Tag Archives: heart

Two-Step Screening Uncovers Heart Failure Risk in Diabetes

Diabetes News


TOPLINE:

A two-step screening, using a risk score and biomarkers, can identify patients with diabetes at a higher risk for heart failure who will most likely benefit from preventive drugs.

METHODOLOGY:

  • Researchers compared screening methods and downstream risk for heart failure in 5 years, particularly those without atherosclerotic cardiovascular disease (ASCVD).
  • They pooled data from 4889 patients (age ≥ 40 years, about half women) with diabetes, no heart failure at baseline, and no signs of ASCVD. All patients had undergone screening to determine their heart failure risk level.
  • Researchers assessed the heart failure risk for patients without ASCVD with one-step screening strategies:
  • They next assessed a sequential two-step strategy, using the second test only for those deemed low risk by the first, with a combination of two tests (WATCH-DM/NT-proBNP, NT-proBNP/hs-cTn, or NT-proBNP/echocardiography), the second used for those deemed low-risk by the first test.
  • The primary outcome was incident heart failure during the 5-year follow-up. The researchers also assessed the cost-effectiveness of screening and subsequent treatment of high-risk patients with a sodium-glucose cotransporter 2 inhibitor.

TAKEAWAY:

  • Overall, 301 (6.2%) heart failure events occurred among participants without ASCVD.
  • Of the heart failure events, 53%-71% occurred among participants deemed high risk by a one-step screening strategy, but 75%-89% occurred among patients assessed as high risk in two steps.
  • The risk for incident heart failure was 3.0- to 3.6-fold higher in the high- vs low-risk group identified using a two-step screening approach.
  • Among the two-step strategies, the WATCH-DM score first, followed by selective NT-proBNP testing for patients deemed low risk by the first test, was the most efficient, with the fewest tests and lowest screening cost.

IN PRACTICE:

“Matching effective but expensive preventive therapies to the highest-risk individuals who are most likely to benefit would be an efficient and cost-effective strategy for heart failure prevention,” the authors wrote.

SOURCE:

The study led by Kershaw Patel of the Houston Methodist Academic Institute, Houston, Texas, was published online in Circulation.

LIMITATIONS:

The study findings may not be generalized, as the study included older adults with a high burden of comorbidities. This study may have missed some individuals with diabetes by defining it with fasting plasma glucose, which was consistently available across cohort studies, instead of with the limited A1c data. Moreover, the screening strategies used did not consider other important prognostic factors, such as diabetes duration and socioeconomic status.

DISCLOSURES:

Two authors declared receiving research support from the National Heart, Lung, and Blood Institute. Several authors disclosed financial relationships with multiple pharmaceutical device and medical publishing companies in the form of receiving personal fees; serving in various capacities such as consultants, members of advisory boards, steering committees, or executive committees; and other ties.



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Len Rome’s Local Health: Diabetes drugs can reduce heart issues

Diabetes News


(WYTV)- A drug we use to treat diabetes could soon have another use.

Researchers at the Cleveland Clinic found it may also be able to help reduce the risk of heart trouble in those who are not diabetic.


Could patients who are overweight or obese who don’t have diabetes find a benefit in this drug called semaglutide? Yes.

We know it worked in those with diabetes, able to reduce the risk for cardiovascular events by about 20%. The results are promising and could pave the way for future treatments.

“So, this marks the first intervention, either a lifestyle or a pharmacologic intervention, that’s ever been shown to reduce the risk of cardiovascular events in patients who are overweight and obese but don’t have diabetes,” said Dr. Michael Lincoff of the Cleveland Clinic.

The diabetic drug seems to work best in adults who are 45 and older, considered overweight or obese, not diabetic, and who have previously had a cardiovascular event.

The drug is available now but the Food and Drug Administration still has to review it for this extra use.



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Diabetes complications worsen prognosis for colorectal cancer patients

Diabetes News


Complications of diabetes can have numerous negative health effects, from impaired vision and nerve damage to kidney dysfunction and heart disease. In an analysis of information on adults with colorectal cancer, patients who also had diabetes—particularly those with diabetic complications—faced a higher risk of dying early. The results are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

For the study, Kuo‐Liong Chien, MD, PhD, of National Taiwan University, and his colleagues examined data registered between 2007 and 2015 in the Taiwan Cancer Registry Database, which is linked to health insurance and death records. Their analysis included 59,202 individuals with stage I–III colorectal cancer who underwent potentially curative surgery to remove their tumors. Among these patients, 9,448 experienced a cancer recurrence and 21,031 died from any cause during the study period.

Compared with individuals without diabetes, those with uncomplicated diabetes were at a minimally or insignificantly higher risk of all‐cause and cancer‐specific death, whereas those with complicated diabetes had 85% higher odds of death from any cause and 41% higher odds of death from cancer. These associations were more pronounced in women and in patients with early‐stage colorectal cancer.

Also, compared to patients without diabetes, patients with uncomplicated or complicated diabetes had a 10–11% higher risk of colorectal cancer recurrence.

The mechanisms behind the relationship between diabetic severity and poor colorectal cancer prognosis could involve various pathways and responses triggered by high insulin and glucose levels in the blood, as well as elevated inflammatory states, which are characteristic of type 2 diabetes.

While a higher diabetes prevalence was noted in patients with colorectal cancer, the study suggests that coordinated medical care involving multiple specialists can help prevent diabetes complications, potentially improving long-term colorectal cancer oncological outcomes, particularly in women and patients with early-stage cancer.”

Kuo‐Liong Chien, MD, PhD, National Taiwan University

Source:

Journal reference:

Hsu, H. Y., et al. (2023) Diabetic severity and oncological outcomes of colorectal cancer following curative resection: A population-based cohort study in Taiwan diabetes and colorectal cancer prognosis. Cancer. doi.org/10.1002/cncr.34975.



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