Understanding the science of incretin biology and implications on cardiovascular risk and diabetes Sanjay Rajagopalan, MD FACC FAHA Melvin Sharoky Professorship in Medicine Chief, Division of Cardiovascular Medicine The University of Maryland School of Medicine Baltimore, MD Slides prepared and presented during CDMC in Almaty, Kazakhstan on Saturday April 12 , 2014
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Understanding the science of incretin biology and implications on cardiovascular risk and diabetes
Sanjay Rajagopalan, MD FACC FAHA Melvin Sharoky Professorship in Medicine Chief, Division of Cardiovascular Medicine The University of Maryland School of Medicine Baltimore, MD
Slides prepared and presented during CDMC in Almaty, Kazakhstan on Saturday April 12 , 2014
Adapted from Monnier L. Eur J Clin Invest. 2000;30(suppl 2):3-11.
Patients With Type 2 Diabetes May Spend
12 Hours Per Day in the Postprandial State
Postprandial Postabsorptive Fasting
Duration of Postprandial State
Breakfast Lunch Dinner Midnight 4AM Breakfast
8 AM 11 AM 2 PM 5 PM
Relationship Between Post-Prandial State
and CV Disease
• CM and CM remnants induce
atherosclerosis (1)
• RLP-C correlates with CIMT (2)
• Higher fasting RLP-C predicts CAD
events (Honolulu Heart Study) (3)
• RLP-C predicts CAD incidence
independent of TC/HDL-C/LDL-C
(Honolulu HS) (4)
• RLP-C strongest causal predictor of
CV events in Copenhagen Heart
Study
• DECODE reported that 2 h glucose
concentrations after OGTT are better
predictors of CV events and all-cause
mortality than fasting blood glucose
The Framingham Offspring Study, 2-h
blood glucose predicted CV events
better than A1C
• A meta-analysis of 38 prospective
studies in non-diabetics confirmed a
strong association between 2-h blood
glucose with fatal and nonfatal
cardiovascular events
3
Post-Prandial Lipemia
1. Zilversmit DB. Atherosclerosis a Post-Prandial Phenomenon. Circulation. 1979
Sep;60(3):473-85.
2. Karpe et al. RLPs are related to IMT of carotid artery independent of LDL-C and plasma
TG. J Lipid Res 2001; 42; 17-21
3. Kugiyama et al Remnant Lipoprotein Levels in Fasting Serum Predict Coronary Events in
patients with CAD. Circulation 1999; 99; 2858-60
4. Imke C and Rodriguez et al. Honolulu Heart Study. Arterioscl Thromb Vasc Biol 2005; 25;
1718-1722
5. Varbo A et al. Circulation. 2013 Sep 17;128(12):1298-30
Post-Prandial Hyperglycemia
1. DECODE Study Group. Glucose tolerance and CV mortality: comparison of fasting
and 2-hour criteria. Arch Intern Med 2001;161:397–405