المؤلفون: He, Ying, Kunutsor, Setor K., Kingsnorth, Andrew P., Gillies, Clare, Choudhary, Pratik, Khunti, Kamlesh, Zaccardi, Francesco

المساهمون: National Institute for Health Research Applied Research Collaboration East of England

المصدر: Diabetes, Obesity and Metabolism ; volume 26, issue 8, page 3361-3370 ; ISSN 1462-8902 1463-1326

الوصف: Aim To assess the differential association of risk factors with severe and non‐severe hypoglycaemia. Materials and Methods The Hypoglycaemia Assessment Tool study evaluated the risk of hypoglycaemia over a 4‐week period in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) on insulin in 24 countries. Negative binomial regressions were applied to examine the associations of several risk factors with severe and non‐severe hypoglycaemia. Results The median age was 41 years in 5949 patients with T1D and 62 years in 12 914 patients with T2D. The 4‐week rates of non‐severe hypoglycaemic were 5.57 and 1.40 episodes per person in T1D and T2D, respectively; the corresponding rates for severe hypoglycaemia were 0.94 and 0.30. The excess risk was 42% higher for severe than non‐severe hypoglycaemia in females versus males with T2D; 27% higher in patients with T2D with versus without a continuous glucose monitoring (CGM); and 47% lower in patients with T1D with versus without an insulin pump. The excess risk also differed across geographical areas and was marginally lower for severe than non‐severe hypoglycaemia for higher values of HbA1c in patients with T2D. Associations with severity of hypoglycaemia were not different for age, diabetes and insulin therapy duration, previous hypoglycaemic episodes and insulin regimen. Conclusions The risk of severe versus non‐severe hypoglycaemia differs in patients with T1D and T2D; sex, the use of a CGM and insulin pump, and geographical areas were differently associated with one type of hypoglycaemia than the other.

الإتاحة: https://doi.org/10.1111/dom.15677Test

المؤلفون: Laukkanen, Jari A, Kunutsor, Setor K

المساهمون: Kliininen lääketiede

الوصف: final draft ; nonPeerReviewed

العلاقة: International journal of cardiology; https://doi.org/10.1016/j.ijcard.2023.131570Test; 131570; 395; https://erepo.uef.fi/handle/123456789/31252Test

الإتاحة: https://doi.org/10.1016/j.ijcard.2023.131570Test
https://erepo.uef.fi/handle/123456789/31252Test

المؤلفون: Kunutsor, Setor K., Bhattacharjee, Atanu, Connelly, Margery A., Bakker, Stephan J. L., Dullaart, Robin P. F.

المصدر: Kunutsor , S K , Bhattacharjee , A , Connelly , M A , Bakker , S J L & Dullaart , R P F 2024 , ' Alcohol Consumption, High-Density Lipoprotein Particles and Subspecies, and Risk of Cardiovascular Disease : Findings from the PREVEND Prospective Study ' , International Journal of Molecular Sciences , vol. 25 , no. 4 , 2290 . https://doi.org/10.3390/ijms25042290Test

مصطلحات موضوعية: Male, Humans, Middle Aged, Female, Prospective Studies, Cholesterol, HDL, Cardiovascular Diseases/epidemiology, Alcohol Drinking/adverse effects, Risk Factors, cardiovascular disease, cohort study, alcohol consumption, HDL subspecies, HDL cholesterol, HDL particles, /dk/atira/pure/subjectarea/asjc/1300/1312, name=Molecular Biology, /dk/atira/pure/subjectarea/asjc/1600/1607, name=Spectroscopy, /dk/atira/pure/subjectarea/asjc/1500/1503, name=Catalysis, /dk/atira/pure/subjectarea/asjc/1600/1604, name=Inorganic Chemistry, /dk/atira/pure/subjectarea/asjc/1700/1706, name=Computer Science Applications, /dk/atira/pure/subjectarea/asjc/1600/1606, name=Physical and Theoretical Chemistry, /dk/atira/pure/subjectarea/asjc/1600/1605, name=Organic Chemistry

الوصف: The associations of HDL particle (HDL-P) and subspecies concentrations with alcohol consumption are unclear. We aimed to evaluate the interplay between alcohol consumption, HDL parameters and cardiovascular disease (CVD) risk. In the PREVEND study of 5151 participants (mean age, 53 years; 47.5% males), self-reported alcohol consumption and HDL-P and subspecies (small, medium, and large) by nuclear magnetic resonance spectroscopy were assessed. Hazard ratios (HRs) with 95% CIs for first CVD events were estimated. In multivariable linear regression analyses, increasing alcohol consumption increased HDL-C, HDL-P, large and medium HDL, HDL size, and HDL subspecies (H3P, H4P, H6 and H7) in a dose-dependent manner. During a median follow-up of 8.3 years, 323 first CVD events were recorded. Compared with abstainers, the multivariable adjusted HRs (95% CIs) of CVD for occasional to light, moderate, and heavy alcohol consumers were 0.72 (0.55-0.94), 0.74 (0.54-1.02), and 0.65 (0.38-1.09), respectively. These associations remained consistent on additional adjustment for each HDL parameter. For CVD, only HDL-C was associated with a statistically significant decreased risk of CVD in a fully adjusted analysis (HR 0.84, 95% CI 0.72-0.97 per 1 SD increment). For coronary heart disease, HDL-C, HDL-P, medium HDL, HDL size, and H4P showed inverse associations, whereas HDL-C and HDL size modestly increased stroke risk. Except for H6P, alcohol consumption did not modify the associations between HDL parameters and CVD risk. The addition of HDL-C, HDL size, or H4P to a CVD risk prediction model containing established risk factors improved risk discrimination. Increasing alcohol consumption is associated with increased HDL-C, HDL-P, large and medium HDL, HDL size, and some HDL subspecies. Associations of alcohol consumption with CVD are largely independent of HDL parameters. The associations of HDL parameters with incident CVD are generally not attenuated or modified by alcohol consumption.

وصف الملف: application/pdf

العلاقة: https://discovery.dundee.ac.uk/en/publications/1df36445-95df-4892-9554-bf324e44bf1bTest

الإتاحة: https://doi.org/10.3390/ijms25042290Test
https://discovery.dundee.ac.uk/en/publications/1df36445-95df-4892-9554-bf324e44bf1bTest
https://discovery.dundee.ac.uk/ws/files/119045480/ijms-25-02290.pdfTest
http://www.scopus.com/inward/record.url?scp=85185898532&partnerID=8YFLogxKTest

المؤلفون: Kunutsor, Setor K., Balasubramanian, Victoria G., Zaccardi, Francesco, Gillies, Clare L., Aroda, Vanita R., Seidu, Samuel, Khunti, Kamlesh

المساهمون: National Institute for Health and Care Research

المصدر: Diabetes, Obesity and Metabolism ; volume 26, issue 6, page 2069-2081 ; ISSN 1462-8902 1463-1326

الوصف: Aim We aimed to determine the macrovascular and microvascular outcomes of intensive versus standard glucose‐lowering strategies in type 2 diabetes (T2D) and investigate the relationships between these outcomes and trial arm glycated haemoglobin (HbA1c) reduction. Materials and Methods In this systematic review and meta‐analysis, we identified relevant trials from MEDLINE, Embase, the Cochrane Library, and bibliographies up to August 2023. Macrovascular and microvascular outcomes, along with safety outcomes, were evaluated. Pooled study‐specific hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, and meta‐regression was employed to analyse the relationships between outcomes and HbA1c reduction. Results We included 11 unique RCTs involving 51 469 patients with T2D (intensive therapy, N = 26 691; standard therapy, N = 24 778). Intensive versus standard therapy reduced the risk of non‐fatal myocardial infarction (MI) (HR 0.84; 95% CI 0.75‐0.94) with no difference in the risk of major adverse cardiovascular events (HR 0.97; 95% CI 0.92‐1.03) and other adverse cardiovascular outcomes. Intensive versus standard therapy reduced the risk of retinopathy (HR 0.85; 0.78‐0.93), nephropathy (HR 0.71; 0.58‐0.87) and composite microvascular outcomes (HR 0.88; 0.77‐1.00). Meta‐regression analyses showed modest evidence of inverse linear relationships between HbA1c reduction and the outcomes of major adverse cardiovascular events, non‐fatal MI, stroke and retinopathy, but these were not statistically significant. Conclusions In people with T2D, intensive glucose control was associated with a reduced risk of non‐fatal MI and several microvascular outcomes, particularly retinopathy and nephropathy. The lack of an effect of intensive glucose‐lowering on most macrovascular outcomes calls for a more comprehensive approach to managing cardiovascular risk factors alongside glycaemic control.

الإتاحة: https://doi.org/10.1111/dom.15511Test

المؤلفون: Kunutsor, Setor K., Zaccardi, Francesco, Balasubramanian, Victoria G., Gillies, Clare L., Aroda, Vanita R., Seidu, Samuel, Davies, Melanie J., Khunti, Kamlesh

المساهمون: NIHR Leicester Biomedical Research Centre

المصدر: Diabetes, Obesity and Metabolism ; volume 26, issue 5, page 1837-1849 ; ISSN 1462-8902 1463-1326

الوصف: Aim Using a systematic review and meta‐analysis of placebo‐controlled cardiovascular outcome trials (CVOTs) of newer glucose‐lowering agents [sodium‐glucose cotransporter‐2 inhibitors (SGLT‐2is), glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs), and dipeptidyl peptidase‐4 inhibitors (DPP‐4is)] in type 2 diabetes (T2D), we aimed to determine the macrovascular and microvascular outcomes of these agents and clarify the relationships between glycated haemoglobin (HbA1c) reduction and risk of these outcomes. Materials and Methods Randomized controlled trials were identified from MEDLINE, Embase and the Cochrane Library until September 2023. Study‐specific hazard ratios with 95% confidence intervals (CIs) were pooled, and meta‐regression was used to assess the relationships between outcomes and between trial arm HbA1c reductions. Results Twenty unique CVOTs (six SGLT‐2is, nine GLP‐1RAs, five DPP‐4is), based on 169 513 participants with T2D, were eligible. Comparing SGLT‐2is, GLP‐1RAs and DPP‐4is with placebo, the hazard ratios (95% CIs) for 3‐point major adverse cardiovascular events were 0.88 (0.82‐0.94), 0.85 (0.79‐0.92) and 1.00 (0.94‐1.06), respectively. SGLT‐2is and GLP‐1RAs consistently reduced the risk of several macrovascular and microvascular complications, particularly kidney events. DPP‐4is showed no macrovascular benefits. There was potential evidence of an inverse linear relationship between HbA1c reduction and 3‐point major adverse cardiovascular event risk (estimated risk per 1% reduction in HbA1c: 0.84, 95% CI 0.67‐1.06; p = .14; R 2 = 14.2%), which was driven by the component of non‐fatal stroke (R 2 = 100.0%; p = .094). There were non‐significant inverse linear relationships between HbA1c reduction and the risk of several vascular outcomes. Conclusions SGLT‐2is and GLP‐1RAs showed consistent risk reductions in macrovascular and microvascular outcomes. The vascular benefits of SGLT‐2is and GLP‐1RAs in patients with T2D extend beyond mere glycaemic control.

الإتاحة: https://doi.org/10.1111/dom.15500Test

المؤلفون: Seidu, Samuel, Lawson, Claire A., Kunutsor, Setor K., Khunti, Kamlesh, Rosano, Giuseppe M.C.

المصدر: European Journal of Heart Failure ; volume 26, issue 5, page 1111-1124 ; ISSN 1388-9842 1879-0844

الوصف: Aim Existing data on the association between blood pressure levels and adverse cardiovascular outcomes in patients with heart failure (HF) are inconsistent. The optimal blood pressure targets for patients with HF remain uncertain. This study sought to assess the associations between blood pressure (systolic [SBP] and diastolic blood pressure [DBP]) levels and adverse cardiovascular disease (CVD) outcomes in patients with HF. Methods and results A systematic review and meta‐analysis were conducted using MEDLINE, Embase, the Cochrane Library, and Web of Science databases up to 5 May 2023. The outcomes of interest included adverse cardiovascular events and all‐cause mortality. Pooled relative risks (RRs) with corresponding 95% confidence intervals (CIs) were calculated. Forty‐three unique observational cohort studies, comprising 120 643 participants with HF, were included. The pooled RRs (95% CIs) for SBP thresholds of ≥140 mmHg versus <140 mmHg were 0.92 (0.83–1.01) for all‐cause mortality, 0.83 (0.67–1.04) for CVD death, and 0.98 (0.80–1.21) for HF hospitalization. The pooled RR (95% CI) for SBP thresholds of ≥160 mmHg versus <160 mmHg and all‐cause mortality was 0.67 (0.62–0.74). SBP levels below <130, <120, and <110 mmHg were each associated with an increased risk of various cardiovascular endpoints and all‐cause mortality. The pooled RR (95% CI) for DBP thresholds of ≥80 mmHg versus <80 mmHg and all‐cause mortality was 0.86 (0.67–1.10). A 10 mmHg increase in SBP or DBP was associated with a reduction in all‐cause mortality and other cardiovascular endpoints. Conclusions The findings suggest that lower and normal baseline SBP levels (<130, <120, and <110 mmHg) may be associated with future risk of worse outcomes in patients with HF. Optimal baseline blood pressure levels for these patients may lie within the range of ≥140 mmHg for SBP. In the absence of observational studies with repeated blood pressure measurements or definitive trials evaluating optimal blood pressure targets, ...

الإتاحة: https://doi.org/10.1002/ejhf.3108Test

المؤلفون: Kunutsor, Setor K., Seidu, Samuel, Kurl, Sudhir, Laukkanen, Jari A.

المصدر: GeroScience ; ISSN 2509-2723

مصطلحات موضوعية: Geriatrics and Gerontology, Aging

الوصف: Triglyceride-glucose (TyG) index is an emerging marker of adverse cardiometabolic conditions such as cardiovascular disease and type 2 diabetes. The long-term relevance of TyG index to chronic kidney disease (CKD) is uncertain. We aimed to assess the association of TyG index with CKD risk and its utility in risk prediction in a prospective study. The TyG index was calculated using fasting triglycerides and fasting plasma glucose (FPG) levels measured in 2362 men aged 42–61 years with normal kidney function using the formula: Ln (fasting triglycerides [mg/dL] × FPG [mg/dL]/2). Multivariable adjusted hazard ratios (HRs) (95% confidence intervals, CIs) were estimated for CKD. Correction for within-person variability was made using data from repeat measurements of triglycerides and FPG taken 11 years after baseline. Over a median follow-up duration of 17.5 years, 223 CKD cases were recorded. The age-adjusted regression dilution ratio for the TyG index was 0.54 (95% CI, 0.48–0.60). The risk of CKD increased continuously with increasing TyG index across the range 9.3 to 11.6 ( p value for nonlinearity<.001). In analysis adjusted for established risk factors, a unit higher TyG index was associated with an increased risk of CKD (HR 1.59, 95% CI 1.24–2.05). Comparing extreme tertiles of the TyG index, the corresponding adjusted HR (95% CI) for CKD was 1.61 (1.15–2.27). Addition of the TyG index to a CKD risk prediction model containing established risk factors improved risk discrimination and reclassification ( p value for difference in −2 log likelihood<.001; NRI=47.66%, p =.014; IDI=0.0164, p <.001). Higher TyG index is associated with an increased risk of CKD and improves the prediction and classification of CKD beyond established risk factors. Using single baseline estimations of the TyG index to investigate its association with CKD risk could considerably under-estimate the true association.

الإتاحة: https://doi.org/10.1007/s11357-023-01044-5Test

المؤلفون: Cho, Min Jeong, Jung, Yong Joon, Min, Ho Jeong, Kim, Hyun Jeong, Kunutsor, Setor K., Jae, Sae Young

المصدر: Clinical Hypertension ; volume 30, issue 1 ; ISSN 2056-5909

مصطلحات موضوعية: Cardiology and Cardiovascular Medicine, Internal Medicine

الوصف: Background This study aimed to examine the associations of leisure time physical activity (LTPA) and occupational physical activity (OPA) with the prevalence of hypertension, while exploring the sex disparities in these associations. Methods A cross-sectional study was conducted using data from the Korea National Health and Nutrition Examination Survey between 2014 and 2019 (n = 26,534). Hypertension was defined as the use of antihypertensive drugs or systolic and diastolic blood pressure ≥ 140/90 mm Hg. Self-reported physical activity (PA), assessed by the global PA questionnaire, was categorized into three domains: total PA, LTPA and OPA. Each PA domain was classified based on METs-min/wk and intensity. Results In a multivariable adjusted model, the odds ratio (OR) with 95% confidence intervals (CIs) for the prevalence of hypertension in the active versus inactive group, based on METs, was 0.92 (95% CI 0.85–0.99) for total PA, 0.90 (95% CI 0.83–0.98) for LTPA and 1.21 (95% CI 1.05–1.38) for OPA. Compared to the inactive group, moderate to vigorous intensity was associated with a lower odds of hypertension for total PA and LTPA (total PA: OR 0.95, 95% CI 0.89-1.00 and LTPA: OR 0.92, 95% CI 0.86–0.98), but a higher odd for OPA (OR 1.17, 95% CI 1.05–1.30). Subgroup analyses showed significant evidence of effect modification by sex on the associations of total PA and LTPA (METs and intensity) with hypertension prevalence ( p -values for interaction < 0.01); the associations were generally stronger for women. OPA was associated with a higher prevalence of hypertension in women, but not in men ( p -value for interaction > 0.05). Conclusions Higher levels of total PA and LTPA were associated with lower prevalence of hypertension in both men and women, with slightly stronger associations for women. However, higher OPA was associated with a higher prevalence of hypertension in women. These findings support the PA health paradox hypothesis and highlight the sex disparities in the association between OPA ...

الإتاحة: https://doi.org/10.1186/s40885-023-00260-7Test

المؤلفون: Kunutsor, Setor K, Dey, Richard S, Touw, Daan J, Bakker, Stephan J L, Dullaart, Robin P F

المساهمون: FoodBall, Joint Programming Initiative A healthy diet for a healthy life, Dutch Kidney Foundation, National Institute for Health and Care Research

المصدر: Nephrology Dialysis Transplantation ; ISSN 0931-0509 1460-2385

مصطلحات موضوعية: Transplantation, Nephrology

الوصف: Background and hypothesis Evidence on the role of smoking in the development of chronic kidney disease (CKD) has mostly relied on self-reported smoking status. We aimed to compare the associations of smoking status as assessed by self-reports and urine cotinine with CKD risk. Methods Using the PREVEND prospective study, smoking status was assessed at baseline using self-reports and urine cotinine in 4333 participants (mean age, 52 years) without a history of CKD at baseline. Participants were classified as never, former, light current, and heavy current smokers according to self-reports and comparable cutoffs for urine cotinine. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated for CKD. Results The percentages of self-reported and cotinine-assessed current smokers were 27.5% and 24.0%, respectively. During a median follow-up of 7.0 years, 593 cases of CKD were recorded. In analyses adjusted for established risk factors, the HRs (95% CI) of CKD for self-reported former, light current, and heavy current smokers compared with never smokers were 1.17 (0.95–1.44), 1.48 (1.10–2.00), and 1.48 (1.14–1.93), respectively. On further adjustment for urinary albumin excretion (UAE), the HRs (95% CI) were 1.07 (0.87–1.32), 1.26 (0.93–1.70), and 1.20 (0.93–1.57), respectively. For urine cotinine-assessed smoking status, the corresponding HRs (95% CI) were 0.81 (0.52–1.25), 1.17 (0.92–1.49), and 1.32 (1.02–1.71), respectively, in analyses adjusted for established risk factors plus UAE. Conclusion Self-reported current smoking is associated with increased CKD risk, but dependent on UAE. The association between urine cotinine-assessed current smoking and increased CKD risk is independent of UAE. Urine cotinine-assessed smoking status may be a more reliable risk indicator for CKD incidence than self-reported smoking status.

الإتاحة: https://doi.org/10.1093/ndt/gfae054Test

المؤلفون: Laukkanen, Jari A., Kunutsor, Setor K.

المساهمون: Department of Health

المصدر: Temperature ; volume 11, issue 1, page 27-51 ; ISSN 2332-8940 2332-8959

الإتاحة: https://doi.org/10.1080/23328940.2023.2300623Test