Dysglycemia predicts cardiovascular and kidney disease in the Kidney Early Evaluation Program.

The cardiometabolic syndrome has been associated with both chronic kidney disease (CKD) and cardiovascular disease (CVD). Using data from the National Kidney Foundation-Kidney Early Evaluation Program, the authors sought to investigate this association in a targeted CKD cohort. A total of 26,992 patients met eligibility criteria including age 18 years and older, diabetes, hypertension, or family history of CKD, diabetes, or hypertension and excluded those taking renal replacement therapy.

Pertinence of myocardial perfusion imaging in octogenarians.

Aim: Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the elderly population. Atypical presentation, reduced activity levels, and comorbidity often confound the diagnosis. We studied the use of stress myocardial perfusion imaging (MPI) in octogenarians.

Diabetes mellitus and CKD awareness: the Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES).

Background: Diabetes contributes to increased morbidity and mortality in patients with chronic kidney disease (CKD). We sought to describe CKD awareness and identify factors associated with optimal glycemic control in diabetic and nondiabetic individuals both aware and unaware of CKD.

Methods: This cross-sectional analysis compared Kidney Early Evaluation Program (KEEP) and National Health and Nutrition and Examination Survey (NHANES) 1999 to 2006 participants with diabetes and CKD.

Endocrine functions of adipose tissue: focus on adiponectin.

Accumulating evidence indicates that obesity and overweight are associated with, and contribute to, the development of type 2 diabetes mellitus (DM), cardiovascular disease (CVD), and chronic kidney disease (CKD). The adipocyte-derived cytokine, adiponectin, has been shown to improve insulin sensitivity, increase rates of fatty acid oxidation, decrease muscle lipid content, and reduce inflammation and vascular injury. However, adiponectin levels have been found to be reduced in persons with obesity and type 2 DM.

Insulin resistance and blood pressure.

Insulin resistance, cardiometabolic syndrome, and hypertension are common health problems with significant consequences for individuals and society. The pathogenesis of these disorders is complex and not fully understood. In this article we review the current knowledge about the effects of lifestyle modification and pharmacologic antihypertensive agents on insulin resistance and hypertension.

Diabetes mellitus in CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition and Examination Survey (NHANES) 1999-2004.

Background: Diabetes mellitus is the leading cause of chronic kidney disease (CKD) and contributes to increased morbidity and mortality in the CKD population. Early diabetes identification through targeted screening programs is important for the development of preventive strategies.

Methods: This is a cross-sectional analysis of the National Kidney Foundation Kidney Early Evaluation Program (KEEP) data and National Health and Nutrition and Examination Survey (NHANES) 1999-2004 data.

CKD in the United States: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999-2004.

Background: The prevalence of chronic kidney disease (CKD) is increasing in the United States, caused in part by older age and increasing prevalences of hypertension and type 2 diabetes. CKD is silent and undetected until advanced stages. The study of populations with earlier stages of kidney disease may improve outcomes of CKD.

Nonalcoholic fatty liver disease and mitochondrial dysfunction.

Nonalcoholic fatty liver disease (NAFLD) includes hepatic steatosis, nonalcoholic steatohepatitis (NASH), fibrosis, and cirrhosis. NAFLD is the most common liver disorder in the United States and worldwide. Due to the rapid rise of the metabolic syndrome, the prevalence of NAFLD has recently dramatically increased and will continue to increase.

NADPH oxidase contributes to vascular inflammation, insulin resistance, and remodeling in the transgenic (mRen2) rat.

Reduced insulin sensitivity is characteristic of various pathological conditions such as type 2 diabetes mellitus and hypertension. Angiotensin II, acting through its angiotensin type 1 receptor, inhibits the actions of insulin in the vasculature which may lead to deleterious effects such as vascular inflammation, remodeling, endothelial dysfunction, and insulin resistance. In contrast, insulin normally exerts vasodilatory, antiinflammatory, and prosurvival actions.

Antihypertensive efficacy of Irbesartan/HCTZ in men and women with the metabolic syndrome and type 2 diabetes.

This subgroup analysis of the Irbesartan/Hydrochlorothiazide (HCTZ) Blood Pressure Reductions in Diverse Patient Populations (INCLUSIVE) trial evaluated the efficacy and safety of irbesartan/HCTZ fixed combinations in adults with uncontrolled systolic blood pressure (SBP) (140-159 mm Hg; 130-159 mm Hg for type 2 diabetes mellitus [T2DM]) after >or=4 weeks of antihypertensive monotherapy. Treatment was sequential: placebo (4-5 weeks), HCTZ 12.5 mg (2 weeks), irbesartan/HCTZ 150/12.

Effect of antihypertensive agents on the development of type 2 diabetes mellitus.

People with hypertension have a high prevalence of insulin resistance and are at relatively high risk of developing type 2 diabetes mellitus. It is becoming increasingly evident that antihypertensive agents have disparate metabolic effects. For example, recent clinical trials indicate that agents that interrupt the renin-angiotensin axis reduce the risk of developing diabetes compared with other classes of antihypertensive agents.

Hypertension--a treatable component of the cardiometabolic syndrome: challenges for the primary care physician.

Patients with the cardiometabolic syndrome (CMS) have an adverse cardiovascular risk factor profile, placing them at increased risk of stroke, coronary artery disease, chronic kidney disease, and type 2 diabetes mellitus. Although no specific treatments for CMS are available per se, prompt recognition and treatment of the individual components of the condition can prevent or delay the development of comorbidities. Primary care physicians are ideally positioned to identify patients with CMS and implement early intervention strategies.

The cardiometabolic syndrome as a cardiovascular risk factor.

The cardiometabolic syndrome (CMS) is associated with cardiovascular disease (CVD) and includes a constellation of risk factors such as central obesity, hypertension, insulin resistance, dyslipidemia, microalbuminuria, and hypercoagulability. Collectively, these risk factors increase CVD endpoints such as stroke, congestive heart failure, chronic kidney disease (CKD), and overall mortality. The CMS is associated with endothelial dysfunction, inflammation, abnormal thrombolysis, and increased oxidative stress that accentuate progression of CVD.

The key role of insulin resistance in the cardiometabolic syndrome.

Insulin resistance is invariably present in patients with the cardiometabolic syndrome and is thought to play a key role in its pathogenesis. It represents a complex interaction of maladaptive characteristics related to impaired insulin action at target organs and external factors such as genetics and environment. It is likely that the molecular factors that underlie insulin resistance and resultant hyperinsulinemia contribute to many of the clinical components of the cardiometabolic syndrome, although the precise associations remain poorly understood.

Oxidative stress in insulin-resistant conditions: cardiovascular implications.

The risk of cardiovascular disease (CVD) in patients with diabetes mellitus is increased more than 3-fold and is the major cause of mortality and morbidity in diabetic patients. Historically, diabetes has been considered an inadequate insulin response leading to elevated plasma glucose levels with morbidities attributable to hyperglycemia. However, diabetes represents a complex pathology that often includes hypertension, dyslipidemia, endothelial dysfunction, microalbuminuria, platelet disaggregation, abnormal fibrinolysis, and chronic inflammation.

Insights into the emerging cardiometabolic prevention and management of diabetes mellitus.

Cardiovascular disease (CVD) and Type 2 diabetes mellitus (DM2), once conceived as different entities, share common origins and pathways. Increased activity of the renin-angiotensin-aldosterone-system, insulin resistance, chronic low-grade inflammation and oxidative stress collectively contribute to endothelial dysfunction and atherosclerosis, which manifest clinically as CVD. Nowadays, it is possible to identify and intervene in high-risk populations even before the clinical diagnosis of DM2.

Intracellular demonstration of active TGFbeta1 in B cells and plasma cells of autoimmune mice. IgG-bound TGFbeta1 suppresses neutrophil function and host defense against Staphylococcus aureus infection.

Infection remains a leading cause of morbidity and mortality in patients with SLE. To investigate this, previously we assessed the host defense status of autoimmune MRL/lpr mice and found that elaboration of active TGFbeta suppressed neutrophil function and decreased survival in response to Staphylococcus aureus infection. The purpose of the present work was to elucidate the molecular form and the cellular source of the active TGFbeta involved.

Salt and water homeostasis: uroguanylin is a circulating peptide hormone with natriuretic activity.

Guanylin and uroguanylin are small, heat-stable peptides that were initially isolated from rat jejunum and opossum urine, respectively. Both peptides bind to and activate a common set of apical membrane receptors that contain a guanylate cyclase catalytic domain within the receptor molecule. The guanylin/uroguanylin receptors are found on the luminal surface of epithelial cells lining the intestinal tract and renal proximal tubules as well as in other organs.

Differential effects of CD4+ T cell depletion on inflammatory central nervous system disease, arthritis and sialadenitis in MRL/lpr mice.

Autoimmune MRL/lpr mice were treated for 12-14 weeks with anti-CD4 monoclonal antibody to define the role of CD4+ T cells in the pathogenesis of the inflammatory central nervous system (CNS) lesions, arthritis and sialadenitis characteristic of the strain. Anti-CD4 therapy effectively prevented the development of CNS lesions and arthropathic changes. Marked depletion of CD4+ T cells was documented in the mononuclear cells infiltrating the major salivary glands but the severity of sialadenitis was significantly increased by chronic anti-CD4 immunotherapy.

Defective neutrophil function in the autoimmune mouse strain MRL/lpr. Potential role of transforming growth factor-beta.

Patients with systemic autoimmune diseases such as SLE and rheumatoid arthritis have increased rates of morbidity and mortality caused by infection. Although this increased risk of infection has been primarily attributed to therapeutic immuno-suppression, some reports exist of defective polymorphonuclear leukocytes (PMN) function in these patients. The purpose of the present work is to investigate the recruitment of PMN phagocytic function in a murine model of autoimmunity, the MRL/lpr mouse.