The number of people with diabetes rose from 108 million in 1980 to 422 million in 2014, according to the latest figures from the World Health Organization (WHO). The prevalence of this disease has been increasing more rapidly in low- and middle-income countries. This disease is a major cause of blindness, renal failure, myocardial infarction, stroke and amputation of the lower limbs.
Between 2000 and 2016, premature mortality from diabetes grew by 5%. In 2019, diabetes was the ninth leading cause of death: an estimated 1.5 million deaths were a direct result of this condition. Globally, approximately 90% of people have type 2 diabetes mellitus (DM2), and Asia is the epicenter of this global epidemic.
New research has shown that through a genetic map it is possible to predict heart disease risk scores for people with this type of diabetes. This situation also allowed us to identify the likelihood that high blood pressure causes heart problems or strokes in people with type 2 diabetes. The paper has just been published in the journal Hypertension of the American Heart Association. This tool can be especially useful for guiding the treatment of people who have just been diagnosed or who have a state of prediabetes.
Previous research has confirmed that adults with type 2 diabetes are twice as likely to have a heart attack or stroke as people who do not have the disease. Several measures of health status, such as blood pressure, cholesterol, and blood sugar levels, are commonly used to determine the risk of developing heart disease.
In this study, researchers at the University of Alabama at Birmingham explored whether genetic variants related to high blood pressure are also linked to subsequent heart disease or stroke. They used that information to determine a risk score.
“The increased genetic risk of high blood pressure may predispose some people with type 2 diabetes to an increased risk of heart attack, stroke or cardiovascular death,” explained the study's lead author, Pankaj Arora, director of the Cardiogenomics Clinical Program and the Clinical Center for Cardiology. and Translational Research Program at the University of Alabama-. We conducted the study to determine whether this genetic risk score can identify people with type 2 diabetes who are more predisposed to cardiovascular events, and whether strict blood sugar control affects the link between the genetic risk of hypertension and outcomes cardiovascular”.
Arora and colleagues evaluated the health records of 6,335 participants in the United States Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial database, for whom genetic data were available. The study group consisted of 37% women and 15% were African-American, 6% were Hispanic; 70% were white; and 9% selected the category “other”. All participants had type 2 diabetes, high blood pressure, and were followed for 3.5 years.
A map of genetic variants of more than 1,000 common variants known to affect blood pressure was compared with the DNA of study participants to determine participants' genetic risk. More matches between DNA and the map of known genetic variants of blood pressure equate to a higher genetic risk score. The researchers found that the score identified study participants with a higher risk of cardiovascular events for people with higher than average scores, each higher grade being associated with a 12% higher risk of heart disease or stroke.
The task force also confirmed that the association of genetic risk with cardiovascular events was the same even if participants were taking medications to control blood sugar levels. Arora and colleagues also noted that findings about differences in individuals' genetic risk scores for high blood pressure did not fully explain why intensive glycemic control (aggressive treatment with insulin, medication, diet, and exercise) did not appear to have a cardiovascular benefit for women. people with long-standing type 2 diabetes.
“However, a genetic risk score may be useful for people newly diagnosed with type 2 diabetes to identify who should have more severe lifestyle changes, such as changes in diet and exercise, and more aggressive control of weight, blood pressure, and consumption of tobacco”, explained Arora.
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