Patrick Campbell

An analysis of patient data from a European diabetes study suggests an increased number of infections requiring antibiotic use was tied to an elevated risk of 

Using data from the Finnish Diabetic Nephropathy Study, investigators determined each annual antibiotic purchase was associated with a 21% increase in risk of coronary heart disease among patients in the study.

"In broader terms, the present study demonstrates how infections associate with the development of late diabetic complications and perhaps even more importantly, how infections associate with the development of coronary heart disease, as the latter relationship has been disputed during recent years," said lead investigator Johan Rasmus Simonsen, MD, of the Folkhälsan Research Center, in Finland, 

. "Interestingly, in our study this association to incident coronary heart disease was seen specifically with antibiotic purchases, making the potential pathophysiologic mechanisms behind this finding intriguing and warranting further studies."

The Finnish Diabetic Nephropathy Study is an ongoing prospective study including more than 3500 diabetic patients aimed at identifying risk factors for diabetic complications. With recent studies shining a spotlight on associations between infections and inflammation with cardiovascular disease, investigators sought to purchase data from the study to assess whether infections and antibiotic use were associated with risk of coronary heart disease in type 1 diabetics.

From the study, investigators identified a cohort of 3781 patients with type 1 diabetes recruited from more than 90 centers across Finland. Of the 3781-patient cohort, 370 patients experienced a coronary heart disease event during the follow-up.

For the purpose of their analysis, coronary heart disease was defined as a group of incident cardiovascular events including fatal or non-fatal myocardial infarction, coronary artery bypass surgery, or percutaneous coronary intervention, which were identified through national hospital discharge register data. National register data related to outpatient antibiotic purchases were used to identify infections among patients. Additionally, investigators obtained data related to bacterial lipopolysaccharide (LPS) activity from serum samples taken at baseline.

Among those included in the study, 75.8% had a normal albumin exertion rate at baseline—14.9% had microalbuminuria and 9.3% had macroalbuminuria. Additionally, investigators pointed out 9.1% of patients diabetic neuropathy progress from baseline to a more advanced stage during the follow-up period, which lasted a mean of 13.7 years for the entire 3781-patient cohort.

Upon analysis, investigators found patients who experienced an incident coronary heart disease event had a higher mean number of antibiotic purchases per follow-up year compared to type 1 diabetics who did not experience such an event (1.34; 95% CI, 1.16-1.52 vs 0.79; 95% CI 0.76-0.82], P < 0.001),. Results also indicated higher levels of LPS activity (0.64 [0.60-0.67], vs 0.58 EU mL_1 [0.57-0.59], 

 <.001) were present among those with an incident coronary heart disease event.

Investigators pointed out results of a multivariable-adjusted Cox proportional hazards model suggested the mean number of antibiotic purchases per follow-up year was an independent risk factor for incident coronary heart disease in the study population (HR 1.21, 95% CI; 1.14-1.29, 

<.0001). Furthermore, increased LPS activity was considered a risk factor for incident coronary heart disease when adjusting for static confounders, which included sex, age, age at onset of diabetes, history of smoking, and stage of diabetic nephropathy (HR 1.93; 95% CI, 1.34-2.78, 

The association between bacterial infections and the risk of coronary heart disease in type 1 diabetes

Articles

Data from a prospective cohort study in Europe indicates increased antibiotic use and LPS activity levels were tied to increased incidence of coronary heart disease events.

Antibiotic Use Tied to Increased Risk of Coronary Heart Disease in Type 1 Diabetics

 is offering clinicians an overview of reproductive risk factors, which investigators hope can lead to earlier identification and treatment of the cardiovascular condition.

One of the largest studies to examine reproductive risk factors, results indicated having 3 or more pregnancies, early menopause, and having a shorter reproductive life were all independent risk factors for obstructive coronary artery disease in women.

"This study expands our knowledge about the link between reproductive factors such as early menopause and shorter reproductive life span and increased cardiovascular risk. Indeed, there is a growing body of evidence suggesting that early loss of ovarian function results in accelerated aging. Future research should be directed toward identifying ways to delay ovarian aging," commented Stephanie Faubion, MD, clinician at Women's Health Clinic at Mayo Clinic and medical director of the North American Menopause Society, 

While previous research has suggested reproductive factors, there is much about the relationship between reproductive factors and subsequent cardiovascular risk. To learn more about how these factors may influence risk of coronary artery disease, a team of investigators from the Tongji Medical College designed the current study to compare reproductive factors among postmenopausal women with no apparent coronary artery disease, nonobstructive coronary artery disease, and obstructive coronary artery disease.

Using women admitted to the cardiovascular department of the Tongji Hospital from between April 2013 and October 2018, investigators were able to identify 2,511 postmenopausal women admitted for chest pain and referred for invasive coronary angiography for possible inclusion in the their study. Of these 974 were excluded due to prior coronary artery disease and 63 were excluded due to missing data. In total, 1474 women were included in the analysis.

Among the 1474 women included, coronary angiography resulted indicated 251 had no apparent coronary artery disease, 342 women had nonobstructive coronary artery disease, and 881 women had obstructive coronary artery disease. For the subsequent analyses, investigators used the those with no coronary artery disease and those with non obstructive coronary artery disease were used as controls.

In adjusted analyses, investigators identified multiple reproductive risk factors associated with an increased risk of obstructive coronary artery disease. Those who entered menopause at 40 years of age or younger were at an increased risk compared to those who entered menopause later in life (aOR, 1.77; 95% CI, 1.14-2.76; 

=.011), those with a reproductive life span of 30 or fewer years were at an increased risk compared to those with a reproductive life span of more than 30 years (aOR, 1.72; 95% CI, 1.26-2.35; 

=.011), and those with multigravidity, which was defined 3 pregnancies or more, were at an increased risk for obstructive coronary artery disease compared to those who were never pregnant (aOR, 1.81; 95% CI, 1.03-3.17; 

Further analysis indicated each additional year in age at menopause or reproductive life span was associated with a 4% reduction in obstructive coronary artery disease (OR, 0.96; 95% CI, 0.94-0.99; 

=.011). Factors not associated with increased risk of obstructive coronary artery disease included parity, age at first birth, spontaneous abortion, induced abortion, stillbirth, hypertensive disorders of pregnancy, gestational diabetes mellitus, and age at menarche.

“These results provide a new direction for the pathophysiological study of obstructive CAD. The prognosis of women with obstructive CAD is usually worse than that of women with no apparent CAD and nonobstructive CAD, and early intervention is necessary,” wrote study investigators. “Therefore, women with these reproductive risk factors should take precautions as early as possible.”

Reproductive risk factors for angiographic obstructive coronary artery disease among postmenopausal women

Having 3 or more pregnancies, a shorter reproductive life span, or early age at menopause onset were linked to increased risk of CAD in a recent study. 

Certain Reproductive Factors Signal Increased Risk of Coronary Artery Disease in Women

This episode of the Endocrine Outlook features a conversation with Jamie Hartmann-Boyce, MA, DPhil, a senior research fellow and departmental lecturer at the Nuffield Department of Primary Care Health Sciences of University of Oxford, focused on diabetes research during the COVID-19 pandemic.

Dr. Hartmann-Boyce is the lead investigator of an article published in 

Diabetes and COVID-19: Risks, Management, and Learnings From Other National Disasters

,” providing an overview of potential associations between COVID-19 and diabetes. Published in May, the article proved to be a valuable resource for clinicians in recent months. That being said, much has changed in the current landscape since the article’s publication so we reached out to Dr. Hartmann-Boyce to learn more about the role of medical research during the COVID-19 era.

Podcasts

A medical researcher from the UK discusses how the ongoing pandemic has impacted diabetes research and how researchers have had to adapt during an uncertain time. 

The Impact of COVID-19 on Diabetes Research

New research from the University of Cambridge in the United Kingdom has linked a diagnosis of 

An analysis of more than 60,000 women from a Danish health registry, results of the study suggested the condition, which is common among women in their 30s and 40s, was associated with a 19% increase in risk of developing cardiovascular disease later in life.

"Heart health appears to be a particular problem for young women with PCOS,” said Clare Oliver-Williams, PhD, MPhil, a junior research fellow in the Cardiovascular Epidemiology Unit of the University of Cambridge, 

. “This may be because they are more likely to be overweight and have high blood pressure and diabetes compared to their peers.”

With previous studies establishing a link between presence of polycystic ovary syndrome and increased risk of cardiovascular risk factors such as obesity and hypertension, Oliver-Williams and a team of investigators sought to determine the specific risk of cardiovascular disease associated with polycystic ovary syndrome in age-adjusted analyses. With this in mind, they designed their study using data from women in the Danish National assisted reproductive technology-Couple II Cohort for a time frame ranging from 1994-2015.

From the registry, investigators identified a cohort of 60,574 women for inclusion in their study. Of these women, 6149 (10.2%) had polycystic ovary syndrome. The median follow-up range of the study population was 8.9 years and 2925 (4.8%) developed cardiovascular disease.

For the purpose of the analysis, investigators used ICD-10 codes to identify incident cardiovascular disease. Additionally, investigators noted the 2 models were used to calculate hazard ratio estimates for cardiovascular disease according to age.

The first model adjusted for age and the second model adjusted for age, year of first assisted reproductive technology treatment, baseline parity, gestational diabetes, relationship status, and education.Of note, specific age groups included in the analyses were defined as less than 30 years, 30-34 years, 35-39 years, 40-49 years, and 50 years and more.Investigators pointed out women with polycystic ovary syndrome were younger, more likely to develop gestational diabetes, and less likely to be single than the overall study cohort.

Results of the investigators’ age-adjusted analysis indicated women with polycystic ovary syndrome were at a greater risk of developing cardiovascular disease when compared to those without polycystic ovary syndrome (HR 1.20; 95% CI, 1.08–1.34). In further adjusted analyses, results indicated these women were at a 19% greater risk of developing cardiovascular disease (aHR 1.19, 95% CI 1.07–1.33).

Investigators highlighted results of the analyses also indicated there was no evidence of increased cardiovascular risk for women with polycystic ovary syndrome after the age of 50 years. In the aforementioned sensitivity analysis, adjustment for BMI, smoking, and alcohol yielded results indicating an increased risk of cardiovascular disease among women with polycystic ovary syndrome (HR, 1.49; 95% CI, 1.04-2.06).

In the aforementioned release, investigators noted the impact modifiable risk factors can have on the development of cardiovascular disease in these patient populations.

"Polycystic ovary syndrome isn't a life sentence - there are many ways to stay heart healthy," added Oliver-Williams. "Small changes add up, like eating more fruits and vegetables and doing more exercise."

Risk of cardiovascular disease for women with polycystic ovary syndrome: results from a national Danish registry cohort study

European Journal of Preventive Cardiology.

An analysis of more than 60k women suggests those with polycystic ovary syndrome were 19% more likely to develop cardiovascular disease.

Author | Patrick Campbell

Articles

Antibiotic Use Tied to Increased Risk of Coronary Heart Disease in Type 1 Diabetics

Certain Reproductive Factors Signal Increased Risk of Coronary Artery Disease in Women

The Impact of COVID-19 on Diabetes Research

Polycystic Ovary Syndrome Linked to Increased Risk of Cardiovascular Disease