Nutrition, metabolism, and cardiovascular diseases : NMCD
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Nutr Metab Cardiovasc Dis · Apr 2014
Review Meta AnalysisMeta-analysis of 14 trials comparing bypass grafting vs drug-eluting stents in diabetic patients with multivessel coronary artery disease.
Clinical trials have reported lower mortality and repeated revascularization rate in diabetic patients treated with coronary artery bypass grafting (CABG) as compared to percutaneous revascularization. However, these studies were conducted in the era of bare-metal stents. Therefore, we performed a meta-analysis to compare CABG to PCI with drug-eluting stents (DES) in diabetic patients with multivessel and/or left main disease. ⋯ The present meta-analysis demonstrates that among diabetic patients with multivessel disease and/or left main disease, CABG provides benefits in mortality and TVR, especially in high-risk patients but it is counterbalanced by a higher risk of stroke. Future trials are certainly needed in the era of new DES and improved antiplatelet therapies.
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Nutr Metab Cardiovasc Dis · Apr 2014
Multicenter StudyA quantitative measure of diabetes risk in community practice impacts clinical decisions: the PREVAIL initiative.
While predictive tools are being developed to identify those at highest risk for developing diabetes, little is known whether these assays affect clinical care. ⋯ The use of a prognostic test in patients perceived to be high risk for diabetes was associated with a modest but significant increase in the prescription of metformin and lifestyle interventions and a reduction in BMI.
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Nutr Metab Cardiovasc Dis · Apr 2014
Systemic inflammation is related to coronary microvascular dysfunction in obese patients without obstructive coronary disease.
Obesity, systemic inflammation and changes in the heart functions are associated with increased cardiovascular risk. This study aimed to investigate coronary microvascular dysfunction as an early marker of atherosclerosis in obese patients without any evidence of cardiovascular disease. ⋯ CFR is often reduced in obese subjects without clinical evidence of heart disease, suggesting a coronary microvascular impairment. This microvascular dysfunction seems to be related to a chronic inflammation mediated by adipocytokines. Our findings may explain the increased cardiovascular risk in obesity, independently of BMI.