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Editor-in-Chief: Dario Galante

Website: http://www.sciepub.com/journal/AJCDR

   

Article

The Metabolic Syndrome in Offspring of Women with a Family History of Early Onset Type 2 Diabetes Mellitus Who Developed Gestational Diabetes Mellitus

1Department of Basic Medical Sciences, Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica


American Journal of Cardiovascular Disease Research. 2016, 4(1), 1-6
doi: 10.12691/ajcdr-4-1-1
Copyright © 2016 Science and Education Publishing

Cite this paper:
R Irving. The Metabolic Syndrome in Offspring of Women with a Family History of Early Onset Type 2 Diabetes Mellitus Who Developed Gestational Diabetes Mellitus. American Journal of Cardiovascular Disease Research. 2016; 4(1):1-6. doi: 10.12691/ajcdr-4-1-1.

Correspondence to: R  Irving, Department of Basic Medical Sciences, Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica. Email: rachael.irving@uwimona.edu.jm

Abstract

Objective: To evaluate for the metabolic syndrome (MS) in offspring of women with family history of early onset type 2 diabetes mellitus (T2DM) who developed gestational diabetes mellitus (GDM) using as controls offspring of women with no family history of diabetes and normal glucose tolerance (NGT). Methods: Anthropometric and biochemical measurements were evaluated for 30 offspring age 10-16 years of women with family history of early onset T2DM who developed GDM. Obstetrical records of these mothers were also noted. Thirty offspring of women (30) with NGT and no family history of diabetes served as controls. Measurements included: Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), fasting and postprandial glucose, insulin, waist circumference, weight and height. For analyses, MS was defined as ≥3 of 4 features: glucose intolerance, dyslipidemia, obesity and hypertension in the childhood/adolescence criteria as recommended by the National Cholesterol Education Program Adult Treatment Panel Third (NCEP-ATP III) modified standard. Cox regression analysis was used to determine the independent hazard (risk) of developing MS attributable to GDM with a family history of early onset T2DM. Results: Offspring of women with GDM and family history of early onset T2DM had significantly more (≥ 2, p<0.05) features of MS than offspring of women with NGT and no family history of diabetes. Thirty percent (30.0%), 29.5% and 39.0% of the offspring of these GDM women had glucose intolerance, obesity and dyslipidemia respectively. These offspring had a hazard of 3.33 (95% CI: 2.12-9.15) of having MS compared to offspring of women with NGT and no family history of diabetes. Conclusion: Offspring of women with GDM and family history of early onset T2DM are at increased risk for MS.

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References

[1]  Metzger B.E., Coustan D.R (Eds.): Proceedings of the Fourth International Work-shop-Conference on gestational diabetes mellitus. Diabetes Care (1998), 21 (2): B1–B167.
 
[2]  Lawlor D.A., Relton C., Sattar N., Nelson S.M. Maternal adiposity—a determinant of perinatal and offspring outcomes? Nat Rev Endocrinol (2012), 8:679-88.
 
[3]  Sridhar S.B., Ferrara A., Ehrlich S.F., Brown S.D., Hedderson M. M. Risk of large-for-gestational-age newborns in women with gestational diabetes by race and ethnicity and body mass index categories. Obstet Gynecol (2013), 121:1255-62.
 
[4]  Barrett H., Nitert M., McIntyre D.,Callaway L. Disturbances of lipoprotein metabolism with hypercholesterolemia have been reported in offspring of GDM pregnancies. Diabetes Care (2014), 37(5):1484-1493.
 
[5]  Friedemann C., Heneghan C., Mahtani K., Thompson M., Perera R., Ward A.M. Cardiovascular disease risk in healthy children and its association with body mass index: systematic review and meta-analysis. BMJ (2012), 345:e4759.
 
Show More References
[6]  West N.A., Crume T.L., Maligie M.A., Dabelea D. Cardiovascular risk factors in children exposed to maternal diabetes in utero. Diabetologia (2011), 54(3):504-7.
 
[7]  Ghosh A., Liu T., Khoury MJ., Valdez R. Family history of diabetes and prevalence of the metabolic syndrome in U. S. adults without diabetes: 6-year results from the National Health and Nutrition Examination Survey (1999-2004). Public Health Genomics (2010),13:353-9.
 
[8]  Eisenmann J.C., Welk G.J., Wickel E.E., Blair S.N. Stability of variables associated with the metabolic syndrome from adolescence to adulthood: the Aerobics center longitudinal study. Am J Hum Biol. (2004), 16(6):690-96.
 
[9]  International Diabetes Federation [IDF]. IDF definition of metabolic syndrome in children and adolescents [updated 2013 Feb; cited 2015 Nov 12]. Available from: http://www.idf.org/metabolic-syndrome/children.
 
[10]  Cook S., Weitzman M., Auinger P., Nguyen M., Dietz W.H., et al. Prevalence of a metabolic syndrome phenotype in adolescents: findings from NHANES-III, 1988-1994. Arch Pediatr Adolesc Med. (2003), 157:821-7.
 
[11]  de Ferranti S., Gauvreau K., Ludwig D., Neufeld E.J., Newburger J.W., Rifai N. Prevalence of the metabolic syndrome in American adolescents. Circulation (2004), 110:2494-7.
 
[12]  Das M., Pal S., Ghosh A. Family history of type 2 diabetes and prevalence of metabolic syndrome in adult Asian Indians. J Cardiovasc Dis Res. (2012), 3(2):104-108
 
[13]  Doria A., Yang Y., Malecki M. Phenotypic characteristics of early-onset autosomal-dominant type 2 diabetes unlinked to known maturity-onset diabetes on the young (MODY) genes. Diabetes Care (1999), 229(2): 253-26.
 
[14]  James J., Irving R., Choo-Kang E., Wright-Pascoe R., McLaughlin W., Mullings A., Gabay L., Kulkarni S. Multigenerational inheritance and clinical characteristics of three large pedigrees with early onset type 2 diabetes in Jamaica. Pan Am J Public Health (2010), 27(6):435-441.
 
[15]  Matthews D.R., Hosker J.P., Rudenski A.S., Naylor B.A., Treacher D.F., Turner R.C. Homeostasis Model Assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia (1985), 28(7):412-419.
 
[16]  Centers for Disease Control [CDC]. Clinical growth charts. Available at: http://www.cdc.gov/growthcharts/clinical_charts.htm,retreived on 1/12/2016.
 
[17]  National Heart Lung and Blood Institute (NHLBI). Available at: nblbi.nih.gov/guidelines/hypertension/child_tbl.htm, retrieved on 12/14/2015.
 
[18]  Landon M., Rice M.M., Yarner M., Casey B., Reddy U., Wapner R., et al. Mild Gestational Diabetes Mellitus and Long-Term Child Health. Diabetes Care (2014).
 
[19]  Kaplan N.M. The deadly quartet. Upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med (1989), 149(7):1514-20.
 
[20]  Tracy R.E., Newman W.P., Wattigney W.A., Srinivasan S.R., Strong J.P., Berenson G.S. Histologic features of atherosclerosis and hypertension from autopsies of young individuals in a defined geographic population: the Bogalusa Heart Study. Atherosclerosis (1995), 116:163-79.
 
[21]  Napoli C., D’Armiento F.P., Mancini F.P., Postiglione A.,Witzhum J.L., Palumbo G .,et al. Fatty streak formation occurs in human fetal aortas and is greatly enhanced by maternal hypercholestemia. Intimal accumulation of low density lipoprotein and its oxidation precede monocyte recruitment into early atherosclerotic lesions. Journal of Clinical Investigation (1997), 100(11): 2680-90.
 
[22]  Yuan G., AL-Shaki KZ., Hegele R. Hypertriglyceridemia: Its etiology, effects and treatment. CMAJ (2007), 176(8):1113-1120.
 
[23]  Dalleck L.C., Kjelland E.M. The prevalence of metabolic syndrome and metabolic syndrome risk factors in college-aged students. Am J Health Promot. (2012), 27(1): 37-42.
 
[24]  Uckun-Kitapci., Firat S., Sipahi T., Barrier R., Edwards L.J., Calikoglu A.S. Obesity and type 2 diabetes mellitus: A population-based study of adolescents Pediatr Endocrinol Metab (2004), 17(12):1633-40.
 
[25]  Kim S., England J., Sharma A., Njoroge T. Gestational diabetes mellitus and risk of childhood overweight and obesity in offspring: A systematic review. Experimental Diabetes Research (2011), 2011: 541308.
 
[26]  Savona-Ventura C., Schranz A.G., Chircop M. Family history in the aetiology of gestational diabetes mellitus and type 2 diabetes. Malta Medical Journal (2003), 15 (2): 25-30.
 
[27]  Zhong-Chang L., Delvin E., Frazer W., Audibert F., Deal C., Julien P., et al. Maternal glucose tolerance in pregnancy affects fetal insulin sensitivity. Diabetes Care (2010), 33(9):2055-2061.
 
[28]  Vaarasmaki M., Pouta A., Elliott P., Tapanairan D., Sovio U., Ruokonen A., et al. Adolescent manifestations of metabolic syndrome amongst children born to women with GDM in a general population birth cohort. Am J Epid. (2009), 169(10): 1209:1215.
 
[29]  Tsadok M.A., Friedlander Y., Paltiel O., Manor O., Meiner V., Hochner H., et al. Obesity and blood pressure in 17-year-old offspring of mothers with gestational diabetes: insights from the Jerusalem perinatal study. Exp Diabetes Res. (2011), 2011:906154.
 
[30]  Bunt J., Tateranni A., Salbe A. Intrauterine exposure to diabetes is a determinant of Hemoglobin A1c and systolic blood pressure in Pima Indian children. J Clin Endocrinol Metab (2005), 90(6): 3225-3229.
 
[31]  Tam W.H., Yang X., Ko G.T., Tong PC., Cockram C.S., Sahota D.S., Rogers M.S., Chan J.C. Glucose intolerance and cardiometabolic risk in children exposed to maternal gestational diabetes mellitus in utero. Pediatrics (2008), 122:1229-1234.
 
[32]  Ding G., Haung H. Paternal transgenerational glucose intolerance with epigenetic alterations in second generation offspring of GDM. Asian J Androl. (2013), 15(4): 451-452.
 
[33]  Dabelea D., Hanson R., Lindsay R, Pettitt D., Imperatore G., Gabir M. Intrauterine exposure to diabetes conveys risk for type 2 diabetes and obesity: a study of discordant sibships. Diabetes. (2000), 49: 2208-2211.
 
[34]  Savona-Ventura C., Schranz AG., Chircop M. Risk factors for gestational impaired glucose tolerance in the Maltese population: a cross-sectional study. J. Obstet. Gynaecol (2001), 21 (6): 591-594.
 
[35]  Rodriquez B., Fujimoto W., Mayer-Davis E., Imperatore G., Williams D.,Bell R. Prevalence of cardiovascular disease risk factors in U.S. children and adolescents with diabetes. The search for diabetes in youth study. Diabetes Care (2006), 29(8): 1891-1896.
 
[36]  da Silva R., Miranda W., Chacra A., Dib S. Metabolic Syndrome and Insulin Resistance in Normal Glucose Tolerant Brazilian Adolescents With Family History of Type 2 Diabetes. Diabetes Care (2005), 28(2):716-718
 
[37]  Rodden A., Diaz V., Mainous11 A.G., Koopman R., Geesey M.E. Insulin resistance in adolescents. Journal of Pediatrics (2007), 151 (3): 275-279.
 
[38]  Yajnik C. Nutrient-mediated teratogenesis and fuel-mediated teratogenesis: Two pathways of intrauterine programming of diabetes. Intern J Gynec & Obstretrics (2009), S27-31.
 
[39]  Malcolm J.C., Lawson M.L., Gaboury I., Lough G., Keely E. Glucose tolerance of offspring of mother with gestational diabetes mellitus in a low-risk population. Diabetic Medicine (2006), 23(5): 565-570.
 
Show Less References

Article

Severe Cardiomyopathy from Limb Girdle Muscular Dystrophy: A Nidus for a Catastrophic Cascade

1Department of Medicine, Overlook Medical Center, Summit, NJ, USA

2Department of Cardiology, Morristown Medical Center, Morristown, NJ, USA


American Journal of Cardiovascular Disease Research. 2016, 4(1), 7-10
doi: 10.12691/ajcdr-4-1-2
Copyright © 2016 Science and Education Publishing

Cite this paper:
Glenmore Lasam, Jenny Lam. Severe Cardiomyopathy from Limb Girdle Muscular Dystrophy: A Nidus for a Catastrophic Cascade. American Journal of Cardiovascular Disease Research. 2016; 4(1):7-10. doi: 10.12691/ajcdr-4-1-2.

Correspondence to: Glenmore  Lasam, Department of Medicine, Overlook Medical Center, Summit, NJ, USA. Email: glenmore_md@yahoo.com

Abstract

We report a case of a 57-year-old female with Limb Girdle Muscular Dystrophy (LGMD) who initially presented to her outpatient physician a year ago with progressive shoulder and pelvic girdle muscle weakness associated with slight limitation of movement, gradual onset of easy fatigability, intermittent episodes of exertional dyspnea, and trace bipedal edema. On the day of admission, she had sudden onset of unresponsiveness due to massive cerebral infarct likely cardioembolic as evidenced by left ventricular thrombus, in the setting of severe cardiomyopathy associated from LGMD. The patient was treated with hemodynamic support and systemic anticoagulation but did not show any signs of neurologic improvement. Comfort care measures were initiated, eventually, the patient succumbed to death.

Keywords

References

[1]  Narayanaswami P, Weiss M, Selcen D, et al. Evidence-based guideline summary: diagnosis and treatment of limb-girdle and distal dystrophies: report of the guideline development subcommittee of the American Academy of Neurology and the practice issues review panel of the American Association of Neuromuscular & Electrodiagnostic Medicine. Neurology 2014; 83(16):1453.
 
[2]  Wicklund MP, Kissel JT. The limb-girdle muscular dystrophies. Neurol Clin 2014; 32:729.
 
[3]  Bushby KM. Limb-Girdle Muscular Dystrophies. National Organization of Rare Disorders. http://rarediseases.org/rare-diseases/limb-girdle-muscular-dystrophies/. Accessed March 8, 2016.
 
[4]  Norwood FL, Harling C, Chinnery PF, Eagle M, Bushby K, Straub V. Prevalence of genetic muscle disease in Northern England: in-depth analysis of a muscle clinic population. Brain 2009;132: 3175-3186.
 
[5]  Darras BT. Limb-girdle muscular dystrophy. UpToDate, Waltham, MA. (Accessed on March 10, 2016.).
 
Show More References
[6]  Okere A, Reddy S, Gupta S, et al. A Cardiomyopathy in a Patient With Limb Girdle Muscular Dystrophy Type 2A. Circulation: Heart Failure. 2013; 6: e12-e13.
 
[7]  Norwood F, de Visser M, Eymard B, Lochmϋller H, Bushby K. EFNS guideline on diagnosis and management of limb girdle muscular dystrophies. Eur J Neurol. 2007; 14:1305-1312.
 
[8]  Hong JS, Ki CS, Kim JW, et al. Cardiac Dysrhythmias, Cardiomyopathy and Muscular Dystrophy in Patients with Emery-Dreifuss Muscular Dystrophy and Limb-Girdle Muscular Dystrophy Type 1B. J Korean Med Sci. 2005 Apr;20(2):283-290.
 
[9]  van der Kooi A, de Voogt W, Barth P, et al. The heart in limb girdle muscular dystrophy. Heart 1998;79:73-77.
 
[10]  Verhaert D, Richards K, Rafael-Fortney JA, Raman SV. Cardiac Involvement in Patients With Muscular Dystrophies: Magnetic Resonance Imaging Phenotype and Genotypic Considerations. Circ Cardiovasc Imaging. 2011;4:1 67-76.
 
[11]  Kalaria VG, Passannante MR, Shah T, et al. Effect of mitral regurgitation on left ventricular thrombus formation in dilated cardiomyopathy. Am Heart J. 1998;135 2 pt 1:215-220.
 
[12]  Falk RH, Foster E, Coats MH et al. Ventricular thrombi and thromboembolism in dilated cardiomyopathy: a prospective follow-up study. Am Heart J. 1992;123:136-142.
 
[13]  Stratton JR, Resnick AD. Increased embolic risk in patients with left ventricular thrombi. Circulation. 1987;75:1004-1011.
 
[14]  Lip GY, Manning WJ, Weissman NJ. Left ventricular thrombus after acute myocardial infarction. UpToDate, Waltham, MA. (Accessed on March 10, 2016.).
 
[15]  Vaitkus PT, Barnathan ES. Embolic potential, prevention and management of mural thrombus complicating anterior myocardial infarction: a meta-analysis. J Am Coll Cardiol. 1993;22(4):1004.
 
[16]  Finsterer J, Stöllberger C: Atrial fibrillation/flutter in myopathies. Int J Cardiol 2008, 128:304-310.
 
[17]  Chen C-H, Tang S-C, Su Y-N, Yang C-C, Jeng J-S. Cardioembolic stroke related to limb-girdle muscular dystrophy 1B. BMC Research Notes. 2013;6:32.
 
[18]  Ambrosi P, Mouly-Bandini A, Attarian S, et al. Heart transplantation in 7 patients from a single family with limb-girdle muscular dystrophy caused by lamin A/C mutation. Int J Cardiol. 2009;137(3):e75.
 
[19]  Margeta M, Connolly AM, Winder TL, et al. Cardiac pathology exceeds skeletal muscle pathology in two cases of limb-girdle muscular dystrophy type 2I. Muscle Nerve. 2009;40(5):883.
 
[20]  Meune C, Van Berlo JH, Anselme F, Bonne G, Pinto YM, Duboc D: Primary prevention of sudden death in patients with lamin A/C gene mutations.N Engl J Med 2006, 354:209-210.
 
Show Less References

Article

Aortic Dissection Presenting with New Onset Slow Atrial Fibrillation

1Department of Internal Medicine, Faculty of Medical Sciences, University of Duhok, Kurdistan, Iraq

2Fellow in Internal Medicine, Duhok directorate of Health, Kurdistan, Iraq


American Journal of Cardiovascular Disease Research. 2016, 4(1), 11-14
doi: 10.12691/ajcdr-4-1-3
Copyright © 2016 Science and Education Publishing

Cite this paper:
Ameen Mosa Mohammad, Shivan Umir Mohammed. Aortic Dissection Presenting with New Onset Slow Atrial Fibrillation. American Journal of Cardiovascular Disease Research. 2016; 4(1):11-14. doi: 10.12691/ajcdr-4-1-3.

Correspondence to: Ameen  Mosa Mohammad, Department of Internal Medicine, Faculty of Medical Sciences, University of Duhok, Kurdistan, Iraq. Email: doctoramb@yahoo.com

Abstract

Here we present a case of 45 year old male who presented to the emergency department in Duhok, Kurdistan, Iraq in 2014 suffering of two hours sudden onset of dizziness and repeated vomiting. He had unremarkable past medical and drug histories apart of current smoking. On examination the patient was conscious, Pulse rate is 50 bpm and irregular, BP is 90/60 mmHg, evidence of audible murmur on heart auscultation, ECG showed slow atrial fibrillation, Cardiac enzymes were negative. Transthoracic echo (TTE) showed severe aortic regurgitation with a dissecting intimal flap in the ascending aorta. Chest CT-scan was ordered to confirm the dissection and then the patient underwent successful aortic dissection repair. A link between slow atrial fibrillation and aortic dissection has not previously recognized.

Keywords

References

[1]  Blas Macedo, Marquez Ramirez, Jose Dominguez. Aortic dissection presenting as a febrile disease and atrial fibrillation. Rev Invest Clin 2007; 59(1):87-89.
 
[2]  Davutoglu V, Kervancioglu S, Celkan A, Soydinc S, Dinckal H. Painless intimoitimal intussusception and fever of unknown origin: an unusual form of aortic dissection. Cardiology 2004; 102:1-3.
 
[3]  Yuan S. M, Lavee J, Kuperstein R. Echocardiographic delineation of type Aaortic dissection. Hong Kong J. emerg. Med. 2012; 19(1): 31-40.
 
[4]  Rizzoli G, Scalia D, Casarotto D, Tiso E. Aortic dissection type A versus type B: a different post-surgical death hazard? Eur J Cardiothorac Surg 1997;12(2): 202-8.
 
[5]  Wiet SP, Pearce WH, McCarthy WJ, Joob AW, Yao JS, McPherson DD. Utility of transesophageal echocardiography in the diagnosis of disease of the thoracic aorta. J Vasc Surg 1994; 20(4): 613-20.
 
Show More References
[6]  Ince H, Nienaber CA. Diagnosis and management of patients with aortic dissection. Heart 2007; 93(2):266-70.
 
[7]  Sawhney NS, DeMaria AN, Blanchard DG. Aortic intramural hematoma: an increasingly recognized and potentially fatal entity. Chest 2001; 120(4):1340-6.
 
[8]  Suzuki T, Mehta RH, Ince H, et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD). Circulation. 2003;108 (suppl 1):II312-II317.
 
[9]  Nikolas L, Loannis M, Elias G, Nikolas D, Vassilios V. Aortic dissection and third degree atrioventricular block in a patient with a hypertensive crisis. J Clin Hypertens 2008; 10:69-72.
 
[10]  Thiene G, Rossi L, Becker AE. The atrioventricular conduction system in dissecting aneurysms of the aorta. Am Heart J. 1979; 98:447-452.
 
Show Less References