| 1. |
- Meziani, Sara, et al.
(author)
-
Mannose-binding lectin does not explain the dismal prognosis after an acute coronary event in dysglycaemic patients : A report from the GAMI cohort
- 2022
-
In: Cardiovascular Diabetology. - : Springer Nature. - 1475-2840. ; 21:1
-
Journal article (peer-reviewed)abstract
- Background Mannose binding lectin (MBL) has been suggested to be associated with an impaired cardiovascular prognosis in dysglycaemic conditions, but results are still contrasting. Our aims are (i) to examine whether MBL levels differ between patients with an acute myocardial infarction (MI) and healthy controls and between subgroups with different glucose tolerance status, and (ii) to investigate the relation between MBL and future cardiovascular events. Methods MBL levels were assessed at discharge and after 3 months in 161 AMI patients without any previously known glucose perturbations and in 183 age- and gender-matched controls from the Glucose metabolism in patients with Acute Myocardial Infarction (GAMI) study. Participants were classified as having dysglycaemia, i.e. type 2 diabetes or impaired glucose tolerance, or not by an oral glucose tolerance test. The primary outcome was a composite of cardiovascular events comprising cardiovascular death, AMI, stroke or severe heart failure during 11 years of follow-up. Total and cardiovascular mortality served as secondary outcomes. Results At hospital discharge patients had higher MBL levels (median 1246 mu g/L) than three months later (median 575 mu g/L; p < 0.01), the latter did not significantly differ from those in the controls (801 mu g/L; p = 0.47). MBL levels were not affected by dysglycaemia either in patients or controls. Independent of glycaemic state, increasing MBL levels did not predict any of the studied outcomes in patients. In unadjusted analyses increasing MBL levels predicted cardiovascular events (hazard ratio HR: 1.67, 95% confidence interval CI 1.06-2.64) and total mortality (HR 1.53, 95% CI 1.12-2.10) in the control group. However, this did not remain in adjusted analyses. Conclusions Patients had higher MBL levels than controls during the hospital phase of AMI, supporting the assumption that elevated MBL reflects acute stress. MBL was not found to be independently associated with cardiovascular prognosis in patients with AMI regardless of glucose state.
|
|
| 2. |
- Wang, Anne, et al.
(author)
-
Dynamics of testosterone levels in patients with newly detected glucose abnormalities and acute myocardial infarction
- 2018
-
In: Diabetes & Vascular Disease Research. - : Sage Publications. - 1479-1641 .- 1752-8984. ; 15:6, s. 511-518
-
Journal article (peer-reviewed)abstract
- Objective: Low testosterone has been associated with increased cardiovascular risk and glucose abnormalities. This study explored the prevalence of low testosterone, dynamics over time and prognostic implications in acute myocardial infarction patients with or without glucose abnormalities. Methods: Male acute myocardial infarction patients (n = 123) and healthy controls (n = 124) were categorised as having normal or abnormal glucose tolerance (impaired glucose tolerance or diabetes) by oral glucose tolerance testing. Testosterone was measured at hospital admission, discharge, 3 and 12 months thereafter in patients. Patients and controls were followed for 11 years for major cardiovascular events (cardiovascular death/acute myocardial infarction/stroke/severe heart failure). Results: At hospital admission, more patients had low testosterone (<= 300 ng/dl) and lower median levels than controls (64 vs 28%; p < 0.001 and 243 vs 380 ng/dl; p < 0.01). At the subsequent time points, testosterone had increased to 311, 345 and 357 ng/dl. Patients with abnormal glucose tolerance had the highest prevalence (75%) of low levels. In adjusted Cox regression models, neither total nor free testosterone predicted major cardiovascular events. Conclusion: Low testosterone levels were common in male acute myocardial infarction patients in the acute phase, especially in the presence of abnormal glucose tolerance, but increased over time indicating that testosterone measured in close proximity to acute myocardial infarction should be interpreted with caution.
|
|
| 3. |
- Kristófi, Robin, et al.
(author)
-
Patients with type 1 and type 2 diabetes hospitalized with COVID-19 in comparison with influenza : mortality and cardiorenal complications assessed by nationwide Swedish registry data
- 2022
-
In: Cardiovascular Diabetology. - : Springer Nature. - 1475-2840. ; 21:1
-
Journal article (peer-reviewed)abstract
- BackgroundThe risk of severe coronavirus disease 2019 (COVID-19) is increased in people with diabetes, but effects of diabetes type and other risk factors remain incompletely characterized. We studied this in a Swedish cohort of hospitalized patients with type 1 and type 2 diabetes (T1D and T2D), also including comparisons with influenza epidemics of recent years.MethodsNationwide healthcare registries were used to identify patients. A total of 11,005 adult patients with diabetes (T1D, n = 373; T2D, n = 10,632) were hospitalized due to COVID-19 from January 1, 2020 to September 1, 2021. Moreover, 5111 patients with diabetes (304 T1D, 4807 T2D) were hospitalized due to influenza from January 1, 2015 to December 31, 2019. Main outcomes were death within 28 days after admission and new hospitalizations for heart failure (HF), chronic kidney disease (CKD), cardiorenal disease (CRD; composite of HF and CKD), myocardial infarction (MI) and stroke during 1 year of follow-up.ResultsNumber of deaths and CRD events were 2025 and 442 with COVID-19 and 259 and 525 with influenza, respectively. Age- and sex-adjusted Cox regression models in COVID-19 showed higher risk of death and HF in T1D vs. T2D, hazard ratio (HR) 1.77 (95% confidence interval 1.41–2.22) and 2.57 (1.31–5.05). With influenza, T1D was associated with higher risk of death compared with T2D, HR 1.80 (1.26–2.57). Older age and previous CRD were associated with higher risks of death and hospitalization for CRD. After adjustment for prior comorbidities, mortality differences were still significant, but there were no significant differences in cardiovascular and renal outcomes. COVID-19 relative to influenza was associated with higher risk of death in both T1D and T2D, HR 2.44 (1.60–3.72) and 2.81 (2.59–3.06), respectively.ConclusionsIn Sweden, patients with T1D as compared to T2D had a higher age- and sex-adjusted risk of death within 28 days and HF within one year after COVID-19 hospitalization, whereas the risks of other non-fatal cardiovascular and renal disease events were similar. Patients with T1D as well as T2D have a greater mortality rate when hospitalized due to COVID-19 compared to influenza, underscoring the importance of vaccination and other preventive measures against COVID-19 for diabetes patients.
|
|
| 4. |
- Ritsinger, Viveca, et al.
(author)
-
Admission Glucose Levels and Associated Risk for Heart Failure After Myocardial Infarction in Patients Without Diabetes.
- 2021
-
In: Journal of the American Heart Association. - : Wolters Kluwer. - 2047-9980. ; 10:22
-
Journal article (peer-reviewed)abstract
- Background Dysglycemia at acute myocardial infarction (AMI) is common and is associated with mortality. Information on other outcomes is less well explored in patients without diabetes in a long-term perspective. We aimed to explore the relationship between admission glucose level and long-term outcomes in patients with AMI without diabetes in a nationwide setting. Methods and Results Patients without diabetes (n=45 468) with AMI registered in SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) and admission glucose ≤11 mmol/L (≤198 mg/dL) were followed for outcomes (AMI, heart failure, stroke, renal failure, and death) between 2012 and 2017 (mean follow-up time 3.3±1.7 years). The association between categorized glucose levels and outcomes was assessed in adjusted Cox proportional hazards regression analyses (glucose levels 4.0-6.0 mmol/L [72-109 mg/dL] as reference). Further nonfatal complications and their associated mortality were explored (patients without events served as a reference). A glucose level of 7.8-11.0 mmol/L (140-198 mg/dL) was associated with hospitalization for heart failure (hazard ratio [HR] 1.40 [95% CI, 1.30-1.51], P<0.001), renal failure (1.17; 1.04-1.33, P=0.009), and death (1.31; 1.20-1.43, P<0.001), but not with recurrent myocardial infarction (0.99; 0.92-1.07, P=0.849) or stroke (1.03; 0.88-1.19, P=0.742). Renal failure had the strongest association with future mortality (age-adjusted HR 4.93 [95% CI, 4.34-5.60], P<0.001), followed by heart failure (3.71; 3.41-4.04, P<0.001), stroke (3.39; 2.94-3.91, P<0.001), and myocardial infarction (2.08; 1.88-2.30, P<0.001). Conclusions Elevated glucose levels at AMI admission identifies patients without diabetes at increased risk of long-term complications: in particular, hospitalization for heart and renal failure. These results emphasize that glucose levels at admission could be useful in risk assessment after myocardial infarction.
|
|
| 5. |
- Ritsinger, Viveca
(author)
-
Causes and mechanisms of an adverse outcome in patients with glucose abnormalities and cardiovascular disease : epidemiological and biochemical analyses
- 2016
-
Doctoral thesis (other academic/artistic)abstract
- Background: Diabetes and previously undetected glucose abnormalities are common in patients with acute myocardial infarction (AMI). It is well established that patients with diabetes have a higher mortality rate after coronary events than patients without diabetes but the complication pattern in a contemporary perspective, the impact of glucose control and whether unknown glucose abnormalities affect the longterm prognosis is less well studied. Data on the prognostic implications of adipokines in patients with prevalent coronary heart disease are contradictory and long-term outcome studies are lacking. Aims: To identify high-risk individuals and study long-term prognosis by 1. Investigating the lasting effect of intensified, insulin-based glucose control on mortality after AMI in patients with diabetes; 2. Analysing mortality and morbidity patterns after AMI in patients with newly discovered glucose abnormalities; 3. Investigating complication patterns after a first percutaneous coronary intervention; 4. Analysing the significance of adiponectin and leptin as biomarkers of cardiovascular complications. Glucose control and mortality after AMI: 306 patients with AMI and diabetes were randomised to intensified insulin-based glycaemic control while 314 served as controls in the DIGAMI-study. During a mean follow-up of 7.3 years 90% of the study population died. The median survival was 2.3 years longer in patients receiving intensified insulin-based glycaemic control after AMI (7.0 years) compared to patients in the control group (4.7 years). Impact of undetected glucose abnormalities on long-term outcome after AMI: Patients (n=167) with AMI and healthy controls (n=184) without previously known diabetes (included in the GAMI study) were investigated with an oral glucose tolerance test (OGTT) at the time of hospital discharge (patients) or at inclusion (controls). Cardiovascular events (cardiovascular mortality, AMI, heart failure and stroke) during 10 years of follow-up were more frequent in patients with abnormal glucose tolerance than in patients with normal glucose tolerance and in controls. Abnormal glucose tolerance at the OGTT was independently associated with future cardiovascular events after an AMI (HR 2.30; 95% CI 1.24-4.25, p=0.008) in contrast to HbA1c (p=0.81) and fasting blood glucose (p=0.52). Long-term outcome after coronary artery disease and revascularisation: High event rates of mortality, heart failure, myocardial infarction and stroke were demonstrated after a first percutaneous coronary intervention in patients with diabetes followed up to five years after inclusion in the Swedish Coronary Angiography Angioplasty Registry (SCAAR) between 2006-2010 (n=58891, 19% with diabetes). Diabetes was an independent predictor for mortality and cardiovascular events. Insulin-treated patients were at a particularly high risk. Adiponectin and leptin as biomarkers for identifying high risk patients: In 180 patients with AMI and without diabetes (the GAMI cohort) elevated levels of adiponectin at discharge independently predicted mortality (HR 1.79; 95% CI 1.07-3.00, p=0.027) but not cardiovascular events the coming decade. High levels of leptin at day 2 were associated with cardiovascular events during the first seven years but did not predict mortality. Conclusion: Diabetes and previously undetected glucose abnormalities are common in patients with coronary events and their presence has a negative influence on the prognosis. Despite improved longevity patients with diabetes are still at increased risk for mortality and cardiovascular complications. An OGTT, but not HbA1c, identifies patients with previously undetected glucose abnormalities at increased cardiovascular risk the next coming 10 years. These findings support that an OGTT should be considered as an important screening tool after AMI. High levels of adiponectin and leptin identifies patients with compromised outcome after AMI. Future studies are warranted to confirm their role as suitable biomarkers. Finally a close follow-up of patients with glucose abnormalities is advocated where multifactorial treatment is important to improve long-term survival after AMI. The present studies do also underline that new treatment strategies are highly warranted.
|
|
| 6. |
- Ritsinger, Viveca, et al.
(author)
-
Characteristics and Prognosis in Women and Men With Type 1 Diabetes Undergoing Coronary Angiography : A Nationwide Registry Report
- 2018
-
In: Diabetes Care. - : AMER DIABETES ASSOC. - 0149-5992 .- 1935-5548. ; 41:4, s. 876-883
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To describe sex aspects on extent of coronary artery disease (CAD) and prognosis in a contemporary population with type 1 diabetes.RESEARCH DESIGN AND METHODS: All patients undergoing coronary angiography, 2001-2013, included in the Swedish Coronary Angiography and Angioplasty Registry and the Swedish National Diabetes Register as type 1 diabetes were followed for mortality until 31 December 2013. The coronary angiogram was classified into normal, one-vessel disease, two-vessel disease, three-vessel disease, and left main stem disease.RESULTS: In all, 2,776 patients (42% women) with mean age 58 years (SD 11) were followed for 7.2 years (SD 2.2). Diabetes duration was longer in women (37 14 vs. 34 +/- 14 years in men; P < 0.001), who also had more retinopathy (68% vs. 65%; P = 0.050), whereas microalbuminuria was less common (41% vs. 51%; P < 0.001). Indications for coronary angiography did not substantially differ in women and men. The extent of CAD was somewhat less severe in women (normal angiogram 23.5% vs. 19.1%, three-vessel and left main stem disease 34.5% vs. 40.4%; P = 0.002), whereas mortality did not differ (adjusted hazard ratio 1.03 [95% CI 0.88-1.20]; P = 0.754). The standard mortality ratio for women the first year was 7.49 (5.73-9.62) and for men was 4.58 (3.60-5.74).CONCLUSIONS: In patients with type 1 diabetes admitted for coronary angiography, the extent of CAD was almost similar in women and men, and total long-term mortality did not differ. Type 1 diabetes was associated with higher mortality risk in women than in men when compared with the general population. These data support that type 1 diabetes attenuates the cardiovascular risk difference seen in men and women in the general population.
|
|
| 7. |
- Ritsinger, Viveca, et al.
(author)
-
Design and rationale of the myocardial infarction and new treatment with metformin study (MIMET) - Study protocol for a registry-based randomised clinical trial
- 2023
-
In: Journal of diabetes and its complications. - : Elsevier. - 1056-8727 .- 1873-460X. ; 37:10
-
Journal article (peer-reviewed)abstract
- Aims: To investigate if addition of metformin to standard care (life-style advice) reduces the occurrence of cardiovascular events and death after myocardial infarction (MI) in patients with newly detected prediabetes.Methods: The Myocardial Infarction and new treatment with Metformin study (MIMET) is a large multicentre registry-based randomised clinical trial (R-RCT) within the SWEDEHEART registry platform expected to include 5160 patients with MI and newly detected prediabetes (identified with fasting blood glucose, HbA1c or 2-h glucose on oral glucose tolerance test) at similar to 20 study sites in Sweden. Patients 18-80 years, without known diabetes and naive to glucose lowering therapy, will be randomised 1:1 to open-label metformin therapy plus standard care or standard care alone.Outcomes: Patients will be followed for 2 years for the primary outcome new cardiovascular event (first of death, non-fatal MI, hospitalisation for heart failure or non-fatal stroke). Secondary endpoints include individual components of the primary endpoint, diabetes diagnosis, initiation of any glucose lowering therapy, cancer, and treatment safety. Events will be collected from national healthcare registries.Conclusions: The MIMET study will investigate if metformin is superior to standard care after myocardial infarction in preventing cardiovascular events in patients with prediabetes (Clinicaltrials.gov identifier: NCT05182970; EudraCT No: 2019-001487-30).
|
|
| 8. |
- Ritsinger, Viveca, et al.
(author)
-
Diabetes, metformin and glucose lowering therapies after myocardial infarction : Insights from the SWEDEHEART registry
- 2020
-
In: Diabetes & Vascular Disease Research. - : SAGE Publications. - 1479-1641 .- 1752-8984. ; 17:6
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To explore real-life use of glucose lowering drugs and prognosis after acute myocardial infarction (AMI) with a special focus on metformin.METHODS: Patients (n = 70270) admitted for AMI 2012-2017 were stratified by diabetes status and glucose lowering treatment and followed for mortality and MACE+ (AMI, heart failure (HF), stroke, mortality) until end of 2017 (mean follow-up time 3.4 ± 1.4 years) through linkage with national registries and SWEDEHEART. Hazard ratios (HR) were calculated in adjusted Cox proportional hazard regression models.RESULTS: Mean age was 68 ± 11 years and 70% were male. Of patients with diabetes (n = 16356; 23%), a majority had at least one glucose lowering drug (81%) of whom 51% had metformin (24% monotherapy), 43% insulin and a minority any SGLT2i/GLP-1 RA (5%). Adjusted HR for patients with versus without diabetes was 1.31 (95% CI 1.27-1.36) for MACE+ and 1.48 (1.41-1.56) for mortality. Adjusted HR for MACE+ for diabetes patients on metformin was 0.92 (0.85-0.997), p = 0.042 compared to diet treated diabetes.CONCLUSION: Diabetes still implies a high complication risk after AMI. Metformin and insulin were the most common treatment used in almost half of the diabetes population. Furthermore, patients treated with metformin had a lower cardiovascular risk after AMI and needs to be confirmed in prospective controlled trials.
|
|
| 9. |
- Ritsinger, Viveca, et al.
(author)
-
Elevated admission glucose is common and associated with high short-term complication burden after acute myocardial infarction : Insights from the VALIDATE-SWEDEHEART study
- 2019
-
In: Diabetes & Vascular Disease Research. - : Sage Publications. - 1479-1641 .- 1752-8984. ; 16:6, s. 582-584
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate the association between admission plasma glucose and cardiovascular events in patients with acute myocardial infarction treated with modern therapies including early percutaneous coronary intervention and modern stents.METHODS: = 5309) with established diabetes and patients without previously known diabetes with a reported admission plasma glucose, included in the VALIDATE trial 2014-2016, were followed for cardiovascular events (first of mortality, myocardial infarction, stroke, heart failure) within 180 days. Event rates were analysed by four glucose categories according to the World Health Organization criteria for hyperglycaemia and definition of diabetes. Odds ratios were calculated in a multivariate logistic regression model.RESULTS: < 0.001), while bleeding complications did not differ significantly (9.1%, 8.5%, 8.4%, 12.2% and 8.5%, respectively). After adjustment, odds ratio (95% confidence interval) was 1.00 (0.65-1.53) for group II, 1.62 (1.14-2.29) for group III and 3.59 (1.99-6.50) for group IV compared to the lowest admission plasma glucose group (group I). The corresponding number for known diabetes was 2.42 (1.71-3.42).CONCLUSION: In a well-treated contemporary population of acute myocardial infarction patients, 42% of those without diabetes had elevated admission plasma glucose levels with a greater risk for clinical events already within 180 days. Event rate increased with increasing admission plasma glucose levels. These findings highlight the importance of searching for undetected diabetes in the setting of acute myocardial infarction and that new treatment options are needed to improve outcome.
|
|
| 10. |
- Ritsinger, Viveca, et al.
(author)
-
Heart failure is a common complication after acute myocardial infarction in patients with diabetes : A nationwide study in the SWEDEHEART registry.
- 2020
-
In: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 27:17, s. 1890-1901
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Several glucose lowering drugs with preventive effects on heart failure and death have entered the market, however, still used in low proportions after acute myocardial infarction. We explored the complication rates of heart failure and death after acute myocardial infarction in patients with and without diabetes.METHODS: All patients (N = 73,959) with acute myocardial infarction admitted for coronary angiography included in the SWEDEHEART registry during the years 2012-2017 were followed for heart failure (until 31 December 2017) and mortality (until 30 June 2018); mean follow-up time 1223 (SD ± 623) days.RESULTS: Mean age was 69 years (SD ± 12), 69% were male and 24% had diabetes. Heart failure occurred more often in diabetes (22% vs. 12% if no diabetes), especially if previous MI (33% vs. 23%). Patients with diabetes had increased risk of HF regardless of previous myocardial infarction (MI); with previous MI adjusted hazard ratio 2.09 (95% confidence interval 1.96-2.20) and without MI 1.52 (1.44-1.61) respectively when non-diabetes patients with first MI served as reference. In patients with no previous heart failure or MI and discharged with left ventricular ejection fraction ≥50% the risk of heart failure was particularly high in those with diabetes (1.56; 1.39-1.76) when compared with those without. Similar findings were seen for death and combined event (heart failure and death).CONCLUSIONS: Heart failure is a common complication after acute myocardial infarction in diabetes, increasing the risk by 50-60% regardless of previous heart failure or MI. This risk is present even with normal reported left ventricular ejection fraction, indicating the existence of a large diabetes population at heart failure risk after acute myocardial infarction.
|
|
