Type 2 diabetes mellitus (T2DM) is associated with increased prevalence of cardiovascular (CV) disease (CVD). Optimal anti-hyperglycemic agents should include control of multiple CV risk factors (RF) ...to improve macrovascular and microvascular complications, as well as glycemia.
In this narrative review, the authors focus on the effects of glucagon-like peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose transport protein 2 inhibitors (SGLT2i) on blood pressure (BP) and the lipid profile, two well-established CV RF.
Results from recent CV outcome trials (CVOTs), showed the impact of GLP-1 RA and SGLT2i on BP and lipid levels. These classes of medication can alter cardiac function by affecting the process of atherosclerosis and/or hemodynamic status. The results of published GLP1-RA and SGLT2i CVOTs have shown multifactorial benefits; in addition to the main effects on glycemia and body weight (BW), there are also positive but moderate effects on BP and lipid levels. Full advantage of the pleiotropic benefit of these agents should be taken to prevent CV events.
Lipids, Statins and Heart Failure: An Update Katsiki, Niki; Doumas, Michael; Mikhailidis, Dimitri P
Current pharmaceutical design,
01/2016, Letnik:
22, Številka:
31
Journal Article
Recenzirano
Heart failure (HF) is characterized by cardiac functional and structural alterations, progressively leading to clinical symptoms and signs. Certain neurohormonal systems (i.e. the sympathetic nervous ...system, the reninangiotensin-aldosterone system and the natriuretic peptide system) as well as interactions between endothelial, monocytes/macrophages and myocardial cells are involved in the process.
The present narrative review discusses the relationships between lipids, statins and HF.
Lipid metabolism is involved in cardiac function. Inflammation, oxidative stress, endothelial and platelet dysfunction, activation of neurohormonal systems, adverse cardiac remodeling, haemodynamic disorders and arrhythmogenesis predispose to HF development and progression. Statins have been shown to reduce HF incidence possibly via their pleiotropic actions on the above mentioned mechanisms. Other cardiovascular (CV) risk factors affecting HF prevalence and outcomes include metabolic syndrome, non-alcoholic fatty liver disease, chronic kidney disease, hyperuricaemia, epicardial fat and increased arterial stiffness that are improved following statin therapy.
Lipid disorders are involved in HF development and progression. Statins may beneficially affect these disorders as well as other CV risk factors linked to HF. However, the impact of statins in patients with established HF has yet to be determined. Further studies are needed to unveil potential benefits of statin therapy (or some statins) in specific groups of HF patients.
We investigated the association between Dietary Inflammatory Index (DII®) scores and cardio-metabolic risk factors singly and in combination as metabolic syndrome (MetS).
We used data from ...participants selected from the US National Health and Nutrition Examination Survey (NHANES). Analyses were restricted to participants with data available on dietary intake, biochemical data, and anthropometric measurements from 2005 to 2012. Statistical analyses used the SPSS® Complex Samples v22.0 (IBM Corp, Armonk, NY) and accounted for the survey design and sample weights. Energy-adjusted-DII (E-DII®) expressed per 1000 kcal was calculated from 24-h dietary recalls. Of the 17,689 participants with evaluable data, 8607 (48.3%) were men. The mean age was 45.8 years in the overall sample, with men being slightly younger than women (44.9 vs. 46.5 years, p = 0.05).
In multivariable-adjusted regression models, the odds of MetS, its components, as well as obesity, and elevated high-sensitivity C-reactive protein (hsCRP) increased across increasing quartiles of E-DII (p < 0.001). In age, sex, race, income-to-poverty ratio-adjusted models, these and other cardiovascular disease risk factors (triglycerides/high density lipoprotein cholesterol (HDL-C) ratio, apolipoprotein (B) and HbA1C) increased across quartiles of the E-DII (all p < 0.001), while HDL-C levels decreased (p < 0.001).
This study suggests associations between MetS, its components, subclinical inflammation, and the DII. These results reinforce the view that diet plays an important role in the occurrence of cardiovascular diseases.
•We investigated the association of cardio-metabolic risk factors, singly or in combination, and inflammatory markers with dietary inflammatory index (DII®) scores.•Our results indicate that adjusted levels of cardio-metabolic risk factors significantly increased (decreased for HDL-cholesterol) across increasing quartiles of DII score.•The prevalence of metabolic syndrome, obesity, elevated high sensitivity C-reactive protein and glucose intolerance increased with increasing inflammatory potential of diet.
Adipose tissue, a major endocrine organ, consists of brown and white adipocytes. Brown fat may play a beneficial role in cardiometabolic disorders. Brown adipose tissue can also improve glucose and ...lipid metabolism. In contrast, the expansion of white adipose tissue has been related to obesity, type 2 diabetes mellitus and cardiovascular disease (CVD). Both the quantity and the quality of the white adipose tissue as well as its distribution may affect CVD risk. In this context, the link between adiposity and CVD risk is greater for visceral than subcutaneous fat. Apart from these fat depots, there are other adipose tissues that are either systemically (i.e. in the liver, muscle or neck) or mainly locally acting (i.e. pericardial/epicardial, perivascular and perirenal). These fat depots can affect the nearby anatomic organs via lipid accumulation and cytokine secretion. In the present narrative review, the associations of excessive peri-organ adipose tissue, namely intrahepatic, epicardial/ pericardial, perivascular, intramuscular, peripancreatic and perirenal fat, with cardiometabolic and CVD risk factors are discussed. The effects of drugs that target vascular risk and/or different fat depots are also considered.
There is considerable controversy regarding the link between serum uric acid (SUA) and mortality. We prospectively evaluated the association between SUA and risk of total and cause specific (coronary ...heart disease CHD, cerebrovascular and cancer) mortality by using the National Health and Nutrition Examination Surveys (NHANES, 1999–2010). Furthermore, a systematic review and meta-analysis of cohort studies was performed to investigate pooled associations of SUA with all-cause and cause-specific mortality.
Vital status through December 31, 2011 was ascertained. PubMed-Medline, SCOPUS, Web of Science and Google Scholar databases were searched (up to April 2018). Adjusted Cox proportional hazard regression models were used to determine the association between SUA and mortality. The DerSimonian-Laird method and generic inverse variance methods were used for quantitative data synthesis.
Overall, 21,025 individuals were included (mean age = 47.6 years, 48.7% men) and 3520 deaths occurred during the 144 months of follow-up. In adjusted models, individuals in the highest quartile of SUA had 10 and 8% greater risk of CHD and stroke mortality, whereas there was no link between SUA, all-cause and cancer mortality. The associations of CHD and stroke mortality with SUA were more pronounced in women and, among women, in those aged >50 years. Furthermore, all-cause mortality was positively and significantly related to SUA concentrations only in women. In the meta-analysis, SUA was shown to predict the risk of total (21%), CHD (24%) and stroke (29%) mortality. Furthermore, participants with a higher level of central adiposity had a greater risk of mortality from CHD and stroke for the same level of SUA.
Our results highlight the adverse impact of SUA on mortality, particularity in older (>50 years) women. The clinical implications of these findings remain to be established in future trials.
•Data from the NHANES revealed that subjects with higher serum uric acid (SUA) levels had a greater risk of coronary heart disease (CHD) and stroke mortality.•The link between CHD and stroke mortality with SUA was more pronounced in women and, among women, in those aged >50 years.•The meta-analysis of available cohort studies showed a detrimental effect of SUA on all-cause, CHD and stroke mortality.•There was no link between SUA, all-cause and cancer mortality.
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a novel category of oral antidiabetic drugs that inhibit renal glucose reabsorption and increase renal glucose excretion, thus lowering plasma ...glucose levels. This unique mechanism of SGLT2i action is insulin independent, thus improving glycemic control without promoting hypoglycemia in the absence of exogenously administered insulin.
The present narrative review addresses the putative associations between SGLT2i and several cardiovascular (CV) and microvascular risk factors, as well as their effects on cardiac and renal function.
SGLT2i improve several CV risk factors, including fasting and postprandial plasma glucose levels, lipids, blood pressure, body weight, serum uric acid and arterial stiffness. These drugs may also favorably modulate cardiac and renal function via their effects on inflammation, oxidative stress, diuresis, fluid and sodium retention, myocardial function, vascular resistance and 'fuel' metabolism. In the EMPA-REG OUTCOME study, the first published large CV outcome SGLT2i trial, empagliflozin significantly reduced the primary composite outcome (i.e. CV death, nonfatal myocardial infarction or stroke) and all-cause death as well as hospitalization for heart failure. In addition, empagliflozin was associated with a slower progression of kidney disease and lower rates of clinically relevant renal events than was placebo when added to standard care in patients at high CV risk.
Multiple metabolic benefits may account for the positive clinical outcomes in the EMPA-REG OUTCOME study. Ongoing CV outcome trials involving other SGLT2i will help establish whether the reported CV and microvascular risk benefits are compound-specific or drug class effects.
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