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Dietary fat intake and coronary heart disease events in subjects with type 2 diabetes
$302
Poster Session 2
dietary fat (low P/S-ratio in men, low intake of monounsaturated fat in women) predicted future CHD events in type 2 diabetic subjects at least partly independently of traditional CHD risk factors.
P1222 Relationship between Intimai-Medial Thickness of Carotid Artery and Plasma Levels of Vascular Endothelial Growth Factor or Platelet-Derived Growth Factor in Type 2 Diabetic Patients T. INUKAI, K. Takebayashi, K. Tayama, Y. Aso, Y. Takemura.
Department of Medicine, Koshigaya Hospital, Dokkyo University School of Medicine, Koshigaya, Japan The intimal-medial thickness (IMT) of carotid artery determined by a cervical ultrasonography is a non-invasive useful hallmark for reflecting the extent of atherosclerosis. Vascular endothelial growth factor (VEGF) or platelet-derived growth factor (PDGF) is known as one of angiogenic growth factors for newly synthesized vessels. We investigated the relationship between IMT and plasma levels of these growth factors in diabetic patients. Studies were conducted with 27 type 2 diabetic patients (14 males and 13 females) and 12 age-matched healthy controls. The IMT was expressed as maximum IMT (Max-IMT) and average IMT (Ave-IMT) of the right carotid artery measured in the two directions by ultrasonography. Both Max-IMT and Ave-IMT were significantly increased in diabetic patients compared with healthy subjects (P<0.01). Ave-IMT exhibited a good positive correaltion with Max-IMT (P<0.001). Both Max-IMT and Ave-IMT showed significant negative correaltions with serum levels of VEGF and PDGE Body mass index and serum levels of LDL-C significantly positively correalted with Ave-IMT, however fasting plasma glucose, HbAlc and serum triglyceride levels did not correlate with IMTs. Diabetic patients with hypertension or ischemic heart disease revealed significantly elevated Ave-IMT and Max-IMT compared with patients without those diseases. No significant relationships were shown between IMTs and the degree of nephropathy and retinopathy, whereas the severity of retinopathy and/or nephropathy tended to increase plasma levels of VEGF and PDGE Conclusions: Diabetic patients showed markedly increased 1MTs of carotid artery compared with healthy subjects, and an increase in IMTs in diabetes may be involved in reduced plasma levels of angiogenic growth factors such as VEGF and PDGE
P1223 Predictors of 10-Year Mortality in Patients with Type 2 Diabetes Mellitns MAR.I-ANNE GALL 1,2, Elisabeth Knudsen 1, Philip Hougaard 2, Knut Borch-Johnsen 1, Hans-Henrik Parving I. ! Steno Diabetes Center, Gentofte; 2 Novo Nordisk A/S, Bagsvaerd, Denmark Aim: To evaluate the impact of micro- and macroalbuminuria and other putative risk factors for mortality in subjects with Type 2 diabetes. Design: Prospective, observational study of a cohort of European subjects with Type 2 diabetes mellitus followed for a median of 10.4 (range 0.1-11.0) years. Main outcome measures: Death. Subjects: 549 (296 M/253 F) Type 2 diabetic subjects with a mean age at entry of 59 4- 11 (SD) years. 323 subjects had normoalbuminuria (urinary albumin excretion rate (UAE) <30 mg/24 h), 151 subjects had microalbuminuria (UAE 30-299 mg/24 h), and 75 subjects macroalbuminuria (UAE >300 mg/24 h) at baseline. Results: During the follow-up period 34% (111/323) of patients with normoalbuminuria, 59% (89/151) with microalbuminuria, and 69% (52/75) with macroalbuminuria had died, p <0.001 (normoalbuminuria vs microand macroalbuminuria) and p = 0.05 (microalbuminuria vs macroalbuminutia). One hundred and thirty two patients died from cardiovascular disease (CVD), 18 from uraemia, 24 from cancer, 19 from infections, and 59 from other or unknown causes. CVD mortality rate per 100
person-years of observation was 1.8, 4.6, and 5.1 in patients with normo-, micro-, and macroalbuminuria, respectively, p <0.001 (normoalbuminuria vs micro- and macroalbuminuria) and p = NS (microalbuminuria vs macroalbuminuria). Multivariate Cox proportional hazards model, after stepwise exclusion, revealed the following predictors of death from all causes and CVD: Baselinevariable
Sex (male) Age (1 year) Serum cholesterol(1 mmol/1) Serumcreatinine(10/zmol/l Serum yon Willebrandfactor (1 U/ml) Pre-existingcoronaryheart disease(0=no, 1=yes) Microalbuminuria(0=no, l=yes) Macroalbuminuria(0=-no,l=yes)
Mortality(relativerisk (95%CI). p -value All-cause(N=252)
CVD (N=132)
1.42 ( 1.07-1.90), < 0.02 1.08 (1.06-1.10), <0.001 1.16 (1.07-1.25), <0.001 1.04 (1.02-1.07), <0.001 1.19 (1.03-1.37), <0.02
1.76 (1.19-2.59), <0.01 1.09 (1.06-1.11), <0.001 1.24 (1.14-1.35), <0.001
2.16 (1.65-2.82), <0.001
3.08 (2.14-4.41), <0.001
1.80 (1.35-2.40), <0,001 2.22 (1.53-3.23), <0.001
2.75 (1.87-4.05), <0.001 2.78 (1.70-4.56), <0.001
Condnsion: Abnormally elevated urinary albumin excretion rate and elevated serum cholesterol level, both potentially modifiable risk factors, indicate a substantially increased all-cause, mainly CVD, mortality risk in subjects with Type 2 diabetes mellitus.
P1224 Asymmetry of Common Carotid Artery Velocity Is a Marker for Cardiovascular Disease in Type 2 Diabetic Patients H. NAKANO, K. Okazaki, T. Suzuki, K. Oba. Nippon Medical School,
Tokyo, Japan The aim of this study is to clarify the clinical usefulness of the high to low velocity ratio between the two carotids (velocity ratio), measured by ultrasonic quantitative flow measurement system in type 2 diabetic patients. We studied 138 type 2 diabetes outpatient (84 males and 54 females), aged 30 to 87 years (average 65.1 4- 10.8 years). Carotid blood velocity was measured using QFM-1100 ultrasonic blood flow meter. We divided the subjects into two groups depending on the velocity ratio; high (H) group (> 1.4; n=50) and low (L) group (< 1.3; n=88). The end point of the study was the occurrence of angina pectoris, nonfatal myocardial infarction, or death from coronary heart disease. The average follow-up period was 3. l -4- 1.3 years. The mean age and systolic blood were significantly higher in H group than L group. The incidence of the ischemic heart disease (IHD; myocardial infarction or angina pectoris) was significantly higher in H group than L group (17.0 vs 34.0%; P=0.04). Other clinical characteristics of the subjects were not found significant difference between two groups. On multiple logistic analyses, age (OR=l.1; p<0.01) and H-group (OR=2.3: p=0.07) were significant predictors for IHD. There were 1 angina pectoris, 6 nonfatal myocardial infarction, and 5 deaths from coronary heart disease during follow-up period. The risk of the end point of defined events was significantly higher in H group than G group (20.0 vs 2.3%; p<0.001 by log-rank test). Uric Acid (RR=I.6; p=0.02) and H-group (RR=l 1.5: p
Poster Session 2
dietary fat (low P/S-ratio in men, low intake of monounsaturated fat in women) predicted future CHD events in type 2 diabetic subjects at least partly independently of traditional CHD risk factors.
P1222 Relationship between Intimai-Medial Thickness of Carotid Artery and Plasma Levels of Vascular Endothelial Growth Factor or Platelet-Derived Growth Factor in Type 2 Diabetic Patients T. INUKAI, K. Takebayashi, K. Tayama, Y. Aso, Y. Takemura.
Department of Medicine, Koshigaya Hospital, Dokkyo University School of Medicine, Koshigaya, Japan The intimal-medial thickness (IMT) of carotid artery determined by a cervical ultrasonography is a non-invasive useful hallmark for reflecting the extent of atherosclerosis. Vascular endothelial growth factor (VEGF) or platelet-derived growth factor (PDGF) is known as one of angiogenic growth factors for newly synthesized vessels. We investigated the relationship between IMT and plasma levels of these growth factors in diabetic patients. Studies were conducted with 27 type 2 diabetic patients (14 males and 13 females) and 12 age-matched healthy controls. The IMT was expressed as maximum IMT (Max-IMT) and average IMT (Ave-IMT) of the right carotid artery measured in the two directions by ultrasonography. Both Max-IMT and Ave-IMT were significantly increased in diabetic patients compared with healthy subjects (P<0.01). Ave-IMT exhibited a good positive correaltion with Max-IMT (P<0.001). Both Max-IMT and Ave-IMT showed significant negative correaltions with serum levels of VEGF and PDGE Body mass index and serum levels of LDL-C significantly positively correalted with Ave-IMT, however fasting plasma glucose, HbAlc and serum triglyceride levels did not correlate with IMTs. Diabetic patients with hypertension or ischemic heart disease revealed significantly elevated Ave-IMT and Max-IMT compared with patients without those diseases. No significant relationships were shown between IMTs and the degree of nephropathy and retinopathy, whereas the severity of retinopathy and/or nephropathy tended to increase plasma levels of VEGF and PDGE Conclusions: Diabetic patients showed markedly increased 1MTs of carotid artery compared with healthy subjects, and an increase in IMTs in diabetes may be involved in reduced plasma levels of angiogenic growth factors such as VEGF and PDGE
P1223 Predictors of 10-Year Mortality in Patients with Type 2 Diabetes Mellitns MAR.I-ANNE GALL 1,2, Elisabeth Knudsen 1, Philip Hougaard 2, Knut Borch-Johnsen 1, Hans-Henrik Parving I. ! Steno Diabetes Center, Gentofte; 2 Novo Nordisk A/S, Bagsvaerd, Denmark Aim: To evaluate the impact of micro- and macroalbuminuria and other putative risk factors for mortality in subjects with Type 2 diabetes. Design: Prospective, observational study of a cohort of European subjects with Type 2 diabetes mellitus followed for a median of 10.4 (range 0.1-11.0) years. Main outcome measures: Death. Subjects: 549 (296 M/253 F) Type 2 diabetic subjects with a mean age at entry of 59 4- 11 (SD) years. 323 subjects had normoalbuminuria (urinary albumin excretion rate (UAE) <30 mg/24 h), 151 subjects had microalbuminuria (UAE 30-299 mg/24 h), and 75 subjects macroalbuminuria (UAE >300 mg/24 h) at baseline. Results: During the follow-up period 34% (111/323) of patients with normoalbuminuria, 59% (89/151) with microalbuminuria, and 69% (52/75) with macroalbuminuria had died, p <0.001 (normoalbuminuria vs microand macroalbuminuria) and p = 0.05 (microalbuminuria vs macroalbuminutia). One hundred and thirty two patients died from cardiovascular disease (CVD), 18 from uraemia, 24 from cancer, 19 from infections, and 59 from other or unknown causes. CVD mortality rate per 100
person-years of observation was 1.8, 4.6, and 5.1 in patients with normo-, micro-, and macroalbuminuria, respectively, p <0.001 (normoalbuminuria vs micro- and macroalbuminuria) and p = NS (microalbuminuria vs macroalbuminuria). Multivariate Cox proportional hazards model, after stepwise exclusion, revealed the following predictors of death from all causes and CVD: Baselinevariable
Sex (male) Age (1 year) Serum cholesterol(1 mmol/1) Serumcreatinine(10/zmol/l Serum yon Willebrandfactor (1 U/ml) Pre-existingcoronaryheart disease(0=no, 1=yes) Microalbuminuria(0=no, l=yes) Macroalbuminuria(0=-no,l=yes)
Mortality(relativerisk (95%CI). p -value All-cause(N=252)
CVD (N=132)
1.42 ( 1.07-1.90), < 0.02 1.08 (1.06-1.10), <0.001 1.16 (1.07-1.25), <0.001 1.04 (1.02-1.07), <0.001 1.19 (1.03-1.37), <0.02
1.76 (1.19-2.59), <0.01 1.09 (1.06-1.11), <0.001 1.24 (1.14-1.35), <0.001
2.16 (1.65-2.82), <0.001
3.08 (2.14-4.41), <0.001
1.80 (1.35-2.40), <0,001 2.22 (1.53-3.23), <0.001
2.75 (1.87-4.05), <0.001 2.78 (1.70-4.56), <0.001
Condnsion: Abnormally elevated urinary albumin excretion rate and elevated serum cholesterol level, both potentially modifiable risk factors, indicate a substantially increased all-cause, mainly CVD, mortality risk in subjects with Type 2 diabetes mellitus.
P1224 Asymmetry of Common Carotid Artery Velocity Is a Marker for Cardiovascular Disease in Type 2 Diabetic Patients H. NAKANO, K. Okazaki, T. Suzuki, K. Oba. Nippon Medical School,
Tokyo, Japan The aim of this study is to clarify the clinical usefulness of the high to low velocity ratio between the two carotids (velocity ratio), measured by ultrasonic quantitative flow measurement system in type 2 diabetic patients. We studied 138 type 2 diabetes outpatient (84 males and 54 females), aged 30 to 87 years (average 65.1 4- 10.8 years). Carotid blood velocity was measured using QFM-1100 ultrasonic blood flow meter. We divided the subjects into two groups depending on the velocity ratio; high (H) group (> 1.4; n=50) and low (L) group (< 1.3; n=88). The end point of the study was the occurrence of angina pectoris, nonfatal myocardial infarction, or death from coronary heart disease. The average follow-up period was 3. l -4- 1.3 years. The mean age and systolic blood were significantly higher in H group than L group. The incidence of the ischemic heart disease (IHD; myocardial infarction or angina pectoris) was significantly higher in H group than L group (17.0 vs 34.0%; P=0.04). Other clinical characteristics of the subjects were not found significant difference between two groups. On multiple logistic analyses, age (OR=l.1; p<0.01) and H-group (OR=2.3: p=0.07) were significant predictors for IHD. There were 1 angina pectoris, 6 nonfatal myocardial infarction, and 5 deaths from coronary heart disease during follow-up period. The risk of the end point of defined events was significantly higher in H group than G group (20.0 vs 2.3%; p<0.001 by log-rank test). Uric Acid (RR=I.6; p=0.02) and H-group (RR=l 1.5: p