Two cross-sectional surveys of diabetes mellitus using a 75-g oral glucose tolerance test (OGTT) conducted in the town of Hisayama showed that the prevalence of diabetes and other glucose intolerance statuses steeply increased during a 14-year period. In a prospective study of Hisayama residents, who underwent the OGTT at baseline, the risks for the development of ischemic stroke in both sexes and coronary heart disease in women were significantly higher in subjects with diabetes than in those with normal glucose tolerance even after adjustment for other confounding factors, but such association was not seen for coronary heart disease in men. Additionally, we observed a synergistic effect between diabetes and metabolic syndrome for the development of ischemic stroke and coronary heart disease.
BACKGROUND Pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis (PCH) are rare causes of pulmonary hypertension. There is no proven medical therapy to treat these diseases, and lung transplantation is thought to be the only cure. Administration of vasodilators including epoprostenol sometimes causes massive pulmonary edema and could be fatal in these patients. METHODS AND RESULTS Eight patients were treated with epoprostenol for 387.3±116.3 days (range, 102-1,063 days), who were finally diagnosed with PVOD or PCH by pathological examination. The maximum dose of epoprostenol given was 55.3±10.7 ng·kg(-1)·min(-1) (range, 21.0-110.5 ng·kg(-1)·min(-1)). With careful management, epoprostenol therapy significantly improved the 6-min walk distance (97.5±39.2 to 329.4±34.6 m, P<0.001) and plasma brain natriuretic peptide levels (381.3±136.8 to 55.2±14.4 pg/ml, P<0.05). The cardiac index significantly increased from 2.1±0.1 to 2.9±0.3 L·min(-1)·m(-2) (P<0.05). However, pulmonary artery pressure and pulmonary vascular resistance were not significantly reduced. For 4 patients, epoprostenol therapy acted as a bridge to lung transplantation. For the other patients who had no chance to undergo lung transplantation, epoprostenol therapy was applied for 528.0±216.6 days and the maximum dose was 63.9±19.0 ng·kg(-1)·min(-1). CONCLUSIONS This study data suggest that cautious application of epoprostenol can be considered as a therapeutic option in patients with PVOD and PCH.
