European Journal of Cardiovascular Prevention & Rehabilitation最新文献

{"title":"A high ankle-brachial index is associated with increased aortic pulse wave velocity: the Czech post-MONICA study.","authors":"Peter Wohlfahrt,&nbsp;Daniel Palous,&nbsp;Michaela Ingrischová,&nbsp;Alena Krajcoviechová,&nbsp;Jitka Seidlerová,&nbsp;Markéta Galovcová,&nbsp;Jan Bruthans,&nbsp;Marie Jozífová,&nbsp;Vera Adámková,&nbsp;Jan Filipovsky,&nbsp;Renata Cífková","doi":"10.1177/1741826711398840","DOIUrl":"https://doi.org/10.1177/1741826711398840","url":null,"abstract":"<p><strong>Background: </strong>Ankle brachial index (ABI) has been increasingly used in general practice to identify individuals with low ABI at high cardiovascular risk. However, there has been no consensus on the clinical significance of high ABI. The aim of our study was to compare aortic stiffness as a marker of cardiovascular risk in individuals with low (<1.0), normal (1.0-1.4), and high ABI (>1.4).</p><p><strong>Methods: </strong>A total of 911 individuals from the Czech post-MONICA study (a randomly selected 1% representative population sample, aged 54 ± 13.5 years, 47% of men) were examined. ABI was measured using a handheld Doppler and aortic pulse wave velocity (aPWV) using the Sphygmocor device.</p><p><strong>Results: </strong>Of the 911 individuals, 28 (3.1%) had low ABI and 23 (2.5%) high ABI. There was a U-shaped association between aPWV and ABI. aPWV was significantly higher in individuals with low and high ABI compared with the normal ABI group (11.1 ± 2.8, 8.3 ± 2.3, p < 0.001; 10.8 ± 2.5, 8.3 ± 2.3 m/s, p < 0.001, respectively). In a model adjusted for age, sex, systolic, diastolic, mean blood pressure and examiner, aPWV remained increased in both extreme ABI groups compared with the normal ABI group. In logistic regression analysis, aPWV together with glucose level, male sex, and a history of deep venous thrombosis were independent predictors of high ABI, while cholesterol was not.</p><p><strong>Conclusion: </strong>This is the first study showing increased aortic stiffness in individuals with high ABI, presumably responsible for increased left ventricular mass described previously in this group. These findings suggest increased cardiovascular risk of high ABI individuals.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826711398840","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29780004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methods for evaluating endothelial function: a position statement from the European Society of Cardiology Working Group on Peripheral Circulation.","authors":"John Lekakis,&nbsp;Pierre Abraham,&nbsp;Alberto Balbarini,&nbsp;Andrew Blann,&nbsp;Chantal M Boulanger,&nbsp;John Cockcroft,&nbsp;Francesco Cosentino,&nbsp;John Deanfield,&nbsp;Augusto Gallino,&nbsp;Ignatios Ikonomidis,&nbsp;Dimitrios Kremastinos,&nbsp;Ulf Landmesser,&nbsp;Athanase Protogerou,&nbsp;Christodoulos Stefanadis,&nbsp;Dimitris Tousoulis,&nbsp;Giuseppe Vassalli,&nbsp;Hans Vink,&nbsp;Nikos Werner,&nbsp;Ian Wilkinson,&nbsp;Charalambos Vlachopoulos","doi":"10.1177/1741826711398179","DOIUrl":"https://doi.org/10.1177/1741826711398179","url":null,"abstract":"<p><p>The endothelium holds a pivotal role in cardiovascular health and disease. Assessment of its function was until recently limited to experimental designs due to its location. The advent of novel techniques has facilitated testing on a more detailed basis, with focus on distinct pathways. This review presents available in-vivo and ex-vivo methods for evaluating endothelial function with special focus on more recent ones. The diagnostic modalities covered include assessment of epicardial and microvascular coronary endothelial function, local vasodilation by venous occlusion plethysmography and flow-mediated dilatation, arterial pulse wave analysis and pulse amplitude tonometry, microvascular blood flow by laser Doppler flowmetry, biochemical markers and bioassays, measurement of endothelial-derived microparticles and progenitor cells, and glycocalyx measurements. Insights and practical information on the theoretical basis, methodological aspects, and clinical application in various disease states are discussed. The ability of these methods to detect endothelial dysfunction before overt cardiovascular disease manifests make them attractive clinical tools for prevention and rehabilitation.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826711398179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29781515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipid lowering in patients with chronic kidney disease: a SHARP turn in the wrong direction?","authors":"Heiner K Berthold,&nbsp;Wilhelm Krone,&nbsp;Erland Erdmann,&nbsp;Ioanna Gouni-Berthold","doi":"10.1177/1741826711423116","DOIUrl":"https://doi.org/10.1177/1741826711423116","url":null,"abstract":"<p><p>The question whether lipid-lowering treatment is associated with a decrease in cardiovascular morbidity and mortality in patients with chronic kidney disease has been disputed for a while, with recent trials in patients on haemodialysis failing to show benefit. Recently, the long-awaited results of the SHARP (Study of Heart And Renal Protection) trial were published. This randomized trial compared the effects of either simvastatin 20 mg plus ezetimibe 10 mg daily or placebo on the occurrence of a first major vascular event in 9720 patients with chronic kidney disease. There was a 17% relative risk reduction but no benefit on survival. We address our concerns regarding the conclusions drawn from this trial. The trial has a major design flaw by comparing the effects of two different lipid-lowering drugs with placebo. Although the SHARP trial showed that lipid lowering may be beneficial for patients with chronic kidney disease, the clinically as well as economically important question remains unanswered as to whether it was statin therapy and/or ezetimibe that mediated this effect. A great opportunity to investigate superiority, equipoise, or potential inferiority of ezetimibe compared to statins was missed.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826711423116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30256943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart rate response to exercise and cardiorespiratory fitness of young women at high familial risk for hypertension: effects of interval vs continuous training.","authors":"Emmanuel G Ciolac,&nbsp;Edimar A Bocchi,&nbsp;Julia M D Greve,&nbsp;Guilherme V Guimarães","doi":"10.1177/1741826711398426","DOIUrl":"https://doi.org/10.1177/1741826711398426","url":null,"abstract":"<p><p>Exercise training is an effective intervention for treating and preventing hypertension, but its effects on heart rate (HR) response to exercise and cardiorespiratory fitness (CRF) of non-hypertensive offspring of hypertensive parents (FH+) has not been studied. We compared the effects of three times per week equal-volume high-intensity aerobic interval (AIT) and continuous moderate-intensity exercise (CME) on HR response to exercise and CRF of FH+. Forty-four young FH+ women (25.0 ± 4.4 years) randomized to control (CON; n = 12), AIT (80-90% of VO(2MAX); n = 16), or CME (50-60% of VO(2MAX); n = 16) performed a graded exercise test (GXT) before and after 16 weeks of follow-up to evaluate HR response to exercise and several parameters of CRF. Resting, maximal, and reserve HR did not change after the follow-up in all groups. HR recovery (difference between HR(MAX) and HR at 1 minute of GXT recovery phase) improved only after AIT (11.8 ± 4.9 vs. 20.6 ± 5.8 bpm, p < 0.01). Both exercise programmes were effective for improving CRF parameters, but AIT was more effective than CME for improving oxygen consumption at the respiratory compensation point (VO(2RCP); 22.1% vs. 8.8%, p = 0.008) and maximal effort (VO(2MAX); 15.8% vs. 8.0%, p = 0.036), as well as tolerance time (TT) to reach anaerobic threshold (TT(AT); 62.0 vs. 37.7, p = 0.048), TT(RCP) (49.3 vs. 32.9, p = 0.032), and TT(MAX) (38.9 vs. 29.2, p = 0.042). Exercise intensity was an important factor in improving HR recovery and CRF of FH+women. These findings may have important implications for designing exercise-training programmes for the prevention of an inherited hypertensive disorder.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826711398426","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29781512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term risk factor management after inpatient cardiac rehabilitation by means of a structured post-care programme.","authors":"Birgit M Harb,&nbsp;Manfred Wonisch,&nbsp;Dieter Brandt,&nbsp;Rudolf Müller","doi":"10.1177/1741826711398837","DOIUrl":"https://doi.org/10.1177/1741826711398837","url":null,"abstract":"<p><strong>Background: </strong>Initiation of a long-term improvement of cardiac risk factors is one of the major aims of a cardiac rehabilitation/secondary prevention programme.</p><p><strong>Methods and participants: </strong>The Health Guide collected data in terms of cardiac risk factors: blood pressure, resting pulse, total cholesterol, LDL cholesterol, body weight, physical activity and number of cigarettes at admission and discharge after a stationary rehabilitation programme and every 3 months. After 12 months the Health Guides were returned. In the prospective study 2664 patients (71.8% men, age: MV = 62.94 years, SD = 9.96; 28% women, MV = 67.59 years, SD = 9.53) with coronary heart disease (CHD) were included.</p><p><strong>Results: </strong>All cardiac risk factors documented by the Health Guide improved during the cardiac rehabilitation programme. After one year, risk factors were significantly lower than at admission, apart from total cholesterol. The individual goal in terms of body weight and LDL cholesterol was partially achieved after the rehabilitation programme and maintained after one year. In the investigation years, 2004-2007, the cholesterol and blood pressure were significantly lower than in the years 2000-2003.</p><p><strong>Conclusion: </strong>The use of a Health Guide resulted in an improved long-term effect of a cardiac rehabilitation/secondary prevention programme. It is a simple and cheap intervention and can help in the guidance of the patients.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826711398837","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29780005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multifactor dimensionality reduction analysis of MTHFR, PAI-1, ACE, PON1, and eNOS gene polymorphisms in patients with early onset coronary artery disease.","authors":"M Agirbasli,&nbsp;A I Guney,&nbsp;H S Ozturhan,&nbsp;D Agirbasli,&nbsp;K Ulucan,&nbsp;D Sevinc,&nbsp;D Kirac,&nbsp;K K Ryckman,&nbsp;S M Williams","doi":"10.1177/1741826711398806","DOIUrl":"https://doi.org/10.1177/1741826711398806","url":null,"abstract":"<p><strong>Background: </strong>Association studies in the Turkish population have investigated the single locus effects of different gene polymorphisms on coronary artery disease (CAD). CAD is a complex polygenic disease that involves complex interactions among multiple genetic and environmental conditions.</p><p><strong>Design: </strong>We evaluated associations of five candidate genetic polymorphisms (methylene tetrahydrofolate reductase C677T, plasminogen activator inhibitor 4G/5G, endothelial nitric oxide synthase (eNOS) 3-27 base pair repeat, insertion, or deletion of a 287 bp Alu repeat sequence polymorhism of angiotensin I converting enzyme, and paraoxonase Gln192Arg PON1 polymorphisms) with the presence and extent of early onset CAD.</p><p><strong>Methods: </strong>DNA was isolated and amplified from 90 consecutive patients with angiographically proven early onset CAD (ages 41 ± 5 for men, 49 ± 7 for women) and also from 90 control subjects with no significant coronary obstruction angiographically (ages 42 ± 5 for men, 48 ± 6 for women). Multifactor dimensionality reduction (MDR) analysis was performed to identify a model of CAD based on both genetic and conventional risk factors.</p><p><strong>Results: </strong>MDR analysis detected a significant model with four genes (prediction success ∼ 61%, p = 0.03). When the total number of the conventional risk factors is analysed with the candidate polymorphisms, a different model is identified that includes three of the four genes from the above model and achieves a similar prediction of CAD as the gene only model.</p><p><strong>Conclusion: </strong>These data indicate that gene-gene and gene-environmental risk interactions form significant models in predicting early onset CAD.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826711398806","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29780007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Additive prognostic value of subjective assessment with respect to clinical cardiological data in patients with chronic heart failure.","authors":"Giuseppina Majani,&nbsp;Antonia Pierobon,&nbsp;Gian Domenico Pinna,&nbsp;Anna Giardini,&nbsp;Roberto Maestri,&nbsp;Maria Teresa La Rovere","doi":"10.1177/1741826711398804","DOIUrl":"https://doi.org/10.1177/1741826711398804","url":null,"abstract":"<p><strong>Background: </strong>Health-related quality of life tools that better reflect the unique subjective perception of heart failure (HF) are needed for patients with this disorder. The aim of this study was to explore whether subjective satisfaction of HF patients about daily life may provide additional prognostic information with respect to clinical cardiological data.</p><p><strong>Methods: </strong>One hundred and seventy-eight patients (age 51 ± 9 years) with moderate to severe HF [New York Heart Association (NYHA) class 2.0 ± 0.7; left ventricular ejection fraction (LVEF) 29 ± 8%] in stable clinical condition underwent a standard clinical evaluation and compiled the Satisfaction Profile (SAT-P) questionnaire focusing on subjective satisfaction with daily life. Cox regression analysis was used to assess whether SAT-P factors (psychological functioning, physical functioning, work, sleep/eating/leisure, social functioning) had any prognostic value.</p><p><strong>Results: </strong>Forty-six cardiac deaths occurred during a median of 30 months. Patients who died had higher NYHA class, more depressed left ventricular function, reduced systolic blood pressure (SBP), increased heart rate (HR), and worse biochemistry (all p < 0.05). Among the SAT-P factors, only physical functioning (PF) was significantly reduced in the patients who died (p = 0.003). Using the best subset selection procedure, resistance to physical fatigue (RPF) was selected from among the items of the PF factor. RPF showed independent predictive value when entered into a prognostic model including NYHA class, LVEF, SBP, and HR with an adjusted hazard ratio of 0.86 per 10 units increase (95% CI 0.75-0.98, p = 0.02).</p><p><strong>Conclusions: </strong>Patients' dissatisfaction with physical functioning is associated with reduced long-term survival, after adjustment for known risk factors in HF. Given its user-friendly structure, simplicity, and significant prognostic value, the RPF score may represent a useful instrument in clinical practice.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826711398804","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29780008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An elevated level of BNP in plasma is related to the development of good collateral circulation in coronary artery disease.","authors":"Wei-Wei Xi,&nbsp;Gang Cheng,&nbsp;Shumin Lv,&nbsp;Qinqin Gao,&nbsp;Gang Bu,&nbsp;Ying Zhou,&nbsp;Geng Xu","doi":"10.1177/1741826710389556","DOIUrl":"https://doi.org/10.1177/1741826710389556","url":null,"abstract":"<p><strong>Objective: </strong>B-type natriuretic peptide (BNP) was recently demonstrated to be a potential stimulator of angiogenesis and arteriogenesis. The correlation between BNP level and collateral formation in patients with coronary artery disease (CAD) has not been reported.</p><p><strong>Methods and results: </strong>The study included 311 consecutive patients who underwent coronary angiography were divided into three groups according to coronary angiography and collateral formation: normal group (100 patients with normal coronary angiographic findings); poor collateral group (116 patients with at least one coronary stenosis of ≥75% without visible collateral circulation); and good collateral group (95 patients with at least one coronary stenosis of ≥75% with well-developed collateral circulation). Collateral score was analyzed using the Cohen-Rentrop classification. Plasma BNP levels were 45.77 ± 4.66 pg/ml, 116.40 ± 28.15 pg/ml, and 254.20 ± 42.85 pg/ml for patients in normal, poor collateral, and good collateral groups, respectively. Plasma BNP levels in the latter were significantly higher than in the normal group (p < 0.01) and poor collateral group (p < 0.05). There were no significant differences between the good collateral group and poor collateral group when compared with left ventricular ejection fraction (LVEF), left ventricular dimensions at end diastole (LVEDd), age, severity of angiographic disease, and other cardiovascular risk factors. After adjustment in the multiple ordinal logistic regression model, plasma BNP levels showed a strong independent association with collateral Cohen-Rentrop score (χ(2 )= 5.636, OR = 1.002, 95% CI 1.000-1.004, p = 0.018).</p><p><strong>Conclusions: </strong>An elevated level of BNP in plasma is independently associated with collateral development; patients with good collaterals tend to have a higher BNP level.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826710389556","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29780692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High intensity interval training reduces systemic inflammation in post-PCI patients.","authors":"Peter Scott Munk,&nbsp;Unni Mathilde Breland,&nbsp;Pål Aukrust,&nbsp;Thor Ueland,&nbsp;Jan Terje Kvaløy,&nbsp;Alf Inge Larsen","doi":"10.1177/1741826710397600","DOIUrl":"https://doi.org/10.1177/1741826710397600","url":null,"abstract":"<p><strong>Background: </strong>Increased plasma levels of inflammatory markers and markers of endothelial cell activation have been associated with increased risk for cardiovascular events. Exercise training may lower the risk for coronary heart disease by attenuating inflammation and improving endothelial function. The objective of this study was to evaluate effects of regular high-intensity exercise training on a wide range of markers of inflammation and endothelial cell activation.</p><p><strong>Materials and methods: </strong>Consecutively, 40 patients were prospectively randomized to a 6 months supervised high-intensity interval training programme or to a control group following successful percutaneous coronary intervention (PCI). Blood samples of 36 patients with stable angina, drawn at baseline (before PCI) and at 6 months, were analysed. Late luminal loss was measured at 6 months using quantitative coronary angiography.</p><p><strong>Results: </strong>At 6 months, levels of the inflammatory markers interleukin (IL)-6 and IL-8 were reduced and levels of the anti-inflammatory cytokine IL-10 increased in the training group only. The decrease in IL-6 and C-reactive protein levels were significantly correlated with the decrease in luminal loss following PCI. In contrast to these anti-inflammatory effects, training had no effect on markers of platelet-mediated inflammation, and the effect of training on markers on endothelial cell activation were rather complex showing attenuating (von Willebrand factor) and enhancing (E-selectin and vascular cell adhesion molecule 1) effects.</p><p><strong>Conclusions: </strong>Regular exercise training in stable angina patients following PCI may attenuate some, but not all, inflammatory pathways, potentially contributing to the beneficial effects of exercise training on restenosis.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826710397600","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29779924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of diabetes and reduction in major cardiovascular events in studies of subjects with prediabetes: meta-analysis of randomised controlled clinical trials.","authors":"Ingrid Hopper,&nbsp;Baki Billah,&nbsp;Marina Skiba,&nbsp;Henry Krum","doi":"10.1177/1741826711421687","DOIUrl":"https://doi.org/10.1177/1741826711421687","url":null,"abstract":"<p><strong>Background: </strong>Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are pre-diabetic states, treatment of which may prevent or delay the onset of overt diabetes and thus potentially reduce major cardiovascular (CV) events. We therefore sought to determine whether interventions (including diet, exercise and pharmacological therapy), altered all-cause and cardiovascular related mortality in such subjects.</p><p><strong>Methods: </strong>We performed a meta-analysis of prospective, randomised controlled trials (RCTs) that were identified in the medical literature and databases. Trials were eligible for inclusion if they reported all-cause mortality rates (at a minimum), recruited approximately 100 patients and had a minimum follow-up of one year. Interventions were divided into pharmacological and non-pharmacological.</p><p><strong>Results: </strong>Ten RCTs that enrolled 23,152 patients met the above entry criteria. Trials ran for an average of 3.75 years. Diabetes was delayed or prevented by these interventions vs control (risk ratio 0.83, 95%CI 0.80-0.86). Non-drug approaches (n = 3495) were superior to drug-based approaches (n = 20,872) in diabetes prevention (0.52, 0.46-0.58 vs 0.70, 0.58-0.85, P < 0.05). There was no difference in risk of all-cause mortality in the intervention versus control group (0.96, 0.84-1.10) and no difference in CV death (1.04, 0.61-1.78). There was a non-significant trend towards reduction in fatal and non-fatal myocardial infarction (0.59, 0.23-1.50). Fatal and non-fatal stroke was borderline reduced (0.76, 0.58-0.99) with intervention versus control.</p><p><strong>Conclusions: </strong>Despite interventions being mostly successful in retarding progression to overt diabetes, this did not result in reductions in all-cause or cardiovascular mortality, or myocardial infarction, with the possible exception of stroke.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826711421687","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29964878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}