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Special Issue "Cardiovascular Complications in Diabetes: Current Treatments and Future Options"

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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 14005

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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

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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

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Keywords

diabetes mellitus
exercise
cardiovascular event

Published Papers (9 papers)

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Open AccessFeature PaperArticle

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

J. Clin. Med. 2023, 12(16), 5218; https://doi.org/10.3390/jcm12165218 - 10 Aug 2023

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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 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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Open AccessArticle

Long-Term Tailor-Made Exercise Intervention Reduces the Risk of Developing Cardiovascular Diseases and All-Cause Mortality in Patients with Diabetic Kidney Disease

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J. Clin. Med. 2023, 12(2), 691; https://doi.org/10.3390/jcm12020691 - 15 Jan 2023

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Abstract

This study aimed to determine the effect of long-term exercise on the risk of developing cardiovascular diseases (CVD) and all-cause mortality in patients with diabetic kidney disease (DKD). A single-center, prospective intervention study using propensity score matching was performed over 24 months. The intervention group (n = 67) received six months of individual exercise instruction from a physical therapist, who performed aerobic and muscle-strengthening exercises under unsupervised conditions. New events were defined as the composite endpoint of stroke or CVD requiring hospitalization, initiation of hemodialysis or peritoneal dialysis, or all-cause mortality. The cumulative survival rate without new events at 24 months was significantly higher in the intervention group (0.881, p = 0.016) than in the control group (n = 67, 0.715). Two-way analysis of variance revealed a significant effect of the group factor on high density lipoprotein-cholesterol (HDL-C) which was higher in the intervention group than in the control group (p = 0.004); eGFRcr showed a significant effect of the time factor, which was lower at 24 months than before intervention (p = 0.043). No interactions were observed for all items. In conclusion, aerobic exercises combined with upper and lower limb muscle strengthening for six months reduce the risk of developing CVD and all-cause mortality in patients with DKD. Full article

(This article belongs to the Special Issue Cardiovascular Complications in Diabetes: Current Treatments and Future Options)

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Open AccessArticle

Decreased Physical and Daily Living Activities in Patients with Peripheral Arterial Disease on Hemodialysis

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J. Clin. Med. 2023, 12(1), 135; https://doi.org/10.3390/jcm12010135 - 24 Dec 2022

Cited by 1 | Viewed by 906

Abstract

Decreased physical activity and activities of daily living (ADL) in patients on hemodialysis (HD) are associated with a poor prognosis. Additionally, comorbid peripheral arterial disease is associated with further deterioration. We conducted a cross-sectional study of ADL difficulty and life-space assessment (LSA) in three groups of patients on hemodialysis according to their ankle-brachial index (ABI) values. The 164 patients were divided into ABI Low (ABI < 0.9), Normal (0.9 ≤ ABI < 1.3), and High (1.3 ≤ ABI) groups, and compared using analysis of covariance with LSA and ADL difficulty adjusted for age. The Kihon checklist (KCL) was used to assess the presence of frailty. The LSA was lower in the Low group than in the High group (F = 3.192, p = 0.044). Similarly, the ADL difficulty was significantly lower in the Low group than in the Normal group (F = 3.659, p = 0.028). In the Low group, the proportion of patients with frailty was 47.1% and KCL physical was significantly lower, indicating that patients on HD with a lower ABI had a higher prevalence of frailty and lower LSA and ADL difficulty. In conclusion, patients on HD with decreased ABI values most likely exhibit decline in physical activity and ADL due to frailty and claudication. Full article

(This article belongs to the Special Issue Cardiovascular Complications in Diabetes: Current Treatments and Future Options)

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Open AccessArticle

Neuromuscular Electrical Stimulation during Hemodialysis Suppresses Postprandial Hyperglycemia in Patients with End-Stage Diabetic Kidney Disease: A Crossover Controlled Trial

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J. Clin. Med. 2022, 11(21), 6239; https://doi.org/10.3390/jcm11216239 - 22 Oct 2022

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Abstract

Hemodialysis patients with diabetic kidney disease (DKD) experience blood glucose fluctuations owing to insulin removal. We evaluated the effects of single and long-term application of neuromuscular electrical stimulation (NMES) during hemodialysis on glycemic control. This trial was conducted in two stages: Stage 1, following a crossover design and 4 week washout period, eleven outpatients with DKD either underwent a single bout of NMES for 30 min (NMES period) or rested (control period) after receiving nutritional support during hemodialysis; Stage 2, following a crossover design and 4 week washout period, each participant received the intervention for 12 weeks. NMES was administered for 30 min at the maximum tolerable intensity. The mean subcutaneous glucose concentration and mean amplitude of glycemic excursion (MAGE) were determined by flash glucose monitoring for 24 h. Changes in glycoalbumin and MAGE before and after NMES initiation were evaluated. The mean blood glucose level and MAGE after a single bout of NMES were significantly lower than those after rest. Glycoalbumin levels and echo intensity of the rectus femoris tended to decrease, but not significantly by ANOVA due to a lack in statistical power after the dropout of three patients. NMES in end-stage DKD decreased blood glucose levels during and after hemodialysis. Full article

(This article belongs to the Special Issue Cardiovascular Complications in Diabetes: Current Treatments and Future Options)

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Open AccessArticle

Association between SGLT2 Inhibitors and Cardiac Rehabilitation Outcomes in Patients with Cardiovascular Disease and Type 2 Diabetes Mellitus

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J. Clin. Med. 2022, 11(19), 5956; https://doi.org/10.3390/jcm11195956 - 09 Oct 2022

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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 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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Open AccessArticle

Serum and Adipose Dipeptidyl Peptidase 4 in Cardiovascular Surgery Patients: Influence of Dipeptidyl Peptidase 4 Inhibitors

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J. Clin. Med. 2022, 11(15), 4333; https://doi.org/10.3390/jcm11154333 - 26 Jul 2022

Cited by 2 | Viewed by 1228

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 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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Open AccessArticle

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

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J. Clin. Med. 2022, 11(10), 2838; https://doi.org/10.3390/jcm11102838 - 17 May 2022

Cited by 2 | Viewed by 1541

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 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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Open AccessArticle

The Prevalence of Metabolic Dysfunction-Associated Fatty Liver Disease and Its Association with Physical Function and Prognosis in Patients with Acute Coronary Syndrome

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J. Clin. Med. 2022, 11(7), 1847; https://doi.org/10.3390/jcm11071847 - 26 Mar 2022

Cited by 3 | Viewed by 2313

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 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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Effect of Pemafibrate on Hemorheology in Patients with Hypertriglyceridemia and Aggravated Blood Fluidity Associated with Type 2 Diabetes or Metabolic Syndrome

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J. Clin. Med. 2023, 12(4), 1481; https://doi.org/10.3390/jcm12041481 - 13 Feb 2023

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Abstract

Persistent high serum triglyceride (TG) and free fatty acid (FFA) levels, which are common in metabolic syndrome and type 2 diabetes, are risk factors for cardiovascular events because of exacerbated hemorheology. To explore the effects of pemafibrate, a selective peroxisome proliferator-activated receptor alpha modulator, on hemorheology, we performed a single-center, nonrandomized, controlled study in patients with type 2 diabetes (HbA1c 6–10%) or metabolic syndrome, with fasting TG levels of ≥ 150 mg/dL and a whole blood transit time of > 45 s on a microarray channel flow analyzer (MCFAN). Patients were divided into a study group, receiving 0.2 mg/day of pemafibrate (n = 50) for 16 weeks, and a non-pemafibrate control group (n = 46). Blood samples were drawn 8 and 16 weeks after entry to the study to evaluate whole blood transit time as a hemorheological parameter, leukocyte activity by MCFAN, and serum FFA levels. No serious adverse events were observed in either of the groups. After 16 weeks, the pemafibrate group showed a 38.6% reduction in triglycerides and a 50.7% reduction in remnant lipoproteins. Pemafibrate treatment did not significantly improve whole blood rheology or leukocyte activity in patients with type 2 diabetes mellitus or metabolic syndrome complicated by hypertriglyceridemia and exacerbated hemorheology. Full article

(This article belongs to the Special Issue Cardiovascular Complications in Diabetes: Current Treatments and Future Options)

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