Associations of Pericardial Fat Area Determined by Routine Chest Computed Tomography With Coronary Risk Factors and Coronary Artery Disease.

BACKGROUND: Pericardial fat has been reported to be associated with coronary risk factors and severity of coronary arterial lesions. Previous studies had measured pericardial fat volume (PFV) by using contrast-enhanced cardiac computed tomography (CT) when pericardial fat was quantified. We determined pericardial fat area (PFA) in the cross section with the height of sternal angle by using routine chest CT. METHODS: We picked up 252 patients who underwent chest and abdominal CT, and we selected patients whose coronary arteries were evaluated by coronary angiography or coronary CT. Coronary artery disease (CAD) was defined as more than 75% lumen stenosis. PFA was defined as any pixel with CT attenuation of -150 to -30 Hounsfield Unit (HU) within the pericardial sac at the sternal angle level. RESULTS: Fifty-three patients were eligible. PFA was significantly larger in men than in women. Serum high-density lipoprotein (HDL)-cholesterol level was significantly and negatively correlated with PFA. Hemoglobin A1c and carotid arterial intima-media thickness tended to be positively correlated with PFA. PFA was significantly and nearly 50% larger in patients with CAD than in patients without CAD. The cut-off value of PFA was 10.4 cm2, and sensitivity and specificity of PFA for CAD were 53.8% and 88.0%, respectively. CONCLUSIONS: Present study is the first to show a significant association of PFA with gender and CAD. PFA can be determined by routine chest CT, and is simpler and more reproducible, and PFA is more available in a greater number of medical institutes as compared with PFV. Present study also showed a discriminatory value of PFA for CAD comparable to PFV.

Sodium-Glucose Cotransporter 2 Inhibitors: Possible Anti-Atherosclerotic Effects Beyond Glucose Lowering.

The new drug for type 2 diabetes, the sodium-glucose cotransporter 2 (SGLT-2) inhibitor, is reversible inhibitor of SGLT-2, leading to reduction of renal glucose reabsorption and decrease of plasma glucose, in an insulin-independent manner. In addition to glucose control, the management of coronary risk factors is very important for patients with diabetes. Here we reviewed published articles about the possible anti-atherosclerotic effects beyond glucose lowering of the SGLT-2 inhibitors. We searched by using Pubmed, and found 770 published articles about SGLT-2 inhibitors. Among 10 kinds of SGLT-2 inhibitors, the number of published articles about dapagliflozin was the greatest among SGLT-2 inhibitors. Since SGLT-2 inhibitors have similar chemical structures, we concentrated on the published articles about dapagliflozin. SGLT-2 inhibitors are proved to be significantly associated with weight loss and reduction of blood pressure by a relatively large number of studies. The studies investigating effects of dapagliflozin on visceral fat, insulin sensitivity, serum lipids, inflammation and adipocytokines are very limited. An influence of increase in glucagon secretion by SGLT-2 inhibitors on metabolic risk factors remains unknown.

Daily Physical Activity Assessed by a Triaxial Accelerometer Is Beneficially Associated with Waist Circumference, Serum Triglycerides, and Insulin Resistance in Japanese Patients with Prediabetes or Untreated Early Type 2 Diabetes.

AIM: To investigate the association between daily physical activity and metabolic risk factors in Japanese adults with prediabetes or untreated early type 2 diabetes (T2D). METHODS: Daily physical activity level was measured using a triaxial accelerometer. We assessed correlations between physical activity level and waist circumference, blood pressure, fasting levels of plasma glucose, serum triglycerides, and insulin and homeostasis model assessment-insulin resistance (HOMA-IR). RESULTS: A total of 80 patients were studied. After adjustment for age and body mass index, in all subjects, physical activity level was negatively associated with waist circumference (ß = -0.124, P = 0.018) and fasting serum triglycerides (ß = -0.239, P = 0.035), insulin (ß = -0.224, P = 0.022). In men, physical activity level was negatively associated with systolic blood pressure (ß = -0.351, P = 0.044), fasting plasma glucose (ß = -0.369, P = 0.025) and insulin (ß = -0.362, P = 0.012), and HOMA-IR (ß = -0.371, P = 0.011). No significant associations were found between physical activity level and metabolic risk factors in women. CONCLUSION: Objectively measured daily physical activity is beneficially associated with waist circumference, serum triglycerides, and insulin resistance in individuals with prediabetes or untreated early T2D. (This trial is registered with UMIN000015774.).

Effects of 6-month sitagliptin treatment on glucose and lipid metabolism, blood pressure, body weight and renal function in type 2 diabetic patients: a chart-based analysis.

BACKGROUND: Sitagliptin is one of the dipeptidyl peptidase-4 (DPP-4) inhibitors which prevent the inactivation of incretins, increasing the endogenous active incretin levels. Incretins stimulate insulin secretion from pancreatic ß-cells and inhibit glucagon secretion from pancreatic α-cells, which is favorable for the treatment of diabetes. Sitagliptin is released on December, 2009, in Japan. We retrospectively studied effects of 6-month-treatment with sitagliptin on glucose and lipid metabolism, blood pressure, body weight and renal function in patients with type 2 diabetes by a chart-based analysis. METHODS: We retrospectively studied 220 type 2 diabetic patients who have taken sitagliptin for 6 months by a chart-based analysis. Subjects studied include patients treated with sitagliptin monotherapy, sitagliptin add-on therapy, and switching from glinide to sitagliptin. We selected patients who have both data before and after 6-month sitagliptin treatment and compared the data before the sitagliptin treatment with the data at 6 month after the sitagliptin treatment started. Body weight, blood pressure, plasma glucose, hemoglobin A1c (HbA1c), serum lipids, and estimated glomerular filtration rate in type 2 diabetic patients were measured almost at the same time points before and after 6-month-treatment with sitagliptin. RESULTS: Body weight was significantly reduced after 6-month sitagliptin treatment by 0.8 kg. HbA1c levels were also significantly decreased after the sitagliptin treatment by 0.6%. We found a significant and negative correlation between change in body weight and body mass index at baseline. We also observed a significant and negative correlation between change in HbA1c and HbA1c levels at baseline. The number of patients who showed the absence of urinary glucose was significantly increased after the sitagliptin treatment.

Dipeptidyl peptidase-4 inhibitor for steroid-induced diabetes.

The addition of the dipeptidyl peptidase-4 (DDP-4) inhibitor has been reported to achieve greater improvements in glucose metabolism with fewer adverse events compared to increasing the metformin dose in type 2 diabetic patients. We present a patient with steroid-induced diabetes whose blood glucose levels were ameliorated by the use of the DPP-4 inhibitor, showing that the DPP-4 inhibitors may be an effective and safe oral anti-diabetic drug for steroid-induced diabetes.