Decreased Insulin Clearance in Individuals with Elevated 1-h Post-Load Plasma Glucose Levels

Reduced insulin clearance has been shown to predict the development of type 2 diabetes. Recently, it has been suggested that plasma glucose concentrations ≥8.6 mmol/l (155 mg/dl) at 1 h during an oral glucose tolerance test (OGTT) can identify individuals at high risk for type 2 diabetes among those who have normal glucose tolerance (NGT 1 h-high). The aim of this study was to examine whether NGT 1 h-high have a decrease in insulin clearance, as compared with NGT individuals with 1-h post-load glucose <8.6 mmol/l (l (155 mg/dl, NGT 1 h-low). To this end, 438 non-diabetic White individuals were subjected to OGTT and euglycemic-hyperinsulinemic clamp to evaluate insulin clearance and insulin sensitivity. As compared with NGT 1 h-low individuals, NGT 1 h-high had significantly higher 1-h and 2-h post-load plasma glucose and 2-h insulin levels as well as higher fasting glucose and insulin levels. NGT 1 h-high exhibited also a significant decrease in both insulin sensitivity (P<0.0001) and insulin clearance (P = 0.006) after adjusting for age, gender, adiposity measures, and insulin sensitivity. The differences in insulin clearance remained significant after adjustment for fasting glucose (P = 0.02) in addition to gender, age, and BMI. In univariate analyses adjusted for gender and age, insulin clearance was inversely correlated with body weight, body mass index, waist, fat mass, 1-h and 2-h post-load glucose levels, fasting, 1-h and 2-h post-load insulin levels, and insulin-stimulated glucose disposal. In conclusion, our data show that NGT 1 h-high have a reduction in insulin clearance as compared with NGT 1 h-low individuals; this suggests that impaired insulin clearance may contribute to sustained fasting and post-meal hyperinsulinemia.     

Plasma Renin Levels and Vascular Complications in Hypertension

Plasma renin levels, measured in 39 untreated patients in 1967, under conditions of sodium loading and sodium depletion have been related to the incidence of stroke and myocardial infarction. Renin levels were not significantly different in patients with or without vascular complications. Out of 13 patients with persistently low renin levels 6 had suffered either a stroke or a myocardial infarction and 7 had not. Plasma renin levels were also measured in 116 treated hypertensive patients. There was no relation between plasma renin level and vascular complications. It is concluded that levels of plasma renin are not a reliable index of the probability of hypertensive patients suffering a stroke or myocardial infarction.     

The Association between Vitamin D and Vascular Stiffness in Adolescents with and without Type 1 Diabetes

Objective

Vitamin D deficiency is common and associated with increased cardiovascular disease (CVD) risk. Pulse wave velocity (PWV) is a marker of vascular stiffness associated with CVD. We hypothesized that Vitamin D (25 (OH) D) levels would be inversely associated with PWV in youth with and without type 1 diabetes (T1D).

Study Design

Comparisons were made between adolescents with T1D (n = 211; age = 17.5±2.3 years; diabetes duration = 10.9±3.2 years; A1c = 9.1±1.7%) and non-DM controls (n = 67; age = 16.9±1.9 years). PWV was measured in the carotid-femoral segment (Sphygmocor Vx, AtCor Medical, Lisle, IL).

Results

Vitamin D levels were similar in adolescents with T1D and controls (27.7±0.7 v. 26.0±1.3 ng/ml; p = 0.26). Vitamin D was significantly inversely associated with PWV after adjusting for age, sex, quarter of the year, and race-ethnicity in adolescents with T1D (beta  = −0.01±0.004, p = 0.02) but not in the non-DM adolescents (beta  = −0.008±0.008, p = 0.32). Vitamin D remained significantly associated with PWV after additionally adjusting for hs-CRP in adolescents with T1D (−0.01±0.004, p = 0.01). After adjusting for BMI z-score, lipids, or blood pressure, the relationship of Vitamin D with PWV was not significant.

Conclusions

Vitamin D levels were inversely associated with PWV in adolescents with T1D, but not independently of BMI, lipids, or blood pressure. Our data contrast with other reports and suggest further research is indicated to determine if Vitamin D supplementation would be beneficial to lower CVD risk in adolescents with T1D with vitamin D insufficiency or deficiency.     

Inverse Association between Serum Bilirubin Levels and Arterial Stiffness in Korean Women with Type 2 Diabetes

Background

Considerable evidence suggests that bilirubin is a potent physiologic antioxidant that may provide important protection against cardiovascular disease (CVD) and inflammation. We investigated the relationship between serum total bilirubin (TB) levels and arterial stiffness, measured by the brachial-ankle pulse wave velocity (baPWV), in patients with type 2 diabetes.

Methods

We conducted a cross-sectional analysis of 1,711 subjects with type 2 diabetes (807 men and 904 women; mean age, 57.1 years). The subjects were stratified based on gender-specific tertiles of TB values, and a high baPWV was defined as greater than 1,745 cm/s ( >75th percentile).

Results

The serum TB concentration was negatively correlated with the duration of diabetes, HbA1c, the 10-year Framingham risk score, and baPWV and was positively correlated with high-density lipoprotein cholesterol and the eGFR in both genders. Inverse association between TB categories and unadjusted prevalence of high PWV was only observed in women. After adjusting for confounding factors, the TB levels were inversely associated with a greater risk of a high baPWV, both as a continuous variable [a 1-SD difference; odds ratio (OR), 0.70; 95% confidence interval (CI), 0.54–0.90; P = 0.005] and when categorized in tertiles (the highest vs. the lowest tertile; OR, 0.49; 95% CI, 0.28–0.85; P = 0.011) in women but not in men. The relationship remained significant even after adjusting for retinopathy and nephropathy.

Conclusions

Low TB levels were significantly associated with arterial stiffness in Korean women with type 2 diabetes. Our data suggested that bilirubin may protect against macrovascular disease in diabetic women.     

The Association between Postload Plasma Glucose Levels and 38-Year Mortality Risk of Coronary Heart Disease: The Prospective NHLBI Twin Study

Background

Due to the paucity of direct evidence, we aimed to evaluate whether the association between postload plasma glucose levels (ppGlucose) and long-term risk of mortality from coronary heart disease was independent of or attributable to genes and common environment.

Methods and Findings

From the prospective National Heart, Lung, and Blood Institute (NHLBI) Twin Study, we included 903 middle-aged male twins, who were nondiabetic, free of coronary heart disease at baseline (1969–1973), and followed for up to 38 years for coronary heart, cardiovascular, and all-cause mortality. Frailty survival models were used to estimate hazard ratio (HR) for various associations: overall (equivalent to singleton population association), within-pair (controlling for genes and environment common to co-twins), and between-pair association (reflecting influences of common factors). Overall associations were statistically significant for coronary heart and cardiovascular but not all-cause deaths after controlling for known risk factors. The associations were not statistically significant in within-pair analyses. The within-pair association was not statistically different by zygosity for specific and all-cause death risk. After the full adjustment for known risk factors, HR (95% confidence interval) for within-pair association was 1.07 (0.90, 1.28), 1.06 (0.94, 1.19), and 0.99 (0.94, 1.05) for coronary heart, cardiovascular, and all-cause mortality, respectively. The fully adjusted between-pair associations were statistically significant for specific and all-cause death risk: a 50 mg/dL increase in the mean value of ppGlucose for a twin pair was associated with a raised death risk [HR (95% confidence interval) 1.15 (1.02, 1.30), 1.10 (1.02, 1.20), and 1.05 (1.01, 1.09) for coronary heart, cardiovascular, and all-cause mortality, respectively]. Between-pair association was significant in dizygotic but not in monozygotic twins.

Conclusion

The positive association between ppGlucose and long-term coronary heart mortality risk is largely explained by factors shared between co-twins, including familial factors; however, within-pair effects cannot be absolutely excluded.     

Association between Polymorphisms in the Renin-Angiotensin-Aldosterone System Genes and Essential Hypertension in the Han Chinese Population

Background

Renin-angiotensin-aldosterone system (RAAS) is the most important endocrine blood pressure control mechanism in our body, genes encoding components of this system have been strong candidates for the investigation of the genetic basis of hypertension. However, previous studies mainly focused on limited polymorphisms, thus we carried out a case-control study in the Han Chinese population to systemically investigate the association between polymorphisms in the RAAS genes and essential hypertension.

Methods

905 essential hypertensive cases and 905 normotensive controls were recruited based on stringent inclusion and exclusion criteria. All 41 tagSNPs within RAAS genes were retrieved from HapMap, and the genotyping was performed using the GenomeLab SNPstream Genotyping System. Logistic regression analysis, Multifactor dimensionality reduction (MDR), stratified analysis and crossover analysis were used to identify and characterize interactions among the SNPs and the non-genetic factors.

Results

Serum levels of total cholesterol (TC) and triglyceride (TG), and body mass index (BMI) were significantly higher in the hypertensive group than in the control group. Of 41 SNPs genotyped, rs3789678 and rs2493132 within AGT, rs4305 within ACE, rs275645 within AGTR1, rs3802230 and rs10086846 within CYP11B2 were shown to associate with hypertension. The MDR analysis demonstrated that the interaction between BMI and rs4305 increased the susceptibility to hypertension. Crossover analysis and stratified analysis further indicated that BMI has a major effect, and rs4305 has a minor effect.

Conclusion

These novel findings indicated that together with non-genetic factors, these genetic variants in the RAAS may play an important role in determining an individual’s susceptibility to hypertension in the Han Chinese.     

基因多态性与原发性高血压的相关性

高血压是一种遗传因素和环境因素相互作用所致的疾病,但高血压的病因尚不明确。已有的研究结果表明,高血压患者或潜在患者常有一种以上与血压调节相关的基因异常。目前,已有多个与高血压相关的基因位点被深入广泛研究。本文旨在就基因多态性与高血压相关性的研究进展进行综述。     

血浆Apelin-36水平与高血压病的相关性研究

目的：探讨原发性高血压（EH）患者24小时平均血压水平与血浆Apelin-36水平的相关性。方法：选择2009年6月一2010年6月在我院心内二科住院的EH患者146例为观察组,选择144例血压正常者作为对照组。抽取空腹静脉血,采用放射免疫法（RIA）检测所有研究对象的血浆Apelin-36水平。结果：①血压正常组血浆Apelin-36水平24.65±4.10pmol/l;EH组20.81±4.98 pmol/l;两组间比较有显著统计学差异（P〈0.01）。②EH患者者血浆Apelin-36水平与24小时平均收缩压、白天平均收缩压、夜间平均收缩压均呈负相关（P〈0.05）。结论：EH组血浆Apelin-36水平显著低于正常对照组,24小时平均血压越高,血浆Apelin-36水平越低,且血浆Apelin-36水平与24小时平均血压水平呈负相关。     

血浆Apelin-36 水平与高血压病的相关性研究

目的:探讨原发性高血压(EH)患者24小时平均血压水平与血浆Apelin-36水平的相关性。方法:选择2009年6月一2010年6月在我院心内二科住院的EH患者146例为观察组,选择144例血压正常者作为对照组。抽取空腹静脉血,采用放射免疫法(RIA)检测所有研究对象的血浆Apelin-36水平。结果:①血压正常组血浆Apelin-36水平24.65±4.10pmol/l;EH组20.81±4.98 pmol/l;两组间比较有显著统计学差异(P<0.01)。②EH患者者血浆Apelin-36水平与24小时平均收缩压、白天平均收缩压、夜间平均收缩压均呈负相关(P<0.05)。结论:EH组血浆Apelin-36水平显著低于正常对照组,24小时平均血压越高,血浆Apelin-36水平越低,且血浆Apelin-36水平与24小时平均血压水平呈负相关。     

Tetrahydrocurcumin Protects against Cadmium-Induced Hypertension,Raised Arterial Stiffness and Vascular Remodeling in Mice

Background

Cadmium (Cd) is a nonessential heavy metal, causing oxidative damage to various tissues and associated with hypertension. Tetrahydrocurcumin (THU), a major metabolite of curcumin, has been demonstrated to be an antioxidant, anti-diabetic, anti-hypertensive and anti-inflammatory agent. In this study, we investigated the protective effect of THU against Cd-induced hypertension, raised arterial stiffness and vascular remodeling in mice.

Methods

Male ICR mice received CdCl₂ (100 mg/l) via drinking water for 8 weeks. THU was administered intragastrically at dose of 50 or 100 mg/kg/day concurrently with Cd treatment.

Results

Administration of CdCl₂ significantly increased arterial blood pressure, blunted vascular responses to vasoactive agents, increased aortic stiffness, and induced hypertrophic aortic wall remodeling by increasing number of smooth muscle cells and collagen deposition, decreasing elastin, and increasing matrix metalloproteinase (MMP)-2 and MMP-9 levels in the aortic medial wall. Supplementation with THU significantly decreased blood pressure, improved vascular responsiveness, and reversed the structural and mechanical alterations of the aortas, including collagen and elastin deposition. The reduction on the adverse response of Cd treatment was associated with upregulated eNOS and downregulated iNOS protein expressions, increased nitrate/nitrite level, alleviated oxidative stress and enhanced antioxidant glutathione. Moreover, THU also reduced the accumulation of Cd in the blood and tissues.

Conclusions

Our results suggest that THU ameliorates cadmium-induced hypertension, vascular dysfunction, and arterial stiffness in mice through enhancing NO bioavailability, attenuating oxidative stress, improving vascular remodeling and decreasing Cd accumulation in other tissues. THU has a beneficial effect in moderating the vascular alterations associated with Cd exposure.     

肾素- 血管紧张素- 醛固酮系统与原发性高血压病的关系

目的:探讨血浆肾素-血管紧张素系统与原发性高血压病的关系。方法:采用病例-对照研究设计,入选125例原发性高血压病患者与60例血压正常健康体检者为对照组。采用放射免疫方法测定立位、卧位血浆肾素活性(PRA),醛固酮(ALD)浓度及血管紧张素Ⅱ(AngⅡ)浓度。结果:原发性高血压患者,立位、卧位血浆PRA均低于正常对照组(P<0.05),而ALD浓度及AngⅡ浓度均高于正常对照组(P<0.05)。根据高血压病1级、2级、3级分组,立位、卧位血浆PRA均依次降低(P<0.05);而ALD浓度及AngⅡ浓度依次升高(P<0.05)。结论:肾素-血管紧张素-醛固酮系统与原发性高血压病的发病关系密切,血浆PRA水平、AngⅡ及ALD浓度有望成为原发性高血压病分级的有效指标;降低原发性高血压患者AngⅡ及ALD量是治疗高血压病的关键,血浆AngII、ALD也有望成为评价原发性高血压病疗效的指标。     

Association Between Blood Glucose Levels and Development of Candidemia in Hospitalized Patients

ObjectiveTo examine the relationship between blood glucose levels in hospitalized patients and the risk of occurrence of candidemia.MethodsWe undertook a retrospective review of medical records and hospital computerized database information to compare blood glucose levels in 48 patients with nosocomial candidemia and 144 contemporaneous matched control subjects without candidemia at a tertiary teaching hospital.ResultsThe proportions of days (for patients with candidemia versus control subjects without candidemia) with blood glucose levels ≥ 100 mg/dL (293 of 325 [90%] versus 849 of 1,007 [84%]; P = .009), ≥ 140 mg/dL (184 of 325 [57%] versus 507 of 1,007 [50%]; P = .049), and ≥ 200 mg/dL (80 of 325 [25%] versus 163 of 1,007 [16%]; P = .001) were significantly higher during the 7 days preceding the diagnosis of candidemia than during a 7-day period of hospitalization of control subjects. Blood glucose levels exceeding 200 mg/dL for 4 or more days of the week preceding the diagnosis of candidemia were significantly associated with its development (P = .04; odds ratio, 2.44; and 95% confidence interval, 1.01 to 5.94).ConclusionInpatient hyperglycemia is an important—and potentially modifiable—risk factor for development of nosocomial candidemia. These findings have implications for innovative infection control strategies that focus on glycemic control. (Endocr Pract. 2009;15:111- 115)     

哈萨克族原发性高血压患者血浆CGRP水平及其相关性研究

目的:探讨血浆降钙素基因相关肽(CGRP)水平与新疆哈萨克族(哈族)原发性高血压病患者血压、血脂、血糖、肥胖等的相关性。方法:选取新疆哈族原发性高血压患者52例为观察组,哈族健康对照组48例,测量血压(BP)、身高、体重、腰围(WC)、臀围(HC),抽取空腹静脉血测定血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C),计算体重指数(BMI)腰臀比(WHR)。结果:①原发性高血压组血浆CGRP水平明显低于对照组,差异有统计学意义(p<0.01);②原发性高血压组血浆CGRP水平与SBP、LDL-C和TG呈显著负相关(p<0.01);对照组血浆CGRP水平与SBP和LDL-C呈显著负相关(p<0.01)。结论:哈族原发性高血压患者血浆CGRP水平与血压、血脂存在相关性。     

Association between Foeto-maternal Bleeding and Hypertension in Pregnancy

A blind prospective survey of foeto-maternal bleeding in 200 primiparous pregnancies was carried out in an investigation of a possible association between foeto-maternal bleeding and hypertension in pregnancy. Evidence of foeto-maternal bleeding was found in 61% of 36 hypertensive pregnancies, and in 51% of 160 normotensive pregnancies, a difference which is not statistically significant.Significant differences between the hypertensive and the normotensive groups were found when foeto-maternal bleeding was related to gestation. In pregnancies that became hypertensive more foetal cells were found in the maternal circulation before week 36 than in normotensive pregnancies. In patients with oedema of the abdominal wall during pregnancy the incidence of foeto-maternal bleeding was significantly increased.These findings seem to explain why pre-eclamptic toxaemia is a significant predisposing factor in women who later develop Rh antibodies. It is recommended that anti-D gammaglobulin should be offered to all Rh-negative women with Rh-positive infants following a hypertensive pregnancy. Consideration should also be given to the question of administering anti-D gammaglobulin during Rh-negative hypertensive pregnancies if this procedure is proved to be both safe to mother and foetus and effective.The results provide contributory evidence that the placental vascular changes in toxaemic pregnancies precede the clinical signs and are not the result of hypertension.     

血浆hs-CRP和Hcy水平与血管性痴呆患者认知功能的关系

目的:探讨血浆超敏C反应蛋白(hs-CRP)和同型半胱氨酸(Hcy)水平与血管性痴呆(VD)患者认知功能的相关性。方法:回顾性分析2011年12月-2014年7月间我院100例脑梗死住院患者的临床资料,按诊断结果,将患者分为VD组55例和非VD组45例,另选取同期50例健康体检者为对照组。检测并比较3组血浆hs-CRP和Hcy水平,采用简易精神状态速检表(MMSE)对VD组进行痴呆程度分类,分析其与血浆hs-CRP和Hcy的相关性。结果:血浆Hcy与hs-CRP在3组间差异有统计学意义(P0.05),且VD组、非VD组均显著高于对照组,VD组显著高于非VD组,差异均有统计学意义(P0.05)。随着痴呆程度的加重,MMSE评分逐渐降低,血浆hs-CRP与Hcy水平则逐渐升高,差异有统计学意义(P0.05)。经相关性分析发现,MMSE评分和血浆hs-CRP与Hcy水平均呈负相关(r=-0.672,-0.703,P0.05)。结论:血浆hs-CRP与Hcy水平与VD患者的认知功能负相关,临床加强对两指标的检测对VD的诊断及防治有着重要的临床意义。     

Protective Effect of Tubotaiwine on Cadmium-Induced Hypertension in Rats through Reduction in Arterial Stiffness and Vascular Remodeling

Doklady Biochemistry and Biophysics - Humans are adversely affected by exposure to cadmium (Cd) as it induces oxidative stress which damages kidneys, bones pulmonary tissues, liver, cardiovascular,...     

Association between Reduction of Plasma Adiponectin Levels and Risk of Bacterial Infection after Gastric Cancer Surgery

Background and Purpose

Infections are important causes of postoperative morbidity after gastric surgery; currently, no factors have been identified that can predict postoperative infection. Adiponectin (ADN) mediates energy metabolism and functions as an immunomodulator. Perioperative ADN levels and perioperative immune functioning could be mutually related. Here we evaluated a potential biological marker to reliably predict the incidence of postoperative infections to prevent such comorbidities.

Methods

We analyzed 150 consecutive patients who underwent elective gastric cancer surgery at the Shiga University of Medical Science Hospital (Shiga, Japan) from 1997 to 2009; of these, most surgeries (n = 100) were performed 2008 onwards. The patient characteristics and surgery-related factors between two groups (with and without infection) were compared by the paired t-test and χ² test, including preoperative ADN levels, postoperative day 1 ADN levels, and ADN ratio (postoperative ADN levels/preoperative ADN levels) as baseline factors. Logistic regression analysis was performed to access the independent association between ADN ratio and postoperative infection. Finally, receiver operating curves (ROCs) were constructed to examine its clinical utility.

Results

Sixty patients (40%) experienced postoperative infections. The baseline values of age, American Society of Anesthesiologists physical status, total operating time, blood loss, surgical procedure, C-reactive protein (CRP) levels, preoperative ADN levels, and ADN ratio were significantly different between groups. Logistic regression analysis using these factors indicated that type 2 diabetes mellitus (T2DM) and ADN ratio were significantly independent variables (*p<0.05, ** p<0.01, respectively). ROC analysis revealed that the useful cutoff values (sensitivity/specificity) for preoperative ADN levels, ADN ratio, blood loss, operating time, and CRP levels were 8.81(0.567/0.568), 0.76 (0.767/0.761), 405 g (0.717/0.693), 342 min (0.617/0.614), and 8.94 mg/dl (0.583/0.591), respectively.

Conclusion

T2DM and ADN ratio were independent predictors of postoperative infection and ADN ratio was the most useful predictor for postoperative infection.