1.
Coronary artery calcifications and diastolic dysfunction versus visceral fat area in type 1 diabetes: VISCERA study.
De Block, CEM, Shivalkar, B, Goovaerts, W, Brits, T, Carpentier, K, Verrijken, A, Van Hoof, V, Parizel, PM, Vrints, C, Van Gaal, LF
Journal of diabetes and its complications. 2018;(3):271-278
Abstract
AIMS: Type 1 diabetic patients (T1DM) experience a higher cardiovascular disease and mortality risk than controls. We investigated whether visceral adipose tissue (VAT) contributes to coronary artery calcifications (CAC) and cardiac dysfunction in T1DM. METHODS A cross-sectional study of 118 T1DM patients without a history of cardiovascular disease (men/women: 68/50, age 46±12years, HbA1c 7.6±0.9%, BMI 25.8±4.1kg/m2) was conducted. CAC and VAT were measured using a CT scan. CAC was scored using the Agatston method. Cardiac functional abnormalities were assessed by echocardiography. RESULTS CAC scored ≥10 in 42% of patients. Systolic function was normal in all, but diastolic dysfunction was present in 75%. Forty-six percent had VAT≥100cm2. CAC score≥10 occurred more often in subjects with VAT≥100cm2 (54% vs 31%; p=0.01). Age (OR=1.10; p<0.0001), diabetes duration (OR=1.10; p=0.008), gender (OR=4.28; p=0.016), LDL-cholesterol (OR=1.03; p=0.009) and metabolic syndrome (OR=5.79; p=0.005) were independently associated with a CACS≥10. Subjects with CACS≥10 were more prone to have diastolic dysfunction (84 vs 54%; p=0.03). Factors independently associated with diastolic dysfunction were age (OR=1.11; p=0.002), waist circumference (OR=1.10; p=0.016) and VAT (OR=0.99; p=0.035). CONCLUSIONS Excess VAT in T1DM, present in 46%, is associated with diastolic dysfunction and CAC, present in respectively 75% and 42% of patients. Timely detection might improve future cardiovascular risk.
2.
Emerging therapeutic strategies for the management of dyslipidemia in patients with the metabolic syndrome.
Davidson, MH
The American journal of cardiology. 2004;(11A):3C-11C
Abstract
The benefits of lipid-lowering therapy in significantly reducing cardiovascular events has been established in many at-risk populations. However, patients with the metabolic syndrome (MS) pose a challenge for clinical management. A high degree of residual risk exists in patients with the MS or diabetes mellitus, and this is of growing importance because of the increasing prevalence of obesity and its associated comorbidities in the world. As the MS has emerged as a major risk factor for both cardiovascular disease and diabetes, targeting treatment to achieve aggressive goals becomes paramount. This article reviews emerging therapeutic strategies for the management of dyslipidemia in patients with the MS.