| 1. |
- Ahrén, Bo
(författare)
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Avoiding hypoglycemia: a key to success for glucose-lowering therapy in type 2 diabetes.
- 2013
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Ingår i: Vascular Health and Risk Management. - 1178-2048. ; 9, s. 155-163
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Tidskriftsartikel (refereegranskat)abstract
- Type 2 diabetes carries a risk for hypoglycemia, particularly in patients on an intensive glucose control plan as a glucose-lowering strategy, where hypoglycemia may be a limitation for the therapy and also a factor underlying clinical inertia. Glucose-lowering medications that increase circulating insulin in a glucose-independent manner, such as insulin and sulfonylurea therapy, are the most common cause of hypoglycemia. However, other factors such as a delayed or missed meal, physical exercise, or drug or alcohol consumption may also contribute. Specific risk factors for development of hypoglycemia are old age, long duration of diabetes, some concomitant medication, renal dysfunction, hypoglycemia unawareness, and cognitive dysfunction. Hypoglycemia is associated with acute short-term symptoms related to either counterregulation, such as tachycardia and sweating, or to neuroglycopenia, such as irritability, confusion, and in severe cases stupor, coma, and even death. However, there are also long-term consequences of hypoglycemia such as reduced working capacity, weight gain, loss of self-confidence with reduced quality of life, and increased risk for cardiovascular diseases. For both the patients, the health care system, and the society at large, hypoglycemia carries a high cost. Strategies to mitigate the risk of hypoglycemia include awareness of the condition; education of patients, relatives, and health care providers; and selecting appropriate glucose-lowering medication that also judges the risk for hypoglycemia to prevent this complication. This article summarizes the current knowledge of hypoglycemia and its consequences with a special emphasis on its consequences for the choice of glucose-lowering therapy.
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| 2. |
- Ahrén, Bo
(författare)
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Novel combination treatment of type 2 diabetes DPP-4 inhibition + metformin.
- 2008
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Ingår i: Vascular Health and Risk Management. - 1178-2048. ; 4:2, s. 383-394
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Tidskriftsartikel (refereegranskat)abstract
- Inhibition of dipeptidyl peptidase-4 (DPP-4) as a novel therapy for type 2 diabetes is based on prevention of the inactivation process of bioactive peptides, the most important in the context of treatment of diabetes of which is glucagon-like peptide-1 (GLP-1). Most clinical experience with DPP-4 inhibition is based on vildagliptin (GalvusR, Novartis) and sitagliptin (JanuviaR, Merck). These compounds improve glycemic control both in monotherapy and in combination with other oral hyperglycemic agents. Both have also been shown to efficiently improve glycemic control when added to ongoing metformin therapy in patients with inadequate glycemic control. Under that condition, they reduce HbA1C levels by 0.65%-1.1% (baseline HbA1C 7.2-8.7%) in studies up to 52 weeks of duration in combination versus continuous therapy with metformin alone. Sitagliptin has also been examined in initial combination therapy with metformin have; HbA1 was reduced by this combination by 2.1% (baseline HbA1C 8.8%) after 24 weeks of treatment. Both fasting and prandial glucose are reduced by DPP-4 inhibition in combination with metformin in association with improvement of insulin secretion and insulin resistance and increase in concentrations of active GLP-1. The combination of DPP-4 inhibition and metformin has been shown to be highly tolerable with very low risk of hypoglycemia. Hence, DPP-4 inhibition in combination with metformin is an efficient, safe and tolerable combination therapy for type 2 diabetes.
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| 3. |
- Beattie, James M., et al.
(författare)
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The Importance of Cultural Awareness in the Management of Heart Failure: A Narrative Review
- 2024
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Ingår i: Vascular Health and Risk Management. - : DOVE MEDICAL PRESS LTD. - 1176-6344 .- 1178-2048. ; 20, s. 109-123
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Forskningsöversikt (refereegranskat)abstract
- Heart failure is a commonly encountered clinical syndrome arising from a range of etiologic cardiovascular diseases and manifests in a phenotypic spectrum of varying degrees of systolic and diastolic ventricular dysfunction. Those affected by this lifelimiting illness are subject to an array of burdensome symptoms, poor quality of life, prognostic uncertainty, and a relatively onerous and increasingly complex treatment regimen. This condition occurs in epidemic proportions worldwide, and given the demographic trend in societal ageing, the prevalence of heart failure is only likely to increase. The marked upturn in international migration has generated other demographic changes in recent years, and it is evident that we are living and working in ever more ethnically and culturally diverse communities. Professionals treating those with heart failure are now dealing with a much more culturally disparate clinical cohort. Given that the heart failure disease trajectory is unique to each individual, these clinicians need to ensure that their proposed treatment options and responses to the inevitable crises intrinsic to this condition are in keeping with the culturally determined values, preferences, and worldviews of these patients and their families. In this narrative review, we describe the importance of cultural awareness across a range of themes relevant to heart failure management and emphasize the centrality of cultural competence as the basis of appropriate care provision.
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| 4. |
- Dencker, Magnus, et al.
(författare)
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Relationship between natriuretic peptides and echocardiography parameters in patients with poorly regulated type 2 diabetes.
- 2010
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Ingår i: Vascular Health and Risk Management. - 1178-2048. ; 6, s. 373-382
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Tidskriftsartikel (refereegranskat)abstract
- This study evaluated the relationship between natriuretic peptide levels and a wide range of echocardiography parameters in a population of thirty-three patients with poorly regulated type 2 diabetes, and no known heart failure. Natriuretic peptides brain natriuretic peptide (BNP) and N-terminal prohormone BNP (NT-proBNP) were measured. Transthoracic echocardiography was performed and cardiac volumes and ejection fraction were measured. Doppler and tissue Doppler were measured and diastolic function was stratified according to recent guidelines. Very few echocardiography parameters were correlated with BNP or NT-proBNP levels. However, left atrial end-systolic volume indexed for body surface area was correlated with natural logarithm (ln) BNP and ln NT-proBNP (r=0.62 and r=0.60; P<0.05). There were significant differences in ln BNP and ln NT-proBNP levels between those with normal and those with abnormal diastolic function (1.4 vs 3.1; P<0.001 and 3.4 vs 5.8; P<0.001). This study showed that very few echocardiography parameters were correlated with BNP or NT-proBNP levels in patients with poorly regulated type 2 diabetes, which in part contradicts previous studies in other diabetic populations. The exception was left atrial end-systolic volume that showed a moderate correlation with BNP or NT-proBNP levels. There were significant differences in BNP and NT-proBNP levels between the group with normal left ventricular diastolic function and the group with abnormal diastolic function.
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| 5. |
- Djekic, Demir, 1989-, et al.
(författare)
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Serum untargeted lipidomic profiling reveals dysfunction of phospholipid metabolism in subclinical coronary artery disease
- 2019
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Ingår i: Vascular Health and Risk Management. - : DOVE Medical Press Ltd.. - 1176-6344 .- 1178-2048. ; 15, s. 123-135
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Disturbed metabolism of cholesterol and triacylglycerols (TGs) carries increased risk for coronary artery calcification (CAC). However, the exact relationship between individual lipid species and CAC remains unclear. The aim of this study was to identify disturbances in lipid profiles involved in the calcification process, in an attempt to propose potential biomarker candidates.Patients and methods: We studied 70 patients at intermediate risk for coronary artery disease who had undergone coronary calcification assessment using computed tomography and Agatston coronary artery calcium score (CACS). Patients were divided into three groups: with no coronary calcification (NCC; CACS: 0; n=26), mild coronary calcification (MCC; CACS: 1-250; n=27), or severe coronary calcification (SCC; CACS: >250; n=17). Patients' serum samples were analyzed using liquid chromatography-mass spectrometry in an untargeted lipidomics approach.Results: We identified 103 lipids within the glycerolipid, glycerophospholipid, sphingolipid, and sterol lipid classes. After false discovery rate correction, phosphatidylcholine (PC)(16:0/20:4) in higher levels and PC(18:2/18:2), PC(36:3), and phosphatidylethanolamine(20:0/18:2) in lower levels were identified as correlates with SCC compared to NCC. There were no significant differences in the levels of individual TGs between the three groups; however, clustering the lipid profiles showed a trend for higher levels of saturated and monounsaturated TGs in SCC compared to NCC. There was also a trend for lower TG (49:2), TG(51:1), TG(54:5), and TG(56:8) levels in SCC compared to MCC.Conclusion: In this study we investigated the lipidome of patients with coronary calcification. Our results suggest that the calcification process may be associated with dysfunction in autophagy. The lipidomic biomarkers revealed in this study may aid in better assessment of patients with subclinical coronary artery disease.
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| 6. |
- Dorkhan, Mozhgan, et al.
(författare)
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A review of pioglitazone HCL and glimepiride in the treatment of type 2 diabetes.
- 2007
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Ingår i: Vascular Health and Risk Management. - 1178-2048. ; 3:5, s. 721-731
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Forskningsöversikt (refereegranskat)abstract
- Type 2 diabetes (T2D) is a progressive disorder with a consistent and steady increase in glycosylated hemoglobin (HbA1c) over time associated with enhanced risk of micro- and macrovascular complications and a substantial reduction in life expectancy. There are three major pathophysiologic abnormalities associated with T2D: impaired insulin secretion, excessive hepatic glucose output, and insulin resistance in skeletal muscle, liver, and adipose tissue. These defects have been treated in clinical praxis by use of oral insulin secretagogues (sulfonylureas/ glinides) or insulin, biguanides, and thiazolidinediones (TZDs) respectively. Pioglitazone HCL is an insulin sensitizer in the TZD family and glimepiride is an insulin secretagogue in the SU family. This article reviews mechanisms of action and clinical data behind the use of these two commonly used oral hypoglycemic agents with documented efficacy and good safety profile of once-daily administration, alone or in combination with insulin or metformin, in the management of T2D in terms of glycemic and non-glycemic effects, tolerability and side effects, and impact on vascular health.
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| 7. |
- Edvinsson, MarieLouise, et al.
(författare)
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Cigarette smoking leads to reduced relaxant responses of the cutaneous microcirculation.
- 2008
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Ingår i: Vascular Health and Risk Management. - 1178-2048. ; 4:3, s. 699-704
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Smoking is a major risk factor for cardiovascular disease. The present study was undertaken to examine if cigarette smoking translates into reduced relaxant responses of the peripheral microcirculation. METHODS: The cutaneous forearm blood flow was measured by laser Doppler flowmetry. The vasodilator response to the iontophorectic administration of acetylcholine (ACh), acting via an endothelial mechanism, and sodium nitroprusside (SNP), and acting via a smooth muscle mechanism were studied. The study population consisted of 17 nonsmokers and 17 current smokers (mean age 64+/-2 years, 13 females and 4 males) in each matched group. RESULTS: There was no difference between the groups in baseline characteristics or in basal flow. Smokers showed however significantly reduced responses to both ACh (mean +/- SEM, from 973+/-137% in nonsmokers to 651+/-114% in smokers, p<0.05) and SNP (from 575+/-111% in nonsmokers to 355+/-83% in smokers, p<0.05). The response to the local heating (44 degrees C) was reduced in smokers (from 1188+/-215% in nonsmokers to 714+/-107% in smokers, p<0.01). In addition, there was no difference between men and women within the groups. CONCLUSIONS: The data show that cigarette smoking results in reduced peripheral microvascular responses to both endothelial and smooth muscle cell stimulation in healthy subjects, suggesting a generalized microvascular vasomotor function.
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| 8. |
- Erhardt, Leif RW, et al.
(författare)
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Comprehensive cardiovascular risk management--what does it mean in practice?
- 2007
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Ingår i: Vascular Health and Risk Management. - 1178-2048. ; 3:5, s. 587-603
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Forskningsöversikt (refereegranskat)abstract
- The continued movement away from the treatment of individual cardiovascular (CV) risk factors to managing overall and lifetime CV risk is likely to have a significant impact on slowing the rate of increase in cardiovascular disease (CVD). However, the management of CVD is currently far from optimal even in parts of the world with well-developed and well-funded healthcare systems. Effective implementation of the knowledge, treatment guidelines, diagnostic tools, therapeutic interventions, and management programs that exist for CVD continues to evade us. A thorough understanding of the multifactorial nature of CVD is essential to its effective management. Improvements continue to be made to management guidelines, risk assessment tools, treatments, and care programs pertaining to CVD. Ultimately, however, preventing the epidemic of CVD will require a combination of both medical and public health approaches. In addition to improvements in the "high-risk" strategy, which forms the basis of current CVD management, an increase in the utilization of population-based management strategies needs to be made to attempt to reduce the number of patients falling within the "at-risk" stratum for CVD. This review outlines how a comprehensive approach to CVD management might be achieved.
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| 9. |
- Erhardt, Leif RW
(författare)
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Rationale for multiple risk intervention: the need to move from theory to practice.
- 2007
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Ingår i: Vascular Health and Risk Management. - 1178-2048. ; 3:6, s. 985-997
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Tidskriftsartikel (refereegranskat)abstract
- Incidence of cardiovascular (CV) and metabolic disease is increasing, in parallel with associated risk factors. These factors, such as low-density lipoprotein (LDL)-cholesterol, elevated blood pressure, obesity, and insulin resistance have a continuous, progressive impact on total CV risk, with higher levels and numbers of factors translating into greater risk. Evaluation of all known modifiable risk factors, to provide a detailed total CV disease (CVD) and metabolic risk-status profile is therefore necessary to ensure appropriate treatment of each factor within the context of a multifactorial, global approach to prevention of CVD and metabolic disease. Effective and well-tolerated pharmacotherapies are available for the treatment of risk-factors. Realization of the potential health and economic benefits of effective risk factor management requires improved risk factor screening, early and aggressive treatment, improved public health support (ie, education and guidelines), and appropriate therapeutic interventions based on current guidelines and accurate risk assessment. Patient compliance and persistence to available therapies is also necessary for successful modulation of CVD risk.
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| 10. |
- Fernberg, Ulrika, 1979-, et al.
(författare)
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Higher Total Physical Activity is Associated with Lower Arterial Stiffness in Swedish, Young Adults : The Cross-Sectional Lifestyle, Biomarkers, and Atherosclerosis Study
- 2021
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Ingår i: Vascular Health and Risk Management. - : DovePress. - 1176-6344 .- 1178-2048. ; 17, s. 175-185
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Arterial stiffness describes the rigidity of the arterial walls and is associated withrisk factors for cardiovascular disease (CVD). Arterial stiffness predicts future events andmortality, and the predictive value is stronger in younger versus older subjects. The aims ofthe present study were, firstly, to present data on physical activity (PA) and time spentsedentary, in the population of Swedish, young adults. Secondly, to explore the associationbetween PA and arterial stiffness.Material and Methods: Self-reported healthy, non-smoking, Swedish, young adults, 18–25years old, participated in the cross-sectional Lifestyle, Biomarkers and Atherosclerosis(LBA) study. The daily PA was objectively measured with an accelerometer for 1 week.Of the 834 participants, 658 individuals had valid registrations. The arterial stiffness measures, pulse wave velocity (PWV) and augmentation index (AIx) were measured withapplanation tonometry.Results: Women were on overall more physically active than men, they spent 214 min/dayin light PA (LPA) compared to men who spent 202 min/day. Women took significantly moresteps per day than men, 7796 vs 7336 steps/day, and spent less time sedentary, 523 min/day,compared to men who spent 547 min/day sedentary. In total, 76% of the individuals spent onaverage at least 30 minutes per day in the recommended moderate and vigorous PA (MVPA).Lower arterial stiffness was associated with more MVPA and total PA in the total population.Conclusion: We conclude that in this age group of young, self-reported healthy adults18–25 years, it is important to highlight the health-enhancing possibilities of time spent inphysical activity on the vascular function, measured as PWV and AIx. It is of high relevancein a public health perspective to expand preventive efforts beyond the high-risk groups andencourage young adults to be physically active.
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