The essence of the recent association between diabetes and cardiovascular disease

Diabetes and cardiovascular and cerebrovascular diseases are the most common systemic diseases. Studies have confirmed that there is a close relationship between them, such as: diabetes people have almost all cardiovascular disease-related risk factors, such as hyperglycemia, dyslipidemia, high blood pressure and so on.

The essence of the recent association between diabetes and cardiovascular disease

1.JACC: bypass vsPCI--the choice of treatment for patients with cardiovascular disease of type 1 diabetes

For patients with type 1 diabetes (T1D) with multivessel disease, the greater benefit of bypass surgery or percutaneous coronary intervention (PCI) has not been elucidated.

This study included T1D patients who underwent the first multivessel reconstruction surgery in Sweden from 1995 to 2013, and conducted a comprehensive evaluation of the patient's clinical information and prognosis through multiple databases. Finally, a total of 683 patients undergoing bypass surgery and 1863 patients undergoing PCI were enrolled. After an average of 10.6 years of follow-up, 53% of patients in the bypass group and 45% of patients in the PCI group died, with bypass therapy. Compared with the group, all-cause mortality was similar in the PCI group (HR: 1.14; 95% CI: 0.99 - 1.32), and the risk of stroke and heart failure was similar, but coronary heart disease (HR: 1.45; 95% CI: The mortality rates of 1.21 - 1.74), myocardial infarction (HR: 1.47; 95% CI: 1.23 - 1.78) and revascularization (HR: 5.64; 95% CI: 4.67 - 6.82) were significantly higher.


The results of the study suggest that for patients with type 1 diabetes with multivessel disease, PCI has a higher risk of death from coronary heart disease, myocardial infarction, and revascularization, and bypass surgery may be a better treatment. (The article is detailed - JACC: bypass vsPCI - the choice of treatment for patients with cardiovascular disease of type 1 diabetes)

2. J Am Geriatr Soc: Statins rank among the "all-purpose medicines", significantly reducing the mortality rate of the elderly

Statins have the effect of lowering blood lipids. As people's eating habits continue to change, the population of hyperlipidemia has not only increased, but statins have become an inseparable choice for many people. A recent study seems to bring the additional good news to the people who are taking the drug, that is, the use of statins can significantly reduce the mortality rate of elderly men, but also reduce the risk of cardiovascular disease (CVD). This is a recent study published in the Journal of the American Geriatrics Society.

Researchers from the Massachusetts Institute of Technology analyzed data from the Boston Epidemiological Research Information Center, which analyzed a prospective cohort of data from 7213 male doctors with an average age of 70 years without a history of cardiovascular disease. The researchers followed these participants for an average of 7 years, of which 1,130 had the habit of taking statins, and the rest did not.

The researchers found that statins reduced the risk of all-cause mortality by 18% during the study period, including cardiovascular disease, stroke, and deaths from other diseases. For participants with high cholesterol levels, participants who took statins on time had significantly fewer major cardiovascular events than those who did not take regular statins.

The researchers pointed out in the report: "Because of the wide variety of statins, further research is needed to determine which statins work best and which older people are most effective in taking statins." (See article - - J Am Geriatr Soc: Statins rank among the "universal drugs", significantly reducing the mortality rate in the elderly)

3. J Hypertens: Diabetes is more harmful to women

The study examined the cardiovascular outcomes of 30,560 individual patients with the aim of analyzing the interaction between gender and type 2 diabetes.

The study used a proportional hazard regression Cox model to test for this interaction, as well as other important risk factors, by univariate and multivariate analyses. The study data were obtained from seven randomized controlled trials including Coope, EWPHE, MRFIT, SHEP, STOP, SYSTEUR (INDANA database) and DIABHYCAR.

The results showed that women with diabetes had an average risk of sudden death, overall death, and fatal myocardial infarction 85%, 23%, and 24%, respectively, compared with men with diabetes, and the difference was statistically significant. The same trend was observed in cardiovascular death, stroke, and coronary heart disease, but these results were not statistically significant.

The results of this study indicate that men are generally at higher risk for women than non-diabetic individuals; however, for diabetic individuals, women have a worse cardiovascular outcome. (See article - J Hypertens: Diabetes is more harmful to women)

4. Lancet diabetes endo: The effect of PCSK9 inhibitor Eevolocumab on the risk of cardiovascular accidents in patients with atherosclerosis complicated with diabetes

The FOURIER trial found that the proprotein convertase subtilisin 9 (PCSK9) inhibitor Eevolocumab reduces the risk of low-density cholesterol (LDL) levels and cardiovascular accidents. The researchers are now investigating the efficacy and safety of Eevolocumab in diabetes and its impact on blood sugar and diabetes risk.

FOURIER was a randomized controlled trial of Eevolocumab in 27,564 atherosclerotic patients undergoing statin therapy with a median follow-up of 2.2 years. Through judgment and analysis, the researchers reviewed or initiated HbA1c≥6.5% (48mmol/mol) or fasting blood glucose (FPG)≥7.0mmol/L according to the initial blood glucose status, past medical history, medical history. The primary node is a combination of cardiovascular death, myocardial infarction, stroke, hospitalized variant angina, or coronary revascularization. Secondary nodes are a combination of cardiovascular death, myocardial infarction, or stroke. The researchers evaluated the effects of Eevolocumab on blood glucose in patients without diabetes at the start and the risk of new-onset diabetes. Detection of HbA1c: onset, once every 24 weeks; detection of FPG: onset, 12 weeks, 24 weeks, followed by every 24 weeks. At the same time, the researchers evaluated the effects of Eevolocumab on blood glucose and the risk of developing diabetes in pre-diabetes patients.

At the start of the study, 11031 (40%) patients had diabetes, and 16533 (60%) patients did not have diabetes (10344 were in pre-diabetes and 6189 were normal). Eevolocumab significantly reduces the incidence of cardiovascular accidents in patients, regardless of whether they have diabetes at the start. For the primary outcome, the hazard ratios (HRs) for patients with or without diabetes were 0.83 (95% CI 0.75-0.93; p=0.0008) and 0.87 (0.79-0.96; p=0.0052), respectively. For the secondary nodes, HRs were 0.82 (0.72-0.93; p=0.0021), 0.78 (0.69-0.89; p=0.0002), respectively.

Eevolocumab does not affect the risk of new-onset diabetes (HRs in patients with normal blood glucose and those with pre-diabetes are 1.05 [0.94-1.17], 1.00 [0.89-1.13], respectively). There was no difference in the levels of HbA1c and FPG between the Eevolocumab and placebo groups (with diabetes, normal blood glucose, pre-diabetes).

The probability of side effects of Eevolocumab and placebo combined with diabetes was 78.5% (4327/5513) and 78.3% (4307/5502), respectively. The probability of side effects in patients with normal blood glucose was 76.8% (6337/8256). ), 76.8% (6337/8254). Eevolocumab significantly reduces the risk of cardiovascular accidents in patients with atherosclerosis, with or without diabetes. Moreover, Eevolocumab does not affect blood sugar and does not increase the risk of diabetes. (See article - Lancet diabetes endo: The effect of PCSK9 inhibitor Eevolocumab on the risk of cardiovascular accidents in patients with atherosclerosis with diabetes)