The impact of multifactorial risk factor intervention, vitamin D and probiotic supplementation on novel and established cardiovascular surrogate measures in subjects with disturbed glucose metabolism

Abstract

Introduction: Individuals with so-called pre-diabetes are at high risk to experience an adverse cardiovascular event in their life. Therefore, treatments and interventions aiming to reduce these events are of great interest. In the first part of my thesis programme, we focused on novel cardiovascular surrogate parameters and how they are affected by multifactorial risk factor intervention. For the second part we investigated the impact of vitamin D and probiotic supplementation, respectively on surrogate measures. Methods: We carried out a prospective, open 2 years clinical trial (CARDIONOR-study) including 97 patients with type 2 diabetes (T2DM). Whilst we have investigated the impact of the multifactorial intervention on intima media thickness (IMT) in the whole population, we have assessed 3 novel cardiovascular surrogate measurements (arginine bioavailability ratios, the reactive hyperaemia index (RHI) and endothelial progenitor cells) in subsets of our study population. In addition, we performed a randomized-controlled pilot study including 30 subjects with metabolic syndrome to investigate the impact of Lactobacillus casei Shirota (LcS) supplementation on glucose tolerance and indices of insulin sensitivity and beta-cell function. Moreover, we performed a randomized-controlled study in coronary artery disease patients with post-challenge hyperglycemia (pcHG) and vitamin d deficiency to investigate the effect of vitamin d supplementation on endothelial function. Additionally, an analysis of 2565 patients of the LURIC study was performed to elucidate whether the association of 25(OH) vitamin D levels with mortality is the same in various stages of glucometabolic disturbances. Results:CARDIONOR: Intensified risk factor management significantly improved global arginine bioavailability ratio (GABR) and arginine to ornithine ratio (AOR). A significant improvement was only seen in patients with short diabetes duration (

Date of Award	2013
Original language	English
Awarding Institution	Medical University Graz
Supervisor	Harald Sourij (Supervisor) & Vanessa Stadlbauer-Köllner (Supervisor)