Tag Archives: diabetes

Introduction As doctors and scientists we are accustomed to breaking down problems and simplifying complex pathology in order to focus our management and identify possible targets for future therapies. The pathophysiology of cardiorenal disease is no different but, as yet, attempts to elucidate the complex interaction between heart and kidneys has failed. Although cardiac and renal disease are often diagnosed together, it is clear that a straightforward causal relationship does not exist. Disease in either serves as a risk factor for disease in the other and perpetuates the progression of that disease, but why this is so is unclear. Whilst th

CORONARY: off-pump and on-pump CABG similar The largest trial ever to compare off-pump and on-pump coronary artery bypass surgery (CABG) has shown no difference between the two techniques in terms of the primary composite end point. There were, however, some differences in certain end points, leading to the suggestion that the decision as to which approach to choose could be individualised with each patient. Table 1. Main results from the CORONARY trial The CORONARY trial enrolled 4,752 patients who were randomised to off-pump or on-pump surgery. At 30 days the primary end point – a composite of death, myocardial infraction (MI), kidney fai

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In the present study, researchers analysed data from the WHI on 153,840 post-menopausal women, of whom 7% were taking statins at baseline. During the study period, 10,242 incident cases of diabetes were reported. In an unadjusted risk model, statin use at baseline was associated with a 71% increased risk of diabetes, but after adjusting for other risk factors, this was reduced to a 48% increased risk. The association appeared to be a class effect. Risk was increased particularly in white, Hispanic, and Asian women, but not in African American women. The association was also observed at all levels of body mass index (BMI) but women with the lo

Introduction Treatment with insulin is essential for a good prognosis in patients with type 1 diabetes, and it is a potent hypoglycaemic agent in patients with type 2 diabetes. Insulin is an anabolic hormone that influences vascular tone in both large calibre conductance vessels and small calibre exchange vessels such as the capillary microcirculation.1,2 In view of the increased burden of cardiovascular disease in patients with diabetes, and the capability of insulin to influence both metabolic and vascular function, insulin therapy has the potential to improve prognosis from cardiovascular disease in patients with diabetes. The metabolic ef

Introduction Developments along the way have included better patient selection, improved peri-procedural management of patients and, with newer-generation drugs and devices, better results. Recent hurdles have been confronted, including left main stem disease, complex bifurcation lesions and total chronic occlusions. Similarly, primary percutaneous coronary intervention (PCI) has become the treatment of choice in acute myocardial infarction. Challenges remain, however, including restenosis. The fine balance between thrombosis and haemostasis demands that we provide more effective and predictable antiplatelet strategies to optimise risk reduct

Introduction While primary PCI, rather than thrombolysis, is now the reperfusion treatment of choice for STEMI, the majority of patients coming for revascularisation in the UK have stable coronary disease or NSTE-ACS. In the treatment of NSTE-ACS, first principles involve the selection of patients for diagnostic angiography followed by either PCI or coronary artery bypass grafting (CABG). Rates of PCI are increasing annually in the UK, which, in part, is a reflection of greater awareness of coronary artery disease, its earlier diagnosis and treatment in the ageing population. This section looks at coronary intervention in general, how PCI act

Introduction The discovery of the thienopyridines, or ADP receptor antagonists, led to the development of more effective oral antiplatelet agents. Trials assessed dual antiplatelet therapy in high-risk patients versus aspirin alone and the significant benefits observed have resulted in dual antiplatelet therapy becoming a mainstay of treatment. As expected with more potent dual therapy, there is always a fine balance between prevention of thrombosis and bleeding risk. There are still many challenges to overcome. Many patients, such as those with diabetes or with a previous stent thrombosis, are at high risk for further infarction, indicating

Increase in kidney failure in people with diabetes Diabetes UK has reported ‘concern’ in recently released figures showing a 20% increase in people with diabetes in England needing dialysis or a kidney transplant between 2008–2009. The figures released by the National Diabetes Audit also reveals, for the same period, that a third of people with diabetes did not have their urine tested, half of people with diabetes were found to have not met their blood pressure targets, and more than a third were found to have poor blood glucose control, with the latter more prevalent in younger people with diabetes. Data for the audit was contributed f

Renal disease and diabetes Microalbuminuria is known to be a marker of increased cardiovascular (CV) risk. It is not clear whether reducing microalbuminuria on its own is associated with an improved cardiovascular prognosis, but in secondary analyses from studies of angiotensin receptor blockers (ARBs) in people with type 2 diabetes, reduction in albuminuria was associated with a decreased risk of a CV event. Observational analyses from the RENAAL trial found that the magnitude of albuminuria reduction predicted the reduced risk of CV events (figure 1).1 Figure 1. Kaplan-Meier curves for cardiovascular (CV) and heart failure end points, strat