OBJECTIVETo analyse the impact of sirolimus-eluting stents (SES) on long-term outcomes in patients with coronary artery disease (CAD) and diabetes.

METHODSAmong 1004 patients with CAD undergone percutaneous coronary intervention (PCI), 84 diabetic and 250 non-diabetic patients received SES, 168 diabetic and 502 non-diabetic patients had bare metal stent (BMS) implantation. Baseline clinical characteristics, interventional procedures (coronary angiography and PCI), occurrence of major adverse cardiac events (MACE), and MACE-free survival rates at one year during follow-up were compared.

RESULTSDuring follow-up (average 16.2 months), patients (with and without diabetes mellitus) who received SES had similar occurrence of MACE (4.8% vs. 3.6%, P = 0.744) and MACE-free survival rates at one year (95.0% vs. 96.7%, P = 0.602). However those received BMS had a higher occurrence of MACE in diabetes mellitus than that in non-diabetic patients (31.0% vs. 21.7%, P = 0.015). MACE-free survival rate at one year was lower in diabetic patients with BMS than that in non-diabetic patients with BMS (74.2% vs. 86.8%, P = 0.001).

CONCLUSIONImplantation of sirolimus-eluting stents may reduce the major adverse cardiac events and the frequency of repeat intervention in patients with diabetes mellitus.

Coronary Disease ; therapy ; Diabetic Angiopathies ; therapy ; Female ; Humans ; Male ; Retrospective Studies ; Sirolimus ; administration & dosage ; Stents

Latest guidelines on lipid management recommend statins as the first-line therapy. Because limited evidence is available on cardiovascular outcomes with varying statin-nonstatin combinations, recommendation levels for these regimens have been weak. However, a recent trial has demonstrated the additive effect of the statin-ezetimibe combination. The statin-fibrate combination has shown an effect in certain subgroups and on diabetic microangiopathy. Recent trials using the statin-niacin combination have been largely negative, whereas the statin-omega-3 fatty acids combination demonstrated a positive effect only in one study. Identifying the benefits and limitations of each combination is important for the best possible management of patients.
Diabetic Angiopathies ; Drug Therapy* ; Ezetimibe ; Fatty Acids ; Fibric Acids ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Niacin

Blood Circulation ; drug effects ; physiology ; Diabetic Angiopathies ; therapy ; Drugs, Chinese Herbal ; Humans ; Medicine, Chinese Traditional

Diabetes Mellitus ; drug therapy ; Diabetic Angiopathies ; drug therapy ; Diagnosis, Differential ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Hypoglycemic Agents ; therapeutic use ; Medicine, Chinese Traditional ; Phytotherapy

This study was designed to assess the relative merits of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD), particularly for Korean diabetics. Among 3,279 patients with MVCAD who were recommended for revascularization were enrolled from nine centers in Korea, 2,154 were selected after statistical adjustments for the disparities between two groups. Survival rates were not significantly different for three years between two groups. Among diabetic patients, the three-year mortality rate in PCI group was 1.9-fold higher than that of CABG group, although it was not statistically significant (PCI 19.8%, CABG 11.4%, p=0.14). The three-year mortality rate was similar between the two groups in non-diabetics (PCI 8.3%, CABG 10.0%, p=0.50). The 30-day rate of cerebrovascular event was higher in CABG group, for both diabetic (CABG 3.6%, PCI 0.0%, p<0.001) and non-diabetic patients (CABG 2.4%, PCI 0.0%, p<0.001). Short- and long-term revascularization rates were higher in PCI group than in CABG group. As a conclusion, this Korean registry demonstrates that PCI was associated with comparable survival rates and lower short-term morbidity, but a greater requirement for repeated revascularization compared with CABG in Korean diabetics.
*Angioplasty, Transluminal, Percutaneous Coronary ; Comparative Study ; *Coronary Artery Bypass ; Coronary Disease/*therapy ; Diabetic Angiopathies/*therapy ; Humans ; *Registries ; Research Support, Non-U.S. Gov't ; Retrospective Studies ; Stents

This study explored the prescription and medication rules of traditional Chinese medicine(TCM) in the prevention and treatment of diabetic microangiopathy based on literature mining. Relevant literature on TCM against diabetic microangiopathy was searched and prescriptions were collected. Microsoft Excel 2021 software was used to establish a prescription database, and an analysis was conducted on the frequency, properties, flavors, meridian tropism, and efficacy classifications of drugs. Association rule analysis, cluster analysis, and factor analysis were performed using SPSS Modeler 18.0 and SPSS Statistics 26.0 software. The characteristic active components and mechanisms of action of medium-high frequency drugs in the analysis of medication rules were explored through li-terature mining. A total of 1 327 prescriptions were included in this study, involving 411 drugs, with a total frequency reaching 19 154 times. The top five high-frequency drugs were Astragali Radix, Angelicae Sinensis Radix, Poria, Salviae Miltiorrhizae Radix et Rhizoma, and Rehmanniae Radix. The cold and warm drugs were used in combination. Drugs were mainly sweet, followed by bitter and pungent, and acted on the liver meridian. The majority of drugs were effective in tonifying deficiency, clearing heat, activating blood, and resolving stasis. Association rule analysis identified the highly supported drug pair of Astragali Radix-Angelicae Sinensis Radix and the highly confident drug combination of Poria-Alismatis Rhizoma-Corni Fructus. The strongest correlation was found among Astragali Radix, Angelicae Sinensis Radix, Poria, and Salviae Miltiorrhizae Radix et Rhizoma through the complex network analysis. Cluster analysis identified nine categories of drug combinations, while factor analysis identified 16 common factors. The analysis of active components in high-frequency drugs for the treatment of diabetic microangiopathy revealed that these effective components mainly exerted their effects by inhibiting oxidative stress and suppressing inflammatory reactions. The study found that the pathogenesis of diabetic microangiopathy was primarily characterized by deficiency in origin, with a combination of deficiency and excess. Deficiency was manifested as Qi deficiency and blood deficiency, while excess as phlegm-heat and blood stasis. The key organ involved in the pathological changes was the liver. The treatment mainly focused on supplementing Qi and nourishing blood, supplemented by clearing heat, coo-ling blood, activating blood, and dredging collaterals. Commonly used formulas included Danggui Buxue Decoction, Liuwei Dihuang Pills, Erzhi Pills, and Buyang Huanwu Decoction. The mechanisms of action of high-frequency drugs in the treatment of diabetic microangiopathy were often related to the inhibition of oxidative stress and suppression of inflammatory reactions. These findings can provide references for the clinical treatment of diabetic microangiopathy and the development of targeted drugs.
Humans ; Medicine, Chinese Traditional ; Drugs, Chinese Herbal/therapeutic use* ; Prescriptions ; Drug Combinations ; Diabetic Angiopathies/drug therapy* ; Data Mining ; Diabetes Mellitus/drug therapy*

BACKGROUNDThere is no agreement as to whether intensive glucose control in type 2 diabetes can reduce the incidence of macrovascular events in these patients. We performed a meta-analysis comparing intensive glucose control or conventional glucose control in randomized controlled trials.

METHODSDatabases including MEDLINE, EMBASE, and Cochrane controlled trials register, the Cochrane Library, and Science Citation Index were searched to find relevant trials. Outcome measures were the incidence of major macrovascular events.

RESULTSSix trials involving 28 065 patients were included. Analysis suggested that there was an obviously decreased incidence of major macrovascular events in patients having intensive glucose treatment vs. controls (RR 0.92; 95%CI 0.87, 0.98; P = 0.005). However, intensive glycemia control strategies in type 2 diabetes showed no significant impact on the incidence of death from any cause compared with conventional glycemia control strategies, intensive 14.7%, controls 12.0% (RR 0.95; 95%CI 0.80, 1.12; P = 0.55), as well as on the incidence of cardiovascular death, intensive 3.7%, controls 3.6% (RR 1.10, 95%CI 0.79, 1.53; P = 0.57).

CONCLUSIONSControl of glycemia to normal (or near normal levels) in type 2 diabetes appears to be effective in reducing the incidence of major macrovascular events, but there were no significant differences of either the mortality from any cause or from cardiovascular death between the two glycemia-control strategies.

Blood Glucose ; analysis ; Diabetes Mellitus, Type 2 ; blood ; complications ; drug therapy ; mortality ; Diabetic Angiopathies ; prevention & control ; Glycated Hemoglobin A ; analysis ; Humans ; Randomized Controlled Trials as Topic

BACKGROUNDDiabetic macrovascular complications are important causes of cardiovascular and cerebrovascular diseases and also one of the major causes of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Phlorizin has been reported to be effective in reducing the blood glucose level in diabetic mellitus, while little is known about its effects on vascular complications. This study aimed to observe the effects of phlorizin on the aorta of diabetes db/db mice and explore its mechanism.

METHODSDiabetic db/db mice (n = 16) and age-matched db/m mice (n = 8) were divided into three groups: normal control group (CC group, db/m mice, n = 8), untreated diabetic group (DM group, db/db mice, n = 8) and diabetic group treated by phlorizin (DMT group, db/db mice, n = 8). Phlorizin (20 mg/kg body weight) was given in normal saline solution intragastrically for 10 weeks. Animals were weighed weekly. At the 10th weekend, all mice were fasted overnight and then sacrificed. Fasting blood was collected, and the aortas were dissected. The blood samples were analyzed for fasting blood glucose (FBG), serum advanced glycation end products (AGEs), malondialdehyde (MDA) and superoxide dismutase (SOD) activity, the aortic ultrastructure was studied.

RESULTSThe weight and serum concentration of FBG, AGEs, and MDA in the DM group were higher than that in the CC group (P < 0.01), and they were significantly lower in the DMT group (P < 0.05). Serum SOD activity was lower than that in the CC group (P < 0.01), and it is significantly higher in the DMT group (P < 0.05). The severity of aorta damage in the DMT group was less than that in the DM group.

CONCLUSIONSPhlorizin protected the db/db mice from diabetic macrovascular complications, attributed to the decreasing of blood glucose and AGEs level, and its antioxidant potential. This study may provide a new natural medicine for treating diabetic macrovascular complications.

Animals ; Aorta, Thoracic ; pathology ; Blood Glucose ; analysis ; Diabetic Angiopathies ; drug therapy ; pathology ; Glycation End Products, Advanced ; metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Phlorhizin ; therapeutic use ; Superoxide Dismutase ; metabolism

Aldehyde Reductase ; physiology ; Cytokines ; biosynthesis ; Diabetic Angiopathies ; etiology ; therapy ; Glycation End Products, Advanced ; physiology ; Humans ; Oxidative Stress ; Protein Kinase C ; physiology

OBJECTIVEAs an endogenous antioxidant, taurine could retard the development of diabetic cardiovascular complications. Whereas, whether TAU has a protective effect on diabetic vascular endothelium in young patients is still unclear. This study aimed to investigate the protective effect of taurine on early vascular endothelial dysfunction and its possible mechanism by detecting the changes of oxLDL/LOX-1 system in young STZ-induced diabetic rats. Doing so, the authors expect to find an effective approach in clinical practice to the prevention and treatment of diabetic vascular complication.

METHODSix-week-old rats were divided randomly into normal control (CN group, n=8), diabetes mellitus group (DM group, n=8) and taurine supplement group (DM+TAU group, n=8). Diabetes was induced in the rats by intraperitoneal injection of streptozotocin (STZ, 60 mg/kg) and after the onset of diabetes, the rats in DM+TAU group were given free access to drinking water containing 1% taurine. At the end of 4 weeks, blood glucose, serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL), oxidized low density lipoprotein (oxLDL) and sICAM-1 levels were determined, meanwhile LOX-1 and ICAM-1 expression on abdominal aortas were examined by immunostaining, Western blotting and reverse transcription PCR, respectively. The results were quantified by densitometry.

RESULTCompared to normal control, in STZ-induced diabetic rats, the levels of serum TC, TG, LDL, oxLDL and sICAM-1 were all increased (P<0.01 for all), meanwhile LOX-1 and ICAM-1 expression (protein and mRNA) in the endothelium layers of abdominal aortas were also markedly enhanced (P<0.01 for all); while in taurine supplemented rats, the levels of serum TG (0.64+/-0.12 vs. 0.97+/-0.18), TC (0.82+/-0.18 vs. 1.01+/-0.23), oxLDL (3.1+/-0.6 vs. 4.2+/-0.6), sICAM-1 (108.3+/-18.0 vs. 130.7+/-17.4), expression of LOX-1 and ICAM-1 protein (1.02+/-0.19 vs. 2.60+/-0.33, 1.21+/-0.22 vs. 2.98+/-0.31) as well as mRNA (0.45+/-0.09 vs. 0.96+/-0.15, 0.50+/-0.07 vs. 0.87+/-0.16) were all markedly lower than those of untreated diabetic rats (P<0.05 for all). Also, the level of LOX-1 protein expression was positively correlated with levels of serum oxLDL (r=0.922, P=0.001), sICAM-1 (r=0.753, P=0.031) and ICAM-1 expression on abdominal aorta (r=0.849, P=0.008).

CONCLUSIONVascular endothelial dysfunction was present in early stage of young diabetic rats and taurine supplement could protect against this early endothelial dysfunction by its antioxidation to inhibit the role of oxLDL/LOX-1 system in young rats with diabetes mellitus.

Animals ; Diabetes Mellitus, Experimental ; drug therapy ; metabolism ; Diabetic Angiopathies ; prevention & control ; Endothelium, Vascular ; metabolism ; Male ; Oxidative Stress ; Rats ; Rats, Wistar ; Taurine ; therapeutic use