Futoshi Anan

Influence of menstrual cycle on QT interval dynamics

Objectives: The aim of this study was to investigate the effects of the menstrual cycle on QT interval dynamics and the autonomic tone in healthy women.

Pioglitazone shift circadian rhythm of blood pressure from non‐dipper to dipper type in type 2 diabetes mellitus

Background  Insulin resistance significantly correlated with a non‐dipper type of essential hypertension. Thiazolidinediones (TZD), oral hypoglycaemic agents that act as insulin sensitizers, have been demonstrated in multiple in vivo and in vitro studies to possess antihypertensive properties. This study examined the efficacy of TZD therapy with pioglitazone at transforming the circadian rhythms of blood pressure from a non‐dipper to a dipper type.

Smoking is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients

Background  Smoking and cardiovascular autonomic dysfunction are associated with high mortality in type 2 diabetic patients. This study tested the hypothesis that smoking is associated with insulin resistance/hyperinsulinaemia and cardiovascular autonomic dysfunction in type 2 diabetic patients who are not treated with insulin.

Early atorvastatin therapy improves cardiac function in patients with acute myocardial infarction.

BACKGROUND A number of experimental and clinical studies have demonstrated a cardioprotective effect of statins; however, the effect of atorvastatin on cardiac function in patients with an acute myocardial infarction (AMI) has not been established. METHODS AND RESULTS Thirty consecutive patients with an AMI (16 males and 14 females) were enrolled. All the patients underwent successful percutaneous coronary intervention in the early phase after the onset of an AMI. Patients with a total cholesterol level > 200mg/dL on admission (n = 14) were assigned to the atorvastatin group. They began taking 10 mg of atorvastatin daily within 48 h after the onset of the AMI, while the other patients (n = 16) did not receive atorvastatin and served as the control group. Echocardiography and blood sampling to measure brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) levels were repeated on the 2nd day (2D), 3 weeks (3W), 12 weeks (12W), and 24 weeks (24W) after the onset of the AMI. The percentage of patients with a high BNP level (BNP > 20 pg/mL) was significantly decreased from 2D to 24W in the atorvastatin group, but not in the control group (100 to 57% in the atorvastatin group, p < 0.05; 100 to 80% in the control group, n.s.). Similar results also occurred with respect to the ANP level (ANP > 40 pg/mL) (62 to 21% in the atorvastatin group, p < 0.05; 57 to 40% in the control group, n.s.). The left ventricular ejection fraction was significantly higher in the atorvastatin group than the control group at 3W (66.0 ± 7.8% vs. 56.5 ± 11.8%, p < 0.05) and 24W (67.5 ± 9.2% vs. 59.7 ± 9.8%, p < 0.05). In the atorvastatin group, the left ventricular systolic diameter was significantly decreased at 24W compared with that at 2D (37.1 ± 8.0 mm to 31.4 ± 6.5 mm, p < 0.05). CONCLUSIONS Initiation of atorvastatin in the early phase of an AMI has beneficial effects on cardiac function, probably by improving left ventricular remodeling.

Association between hippocampal volume and serum adiponectin in patients with type 2 diabetes mellitus

Type 2 diabetes mellitus (DM) is associated with cognitive dysfunction and hippocampus volume. The aim of the present study was to test the hypothesis that the level of the adipocytokine adiponectin correlates with hippocampus volume and insulin resistance in patients with type 2 DM. A total of 45 patients with type 2 DM were divided into two groups: a low adiponectin group and a normal adiponectin group. Hippocampus volume was measured by computer-assisted analysis using a magnetic resonance imaging (MRI) voxel-based specific regional analysis system developed for the study of Alzheimers disease as the end point for assessment of hippocampus volume. Mean hippocampus volume was lower in the low adiponectin group than in the normal adiponectin group (P<.0001). Fasting serum concentrations of glucose (P<.05) and insulin (P<.0001), and homeostasis model assessment index (P<.0001), were all higher in the low adiponectin group than in the normal adiponectin group. Multiple regression analysis showed that hippocampus volume independently predicted serum adiponectin level. These results suggest that circulating levels of adiponectin are related to hippocampus volume in patients with type 2 DM.

Abdominal visceral fat accumulation is associated with hippocampus volume in non-dementia patients with type 2 diabetes mellitus

Obesity is associated with cognitive dysfunction, for which changes in the hippocampus plausibly play a pivotal role. We tested the hypothesis that an elevated level of visceral fat accumulation (VFA) correlates with hippocampus volume and insulin resistance in non-dementia patients with type 2 diabetes. Subjects included 48 non-dementia patients with type 2 diabetes, who were divided into two groups, high VFA group (mean+/-standard deviation: age=65+/-6 years, n=30) and normal VFA group (65+/-5 years, n=18). Hippocampus volume has been quantitated with computer-assisted analysis using a magnetic resonance imaging (MRI) voxel-based specific regional analysis system developed for the study of Alzheimers disease (VSRAD), which yields a Z-score as the end point for assessment of hippocampal volume. The Z-score was higher in the high VFA group than in the normal VFA group (p<0.0001). The fasting plasma glucose (p<0.05) and insulin concentrations (p<0.0001) and the homeostasis model assessment (HOMA) index (p<0.0001) were higher in the high VFA group than in the normal VFA group. Multiple regression analysis showed that VFA levels were independently predicted by Z-score and HOMA index. Our results indicate that the elevated level of VFA in Japanese non-dementia patients with type 2 diabetes is characterized by increased hippocampus volume and insulin resistance, and that the Z-score and HOMA index are independent predictors of VFA.

Visceral fat accumulation is a significant risk factor for white matter lesions in Japanese type 2 diabetic patients

Background  The presence of white matter lesions (WML) is an important prognostic factor for the development of stroke. The elevated visceral fat accumulation (VFA) has been reported to be closely related to the development of atherosclerosis. This preliminary study was therefore designed to test the hypothesis that the presence of WML correlates with VFA and insulin resistance in type 2 diabetic patients not receiving insulin treatment.

High-sensitivity C-reactive protein is associated with hippocampus volume in nondementia patients with type 2 diabetes mellitus

The elevated level of high-sensitivity C-reactive protein (HSCRP) is associated with cognitive dysfunction, for which changes in the hippocampus plausibly play a pivotal role. We tested the hypothesis that an elevated level of HSCRP correlates with hippocampus volume and insulin resistance in nondementia patients with type 2 diabetes mellitus. Subjects included 45 nondementia patients with type 2 diabetes mellitus, who were divided into 2 groups: high-HSCRP group (age, 65 ± 6 years [mean ± SD]; n = 17) and normal-HSCRP group (65 ± 7 years, n = 28). Hippocampus volume has been quantitated with computer-assisted analysis using a magnetic resonance imaging voxel-based specific regional analysis system developed for the study of Alzheimer disease (VSRAD), which yields a z score as the end point for assessment of hippocampal volume. The z score was higher in the high-HSCRP group than in the normal-HSCRP group (P < .0001). The fasting plasma glucose (P < .05) and insulin concentrations (P < .0001) and the homeostasis model assessment (HOMA) index (P < .0001) were higher in the high-HSCRP group than in the normal-HSCRP group. Multiple regression analysis showed that HSCRP levels were independently predicted by z score and HOMA index. Our results indicate that the elevated level of HSCRP in Japanese nondementia patients with type 2 diabetes mellitus is characterized by increased hippocampus volume and insulin resistance, and that the z score and HOMA index are independent predictors of HSCRP.

High-Density Lipoprotein Cholesterol and Insulin Resistance Are Independent and Additive Markers of Left Ventricular Hypertrophy in Essential Hypertension

We examined whether plasma high-density lipoprotein-cholesterol (HDL-C) levels and glucose metabolism parameters are independent or additive predictors of left ventricular hypertrophy (LVH) in patients with untreated essential hypertension. The study group consisted of 41 Japanese patients with untreated essential hypertension and LVH (left ventricular mass index [LVMI] >125 g/m2; age 58±6 years, mean±SD), and the control group consisted of 39 age-matched patients with untreated essential hypertension without LVH (LVMI ≤125 g/m2; age 58±7 years). The following metabolic parameters were higher in the group with LVH: fasting plasma glucose (FPG) (p<0.01), fasting insulin concentration (F-IRI) (p<0.0001), and homeostasis model assessment (HOMA)-index (p<0.0001). Among the laboratory parameters investigated, plasma HDL-C levels were lower (p<0.0001), and triglyceride and uric acid levels were higher in the group with LVH (p<0.05 for both). The nighttime systolic and diastolic ambulatory blood pressure (ABP) (p<0.0001, p<0.01, respectively) and nighttime heart rate (p<0.01) were higher in patients with LVH. Multivariate logistic analysis identified HDL-C (odds ratio [OR]=0.92, 95% confidence interval [CI]=0.87–0.98, p<0.05), HOMA-index (OR=3.83, 95% CI=1.28–11.5, p<0.05) and nighttime systolic ambulatory blood pressure (ABP) (OR=1.06, 95% CI=1.00–1.13, p<0.05) as independent significant risk factors for LVH. Our findings suggest that HDL-C, HOMA-index and nighttime systolic ABP are independent predictors for the presence of LVH in Japanese patients with essential hypertension.

The role of microalbuminuria and insulin resistance as significant risk factors for white matter lesions in Japanese type 2 diabetic patients

ABSTRACT Objective: The presence of white matter lesions (WML) is an important prognostic factor for the development of stroke. Microalbuminuria, which is associated with diabetes, has been flagged as a novel predictor for cerebrovascular events. This preliminary study was therefore designed to test the hypothesis that the presence of WML correlates with microalbuminuria and insulin resistance in patients with type 2 diabetic mellitus (DM) not receiving insulin treatment. Patients and methods: Based on brain magnetic resonance imaging (MRI) findings, 90 type 2 diabetic patients were divided into two groups: a WML-positive group (57 ± 8 years, mean ± SD, n = 34) and a WML-negative group (57 ± 6 years, n = 56). The level of blood glucose was assessed by fasting plasma glucose (FPG), fasting immunoreactive insulin (F-IRI), homeostasis model assessment (HOMA) index, and hemoglobin A 1c (HbA1c). Results: The body mass index was higher in the WML-positive group than in the WML-negative group (p < 0.01). Plasma levels of triglycerides were higher while high-density lipoprotein cholesterol (HDL-C) was lower in the WML-positive group than in the WML-negative group (p < 0.05 and p < 0.0001, respectively). Fasting plasma glucose (p < 0.005), insulin concentrations (p < 0.0001), HOMA index (p < 0.0001), and urinary albumin excretion (p < 0.0001) levels were higher in the WML-positive group than in the WML-negative group. Multivariate logistic analysis revealed that WML was independently predicted by the microalbuminuria and insulin resistance (p < 0.005, p < 0.0005, respectively). Conclusion: The results of this preliminary study indicate that the presence of WML was associated with the microalbuminuria and insulin resistance in these Japanese patients with type 2 DM; larger cohort studies are warranted to confirm these findings.