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Cardiovascular Complications in Diabetes: Current Treatments and Future Options
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Cardiovascular Complications in Diabetes: Current Treatments and Future Options

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: closed (20 August 2023) | Viewed by 12885

Special Issue Editors

Prof. Dr. Takanori Yasu

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Guest Editor
Department of Cardiovascular Medicine & Nephrology, Dokkyo Medical University Nikko Medical Center, Nikko, Tochigi 321-2593, Japan
Interests: cardiology; diabetes mellitus; exercise; microcirculation
Prof. Dr. Yoshimasa Aso

E-Mail Website
Guest Editor
Department of Endocrinology and Metabolism, Dokkyo Medical University, Mibu, Tochigi, Japan
Interests: diabetic neuropathy; atherosclerotic cardiovascular disease; non-alcoholic fatty liver disease; chemokines; coagulation-fibrinolysis system; anti-diabetic drugs; basic research using model mice

Special Issue Information

Dear Colleagues,

Diabetes mellitus is increasing throughout the world, with the expected number of affected individuals to be around 640 million in 2040. Patients with diabetes mellitus are at an approximate two- to fourfold risk of for developing a macroangiopathy such as coronary artery and cerebrovascular arterial events and/or heart failure, requiring hospitalization compared with non-diabetic individuals. The goal of diabetes mellitus treatment is to prevent complications from developing or worsening, to ensure the same quality of life as in non-diabetic individuals and to maximize life expectancy. Although conventional diabetic therapies can prevent microangiopathy through better blood glucose control, macroangiopathy is still difficult to prevent, to date. Current evidence-based guidelines support a multifactorial approach in patients with diabetes, including lifestyle intervention and pharmacological treatment of hyperglycemia, hypertension, and dyslipidemia. In addition, recent cardiovascular outcome trials demonstrated that sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide 1 receptor agonists improve cardiovascular outcomes in patients with diabetes. Considering the rising burden of cardiovascular complications, there is need to improve the quality of care in patients with diabetes. The aim of this Special Issue is to highlight recent advances in the context of Cardiovascular Complications in Diabetes: Current Treatments and Future Options.

Prof. Dr. Takanori Yasu
Prof. Dr. Yoshimasa Aso
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • diabetes mellitus
  • exercise
  • cardiovascular event
  • complications
  • pharmacological treatment

Published Papers (5 papers)

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Research

23 pages, 1573 KiB  
Article
Impact of Advanced Age on the Incidence of Major Adverse Cardiovascular Events in Patients with Type 2 Diabetes Mellitus and Stable Coronary Artery Disease in a Real-World Setting in Spain
by Carlos González-Juanatey, Manuel Anguita-Sánchez, Vivencio Barrios, Iván Núñez-Gil, Juan José Gómez-Doblas, Xavier García-Moll, Carlos Lafuente-Gormaz, María Jesús Rollán-Gómez, Vicente Peral-Disdier, Luis Martínez-Dolz, Miguel Rodríguez-Santamarta, Xavier Viñolas-Prat, Toni Soriano-Colomé, Roberto Muñoz-Aguilera, Ignacio Plaza, Alejandro Curcio-Ruigómez, Ernesto Orts-Soler, Javier Segovia-Cubero, Víctor Fanjul, Judith Marín-Corral, Ángel Cequier and SAVANA Research Groupadd Show full author list remove Hide full author list
J. Clin. Med. 2023, 12(16), 5218; https://doi.org/10.3390/jcm12165218 - 10 Aug 2023
Cited by 1 | Viewed by 2051
Abstract
Patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) without myocardial infarction (MI) or stroke are at high risk for major cardiovascular events (MACEs). We aimed to provide real-world data on age-related clinical characteristics, treatment management, and incidence of major [...] Read more.
Patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) without myocardial infarction (MI) or stroke are at high risk for major cardiovascular events (MACEs). We aimed to provide real-world data on age-related clinical characteristics, treatment management, and incidence of major cardiovascular outcomes in T2DM-CAD patients in Spain from 2014 to 2018. We used EHRead® technology, which is based on natural language processing and machine learning, to extract unstructured clinical information from electronic health records (EHRs) from 12 hospitals. Of the 4072 included patients, 30.9% were younger than 65 years (66.3% male), 34.2% were aged 65–75 years (66.4% male), and 34.8% were older than 75 years (54.3% male). These older patients were more likely to have hypertension (OR 2.85), angina (OR 1.64), heart valve disease (OR 2.13), or peripheral vascular disease (OR 2.38) than those aged <65 years (p < 0.001 for all comparisons). In general, they were also more likely to receive pharmacological and interventional treatments. Moreover, these patients had a significantly higher risk of MACEs (HR 1.29; p = 0.003) and ischemic stroke (HR 2.39; p < 0.001). In summary, patients with T2DM-CAD in routine clinical practice tend to be older, have more comorbidities, are more heavily treated, and have a higher risk of developing MACE than is commonly assumed from clinical trial data. Full article
(This article belongs to the Special Issue Cardiovascular Complications in Diabetes: Current Treatments and Future Options)
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10 pages, 935 KiB  
Article
Association between SGLT2 Inhibitors and Cardiac Rehabilitation Outcomes in Patients with Cardiovascular Disease and Type 2 Diabetes Mellitus
by Ayuko Kashima, Kentaro Kamiya, Nobuaki Hamazaki, Kensuke Ueno, Kohei Nozaki, Takafumi Ichikawa, Masashi Yamashita, Shota Uchida, Takumi Noda, Kazuki Hotta, Emi Maekawa, Minako Yamaoka-Tojo, Atsuhiko Matsunaga and Junya Ako
J. Clin. Med. 2022, 11(19), 5956; https://doi.org/10.3390/jcm11195956 - 09 Oct 2022
Cited by 2 | Viewed by 3431
Abstract
The use of sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus (T2DM) has been associated with decreased skeletal muscle mass but remains unclear in patients with cardiovascular disease (CVD) undergoing comprehensive outpatient cardiac rehabilitation (CR). Therefore, this study investigates [...] Read more.
The use of sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus (T2DM) has been associated with decreased skeletal muscle mass but remains unclear in patients with cardiovascular disease (CVD) undergoing comprehensive outpatient cardiac rehabilitation (CR). Therefore, this study investigates the effect of SGLT2 inhibitors on the outcomes of patients with CVD and T2DM undergoing comprehensive outpatient CR. The study included 402 patients with CVD and T2DM who participated in comprehensive outpatient CR. Physical functions (grip strength, maximal quadriceps isometric strength, usual gait speed, and 6-minute walking distance) were measured at discharge as baseline and 5 months thereafter, and the association between physical functions and SGLT2 inhibitor use was reviewed. Physical functions improved regardless of SGLT2 inhibitor use. Multiple regression analysis showed that SGLT2 inhibitor use was not associated with improvement or decline in physical functions (p ≥ 0.05). The use of SGLT2 inhibitors in patients with CVD and T2DM undergoing outpatient CR did not impair improvement in physical functions. Full article
(This article belongs to the Special Issue Cardiovascular Complications in Diabetes: Current Treatments and Future Options)
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15 pages, 827 KiB  
Article
Serum and Adipose Dipeptidyl Peptidase 4 in Cardiovascular Surgery Patients: Influence of Dipeptidyl Peptidase 4 Inhibitors
by Ikuko Shibasaki, Toshiaki Nakajima, Taira Fukuda, Takaaki Hasegawa, Hironaga Ogawa, Go Tsuchiya, Yusuke Takei, Masahiro Tezuka, Takashi Kato, Yuta Kanazawa, Yasuyuki Kano, Toshiyuki Kuwata, Motoshi Ouchi, Shigeru Toyoda, Yoshimasa Aso and Hirotsugu Fukuda
J. Clin. Med. 2022, 11(15), 4333; https://doi.org/10.3390/jcm11154333 - 26 Jul 2022
Cited by 3 | Viewed by 1605
Abstract
Dipeptidyl peptidase 4 (DPP-4) is a novel adipokine and may be involved in the association between adipose tissue and metabolic syndrome. We investigated DPP-4 and adiponectin levels in the serum, subcutaneous adipose tissue (SAT), and epicardial adipose tissue (EAT), and their relationship with [...] Read more.
Dipeptidyl peptidase 4 (DPP-4) is a novel adipokine and may be involved in the association between adipose tissue and metabolic syndrome. We investigated DPP-4 and adiponectin levels in the serum, subcutaneous adipose tissue (SAT), and epicardial adipose tissue (EAT), and their relationship with preoperative factors, as well as comparing the DPP-4 levels in SAT and EAT with and without DPP-4 inhibitors. This study included 40 patients (25 men, age 67.5 ± 13.8 years). The serum adipokine, DPP-4, and adiponectin levels in SAT and EAT were measured using ELISA and Western blotting. The DPP-4 and adiponectin levels were significantly higher in the SAT than in the EAT. The serum DPP-4 and DPP-4 activity levels had no correlation with the DPP-4 levels in the SAT and EAT, but the DPP-4 levels in the SAT and EAT had a positive correlation. The DPP-4 levels in the SAT were positively correlated with atherosclerosis, diabetes mellitus, DPP-4-inhibitor use, and fasting blood glucose. The DPP-4 levels in the EAT showed a negative correlation with eGFR and a positive correlation with atrial fibrillation. The DPP-4 activity in the serum had a lower tendency in the group taking DPP-4 inhibitors than in the group not taking them. DPP-4 inhibitors may suppress angiogenesis and adipose-tissue hypertrophy. Full article
(This article belongs to the Special Issue Cardiovascular Complications in Diabetes: Current Treatments and Future Options)
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9 pages, 847 KiB  
Article
Association of Oxidized Low-Density Lipoprotein in Nonalcoholic Fatty Liver Disease with High-Risk Plaque on Coronary Computed Tomography Angiography: A Matched Case–Control Study
by Takahiro Nishihara, Toru Miyoshi, Keishi Ichikawa, Kazuhiro Osawa, Mitsutaka Nakashima, Takashi Miki and Hiroshi Ito
J. Clin. Med. 2022, 11(10), 2838; https://doi.org/10.3390/jcm11102838 - 17 May 2022
Cited by 4 | Viewed by 1960
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a risk factor for the development of atherosclerotic cardiovascular diseases (CVDs), and oxidative stress has been proposed as a shared pathophysiological condition. This study examined whether oxidized low-density lipoprotein (LDL) is involved in the underlying mechanism that [...] Read more.
Nonalcoholic fatty liver disease (NAFLD) is a risk factor for the development of atherosclerotic cardiovascular diseases (CVDs), and oxidative stress has been proposed as a shared pathophysiological condition. This study examined whether oxidized low-density lipoprotein (LDL) is involved in the underlying mechanism that links coronary atherosclerosis and NAFLD. This study included 631 patients who underwent coronary computed tomography angiography (CTA) for suspected coronary artery disease. NAFLD was defined on CT images as a liver-to-spleen attenuation ratio of <1.0. Serum-malondialdehyde-modified LDL (MDA-LDL) and coronary CTA findings were analyzed in a propensity-score-matched cohort of patients with NAFLD (n = 150) and those without NAFLD (n = 150). This study analyzed 300 patients (median age, 65 years; 64% men). Patients with NAFLD had higher MDA-LDL levels and a greater presence of CTA-verified high-risk plaques than those without NAFLD. In the multivariate linear regression analysis, MDA-LDL was independently associated with NAFLD (β = 11.337, p = 0.005) and high-risk plaques (β = 12.487, p = 0.007). Increased MDA-LDL may be a mediator between NAFLD and high-risk coronary plaque on coronary CTA. Increased oxidative stress in NAFLD, as assessed using MDA-LDL, may be involved in the development of CVDs. Full article
(This article belongs to the Special Issue Cardiovascular Complications in Diabetes: Current Treatments and Future Options)
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14 pages, 1146 KiB  
Article
The Prevalence of Metabolic Dysfunction-Associated Fatty Liver Disease and Its Association with Physical Function and Prognosis in Patients with Acute Coronary Syndrome
by Takumi Noda, Kentaro Kamiya, Nobuaki Hamazaki, Kohei Nozaki, Takafumi Ichikawa, Masashi Yamashita, Shota Uchida, Emi Maekawa, Tasuku Terada, Jennifer L. Reed, Minako Yamaoka-Tojo, Atsuhiko Matsunaga and Junya Ako
J. Clin. Med. 2022, 11(7), 1847; https://doi.org/10.3390/jcm11071847 - 26 Mar 2022
Cited by 6 | Viewed by 2880
Abstract
It is believed that patients with acute coronary syndrome (ACS) are at an increased risk of nonalcoholic fatty liver disease (NAFLD), which can lead to sarcopenia and physical dysfunction. However, the relationship between metabolic dysfunction-associated fatty liver disease (MAFLD) and physical dysfunction and [...] Read more.
It is believed that patients with acute coronary syndrome (ACS) are at an increased risk of nonalcoholic fatty liver disease (NAFLD), which can lead to sarcopenia and physical dysfunction. However, the relationship between metabolic dysfunction-associated fatty liver disease (MAFLD) and physical dysfunction and prognosis remains unclear. We investigated the prevalence of MAFLD in patients with ACS to assess the relationship between MAFLD and muscle strength, walking speed, and 6-min walking distance (6 MWD). We reviewed patients with ACS who were assessed for hepatic steatosis using the fatty liver index, and the results were further assessed to determine the presence of MAFLD. Among 479 enrolled hospitalized patients, MAFLD was identified in 234 (48.9%) patients. Multiple regression analysis revealed that MAFLD was independently associated with lower leg strength, gait speed, and 6 MWD (leg strength, p = 0.020; gait speed, p = 0.003 and 6 MWD, p = 0.011). Furthermore, in multivariate Poisson regression models after adjustment for clinical confounding factors, combined MAFLD and reduced physical functions were significantly associated with a higher incidence of clinical events. MAFLD is common in hospitalized patients with ACS and is associated with impaired physical function. Also, the coexistence of MAFLD and lower physical function predict the incidence of clinical events in patients with ACS. Full article
(This article belongs to the Special Issue Cardiovascular Complications in Diabetes: Current Treatments and Future Options)
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