I am greatly honored to take on the responsibility of being the editor of the International Journal of Cardiodiabetes. The incidence of diabetes is increasing worldwide and although there are many therapies that effectively control blood glucose levels patients with diabetes they continue to be at an increased risk of myocardial infarction, stroke and peripheral […]
Metabolic syndrome (MetS) is a complex multisystem disorder, including visceral obesity, hypertension, raised fasting glucose and dyslipidaemia, which increases the risk of cardiovascular disease (CVD) and type 2 diabetes (T2DM). MetS has been defined by various organisations with the latest iteration in 2006 and has a varying worldwide prevalence (<10% to 84%). There is increasing data confirming that obstructive sleep apnoea (OSA) and non-alcoholic fatty liver disease (NAFLD) share common underlying pathological features which no doubt add complexity to this syndrome. They are also both independently associated with increased CVD. This editorial discusses recent advances in MetS with an aim to update the current definition and present the importance of a new multi-specialty integrated approach in order to improve patient care.
A shifting paradigm in metabolic syndrome; time for a new definition Read More
Given the increasing prevalence of diabetes, with cardiovascular disease representing the principle cause of death and morbidity amongst diabetics, it is imperative that early investigation and then intervention is achieved. Diabetic patients are at increased risk of peripheral arterial disease (PAD), with an earlier onset and a more severe and diffuse manifestation often being seen. The key factors in diabetic arteriopathy include vascular smooth vessel dysfunction, inflammation, hypercoagulability and endothelial dysfunction. Moreover, the presence of PAD is a marker of generalised atherosclerosis and is a strong indicator of increased morbidity and mortality due to cardiovascular ischaemic events, with the risk of atherothrombotic events increasing in the presence of concomitant diabetes.
Epicardial adipose tissue (EAT) is a metabolically active fat depot which modulates coronary arterial function. The measurement of EAT volume and attenuation from non-contrast cardiac computed tomography (CT) provides valuable information on cardiometabolic risk. Pericoronary adipose tissue (PCAT), a subset of EAT which directly surrounds the coronary vessels, may function as a sensor of coronary inflammation. PCAT attenuation on coronary CT angiography associates with coronary plaque morphology, stages of coronary artery disease, and risk of future cardiac events. Quantification of EAT and PCAT has incremental and complementary prognostic value over and above current risk assessment tools. This review covers the biological role of EAT in healthy and dysfunctional states, and CT-based assessment of EAT and PCAT towards the development of clinically meaningful imaging biomarkers.
The role of epicardial and pericoronary adipose tissue in cardiometabolic disease Read More
The mechanisms causing diabetes and heart failure are inextricably linked, as are the prognostic outcomes seen in these two complex disease processes. Treating both conditions together is absolutely vital to bring about the best long-term outcomes for patients. We have strong evidence-based therapies which have been shown to successfully treat both these conditions with improved prognosis and patient outcomes. The more recent development of SGLT2 inhibitors have further enhanced this clear clinical benefit for heart failure and diabetes combined. This is an exciting area of rapidly expanding research and further trials looking at these benefits are underway.
India has become the diabetes capital of the world. Coronary artery disease in diabetes patients are often silent and complex. Incidence of diffuse and multi vessel disease are more predominant in diabetes patients. Triple vessel disease and diffuse disease are common and often bring challenges in selecting treatment option. The incidence of stent thrombosis, in stent restenosis and repeat interventional procedures are more common in diabetes pati ents. Though coronary artery bypass surgery is known to achieve better long -term outcome in triple vessel disease in diabetes patients but coronary interventions with latest generation drug eluting stents are also shown to achieve similar type of outcome. Careful selection of cases with consideration of coronary anatomy and a multidisciplinary approach in treatment of complex coronary disease are the keys of success and better long -term result.
Coronary Revascularization in Diabetes Patients Read More
This article reviews current knowledge concerning cardiovascular disease in subjects with (and without) diabetes mellitus. It discusses the worldwide distribution and dimensions of these disorders. It contrasts incidence, prevalence, investigations, treatment strategies and outcomes of coronary heart disease and myocardial infarction amongst patients with and without diabetes. Emphasis is given to discussing the outcomes of various trials of treatments and management strategies applied to such patients and how closely they apply to the diabetic cohorts who constitute a substantial proportion of most of those trials. The article concludes with a review of specific treatments for elevated glucose which may have prognostic benefits in CVD.
Coronary artery bypass grafting remains the treatment of choice for diabetics with left main stem disease.
Debate- PCI or CABG for diabetics with left main stem disease Read More
An obesity paradox wherein a lower incidence of cardiovascular (CV) morbidity and mortality is seen in overweight/obese patients compared with patients with a ‘normal’ body mass index (BMI) has been reported in patients with type 2 diabetes mellitus (T2DM). We evaluated the relationship between BMI and coronary atherosclerosis in a cohort of subjects with T2DM who were asymptomatic for CV disease using computed tomography coronary angiography. Subjects were followed up for a composite endpoint of all-cause death, non-fatal myocardial infarction or late coronary artery revascularisation. Of the 258 patients enrolled, 226 were eligible for follow-up over a median of 22.8 months. In patients with a normal BMI (<25 kg/m2), 53% had ≥1 significantly stenotic plaque compared with 26% of patients with a BMI >30 kg/m2 at baseline. Subjects with a BMI ≥35 kg/m2 were 82% less likely to present with significant coronary artery plaque at baseline compared with those with a BMI <25 kg/m2 (p=0.01). The risk of a composite CV endpoint event in the overweight/obese group (>25 kg/m2) was approximately 70% lower than in subjects with normal weight. In conclusion, higher BMI may be associated with a lower prevalence of coronary atherosclerosis in patients with T2DM.
It is a great honour to have been asked to write the foreword to the inaugural edition of The International Journal of cardiodiabetes. At such a time with the COVID Pandemic still raging in many parts of the world, one might reasonably ask why at this time we need to have yet another medical journal in addition to the numerous publications that already exist? However, it is precisely the mortality, morbidity, geographical spread, economic effects, social disruption and inequalities which the Pandemic has highlighted that merit an even wider view of the importance of global healthcare. Whilst COVID is a global communicable disease, diabetes mellitus is in many senses a non-communicable equivalent with an ever burgeoning significance.