Background:While type 2 diabetes mellitus(T2DM)is considered a putative causal risk factor for coronary artery disease(CAD),the intrinsic link underlying T2DM and CAD is not fully understood.We aimed to highlight the ...Background:While type 2 diabetes mellitus(T2DM)is considered a putative causal risk factor for coronary artery disease(CAD),the intrinsic link underlying T2DM and CAD is not fully understood.We aimed to highlight the importance of integrated care targeting both diseases by investigating the phenotypic and genetic relationships between T2DM and CAD.Methods:We evaluated phenotypic associations using data from the United Kingdom Biobank(N=472,050).We investigated genetic relationships by leveraging genomic data conducted in European ancestry for T2DM,with and without adjustment for body mass index(BMI)(T2DM:N_(case)/N_(control)=74,124/824,006;T2DM adjusted for BMI[T2DM_(adj)BMI]:N_(case)/N_(control)=50,409/523,897)and for CAD(N_(case)/N_(control)=181,522/984,168).We performed additional analyses using genomic data conducted in multiancestry individuals for T2DM(N_(case)/N_(control)=180,834/1,159,055).Results:Observational analysis suggested a bidirectional relationship between T2DM and CAD(T2DM→CAD:hazard ratio[HR]=2.12,95%confidence interval[CI]:2.01–2.24;CAD→T2DM:HR=1.72,95%CI:1.63–1.81).A positive overall genetic correlation between T2DM and CAD was observed(r_(g)=0.39,P=1.43×10^(-75)),which was largely independent of BMI(T2DM_(adj)BMI–CAD:r_(g)=0.31,P=1.20×10^(–36)).This was corroborated by six local signals,among which 9p21.3 showed the strongest genetic correlation.Cross-trait meta-analysis replicated 101 previously reported loci and discovered six novel pleiotropic loci.Mendelian randomization analysis supported a bidirectional causal relationship(T2DM→CAD:odds ratio[OR]=1.13,95%CI:1.11-1.16;CAD→T2DM:OR=1.12,95%CI:1.07-1.18),which was confirmed in multiancestry individuals(T2DM→CAD:OR=1.13,95%CI:1.10-1.16;CAD→T2DM:OR=1.08,95%CI:1.04-1.13).This bidirectional relationship was significantly mediated by systolic blood pressure and intake of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors,with mediation proportions of 54.1%(95%CI:24.9-83.4%)and 90.4%(95%CI:29.3-151.5%),respectively.Conclusion:Our observational and genetic analyses demonstrated an intrinsic bidirectional relationship between T2DM and CAD and clarified the biological mechanisms underlying this relationship.展开更多
BACKGROUND It is increasingly common to find patients affected by a combination of type 2 diabetes mellitus(T2DM)and coronary artery disease(CAD),and studies are able to correlate their relationships with available bi...BACKGROUND It is increasingly common to find patients affected by a combination of type 2 diabetes mellitus(T2DM)and coronary artery disease(CAD),and studies are able to correlate their relationships with available biological and clinical evidence.The aim of the current study was to apply association rule mining(ARM)to discover whether there are consistent patterns of clinical features relevant to these diseases.ARM leverages clinical and laboratory data to the meaningful patterns for diabetic CAD by harnessing the power help of data-driven algorithms to optimise the decision-making in patient care.AIM To reinforce the evidence of the T2DM-CAD interplay and demonstrate the ability of ARM to provide new insights into multivariate pattern discovery.METHODS This cross-sectional study was conducted at the Department of Biochemistry in a specialized tertiary care centre in Delhi,involving a total of 300 consented subjects categorized into three groups:CAD with diabetes,CAD without diabetes,and healthy controls,with 100 subjects in each group.The participants were enrolled from the Cardiology IPD&OPD for the sample collection.The study employed ARM technique to extract the meaningful patterns and relationships from the clinical data with its original value.RESULTS The clinical dataset comprised 35 attributes from enrolled subjects.The analysis produced rules with a maximum branching factor of 4 and a rule length of 5,necessitating a 1%probability increase for enhancement.Prominent patterns emerged,highlighting strong links between health indicators and diabetes likelihood,particularly elevated HbA1C and random blood sugar levels.The ARM technique identified individuals with a random blood sugar level>175 and HbA1C>6.6 are likely in the“CAD-with-diabetes”group,offering valuable insights into health indicators and influencing factors on disease outcomes.CONCLUSION The application of this method holds promise for healthcare practitioners to offer valuable insights for enhancing patient treatment targeting specific subtypes of CAD with diabetes.Implying artificial intelligence techniques with medical data,we have shown the potential for personalized healthcare and the development of user-friendly applications aimed at improving cardiovascular health outcomes for this high-risk population to optimise the decision-making in patient care.展开更多
目的:探讨脂蛋白相关磷脂酶A2(Lp-PLA2)与冠心病(CHD)和2型糖尿病(T2DM)的关系。方法:入选患者200例,分为4组,CHD组80例,T2DM组20例,CHD+T2DM组60例,对照组(非CHD非T2DM组)40例。检测Lp-PLA2及C反应蛋白(CRP)。采用析因设计方差分析研究...目的:探讨脂蛋白相关磷脂酶A2(Lp-PLA2)与冠心病(CHD)和2型糖尿病(T2DM)的关系。方法:入选患者200例,分为4组,CHD组80例,T2DM组20例,CHD+T2DM组60例,对照组(非CHD非T2DM组)40例。检测Lp-PLA2及C反应蛋白(CRP)。采用析因设计方差分析研究Lp-PLA2及CRP与CHD和T2DM的相关性。同时分析CHD合并T2DM患者Lp-PLA2水平与冠脉病变程度的相关性。结果:CHD组、T2DM组、CHD+T2DM组Lp-PLA2及CRP均高于对照组(均P<0.05),且经析因设计方差分析显示CHD和T2DM在CRP及Lp-PLA2升高方面有交互作用(F=7.62,P<0.05;F=9.68,P<0.05)。CHD+T2DM组冠脉Gensini积分大于CHD组(44.15±36.28 vs 60.51±42.58,P=0.020)。CHD组Lp-PLA2水平与Gensini积分呈正相关(r=0.181,P=0.016),CHD+T2DM组Lp-PLA2水平与Gensini积分也呈正相关(r=0.224,P=0.011),且后者相关性更好。结论:CHD和T2DM在CRP及Lp-PLA2升高方面有交互作用;与单纯CHD患者相比,CHD合并T2DM患者Lp-PLA2水平更高,冠脉病变更重。展开更多
基金This work was partly supported by National Natural Scientific Foundation （81070171, 81241121）, Specialized Research Fund for the Doctoral Program of Higher Education of China （20111106110013）, Capital Special Foundation of Clinical Application Research （Z 121107001012015）, Capital Health Development Fund （2011400302）, and Beijing Natural Science Foundation （7131014） awarded to Dr. Jian-Jun LI.
基金supported by the National Key R&D Program of China(Nos.2022YFC3600600,2022YFC3600604)the National Natural Science Foundation of China(Nos.U22A20359,81874283,and 81673255)+2 种基金the Recruitment Program for Young Professionals of Chinathe Promotion Plan for Basic Medical Sciencesthe Development Plan for Cutting-Edge Disciplines,Sichuan University.
文摘Background:While type 2 diabetes mellitus(T2DM)is considered a putative causal risk factor for coronary artery disease(CAD),the intrinsic link underlying T2DM and CAD is not fully understood.We aimed to highlight the importance of integrated care targeting both diseases by investigating the phenotypic and genetic relationships between T2DM and CAD.Methods:We evaluated phenotypic associations using data from the United Kingdom Biobank(N=472,050).We investigated genetic relationships by leveraging genomic data conducted in European ancestry for T2DM,with and without adjustment for body mass index(BMI)(T2DM:N_(case)/N_(control)=74,124/824,006;T2DM adjusted for BMI[T2DM_(adj)BMI]:N_(case)/N_(control)=50,409/523,897)and for CAD(N_(case)/N_(control)=181,522/984,168).We performed additional analyses using genomic data conducted in multiancestry individuals for T2DM(N_(case)/N_(control)=180,834/1,159,055).Results:Observational analysis suggested a bidirectional relationship between T2DM and CAD(T2DM→CAD:hazard ratio[HR]=2.12,95%confidence interval[CI]:2.01–2.24;CAD→T2DM:HR=1.72,95%CI:1.63–1.81).A positive overall genetic correlation between T2DM and CAD was observed(r_(g)=0.39,P=1.43×10^(-75)),which was largely independent of BMI(T2DM_(adj)BMI–CAD:r_(g)=0.31,P=1.20×10^(–36)).This was corroborated by six local signals,among which 9p21.3 showed the strongest genetic correlation.Cross-trait meta-analysis replicated 101 previously reported loci and discovered six novel pleiotropic loci.Mendelian randomization analysis supported a bidirectional causal relationship(T2DM→CAD:odds ratio[OR]=1.13,95%CI:1.11-1.16;CAD→T2DM:OR=1.12,95%CI:1.07-1.18),which was confirmed in multiancestry individuals(T2DM→CAD:OR=1.13,95%CI:1.10-1.16;CAD→T2DM:OR=1.08,95%CI:1.04-1.13).This bidirectional relationship was significantly mediated by systolic blood pressure and intake of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors,with mediation proportions of 54.1%(95%CI:24.9-83.4%)and 90.4%(95%CI:29.3-151.5%),respectively.Conclusion:Our observational and genetic analyses demonstrated an intrinsic bidirectional relationship between T2DM and CAD and clarified the biological mechanisms underlying this relationship.
文摘BACKGROUND It is increasingly common to find patients affected by a combination of type 2 diabetes mellitus(T2DM)and coronary artery disease(CAD),and studies are able to correlate their relationships with available biological and clinical evidence.The aim of the current study was to apply association rule mining(ARM)to discover whether there are consistent patterns of clinical features relevant to these diseases.ARM leverages clinical and laboratory data to the meaningful patterns for diabetic CAD by harnessing the power help of data-driven algorithms to optimise the decision-making in patient care.AIM To reinforce the evidence of the T2DM-CAD interplay and demonstrate the ability of ARM to provide new insights into multivariate pattern discovery.METHODS This cross-sectional study was conducted at the Department of Biochemistry in a specialized tertiary care centre in Delhi,involving a total of 300 consented subjects categorized into three groups:CAD with diabetes,CAD without diabetes,and healthy controls,with 100 subjects in each group.The participants were enrolled from the Cardiology IPD&OPD for the sample collection.The study employed ARM technique to extract the meaningful patterns and relationships from the clinical data with its original value.RESULTS The clinical dataset comprised 35 attributes from enrolled subjects.The analysis produced rules with a maximum branching factor of 4 and a rule length of 5,necessitating a 1%probability increase for enhancement.Prominent patterns emerged,highlighting strong links between health indicators and diabetes likelihood,particularly elevated HbA1C and random blood sugar levels.The ARM technique identified individuals with a random blood sugar level>175 and HbA1C>6.6 are likely in the“CAD-with-diabetes”group,offering valuable insights into health indicators and influencing factors on disease outcomes.CONCLUSION The application of this method holds promise for healthcare practitioners to offer valuable insights for enhancing patient treatment targeting specific subtypes of CAD with diabetes.Implying artificial intelligence techniques with medical data,we have shown the potential for personalized healthcare and the development of user-friendly applications aimed at improving cardiovascular health outcomes for this high-risk population to optimise the decision-making in patient care.
文摘目的:探讨脂蛋白相关磷脂酶A2(Lp-PLA2)与冠心病(CHD)和2型糖尿病(T2DM)的关系。方法:入选患者200例,分为4组,CHD组80例,T2DM组20例,CHD+T2DM组60例,对照组(非CHD非T2DM组)40例。检测Lp-PLA2及C反应蛋白(CRP)。采用析因设计方差分析研究Lp-PLA2及CRP与CHD和T2DM的相关性。同时分析CHD合并T2DM患者Lp-PLA2水平与冠脉病变程度的相关性。结果:CHD组、T2DM组、CHD+T2DM组Lp-PLA2及CRP均高于对照组(均P<0.05),且经析因设计方差分析显示CHD和T2DM在CRP及Lp-PLA2升高方面有交互作用(F=7.62,P<0.05;F=9.68,P<0.05)。CHD+T2DM组冠脉Gensini积分大于CHD组(44.15±36.28 vs 60.51±42.58,P=0.020)。CHD组Lp-PLA2水平与Gensini积分呈正相关(r=0.181,P=0.016),CHD+T2DM组Lp-PLA2水平与Gensini积分也呈正相关(r=0.224,P=0.011),且后者相关性更好。结论:CHD和T2DM在CRP及Lp-PLA2升高方面有交互作用;与单纯CHD患者相比,CHD合并T2DM患者Lp-PLA2水平更高,冠脉病变更重。
