@article{GybergDeBacquerDeBackeretal.2015, author = {Gyberg, Viveca and De Bacquer, Dirk and De Backer, Guy and Jennings, Catriona and Kotseva, Kornelia and Mellbin, Linda and Schnell, Oliver and Tuomilehto, Jaakko and Wood, David and Ryden, Lars and Amouyel, Philippe and Bruthans, Jan and Conde, Almudena Castro and Cifkova, Renata and Deckers, Jaap W. and De Sutter, Johan and Dilic, Mirza and Dolzhenko, Maryna and Erglis, Andrejs and Fras, Zlatko and Gaita, Dan and Gotcheva, Nina and Goudevenos, John and Heuschmann, Peter and Laucevicius, Aleksandras and Lehto, Seppo and Lovic, Dragan and Milicic, Davor and Moore, David and Nicolaides, Evagoras and Oganov, Raphae and Pajak, Andrzej and Pogosova, Nana and Reiner, Zeljko and Stagmo, Martin and St{\"o}rk, Stefan and Tokg{\"o}zoglu, Lale and Vulic, Dusko}, title = {Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology}, series = {Cardiovascular Diabetology}, volume = {14}, journal = {Cardiovascular Diabetology}, number = {133}, doi = {10.1186/s12933-015-0296-y}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-141358}, year = {2015}, abstract = {Background: In order to influence every day clinical practice professional organisations issue management guidelines. Cross-sectional surveys are used to evaluate the implementation of such guidelines. The present survey investigated screening for glucose perturbations in people with coronary artery disease and compared patients with known and newly detected type 2 diabetes with those without diabetes in terms of their life-style and pharmacological risk factor management in relation to contemporary European guidelines. Methods: A total of 6187 patients (18-80 years) with coronary artery disease and known glycaemic status based on a self reported history of diabetes (previously known diabetes) or the results of an oral glucose tolerance test and HbA1c (no diabetes or newly diagnosed diabetes) were investigated in EUROASPIRE IV including patients in 24 European countries 2012-2013. The patients were interviewed and investigated in order to enable a comparison between their actual risk factor control with that recommended in current European management guidelines and the outcome in previously conducted surveys. Results: A total of 2846 (46 \%) patients had no diabetes, 1158 (19 \%) newly diagnosed diabetes and 2183 (35 \%) previously known diabetes. The combined use of all four cardioprotective drugs in these groups was 53, 55 and 60 \%, respectively. A blood pressure target of <140/90 mmHg was achieved in 68, 61, 54 \% and a LDL-cholesterol target of <1.8 mmol/L in 16, 18 and 28 \%. Patients with newly diagnosed and previously known diabetes reached an HbA1c <7.0 \% (53 mmol/mol) in 95 and 53 \% and 11 \% of those with previously known diabetes had an HbA1c >9.0 \% (>75 mmol/mol). Of the patients with diabetes 69 \% reported on low physical activity. The proportion of patients participating in cardiac rehabilitation programmes was low (approximate to 40 \%) and only 27 \% of those with diabetes had attended diabetes schools. Compared with data from previous surveys the use of cardioprotective drugs had increased and more patients were achieving the risk factor treatment targets. Conclusions: Despite advances in patient management there is further potential to improve both the detection and management of patients with diabetes and coronary artery disease.}, language = {en} } @article{WagnerAshbyKurtzetal.2015, author = {Wagner, Martin and Ashby, Damien R. and Kurtz, Caroline and Alam, Ahsan and Busbridge, Mark and Raff, Ulrike and Zimmermann, Josef and Heuschmann, Peter U. and Wanner, Christoph and Schramm, Lothar}, title = {Hepcidin-25 in diabetic chronic kidney disease is predictive for mortality and progression to end stage renal disease}, series = {PLoS One}, volume = {10}, journal = {PLoS One}, number = {4}, doi = {10.1371/journal.pone.0123072}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-125514}, pages = {e0123072}, year = {2015}, abstract = {Background Anemia is common and is associated with impaired clinical outcomes in diabetic chronic kidney disease (CKD). It may be explained by reduced erythropoietin (EPO) synthesis, but recent data suggest that EPO-resistance and diminished iron availability due to inflammation contribute significantly. In this cohort study, we evaluated the impact of hepcidin-25—the key hormone of iron-metabolism—on clinical outcomes in diabetic patients with CKD along with endogenous EPO levels. Methods 249 diabetic patients with CKD of any stage, excluding end-stage renal disease (ESRD), were enrolled (2003-2005), if they were not on EPO-stimulating agent and iron therapy. Hepcidin-25 levels were measured by radioimmunoassay. The association of hepcidin-25 at baseline with clinical variables was investigated using linear regression models. All-cause mortality and a composite endpoint of CKD progression (ESRD or doubling of serum creatinine) were analyzed by Cox proportional hazards models. Results Patients (age 67 yrs, 53\% male, GFR 51 ml/min, hemoglobin 131 g/L, EPO 13.5 U/L, hepcidin-25 62.0 ng/ml) were followed for a median time of 4.2 yrs. Forty-nine patients died (19.7\%) and forty (16.1\%) patients reached the composite endpoint. Elevated hepcidin levels were independently associated with higher ferritin-levels, lower EPO-levels and impaired kidney function (all p<0.05). Hepcidin was related to mortality, along with its interaction with EPO, older age, greater proteinuria and elevated CRP (all p<0.05). Hepcidin was also predictive for progression of CKD, aside from baseline GFR, proteinuria, low albumin- and hemoglobin-levels and a history of CVD (all p<0.05). Conclusions We found hepcidin-25 to be associated with EPO and impaired kidney function in diabetic CKD. Elevated hepcidin-25 and EPO-levels were independent predictors of mortality, while hepcidin-25 was also predictive for progression of CKD. Both hepcidin-25 and EPO may represent important prognostic factors of clinical outcome and have the potential to further define "high risk" populations in CKD.}, language = {en} }