Background Although thyroid hormone （TH） has important effects on lipid metabolism, the relationship between TH and statin responsiveness has never been investigated. We hypothesize that TH plays an important role i...Background Although thyroid hormone （TH） has important effects on lipid metabolism, the relationship between TH and statin responsiveness has never been investigated. We hypothesize that TH plays an important role in statin responsiveness in patients with acute myocardial infarction （AMI）. Methods Consecutive 1091 hospitalized AMI patients in Fuwai hospital （Beijing, China） were enrolled into this current study. The study population was divided into three groups based on the intensity of statin treatment： low-intensity （n = 221）, moderate-intensity （n = 712） and high-intensity （n = 158）. Lipid levels were measured after statin therapy lasting for 10-14 days. The association between TH, lipid profile levels and achievement of low-density lipoprotein cholesterol （LDL-C） lowering goals was explored in patients with AMI on statin therapy. Results By general linear analysis, a significant linear trend between free triiodothyronine （FT3） and LDL-C level （linear coefficient r = -0.082, P = 0.001） and FT3 and total cholesterol （TC） level （r = -0.105, P = 0.031） was observed in the moderate-intensity statin group. A more apparent linear trend was detected in the high-intensity statin group （for LDL-C： r = -0.113, P = 0.005; for TC： r = -0.172, P = 0.029, respectively）. However, no significant correlation was observed in the low-intensity statin group. Compared with the low-FT3 group （defined as FT3 〈 1.79 pg/mL）, the OR （95% CI） for attaining a LDL-C 〈 3.0mmol/L was found to be 2.217 （1.001–4.839） in the higher FT3 group （〉 2.95 pg/mL）. The OR （95% CI） for attaining the more intensive goal （LDL-C 〈 1.8mmol/L） was 2.836 （1.014–5.182）. Conclusions Our study reveals that variation in FT3 levels is related to the cholesterol-lowering responsiveness of statins in AMI patients. These findings suggest that low FT3 may be a factor responsible for lack of LDL-C goal attainment and patients’ poor responsiveness to statin treatment.展开更多
AIM:To evaluate the impact on glucose variability(GLUCV)of an nurse-implemented insulin infusion protocol when compared with a conventional insulin treatment during the day-to-day clinical activity.METHODS:We enrolled...AIM:To evaluate the impact on glucose variability(GLUCV)of an nurse-implemented insulin infusion protocol when compared with a conventional insulin treatment during the day-to-day clinical activity.METHODS:We enrolled 44 type 2 diabetic patients(n=32 males;n=12 females)with acute coronary syndrome(ACS)and randomy assigned to standard a subcutaneous insulin treatment(n=23)or a nurse-implemented continuous intravenous insulin infusion protocol(n=21).We utilized some parameters of GLUCV representing well-known surrogate markers of prognosis,i.e.,glucose standard deviation(SD),the mean dailyδglucose(mean of daily difference between maximum and minimum glucose),and the coefficient of variation(CV)of glucose,expressed as percent glucose(SD)/glu-cose(mean).RESULTS:At the admission,first fasting blood glucose,pharmacological treatments(insulin and/or anti-diabetic drugs)prior to entering the study and basal glycated hemoglobin(HbA1c)were observed in the two groups treated with subcutaneous or intravenous insulin infusion,respectively.When compared with patients submitted to standard therapy,insulin-infused patients showed both increased first 24-h(median 6.9 mmol/L vs 5.7mmol/L P<0.045)and overall hospitalizationδglucose(median 10.9 mmol/L vs 9.3 mmol/L,P<0.028),with a tendency to a significant increase in first 24-h glycaemic CV(23.1%vs 19.6%,P<0.053).Severe hypoglycaemia was rare(14.3%),and it was observed only in 3 patients receiving insulin infusion therapy.HbA1c values measured during hospitalization and 3 mo after discharge did not differ in the two groups of treatment.CONCLUSION:Our pilot data suggest that no real benefit in terms of GLUCV is observed when routinely managing blood glucose by insulin infusion therapy in type 2 diabetic ACS hospitalized patients in respect to conventional insulin展开更多
基金We acknowledge the help from Wei LI, Yang WANG and Yan-Yan ZHAO （Medical Research ＆ Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Disease, China） with the statistical analyses. This work was supported by the National Natural Science Foundation of China （No. 81470485）, Capital Clinical Featured Application Research Project （No. z151100004015175）, and CAMS Innovation Fund for Medical Sciences （CIFMS 2016-I2M- 1-009）. The authors have no potential conflict of interest to declare.
文摘Background Although thyroid hormone （TH） has important effects on lipid metabolism, the relationship between TH and statin responsiveness has never been investigated. We hypothesize that TH plays an important role in statin responsiveness in patients with acute myocardial infarction （AMI）. Methods Consecutive 1091 hospitalized AMI patients in Fuwai hospital （Beijing, China） were enrolled into this current study. The study population was divided into three groups based on the intensity of statin treatment： low-intensity （n = 221）, moderate-intensity （n = 712） and high-intensity （n = 158）. Lipid levels were measured after statin therapy lasting for 10-14 days. The association between TH, lipid profile levels and achievement of low-density lipoprotein cholesterol （LDL-C） lowering goals was explored in patients with AMI on statin therapy. Results By general linear analysis, a significant linear trend between free triiodothyronine （FT3） and LDL-C level （linear coefficient r = -0.082, P = 0.001） and FT3 and total cholesterol （TC） level （r = -0.105, P = 0.031） was observed in the moderate-intensity statin group. A more apparent linear trend was detected in the high-intensity statin group （for LDL-C： r = -0.113, P = 0.005; for TC： r = -0.172, P = 0.029, respectively）. However, no significant correlation was observed in the low-intensity statin group. Compared with the low-FT3 group （defined as FT3 〈 1.79 pg/mL）, the OR （95% CI） for attaining a LDL-C 〈 3.0mmol/L was found to be 2.217 （1.001–4.839） in the higher FT3 group （〉 2.95 pg/mL）. The OR （95% CI） for attaining the more intensive goal （LDL-C 〈 1.8mmol/L） was 2.836 （1.014–5.182）. Conclusions Our study reveals that variation in FT3 levels is related to the cholesterol-lowering responsiveness of statins in AMI patients. These findings suggest that low FT3 may be a factor responsible for lack of LDL-C goal attainment and patients’ poor responsiveness to statin treatment.
基金Supported by Fondazione CNR/Regione Toscana G Monasterio
文摘AIM:To evaluate the impact on glucose variability(GLUCV)of an nurse-implemented insulin infusion protocol when compared with a conventional insulin treatment during the day-to-day clinical activity.METHODS:We enrolled 44 type 2 diabetic patients(n=32 males;n=12 females)with acute coronary syndrome(ACS)and randomy assigned to standard a subcutaneous insulin treatment(n=23)or a nurse-implemented continuous intravenous insulin infusion protocol(n=21).We utilized some parameters of GLUCV representing well-known surrogate markers of prognosis,i.e.,glucose standard deviation(SD),the mean dailyδglucose(mean of daily difference between maximum and minimum glucose),and the coefficient of variation(CV)of glucose,expressed as percent glucose(SD)/glu-cose(mean).RESULTS:At the admission,first fasting blood glucose,pharmacological treatments(insulin and/or anti-diabetic drugs)prior to entering the study and basal glycated hemoglobin(HbA1c)were observed in the two groups treated with subcutaneous or intravenous insulin infusion,respectively.When compared with patients submitted to standard therapy,insulin-infused patients showed both increased first 24-h(median 6.9 mmol/L vs 5.7mmol/L P<0.045)and overall hospitalizationδglucose(median 10.9 mmol/L vs 9.3 mmol/L,P<0.028),with a tendency to a significant increase in first 24-h glycaemic CV(23.1%vs 19.6%,P<0.053).Severe hypoglycaemia was rare(14.3%),and it was observed only in 3 patients receiving insulin infusion therapy.HbA1c values measured during hospitalization and 3 mo after discharge did not differ in the two groups of treatment.CONCLUSION:Our pilot data suggest that no real benefit in terms of GLUCV is observed when routinely managing blood glucose by insulin infusion therapy in type 2 diabetic ACS hospitalized patients in respect to conventional insulin
