bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relation of Characteristics of Metabolic Syndrome to Short-Term Prognosis and Effects of Intensive Statin Therapy After Acute Coronary Syndrome
Authors: Schwartz Gregory G. , Olsson Anders G. , Szarek Michael , Sasiela William J. 
Published: March 2007

OBJECTIVE—We examined relations between characteristics of the metabolic syndrome, early cardiovascular risk, and effect of early, intensive statin therapy after acute coronary syndrome.
RESEARCH DESIGN AND METHODS—A total of 3,038 patients in the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) trial were characterized by the presence or absence of a history of diabetes, a history of hypertension and/or blood pressure ≥130/≥85, BMI &gt;30 kg/m2, HDL cholesterol &lt;40 mg/dl (men) or &lt;50 mg/dl (women), and triglycerides ≥150 mg/dl. Patients with three or more of these characteristics were categorized as having metabolic syndrome.
RESULTS—A total of 38% of patients (n = 1,161) met criteria for metabolic syndrome as defined in this study and had a 19% incidence of a primary end point event (death, nonfatal myocardial infarction, cardiac arrest, or recurrent unstable myocardial ischemia) during the 16-week trial. Patients with two or fewer characteristics (n = 1,877) were classified as not having metabolic syndrome and had a 14% incidence of a primary end point event. In univariate analysis, the individual characteristics that bore a significant relation to risk were diabetes and low HDL cholesterol. In a multivariable model including age, sex, and randomized treatment assignment, presence of metabolic syndrome was associated with a hazard ratio of 1.49 (95% CI 1.24–1.79, P &lt; 0.0001). Relative risk reduction with 80 mg atorvastatin daily compared with placebo was similar in patients with and without metabolic syndrome.
CONCLUSIONS—Metabolic syndrome, as defined in the context of this clinical trial, is a strong predictor of early recurrent ischemic events after acute coronary syndrome.
Urinary Albumin Excretion and Its Relation With C-Reactive Protein and the Metabolic Syndrome in the Prediction of Type 2 Diabetes
Authors: Brantsma Auke H. , Bakker Stephan J.L. , Hillege Hans L. , de Zeeuw Dick , de Jong Paul E. , Gansevoort Ronald T. ,   the PREVEND Study Group
Published: March 2007

OBJECTIVE—To investigate urinary albumin excretion (UAE) and its relation with C-reactive protein (CRP) and the metabolic syndrome in the prediction of the development of type 2 diabetes.
RESEARCH DESIGN AND METHODS—We used data from the Prevention of Renal and Vascular End Stage Disease (PREVEND) study, an ongoing, community-based, prospective cohort study initiated in 1997 in the Netherlands. The initial cohort consisted of 8,592 subjects. After 4 years, 6,894 subjects participated in a follow-up survey. Subjects with diabetes at baseline or missing data on fasting glucose were excluded, leaving 5,654 subjects for analysis. The development of type 2 diabetes, defined as a fasting glucose ≥7.0 mmol/l and/or the use of antidiabetic medication, was used as the outcome measure. UAE was calculated as the mean UAE from two consecutive 24-h urine collections. Logistic regression models were used, with the development of type 2 diabetes as the dependent variable.
RESULTS—Of the 5,654 subjects for whom data were analyzed, 185 (3.3%) developed type 2 diabetes during a mean follow-up period of 4.2 years. UAE, CRP, and the presence of the metabolic syndrome at baseline were significantly associated with the incidence of type 2 diabetes (P &lt; 0.001 for all variables). In a univariate model, the odds ratio (OR) for UAE was 1.59 (95% CI 1.42–1.79). In our full model, adjusted for age, sex, number of criteria of metabolic syndrome, and other known risk factors for the development of type 2 diabetes (including fasting insulin), the association between UAE and type 2 diabetes remained significant (OR 1.53, 95% CI 1.25–1.88, P &lt; 0.001). There was a significant interaction between UAE and CRP (P = 0.002). After CRP was stratified into tertiles, the ORs for the association between baseline UAE and the development of type 2 diabetes were 2.2 (1.47–3.3), 1.33 (0.96–1.84), and 1.04 (0.83–1.31) for the lowest to highest tertiles, respectively.
CONCLUSIONS—UAE predicts type 2 diabetes independent of the metabolic syndrome and other known risk markers of development of type 2 diabetes. The predictive value of UAE was modified by the level of CRP.
Effect of a High-Carbohydrate Versus a High—cis-Monounsaturated Fat Diet on Blood Pressure in Patients With Type 2 Diabetes
Authors: Shah Meena , Adams-Huet Beverley , Bantle John P. , Henry Robert R. , Griver Kay A. , Raatz Susan K. , Brinkley Linda J. , Reaven Gerald M. , Garg Abhimanyu 
Published: March 2007

OBJECTIVE—To investigate whether blood pressure is different in type 2 diabetic patients on a diet rich in carbohydrates versus a diet rich in cis-monounsaturated fatty acids. Data on the dietary effects on these diets’ glucose and lipid metabolism have been previously published.
RESEARCH DESIGN AND METHODS—The study compared the effect of feeding 42 type 2 diabetic patients a carefully controlled isoenergic high-carbohydrate (high-carb; 55% energy as carbohydrate, 30% as fat, and 10% as monounsaturated fat) and high−monounsaturated fat (high-mono; 45% energy as fat, 25% as monounsaturated fat, and 40% as carbohydrate) diet for 6 weeks each in a four-center, randomized, cross-over study on blood pressure. Twenty-one patients continued the diet they received during the second phase for an additional 8 weeks.
RESULTS—According to repeated-measures ANOVA, blood pressure during the last 3 days of each phase was similar after 6 weeks of the high-carb and high-mono diets (systolic blood pressure: 128 ± 16 vs. 127 ± 15 mmHg, P = 0.9; diastolic blood pressure: 75 ± 7 vs. 75 ± 8 mmHg, P = 0.7). However, after 14 weeks of the high-carb diet (n = 13), there was a significant increase in blood pressure compared with 6 weeks of the high-mono diet (systolic blood pressure: 132 ± 13 vs. 126 ± 11 mmHg, P = 0.04; diastolic blood pressure: 83 ± 6 vs. 76 ± 7 mmHg, P = 0.002). After 14 weeks of the high-mono diet (n = 8), the reduction in blood pressure was not significant compared with 6 weeks of the high-carb diet (systolic blood pressure: 118 ± 14 vs. 121 ± 16 mmHg, P = 0.4; diastolic blood pressure: 71 ± 8 vs. 75 ± 10 mmHg, P = 0.3).
CONCLUSION—Although the exchange of carbohydrates with monounsaturated fats may not affect blood pressure in the short term, long-term consumption of a high-carbohydrate diet may modestly raise blood pressure in type 2 diabetic patients.
The Effects of Race and Region on Cardiovascular Morbidity Among Elderly Americans With Diabetes
Authors: Bertoni Alain G. , Kirk Julienne K. , Case L. Douglas , Kay Christine , Goff David C. , Narayan K.M. Venkat , Bell Ronny A. 
Published: March 2007

OBJECTIVE—There is conflicting evidence about whether nonwhite Americans with diabetes have an increased risk of cardiovascular disease (CVD). Because geographic region is known to influence the risk of CVD in the U.S., we sought to determine the effects of race and region on cardiovascular morbidity among elderly Americans with diabetes.
RESEARCH DESIGN AND METHODS—We performed a national, retrospective, cohort study using the Medicare claims of 126,153 white and 17,962 black patients with diabetes, aged ≥65 years in 1994, who were followed through 1999 for incident acute myocardial infarction, ischemic heart disease, stroke, and heart failure. The effect of race, sex, and region on the incidence of these diseases was assessed using Cox proportional hazards regression, adjusting for baseline demographics and comorbidities.
RESULTS—The incidence of any CVD ranged from 23.9/100 person-years among southern black men to 29.2/100 person-years among non-southern black women. The risk of CVD was lower among southern black men (hazard ratio 0.87 [95% CI 0.82–0.92]) and women (0.95 [0.91–0.99]) than their southern white counterparts. In the three other U.S. regions combined (northeast, midwest, and west), black men had a similar risk for CVD (1.01 [0.95–1.07]), and black women had a greater risk (1.10 [1.05–1.16]) than non-southern white men and women, respectively.
CONCLUSIONS—Among elderly Americans with diabetes, the incidence of CVD is unlikely to differ a great deal between whites and blacks. Residence in the South seems to confer a modest benefit for elderly black people with diabetes.
The Impact of Diabetes on Employment and Work Productivity
Authors: Tunceli Kaan , Bradley Cathy J. , Nerenz David , Williams L. Keoki , Pladevall Manel , Elston Lafata Jennifer 
Published: March 2007

OBJECTIVE—The purpose of this study was to longitudinally examine the effect of diabetes on labor market outcomes.
RESEARCH DESIGN AND METHODS—Using secondary data from the first two waves (1992 and 1994) of the Health and Retirement Study, we identified 7,055 employed respondents (51–61 years of age), 490 of whom reported having diabetes in wave 1. We estimated the effect of diabetes in wave 1 on the probability of working in wave 2 using probit regression. For those working in wave 2, we modeled the relationships between diabetic status in wave 1 and the change in hours worked and work-loss days using ordinary least-squares regressions and modeled the presence of health-related work limitations using probit regression. All models control for health status and job characteristics and are estimated separately by sex.
RESULTS—Among individuals with diabetes, the absolute probability of working was 4.4 percentage points less for women and 7.1 percentage points less for men relative to that of their counterparts without diabetes. Change in weekly hours worked was not statistically significantly associated with diabetes. Women with diabetes had 2 more work-loss days per year compared with women without diabetes. Compared with individuals without diabetes, men and women with diabetes were 5.4 and 6 percentage points (absolute increase), respectively, more likely to have work limitations.
CONCLUSIONS—This article provides evidence that diabetes affects patients, employers, and society not only by reducing employment but also by contributing to work loss and health-related work limitations for those who remain employed.
The Association of Comorbid Depression With Mortality in Patients With Type 2 Diabetes
Authors: Katon Wayne J. , Rutter Carolyn , Simon Greg , Lin Elizabeth H.B. , Ludman Evette , Ciechanowski Paul , Kinder Leslie , Young Bessie , Von Korff Michael 
Published: March 2007

OBJECTIVE—We assessed whether patients with comorbid minor and major depression and type 2 diabetes had a higher mortality rate over a 3-year period compared with patients with diabetes alone.
RESEARCH DESIGN AND METHODS—In a large health maintenance organization (HMO), 4,154 patients with type 2 diabetes were surveyed and followed for up to 3 years. Patients initially filled out a written questionnaire, and HMO-automated diagnostic, laboratory, and pharmacy data and Washington State mortality data were collected to assess diabetes complications and deaths. Cox proportional hazards regression models were used to calculate adjusted hazard ratios of death for each group compared with the reference group.
RESULTS—There were 275 (8.3%) deaths in 3,303 patients without depression compared with 48 (13.6%) deaths in 354 patients with minor depression and 59 (11.9%) deaths among 497 patients with major depression. A proportional hazards model with adjustment for age, sex, race/ethnicity, and educational attainment found that compared with the nondepressed group, minor depression was associated with a 1.67-fold increase in mortality (P = 0.003), and major depression was associated with a 2.30-fold increase (P &lt; 0.0001). In a second model that controlled for multiple potential mediators, both minor and major depression remained significant predictors of mortality.
CONCLUSIONS—Among patients with diabetes, both minor and major depression are strongly associated with increased mortality. Further research will be necessary to disentangle causal relationships among depression, behavioral risk factors (adherence to medical regimens), diabetes complications, and mortality.
Development, Progression, and Regression of Microalbuminuria in Japanese Patients With Type 2 Diabetes Under Tight Glycemic and Blood Pressure Control
Authors: Yamada Takashi , Komatsu Mitsuhisa , Komiya Ichiro , Miyahara Yasuhiro , Shima Yukino , Matsuzaki Mitsuko , Ishikawa Yuka , Mita Reiko , Fujiwara Mika , Furusato Nobuko , Nishi Kazue , Aizawa Toru 
Published: March 2007

OBJECTIVE— The goal of this study was to know the fate of albuminuria in Japanese patients with type 2 diabetes under tight blood pressure and glycemic control.
RESEARCH DESIGN AND METHODS— Patients having normoalbuminuria (urinary albumin excretion &lt;30 mg/g creatinine, n = 179) or microalbuminuria (albumin excretion 30–299 mg/g creatinine, n = 94) at baseline have been followed up for 8 years: ratio of men to women was 160/113, the mean age was 58 years, pretreatment HbA1c (A1C) was 8.8%, and blood pressure was 136/76 mmHg. A1C &lt;6.5% and blood pressure &lt;130/80 mmHg were targeted, and the A1C of 6.5 ± 0.7% (mean ± SD) and blood pressure of 127 ± 11/72 ± 6 mmHg have been maintained during the 8 years. Development of microalbuminuria or macroalbuminuria (albumin excretion ≥300 mg/g creatinine) in initially normoalbuminuric patients and progression to macroalbuminuria or regression to normoalbuminuria in initially microalbuminuric patients were assessed at year 8.
RESULTS— Development occurred in 27 (15%) of the normoalbuminuric patients and progression and regression in 16 (17%) and 20 (21%), respectively, of the microalbuminuric patients. Significant independent relationships existed between development and higher achieved mean systolic blood pressure (SBP) and regression and lower achieved mean SBP. In the patients with achieved mean SBP &lt;120 mmHg, development was 3%, progression was 11%, and regression was 44% during 8 years. Prediction for nephropathy by blood pressure and glycemia alone was limited. Nevertheless, albumin excretion at year 8 was positively correlated with achieved mean SBP and baseline albuminuria.
CONCLUSIONS— Development and progression were low and regression was high with SBP of 120 mmHg, provided A1C was maintained at 6.5%.
Prevalence of the Metabolic Syndrome Defined by the International Diabetes Federation Among Adults in the U.S.
Authors: Ford Earl S. 
Published: March 2007

OBJECTIVE—The International Diabetes Federation (IDF) has proposed a new definition of the metabolic syndrome that emphasizes central adiposity as determined by ethnic group–specific thresholds of waist circumference. The objective of this study was to estimate the prevalence of this syndrome using the IDF definition among U.S. adults and to compare it with the prevalence estimated using the definition of the National Cholesterol Education Program (NCEP).
RESEARCH DESIGN AND METHODS—A total of 3,601 men and women aged ≥20 years from the National Health and Nutrition Examination Survey 1999–2002 were included in the analyses.
RESULTS—Based on the NCEP definition, the unadjusted prevalence of the metabolic syndrome was 34.5 ± 0.9% (percent ± SE) among all participants, 33.7 ± 1.6% among men, and 35.4 ± 1.2% among women. Based on the IDF definition, the unadjusted prevalence of the metabolic syndrome was 39.0 ± 1.1% among all participants, 39.9 ± 1.7% among men, and 38.1 ± 1.2% among women. The IDF definition led to higher estimates of prevalence in all of the demographic groups, especially among Mexican-American men. The two definitions similarly classified ∼93% of the participants as having or not having the metabolic syndrome.
CONCLUSIONS—In the U.S., the use of the IDF definition of the metabolic syndrome leads to a higher prevalence estimate of the metabolic syndrome than the estimate based on the NCEP definition.
Increased Mortality Risks of Pre-Diabetes (Impaired Fasting Glucose) in Taiwan
Authors: Wen Chi Pang , Cheng Ting Yuan David , Tsai Shan Pou , Hsu Hui Ling , Wang Shu Li 
Published: March 2007

OBJECTIVE—The objective of this article was to assess mortality risks at different levels of fasting blood glucose (FBG) in Taiwan, with particular attention to those pre-diabetic subjects with impaired fasting glucose (IFG).
RESEARCH DESIGN AND METHODS—Governmental employees and schoolteachers were followed up for an average of 11 years. With the use of Cox regression analyses, mortality risks were calculated for 36,386 subjects, aged 40–69.
RESULTS—FBG ≥110 mg/dl was associated with increased mortality risks for all causes, cardiovascular diseases (CVD), and diabetes. IFG, when defined as 110–125 mg/dl, was associated with a significant increase for CVD and/or diabetes mortality. These mortality risks remained elevated when known CVD risk factors were adjusted for. The IFG group shared risk factor characteristics more with the FBG ≥126 mg/dl group than with the FBG &lt;110 mg/dl group. When IFG was defined as 100–125 mg/dl, the number of subjects quadrupled, but mortality risks diminished substantially because of the inclusion of 100–109 mg/dl group. The lowest FBG group, 50–75 mg/dl, had a significant 2-fold risk from all causes.
CONCLUSIONS—There was an overall J-shaped relationship between all-cause mortality and FBG. IFG, when defined as 110–125 mg/dl, is an independent risk factor and should be aggressively treated as a disease because its subsequent mortality risks for CVD and diabetes were significantly increased. The newly defined IFG at 100–125 mg/dl did not have the predictive power for later increases in CVD or diabetes mortality.
Beneficial Effects of a Dietary Approaches to Stop Hypertension Eating Plan on Features of the Metabolic Syndrome
Authors: Azadbakht Leila , Mirmiran Parvin , Esmaillzadeh Ahmad , Azizi Tohid , Azizi Fereidoun 
Published: March 2007

OBJECTIVE—To determine the effects of a Dietary Approaches to Stop Hypertension (DASH) eating plan on metabolic risks in patients with the metabolic syndrome.
RESEARCH DESIGN AND METHODS—This was a randomized controlled outpatient trial conducted on 116 patients with the metabolic syndrome. Three diets were prescribed for 6 months: a control diet, a weight-reducing diet emphasizing healthy food choices, and the DASH diet with reduced calories and increased consumption of fruit, vegetables, low-fat dairy, and whole grains and lower in saturated fat, total fat, and cholesterol and restricted to 2,400 mg Na. The main outcome measures were the components of the metabolic syndrome.
RESULTS—Relative to the control diet, the DASH diet resulted in higher HDL cholesterol (7 and 10 mg/dl), lower triglycerides (−18 and −14 mg/dl), systolic blood pressure (SBP) (−12 and −11 mmHg), diastolic blood pressure (−6 and −7 mmHg), weight (−16 and −14 kg), fasting blood glucose (FBG) (−15 and −8 mg/dl), and weight (−16 and −15 kg), among men and women, respectively (all P &lt; 0.001). The net reduction in triglycerides (−17 and −18 mg/dl), SBP (−11 and −11 mmHg), diastolic blood pressure (−5 and −6 mmHg), and FBG (−4 and −6 mg/dl), weight (−16 and −15 kg), and increase in HDL (5 and 10 mg/dl) among men and women, respectively, was higher in the DASH group (all P &lt; 0.05). The weight-reducing diet resulted in significant change in triglycerides (−13 and −10 mg/dl), SBP (−6 and −6 mmHg), and weight (−13 and −12 kg) among men and women, respectively (all P &lt; 0.05).
CONCLUSIONS—The DASH diet can likely reduce most of the metabolic risks in both men and women; the related mechanisms need further study.
Race Differences in Long-Term Diabetes Management in an HMO
Authors: Adams Alyce S. , Zhang Fang , Mah Connie , Grant Richard W. , Kleinman Ken , Meigs James B. , Ross-Degnan Dennis 
Published: March 2007

OBJECTIVE—We examined race differences in diabetes outcomes over 4–8 years in a single HMO.
RESEARCH DESIGN AND METHODS—We identified black and white adult diabetic patients who were continuously enrolled (1992–2001) and in whom diabetes was 1) diagnosed before 1994 (n = 1,686) or 2) newly diagnosed in 1994–1997 (n = 1,280). We used hierarchical models to estimate the effect of race on average annual HbA1c (A1C) controlling for baseline A1C, BMI, and age, as well as annual measures of type of diabetes medications, diabetes-related hospitalization, time and the number of A1C tests, physician visits, and nondiabetes medications. Stratifying by sex accounted for significant interactions between sex and race.
RESULTS—At baseline, black and white patients had similar rates of A1C testing and physician visits, but blacks had higher unadjusted A1C values. In multivariate models, among patients with previously diagnosed diabetes, average A1C was nonsignificantly 0.11 higher (95% CI −0.12 to 0.34) in black than in white men but was 0.30 higher (0.14–0.46; P = 0.0007) in black than in white women. Among patients with newly diagnosed diabetes, the adjusted black-white gap was 0.49 among men (0.17–0.80; P = 0.007) and was 0.05 among women (−0.20 to –0.31), which was positive but not significant.
CONCLUSIONS—Factors other than the quality of care may explain persistent race differences in A1C in this setting. Future interventions should target normalization of A1C by identifying potential psychosocial barriers to therapy intensification among patients and clinicians and development of culturally appropriate interventions to aid patients in successful self-management.
Elevated Hip Fracture Risk in Type 1 Diabetic Patients
Authors: Miao Junmei , Brismar Kerstin , Nyrén Olof , Ugarph-Morawski Anna , Ye Weimin 
Published: March 2007

OBJECTIVE—Patients with type 1 diabetes often have low bone mineral density, but epidemiological data on fracture risk are sparse and imprecise, particularly for men.
RESEARCH DESIGN AND METHODS—In the Swedish Inpatient Register, we identified a population-based cohort of 24,605 patients (12,551 men and 12,054 women) who were hospitalized for diabetes before age 31 years during 1975 through 1998. Follow-up for hip fracture was accomplished through cross-linkage in the Inpatient Register until the end of 1998. Censoring information was obtained from the registers of Death and Migration. Using the Kaplan-Meier method, we calculated the cumulative probability of getting a hip fracture. Standardized hospitalization ratios and their 95% CIs estimated relative risks with the age-, sex-, and calendar period–matched Swedish general population as reference.
RESULTS—In total, 70 and 51 first hip fractures were ascertained in men and women, respectively, corresponding to a cumulative probability (both sexes) of 65.8/1,000 until age 65 years. Markedly elevated risks were observed in both men and women (standardized hospitalization ratios = 7.6 [95% CI 5.9–9.6] and 9.8 [7.3–12.9], respectively), increasing with follow-up time. Ophthalmic, nephropathic, neurological, and cardiovascular complications were indicators of particularly high risks.
CONCLUSIONS—Both male and female type 1 diabetic patients are at increased risk for hip fracture. Although optimal preventive measures still need to be defined, the co-occurrence with other diabetes complications suggests that tighter metabolic control might reduce the risk.