Edic.

38 Junio 2011

ndice
1. Revista Espaola de Cardiologa______________________ 2
2. Medicina Clnica ___________________________________ 3
3. European Heart Journal_____________________________ 5
4. Hipertensin revista de la SEH LELHA __________________ 6
5. Hypertension _____________________________________ 6
6. Journal of Hypertension ___________________________ 10
7. British Medica Journal (BMJ) _______________________ 16
8. American Journal of Hypertension ___________________ 16
9. Diabetes Care ____________________________________ 18
10. Diabetes ________________________________________ 26
11. The Lancet ______________________________________ 29
12. JAMA __________________________________________ 29
13. The New England Journal of Medicine ________________ 29
14. Annals of Internal Medicine ________________________ 29

Edic. 38 Junio 2011

1. Revista Espaola de Cardiologa

Qu medida del grosor ntima-media carotdeo caracteriza mejor la carga aterosclertica del paciente
hipertenso: valor mximo o medio?
Pages 417-420
Irene Mateo, Pedro Morillas, Juan Quiles, Jess Castillo, Helder Andrade, Julin Roldn, Pilar Agudo, Vicente
Bertomeu-Martnez
Revista Espaola de Cardiologa Volume 64, Issue 5, May 2011, Pages 417-420
Resumen
El aumento del grosor ntima-media carotdeo (GIMc) es un marcador de lesin de rgano diana establecido en las
guas de hipertensin arterial, si bien no especifica si debemos utilizar el GIMc mximo o medio. Nuestro objetivo
es comparar ambas medidas y su relacin con la carga aterosclertica. Hemos analizado consecutivamente a 215
pacientes hipertensos que han sido clasificados en tres grupos: GIMc mximo > 0,9 mm (GIMc medio < 0,9 mm),
GIMc medio > 0,9 mm (GIMc medio y mximo > 0,9 mm) y grupo GIMc normal. Los pacientes con GIMc patolgico
(mximo o medio) presentaban mayor prevalencia de dislipemia, mayor edad, mayor tiempo de evolucin de la
hipertensin y peor filtrado glomerular e ndice tobillo-brazo. Adems, los pacientes con GIMc medio > 0,9 mm
tenan mayor prevalencia de placas y estenosis carotdeas y peor ndice tobillo-brazo que los pacientes con GIMc
mximo > 0,9 mm. El GIMc medio supone una mejor aproximacin de la carga aterosclertica del paciente
hipertenso.
Abstract
Recent guidelines on arterial hypertension regard increased carotid intimamedia thickness (IMT) as a marker of
end-organ damage. However, these guidelines do not specify whether the maximum or mean IMT should be used
as an indicator. The aim of this study was to compare these two measures and their relationship to atherosclerotic
burden. The study involved 215 consecutive hypertensive patients who were divided into three groups according to
their IMT: maximum IMT > 0.9 mm (with mean IMT < 0.9 mm); mean IMT > 0.9 mm (i.e. mean and maximum IMT >
0.9 mm); and normal IMT. Patients with a pathologically raised IMT (whether maximum or mean value) were more
likely to be dyslipidemic, were older, had a longer history of hypertension, and had a poorer glomerular filtration rate
and anklebrachial index. Patients with a mean IMT > 0.9 mm were more likely to have carotid plaque, carotid
stenosis and a low anklebrachial index than those with a maximum IMT > 0.9 mm. The mean IMT provided a
better indication of atherosclerotic burden in patients with hypertension.

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Edic. 38 Junio 2011

2. Medicina Clnica
Prevalencia de hipertensin arterial enmascarada en una cohorte de pacientes hipertensos controlados en
Espaa
Sobrino, Javier; Domenech, Mnica; Camafort, Miguel; Vinyoles, Ernest; Coca, Antonio
Medicina Clnica Volumen 136, Nmero 14, Mayo 2011
http://www.elsevier.es/es/revistas/medicina-clinica-2/prevalencia-hipertension-arterial-enmascarada-una-cohortepacientes-90010413-originales-2011
Resumen
Fundamento y objetivo
La evidencia sobre el elevado riesgo cardiovascular asociado a la hipertensin arterial enmascarada (HTAE) es
cada vez ms slida, por lo que conocer su prevalencia en nuestro entorno permitir una mejor estratificacin y
manejo de los pacientes hipertensos. Sin embargo, los datos sobre su prevalencia en Espaa son escasos y con
una elevada variabilidad en funcin de la poblacin estudiada. Por ello, el grupo para el ESTudio de la
Hipertensin arterial Enmascarada (ESTHEN) de la Sociedad Espaola de Hipertensin promovi el siguiente
estudio con el objetivo de conocer la prevalencia de la HTAE entre la poblacin de pacientes hipertensos atendidos
y controlados en las Unidades de Hipertensin de hospitales de todo el territorio espaol.
Pacientes y mtodos
Estudio prospectivo de una cohorte de pacientes hipertensos atendidos en 75 Unidades de HTA de todo el
territorio espaol. Se incluyeron hipertensos tratados 18 aos con buen control de las cifras de presin arterial
(PA) clnica definida por cifras de PA < 140/90mmHg. Se defini HTAE si la media de PA del perodo diurno era
135/85mmHg.
Resultados
Se analizaron datos de 302 pacientes. La edad media fue de 56,2 aos y el 56% eran varones. La prevalencia de
HTAE fue del 48% (intervalo de confianza del 95% [IC 95%] 42-53). En cuanto a los factores de riesgo asociados,
el ms prevalente fue la obesidad abdominal (22,5%), fumador activo (24,2%), antecedentes familiares de
enfermedad cardiovascular prematura (22,5%) y diabetes (11,6%). La prevalencia de hipertrofia ventricular
izquierda fue del 23,8%, el 22,2% tenan enfermedad cardiovascular establecida y el 6,3% enfermedad renal. La
HTAE se asoci con la ausencia de enfermedad cardiovascular establecida (odds ratio [OR] 0,306; IC 95% 0,1390,676) y la proximidad de las cifras de PA clnica a los lmites considerados para el control (OR 0,901; IC 95%
0,842-0,963). La OR para el diagnstico de HTAE disminua en un 10% por cada mmHg que nos alejamos de las
cifras definidas como control de la PA clnica.
Conclusin
La prevalencia de HTAE en los pacientes hipertensos tratados en las Unidades de HTA de Espaa es
prcticamente del 50%, la monitorizacin ambulatoria de la PA es una herramienta imprescindible para un correcto
diagnstico y manejo de todos los pacientes hipertensos.

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Edic. 38 Junio 2011

Factores de riesgo en los pacientes con hipertensin arterial sin eventos cardiovasculares previos
de la Sierra, Alejandro; Gonzlez-Segura, Diego
Medicina Clnica Volumen 136, Nmero 13, Mayo 2011
http://www.elsevier.es/es/revistas/medicina-clinica-2/factores-riesgo-los-pacientes-hipertension-arterial-eventos90003355-originales-2011
Resumen
Fundamento y objetivo
Las principales guas clnicas recomiendan que la toma de decisiones en el paciente hipertenso se base no slo en
las cifras de presin, sino en el riesgo cardiovascular global. El objetivo del presente trabajo ha sido el de evaluar
la distribucin del riesgo cardiovascular en pacientes hipertensos sin enfermedad cardiovascular previa, as como
el impacto relativo de los factores que inciden en dicha distribucin.
Pacientes y mtodo
Estudio transversal, observacional y multicntrico en una cohorte de 6.762 pacientes hipertensos tratados, sin
antecedentes de eventos cardiovasculares previos. Se recogieron los datos que influan en la estratificacin de
riesgo cardiovascular (factores adicionales de riesgo y lesin subclnica de rgano diana). Se evalu la prevalencia
de dichos modificadores, as como el cambio de estratificacin que se produca si stos eran o no incluidos en el
clculo del riesgo.
Resultados
La mayora de pacientes (83,1%) presentaba criterios de riesgo cardiovascular elevado o muy elevado. El
elemento que ms frecuentemente estaba presente como modificador de riesgo era el trastorno lipdico (73,6%),
seguido de la edad avanzada, ajustada por gnero (50,8%), y la obesidad abdominal (31,7%). Por lo que respecta
a la lesin orgnica, las alteraciones de la funcin renal (24,1%), hipertrofia ventricular izquierda (16,4%) y
microalbuminuria (10,7%) eran las anomalas ms frecuentes. Un 29% de pacientes hubiera reducido su categora
de riesgo si los trastornos lipdicos no hubieran estado presentes o se hubieran normalizado, frente a una
reduccin inferior al 10% de los pacientes observada cuando los dems factores no eran tenidos en cuenta en la
estratificacin.
Conclusin
La mayora de pacientes hipertensos se sita en categoras de riesgo cardiovascular elevado o muy elevado. La
presencia de trastornos lipdicos es el modificador de riesgo ms frecuente y que tiene el impacto
cuantitativamente ms importante en la estratificacin del riesgo cardiovascular.

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Edic. 38 Junio 2011

3. European Heart Journal

Expansion of CD4+CD28null T-lymphocytes in diabetic patients: exploring new pathogenetic mechanisms
of increased cardiovascular risk in diabetes mellitus
Simona Giubilato, Giovanna Liuzzo, Salvatore Brugaletta, Dario Pitocco, Francesca Graziani, Costantino
Smaldone, Rocco Antonio Montone, Vincenzo Pazzano, Daniela Pedicino, Luigi Marzio Biasucci, Giovanni
Ghirlanda, and Filippo Crea
European Heart Journal Volume32 (2011 May), Issue10Pp. 1214-1226.
Abstract
Aims Diabetes mellitus (DM) is associated with high incidence of first and recurrent cardiovascular events,
especially acute coronary syndromes (ACSs); however, the mechanisms involved are still unknown. We sought to
investigate the role of CD4+CD28nullT-lymphocytes, a rare long-lived subset of T-lymphocytes with proatherogenic
and plaque-destabilizing properties, in the increased cardiovascular risk associated with DM.
Methods and results CD4+CD28nullT-cell frequency was analysed by flow-cytometry in 60 DM patients without
overt cardiovascular disease (cDM), in 166 ACS patients with or without DM (ACS/DM+, n= 51 and ACS/DM, n=
115), and in 60 healthy individuals. The incidence of cardiovascular events (death, myocardial infarction, unstable
angina) was assessed at 36 months follow-up. CD4+CD28nullT-cell frequency (median, range) was higher in
ACS/DM+ (12.7%, 0.148) vs. ACS/DM (3.9%, 0.235), cDM (3.1%, 0.322.4), and controls (1.5%, 0.19.1) (P<
0.001 for all comparisons). Notably, cDM patients had significantly higher CD4+CD28nullT-cell frequency than
controls (P= 0.001). Glycosylated haemoglobin A1c was the only parameter independently associated with
CD4+CD28nullT-cells in cDM. The 36-month event-free survival was significantly lower in cDM patients with
CD4+CD28nullT-cells 4% (90th percentile of normal distribution) than in those with CD4+CD28nullT-cells <4% (P=
0.039). Among ACS patients, the 36-month event-free survival was the lowest in those with DM and
CD4+CD28nullT-cells 4% and highest in those without DM and CD4+CD28nullT-cells <4% (P< 0.001), being
intermediate in those with only one of these features.
Conclusions In DM patients, CD4+CD28nullT-cells are expanded and are associated with poor glycaemic control;
they also correlate with the occurrence of a first cardiovascular event and with a worse outcome after an ACS.

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Edic. 38 Junio 2011

4. Hipertensin revista de la SEH LELHA

No se ha publicado este mes

5. Hypertension
Chronic Lowering of Blood Pressure by Carotid Baroreflex Activation: Mechanisms and Potential for
Hypertension Therapy
Thomas E. Lohmeier and Radu Iliescu
Hypertension. Volume 57, Issue 5; May 1, 2011:880-886
Recent technical advances have renewed interest in device-based therapy for the treatment of drug-resistant
hypertension. Findings from recent clinical trials regarding the efficacy of electric stimulation of the carotid sinus for
the treatment of resistant hypertension are reviewed here. The main goal of this article, however, is to summarize
the preclinical studies that have provided insight into the mechanisms that account for the chronic blood pressure
lowering effects of carotid baroreflex activation. Some of the mechanisms identified were predictable and confirmed
by experimentation. Others have been surprising and controversial, and resolution will require further investigation.
Although feasibility studies have been promising, firm conclusions regarding the value of this device-based therapy
for the treatment of resistant hypertension awaits the results of current multicenter trials.
Cardiovascular Outcomes in Framingham Participants With Diabetes: The Importance of Blood Pressure
Guanmin Chen, Finlay A. McAlister, Robin L. Walker, Brenda R. Hemmelgarn, and Norm R.C. Campbell
Hypertension. Volume 57, Issue 5; May 1, 2011:891-897
We designed this study to explore to what extent the excess risk of cardiovascular events in diabetic individuals is
attributable to hypertension. We retrospectively analyzed prospectively collected data from the Framingham original
and offspring cohorts. Of the 1145 Framingham subjects newly diagnosed with diabetes mellitus who did not have a
previous history of cardiovascular events, 663 (58%) had hypertension at the time that diabetes mellitus was
diagnosed. During 4154 person-years of follow-up, 125 died, and 204 experienced a cardiovascular event.
Framingham participants with hypertension at the time of diabetes mellitus diagnosis exhibited higher rates of allcause mortality (32 versus 20 per 1000 person-years; P<0.001) and cardiovascular events (52 versus 31 per 1000
person-years; P<0.001) compared with normotensive subjects with diabetes mellitus. After adjustment for
demographic and clinical covariates, hypertension was associated with a 72% increase in the risk of all-cause
death and a 57% increase in the risk of any cardiovascular event in individuals with diabetes mellitus. The
population-attributable risk from hypertension in individuals with diabetes mellitus was 30% for all-cause death and
25% for any cardiovascular event (increasing to 44% and 41%, respectively, if the 110 normotensive subjects who
developed hypertension during follow-up were excluded from the analysis). In comparison, after adjustment for
concurrent hypertension, the population-attributable risk from diabetes mellitus in Framingham subjects was 7% for
all-cause mortality and 9% for any cardiovascular disease event. Although diabetes mellitus is associated with
increased risks of death and cardiovascular events in Framingham subjects, much of this excess risk is attributable
to coexistent hypertension.
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Edic. 38 Junio 2011

Clinical Features of 8295 Patients With Resistant Hypertension Classified on the Basis of Ambulatory Blood
Pressure Monitoring
Alejandro de la Sierra, Julin Segura, Jos R. Banegas, Manuel Gorostidi, Juan J. de la Cruz, Pedro Armario, Anna
Oliveras, and Luis M. Ruilope
Hypertension. Volume 57, Issue 5; May 1, 2011:898-902
We aimed to estimate the prevalence of resistant hypertension through both office and ambulatory blood pressure
monitoring in a large cohort of treated hypertensive patients from the Spanish Ambulatory Blood Pressure
Monitoring Registry. In addition, we also compared clinical features of patients with true or white-coatresistant
hypertension. In December 2009, we identified 68 045 treated patients with complete information for this analysis.
Among them, 8295 (12.2% of the database) had resistant hypertension (office blood pressure 140 and/or 90 mm
Hg while being treated with 3 antihypertensive drugs, 1 of them being a diuretic). After ambulatory blood pressure
monitoring, 62.5% of patients were classified as true resistant hypertensives, the remaining 37.5% having whitecoat resistance. The former group was younger, more frequently men, with a longer duration of hypertension and a
worse cardiovascular risk profile. The group included larger proportions of smokers, diabetics, target organ damage
(including left ventricular hypertrophy, impaired renal function, and microalbuminuria), and documented
cardiovascular disease. Moreover, true resistant hypertensives exhibited in a greater proportion a riser pattern
(22% versus 18%; P<0.001). In conclusion, this study first reports the prevalence of resistant hypertension in a
large cohort of patients in usual daily practice. Resistant hypertension is present in 12% of the treated hypertensive
population, but among them more than one third have normal ambulatory blood pressure. A worse risk profile is
associated with true resistant hypertension, but this association is weak, thus making it necessary to assess
ambulatory blood pressure monitoring for a correct diagnosis and management.n
Association of Hypertension Drug Target Genes With Blood Pressure and Hypertension in 86 588
Individuals
Andrew D. Johnson, Christopher Newton-Cheh, Daniel I. Chasman, Georg B. Ehret, Toby Johnson, Lynda Rose,
Kenneth Rice, Germaine C. Verwoert, Lenore J. Launer, Vilmundur Gudnason, Martin G. Larson, Aravinda
Chakravarti, Bruce M. Psaty, Mark Caulfield, Cornelia M. van Duijn, Paul M. Ridker, Patricia B. Munroe, Daniel Levy
on Behalf of the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium, Global BPgen
Consortium, and Women's Genome Health Study
Hypertension. Volume 57, Issue 5; May 1, 2011:903-910

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Edic. 38 Junio 2011

Catheter-Based Renal Sympathetic Denervation for Resistant Hypertension: Durability of Blood Pressure
Reduction Out to 24 Months
Symplicity HTN-1 Investigators
Hypertension. Volume 57, Issue 5; May 1, 2011:911-917
Renal sympathetic hyperactivity is seminal in the maintenance and progression of hypertension. Catheter-based
renal sympathetic denervation has been shown to significantly reduce blood pressure (BP) in patients with
hypertension. Durability of effect beyond 1 year using this novel technique has never been reported. A cohort of 45
patients with resistant hypertension (systolic BP 160 mm Hg on 3 antihypertension drugs, including a diuretic)
has been originally published. Herein, we report longer-term follow-up data on these and a larger group of similar
patients subsequently treated with catheter-based renal denervation in a nonrandomized manner. We treated 153
patients with catheter-based renal sympathetic denervation at 19 centers in Australia, Europe, and the United
States. Mean age was 5711 years, 39% were women, 31% were diabetic, and 22% had coronary artery disease.
Baseline values included mean office BP of 176/9817/15 mm Hg, mean of 5 antihypertension medications, and an
estimated glomerular filtration rate of 8320 mL/min per 1.73 m2. The median time from first to last radiofrequency
energy ablation was 38 minutes. The procedure was without complication in 97% of patients (149 of 153). The 4
acute procedural complications included 3 groin pseudoaneurysms and 1 renal artery dissection, all managed
without further sequelae. Postprocedure office BPs were reduced by 20/10, 24/11, 25/11, 23/11, 26/14, and 32/14
mm Hg at 1, 3, 6, 12, 18, and 24 months, respectively. In conclusion, in patients with resistant hypertension,
catheter-based renal sympathetic denervation results in a substantial reduction in BP sustained out to 2 years of
follow-up, without significant adverse events.
Control of Blood Pressure, Appetite, and Glucose by Leptin in Mice Lacking Leptin Receptors in
Proopiomelanocortin Neurons
Jussara M. do Carmo, Alexandre A. da Silva, Zhengwei Cai, Shuying Lin, John H. Dubinion, and John E. Hall
Hypertension. Volume 57, Issue 5; May 1, 2011:918-926
Although the central nervous system melanocortin system is an important regulator of energy balance, the role of
proopiomelanocortin (POMC) neurons in mediating the chronic effects of leptin on appetite, blood pressure, and
glucose regulation is unknown. Using Cre/loxP technology we tested whether leptin receptor deletion in POMC
neurons (LepRflox/flox/POMC-Cre mice) attenuates the chronic effects of leptin to increase mean arterial pressure
(MAP), enhance glucose use and oxygen consumption, and reduce appetite. LepRflox/flox/POMC-Cre, wild-type,
LepRflox/flox, and POMC-Cre mice were instrumented for MAP and heart rate measurement by telemetry and
venous catheters for infusions. LepRflox/flox/POMC-Cre mice were heavier, hyperglycemic, hyperinsulinemic, and
hyperleptinemic compared with wild-type, LepRflox/flox, and POMC-Cre mice. Despite exhibiting features of
metabolic syndrome, LepRflox/flox/POMC-Cre mice had normal MAP and heart rate compared with LepRflox/flox
but lower MAP and heart rate compared with wild-type mice. After a 5-day control period, leptin was infused (2
g/kg per minute, IV) for 7 days. In control mice, leptin increased MAP by {approx}5 mm Hg despite decreasing
food intake by {approx}35%. In contrast, leptin infusion in LepRflox/flox/POMC-Cre mice reduced MAP by {approx}3
mm Hg and food intake by {approx}28%. Leptin significantly decreased insulin and glucose levels in control mice
but not in LepRflox/flox/POMC-Cre mice. Leptin increased oxygen consumption in LepRflox/flox/POMC-Cre and
wild-type mice. Activation of POMC neurons is necessary for the chronic effects of leptin to raise MAP and reduce
insulin and glucose levels, whereas leptin receptors in other areas of the brain other than POMC neurons appear to
play a key role in mediating the chronic effects of leptin on appetite and oxygen consumption.

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Edic. 38 Junio 2011

Induction of Heme Oxygenase 1 Attenuates Placental IschemiaInduced Hypertension
Eric M. George, Kathy Cockrell, Marietta Aranay, Eva Csongradi, David E. Stec, and Joey P. Granger
Hypertension. Volume 57, Issue 5; May 1, 2011:941-948
Recent in vitro studies have reported that heme oxygenase 1 (HO-1) downregulates the angiostatic protein soluble
fms-like tyrosine kinase 1 from placental villous explants and that the HO-1 metabolites CO and bilirubin negatively
regulate endothelin 1 and reactive oxygen species. Although soluble fms-like tyrosine kinase 1, endothelin 1, and
reactive oxygen species have been implicated in the pathophysiology of hypertension during preeclampsia and in
response to placental ischemia in pregnant rats, it is unknown whether chronic induction of HO-1 alters the
hypertensive response to placental ischemia. The present study examined the hypothesis that HO-1 induction in a
rat model of placental ischemia would beneficially affect blood pressure, angiogenic balance, superoxide, and
endothelin 1 production in the ischemic placenta. To achieve this goal we examined the effects of cobalt
protoporphyrin, an HO-1 inducer, in the reduced uterine perfusion pressure (RUPP) placental ischemia model and
in normal pregnant rats. In response to RUPP treatment, mean arterial pressure increases 29 mm Hg (1367
versus 1065 mm Hg), which is significantly attenuated by cobalt protoporphyrin (1185 mm Hg). Although RUPP
treatment causes placental soluble fms-like tyrosine kinase 1/vascular endothelial growth factor ratios to alter
significantly to an angiostatic balance (1.000.10 versus 1.270.20), treatment with cobalt protoporphyrin causes a
significant shift in the ratio to an angiogenic balance (0.680.10). Placental superoxide increased in RUPP
(952.5278.8 versus 243.970.5 relative light units/min per milligram) but was significantly attenuated by HO-1
induction (482.7117.4 relative light units/min per milligram). Also, the preproendothelin message was significantly
increased in RUPP, which was prevented by cobalt protoporphyrin. These data indicate that HO-1, or its
metabolites, is a potential therapeutic for the treatment of preeclampsia.
CD4+ T-Helper Cells Stimulated in Response to Placental Ischemia Mediate Hypertension During
Pregnancy
Kedra Wallace, Sarah Richards, Pushpinder Dhillon, Abram Weimer, Eva-stina Edholm, Eva Bengten, Melanie
Wilson, James N. Martin, Jr, and Babbette LaMarca
Hypertension. Volume 57, Issue 5; May 1, 2011:949-955
We have shown that hypertension in response to chronic placental ischemia is associated with elevated
inflammatory cytokines and CD4+ T cells. However, it is unknown whether these cells play an important role in
mediating hypertension in response to placental ischemia. Therefore, we hypothesize that reduced uterine
perfusion pressure (RUPP)induced CD4+ T cells increase blood pressure during pregnancy. To answer this
question, CD4+ T cells were isolated from spleens at day 19 of gestation from control normal pregnant (NP) and
pregnant RUPP rats, cultured, and adjusted to 106 cells per 100 L of saline for intraperitoneal injection into NP
rats at day 13 of gestation. On day 18, in the experimental groups of rats, arterial catheters were inserted, and on
day 19 mean arterial pressure was analyzed. Inflammatory cytokines and antiangiogenic factor soluble fms-like
tyrosine kinase 1 were determined via ELISA. Mean arterial pressure increased from 1042 mm Hg in NP rats to
1242 mm Hg in RUPP rats (P<0.001) and to 1181 mm Hg in rats receiving RUPP CD4+ T cells (P<0.001).
Circulating tumor necrosis factor- and soluble fms-like tyrosine kinase 1 were elevated in recipients of RUPP
CD4+ T cells to levels similar to control RUPP rats. In contrast, virgin rats injected with NP or RUPP CD4+ T cells
exhibited no blood pressure changes compared with control virgin rats. Importantly, mean arterial pressure did not
change in recipients of NP CD4+ T cells (1093 mm Hg). These data support the hypothesis that RUPP-induced
CD4+ T cells play an important role in the pathophysiology of hypertension in response to placental ischemia.
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Edic. 38 Junio 2011

6. Journal of Hypertension
Benefit assessment of salt reduction in patients with hypertension: systematic overview
Matyas, Eva; Jeitler, Klaus; Horvath, Karl; Semlitsch, Thomas; Hemkens, Lars G; Pignitter, Nicole; Siebenhofer,
Andrea
Journal of Hypertension. 29(5):821-828, May 2011.
Collapse Box
Abstract
Objective: We assessed the benefits and harm of reduced salt intake in patients with essential hypertension
focusing on patient-relevant outcomes and blood pressure.
Methods: A systematic search of five electronic databases was performed to identify high-quality secondary
literature based on randomized controlled trials (RCTs). An update primary literature search (RCTs) was performed
for the time period up to 2010 that was not covered by secondary literature. Major outcomes were death,
cardiovascular morbidity/mortality, hospital stays, terminal renal failure, quality of life, and adverse events. Change
in blood pressure was defined as surrogate parameter.
Results: Four different systematic reviews and two RCTs met the inclusion criteria. Only one review reported limited
data on patient-relevant outcomes. Over an intervention period of up to 12 months, mean SBP was reduced by 3.6
8.0 mmHg in all reviews. For the same intervention period, a statistically significant advantage with regard to mean
DBP reduction ranging from 1.9 to 2.8 mmHg was found in three reviews. The fourth publication reported a
nonsignificant reduction (DBP reduction of 4.7 mmHg). None of the RCTs identified in the primary literature search
update reported data on patient-relevant outcomes. However, both RCTs found blood pressure improvements with
salt reduction.
Conclusion: A benefit from a salt-reduced diet in patients with high blood pressure is not proven with regard to
patient-relevant outcomes based on systematic reviews and RCTs published up to 2010. The results indicate a
blood pressure-lowering effect through reduced salt intake in hypertensive patients.

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Edic. 38 Junio 2011

Circulating plasma cholesteryl ester transfer protein activity and blood pressure tracking in the community
Zachariah, Justin P; Pencina, Michael J; Lyass, Asya; Kaur, Guneet; D'Agostino, Ralph B; Ordovas, Jose M;
Vasan, Ramachandran S
Journal of Hypertension. 29(5):863-868, May 2011.
Abstract
Objective: Clinical trials using cholesteryl ester transfer protein (CETP) inhibitors to raise high-density lipoprotein
cholesterol (HDL-C) concentrations reported an off-target blood pressure (BP) raising effect. We evaluated the
relations of baseline plasma CETP activity and longitudinal BP change.
Methods and results: One thousand, three hundred and seven Framingham Study participants free of
cardiovascular disease attending consecutive examinations 4 years apart (mean age 48 years) had baseline
plasma CETP activity related to change in BP over the 4-year interval, adjusting for standard risk factors. Systolic
BP increased [median +2 mmHg, 95% confidence interval (CI) 16,+23 mmHg], whereas diastolic BP decreased
(median 3 mmHg, 95% CI 15,+11 mmHg). Plasma CETP activity was not related to change in diastolic BP, but
was inversely related to change in systolic BP that was borderline significant (P = 0.09). On multivariable analyses,
plasma CETP activity was inversely related to change in pulse pressure (PP; beta per SD increment = 0.71
mmHg, P = 0.005). When dichotomized at the median, plasma CETP activity above the median was associated
with a 1 mmHg lower PP on follow-up (P = 0.045).
Conclusion: Decreasing plasma CETP activity was modestly related to increasing PP on follow-up in our
community-based sample, suggesting that inhibition of intrinsic CETP activity itself is likely associated with minimal
changes in BP.

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Edic. 38 Junio 2011

Combined effects of office and 24-h blood pressure on aortic stiffness in human hypertension
Schillaci, Giuseppe; Pucci, Giacomo; Pirro, Matteo; Settimi, Laura; Hijazi, Raed; Franklin, Stanley S; Mannarino,
Elmo
Journal of Hypertension. 29(5):869-875, May 2011.
Abstract
Objective: Aortic stiffness, a prognostically adverse marker of arteriosclerosis, is critically dependent on blood
pressure (BP). Office BP may not always reflect BP behaviour away from the medical environment, and it is
uncertain whether office or out-of-office BP values are stronger determinants of arterial stiffness.
Methods: Twenty-four-hour BP and carotid-to-femoral pulse wave velocity (PWV) a direct measure of aortic
stiffness were measured in 539 never-treated hypertensive patients and in 71 normotensive individuals.
Results: Sustained hypertensive patients had a higher age and heart-rate-adjusted aortic PWV than normotensive
individuals (9.7 2 vs. 8.5 2 m/s, P < 0.001), even after further adjustment for office mean pressure as a measure
of distending pressure (P = 0.018). The higher aortic PWV in white-coat hypertensive patients as compared with
normotensive individuals (9.3 2 vs. 8.5 2 m/s, P = 0.026) did not hold after adjustment for office mean pressure
(P = 0.16). To examine the independent effect of office BP on aortic PWV beyond the influence of 24-h BP, patients
were classified according to the difference between observed and predicted office systolic BP (the latter determined
by regressing 24-h BP on office BP). Despite having comparable 24-h BP values (131/82 vs. 131/84 mmHg), the
patients with higher-than-predicted office BP had higher aortic PWV than those with lower-than-predicted office BP
(10.1 2 vs. 9.2 2 m/s, P < 0.001). Similarly, after regressing office BP on 24-h BP, the group with higher-thanpredicted 24-h BP also had higher aortic PWV (9.9 2 vs. 9.5 2 m/s, P < 0.05) despite having identical office BP
(152/95 vs. 152/96 mmHg). In a multivariate regression model, both 24-h and office mean BP independently
predicted aortic PWV.
Conclusions: Both office and out-of-office BP are independent predictors of aortic PWV in hypertension. Elevated
BP values over the 24 h are associated with increased isobaric aortic stiffness.

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Edic. 38 Junio 2011

Endothelial dysfunction, platelet activation, thrombogenesis and fibrinolysis in patients with hypertensive
crisis
van den Born, Bert-Jan H; Lwenberg, Ester C; van der Hoeven, Niels V; de Laat, Bas; Meijers, Joost CM; Levi,
Marcel; van Montfrans, Gert A
Journal of Hypertension. 29(5):922-927, May 2011.
Collapse Box
Abstract
Background: Hypertensive crisis is an extreme phenotype of hypertension and hypertension-related thrombotic
complications. This is most evident in patients with hypertensive crisis having advanced retinopathy and thrombotic
microangiopathy (TMA). We examined whether hypertensive crisis complicated by advanced retinopathy is
associated with endothelial dysfunction, platelet activation, thrombin generation and decreased fibrinolytic activity.
In addition, we tested the association between these procoagulant changes and the development of TMA and endorgan dysfunction.
Methods: Several key mediators of coagulation were assessed in 40 patients with hypertensive crisis with and
without retinopathy and compared with 20 age, sex and ethnicity-matched normotensive controls. In patients with
hypertensive crisis, associations with markers of TMA and renal dysfunction were assessed by regression analysis.
Results: Soluble P-selectin levels were higher in patients with hypertensive crisis compared with controls regardless
of the presence or absence of retinopathy (P < 0.01). Levels of von Willebrand factor (VWF), VWF propeptide,
prothrombin fragment 1 + 2 (F1 + 2) and plasminantiplasmin (PAP) complexes were significantly higher in
hypertensive crisis with retinopathy compared with normotensive controls (P-values < 0.01), whereas in patients
without retinopathy only VWF propeptide was higher (P = 0.04). VWF, VWF propeptide, soluble tissue factor, F1 +
2 and PAP were positively associated with markers of TMA and renal dysfunction (P 0.05).
Conclusion: Hypertensive crisis with retinopathy confers a prothrombotic state characterized by endothelial
dysfunction, platelet activation and increased thrombin generation, whereas fibrinolytic activity is enhanced. The
observed changes in prothrombotic and antithrombotic pathways may contribute to the increased risk of ischaemic
and haemorrhagic complications in this extreme hypertension phenotype.
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Edic. 38 Junio 2011

Reduced circulating apelin in essential hypertension and its association with cardiac dysfunction
Przewlocka-Kosmala, Monika; Kotwica, Tomasz; Mysiak, Andrzej; Kosmala, Wojciech
Journal of Hypertension. 29(5):971-979, May 2011.
Abstract
Objective: Apelin a novel multifunction peptide implicated in regulation of the cardiovascular system, including
blood pressure and cardiac function control has been postulated to be involved in the pathophysiology of
hypertension and hypertensive heart disease. We investigated the circulating apelin level and its relationship to left
ventricular function in patients with essential hypertension.
Methods: We enrolled 232 hypertensive patients without concomitant diseases affecting cardiovascular functions
and 76 healthy controls. Each patient underwent plasma apelin measurement and echocardiographic assessment
of left ventricular systolic and diastolic function using myocardial velocities and deformation parameters, and
myocardial reflectivity using calibrated integrated backscatter.
Results: Hypertensive patients demonstrated lower plasma apelin than the controls (265 127 vs. 330 159 pg/ml;
P < 0.001). Patients with the lowest plasma apelin, that is, from the first tertile, exhibited more severe left ventricular
systolic and diastolic function abnormalities than their peers from the other two tertiles. In multivariable regression
analysis, apelin was, in addition to patient age, BMI, blood pressure, left ventricular mass index and calibrated
integrated backscatter in the basal septum, an independent correlate of left ventricular systolic function parameters
( = 0.18; P < 0.001 for strain and = 0.12; P < 0.03 for systolic strain rate) and diastolic function parameters ( =
0.13; P < 0.01 for early diastolic strain rate, = 0.11; P < 0.04 for early diastolic myocardial velocity, and = 0.11;
P < 0.04 for the ratio of mitral inflow to mitral annular early diastolic velocity).
Conclusion: In patients with essential hypertension, circulating apelin levels are reduced, and lower plasma apelin
is independently associated with more profound left ventricular systolic and diastolic function impairment.

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Edic. 38 Junio 2011

Age-dependent gender differences in hypertension management

Daugherty, Stacie L; Masoudi, Frederick A; Ellis, Jennifer L; Ho, P Michael; Schmittdiel, Julie A; Tavel, Heather M;
Selby, Joe V; O'Connor, Patrick J; Margolis, Karen L; Magid, David J
Journal of Hypertension. 29(5):1005-1011, May 2011.
Abstract
Objective: Despite gender-neutral guidelines, prior studies suggest that women have lower rates of hypertension
control and these differences may vary with age. Accordingly, we compared rates of hypertension control between
women and men as a function of age.
Methods: Within three integrated healthcare systems in the Cardiovascular Research Network, we studied all
patients seen from 2001 to 2007 with incident hypertension. Within 1 year of cohort entry, patient's hypertension
was categorized as controlled based upon achieving guideline-recommended blood pressure levels, recognized if
hypertension was diagnosed or a hypertension medication dispensed, and treated based on hypertension
medications dispensed. Multivariable logistic regression models assessed the association between gender and 1year hypertension outcomes, adjusted for patient characteristics.
Results: Among the 152 561 patients with incident hypertension, 55.6% were women. Compared to men, women
were older, had more kidney disease and more blood pressure measures during follow-up. Overall, men tended to
have lower rates of hypertension control compared to women (41.2 vs. 45.7%, adjusted odds ratio 0.93, 95%
confidence interval 0.910.95). A significant gender by age interaction was found with men aged 1849 having 17%
lower odds of hypertension control and men aged at least 65 having 12% higher odds of hypertension control
compared to women of similar ages (P < 0.001).
Conclusion: In this incident hypertension cohort, younger men and older women had lower rates of hypertension
control compared to similarly aged peers. Future studies should investigate why gender differences vary by age in
order to plan appropriate means of improving hypertension management regardless of gender or age.
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Edic. 38 Junio 2011

7. British Medica Journal (BMJ)

No se han publicado abstracts este mes

8. American Journal of Hypertension

Diagnosis and Management of Left Ventricular Diastolic Dysfunction in the Hypertensive Patient
Maurizio Galderisi
Am J Hypertens Volume 24, Issue 5 (May 2011): 507-517
Abstract
The progression of hypertensive involvement toward heart failure includes myocardial fibrosis and changes of left
ventricular (LV) geometry. In the presence of these abnormalities, diastolic abnormalities occur and are defined as
LV diastolic dysfunction (DD). They include alterations of both relaxation and filling, precede alterations of chamber
systolic function and can induce symptoms of heart failure even when ejection fraction is normal. The prevalence of
heart failure with normal ejection fraction (HFNEF) increased over time whereas the rate of death from this disorder
remained unchanged. In this view, diagnosis, prognosis, and therapeutic management of DD and HFNEF in
hypertensive patients is a growing public health problem. DD may be asymptomatic and identified occasionally
during a Doppler-echocardiographic examination. This tool has gained, therefore, important clinical position for
diagnosis of DD. Comprehensive assessment of diastolic function should be done not by a simple classification of
DD progression but by estimating the degree of LV filling pressure (FP), a true determinant of symptoms and
prognosis. This can be obtained by different ultrasound maneuvers/tools but the ratio between transmitral E velocity
and pulsed tissue Dopplerderived early diastolic velocity (E/e ratio) is the most feasible and accurate. The
identification of left atrial enlargement may be useful in uncertain cases. The recommended management of DD in
hypertensive patients should correspond to blood pressure (BP) lowering and to the attempt of reducing LV mass
and normalizing LV geometry. Prospective studies with well-defined entry criteria are needed to establish whether
this approach could reflect a better prognosis.
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Taurine Prevents Hypertension and Increases Exercise Capacity in Rats With Fructose-Induced
Hypertension
Mizanur M. Rahman, Hye-Min Park, Shang-Jin Kim, Hyeon-Kyu Go, Gi-Beum Kim, Chul-Un Hong, Young-Up Lee,
Sung-Zoo Kim, Jin-Shang Kim and Hyung-Sub Kang
Am J Hypertens Volume 24, Issue 5 (May 2011): 574-581
Abstract
Background
Fructose-induced hypertension was used to test the hypothesis that taurine supplementation and/or exercise can
prevent hypertension and increase exercise capacity.
Methods
Five groups of 15 SpragueDawley rats were allocated and designated as control, high fructosefed (fructose),
high fructosefed plus exercise (FE), high fructosefed plus 2% taurine supplement (FT) and high fructosefed plus
2% taurine supplement and exercise (FET) groups. Noninvasive systolic blood pressure (SBP) was recorded
weekly and invasive arterial blood pressure (ABP) was recorded at the end of the 4-week trial. Three consecutive
swimming tests were performed in the selected rats from each group and the plasma biomarkers were measured in
the remaining rats.
Results
Noninvasive SBP differed significantly (P < 0.001) from week 3, both noninvasive and invasive ABP increased
significantly (P < 0.001), and exercise capacity significantly decreased (P < 0.001) in the fructose group compared
with the control group. The individual effects of swimming and taurine supplementation were incapable of
preventing the development of hypertension and SBP significantly (P < 0.001) increased in the FE and FT groups;
exercise capacity in those groups remained similar to control. The combined effects of exercise and taurine
alleviated hypertension and significantly increased exercise capacity in the FET group. Insulin resistance increased
significantly and plasma nitric oxide (NO) decreased significantly in the F, FE, and FT groups. Both parameters
remained similar to control values in the FET group with an increasing antioxidant activity.
Conclusion
Taurine supplementation in combination with exercise prevents hypertension and increases exercise capacity by
possibly antioxidation and maintaining NO concentrations.
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Edic. 38 Junio 2011

9. Diabetes Care
Understanding Physicians Challenges When Treating Type 2 Diabetic Patients Social and Emotional
Difficulties: A qualitative study
Elizabeth A. Beverly, Brittney A. Hultgren, Kelly M. Brooks, Marilyn D. Ritholz, Martin J. Abrahamson, and Katie
Weinger
Diabetes Care May 2011 34:1086-1088
Abstract
OBJECTIVE To explore physicians awareness of and responses to type 2 diabetic patients social and emotional
difficulties.
RESEARCH DESIGN AND METHODS We conducted semistructured interviews with 19 physicians. Interviews
were transcribed, coded, and analyzed using thematic analysis.
RESULTS Three themes emerged: 1) physicians awareness of patients social and emotional difficulties:
physicians recognized the frequency and seriousness of patients social and emotional difficulties; 2) physicians
responses to patients social and emotional difficulties: many reported that intervening with these difficulties was
challenging with few treatment options beyond making referrals, individualizing care, and recommending more
frequent follow-up visits; and 3) the impact of patients social and emotional difficulties on physicians: few available
patient treatment options, time constraints, and a perceived lack of psychological expertise contributed to
physicians feeling frustrated, inadequate, and overwhelmed.
CONCLUSIONS Recognition and understanding of physicians challenges when treating diabetes patients social
and emotional difficulties are important for developing programmatic interventions.

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Edic. 38 Junio 2011

Diabetes-Related Distress and Physical and Psychological Health in Chinese Type 2 Diabetic Patients
Rose Z.W. Ting, Hairong Nan, Mandy W.M. Yu, Alice P.S. Kong, Ronald C.W. Ma, Rebecca Y.M. Wong, Kitman
Loo, Wing-Yee So, Chun-Chung Chow, Gary T.C. Ko, Yun-Kwok Wing, and Juliana C.N. Chan
Diabetes Care May 2011 34:1094-1096
Abstract
OBJECTIVE To validate a Chinese version of the Diabetes Distress Scale (CDDS).
RESEARCH DESIGN AND METHODS The CDDS was derived using forward-backward translation and
administered in 189 Chinese type 2 diabetic patients with evaluation of its psychometric properties.
RESULTS On the basis of principal-component analysis, three factors of the 15-item version of the CDDS (CDDS15) accounted for 63% of the variance. The correlation coefficient between the original 17-item and 15-item scales
was 0.99. The Cronbach for internal consistency was 0.90, and the test-retest reliability coefficient was 0.74. The
CDDS-15 score was significantly associated with glycemic control, obesity, depressive symptoms, and quality of
life.
CONCLUSIONS The CDDS-15 is a valid and reliable instrument to assess diabetes-related distress.
Effect of Socioeconomic Status on Mortality Among People With Type 2 Diabetes: A study from the
Scottish Diabetes Research Network Epidemiology Group
Jeremy J. Walker, Shona J. Livingstone, Helen M. Colhoun, Robert S. Lindsay, John A. McKnight, Andrew D.
Morris, John R. Petrie, Sam Philip, Naveed Sattar, Sarah H. Wild, and on behalf of the Scottish Diabetes Research
Network Epidemiology Group
Diabetes Care May 2011 34:1127-1132
Abstract
OBJECTIVE The study objective was to describe the effect of socioeconomic status (SES) on mortality among
people with type 2 diabetes.
RESEARCH DESIGN AND METHODS We used a population-based national electronic diabetes database for 35to 84-year-olds in Scotland for 20012007 linked to mortality records. SES was derived from an area-based
measure with Q5 and Q1 representing the most deprived and affluent quintiles, respectively. Poisson regression
was used to estimate relative risks (RRs) for mortality among people with type 2 diabetes compared with the
population without diabetes stratified by age (3564 and 6584 years), sex, duration of diabetes (<2 and 2 years),
and SES.
RESULTS Complete data were available for 210,994 eligible individuals (99.4%), and there were 33,842 deaths.
Absolute mortality from all causes among people with type 2 diabetes increased with increasing age and
socioeconomic deprivation and was higher for men than women. RR for mortality associated with type 2 diabetes
was highest for women aged 3564 years in Q1 with diabetes duration <2 years at 4.83 (95% CI 3.157.40) and
lowest for men aged 6584 years in Q5 with diabetes duration 2 years at 1.13 (1.031.24).
CONCLUSIONS SES modifies the association between type 2 diabetes and mortality so that RR for mortality is
lower among more deprived populations. Age, sex, and duration of diabetes also interact with type 2 diabetes to
influence RR of mortality. Differences in prevalence of comorbidities may explain these findings.

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Edic. 38 Junio 2011

Serum 25-Hydroxyvitamin D, Calcium Intake, and Risk of Type 2 Diabetes After 5 Years: Results from a
national, population-based prospective study (the Australian Diabetes, Obesity and Lifestyle study)
Claudia Gagnon, Zhong X. Lu, Dianna J. Magliano, David W. Dunstan, Jonathan E. Shaw, Paul Z. Zimmet, Ken
Sikaris, Narelle Grantham, Peter R. Ebeling, and Robin M. Daly
Diabetes Care May 2011 34:1133-1138
Abstract
OBJECTIVE To examine whether serum 25-hydroxyvitamin D (25OHD) and dietary calcium predict incident type 2
diabetes and insulin sensitivity.
RESEARCH DESIGN AND METHODS A total of 6,537 of the 11,247 adults evaluated in 19992000 in the
Australian Diabetes, Obesity and Lifestyle (AusDiab) study, returned for oral glucose tolerance test (OGTT) in
20042005. We studied those without diabetes who had complete data at baseline (n = 5,200; mean age 51 years;
55% were women; 92% were Europids). Serum 25OHD and energy-adjusted calcium intake (food frequency
questionnaire) were assessed at baseline. Logistic regression was used to evaluate associations between serum
25OHD and dietary calcium on 5-year incidence of diabetes (diagnosed by OGTT) and insulin sensitivity
(homeostasis model assessment of insulin sensitivity [HOMA-S]), adjusted for multiple potential confounders,
including fasting plasma glucose (FPG).
RESULTS During the 5-year follow-up, 199 incident cases of diabetes were diagnosed. Those who developed
diabetes had lower serum 25OHD (mean 58 vs. 65 nmol/L; P < 0.001) and calcium intake (mean 881 vs. 923
mg/day; P = 0.03) compared with those who remained free of diabetes. Each 25 nmol/L increment in serum 25OHD
was associated with a 24% reduced risk of diabetes (odds ratio 0.76 [95% CI 0.630.92]) after adjusting for age,
waist circumference, ethnicity, season, latitude, smoking, physical activity, family history of diabetes, dietary
magnesium, hypertension, serum triglycerides, and FPG. Dietary calcium intake was not associated with reduced
diabetes risk. Only serum 25OHD was positively and independently associated with HOMA-S at 5 years.
CONCLUSIONS Higher serum 25OHD levels, but not higher dietary calcium, were associated with a significantly
reduced risk of diabetes in Australian adult men and women.

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Edic. 38 Junio 2011

Prevalence of and Risk Factors for Hepatic Steatosis and Nonalcoholic Fatty Liver Disease in People With
Type 2 Diabetes: the Edinburgh Type 2 Diabetes Study
Rachel M. Williamson, Jackie F. Price, Stephen Glancy, Elisa Perry, Lisa D. Nee, Peter C. Hayes, Brian M. Frier,
Liesbeth A.F. Van Look, Geoffrey I. Johnston, Rebecca M. Reynolds, Mark W.J. Strachan, and on behalf of the
Edinburgh Type 2 Diabetes Study Investigators
Diabetes Care May 2011 34:1139-1144
Abstract
OBJECTIVE Type 2 diabetes is an established risk factor for development of hepatic steatosis and nonalcoholic
fatty liver disease (NAFLD). We aimed to determine the prevalence and clinical correlates of these conditions in a
large cohort of people with type 2 diabetes.
RESEARCH DESIGN AND METHODS A total of 939 participants, aged 6176 years, from the Edinburgh Type 2
Diabetes Study (ET2DS)a large, randomly selected population of people with type 2 diabetesunderwent liver
ultrasonography. Ultrasound gradings of steatosis were compared with magnetic resonance spectroscopy in a
subgroup. NAFLD was defined as hepatic steatosis in the absence of a secondary cause (screened by
questionnaire assessing alcohol and hepatotoxic medication use, plasma hepatitis serology, autoantibodies and
ferritin, and record linkage to determine prior diagnoses of liver disease). Binary logistic regression was used to
analyze independent associations of characteristics with NAFLD.
RESULTS Hepatic steatosis was present in 56.9% of participants. After excluding those with a secondary cause for
steatosis, the prevalence of NAFLD in the study population was 42.6%. Independent predictors of NAFLD were
BMI, lesser duration of diabetes, HbA1c, triglycerides, and metformin use. These remained unchanged after
exclusion of participants with evidence of hepatic fibrosis from the group with no hepatic steatosis.
CONCLUSIONS Prevalences of hepatic steatosis and NAFLD were high in this unselected population of older
people with type 2 diabetes, but lower than in studies in which ultrasound gradings were not compared with a gold
standard. Associations with features of the metabolic syndrome could be used to target screening for this condition.

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Edic. 38 Junio 2011

Diet-Quality Scores and the Risk of Type 2 Diabetes in Men

Lawrence de Koning, Stephanie E. Chiuve, Teresa T. Fung, Walter C. Willett, Eric B. Rimm, and Frank B. Hu
Diabetes Care May 2011 34:1150-1156
Abstract
OBJECTIVE To 1) compare associations of diet-quality scores, which were inversely associated with cardiovascular
disease, with incident type 2 diabetes and 2) test for differences in absolute-risk reduction across various strata.
RESEARCH DESIGN AND METHODS Men from the Health Professionals Follow-Up Study, who were initially free
of type 2 diabetes, cardiovascular disease, or cancer (n = 41,615), were followed for 20 years. The Healthy Eating
Index (HEI) 2005, the alternative HEI (aHEI) the Recommended Food Score, the alternative Mediterranean Diet
(aMED) Score, and the Dietary Approaches to Stop Hypertension (DASH) Score were calculated from foodfrequency questionnaires. Cox proportional hazard models with time-varying covariates were used to assess risk by
quintiles and continuous intervals.
RESULTS There were 2,795 incident cases of type 2 diabetes. After multivariate adjustment, the aHEI, aMED, and
DASH scores were significantly associated with reduced risk. A 1-SD increase was associated with 913% reduced
risk (P < 0.01), and the DASH score was associated with lower risk independent of other scores. These scores
were associated with lower absolute risk among those who were overweight or obese compared with normal weight
(P for interaction < 0.01).
CONCLUSIONS Several diet-quality scores were associated with a lower risk of type 2 diabetes and reflect a
common dietary pattern characterized by high intakes of plant-based foods such as whole grains; moderate
alcohol; and low intakes of red and processed meat, sodium, sugar-sweetened beverages, and trans fat. Highquality diets may yield the greatest reduction in diabetes cases when followed by those with a high BMI.

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Edic. 38 Junio 2011

Evidence Linking Hypoglycemic Events to an Increased Risk of Acute Cardiovascular Events in Patients
With Type 2 Diabetes
Stephen S. Johnston, Christopher Conner, Mark Aagren, David M. Smith, Jonathan Bouchard, and Jason Brett
Diabetes Care May 2011 34:1164-1170
Abstract
OBJECTIVE This retrospective study examined the association between ICD-9-CMcoded outpatient hypoglycemic
events (HEs) and acute cardiovascular events (ACVEs), i.e., acute myocardial infarction, coronary artery bypass
grafting, revascularization, percutaneous coronary intervention, and incident unstable angina, in patients with type 2
diabetes.
RESEARCH DESIGN AND METHODS Data were derived from healthcare claims for individuals with employersponsored primary or Medicare supplemental insurance. A baseline period (30 September 2006 to 30 September
2007) was used to identify eligible patients and collect information on their clinical and demographic characteristics.
An evaluation period (1 October 2007 to 30 September 2008) was used to identify HEs and ACVEs. Patients aged
18 years with type 2 diabetes were selected for analysis by a modified Healthcare Effectiveness Data and
Information Set algorithm. Data were analyzed with multiple logistic regression and backward stepwise selection
(maximum P = 0.01) with adjustment for important confounding variables, including age, sex, geography, insurance
type, comorbidity scores, cardiovascular risk factors, diabetes complications, total baseline medical expenditures,
and prior ACVEs.
RESULTS Of the 860,845 patients in the analysis set, 27,065 (3.1%) had ICD-9-CMcoded HEs during the
evaluation period. The main model retained 17 significant independent variables. Patients with HEs had 79% higher
regression-adjusted odds (HE odds ratio [OR] 1.79; 95% CI 1.691.89) of ACVEs than patients without HEs; results
in patients aged 65 years were similar to those for the entire population (HE OR 1.78, 95% CI 1.651.92).
CONCLUSIONS ICD-9-CMcoded HEs were independently associated with an increased risk of ACVEs. Further
studies of the relationship between hypoglycemia and the risk of ACVEs are warranted.
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Effects of Exercise on Cardiovascular Risk Factors in Type 2 Diabetes: A meta-analysis

Anna Chudyk and Robert J. Petrella
Diabetes Care May 2011 34:1228-1237
Abstract
OBJECTIVE Exercise is a cornerstone of diabetes management and the prevention of incident diabetes. However,
the impact of the mode of exercise on cardiovascular (CV) risk factors in type 2 diabetes is unclear.
RESEARCH DESIGN AND METHODS We conducted a systematic review of the literature between 1970 and
October 2009 in representative databases for the effect of aerobic or resistance exercise training on clinical
markers of CV risk, including glycemic control, dyslipidemia, blood pressure, and body composition in patients with
type 2 diabetes.
RESULTS Of 645 articles retrieved, 34 met our inclusion criteria; most investigated aerobic exercise alone, and 10
reported combined exercise training. Aerobic alone or combined with resistance training (RT) significantly improved
HbA1c 0.6 and 0.67%, respectively (95% CI 0.98 to 0.27 and 0.93 to 0.40, respectively), systolic blood
pressure (SBP) 6.08 and 3.59 mmHg, respectively (95% CI 10.79 to 1.36 and 6.93 to 0.24, respectively),
and triglycerides 0.3 mmol/L (95% CI 0.48 to 0.11 and 0.57 to 0.02, respectively). Waist circumference was
significantly improved 3.1 cm (95% CI 10.3 to 1.2) with combined aerobic and resistance exercise, although
fewer studies and more heterogeneity of the responses were observed in the latter two markers. Resistance
exercise alone or combined with any other form of exercise was not found to have any significant effect on CV
markers.
CONCLUSIONS Aerobic exercise alone or combined with RT improves glycemic control, SBP, triglycerides, and
waist circumference. The impact of resistance exercise alone on CV risk markers in type 2 diabetes remains
unclear.

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Edic. 38 Junio 2011

Diabetic Retinopathy Predicts All-Cause Mortality and Cardiovascular Events in Both Type 1 and 2
Diabetes: Meta-analysis of observational studies
Caroline K. Kramer, Ticiana C. Rodrigues, Luis H. Canani, Jorge L. Gross, and Mirela J. Azevedo
Diabetes Care May 2011 34:1238-124
Abstract
OBJECTIVE The prognostic significance of diabetic retinopathy (DR) for death and cardiovascular (CV) outcomes
is debated. We investigated the association of DR with all-cause mortality and CV events in patients with diabetes
by a systematic review and meta-analysis.
RESEARCH DESIGN AND METHODS The electronic databases Medline and Embase were searched for cohort
studies that evaluated DR in type 2 or type 1 diabetic patients and reported total mortality and/or fatal and nonfatal
CV events, including myocardial infarction, angina pectoris, coronary artery bypass graft, ischemic changes on a
conventional 12-lead electrocardiogram, transient ischemic attack, nonfatal stroke, or lower leg amputation. Data
extraction was performed by two reviewers independently. Pooled effect estimates were obtained by using randomeffects meta-analysis.
RESULTS The analysis included 20 studies that fulfilled the inclusion criteria, providing data from 19,234 patients.
In patients with type 2 diabetes (n = 14,896), the presence of any degree of DR increased the chance for all-cause
mortality and/or CV events by 2.34 (95% CI 1.962.80) compared with patients without DR. In patients with type 1
diabetes (n = 4,438), the corresponding odds ratio was 4.10 (1.5011.18). These associations remained after
adjusting for traditional CV risk factors. DR was also predictive of all-cause mortality in type 2 diabetes (odds ratio
2.41 [1.873.10]) and type 1 diabetes (3.65 [1.0512.66]).
CONCLUSIONS The presence of DR was associated with an increased risk of all-cause mortality and CV events in
both type 2 and type 1 diabetic patients.

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Edic. 38 Junio 2011

10.

Diabetes

Rhythmic Diurnal Gene Expression in Human Adipose Tissue From Individuals Who Are Lean, Overweight,
and Type 2 Diabetic
Daniella T. Otway, Simone Mntele, Silvia Bretschneider, John Wright, Paul Trayhurn, Debra J. Skene, M. Denise
Robertson, and Jonathan D. Johnston
Diabetes May 2011 60:1577-1581
Abstract
OBJECTIVE Previous animal studies suggest a functional relationship between metabolism, type 2 diabetes, and
the amplitude of daily rhythms in white adipose tissue (WAT). However, data interpretation is confounded by
differences in genetic background and diet or limited sampling points. We have taken the novel approach of
analyzing serial human WAT biopsies across a 24-h cycle in controlled laboratory conditions.
RESEARCH DESIGN AND METHODS Lean (n = 8), overweight/obese (n = 11), or overweight/obese type 2
diabetic (n = 8) volunteers followed a strict sleepwake and dietary regimen for 1 week prior to the laboratory study.
They were then maintained in controlled lightdark conditions in a semirecumbent posture and fed hourly during
wake periods. Subcutaneous WAT biopsies were collected every 6 h over 24 h, and gene expression was
measured by quantitative PCR.
RESULTS Lean individuals exhibited significant (P < 0.05) temporal changes of core clock (PER1, PER2, PER3,
CRY2, BMAL1, and DBP) and metabolic (REVERB, RIP140, and PGC1) genes. The BMAL1 rhythm was in
approximate antiphase with the other clock genes. It is noteworthy that there was no significant effect (P > 0.05) of
increased body weight or type 2 diabetes on rhythmic gene expression.
CONCLUSIONS The robust nature of these rhythms and their relative phasing indicate that WAT now can be
considered as a peripheral tissue suitable for the study of in vivo human rhythms. Comparison of data between
subject groups clearly indicates that obesity and type 2 diabetes are not related to the amplitude of rhythmic WAT
gene expression in humans maintained under controlled conditions.

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Edic. 38 Junio 2011

Effects of 34 Risk Loci for Type 2 Diabetes or Hyperglycemia on Lipoprotein Subclasses and Their
Composition in 6,580 Nondiabetic Finnish Men
Alena Stankov, Jussi Paananen, Pasi Soininen, Antti J. Kangas, Lori L. Bonnycastle, Mario A. Morken, Francis
S. Collins, Anne U. Jackson, Michael L. Boehnke, Johanna Kuusisto, Mika Ala-Korpela, and Markku Laakso
Diabetes May 2011 60:1608-1616
Abstract
OBJECTIVE We investigated the effects of 34 genetic risk variants for hyperglycemia/type 2 diabetes on lipoprotein
subclasses and particle composition in a large population-based cohort.
RESEARCH DESIGN AND METHODS The study included 6,580 nondiabetic Finnish men from the populationbased Metabolic Syndrome in Men (METSIM) study (aged 57 7 years; BMI 26.8 3.7 kg/m2). Genotyping of 34
single nucleotide polymorphism (SNPs) for hyperglycemia/type 2 diabetes was performed. Proton nuclear magnetic
resonance spectroscopy was used to measure particle concentrations of 14 lipoprotein subclasses and their
composition in native serum samples.
RESULTS The glucose-increasing allele of rs780094 in GCKR was significantly associated with low concentrations
of VLDL particles (independently of their size) and small LDL and was nominally associated with low concentrations
of intermediate-density lipoprotein, all LDL subclasses, and high concentrations of very large and large HDL
particles. The glucose-increasing allele of rs174550 in FADS1 was significantly associated with high concentrations
of very large and large HDL particles and nominally associated with low concentrations of all VLDL particles. SNPs
rs10923931 in NOTCH2 and rs757210 in HNF1B genes showed nominal or significant associations with several
lipoprotein traits. The genetic risk score of 34 SNPs was not associated with any of the lipoprotein subclasses.
CONCLUSIONS Four of the 34 risk loci for type 2 diabetes or hyperglycemia (GCKR, FADS1, NOTCH2, and
HNF1B) were significantly associated with lipoprotein traits. A GCKR variant predominantly affected the
concentration of VLDL, and the FADS1 variant affected very large and large HDL particles. Only a limited number
of risk loci for hyperglycemia/type 2 diabetes significantly affect lipoprotein metabolism.

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Edic. 38 Junio 2011

Effects of 34 Risk Loci for Type 2 Diabetes or Hyperglycemia on Lipoprotein Subclasses and Their
Composition in 6,580 Nondiabetic Finnish Men
Alena Stankov, Jussi Paananen, Pasi Soininen, Antti J. Kangas, Lori L. Bonnycastle, Mario A. Morken, Francis
S. Collins, Anne U. Jackson, Michael L. Boehnke, Johanna Kuusisto, Mika Ala-Korpela, and Markku Laakso
Diabetes May 2011 60:1608-1616
Abstract
OBJECTIVE We investigated the effects of 34 genetic risk variants for hyperglycemia/type 2 diabetes on lipoprotein
subclasses and particle composition in a large population-based cohort.
RESEARCH DESIGN AND METHODS The study included 6,580 nondiabetic Finnish men from the populationbased Metabolic Syndrome in Men (METSIM) study (aged 57 7 years; BMI 26.8 3.7 kg/m2). Genotyping of 34
single nucleotide polymorphism (SNPs) for hyperglycemia/type 2 diabetes was performed. Proton nuclear magnetic
resonance spectroscopy was used to measure particle concentrations of 14 lipoprotein subclasses and their
composition in native serum samples.
RESULTS The glucose-increasing allele of rs780094 in GCKR was significantly associated with low concentrations
of VLDL particles (independently of their size) and small LDL and was nominally associated with low concentrations
of intermediate-density lipoprotein, all LDL subclasses, and high concentrations of very large and large HDL
particles. The glucose-increasing allele of rs174550 in FADS1 was significantly associated with high concentrations
of very large and large HDL particles and nominally associated with low concentrations of all VLDL particles. SNPs
rs10923931 in NOTCH2 and rs757210 in HNF1B genes showed nominal or significant associations with several
lipoprotein traits. The genetic risk score of 34 SNPs was not associated with any of the lipoprotein subclasses.
CONCLUSIONS Four of the 34 risk loci for type 2 diabetes or hyperglycemia (GCKR, FADS1, NOTCH2, and
HNF1B) were significantly associated with lipoprotein traits. A GCKR variant predominantly affected the
concentration of VLDL, and the FADS1 variant affected very large and large HDL particles. Only a limited number
of risk loci for hyperglycemia/type 2 diabetes significantly affect lipoprotein metabolism.
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Edic. 38 Junio 2011

11.

The Lancet

No hay abstracts este mes

12.

JAMA

No hay abstracts este mes

13.

The New England Journal of Medicine

No hay abstracts este mes

14.

Annals of Internal Medicine

No hay abstracts este mes

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