Cardiovascular Diseases and Type 2 Diabetes

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Epidemiology & Public Health".

Deadline for manuscript submissions: 30 April 2024 | Viewed by 7046

Special Issue Editors

Department of Functional Sciences—Medical Informatics and Biostatistics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
Interests: diabetes
County Emergency Hospital “Pius Brinzeu”, L. Rebreanu, Timisoara, Romania
Interests: cardiovascular diseases
Department VII, Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, Timisoara, Romania
Interests: pulmonary hypertension; heart failure; heart rate variability; miocarditis; pericarditis; COVID-19; post-acute COVID-19 syndrome
Special Issues, Collections and Topics in MDPI journals
Second Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
Interests: epidemiology; children; type 1 diabetes; chronic kidney disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cardiovascular diseases and type 2 diabetes mellitus are among the most widespread pathologies in our society and their prevalence increases with advancing age. These pathologies are associated with increased morbidity and mortality and are responsible for most hospital admissions, and at the same time extending the duration of hospitalization for other conditions.

The relationship between these two pathologies is bidirectional. On one side, type 2 diabetes mellitus represents an independent risk factor for atherosclerosis, peripheral and coronary artery disease, and systemic hypertension, intervening through multiple pathways in the pathophysiology of cardiovascular diseases.  In particular, diabetes mellitus type 2 determines endothelial dysfunction being responsible for the development of new cardiovascular complications or may aggravate pre-existing pathologies. On the other side, the coexistence of cardiovascular diseases represents a challenge for the management of diabetes mellitus, rising the risk for developing other systemic complications among which the renal and neurological ones are the most significant.

In this Special Issue, we focus on the interrelation between cardiovascular pathologies and diabetes mellitus type 2. We are interested in original research or review articles describing pathophysiological mechanisms, clinical approaches, new diagnostic techniques, or therapeutic options.

Dr. Mirela Frandes
Dr. Mariana Tudoran
Dr. Cristina Tudoran
Dr. Adrian Vlad
Guest Editors

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Keywords

  • acute and chronic coronary syndrome
  • endothelial dysfunction
  • arterial hypertension
  • heart failure
  • insulin resistance
  • diabetes mellitus type 2

Published Papers (5 papers)

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Research

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10 pages, 315 KiB  
Article
Systemic Immune-Inflammation Index in Relation to Diabetes Markers in Saudi Adults: A Retrospective Study
by Ghadeer S. Aljuraiban, Fahad J. Alharbi, Ali O. Aljohi, Abdullah Z. Almeshari, Masoud N. Alotaibi, Salem S. AlShammari, Sara Al-Musharaf, Madhawi M. Aldhwayan and Manal Abudawood
Medicina 2024, 60(3), 442; https://doi.org/10.3390/medicina60030442 - 07 Mar 2024
Viewed by 594
Abstract
Background and objectives: Low-grade inflammation is associated with metabolic disturbances like diabetes. The systemic immune-inflammation index (SII) has been proposed as a predictive tool to identify individuals at a greater risk of diabetes. This study aims to examine the association between SII [...] Read more.
Background and objectives: Low-grade inflammation is associated with metabolic disturbances like diabetes. The systemic immune-inflammation index (SII) has been proposed as a predictive tool to identify individuals at a greater risk of diabetes. This study aims to examine the association between SII and diabetes markers. Method and materials: We used retrospective data from a large cohort of adults (n = 3895) aged ≥18 in Saudi Arabia. The SII was calculated, and the markers of diabetes such as fasting blood glucose (FBG), insulin, and hemoglobin A1c (HbA1c) were included. Results: Across the quartiles of SII, FBG, insulin, and HbA1c were significantly higher in adults with higher compared to lower SII (p < 0.0001, p = 0.04, p < 0.0001, respectively). A two SD higher FBG was significantly associated with an SII difference of 47.7 (95% CI: (15.5, 91.9)). In subgroup analysis, this relationship prevailed in normal-weight participants and among those with normoglycemia and prediabetes but was attenuated in participants with diabetes. The association also prevailed in separate analyses for males and females but was stronger among females. Linear regression models showed no significant association between insulin, HbA1c, and SII. Conclusions: SII was associated with the markers of diabetes. The utility of SII for predicting diabetes can be confirmed with prospective cohort studies. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and Type 2 Diabetes)
12 pages, 1638 KiB  
Article
Significant Association between Subclinical Left Cardiac Dysfunction and Liver Stiffness in Metabolic Syndrome Patients with Diabetes Mellitus and Non-Alcoholic Fatty Liver Disease
by Alexandru Apostu, Daniel Malita, Sergiu-Florin Arnautu, Mirela-Cleopatra Tomescu, Dan Gaiță, Alina Popescu, Ruxandra Mare, Ramona Gidea and Diana-Aurora Arnautu
Medicina 2023, 59(2), 328; https://doi.org/10.3390/medicina59020328 - 09 Feb 2023
Cited by 1 | Viewed by 1495
Abstract
Background and Objectives: Diabetes mellitus (DM) is connected to both cardiovascular disease and non-alcoholic fatty liver disease (NAFLD), and is an important component of metabolic syndrome (MetS). NAFLD can be detected and quantified using the vibration controlled transient elastography (VCTE) and the controlled [...] Read more.
Background and Objectives: Diabetes mellitus (DM) is connected to both cardiovascular disease and non-alcoholic fatty liver disease (NAFLD), and is an important component of metabolic syndrome (MetS). NAFLD can be detected and quantified using the vibration controlled transient elastography (VCTE) and the controlled attenuation parameter (CAP), whereas traditional and two-dimensional speckle tracking echocardiography (2D-STE) can reveal subclinical abnormalities in heart function. We sought to see if there was a link between left cardiac dysfunction and different levels of hepatic fibrosis in MetS patients with DM and NAFLD. Patients and Methods: We recruited successive adult subjects with MetS and a normal left ventricular ejection fraction, who were divided into two groups according to the presence or absence of DM. The presence of NAFLD was established by CAP and VCTE, while conventional and 2D-STE were used to assess left heart’s systolic and diastolic function. The mean age of the MetS subjects was 62 ± 10 years, 82 (55%) were men. The distribution of liver steatosis severity was similar among diabetics and non-diabetics, while liver fibrosis grade 2 and 3 was significantly more frequent in diabetics (p = 0.02, respectively p = 0.001). LV diastolic dysfunction was found in 52% of diabetic and in 36% of non-diabetic MetS patients (p = 0.04). 2D-STE identified in the diabetic subjects increased LA stiffness (40% versus 24%, p = 0.03) and reduced global left ventricular longitudinal strain (47% versus 16%, p < 0.0001). Liver fibrosis grade ≥ 2 was identified as an independent predictor of both subclinical LV systolic dysfunction and of LA dysfunction in MetS patients with DM (p < 0.0001). Conclusions: The current investigation confirms the link between liver stiffness and subclinical cardiac dysfunction as detected by 2D-STE in MetS patients with DM. The novel parameters derived from LA and LV 2D-STE have demonstrated greater sensitivity compared to the older measurements, and a substantial connection with hepatic fibrosis. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and Type 2 Diabetes)
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Review

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18 pages, 1855 KiB  
Review
Echocardiographic Myocardial Work: A Novel Method to Assess Left Ventricular Function in Patients with Coronary Artery Disease and Diabetes Mellitus
by Alexandra-Cătălina Frișan, Cristian Mornoș, Mihai-Andrei Lazăr, Raluca Șoșdean, Simina Crișan, Ioana Ionac and Constantin-Tudor Luca
Medicina 2024, 60(2), 199; https://doi.org/10.3390/medicina60020199 - 24 Jan 2024
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Abstract
Myocardial ischemia caused by coronary artery disease (CAD) and the presence of metabolic abnormalities and microvascular impairments detected in patients with diabetes mellitus (DM) are a common cause of left ventricular (LV) dysfunction. Transthoracic echocardiography is the most-used, non-invasive imaging method for the [...] Read more.
Myocardial ischemia caused by coronary artery disease (CAD) and the presence of metabolic abnormalities and microvascular impairments detected in patients with diabetes mellitus (DM) are a common cause of left ventricular (LV) dysfunction. Transthoracic echocardiography is the most-used, non-invasive imaging method for the assessment of myocardial contractility. The accurate evaluation of LV function is crucial for identifying patients who are at high risk or may have worse outcomes. Myocardial work (MW) is emerging as an alternative tool for the evaluation of LV systolic function, providing additional information on cardiac performance when compared to conventional parameters such as left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) because it incorporates deformation and load into its analysis. The potential of MW in various conditions is promising and it has gained increased attention. However, larger studies are necessary to further investigate its role and application before giving an answer to the question of whether it can have widespread implementation into clinical practice. The aim of this review is to summarize the actual knowledge of MW for the analysis of LV dysfunction caused by myocardial ischemia and hyperglycemia. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and Type 2 Diabetes)
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14 pages, 651 KiB  
Review
Associations between Oral Glucose-Lowering Agents and Increased Risk for Life-Threatening Arrhythmias in Patients with Type 2 Diabetes Mellitus—A Literature Review
by Cristina Tudoran, Mariana Tudoran, Catalina Giurgi-Oncu, Ahmed Abu-Awwad, Simona-Alina Abu-Awwad and Florica Voiţă-Mekereş
Medicina 2023, 59(10), 1760; https://doi.org/10.3390/medicina59101760 - 02 Oct 2023
Cited by 1 | Viewed by 1066
Abstract
Background and Objectives: The relationship between type 2 diabetes mellitus (T2DM) and cardiovascular (CV) morbidity and mortality is well-established. Ventricular arrhythmias (VA) are frequently diagnosed in patients with T2DM, especially in those with associated coronary syndrome, non-ischemic dilated cardiomyopathy (NIDCM), and heart [...] Read more.
Background and Objectives: The relationship between type 2 diabetes mellitus (T2DM) and cardiovascular (CV) morbidity and mortality is well-established. Ventricular arrhythmias (VA) are frequently diagnosed in patients with T2DM, especially in those with associated coronary syndrome, non-ischemic dilated cardiomyopathy (NIDCM), and heart failure (HF). In these patients, VA and sudden cardiac arrest (SCA) are considered responsible for more than 50% of CV deaths. Newly developed glucose-lowering agents (GLA) seem not only to ameliorate CV morbidity and mortality, but also to reduce the risk of VA and SCA. Materials and Methods: We researched the medical literature on Pub-Med, Clarivate, and Google Scholar for original articles published in the last five years that debated the possible effects of various GLA on ventricular arrhythmias. Results: We identified nineteen original articles, nine of them debating the antiarrhythmic effects of sodium-glucose cotransporter-2 inhibitors (SGLT2i); Conclusions: The results concerning the impact of various GLA on VA/SCA were heterogeneous depending on the pharmacological class studied, with some of them having neutral, positive, or negative effects. Although it appears that SGLT2i reduces the prevalence of atrial fibrillation and SCA, their effect on VA is not conclusive. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and Type 2 Diabetes)
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20 pages, 2251 KiB  
Review
Reactive Hyperemia and Cardiovascular Autonomic Neuropathy in Type 2 Diabetic Patients: A Systematic Review of Randomized and Nonrandomized Clinical Trials
by Erislandis López-Galán, Arquímedes Montoya-Pedrón, Rafael Barrio-Deler, Miguel Enrique Sánchez-Hechavarría, Mario Eugenio Muñoz-Bustos and Gustavo Alejandro Muñoz-Bustos
Medicina 2023, 59(4), 770; https://doi.org/10.3390/medicina59040770 - 16 Apr 2023
Cited by 1 | Viewed by 2198
Abstract
Objective: This work aimed to determine the relationship between the autonomic nervous system and reactive hyperemia (RH) in type 2 diabetes patients with and without cardiovascular autonomic neuropathy (CAN). Methodology: A systematic review of randomized and nonrandomized clinical studies characterizing reactive [...] Read more.
Objective: This work aimed to determine the relationship between the autonomic nervous system and reactive hyperemia (RH) in type 2 diabetes patients with and without cardiovascular autonomic neuropathy (CAN). Methodology: A systematic review of randomized and nonrandomized clinical studies characterizing reactive hyperemia and autonomic activity in type 2 diabetes patients with and without CAN was performed. Results: Five articles showed differences in RH between healthy subjects and diabetic patients with and/or without neuropathy, while one study did not show such differences between healthy subjects and diabetic patients, but patients with diabetic ulcers had lower RH index values compared to healthy controls. Another study found no significant difference in blood flow after a muscle strain that induced reactive hyperemia between normal subjects and non-smoking diabetic patients. Four studies measured reactive hyperemia using peripheral arterial tonometry (PAT); only two found a significantly lower endothelial-function-derived measure of PAT in diabetic patients than in those without CAN. Four studies measured reactive hyperemia using flow-mediated dilation (FMD), but no significant differences were reported between diabetic patients with and without CAN. Two studies measured RH using laser Doppler techniques; one of them found significant differences in the blood flow of calf skin after stretching between diabetic non-smokers and smokers. The diabetic smokers had neurogenic activity at baseline that was significantly lower than that of the normal subjects. The greatest evidence revealed that the differences in RH between diabetic patients with and without CAN may depend on both the method used to measure hyperemia and that applied for the ANS examination as well as the type of autonomic deficit present in the patients. Conclusions: In diabetic patients, there is a deterioration in the vasodilator response to the reactive hyperemia maneuver compared to healthy subjects, which depends in part on endothelial and autonomic dysfunction. Blood flow alterations in diabetic patients during RH are mainly mediated by sympathetic dysfunction. The greatest evidence suggests a relationship between ANS and RH; however, there are no significant differences in RH between diabetic patients with and without CAN, as measured using FMD. When the flow of the microvascular territory is measured, the differences between diabetics with and without CAN become evident. Therefore, RH measured using PAT may reflect diabetic neuropathic changes with greater sensitivity compared to FMD. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and Type 2 Diabetes)
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