ABSTRACT
Over the last 5 years there have been many new developments in the management of diabetic kidney disease. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT2) inhibitors were initially used for glycemic control, but more recent studies have now shown that their benefits extend to cardiovascular and kidney outcomes. The recent addition of data on the novel mineralocorticoid receptor antagonist (MRA) gives us another approach to further decrease the residual risk of diabetic kidney disease progression. In this review we describe the mechanism of action, key studies, and possible adverse effects related to these three classes of medications. The management of type 2 diabetes now includes an increasing number of medications for the management of comorbidities in a patient population at significant risk of cardiovascular disease and progression of chronic kidney disease. It is from this perspective that we seek to outline the rationale for the sequential and/or combined use of SGLT2 inhibitors, GLP-1 RA and MRAs in patients with type 2 diabetes for heart and kidney protection.
ABSTRACT
Over the last 5 years there have been many new developments in the management of diabetic kidney disease. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT2) inhibitors were initially used for glycemic control, but more recent studies have now shown that their benefits extend to cardiovascular and kidney outcomes. The recent addition of data on the novel mineralocorticoid receptor antagonist (MRA) gives us another approach to further decrease the residual risk of diabetic kidney disease progression. In this review we describe the mechanism of action, key studies, and possible adverse effects related to these three classes of medications. The management of type 2 diabetes now includes an increasing number of medications for the management of comorbidities in a patient population at significant risk of cardiovascular disease and progression of chronic kidney disease. It is from this perspective that we seek to outline the rationale for the sequential and/or combined use of SGLT2 inhibitors, GLP-1 RA and MRAs in patients with type 2 diabetes for heart and kidney protection.
ABSTRACT
BACKGROUND: Overweight, obesity, and cardiovascular disease risk factors are prevalent among firefighters in some developed countries. It is unclear whether physical activity and cardiopulmonary fitness reduce cardiovascular disease risk and the cardiovascular workload at work in firefighters. The present study investigated the relationship between leisure-time physical activity, cardiopulmonary fitness, cardiovascular disease risk factors, and cardiovascular workload at work in firefighters in Hong Kong. METHODS: Male firefighters (n = 387) were randomly selected from serving firefighters in Hong Kong (n = 5,370) for the assessment of cardiovascular disease risk factors (obesity, hypertension, diabetes mellitus, dyslipidemia, smoking, known cardiovascular diseases). One-third (Target Group) were randomly selected for the assessment of off-duty leisure-time physical activity using the short version of the International Physical Activity Questionnaire. Maximal oxygen uptake was assessed, as well as cardiovascular workload using heart rate monitoring for each firefighter for four "normal" 24-hour working shifts and during real-situation simulated scenarios. RESULTS: Overall, 33.9% of the firefighters had at least two cardiovascular disease risk factors. In the Target Group, firefighters who had higher leisure-time physical activity had a lower resting heart rate and a lower average working heart rate, and spent a smaller proportion of time working at a moderateintensity cardiovascular workload. Firefighters who had moderate aerobic fitness and high leisuretime physical activity had a lower peak working heart rate during the mountain rescue scenario compared with firefighters who had low leisure-time physical activities. CONCLUSION: Leisure-time physical activity conferred significant benefits during job tasks of moderate cardiovascular workload in firefighters in Hong Kong.
Subject(s)
Humans , Male , Cardiovascular Diseases , Developed Countries , Diabetes Mellitus , Dyslipidemias , Firefighters , Heart Rate , Hong Kong , Hypertension , Leisure Activities , Motor Activity , Obesity , Overweight , Oxygen , Risk Factors , Smoke , SmokingABSTRACT
To assess the adverse effects of dust on pulmonary function and to determine the association between subjective respiratory symptoms, cognitions about working environments and pulmonary functions, the study was conducted on 719 coal mine workers (395 workers on direct part, 324 workers on indirect part) being employed in a coal mine industry located in Hwa-Soon area. Questionnaires on respiratory symptoms and cognitions about working environments were filled out by themselves, and pulmonary function test was given by trained doctors. The results obtained were as follows ; 1. Significantly increased subjective respiratory symptoms prevalence were found in the workers on direct part comparing to workers on indirect part, and symptoms prevalence rate was higher in sputum, coughing, respiratory difficulty, palpitation and chest pain in order. 2. Significantly increased cognitions degree about working environments were found in workers on direct part comparing to workers on indirect part, and the degree was higher in dust concentration, temperature, working density and humidity in order. 3. FVC, FEV(0.5), FEF(200-1200ml) and FEF(25-75%) were lower for workers on direct part than that for workers on indirect part. 4. In workers on direct and indirect part, lung functions except FEF(200-l200ml) for the high subjective symptom group was smaller than that for the low group. There was not significane statistically, but the significane was found in FVC and FEVt in total coal workers. 5. In workers on direct part, FEVt and FEF(25-75%) for high cognition group about working environmental conditions was smaller than that for the low group but other lung functions were reversed. But in workers on indirect part, similar results was found and the significance was found in FEV(0.5) FEF(25-75%) and FEF(200-1200ml) in total coal workers. 6. Lung functions had negative correlation between sputum and FEF(200-1200ml).