Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Volume 53 , Issue 8
Showing 1-23 articles out of 23 articles from the selected issue
EDITORIAL
ORIGINAL ARTICLES
  • Akihiro Endo, Yasuyuki Yoshida, Kenji Kageshima, Hirotomo Sato, Toshim ...
    2014 Volume 53 Issue 8 Pages 819-828
    Published: 2014
    Released: April 15, 2014
    JOURNALS OPEN ACCESS
    Objective The low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio is considered to be a sensitive marker of the risk of atherosclerotic cardiovascular disease; however, in patients with a previous history of percutaneous coronary intervention (PCI), there is little information regarding the predictive value of this parameter beyond the period of early restenosis. The aim of this study was to investigate contributing factors to newly developed coronary artery disease in patients with a previous history of PCI after stabilization.
    Methods The clinical characteristics of 238 patients with a previous history of PCI who underwent coronary angiography following recurrent cardiac ischemia beyond the period of early restenosis were examined.
    Results Overall, 64% of the patients underwent late revascularization, while 31% and 50% underwent late target lesion revascularization and new lesion revascularization, respectively. A multivariate analysis identified the LDL-C/HDL-C ratio to be an independent contributor to late revascularization (hazard ratio (HR), 1.37; p<0.001). Similarly, the independent contributors to late target lesion revascularization and new lesion revascularization were the non-HDL-C level and LDL-C/HDL-C ratio, respectively. Based on the median value of the LDL-C/HDL-C ratio, the patients were classified into high and low LDL-C/HDL-C ratio groups. The log-rank test revealed a significantly higher incidence of late revascularization in the high-LDL-C/HDL-C ratio group than in the low-LDL-C/HDL-C ratio group among the patients with an LDL-C level of ≥100 mg/dL (p=0.011). However, the difference between the two groups was diminished among the patients with an LDL-C level of <100 mg/dL (p=0.047), and only diabetes mellitus (HR, 2.239; p=0.009) was found to be an independent contributor to late coronary revascularization in these patients.
    Conclusion The LDL-C/HDL-C ratio is an important contributor to the development of new coronary artery disease in patients with a previous history of PCI beyond the period of early restenosis, particularly among patients with an LDL-C level of ≥100 mg/dL.
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  • Kenji Shima, Machiko Komatsu, Yoshihiko Noma, Keiko Miya
    2014 Volume 53 Issue 8 Pages 829-835
    Published: 2014
    Released: April 15, 2014
    JOURNALS OPEN ACCESS
    Objective The aim of this study was to compare the utility of hemoglobin A1c (HbA1c) and glycated albumin (GA) for evaluating the efficacy of the dipeptidyl peptidase-4 (DPP-4) inhibitor, sitagliptin, in patients with type 2 diabetes.
    Methods Sitagliptin (50 mg) was administered orally once daily in 67 outpatients with type 2 diabetes. Drug effectiveness was deemed present if the HbA1c or GA level decreased by 5% at week 4 and week 12 relative to the baseline value.
    Results The mean HbA1c level decreased from 8.1±1.0% at baseline to 7.8±0.9% at week 4 and 7.2±0.8% at week 12. The mean GA level decreased from 25.0±4.5% at baseline to 22.2±3.8% at week 4 and 20.8±3.5% at week 12. At week 4 and week 12, the drug was effective in 37.8% and 71.6% of the patients, respectively, when assessed based on changes in HbA1c, and in 83.6% and 97.0% of the patients, respectively, when assessed based on changes in GA.
    Conclusion GA is superior to HbA1c for evaluating the efficacy of sitagliptin treatment in patients with type 2 diabetes.
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  • Yuji Shimizu, Mio Nakazato, Takaharu Sekita, Jun Koyamatsu, Koichiro K ...
    2014 Volume 53 Issue 8 Pages 837-843
    Published: 2014
    Released: April 15, 2014
    JOURNALS OPEN ACCESS
    Objective Our previous study reported that categorizing diabetes patients according to the serum triglycerides-to-high-density lipoprotein cholesterol (TG-HDL) ratio is useful for estimating the risk of atherosclerosis, as a high TG-HDL ratio in patients with diabetes constitutes risk factors for atherosclerosis. Another study showed that a high hemoglobin level is associated with the risk of atherosclerosis. However, no previous studies have examined the association between the hemoglobin level and diabetes categorized by the TG-HDL ratio. In order to investigate these associations, we conducted a cross-sectional study of 3,733 (1,299 men and 2,434 women) Japanese participants 30-89 years of age undergoing a general health checkup.
    Methods We investigated the association between the hemoglobin levels and the incidence of diabetes in all subjects, who were divided into tertiles according to the TG-HDL ratio. Diabetes was defined as an HbA1c (NGSP) level of ≥6.5% and/or the initiation of glucose-lowering or insulin therapy.
    Results Of the 265 diabetes patients identified in this study, 116 had a high TG-HDL ratio (high TG-HDL diabetes) and 71 had a low TG-HDL ratio (low TG-HDL diabetes). Independent from classical cardiovascular risk factors, the multivariate odds ratio of a 1 SD (standard deviation) increment in hemoglobin (1.30 g/dL for men, 1.16 g/dL for women) was 1.04 (95% confidence intervals (CI): 0.88-1.22) for all patients with diabetes, 1.44 (95%CI: 1.17-1.77) for the patients with high TG-HDL diabetes and 0.67 (95%CI: 0.54-0.83) for the patients with low TG-HDL diabetes.
    Conclusion The hemoglobin level is positively associated with high TG-HDL diabetes and inversely associated with low TG-HDL diabetes. These findings suggest that measuring the hemoglobin level is clinically relevant for estimating the risk of atherosclerosis in patients with diabetes categorized according to the TG-HDL ratio.
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