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Cited by 38Diabetes, Cardiovascular Risks, and LipoproteinsMenopause: Health Impacts and TreatmentsCardiac Imaging and Diagnostics

Diabetes, the Metabolic Syndrome, and Angiographic Progression of Coronary Arterial Disease in Postmenopausal Women

Open access
Mellen, Philip B., Cefalu, William T., Herrington, David M.·2006·Arteriosclerosis Thrombosis and Vascular Biology
DOI 10.1161/01.atv.0000191656.71812.7c
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Abstract

OBJECTIVE: Although the metabolic syndrome (MS) is associated with increased cardiovascular risk, its relationship with atherosclerotic progression is less well defined. We sought to determine whether the MS predicts angiographic progression of coronary heart disease in a cohort of postmenopausal women. METHODS AND RESULTS: A total of 309 postmenopausal women entered the Estrogen Replacement and Atherosclerosis trial, of whom 248 underwent baseline angiography and completed follow-up angiography after an average of 3.2 years. Women were identified as having type 2 diabetes mellitus (T2DM) or the MS (National Cholesterol Education Panel diagnostic criteria). In adjusted models, participants with T2DM and the MS had greater angiographic progression [change in minimal diameter (DeltaMD): -0.15] than women without T2DM or the MS (DeltaMD: -0.08; P<0.05) or with MS alone (DeltaMD: -0.07; P<0.005); there was no difference in progression by MS status in women without T2DM (P=0.54)]. In adjusted logistic regression models, T2DM predicted coronary heart disease events [odds ratio, 2.79 (95% CI, 1.29 to 6.02)], and the MS demonstrated a similar trend [odds ratio, 1.98 (95% CI, 0.90 to 4.33)]. CONCLUSIONS: Among postmenopausal women with coronary heart disease, the presence of diabetes predicted disease progression, but the MS did not.

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Cites

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Claims the paper makes

0 of 41 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The MS did not predict angiographic progression in postmenopausal women with coronary artery disease.

    “Conclusions-Among postmenopausal women with coronary heart disease, the presence of diabetes predicted disease progression, but the MS did not.”
    • Also stated in: § Discussion · plain
      “Conversely, the MS did not predict progression, but there was a trend toward increased clinical events in women with the MS.”
    Quote in the paperSubstantial claim
  • Findingown data

    In postmenopausal women with coronary artery disease, diabetes predicted angiographic progression of coronary atherosclerosis.

    “When comparing all of the women with T2DM to those without T2DM in the full model, those with T2DM had significantly greater progression (⌬MD: Ϫ0.07Ϯ0.03versus Ϫ0.14Ϯ0.03mm; PϽ0.005).”
    • Also stated in: § Discussion · plain
      “We found that diabetes predicted angiographic progression of coronary atherosclerosis and clinical cardiovascular events in postmenopausal women with coronary artery disease.”
    • Also stated in: § Discussion · plain
      “In conclusion, diabetes predicted angiographic progression of coronary artery disease in postmenopausal women, but the MS did not.”
    Quote in the paperSubstantial claim
  • Findingown data

    In the base model, individuals with both diabetes and MS had significantly more CHD events than those with neither (OR 2.79, 95% CI 1.29 to 6.02).

    “With respect to the CHD composite clinical end point, individuals with diabetes and the MS had significantly more events than those without diabetes or the MS [odds ratio (OR), 2.79 (95% CI, 1.29 to 6.02), base model]”
    Quote in the paperSubstantial claim
  • Findingown data

    Among women without T2DM, angiographic progression did not differ between those with MS and those without MS (P=0.54).

    “there was no difference in progression by MS status in women without T2DM (Pϭ0.54)”
    • Also stated in: § Results · plain
      “There was no difference in angiographic progression (change in minimal diameter, ⌬MD) between women with the MS and without T2DM (⌬MD: Ϫ0.07Ϯ0.03)and those with neither (⌬MD: Ϫ0.08Ϯ0.03;Pϭ0.54; Figure 1).”
    Quote in the paperSubstantial claim
  • Findingown data

    In adjusted models, postmenopausal women with both T2DM and MS had greater angiographic progression (change in minimal diameter -0.15) than women with neither T2DM nor MS (change -0.08; P<0.05).

    “In adjusted models, participants with T2DM and the MS had greater angiographic progression [change in minimal diameter (⌬MD): Ϫ0.15] than women without T2DM or the MS (⌬MD: Ϫ0.08; PϽ0.05)”
    • Also stated in: § Results · plain
      “Conversely, women with T2DM and the MS had greater progression (⌬MD: Ϫ0.15Ϯ0.03)than women with the MS alone (PϽ0.05) or neither the MS nor T2DM (PϽ0.005).”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 19
  • May combine two claims. 10

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Analyses using WHO criteria for the MS gave qualitatively similar results.

    “Analyses using the World Health Organization criteria for the MS were qualitatively similar (data not shown).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In adjusted models, postmenopausal women with both T2DM and MS had greater angiographic progression (change in minimal diameter -0.15) than women with MS alone (change -0.07), with reported P<0.05 in Results and P<0.005 in Abstract.

    “In adjusted models, participants with T2DM and the MS had greater angiographic progression [change in minimal diameter (⌬MD): Ϫ0.15] than women without T2DM or the MS (⌬MD: Ϫ0.08; PϽ0.05) or with MS alone (⌬MD: Ϫ0.07; PϽ0.005)”
    • Also stated in: § Results · plain
      “Conversely, women with T2DM and the MS had greater progression (⌬MD: Ϫ0.15Ϯ0.03)than women with the MS alone (PϽ0.05) or neither the MS nor T2DM (PϽ0.005).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    After additional adjustment for smoking, cholesterol, and SBP, the difference in progression between women with both T2DM and MS and those with neither was attenuated and no longer statistically significant (P=0.07).

    “These findings were attenuated after additional adjustment for smoking, cholesterol, and SBP [T2DM(ϩ)/MS(ϩ) versus T2DM(Ϫ)/MS(ϩ), PϽ0.005; T2DM(ϩ)/MS(ϩ) versus T2DM(Ϫ)/MS(Ϫ), Pϭ0.07].”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The odds ratios for CHD events were attenuated after additional adjustment for smoking, cholesterol, and SBP but remained similar in magnitude.

    “The ORs were attenuated after additional adjustment for smoking, cholesterol, and SBP but remained similar in magnitude.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Additional logistic regression models accounted for base model covariates plus SBP, smoking, and total cholesterol (full model).

    “Additional logistic regression models accounted for the base model covariates, as well as SBP, smoking, and total cholesterol (full model).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Both overt diabetes and the metabolic syndrome are associated with increased risk of cardiovascular events and death.

    “Both overt diabetes 3,4 and the MS [5][6][7][8][9][10][11] are associated with increased risk of cardiovascular events and death.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [3] 3. Wilson PWF, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor cate- gories. Circulation. 1998;97:1837-1847.

      Not checked in the free run.

    • cites [4] 4. Kanaya AM, Grady D, Barrett-Connor E. Explaining the sex difference in coronary heart disease mortality among patients with type 2 diabetes mellitus: a meta-analysis. Arch Intern Med. 2002;162:1737-1745. source

      Not checked in the free run.

    • cites [5] 5. Lempiainen P, Mykkanen L, Pyorala K, Laakso M, Kuusisto J. Insulin resistance syndrome predicts coronary heart disease events in elderly nondiabetic men. Circulation. 1999;100:123-128. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The ERA trial was a randomized, controlled trial evaluating the effect of hormone replacement therapy on angiographic progression of atherosclerosis.

    “The Estrogen Replacement and Atherosclerosis (ERA) trial was a randomized, controlled trial that evaluated the effect of hormone replacement therapy on angiographic progression of atherosclerosis.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [12] 12. Herrington DM, Reboussin DM, Klein KP, Sharp PC, Shumaker SA, Snyder TE, Geisinger KR. The Estrogen Replacement and Atherosclero- sis (ERA) Study: study design and baseline characteristics of the cohort. Control Clin Trials. 2000;21:257-285. source

      Not checked in the free run.

    • cites [13] 13. Herrington DM, Reboussin DM, Brosnihan KB, Sharp PC, Shumaker SA, Snyder TE, Furberg CD, Kowalchuk GJ, Stuckey TD, Rogers WJ, Givens DH, Waters D. Effects of estrogen replacement on the progression of coronary-artery atherosclerosis. N Engl J Med. 2000;343:522-529. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Angiographic analyses were performed by operators blinded to patient information and the temporal sequence of films.

    “Angiographic analyses were performed by operators who were blinded to patient information and the temporal sequence of films.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Suspected cardiovascular events were documented by hospital records and verified by an independent adjudicator using a classification strategy from the Heart and Estrogen/Progestin Replacement Study.

    “Hospital discharge summaries were obtained for each hospitalization, and suspected cardiovascular events were documented by hospital records (based on admission/discharge notes, cardiac enzymes, electrocardiograms, and cardiac tests/procedures) and verified by an independent adjudicator using a classification strategy drawn from the Heart and Estrogen/Progestin Replacement Study.14”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] 14. Grady D, Applegate W, Bush T, Furberg C, Riggs B, Hulley SB. Heart and Estrogen/progestin Replacement Study (HERS): design, methods, and baseline characteristics. Control Clin Trials. 1998;19:314 -335. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The composite clinical end point was a secondary outcome, so conclusions from it must be made with caution.

    “Furthermore, the composite clinical end point was a secondary outcome, and conclusions drawn from this measure must be made with caution.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Additional analyses adjusted for SBP, cigarette use, and total cholesterol (full model).

    “Additional analyses adjusted for the base model, as well as SBP, cigarette use, and total cholesterol (full model).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Review and analysis of paired angiographic films used a previously validated system of cine projectors and software.

    “Review and analysis of the paired films were performed using a previously validated system of cine projectors (SME-3500; Sony) and software (QCAPlus; Sanders Data Systems).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior studies have observed an association between diabetes and angiographic progression of coronary atherosclerosis.

    “Prior studies have observed the association between diabetes and angiographic progression of coronary atherosclerosis.18 -22”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [18] 18. Alderman EL, Corley SD, Fisher LD, Chaitman BR, Faxon DP, Foster ED, Killip T, Sosa JA, Bourassa MG. Five-year angiographic follow-up of factors associated with progression of coronary artery disease in the Coronary Artery Surgery Study (CASS). CASS Participating Investi- gators and Staff. J Am Coll Cardiol. 1993;22:1141-1154. source

      Not checked in the free run.

    • cites [19] 19. Vanhaecke J, Piessens J, Van de WF, Willems JL, De Geest H. Angio- graphic evolution of coronary atherosclerosis in non-operated patients. Eur Heart J. 1983;4:547-556. source

      Not checked in the free run.

    • cites [20] 20. Takenaka S, Nakamura N, Shiode N, Shirota K, Suyama H, Goto Y, Hirao H, Nakazawa Y, Inoue K, Nagamatsu T. Five-year angiographic outcome in patients without restenosis following coronary balloon angio- plasty: a comparison between nondiabetic and diabetic lesions. Jpn Heart J. 2003;44:31-39. source

      Not checked in the free run.

    • cites [21] 21. Raichlen JS, Healy B, Achuff SC, Pearson TA. Importance of risk factors in the angiographic progression of coronary artery disease. Am J Cardiol. 1986;57:66 -70. source

      Not checked in the free run.

    • cites [22] 22. Mercado N, Boersma E, Wijns W, Gersh BJ, Morillo CA, de Valk V, van Es GA, Grobbee DE, Serruys PW. Clinical and quantitative coronary angiographic predictors of coronary restenosis: A comparative analysis from the balloon-to-stent era. J Am Coll Cardiol. 2001;38:645-652. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Type 2 diabetes has long been recognized as a significant risk factor for coronary heart disease and as a CHD equivalent.

    “T ype 2 diabetes mellitus (T2DM) has long been recog- nized as a significant risk factor for coronary heart disease (CHD) and has been acknowledged as a CHD equivalent. 1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] 1. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circu- lation. 2002;106:3143. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The MS has been associated with incident CHD and CHD mortality.

    “The MS has been associated with incident CHD and CHD mortality, [5][6][7][8][9][10][11]”
    Quote in the paperNot a substantial claim0 of 7 sources checked
    • cites [5] 5. Lempiainen P, Mykkanen L, Pyorala K, Laakso M, Kuusisto J. Insulin resistance syndrome predicts coronary heart disease events in elderly nondiabetic men. Circulation. 1999;100:123-128. source

      Not checked in the free run.

    • cites [6] 6. Pyorala M, Miettinen H, Halonen P, Laakso M, Pyorala K. Insulin resistance syndrome predicts the risk of coronary heart disease and stroke in healthy middle-aged men: the 22-year follow-up results of the Helsinki Policemen Study. Arterioscler Thromb Vasc Biol. 2000;20:538 -544.

      Not checked in the free run.

    • cites [7] 7. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, Taskinen MR, Groop L. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001;24:683-689. source

      Not checked in the free run.

    • cites [8] 8. Sattar N, Gaw A, Scherbakova O, Ford I, O'Reilly DS, Haffner SM, Isles C, Macfarlane PW, Packard CJ, Cobbe SM, Shepherd J. Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Circulation. 2003;108:414 -419. source

      Not checked in the free run.

    • cites [9] 9. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, Salonen JT. The metabolic syndrome and total and cardio- vascular disease mortality in middle-aged men. JAMA. 2002;288: 2709 -2716. source

      Not checked in the free run.

    • cites [10] 10. Rutter MK, Meigs JB, Sullivan LM, D'Agostino RB Sr, Wilson PWF. C-reactive protein, the metabolic syndrome, and prediction of cardiovas- cular events in the Framingham Offspring Study. Circulation. 2004;110: 380 -385. source

      Not checked in the free run.

    • cites [11] 11. Hu G, Qiao Q, Tuomilehto J, Balkau B, Borch-Johnsen K, Pyorala K. Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women. Arch Intern Med. 2004;164:1066 -1076. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Logistic regression models for CHD events were adjusted for age, race, clinical site, study arm, and lipid-lowering medications (base model).

    “Logistic regression models, adjusted for age, race, clinical site, study arm, and lipid-lowering medications (base model), were used to evaluate a composite clinical outcome of any CHD event”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    The study was a post hoc analysis and may only generate or support hypotheses.

    “First, as a post hoc analysis, it may only generate or support hypotheses.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    QCA has been used to follow disease progression in both interventional and observational settings.

    “The ERA study used QCA, which has been used to follow disease progression in both interventional and observational settings.[33][34][35][36]”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [33] 33. Blankenhorn DH, Azen SP, Kramsch DM, Mack WJ, Cashin-Hemphill L, Hodis HN, DeBoer LW, Mahrer PR, Masteller MJ, Vailas LI. Coronary angiographic changes with lovastatin therapy. The Monitored Atheroscle- rosis Regression Study (MARS). The MARS Research Group. Ann Intern Med. 1993;119:969 -976. source

      Not checked in the free run.

    • cites [34] 34. Janszky I, Mukamal KJ, Orth-Gomer K, Romelsjo A, Schenck- Gustafsson K, Svane B, Kirkeeide RL, Mittleman MA. Alcohol con- sumption and coronary atherosclerosis progression-the Stockholm Female Coronary Risk Angiographic Study. Atherosclerosis. 2004;176: 311-319. source

      Not checked in the free run.

    • cites [35] 35. Waters D, Higginson L, Gladstone P, Kimball B, Le May M, Boccuzzi SJ, Lesperance J. Effects of monotherapy with an HMG-CoA reductase inhibitor on the progression of coronary atherosclerosis as assessed by serial quantitative arteriography. The Canadian Coronary Atherosclerosis Intervention Trial. Circulation. 1994;89:959 -968.

      Not checked in the free run.

    • cites [36] 36. Ornish D, Scherwitz LW, Billings JH, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280:2001-2007. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The NCEP noted that the MS is characterized by a prothrombotic and proinflammatory state, but the diagnostic criteria do not reflect these components.

    “Although the NCEP noted that the MS is characterized by a prothrombotic and proinflammatory state, the diagnostic criteria do not reflect these components of the syndrome.1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] 1. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circu- lation. 2002;106:3143. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Older women (≥60 years) have the highest prevalence of the MS (56%).

    “Recent data from the National Health and Nutrition Examination and Survey (1999 -2000) reveal that older women (Ն60 years.)have the highest prevalence of the MS (56%), 41”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] 41. Ford ES, Giles WH, Mokdad AH. Increasing prevalence of the metabolic syndrome among U.S. Adults. Diabetes Care. 2004;27:2444 -2449. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The MS and insulin resistance have been associated with atherosclerosis in cross-sectional studies.

    “although the MS and insulin resistance have been associated with atherosclerosis in crosssectional studies, [23][24][25][26]”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [23] 23. McNeill AM, Rosamond WD, Girman CJ, Heiss G, Golden SH, Duncan BB, East HE, Ballantyne C. Prevalence of coronary heart disease and carotid arterial thickening in patients with the metabolic syndrome (The ARIC Study). Am J Cardiol. 2004;94:1249 -1254. source

      Not checked in the free run.

    • cites [24] 24. Hunt ME, O'Malley PG, Feuerstein I, Taylor AJ. The relationship between the 'metabolic score' and sub-clinical atherosclerosis detected with electron beam computed tomography. Coron Artery Dis. 2003;14: 317-322.

      Not checked in the free run.

    • cites [25] 25. Larsson H, Berglund G, Ahren B. Insulin sensitivity, insulin secretion, and glucose tolerance versus intima-media thickness in nondiabetic post- menopausal women. J Clin Endocrinol Metab. 2003;88:4791-4797. source

      Not checked in the free run.

    • cites [26] 26. Reilly MP, Wolfe ML, Rhodes T, Girman C, Mehta N, Rader DJ. Measures of insulin resistance add incremental value to the clinical diagnosis of metabolic syndrome in association with coronary atheroscle- rosis. Circulation. 2004;110:803-809. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    The study's findings may provide insights into the pathophysiology of cardiovascular risk along the continuum of the MS and type 2 diabetes.

    “These observations, taken in the context of existing knowledge, may provide insights into the pathophysiology of cardiovascular risk along the continuum of the MS and type 2 diabetes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Many studies evaluating the MS and clinical cardiovascular outcomes included only men or noted a relative paucity of events among women compared with men.

    “Many of the studies evaluating the MS and clinical cardiovascular outcomes have included only men 5,6,8,9 or have noted a relative paucity of events among women compared with men.11,39,40”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [5] 5. Lempiainen P, Mykkanen L, Pyorala K, Laakso M, Kuusisto J. Insulin resistance syndrome predicts coronary heart disease events in elderly nondiabetic men. Circulation. 1999;100:123-128. source

      Not checked in the free run.

    • cites [6] 6. Pyorala M, Miettinen H, Halonen P, Laakso M, Pyorala K. Insulin resistance syndrome predicts the risk of coronary heart disease and stroke in healthy middle-aged men: the 22-year follow-up results of the Helsinki Policemen Study. Arterioscler Thromb Vasc Biol. 2000;20:538 -544.

      Not checked in the free run.

    • cites [8] 8. Sattar N, Gaw A, Scherbakova O, Ford I, O'Reilly DS, Haffner SM, Isles C, Macfarlane PW, Packard CJ, Cobbe SM, Shepherd J. Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Circulation. 2003;108:414 -419. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Bonora et al found an association between the MS and progression of carotid atherosclerosis in the Bruneck cohort.

    “Bonora et al 27 found an association between the MS and progression of carotid atherosclerosis, a CHD surrogate, in the Bruneck cohort.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] 27. Bonora E, Kiechl S, Oberhollenzer F, Egger G, Bonadonna RC, Muggeo M, Willeit J. Impaired glucose tolerance, Type II diabetes mellitus and carotid atherosclerosis: prospective results from the Bruneck Study. Dia- betologia. 2000;43:156 -164. source

      Not checked in the free run.

24 of 24

  • The paper relies on this without support.

    It is unclear whether the associations of diabetes and MS with clinical events are due to effects on atherosclerotic progression, plaque stability, or acute thrombotic events.

    “However, it remains unclear whether these associations with clinical events result from an effect on the progression of atherosclerosis, a consequence of changes in stability of existing plaques, or a result of other changes that might facilitate the development of an acute thrombotic event.”

  • The paper relies on this without support.

    Women who underwent follow-up angiography are representative of the enrolled cohort.

    “A total of 309 postmenopausal women entered the Estrogen Replacement and Atherosclerosis trial, of whom 248 underwent baseline angiography and completed follow-up angiography after an average of 3.2 years.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Cardiovascular risk from postprandial or post-challenge glycemia begins to increase at 80 mg/dl.

    “At only 80 mg/dl the CV risk of post-prandial or post-challenge glycemia begins to increase; by 140 mg/dl, the point at which we traditionally only begin to classify patients as glucose intolerant or pre-diabetic, the risk is already increased by 58% (9,10) (Fig. 1).”

    From Dietary Strategies for Improving Post-Prandial Glucose, Lipids, Inflammation, and Cardiovascular Health (2008) · cites this paper as [10]

    The Diabetes and the MS section defines diabetes using a two-hour postchallenge glucose threshold of 200 mg/dL; the Results compare cardiovascular outcomes by diabetes and metabolic-syndrome status. Searches for 80 mg/dL, postchallenge risk, and 140 mg/dL found no passage identifying where cardiovascular risk begins to increase. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • At a glucose level of 140 mg/dl, cardiovascular risk is already increased by 58%.

    “At only 80 mg/dl the CV risk of post-prandial or post-challenge glycemia begins to increase; by 140 mg/dl, the point at which we traditionally only begin to classify patients as glucose intolerant or pre-diabetic, the risk is already increased by 58% (9,10) (Fig. 1).”

    From Dietary Strategies for Improving Post-Prandial Glucose, Lipids, Inflammation, and Cardiovascular Health (2008) · cites this paper as [10]

    The Diabetes and the MS section defines diabetes using a 2-hour postchallenge glucose threshold of 200 mg/dL, while the Results report coronary outcomes by diabetes and metabolic-syndrome category. Neither section reports cardiovascular risk at 140 mg/dL or a 58% increase; searches for those figures found no supporting passage in our copy. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

  • In patients with normal glucose tolerance, a postprandial glucose level below 87 mg/dl was associated with coronary regression, while the remaining patients had coronary progression proportional to the increase in postprandial glucose.

    “Patients with normal glucose tolerance who had a post-prandial glucose level of Ͻ87 mg/dl had coronary regression.The remaining patients had coronary progression in proportion to the increase in post-prandial glucose.Data from Mellen et al. (10).”

    From Dietary Strategies for Improving Post-Prandial Glucose, Lipids, Inflammation, and Cardiovascular Health (2008) · cites this paper as [10]

    The Results report angiographic progression by diabetes and metabolic-syndrome status, not by postprandial glucose level. A search for the 87 mg/dL threshold and for regression among patients with normal glucose tolerance found no passage addressing either part of the claim. Page numbers were not available in our copy. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

  • Over time, lower glycemic index diets combined with regular exercise may help optimize loss of excess visceral fat.

    “Thus over time lower glycemic index diets combined with regular exercise may be useful for optimizing loss of excess visceral fat (10,25,40).”

    From Dietary Strategies for Improving Post-Prandial Glucose, Lipids, Inflammation, and Cardiovascular Health (2008) · cites this paper as [10]

    The Abstract describes a study of diabetes, metabolic syndrome, and coronary atherosclerosis in postmenopausal women. The Discussion mentions increased physical activity in the context of cardiovascular risk management, but our copy does not address whether lower-glycemic-index diets combined with exercise improve visceral-fat loss (searched: glycemic index, visceral fat, diet and exercise). No page numbers were available in the indexed passages. (LLM, conf=0.77)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Abstract and Results reverse the comparison P values

    Minor

    The abstract assigns P<0.05 to the comparison with neither condition and P<0.005 to the comparison with MS alone. The Results section assigns those P values to the opposite comparisons.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. 10.1161/circ.97.18.1837 · DOI
  2. 10.1161/atvb.20.2.538 · DOI
  3. 2003, Coron Artery Dis, 14, 317
  4. 10.1161/circ.89.3.8124836 · DOI
  5. 10.1161/circ.87.4.8484829 · DOI

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Authors
Mellen, P. B., Cefalu, W. T., & Herrington, D. M.
Affiliations
Pennington Biomedical Research Center (US)
ORCID
Venue
Arteriosclerosis Thrombosis and Vascular Biology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2006-01
Volume
26
Issue
1
Pages
189-193
ISSN
  • 1079-5642 (ISSN-L)
  • 1524-4636
DOI
10.1161/01.atv.0000191656.71812.7c
OpenAlex
W2016919932
Cited by
38
References
46
Citations by year
2023: 1 · 2022: 1 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 1 · 2016: 1 · 2015: 1 · 2014: 1 · 2013: 3 · 2012: 2
FWCI
2.69
Type
journal article
Language
en
Open access
Locations
  • Arteriosclerosis Thrombosis and Vascular Biology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01hl065367-02)
  • U.S. Public Health Service (M0107122)
  • National Heart, Lung, and Blood Institute (R01HL65367, HL076132, T32HL076132)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Keywords
metabolic syndrome, type 2 diabetes, coronary artery disease, coronary artery disease progression, postmenopausal women, atherosclerosis, estrogen replacement therapy
MeSH terms
Aged, Coronary Artery Disease, Diabetes Mellitus, Type 2, Estrogens, Female, Follow-Up Studies, Humans, Middle Aged, Predictive Value of Tests, Risk Factors, Cohort Studies, Estrogen Replacement Therapy, Coronary Angiography, Postmenopause, Disease Progression, Metabolic Syndrome

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-27.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-27.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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