CrossRef
  • Pharmacological actions and therapeutic potentials of bilirubin in islet transplantation for the treatment of diabetes
    Qing Yao, Xue Jiang, Longfa Kou, Adelaide T. Samuriwo, He-Lin Xu, Ying-Zheng Zhao
    Pharmacological Research.2019; 145: 104256.     CrossRef
  • Evaluation of genetic effect of NOS3 and G×E interaction on the variability of serum bilirubin in a Han Chinese population
    Yingshui Yao, Zhengmei Fang, Song Yang, Hailong Zhao, Yanchun Chen, Yuelong Jin, Xianghai Zhao, Lijun Zhu, Yuanrui Tian, Chong Shen
    Nitric Oxide.2017; 70: 25.     CrossRef
  • Supplementation with Phycocyanobilin, Citrulline, Taurine, and Supranutritional Doses of Folic Acid and Biotin—Potential for Preventing or Slowing the Progression of Diabetic Complications
    Mark McCarty
    Healthcare.2017; 5(1): 15.     CrossRef
  • Effect of bilirubin concentration on the risk of diabetic complications: A meta-analysis of epidemiologic studies
    Bo Zhu, Xiaomei Wu, Yifei Bi, Yang Yang
    Scientific Reports.2017;[Epub]     CrossRef
  • Role of Bilirubin in Diabetic Vascular Complications: Can Bilirubin Predict More than Just Liver Disease?
    Jun Sung Moon
    Diabetes & Metabolism Journal.2015; 39(5): 384.     CrossRef
Predictive Factors for Efficacy of Dipeptidyl Peptidase-4 Inhibitors in Patients with Type 2 Diabetes Mellitus
Shusuke Yagi, Ken-ichi Aihara, Masashi Akaike, Daiju Fukuda, Hotimah Masdan Salim, Masayoshi Ishida, Tomomi Matsuura, Takayuki Ise, Koji Yamaguchi, Takashi Iwase, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki, Michio Shimabukuro, Toshio Matsumoto, Masataka Sata
Diabetes Metab J. 2015;39(4):342-347.   Published online July 21, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.4.342
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AbstractAbstract PDFPubReader   
Background

Predictive factors for the efficacy of dipeptidyl peptidase-4 (DPP-4) inhibitors for lowering glycosylated hemoglobin (HbA1c) remain unclear in patients with type 2 diabetes mellitus. The aim of this study is therefore to clarify predictive factors of the efficacy of DPP-4 inhibitors for lowering HbA1c after 12 months of treatment.

Methods

A total of 191 consecutive type 2 diabetic patients (male sex 55%, mean age, 68.3±35.8 years), who had been treated with DPP-4 inhibitors for 12 months, were enrolled in this study and evaluated retrospectively.

Results

After 12 months of DPP-4 inhibitor treatment, random blood glucose level, and HbA1c level, decreased from 167±63 to 151±49 mg/dL (P<0.01), and from 7.5%±1.3% to 6.9%±0.9% (P<0.01) respectively, without severe side effects. Multiple regression analysis showed that predictors of DPP-4 inhibitor treatment efficacy in lowering HbA1c level after 12 months were a decrease in HbA1c level after 3 months of treatment, a high baseline HbA1c level, a low baseline body mass index, and the absence of coronary artery disease.

Conclusion

Most suitable candidates for treatment with DPP-4 inhibitors are diabetics who are not obese and do not have coronary artery disease. In addition, long-term efficacy of DPP-4 inhibitors can be predicted by decrement of HbA1c after 3 months of treatment.

Citations

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  • Endogenous GLP-1 levels play an important role in determining the efficacy of DPP-IV Inhibitors in both prediabetes and type 2 diabetes
    Shiau Chin Chong, Norlela Sukor, Sarah Anne Robert, Kim Fong Ng, Nor Azmi Kamaruddin
    Frontiers in Endocrinology.2022;[Epub]     CrossRef
  • Dipeptidyl peptidase‐4 inhibitor, anagliptin, alters hepatic insulin clearance in relation to the glycemic status in Japanese individuals with type 2 diabetes
    Takahiro Abe, Yasuhiro Matsubayashi, Sayaka Muragishi, Akihiro Yoshida, Hideki Suganami, Kenichi Furusawa, Kazuya Fujihara, Shiro Tanaka, Kohei Kaku, Hirohito Sone
    Journal of Diabetes Investigation.2021; 12(10): 1805.     CrossRef
  • Effects of omarigliptin on glucose variability and oxidative stress in type 2 diabetes patients: A prospective study
    Makoto Ohara, Hiroe Nagaike, Tomoki Fujikawa, Yo Kohata, Maiho Ogawa, Takemasa Omachi, Risa Sasajima, Hirotoshi Chiba, Toshimasa Ara, Ayuka Sugawara, Munenori Hiromura, Michishige Terasaki, Yusaku Mori, Tomoyasu Fukui, Tsutomu Hirano, Hiroki Yokoyama, Sho
    Diabetes Research and Clinical Practice.2021; 179: 108999.     CrossRef
  • Factors associated with the glucose‐lowering efficacy of sitagliptin in Japanese patients with type 2 diabetes mellitus: Pooled analysis of Japanese clinical trials
    Naoko Tajima, Jun‐ichi Eiki, Taro Okamoto, Kotoba Okuyama, Masaru Kawashima, Samuel S Engel
    Journal of Diabetes Investigation.2020; 11(3): 640.     CrossRef
  • Efficacy and safety of evogliptin versus sitagliptin as add on to metformin alone in a combined russian-korean population. Evo-combi trial
    Alina Y. Babenko, Anna A. Mosikian, Igor E. Makarenko, Victoriya V. Leusheva, Evgeny V. Shlyakhto
    Diabetes mellitus.2018; 21(4): 241.     CrossRef
  • Predictors for the Treatment Effect of Sodium Glucose Co-transporter 2 Inhibitors in Patients with Type 2 Diabetes Mellitus
    Shusuke Yagi, Ken-ichi Aihara, Takeshi Kondo, Kiyoe Kurahashi, Sumiko Yoshida, Itsuro Endo, Daiju Fukuda, Yutaka Nakaya, Kin-ichiro Suwaki, Takashi Takeji, Toshihiro Wada, Hotimah Masdan Salim, Saori Hama, Tomomi Matsuura, Takayuki Ise, Kenya Kusunose, Ko
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    Yuli Cai, Tianshu Zeng, Zhongyuan Wen, Lulu Chen
    Diabetes Therapy.2018; 9(1): 177.     CrossRef
  • Effectiveness prediction of Evogliptin treatment in type 2 diabetes mellitus in russian-korean population
    Anna A. Mosikian, Alina Y. Babenko, Yulia A. Sevastyanova, Roman V. Drai, Evgenij V. Shlyakhto
    Diabetes mellitus.2018; 21(5): 333.     CrossRef
  • Efficacy and Safety of Linagliptin in 2681 Asian Patients Stratified by Age, Obesity, and Renal Function: A Pooled Analysis of Randomized Clinical Trials
    Guang Ning, Tushar Bandgar, Uwe Hehnke, Jisoo Lee, Juliana C. N. Chan
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    Shui-Dong Feng, Ji-Hua Yang, Chao Hua Yao, Si-Si Yang, Ze-Mei Zhu, Di Wu, Hong-Yan Ling, Liang Zhang
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    Xiaoling Cai, Wenjia Yang, Xueying Gao, Lingli Zhou, Xueyao Han, Linong Ji, Francesco Giorgino
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  • Letter: Predictive Factors for Efficacy of Dipeptidyl Peptidase-4 Inhibitors in Patients with Type 2 Diabetes Mellitus (Diabetes Metab J2015;39:342-7)
    Ye An Kim
    Diabetes & Metabolism Journal.2015; 39(5): 444.     CrossRef
  • Response: Predictive Factors for Efficacy of Dipeptidyl Peptidase-4 Inhibitors in Patients with Type 2 Diabetes Mellitus (Diabetes Metab J2015;39:342-7)
    Shusuke Yagi, Ken-ichi Aihara, Masataka Sata
    Diabetes & Metabolism Journal.2015; 39(5): 446.     CrossRef
Assessment of the Association between Mean Hemoglobin A1c Levels for 5 Years and Coronary Artery Disease by Coronary Angiography in Nondiabetic Patients
Jae-Joon Kim, Ji-Hoon Kang, Ja-Jun Goo, Kyoung-Nyoun Kim, Ja-Young Lee, Mi-kyung Kim, Tae Ik Kim
Diabetes Metab J. 2014;38(1):58-63.   Published online February 19, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.1.58
  • 4,223 View
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  • 4 Web of Science
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AbstractAbstract PDFPubReader   
Background

The effects of glucose on cardiovascular events or mortality in nondiabetic patients has been recently reported. However, since atherosclerosis can be formed over a long period of time, it is necessary to devote several years to unveil the relationship between the two factors. Here, we attempted to find out the relationship between the mean hemoglobin A1c (HbA1c) level and HbA1c variability for 5 years and coronary artery disease (CAD) by using coronary angiography (CAG) to assess nondiabetic patients.

Methods

We reviewed patients who performed CAG who were followed up for at least 5 years after the initial diagnosis. The fasting blood test was performed annually for glucose and HbA1c level. CAD was defined as more than 50% of luminal narrowing. The severity of CAD was divided into two groups depending on whether no vessels were involved or one more vessel were involved (CAD(-) or CAD(+), respectively).

Results

The patients in CAD(+) group had higher mean HbA1c level for 5 years than CAD(-) group (5.71±0.40 vs. 5.86±0.68; P=0.04). Mean HbA1c was a significant predictor for CAD in multiple regression (odds ratio, 2.224; P=0.028). The percentage of patients with CAD was significantly higher in patients with >6.2% of mean HbA1c levels compared to patients with <6.2% of mean HbA1c levels (P<0.019).

Conclusion

When the mean HbA1c levels were above 6.2%, the risk of CAD was higher. Also this study shows that HbA1c level can be one of the predictors for CAD even if the patients do not have diabetes.

Citations

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  • Impact of a comprehensive cardiac rehabilitation programme versus coronary revascularisation in patients with stable angina pectoris: study protocol for the PRO-FIT randomised controlled trial
    Joyce M. Heutinck, Iris A. De Koning, Tom Vromen, Robert-Jan M. Van Geuns, Dick H.J. Thijssen, Hareld M.C. Kemps, Eddy M. Adang, Johanna M. Geleijnse, Pieter van Gorp, Arnoud W. J. van ‘t Hof, Veronica R. Janssen, Harald T. Jorstad, Roderik A. Kraaijenhag
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    Denis Monneret
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Diagnostic Accuracy of 64-Slice MDCT Coronary Angiography for the Assessment of Coronary Artery Disease in Korean Patients with Type 2 Diabetes
Jun Sung Moon, Ji Sung Yoon, Kyu Chang Won, Ihn-Ho Cho, Hyoung Woo Lee
Diabetes Metab J. 2013;37(1):54-62.   Published online February 15, 2013
DOI: https://doi.org/10.4093/dmj.2013.37.1.54
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AbstractAbstract PDFPubReader   
Background

A 64-slice multidetector computed tomography (MDCT) is well known to be a useful noninvasive form of angiography for the general population, but not for certain patients with diabetes. The aim of this study was to investigate the diagnostic accuracy and usefulness of 64-slice MDCT coronary angiography for detecting coronary artery disease in Korean patients with type 2 diabetes mellitus (T2DM).

Methods

A total of 240 patients were included, 74 of whom had type 2 diabetes (M:F=40:33; 41.8±9.5 years). We compared significant coronary stenosis (>50% luminal narrowing) in MDCT with invasive coronary angiography (ICA) by segment, artery, and patient. We also evaluated the influence of obesity and coronary calcium score on MDCT accuracy.

Results

Of the 4,064 coronary segments studied, 4,062 segments (T2DM=1,109) were assessed quantitatively by both MDCT and ICA, and 706 segments (T2DM=226) were detected as a significant lesion by ICA in all patients. Sensitivity, specificity, as well as positive and negative predictive values for the presence of significant stenosis in T2DM were: by segment, 89.4%, 96.4%, 85.8%, and 97.4%, respectively; by artery (n=222), 95.1%, 92.9%, 94.4%, and 93.8%, respectively; by patients (n=74), 98.4%, 100.0%, 98.4%, and 90.0%, respectively. Regardless of presence of diabetes, there was no significant difference in diagnostic accuracy. Obesity (≥25 kg/m2) and coronary calcium score did not also affect the diagnostic accuracy of MDCT.

Conclusion

The 64-slice MDCT coronary angiography was found to have similar diagnostic accuracy with ICA, regardless of diabetes. These results suggest MDCT may be helpful to reduce unnecessary invasive studies for patients with diabetes.

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Metabolic Syndrome versus Framingham Risk Score for Association of Self-Reported Coronary Heart Disease: The 2005 Korean Health and Nutrition Examination Survey
Hye Mi Kang, Dong-Jun Kim
Diabetes Metab J. 2012;36(3):237-244.   Published online June 14, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.3.237
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AbstractAbstract PDFPubReader   
Background

Several studies in Western populations have indicated that metabolic syndrome (MetS) is inferior to the Framingham risk score (FRS) in predicting coronary heart disease (CHD). However there has been no study about the predictability of MetS vs. FRS for CHD in Korea.

Methods

Among the 43,145 persons from the third Korea National Health and Nutrition Examination Survey in 2005, laboratory test and nutritional survey data from 5,271 persons were examined. Participants were also asked to recall a physician's diagnosis of CHD.

Results

The median age was 46 (range, 20 to 78) in men (n=2,257) and 44 (range, 20 to 78) years in women (n=3,014). Prevalence of self-reported CHD was 1.7% in men and 2.1% in women. Receiver operating characteristic curves and their respective area under the curve (AUC) were used to compare the ability of the FRS and the number of components of MetS to predict self-reported CHD in each sex. In men, AUC of FRS was significantly larger than that of MetS (0.767 [0.708 to 0.819] vs. 0.677 [0.541 to 0.713], P<0.01). In women, AUC of FRS was comparable to that of MetS (0.777 [0.728 to 0.826] vs. 0.733 [0.673 to 0.795]), and was not significant.

Conclusion

The data suggested that FRS was more closely associated with CHD compared to MetS in Korean men.

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Relationship between Chemerin Levels and Cardiometabolic Parameters and Degree of Coronary Stenosis in Korean Patients with Coronary Artery Disease
Yu-Jin Hah, Nam-Keong Kim, Mi-Kyung Kim, Hye-Soon Kim, Seung-Ho Hur, Hyuck-Jun Yoon, Yoon-Nyun Kim, Keun-Gyu Park
Diabetes Metab J. 2011;35(3):248-254.   Published online June 30, 2011
DOI: https://doi.org/10.4093/dmj.2011.35.3.248
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AbstractAbstract PDFPubReader   
Background

Chemerin is a novel adipokine that is associated with inflammation and adipogenesis. However, it remains unclear whether chemerin is involved in patients with cardiovascular disease. We investigated whether the serum chemerin levels of Korean patients with coronary artery disease correlated with specific cardiometabolic parameters.

Methods

In total, 131 patients, all of whom had coronary artery stenosis exceeding 50%, participated in this study. Their serum chemerin levels and cardiometabolic parameters were measured. The serum chemerin levels of two groups of patients were compared; those with one stenotic vessel (n=68) and those with multiple stenotic vessels, including left main coronary artery disease (n=63).

Results

Serum chemerin levels correlated positively with the degree of coronary artery stenosis and fasting glucose, triglyceride, total cholesterol, low density lipoprotein cholesterol, and high sensitive C-reactive protein levels. The group with multiple stenotic vessels, including left main disease, had higher chemerin levels than the group with one stenotic vessel (t=-2.129, P=0.035). Multiple binary logistic regression showed chemerin was not an independent risk factor of multiple vessel disease (odds ratio, 1.018; confidence interval, 0.997 to 1.040; P=0.091).

Conclusion

Serum chemerin levels have a significant correlation with several cardiometabolic risk factors and the degree of coronary artery stenosis in Korean patients with coronary artery disease. However, multiple binary logistic regression showed chemerin was not an independent risk factor of multiple vessel disease. Additional investigations are necessary to fully elucidate the role of chemerin in cardiovascular disease.

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Lack of Association between Serum Cystatin C Levels and Coronary Artery Disease in Diabetic Patients
Eun Hee Kim, Ji Hee Yu, Sang Ah Lee, Eui Young Kim, Won Gu Kim, Seung Hun Lee, Eun Hee Cho, Eun Hee Koh, Woo Je Lee, Min-Seon Kim, Joong-Yeol Park, Ki-Up Lee
Korean Diabetes J. 2010;34(2):95-100.   Published online April 30, 2010
DOI: https://doi.org/10.4093/kdj.2010.34.2.95
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AbstractAbstract PDFPubReader   
Background

Serum cystatin C level is a more sensitive marker of renal dysfunction than serum creatinine level. Serum cystatin C level was recently reported to predict the development of cardiovascular disease. This study was performed to evaluate whether the cystatin C level is associated with coronary artery disease (CAD), independent of diabetic nephropathy.

Methods

We conducted a case-control study to assess the relationship between serum cystatin C level and coronary artery disease in diabetic patients. Among 460 diabetic patients, 38 diabetic patients had CAD. The control group consisted of 38 diabetic patients who were matched to cases by age, sex, and presence/absence of diabetic nephropathy. Serum cystatin C level was measured in stored samples.

Results

Serum cystatin C level was significantly higher in patients with diabetic nephropathy, both in CAD and non-CAD patients. However, serum cystatin C level did not differ between CAD and non-CAD patients, regardless of diabetic nephropathy.

Conclusion

Serum cystatin C level is a marker of renal dysfunction, but not coronary artery disease, in diabetic patients.

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The Association Between Urinary Albumin to Creatinine Ratio and Coronary Artery Calcification in Type 2 Diabetic Patients.
Ju Young Lee, Yeon Kyung Choi, Hyun Ae Seo, Jae Han Jeon, Jung Eun Lee, Seong Su Moon, Jung Guk Kim, Bo Wan Kim, In Kyu Lee
Korean Diabetes J. 2009;33(4):289-298.   Published online August 1, 2009
DOI: https://doi.org/10.4093/kdj.2009.33.4.289
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AbstractAbstract PDF
BACKGROUND
Atherosclerosis, the most common cause of death in type 2 diabetic patients, is closely associated with coronary artery calcium deposition. The coronary calcifications can be easily measured using coronary calcium scoring computed tomography (CT). And microalbuminuria is known as an independent risk factor of cardiovascular disease. So, we examined the association of urinary albumin to creatinine ratio (UACR) and coronary calcification score (CCS) in type 2 diabetic patients. METHODS: Among type 2 diabetic patients who underwent the multidetector CT scanning for the evaluation of CCS at Kyungpook National University Hospital between December 2007 and May 2008, 155 subjects were included. CCS, demographic and laboratory data were assessed. RESULTS: Coronary artery calcifications were identified in 90 patients (51%) and mean, median CCS was 205.8 +/- 476.9, 8.74 (0, 132.0). 60 subjects revealed UACR greater than 30 ug/mg. With the UACR increment, CCS revealed a significant increase (P < 0.001). Age, duration of diabetes, serum Apo A1 level, serum high sensitivity C-reactive protein (hs-CRP) level were also associated with CCS. However, after adjusting for age, UACR and CCS exhibited a significant positive relationship (P = 0.002). CONCLUSION: Increased UACR is associated with coronary artery calcification in type 2 diabetic patients and these results will be useful in early evaluating the presence of macrovascular complications in these patients.
The Relationship between Serum Retinol-Binding Protein 4 Levels and Coronary Artery Disease in Korean Adults.
Ji Hoon Kim, Eun Jung Rhee, Eun Suk Choi, Jong Chul Won, Cheol Young Park, Won Young Lee, Ki Won Oh, Byung Jin Kim, Ki Chul Sung, Bum Soo Kim, Jin Ho Kang, Sung Woo Park, Sun Woo Kim, Man Ho Lee, Jung Roe Park
Korean Diabetes J. 2009;33(2):105-112.   Published online April 1, 2009
DOI: https://doi.org/10.4093/kdj.2009.33.2.105
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AbstractAbstract PDF
BACKGROUND
A recently discovered adipokine, retinol-binding protein-4 (RBP-4), is reportedly associated with insulin resistance and metabolic syndrome. This study was performed to analyze the relationship between serum RBP-4 levels and coronary artery disease (CAD) in Korean adults. METHODS: In 235 subjects (mean age 58 years) in whom coronary artery angiograms were performed due to complaints of chest pain, serum RBP-4 levels were measured by enzyme-linked immunosorbent assay. Coronary artery angiograms were performed in all subjects and the severity of CAD was assessed by the number of stenotic vessels. The presence of metabolic syndrome was defined by AHA/NHLBI criteria with body mass index substituted for waist circumference. RESULTS: Coronary angiogram showed that 101 subjects (43%) had normal coronary vessel, 82 subjects (34.9%) had 1-vessel disease, 31 subjects (13.2%) had 2-vessel disease and 21 subjects (8.9%) had 3-vessel disease. Subjects with coronary artery stenosis showed a higher mean age (60.5 +/- 10.0 years), fasting glucose (123.3 mg +/- 45.0 mg/dL) and lower mean value for high-density lipoprotein cholesterol (HDL-C) level (49.0 +/- 13.2 mg/dL), although serum RBP-4 levels were not significantly different between those with and without CAD. Mean age and fasting glucose level increased significantly as the number of stenotic vessels increased, although serum RBP4 level showed no significant differences among the different groups. Among the metabolic parameters, only serum triglyceride levels showed a significant correlation with serum RBP-4 levels. CONCLUSION: There was no difference in mean serum RBP-4 levels between subjects with or without coronary artery disease in Korean adults. Further studies are warranted to draw a clear conclusion on the effect of RBP-4 on atherosclerosis.

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  • Retinol binding protein 4 levels relate to the presence and severity of coronary artery disease
    Gokay Nar, Sara Sanlialp, Rukiye Nar
    Journal of Medical Biochemistry.2021; 40(4): 384.     CrossRef
Insulin Resistance and severity of coronary artery diseases in Patients with Coronary Artery Diseases.
Dae Jung Kim, Jae Hyun Nam, Dong Hoon Choi, Hyeung Jin Kim, Soo Kyung Kim, Se Hwa Kim, Yumie Rhee, Chul Woo Ahn, Bong Soo Cha, Young Duk Song, Sung Kil Lim, Kyeong Rae Kim, Hyun Chul Lee, Kap Bum Huh
Korean Diabetes J. 2002;26(3):189-198.   Published online June 1, 2002
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AbstractAbstract PDF
BACKGROUND
Insulin resistance (IR) has been identified as a risk factor of atherosclerosis, which may be induced through a mechanism brought about by hypertension, obesity, glucose intolerance and dyslipidemia. The purpose of this study was to investigate the relationship between coronary artery disease (CAD) and insulin resistance. METHODS: Of 92 subjects having undergone coronary angiography 70 with significantly stenotic coronary artery were designated as the CAD group, with the other 22, without stenosis, as the control group. The CAD group was subdivided into 3 smaller groups according to the severity of their CAD; these being 1-vessel disease (group 1, n=31), 2-vessel disease (group 2, n=25), and 3-vessel disease (group 3, n=14). RESULTS: Kitt for patients with CAD was significantly lower than in the control group, and also for those in group 1 compared to groups 2 and 3, 2.72+/-1.29, 2.25+/-0.68 and 2.21+/-0.78%/min, with that of the controls being 3.01+/-1.22%/min p<0.05). There were significant differences between the IR group and the non-IR group in the common carotid artery intima-media thickness (1.09mm vs. 0.87mm, p<0.05), the waist-hip ratio (1.09 vs. 0.93, p<0.05) and the body fat contents (32% vs. 27%, p<0.05).Insulin resistance was assessed by the short insulin tolerance test, and the insulin resistance (IR) group was defined as having a Kitt less than 2.5%/min. CONCLUSION: These results suggest that insulin resistance is an important risk factor for CAD, and is related to the severity of coronary atherosclerosis.
Clinical and Coronary Angiographic Findings of Coronary Artery Disease in Patients with Noninsulin Dependent Diabetes Mellitus.
Bon Jeong Ku, Bong Soo An, Jin Ok Jeong, In Whan Seong, Eun Seok Jeon, Min Ho Shong, Heung Kyu Ro, Young Kun Kim
Korean Diabetes J. 1997;21(3):308-313.   Published online January 1, 2001
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AbstractAbstract PDF
BACKGROUND
Diabetes mellitus has a major impact on cardiac morbidity and mortality. We analyzed the clinical characteristics and coronary angiographic findings in patients with a coronary artery disease and with noninsulin dependent diabetes mellitus. METHODS: We retrospectively reviewed the clinical and coronary angiographic findings in 74 patients with noninsulin dependent cliabetes mellitus and in 328 non-diabetic patients who had a coronary insufficiency. RESULTS: Significant coronary occlusions and multiple coronary artery diseases were more common in diabetics than in non-diabetics. The patients with noninsulin dependent diabetes mellitus has several limiting factors to perform the successful percutaneous coronary angioplasty, it could be a possible factor for rapid deterioration of coronary insufficiency in patients with diabetes mellitus. Smoking and hypertension significantly increased the incidence of signiftcant coronary occlusions whereas obesity and hypercholesterolemia did not any significant influence on incidence of the significant coronary occlusions. The longer duration of diabetes rnellitus associated with higher incidence of significant coronary occlusions and multiple coronary diseases. CONCLUSION: Significant coronary occlusions and multiple coronary artery diseases were occurred more common in diabetics than in non-diabetics. Coronary angiography should be performed routinely in noninsulin dependent diabetes.

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