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Cardiovascular risk

Adolescent body mass index predicts future cardiovascular risk

18 Apr, 17 | by flee

One-third of the adolescent population in Western countries is now considered to be overweight or obese.  The implications of this epidemic remain unclear but may well lead to an increased prevalence of cardiovascular disease and an erosion in the mortality and morbidity gains that have been apparent in the last few decades.  To further explore this question, records from an Israeli national database containing the BMIs of adolescents was analyzed.  Data for a total of 2.3 million individuals (mean age 17 yrs.) was available between 1967 and 2010 compromising a total of over 42,000,000 years of person follow-up.  Body mass index (BMI) was assessed by centiles and linked to mortality data for the population.  9.1% of deaths in this young cohort were attributable to cardiovascular causes with 1497 from coronary disease, 528 from stroke and 893 from sudden death.  Using a multivariable model adjusting for factors including birth year, sex and socioeconomic class there was a clear and graded increase in the risk of death from cardiovascular causes starting in the group between the 50th and 74th centiles and increasing rapidly as BMI increased such that in the 95th centile, the relative risk of death from coronary disease was 4.9 and from stroke was 2.6.

 

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Empagliflozin reduces cardiovascular mortality in Type 2 Diabetics

22 Oct, 15 | by flee

The prevalence of type 2 diabetes is increasing rapidly and represents a major risk factor for cardiovascular disease.  Although glycemic control has been shown to reduce microvascular complications, the effect of glycemic control on macrovascular disease is more limited.  Furthermore, some glucose lowering drugs have been associated with worse cardiovascular outcomes.  Accordingly, ensuring the cardiovascular safety of new diabetic therapies is important. Empaglifozin is one of the first in a new class of drugs that lowers serum glucose levels by decreasing renal glucose reabsorption.  In this study of 7020 patients at high risk of cardiovascular events, patients were randomized to one of two doses of empagliflozin (10 mg or 25 mg) or placebo, as well as standard guideline based diabetic therapy.  The primary outcome was a composite of major adverse cardiovascular events or cardiovascular death.  Although powered as a non-inferiority study, empaglifozin demonstrated statistical superiority as add-on diabetic therapy, significantly reducing the incidence of the primary end-point (10.5% vs. 12.1%, HR 0.86; 95% CI, 0.74 to 0.99; P=0.04 for superiority), including a significant reduction in the risk of death (5.7% and 8.3%, respectively; 32% relative risk reduction).  Use of empaglifozin increased the rates of genital infection (although UTI rates were similar), presumably secondary to the increased amount of glucose present in urine.  No other adverse events were increased with use of empaglifozin. more…

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