Role of surrogate markers in assessing patients with diabetes mellitus and the metabolic syndrome and in evaluating lipid-lowering therapy

Diabetes mellitus and the metabolic syndrome (MS) are reaching epidemic proportions in the United States, and cardiovascular disease continues to be the leading cause of death among patients with diabetes. A range of noninvasive screening tools may help reduce the morbidity and mortality of patients...

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Published inThe American journal of cardiology Vol. 93; no. 11; pp. 32 - 48
Main Authors Rajaram, Venkataraman, Pandhya, Sanjay, Patel, Samir, Meyer, Peter M, Goldin, Marshall, Feinstein, Matt J.M, Neems, Rachel, Liebson, Philip R, Fiedler, Benjamin M, Macioch, James E, Feinstein, Steven B
Format Journal Article Conference Proceeding
LanguageEnglish
Published New York, NY Elsevier Inc 03.06.2004
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Abstract Diabetes mellitus and the metabolic syndrome (MS) are reaching epidemic proportions in the United States, and cardiovascular disease continues to be the leading cause of death among patients with diabetes. A range of noninvasive screening tools may help reduce the morbidity and mortality of patients with diabetes because of early detection of subclinical cardiovascular disease and active monitoring of the effectiveness of therapy. Surrogate markers of subclinical disease include conventional and contrast-enhanced ultrasound imaging of carotid artery intima-media thickness (c-IMT), 2-dimensional echocardiography, coronary artery calcium imaging, cardiac magnetic resonance imaging, ankle-brachial indices, and brachial artery reactivity testing. Because these noninvasive imaging tools are relatively comfortable and entail relatively low risk to the patient, they are ideal for initial screening and for the repeated imaging that is required for monitoring the effectiveness of therapy. Moreover, when used in large numbers of patients with diabetes, prediabetes, and the MS, these imaging tools may be useful in developing and validating thresholds for the use of lipid-lowering therapy as well as clear therapeutic goals for this population. In addition, contrast-enhanced c-IMT scans now produce real-time images of the vasa vasorum and neovascularization of atherosclerotic plaque, potentially causing a paradigm shift in our view of the genesis of atherosclerosis and affecting treatment options for all populations. Thus, surrogate markers may not only help improve individual patient outcomes, they also may help direct scarce medical resources to maximize medical benefits, improve overall medical care, and minimize costs and untoward side effects.
AbstractList Diabetes mellitus and the metabolic syndrome (MS) are reaching epidemic proportions in the United States, and cardiovascular disease continues to be the leading cause of death among patients with diabetes. A range of noninvasive screening tools may help reduce the morbidity and mortality of patients with diabetes because of early detection of subclinical cardiovascular disease and active monitoring of the effectiveness of therapy. Surrogate markers of subclinical disease include conventional and contrast-enhanced ultrasound imaging of carotid artery intima-media thickness (c-IMT), 2-dimensional echocardiography, coronary artery calcium imaging, cardiac magnetic resonance imaging, ankle-brachial indices, and brachial artery reactivity testing. Because these noninvasive imaging tools are relatively comfortable and entail relatively low risk to the patient, they are ideal for initial screening and for the repeated imaging that is required for monitoring the effectiveness of therapy. Moreover, when used in large numbers of patients with diabetes, prediabetes, and the MS, these imaging tools may be useful in developing and validating thresholds for the use of lipid-lowering therapy as well as clear therapeutic goals for this population. In addition, contrast-enhanced c-IMT scans now produce real-time images of the vasa vasorum and neovascularization of atherosclerotic plaque, potentially causing a paradigm shift in our view of the genesis of atherosclerosis and affecting treatment options for all populations. Thus, surrogate markers may not only help improve individual patient outcomes, they also may help direct scarce medical resources to maximize medical benefits, improve overall medical care, and minimize costs and untoward side effects. [PUBLICATION ABSTRACT]
Diabetes mellitus and the metabolic syndrome (MS) are reaching epidemic proportions in the United States, and cardiovascular disease continues to be the leading cause of death among patients with diabetes. A range of noninvasive screening tools may help reduce the morbidity and mortality of patients with diabetes because of early detection of subclinical cardiovascular disease and active monitoring of the effectiveness of therapy. Surrogate markers of subclinical disease include conventional and contrast-enhanced ultrasound imaging of carotid artery intima-media thickness (c-IMT), 2-dimensional echocardiography, coronary artery calcium imaging, cardiac magnetic resonance imaging, ankle-brachial indices, and brachial artery reactivity testing. Because these noninvasive imaging tools are relatively comfortable and entail relatively low risk to the patient, they are ideal for initial screening and for the repeated imaging that is required for monitoring the effectiveness of therapy. Moreover, when used in large numbers of patients with diabetes, prediabetes, and the MS, these imaging tools may be useful in developing and validating thresholds for the use of lipid-lowering therapy as well as clear therapeutic goals for this population. In addition, contrast-enhanced c-IMT scans now produce real-time images of the vasa vasorum and neovascularization of atherosclerotic plaque, potentially causing a paradigm shift in our view of the genesis of atherosclerosis and affecting treatment options for all populations. Thus, surrogate markers may not only help improve individual patient outcomes, they also may help direct scarce medical resources to maximize medical benefits, improve overall medical care, and minimize costs and untoward side effects.
Author Meyer, Peter M
Patel, Samir
Liebson, Philip R
Macioch, James E
Fiedler, Benjamin M
Rajaram, Venkataraman
Feinstein, Matt J.M
Goldin, Marshall
Feinstein, Steven B
Pandhya, Sanjay
Neems, Rachel
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Issue 11
Keywords Endocrinopathy
Human
Treatment
X Syndrome
Diabetes mellitus
Biological marker
Cardiovascular disease
Metabolic diseases
Lipids
Circulatory system
Cardiology
Phlebology
Language English
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Snippet Diabetes mellitus and the metabolic syndrome (MS) are reaching epidemic proportions in the United States, and cardiovascular disease continues to be the...
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StartPage 32
SubjectTerms Adult
Aged
Biological and medical sciences
Biomarkers - analysis
Biopsy, Needle
Blood Glucose - analysis
Cardiology. Vascular system
Cardiovascular Diseases - prevention & control
Carotid Stenosis - diagnosis
Carotid Stenosis - prevention & control
Comorbidity
Coronary Angiography - methods
Coronary Artery Disease - diagnosis
Coronary Artery Disease - prevention & control
Diabetes
Diabetes Mellitus - diagnosis
Diabetes Mellitus - drug therapy
Diabetes Mellitus - epidemiology
Female
Heart
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Immunohistochemistry
Lipids
Male
Medical imaging
Medical sciences
Medical screening
Medical treatment
Metabolic diseases
Metabolic Syndrome - diagnosis
Metabolic Syndrome - drug therapy
Metabolic Syndrome - epidemiology
Metabolism
Middle Aged
Miscellaneous
Mortality
Other metabolic disorders
Prognosis
Randomized Controlled Trials as Topic
Sensitivity and Specificity
Severity of Illness Index
Tunica Intima - drug effects
Tunica Intima - pathology
Ultrasonography, Doppler
Title Role of surrogate markers in assessing patients with diabetes mellitus and the metabolic syndrome and in evaluating lipid-lowering therapy
URI https://dx.doi.org/10.1016/j.amjcard.2004.02.004
https://www.ncbi.nlm.nih.gov/pubmed/15178515
https://www.proquest.com/docview/230360006
https://search.proquest.com/docview/71977671
Volume 93
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