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ACEI reduce mortality whereas ARB did not in diabetic populations  

29 Jun, 14 | by Alistair Lindsay

Where the benefits of renin-angiotensin-aldosterone system blockade for reduction of cardiovascular risk are similar for ACE inhibitors (ACEI) and ARBs are unknown.  The answer to this question is of particular importance among diabetics, given the higher cardiovascular risk in this patient population.  In this meta-analysis, the authors examined effect of ACEI and ARBs on the incidence of mortality and cardiovascular events in diabetics. A total of 23 randomized trials comparing ACEI to placebo/no treatment/ other medications and 13 trials comparing ARBS to placebo/other medications were included. Trials with ACEI enrolled more patients with coronary artery disease than trials of ARBs. Pooled results showed that ACEI reduced the risk of all-cause mortality (relative risk [RR] 0.87; 95% CI 0.78 – 0.98) and cardiovascular events (RR 0.83; 95% CI 0.70 – 0.99). Treatment with ARBs did not influence all-cause mortality (RR 0.94; 95% CI 0.82 – 1.08) or cardiac mortality (RR 0.94; 95% CI 0.85 – 1.01). Meta-regression found the observed effects of ACEI on mortality did not differ by patient baseline characteristics or by ACEI agent. more…

Bilateral internal mammary grafts in diabetics: benefits outweigh perioperative risks

3 Sep, 13 | by Alistair Lindsay

Patients with diabetes have more severe coronary disease at presentation and worse overall outcomes than their non-diabetic counterparts, even following surgical revascularisation. Whilst use of the left internal thoracic artery (LITA) is well established and improves event free survival when anastomosed to the LAD, the use of both right and left internal thoracic arteries in bilateral (BITA) grafting is less well described with concerns remaining over the associated increased risks of sternal wound infection, particularly in diabetics. more…

Weight gain, smoking cessation, and cardiovascular risk

18 Mar, 13 | by Alistair Lindsay

It is known that smoking cessation substantially reduces the risk of cardiovascular disease (CVD), but does any subsequent weight gain attenuate the benefits of quitting smoking?  The goal of this study was to answer this question in adults with and without diabetes.  Specifically, the authors tested the hypothesis that quitting smoking decreases CVD risk compared with continuing smoking, regardless of any associated weight gain. more…

FREEDOM: CABG superior to PCI in diabetics

16 Dec, 12 | by Alistair Lindsay

Diabetes is one of the principle aetiological factors for coronary artery disease with vascular disease in diabetics displaying a particularly aggressive phenotype, often resulting in multivessel disease. Current evidence suggests that CABG is particularly beneficial in these patients as compared with PCI. however, much of this evidence was either gathered in the era before modern drug eluting stents or is from meta-analyses of smaller studies. more…

Fish oils fail to prevent cardiovascular events in diabetics

19 Sep, 12 | by Alistair Lindsay

The use of fish derived n-3 fatty acids following myocardial infarction has been shown to be beneficial in preventing further cardiovascular events and reducing mortality, particularly from sudden cardiac death. However the effects of these drugs in preventing cardiovascular events in high risk patients with (or at risk for) type 2 diabetes mellitus, but who are otherwise stable, are unknown. In the double-blind, multi-centre ORIGIN study 12,536 patients who had impaired fasting glucose, impaired glucose tolerance, or diabetes, were randomised in a 2-by-2 factorial design to receive either a 1-g capsule of n-3 fatty acids or placebo daily (with the other arm of the study randomising to receive either insulin glargine or standard care). Mean age of participants was 64 and 59% had had a previous cardiovascular event at baseline. The primary outcome was death from cardiovascular causes. After a median follow up of 6.2 years there was no significant difference between the n-3 fatty acids and placebo arms as regards the primary outcome (574 patients [9.1%] vs. 581 patients [9.3%];HR, 0.98; 95% CI, 0.87 to 1.10; P=0.72). The use of n-3 fatty acids also had no significant effect on the rates of major vascular events (P=0.81), death from any cause (P=0.63), or death from arrhythmia (P=0.26). Similarly, the use of insulin glargine in the other arm of the study failed to improve cardiovascular outcomes. more…

High-dose statin therapy linked to diabetes

10 Jul, 11 | by Alistair Lindsay

Three recent trials comparing intensive- to moderate-dose statin therapy have suggested an increased risk of incident diabetes in patients treated with high-dose statin regimens.  To investigate this phenomenon further, the authors conducted a collaborative meta-anlysis of published and unpublished data from five statin trials, all of which were randomise controlled end-point trials that compared intensive-dose statin therapy with moderate-dose therapy for more than one year. more…

No benefit from screening asymptomatic type 2 diabetics for CAD

17 May, 09 | by Alistair Lindsay

Should patients with type 2 diabetes be screened for coronary artery disease if asymptomatic? In the DIAD study (Detection of Ischemia in Asymptomatic Diabetics), 1123 patients with type 2 diabetes and no symptoms of coronary artery disease (CAD) were randomly assigned to be screened with adenosine-stress myocardial perfusion imaging (MPI) or to no screening. The main outcome measure was the incidence of cardiac death or nonfatal myocardial infarction (MI) during long-term follow-up. more…

UKPDS – 10 year Follow-Up Data Reported

17 Jan, 09 | by Alistair Lindsay

The United Kingdom Prospective Diabetes Study (UKPDS) was a randomised multi-centre trial which demonstrated that intensive glucose therapy in patients with newly diagnosed type 2 diabetes mellitus resulted in a decreased risk of clinically evident microvascular complications and a non-significant reduction in the relative risk of myocardial infarction (p=0.052).  The results of 10 year follow up of the UKPDS survivor cohort have been published ‘on-line early’ in the New England Journal of Medicine’ and examined:
1.    was a microvascular benefit from earlier improved glycaemic control sustained?
2.    did such therapy have a long term effect on macrovascular outcomes?
3.    was a continued benefit of earlier improved blood pressure control evident  and if so to what degree did this persist? more…

Longer antiplatelet therapy gives good DES outcomes

14 Oct, 08 | by Alistair Lindsay

Recently an excess of acute adverse coronary events has been reported among diabetic patients treated with drug eluting coronary stents (DES) who received short-term (<6 months) dual antiplatelet therapy (Circulation 2007;115:1440-55). more…

Plastics additive linked to cardiovascular disease

14 Oct, 08 | by Alistair Lindsay

Bisphenol A (BPA) is the base chemical used to make several plastic containers, cans and dental sealants.  Evidence from animal studies has suggested several potential biological effects of BPA, including estrogenic activity, liver damage, thyroid hormone dysfunction, and obesity-promotion. more…

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