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Showing papers by "Anushka Patel published in 2006"


Journal Article
TL;DR: Evidence of a strong continuous association between body mass index and diabetes in the Asia Pacific region is provided and considerable potential for reduction in incidence of diabetes with population-wide lowering of body massIndex in this region is indicated.
Abstract: Few prospective data from the Asia Pacific region are available relating body mass index to the risk of diabetes. Our objective was to provide reliable age, sex and region specific estimates of the associations between body mass index and diabetes. Twenty-seven cohort studies from Asia, New Zealand and Australia, including 154,989 participants, contributed 1,244,793 person-years of follow-up. Outcome data included a combination of incidence of diabetes (based on blood glucose measurements) and fatal diabetes events. Hazard ratios were calculated from Cox models, stratified by sex and cohort, and adjusted for age at risk and smoking. During follow-up (mean = 8 years), 75 fatal diabetes events and 242 new cases of diabetes were documented. There were continuous positive associations between baseline body mass index and risk of diabetes with each 2 kg/m(2) lower body mass index associated with a 27% (23-30%) lower risk of diabetes. The associations were stronger in younger age groups, and regional comparisons demonstrated slightly stronger associations in Asian than in Australasian cohorts (P = 0.04). This overview provides evidence of a strong continuous association between body mass index and diabetes in the Asia Pacific region. The results indicate considerable potential for reduction in incidence of diabetes with population-wide lowering of body mass index in this region.

89 citations


Journal ArticleDOI
TL;DR: Participation in ironman triathlon often resulted in persistently raised cTnT levels, and the troponin rise was associated with echocardiographic evidence of abnormal left ventricular function.
Abstract: Background: There is concern about whether cardiac damage occurs as a result of prolonged strenuous exercise. Objective: To investigate whether competing in a triathlon is associated with cardiac damage based on a sustained increase in cardiac troponin T (cTnT), and whether such an increase correlates with echocardiographic changes Methods: cTnT and echocardiographic measurements were made in 38 participants in the 2001 Australian ironman triathlon. cTnT was measured the day before, immediately after, and the day following the race. Echocardiography was done the day before, immediately after, and two to six weeks later for measurement of ejection fraction, stroke volume, cardiac output, wall motion analysis, and global left ventricular function (LVF). Results: No subject had detectable cTnT in the pre-race sample. Following the race, 32 subjects (86.5%) had detectable levels of cTnT (>0.01 ng/ml), with six (16.2%) having >0.10 ng/ml. The day after the race, nine subjects (23.7%) still had detectable cTnT, with two recording a level >0.10 ng/ml. Previously described echocardiographic changes of “cardiac fatigue” were observed in the whole cohort. There was a modest but significant correlation between change in ejection fraction and peak cTnT level (p = 0.02, r = 0.39). Athletes with a post-race cTnT >0.10 ng/ml had a greater decrease in global LVF (p = 0.02) and a trend toward a greater fall in ejection fraction and stroke volume than athletes with cTnT levels 0.10 ng/ml (p>0.05). Conclusions: Participation in ironman triathlon often resulted in persistently raised cTnT levels, and the troponin rise was associated with echocardiographic evidence of abnormal left ventricular function. The clinical significance and long term sequelae of such damage remains to be determined.

73 citations


Journal ArticleDOI
TL;DR: As expected, abnormal waist circumference was considerably more prevalent among individuals with the metabolic syndrome in the US compared with their Asian counterparts, but substantial variation was also observed between the Asian populations.

65 citations


Journal ArticleDOI
TL;DR: Measurement of sVCAM-1 and NT-proBNP levels provides prognostic information for recurrent ischemic stroke beyond traditional risk factors.
Abstract: Background Patients with stroke or transient ischemic attack are at high risk of another stroke, and there is need for improved strategies to predict recurrent stroke. Objective To assess the prognostic value of levels of soluble vascular cell adhesion molecule 1 (sVCAM-1), N-terminal pro–B-type natriuretic peptide (NT-proBNP), C-reactive protein, homocysteine, renin, and lipids and lipoprotein particle concentration and size in patients with previous stroke or transient ischemic attack. Design, Setting, and Participants A nested case-control study of participants of the Perindopril Protection Against Recurrent Stroke Study was performed. The Perindopril Protection Against Recurrent Stroke Study was a placebo-controlled trial of a perindopril erbumine–based, blood pressure–lowering regimen that reduced ischemic stroke risk by 24% among individuals with previous stroke or transient ischemic attack. Each of 252 patients who experienced ischemic stroke during a mean follow-up of 3.9 years was matched to 1 to 3 control patients. Matching variables were age, sex, treatment allocated, region, and most recent qualifying event at randomization. Main Outcome Measures Risk of ischemic stroke predicted by baseline levels of sVCAM-1, NT-proBNP, C-reactive protein, homocysteine, renin, and lipids and lipoprotein particle concentration and size. Results Levels of sVCAM-1 and NT-proBNP predicted recurrent ischemic stroke. The odds ratio for patients in the highest, as compared with the lowest, quarter was 2.24 (95% confidence interval, 1.35-3.73) for sVCAM-1 level and 1.62 (95% confidence interval, 0.98-2.69) for NT-proBNP level, after adjustment for matching and other risk factors. Patients in the highest quarters for both sVCAM-1 and NT-proBNP levels had 3.6 times the risk of recurrent ischemic stroke compared with patients in the lowest quarters for both biologic markers. Level of sVCAM-1 was similarly predictive of ischemic stroke in patients allocated to placebo and perindopril-based therapy. Baseline plasma levels of C-reactive protein, homocysteine, renin, and lipids and lipoprotein particle concentration and size did not predict recurrent ischemic stroke risk. Conclusion Measurement of sVCAM-1 and NT-proBNP levels provides prognostic information for recurrent ischemic stroke beyond traditional risk factors. Published online November 14, 2005 (doi:10.1001/archneur.63.1.noc50221).

43 citations


Journal ArticleDOI
TL;DR: Specific cut-points for metabolic risk factors are not generalizable between populations and a multivariable definition of the metabolic syndrome including all risk factors as continuous variables improves CHD risk discrimination substantially.

24 citations


Journal ArticleDOI
TL;DR: Safe and effective blood pressure lowering with the fixed low-dose combination of perindopril and indapamide was confirmed during the run-in phase in 11 140 patients with type 2 diabetes, who were subsequently randomly assigned.
Abstract: Objective and rationale ADVANCE (Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation) is a large-scale trial designed to investigate the benefits of blood pressure lowering and intensive glucose control in patients with type 2 diabetes, and to address a number of unresolved issues: whether blood pressure-lowering therapy and intensive glucose control therapy will reduce the risk of major vascular disease regardless of initial blood pressure or glucose concentration; whether more intensive glucose control targeting a haemoglobin A1c (HbA1c) level of 6.5% or less will confer greater protection against microvascular disease; and whether the benefits of the two interventions are additive. Design and methods ADVANCE is a 2 × 2 factorial randomized clinical trial evaluating the risks and benefits of the low-dose fixed combination of perindopril and indapamide versus placebo to lower blood pressure and of an intensive gliclazide-MR-based glucose control regimen, targeting an HbA1c of 6.5% or less versus standard guidelines based therapy for glucose control. There are two primary outcomes: a composite macrovascular endpoint and a composite microvascular endpoint. Results A total of 12 878 participants from 215 centres in 20 countries entered a 6-week run-in phase between June 2001 and January 2003, and 11 140 patients were randomly assigned by March 2003. The average (SD) systolic and diastolic blood pressure fell from 145 (22)/81 (11) to 137 (20)/78 (10) mmHg during the 6-week run-in phase, during which participants received one tablet of open-labelled perindopril 2 mg/indapamide 0.625 mg. Of the 12 878 patients who entered the run-in, only 3.6% withdrew because of suspected intolerance to perindopril/indapamide. The study is half way through follow-up and both the study medications (perindopril 2 mg/indapamide 0.625 mg and gliclazide-MR) continue to be well tolerated. Completion is expected in 2007. Conclusion Safe and effective blood pressure lowering with the fixed low-dose combination of perindopril and indapamide was confirmed during the run-in phase in 11 140 patients with type 2 diabetes, who were subsequently randomly assigned. Post-randomization study treatments have been well tolerated, and the completion of follow-up is scheduled in 2007.

20 citations


Journal ArticleDOI
TL;DR: There is no justification for developing separate risk prediction models for those with and without diabetes, nor for assuming that everyone with diabetes should be considered as being at a common high level of risk.
Abstract: nBackground Coronary risk prediction 'engines' are now in common use, and their worth is well proven. There remains the question of how to deal with a prior diagnosis of diabetes. Design An individual participant meta-analysis of 33 cohort studies involving 364 566 subjects. Methods Fatal coronary hazard ratios for age, smoking, systolic blood pressure and cholesterol, were computed from Cox models, comparing those with and without diabetes. Three risk prediction equations were compared: a 'stepped model, which included the risk factors and diabetes status; an 'interaction model, which included interactions between diabetes and the risk factors; and a 'fixed model, which fixed the 10-year rate of coronary death amongst those with diabetes to be 7%. These were compared through the area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow statistics. Results The hazard ratio for age was greater for those without diabetes than those with, for men (P=0.005) and women (P=0.02); for men only, systolic blood pressure showed a similar differential (P=0.011). Nevertheless, AUCs were only 0.001 different for the stepped and interaction models for each sex. The AUC for the fixed model was lower and, unlike the other two, showed significant lack of fit for both sexes (P l 0.001). Conclusions There is no justification for developing separate risk prediction models for those with and without diabetes, nor for assuming that everyone with diabetes should be considered as being at a common high level of risk. Diabetes status might, instead, be used as a risk variable in an overall population equation.

16 citations


Journal ArticleDOI
TL;DR: Patel and Kengne discuss a new study inPLoS Medicine which found a 2-fold increased risk of cardiovascular death associated with diabetes in people over 65 years old.
Abstract: It is well established that diabetes mellitus is associated with adverse health outcomes. Data from general population cohorts indicate a 2- to 3-fold increase in cardiovascular risks and about a 50 percent increase in the risks of non-cardiovascular mortality associated with this condition [1–3]. These associations appear largely consistent across populations in different regions of the world [3]. There is some evidence that diabetes may be a more important determinant of cardiovascular risk for women than men [4]. However, the relative effects of diabetes on vascular and other diseases among older, compared with younger, individuals is less certain. Heterogeneity by age in the association between diabetes and cardiovascular disease has been reported, with a consistently weaker association observed among older individuals [3,5]. Given this possible age-dependency in the epidemiological associations, and the frequent observation that cardiovascular risk factors are often managed less aggressively in older people than in younger people [6], a better understanding of the relationship between diabetes and disease-specific causes of death among older people is important.

10 citations


Journal ArticleDOI
TL;DR: A substantial fall in blood pressure was observed following 6 weeks of treatment with a fixed low-dose combination of perindopril-indapamide in a broad range of high-risk individuals with type 2 diabetes.
Abstract: Background. ADVANCE is a major international trial assessing the effects of routine compared with more intensive blood pressure lowering and intensive glucose control on macrovascular and microvascular outcomes, among high-risk individuals with type 2 diabetes. We describe the experience of participants receiving active blood pressure lowering therapy during the run-in phase of the study, and the characteristics of participants who withdrew during this phase. Methods.All participants potentially eligible for inclusion in ADVANCE underwent 6 weeks of therapy with fixed low-dose perindopril 2 mg and indapamide 0.625 mg combination daily, as part of an active run-in phase of the study. This treatment was provided in addition to the participants' existing therapeutic regimen, including other blood pressure lowering drugs. Results.Of the 12 878 registered participants who entered the run-in phase, 11 140 participants were randomized. Only 459 participants (3.6%) withdrew due to suspected intolerance of perindopril-indapamide. The mean blood pressure fell by an average of 8/3 mmHg from 145/81 mmHg (standard deviation 22/11 mmHg) to 137/78 (20/10). Participants who proceeded to randomization were broadly similar to those who withdrew during the run-in phase; however, some features suggest that those randomized were a higher risk group overall. Conclusions. A substantial fall in blood pressure was observed following 6 weeks of treatment with a fixed low-dose combination of perindopril-indapamide in a broad range of high-risk individuals with type 2 diabetes. Good tolerability and safety of the study drug was confirmed during the active run-in phase of the ADVANCE study.

7 citations