Circulation. 2006;113:1717
(Circulation. 2006;113:1717.)
© 2006 American Heart Association, Inc.
Issue Highlights
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PROGRESSION OF PLASMINOGEN ACTIVATOR INHIBITOR-1 AND FIBRINOGEN LEVELS IN RELATION TO INCIDENT TYPE 2 DIABETES, by Festa et al.
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Several studies have shown that fibrinolytic and coagulation
abnormalities predict the incidence of type 2 diabetes. These
prior reports used single measurements of biomarkers and did
not investigate the possibility that changes in fibrinolytic/coagulation
biomarkers are related to the development of diabetes. In this
issue of
Circulation, Festa and colleagues studied the relations
of changes in circulating plasminogen activator inhibitor-1
(PAI-1) and fibrinogen levels to the incidence of diabetes in
843 healthy, nondiabetic participants in the Insulin Resistance
Atherosclerosis Study. The investigators noted that baseline
and follow-up measurements of PAI-1 and fibrinogen were higher
in individuals who developed diabetes compared with levels of
these biomarkers in those who did not develop diabetes over
the 5-year follow-up period. In multivariable analyses adjusting
for other known predictors, change in PAI-1 was related positively
to greater odds of developing diabetes, whereas change in fibrinogen
was not associated with incident diabetes. These observations
raise the possibility that dynamic changes in PAI-1 antedate
the development of diabetes. The authors speculate that pharmacological
alteration of PAI-1 levels may influence the risk of developing
diabetes in high-risk individuals and note that clinical trials
would be required to test this premise. See p
1753.
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ASSOCIATION BETWEEN HUMAN FETUIN-A AND THE METABOLIC SYNDROME: DATA FROM THE HEART AND SOUL STUDY, by Ix et al.
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Fetuin-A is a multifunctional hepatic secretory protein that
has complex physiological effects. It inhibits the action of
insulin in experimental animals; fetuin-A knockout mice have
increased insulin sensitivity and do not gain weight. Fetuin-A
also inhibits vascular calcification in experimental studies.
In this issue of
Circulation, Ix and colleagues evaluated the
cross-sectional relations of serum fetuin-A levels and the prevalence
of the metabolic syndrome and its individual components in 711
individuals with prior coronary disease but no diabetes. The
highest quartile of serum fetuin-A was associated with 2.7-fold
greater odds of prevalence of the metabolic syndrome compared
to the lowest quartile in analyses that adjusted for other predictors.
Prevalence of the number of components of the metabolic syndrome
increased across fetuin-A quartiles. Higher serum fetuin-A levels
correlated positively with dyslipidemia (higher low-density
lipoprotein and triglyceride concentrations but lower high-density
lipoprotein cholesterol levels). These observations are intriguing
because of other reports demonstrating an association of low
serum fetuin-A levels with increased cardiovascular mortality
in patients with renal failure. The authors emphasize the need
for additional studies to investigate the relations of fetuin-A
to risk of cardiovascular disease. See p
1760.
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EVIDENCE OF A DOMINANT BACKWARD-PROPAGATING "SUCTION" WAVE RESPONSIBLE FOR DIASTOLIC CORONARY FILLING IN HUMANS, ATTENUATED IN LEFT VENTRICULAR HYPERTROPHY, by Davies et al.
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The oxygen- and nutrient-enriched forward-flow blood perfusion
of organs and tissues has been long established to be the consequence
a cyclical pressure gradient developed during peak systole between
the central left ventricular-arterial system and the peripheral
organ capillaries. For more than 300 years, investigators have
been perplexed about how the left ventricular muscle is perfused,
implying a differential physiology that must take into account
the impedance of flow generated within the ventricle during
systole. The prior coronary flow models of phase-shifted potential
energy developed within the elastic aorta have not fully explained
the physiology of observed diastolic coronary flow. Davies et
al have employed the technique of wave intensity analysis to
demonstrate that the primary force providing normal coronary
flow is not the forward wave provided by the elastic aorta but
rather a backward suction wave developed during early diastole
from the relaxing myocardial microvasculature. Moreover, the
authors show that the reduction of coronary flow seen in left
ventricular hypertrophy is due to reduced capacity of the fibrotic
and stiff microvasculature to properly relax, thus causing a
reduction in the normally expected diastolic backward-propagating
suction wave component. See p
1768.
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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Atypical Transient Left Ventricular Ballooning Without Involvement
of Apical Segment. See p
e686.
Coronary Artery Spasm. See p e689.
Recovery of Left Ventricular Systolic Function After Biventricular Resynchronization Pacing in a Child With Repaired Tetralogy of Fallot and Severe Biventricular Dysfunction. See p e691.
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Correspondence
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See p
e693.
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Association Between Human Fetuin-A and the Metabolic Syndrome: Data From the Heart and Soul Study
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Evidence of a Dominant Backward-Propagating "Suction" Wave Responsible for Diastolic Coronary Filling in Humans, Attenuated in Left Ventricular Hypertrophy
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Progression of Plasminogen Activator Inhibitor-1 and Fibrinogen Levels in Relation to Incident Type 2 Diabetes
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[Abstract]
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PROGRESSION OF PLASMINOGEN...
ASSOCIATION BETWEEN HUMAN FETUIN...