851
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Couch SC, Crandell JL, Shah AS, Dolan LM, Merchant AT, Liese AD, Lawrence JM, Pihoker C, Mayer-Davis EJ. Fructose intake and cardiovascular risk factors in youth with type 1 diabetes: SEARCH for diabetes in youth study. Diabetes Res Clin Pract 2013; 100:265-71. [PMID: 23540682 PMCID: PMC3764988 DOI: 10.1016/j.diabres.2013.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 02/01/2013] [Accepted: 03/06/2013] [Indexed: 12/11/2022]
Abstract
AIMS High consumption of dietary fructose has been shown to contribute to dyslipidemia and elevated blood pressure in adults, but there are few data in youth, particularly those at greater risk of cardiovascular disease (CVD). The aim of this study was to examine the association between fructose intake and CVD risk factors in a diverse population of youth with type 1 diabetes (T1D). METHODS This was a cross-sectional analysis of data from the SEARCH for Diabetes in Youth study, including 2085 youth ages 10-22 years with T1D, of which 22% were racial/ethnic minority and 50% were female. A semi-quantitative food frequency questionnaire was used to assess intake. RESULTS Median daily fructose consumption was 7.9% of total calories. Fructose intake was positively associated with triglycerides (p<.01), but not with total cholesterol, LDL-cholesterol, HDL-cholesterol, or blood pressure after adjustment for physical activity and socio-demographic, clinical, and dietary covariates. An increase in fructose intake of 22 g (equivalent to a 12 oz can of soda) was associated with 23% higher odds of borderline/high versus low triglycerides (p<.005). CONCLUSION These data suggest that children with T1D should moderate their intake of fructose, particularly those with borderline or high triglycerides.
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Affiliation(s)
- Sarah C Couch
- Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, OH 45267-0394, United States.
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852
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Abstract
As life expectancy lengthens, dementia is becoming a significant human condition in terms of its prevalence and cost to society worldwide. It is important in that context to understand the preventable and treatable causes of dementia. This article exposes the link between dementia and heart disease in all its forms, including coronary artery disease, myocardial infarction, atrial fibrillation, valvular disease, and heart failure. This article also explores the cardiovascular risk factors and emphasizes that several of them are preventable and treatable. In addition to medical therapies, the lifestyle changes that may be useful in retarding the onset of dementia are also summarized.
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Affiliation(s)
- B Ng Justin
- Departments of Neuroscience and Psychology, McGill University, Montreal, QC, Canada
| | - Michele Turek
- Division of Cardiology, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Antoine M Hakim
- Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
- Canadian Stroke Network, Ottawa, ON, Canada
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853
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Goldfine AB, Conlin PR, Halperin F, Koska J, Permana P, Schwenke D, Shoelson SE, Reaven PD. A randomised trial of salsalate for insulin resistance and cardiovascular risk factors in persons with abnormal glucose tolerance. Diabetologia 2013; 56:714-23. [PMID: 23370525 PMCID: PMC4948114 DOI: 10.1007/s00125-012-2819-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 12/10/2012] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS Chronic sub-acute inflammation contributes to the pathogenesis of type 2 diabetes mellitus and cardiovascular disease. High doses of salicylate reduce inflammation, glucose and triacylglycerols, and may improve insulin sensitivity, suggesting therapeutic potential in impaired fasting glucose and/or impaired glucose tolerance. This trial aimed to evaluate the effect of salsalate vs placebo on insulin resistance and glycaemia in impaired fasting glucose and/or impaired glucose tolerance. METHODS We conducted a 12 week, two-centre, randomised, placebo-controlled study to evaluate the effect of salsalate (up to 4 g/day) vs placebo on systemic glucose disposal. Secondary objectives included treatment effects on glycaemia, inflammation and cardiovascular risk factors. Seventy-eight participants with impaired fasting glucose and/or impaired glucose tolerance from two VA healthcare systems were enrolled. Randomisation assignment was provided by the coordinating center directly to site pharmacists, and participants and research staff were blinded to treatment assignment. RESULTS Seventy-one individuals were randomised to placebo (n = 36) or salsalate (n = 35). Glucose disposal did not change in either group (salsalate 1% [95% CI -39%, 56%]; placebo 6% [95% CI -20%, 61%], p = 0.3 for placebo vs salsalate). Fasting glucose was reduced by 6% during the study by salsalate (p = 0.006) but did not change with placebo. Declines in glucose were accompanied by declines in fasting C-peptide with salsalate. Insulin clearance was reduced with salsalate. In the salsalate group, triacylglycerol levels were lower by 25% (p = 0.01) and adiponectin increased by 53% (p = 0.02) at the end of the study. Blood pressure, endothelial function and other inflammation markers did not differ between groups. Adipose tissue nuclear factor κB (NF-κB) activity declined in the salsalate group compared with placebo (-16% vs 42%, p = 0.005), but was not correlated with metabolic improvements. The frequency of tinnitus was low but tended to be higher with salsalate therapy (n = 4 vs n = 2). CONCLUSIONS/INTERPRETATION In summary, salsalate therapy was well tolerated, lowered fasting glucose, increased adiponectin and reduced adipose tissue NF-κB activity. These changes were not related to changes in peripheral insulin sensitivity, suggesting additional mechanisms for metabolic improvement. TRIAL REGISTRATION ClinicalTrials.gov NCT00330733. FUNDING Office of Research and Development, Medical Research Service, Department of Veterans Affairs and NIH K24 DK63214.
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Affiliation(s)
- A. B. Goldfine
- Department of Medicine, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - P. R. Conlin
- Department of Medicine, Boston VA Health Care System, Brigham and Women’s Hospital, Boston, MA, USA
| | - F. Halperin
- Department of Medicine, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - J. Koska
- Research Department, Phoenix VA Health Care System, Phoenix, AZ, USA
| | - P. Permana
- Research Department, Phoenix VA Health Care System, Phoenix, AZ, USA
| | - D. Schwenke
- Research Department, Phoenix VA Health Care System, Phoenix, AZ, USA
| | - S. E. Shoelson
- Department of Medicine, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - P. D. Reaven
- Department of Medicine, Phoenix VA Health Care System, Phoenix, AZ, USA
- Department of Medicine, University of Arizona, Phoenix, AZ, USA
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854
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Cinteza E, Balgradean M. Hypertension in romanian children and adolescents: a cross-sectional survey. Maedica (Bucur) 2013; 8:5-10. [PMID: 24023591 PMCID: PMC3749763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 03/20/2013] [Indexed: 06/02/2023]
Abstract
UNLABELLED AIM Knowledge of the existence of a prolonged action of cardiovascular risk factors since childhood is extremely important in a country with one of the highest cardiovascular mortality in Europe. The purpose of this survey was to study the prevalence of arterial hypertension (AH) and cardiovascular risk factors in Romanian paediatric population. METHODS Children and adolescents (2407 males, 2459 females), aged 3 to 17 years from Bucharest and Ilfov County were admitted in a cross-sectional survey. Body weight, height, and blood pressure (BP) were measured and the percentiles for height, BP and body mass index were established. An interviewer-administered questionnaire about some presumed risk factors was used. RESULTS The prevalence of AH in our population was 7.4%. In Bucharest AH prevalence was 8% and in rural areas 6.8% (P=0.69). AH prevalence was higher both in overweight (12.4%) and obese (24.4%) groups comparing with normal weight (5.8%), (P<0.0001). In the underweight group, AH prevalence was 3.8%. We found statistically significant the association between male gender and SH (P=0.032). While SH increases with age (P=0.015), diastolic DH decreases with age (P=0.0003). We found no correlation between AH in children and adolescents and consumption of caffeinated beverages, family history of cardiovascular disease, smoking, low birth weight, sleep disorders and abnormal sleep duration, absence of extra-school sport activity. CONCLUSION The high AH prevalence together with overweight or obesity represent cardiovascular risk factors, identified within our population.
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Affiliation(s)
- Eliza Cinteza
- "Maria S Curie" Emergency Children's Hospital, Romania ; "Carol Davila" University of Medicine and Pharmacy, Romania
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855
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Abstract
Genome-wide association studies have been published since 2005 and remain exemplary in translating knowledge fostered by the human genome project into genomic lessons on health and disease. Although our understanding of the basis of complex disease remains by far incomplete, the knowledge of the genetic basis of cardiovascular risk factors and their end organ damage has been significantly improved. The Framingham Heart Study was one of the earliest population-based studies to apply genomic methods and is an important contributor to large disease-based consortia as the International Consortium for Blood Pressure Genome-Wide Association Studies (ICBP), the Global Lipids Genetics Consortium (GLGC), the DIAbetes Genetics Replication And Meta-analysis consortium (DIAGRAM), and the Coronary ARtery DIsease Genome-wide Replication And Meta-Analysis consortium (CARDIoGRAM). The variability of these principal cardiovascular risk factors is to large extent genetic and knowledge on the genetic basis originated largely from analysis of monogenic disease in rare syndromes before the use of genome-wide, common SNP analysis. Genome-wide association studies have identified ~45 common variants associated with systolic- and diastolic blood pressure, ~65 common variants for type 2 diabetes and ~95 common variants for lipid traits. One major end organ damage is coronary heart disease and ~25 loci could be shown to be associated. Risk scores using multiple cardiovascular risk factor SNPs are clearly correlated with cardiovascular outcome. This review summarizes recent findings by genome-wide association studies and the contributions by the Framingham Heart Study on the basis of seminal articles and gives an outlook on some of the future experiments.
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Affiliation(s)
- Georg B Ehret
- Cardiology, Department of Specialties of Internal Medicine, Geneva, Switzerland ; McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, USA
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856
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Powell-Wiley TM, Banks-Richard K, Williams-King E, Tong L, Ayers CR, de Lemos JA, Gimpel N, Lee JJ, DeHaven MJ. Churches as targets for cardiovascular disease prevention: comparison of genes, nutrition, exercise, wellness and spiritual growth (GoodNEWS) and Dallas County populations. J Public Health (Oxf) 2013; 35:99-106. [PMID: 22811446 PMCID: PMC3580052 DOI: 10.1093/pubmed/fds060] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We compared cardiovascular (CV) risk factors (CVRFs) of community-based participatory research (CBPR) participants with the community population to better understand how CBPR participants relate to the population as a whole. METHODS GoodNEWS participants in 20 African-American churches in Dallas, Texas were compared with age/sex-matched African-Americans in the Dallas Heart Study (DHS), a probability-based sample of Dallas County residents. DHS characteristics were sample-weight adjusted to represent the Dallas County population. RESULTS Despite having more education (college education: 75 versus 51%, P< 0.0001), GoodNEWS participants were more obese (mean body mass index: 34 versus 31 kg/m(2), P< 0.001) and had more diabetes (23 versus 12%, P< 0.001) and hyperlipidemia (53 versus 14%, P< 0.001) compared with African-Americans in Dallas County. GoodNEWS participants had higher rates of treatment and control of most CVRFs (treated hyperlipidemia: 95 versus 64%, P< 0.001; controlled diabetes: 95 versus 21%, P< 0.001; controlled hypertension: 70 versus 52%, P= 0.003), were more physically active (233 versus 177 metabolic equivalent units-min/week, P< 0.0001) and less likely to smoke (10 versus 30%, P< 0.001). CONCLUSIONS Compared with African-Americans in Dallas County, CBPR participants in church congregations were more educated, physically active and had more treatment and control of most CVRFs. Surprisingly, this motivated population had a greater obesity burden, identifying them as a prime target for CBPR-focused obesity treatment.
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Affiliation(s)
- Tiffany M Powell-Wiley
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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857
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Abstract
Metabolic syndrome (MetS), a constellation of central obesity, hypertension, dyslipidaemia and glucose intolerance, is highly prevalent in individuals with schizophrenia and conveys significant cardiovascular risk and mortality. Associated risk factors are female sex, some ethnic groups, advanced age, long duration of illness, smoking and exposure to antipsychotic agents. The prevalence of MetS varies across countries and psychiatric populations, and its development can be very rapid. Regular monitoring of all features of MetS is the cornerstone of its early detection and management. Future research needs to focus more on genetic determinants of MetS in the context of schizophrenic illness. This review aims to update the reader with the latest knowledge about the prevalence of MetS in schizophrenia and what might be the underlying pathophysiological mechanisms.
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Affiliation(s)
- Evangelos Papanastasiou
- CSI Lab, Department of Psychosis Studies, Institute of Psychiatry, KCL, De Crespigny Park, PO63, Denmark Hill, Camberwell, London SE5 8AF, UK
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858
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Makulska I, Szczepańska M, Drożdż D, Polak-Jonkisz D, Zwolińska D. Skin autofluorescence as a marker of cardiovascular risk in children with chronic kidney disease. Pediatr Nephrol 2013; 28:121-8. [PMID: 22976887 PMCID: PMC3505501 DOI: 10.1007/s00467-012-2280-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 07/13/2012] [Accepted: 07/13/2012] [Indexed: 01/20/2023]
Abstract
BACKGROUND We examined skin autofluorescence (sAF) in chronic kidney disease children (CKD) in relation to renal function and dialysis modality. METHODS Twenty children on hemodialysis (HD), 20 on peritoneal dialysis (PD), 36 treated conservatively, and 26 healthy subjects were enrolled into the study. In all children sAF, pulse-wave velocity indexed to height (PWV/ht), left ventricular mass index (LVMI), blood pressure (BP), serum lipid profile, phosphate (P), calcium (Ca), and homocysteine were measured. RESULTS sAF was significantly elevated in CKD groups vs. controls and was significantly associated with PWV/ht, LVMI, BP, P, Ca × P product and homocysteine. sAF in HD and PD groups was positively correlated with dialysis vintage, and in the predialysis group negatively correlated with glomerular filtration rate (eGFR). Multiple regression analysis showed significant association of sAF with LVMI and P in the CKD patient group, and with dialysis treatment duration and BP in dialyzed children. CONCLUSIONS In CKD children, tissue accumulation of advanced glycation end-products (AGEs) was observed. This was aggravated as eGFR declined and was related to early cardiovascular changes and some biochemical cardiovascular disease (CVD) risk markers. sAF as a non-invasive method may be a useful tool for identification of a clinical risk factors of cardiovascular disease in CKD children.
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Affiliation(s)
- Irena Makulska
- Department of Pediatric Nephrology, Wrocław Medical University, ul. Borowska 213, Wrocław, Poland
| | - Maria Szczepańska
- Pediatric Dialysis Unit, Zabrze, Medical University of Silesia, Katowice, Poland
| | - Dorota Drożdż
- Dialysis Unit, Jagiellonian University Medical College, Kraków, Poland
| | - Dorota Polak-Jonkisz
- Department of Pediatric Nephrology, Wrocław Medical University, ul. Borowska 213, Wrocław, Poland
| | - Danuta Zwolińska
- Department of Pediatric Nephrology, Wrocław Medical University, ul. Borowska 213, Wrocław, Poland
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859
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Frierson GM, Howard EN, DeFina LE, Powell-Wiley TM, Willis BL. Effect of race and socioeconomic status on cardiovascular risk factor burden: the Cooper Center Longitudinal Study. Ethn Dis 2013; 23:35-42. [PMID: 23495620 PMCID: PMC4266688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVES This study examines the prevalence of cardiovascular risk factors and chronic disease burden among African Americans compared to Caucasians in a population of higher socioeconomic status. DESIGN The current study is a cross-sectional, secondary data analysis of the Cooper Center Longitudinal Study. SETTING Patients with a medical examination from 1970-2010 at the Cooper Clinic. PARTICIPANTS 762 African Americans and 40,051 Caucasians who met the criteria. OUTCOME MEASURES Racial differences in cardiovascular risk factors/burden of disease between African Americans and Caucasians. RESULTS African Americans had higher prevalence of evaluated cardiovascular risk factors than did Caucasians after controlling for obesity, tobacco use, and physical fitness. Caucasians had greater likelihood of no risk factors while African Americans were more likely to have all three risk factors. Race was typically predictive of cardiovascular risk factors in African Americans compared to Caucasians. CONCLUSIONS Findings suggest that health differences persist despite greater socioeconomic status, and further investigations of biopsychosocial causes are warranted.
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860
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Abstract
It is well known that abdominal obesity, dyslipidemia, and insulin resistance are highly prevalent in patients receiving maintenance treatment with antipsychotics, but there is limited knowledge about the association between cardiovascular risk factors and treatment with antipsychotic drugs. In this naturalistic study we investigated a sample of 809 antipsychotic-treated patients from Swedish psychosis outpatient teams. Cardiovascular risk factors (eg, metabolic syndrome, homeostasis model assessment of insulin resistance, and low-density lipoprotein values) were measured, and their associations to current antipsychotic pharmacotherapy were studied. Ten antipsychotic drugs were compared in a stepwise logistic regression model. For the patients, the presence of the components of metabolic syndrome ranged from 35% for hyperglycemia to 64% for elevated waist circumference. Hypertriglyceridemia was associated with clozapine (odds ratio [OR] = 1.81, 95% confidence interval [CI] 1.08-3.04), reduced high-density lipoprotein with both clozapine and olanzapine (OR = 1.73, 95% CI 1.01-2.97; and OR = 2.03, 95% CI 1.32-3.13), hypertension with perphenazine (OR = 2.00, 95% CI 1.21-3.59), and hyperglycemia inversely with ziprasidone (OR = 0.21, 95% CI 0.05-0.89) and positively with haloperidol (OR = 2.02, 95% CI 1.18-3.48). There were no significant relationships between any of the antipsychotic drugs and increased waist circumference, homeostasis model assessment of insulin resistance, or low-density lipoprotein levels. In conclusion, treatment with antipsychotic drugs is differentially associated with cardiovascular risk factors, even after adjusting for waist circumference, sex, age, and smoking.
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Affiliation(s)
- Robert Bodén
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden ; Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
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861
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Bradley E, Parker J, Novak E, Ludbrook P, Billadello J, Cedars A. Cardiovascular disease in late survivors of tetralogy of fallot: a tertiary care center experience. Tex Heart Inst J 2013; 40:418-423. [PMID: 24082371 PMCID: PMC3783145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Patients with tetralogy of Fallot can survive to late adulthood; however, there are few data on cardiovascular outcomes in this population. We conducted a single-center retrospective analysis of cardiovascular outcomes and risk factors in 208 patients with tetralogy of Fallot to better evaluate the burden of cardiovascular disease in this group. Descriptive statistics were used to determine the prevalence of relevant cardiovascular risk factors and outcomes, including a composite analysis of cardiovascular disease. Rates and mean values from the American Heart Association 2011 Heart Disease and Stroke Statistics Update were used as population estimates for comparison. In tetralogy of Fallot patients, cardiovascular disease prevalence was not different from that found in the general population (40% vs. 36%, P=0.3). However, there was significantly more cardiovascular disease in tetralogy of Fallot men aged 20 to 39 years (30% vs. 14%, P < 0.05) and in tetralogy of Fallot men aged 40 to 59 years (63% vs. 29%, P < 0.0001). This was due to higher prevalence of coronary disease (12% vs. 7%, P < 0.05) and heart failure (16% vs. 2%, P < 0.0001). In particular, the increased prevalence of heart failure (regardless of pulmonary valve disease) accounts for the frequency of cardiovascular disease in tetralogy of Fallot men aged 20 to 59 years. These data support the need to routinely screen young adult male survivors of tetralogy of Fallot for asymptomatic heart failure. Further studies are needed to determine the incidence, severity, and long-term effects of cardiovascular disease in the adult congenital heart disease population.
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Affiliation(s)
- Elisa Bradley
- Division of Cardiovascular Medicine, Washington University, St. Louis, Missouri 63110
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862
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Trombetta IC, Maki-Nunes C, Toschi-Dias E, Alves MJNN, Rondon MUPB, Cepeda FX, Drager LF, Braga AMFW, Lorenzi-Filho G, Negrao CE. Obstructive sleep apnea is associated with increased chemoreflex sensitivity in patients with metabolic syndrome. Sleep 2013; 36:41-9. [PMID: 23288970 PMCID: PMC3524508 DOI: 10.5665/sleep.2298] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is often observed in patients with metabolic syndrome (MetS). In addition, the association of MetS and OSA substantially increases sympathetic nerve activity. However, the mechanisms involved in sympathetic hyperactivation in patients with MetS + OSA remain to be clarified. We tested the hypothesis that chemoreflex sensitivity is heightened in patients with MetS and OSA. DESIGN Prospective clinical study. PARTICIPANTS Forty-six patients in whom MetS was newly diagnosed (ATP-III) were allocated into: (1) MetS + OSA (n = 24, 48 ± 1.8 yr); and (2) MetS - OSA (n = 22, 44 ± 1.7 yr). Eleven normal control subjects were also studied (C, 47 ± 2.3 yr). MEASUREMENTS OSA was defined as an apnea-hypopnea index ≥ 15 events/hr (polysomnography). Muscle sympathetic nerve activity (MSNA) was measured by microneurography technique. Peripheral chemoreflex sensitivity was assessed by inhalation of 10% oxygen and 90% nitrogen (carbon dioxide titrated), and central chemoreflex sensitivity by 7% carbon dioxide and 93% oxygen. RESULTS Physical characteristics and MetS measures were similar between MetS + OSA and MetS - OSA. MSNA was higher in MetS + OSA patients compared with MetS - OSA and C (33 ± 1.3 versus 28 ± 1.2 and 18 ± 2.2 bursts/min, P < 0.05). Isocapnic hypoxia caused a greater increase in MSNA in MetS + OSA than MetS - OSA and C (P = 0.03). MSNA in response to hyperoxic hypercapnia was greater in MetS + OSA compared with C (P = 0.005). Further analysis showed a significant association between baseline MSNA and peripheral (P < 0.01) and central (P < 0.01) chemoreflex sensitivity. Min ventilation in response to hyperoxic hypercapnia was greater in MetS + OSA compared with C (P = 0.001). CONCLUSION OSA increases sympathetic peripheral and central chemoreflex response in patients with MetS, which seems to explain, at least in part, the increase in sympathetic nerve activity in these patients. In addition, OSA increases ventilatory central chemoreflex response in patients with MetS.
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Affiliation(s)
- Ivani C Trombetta
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
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863
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Dobranici M, Buzea A, Popescu R. The cardiovascular risk factors of the Roma (gypsies) people in Central-Eastern Europe: a review of the published literature. J Med Life 2012; 5:382-9. [PMID: 23390466 PMCID: PMC3565246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 12/15/2012] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Estimated number of the Roma people in central-eastern Europe cannot be precisely appreciated, but official data suggest that in the 2004 they were approximately 4.2 million. At this time, there are few available data about the health status of the Roma people, mostly assessing genetic and infectious diseases, which reflect poverty, overcrowding, and lack of education. There is even less data regarding non-communicable and chronic diseases, especially cardiovascular diseases. METHODS We searched the published literature on the cardiovascular risk factors in Roma people using PubMed from January 2000 to July 2011. The searching criteria were: (1) randomized, prospective observational, retrospective and meta-analysis; (2) adult patients with cardiac diseases or cardiovascular risk factors (3) data available for cardiovascular patients. Search terms included dyslipidemia, obesity, tobacco, hypertension, and diabetes mellitus. RESULTS Twenty-five studies were identified. Approximately 75% of them were related to just four countries: Slovakia, Croatia, Czech Republic, and Serbia. This paper is a review based on existing literature concerning classical risk factors in Roma people with emphasis on their ethnical features. Despite limited data, the results showed that this ethnicity has the incriminated risk factors more frequently than the majority and consequently a higher cardiovascular morbidity rate. CONCLUSIONS Quantification of the cardiovascular risk factor and their implication in the shortening of life expectancy in Roma population was a provocation due to a paucity of reliable data. At this time, we should pay more attention on the Roma health issues and the cultural concerns that might affect them in the context of borderless Europe.
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Affiliation(s)
- M Dobranici
- Cardiology Department, “Colentina” University Hospital, Bucharest
,”Carol Davila” University of Medicine and Pharmacy, Bucharest
| | - A Buzea
- Cardiology Department, “Colentina” University Hospital, Bucharest
,”Carol Davila” University of Medicine and Pharmacy, Bucharest
| | - R Popescu
- Cardiology Department, “Colentina” University Hospital, Bucharest
,”Carol Davila” University of Medicine and Pharmacy, Bucharest
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864
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Kovács T, Vas T, Kovesdy CP, Késõi I, Sági B, Wittmann I, Nagy J. Metabolic syndrome and other cardiovascular risk factors associated with the progression of IgA nephropathy. Clin Kidney J 2012; 6:395-401. [PMID: 27293567 PMCID: PMC4898329 DOI: 10.1093/ckj/sfs131] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 08/18/2012] [Indexed: 01/21/2023] Open
Abstract
Background The metabolic syndrome is associated with modest but independent and additive risk of new onset chronic kidney disease (CKD) in several studies. The purpose of our study was to determine whether metabolic syndrome and other cardiovascular risk factors (hyperuricaemia and smoking) are associated with the progression of IgA nephropathy (IgAN). Methods Two hundred and twenty three IgAN patients (107 with and 116 without metabolic syndrome) were examined. The primary renal end point was doubling of serum creatinine; secondary end points were reaching eGFR of ≤ 60 ml/min/1,73m2 or eGFR of ≤30 ml/min/1.73 m2, and end-stage renal disease, ESRD (the composite of serum creatinine ≥500 μmol/l, initiation of dialysis treatment or transplantation). The association of metabolic syndrome with renal end points was examined using the Kaplan-Meier method and Cox models. Results Metabolic syndrome established at the diagnosis or during follow-up of IgAN patients was significantly associated with the primary renal end point (unadjusted hazard ratio of doubling of serum creatinine, 95% confidence interval: 1.96 (1.17–1.33, p = 0.011). The association remained significant after adjustment for confounders: 1.70 (1.02–3.83, p = 0.040). Results were similar for secondary end points except ESRD which was not associated with the presence of metabolic syndrome. Hyperuricaemia and smoking were independent risk factors of progression. Survival curves stratified on metabolic syndrome status showed significant differences for the end points (p = 0.017–0.001) except for ESRD. Conclusions Early diagnosis and treatment of metabolic syndrome, hyperuricaemia and smoking may be an additional cost-effective strategy for preventing the progression of IgAN.
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Affiliation(s)
- Tibor Kovács
- Second Department of Medicine and Nephrological Center, Faculty of Medicine , University of Pécs, Pécs , Hungary
| | - Tibor Vas
- Second Department of Medicine and Nephrological Center, Faculty of Medicine , University of Pécs, Pécs , Hungary
| | - Csaba P Kovesdy
- Health Science Center , University of Tennessee , Memphis, TN , USA
| | - István Késõi
- Second Department of Medicine and Nephrological Center, Faculty of Medicine , University of Pécs, Pécs , Hungary
| | - Balázs Sági
- Second Department of Medicine and Nephrological Center, Faculty of Medicine , University of Pécs, Pécs , Hungary
| | - István Wittmann
- Second Department of Medicine and Nephrological Center, Faculty of Medicine , University of Pécs, Pécs , Hungary
| | - Judit Nagy
- Second Department of Medicine and Nephrological Center, Faculty of Medicine , University of Pécs, Pécs , Hungary
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865
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Abstract
Type 2 diabetes mellitus (T2DM) is a well-recognized risk factor for the development of cardiovascular disease. With an increasing prevalence of obesity, this risk has increased further. Management of T2DM in obese patients is particularly challenging as treatment with the majority of glucose-lowering agents results in weight gain. Thus, the development of a therapeutic option which could improve glycemic control without weight gain or hypoglycemia, such as the glucagon-like peptide-1 (GLP-1) analog exenatide, is a welcome addition to the currently available therapies in the management of T2DM. With recognition and better understanding of the role of incretin hormones in T2DM, exenatide was developed and introduced into clinical practice in 2005. Both randomized controlled trials and retrospective observational studies have shown that treatment with exenatide not only improves glycemic control, with a low risk of hypoglycemia, but also results in concurrent weight loss and the additional benefit of improvement in cardiovascular risk factors. This article will provide an overview of both short- and long-acting exenatide in the management of T2DM and associated cardiovascular risk factors.
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Affiliation(s)
- Zin Z. Htike
- Department of Diabetes and Endocrinology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kamlesh Khunti
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Melanie Davies
- Department of Cardiovascular Sciences, University of Leicester, Leicester Royal Infirmary, c/o Victoria Building, Leicester, LE1 5WW UK
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866
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Gomes MB, Cobas RA, Matheus AS, Tannus LR, Negrato CA, Rodacki M, Braga N, Cordeiro MM, Luescher JL, Berardo RS, Nery M, Arruda-Marques MDC, Calliari LE, Noronha RM, Manna TD, Zajdenverg L, Salvodelli R, Penha FG, Foss MC, Foss-Freitas MC, Pires AC, Robles FC, Guedes M, Dib SA, Dualib P, Silva SC, Sepulvida J, Almeida HG, Sampaio E, Rea R, Faria ACR, Tschiedel B, Lavigne S, Cardozo GA, Azevedo MJ, Canani LH, Zucatti AT, Coral MHC, Pereira DA, Araujo LA, Tolentino M, Pedrosa HC, Prado FA, Rassi N, Araujo LB, Fonseca RMC, Guedes AD, Matos OS, Faria M, Azulay R, Forti AC, Façanha C, Montenegro AP, Montenegro R, Melo NH, Rezende KF, Ramos A, Felicio JS, Santos FM, Jezini DL, Cordeiro MM. Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group. Diabetol Metab Syndr 2012; 4:44. [PMID: 23107314 PMCID: PMC3538646 DOI: 10.1186/1758-5996-4-44] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 09/19/2012] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED BACKGROUND To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated. METHODS This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians) aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years (<1 to 50 years). RESULTS Overall, 18.4% patients had HbA1c levels <7.0%, and 47.5% patients had HbA1c levels ≥ 9%. HbA1c levels were associated with lower economic status, female gender, age and the daily frequency of self-blood glucose monitoring (SBGM) but not with insulin regimen and geographic region. Hypertension was more frequent in the mid-west (32%) and north/northeast (25%) than in the southeast (19%) and south (17%) regions (p<0.001). More patients from the southeast region achieved LDL cholesterol goals and were treated with statins (p<0.001). Fewer patients from the north/northeast and mid-west regions were screened for retinopathy and nephropathy, compared with patients from the south and southeast. Patients from the south/southeast regions had more intensive insulin regimens than patients from the north/northeast and mid-west regions (p<0.001). The most common insulin therapy combination was intermediate-acting with regular human insulin, mainly in the north/northeast region (p<0.001). The combination of insulin glargine with lispro and glulisine was more frequently used in the mid-west region (p<0.001). Patients from the north/northeast region were younger, non-Caucasian, from lower economic status, used less continuous subcutaneous insulin infusion, performed less SBGM and were less overweight/obese (p<0.001). CONCLUSIONS A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.
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Affiliation(s)
- Marília B Gomes
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Roberta A Cobas
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Alessandra S Matheus
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Lucianne R Tannus
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Carlos Antonio Negrato
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Melanie Rodacki
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Neuza Braga
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Marilena M Cordeiro
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Jorge L Luescher
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Renata S Berardo
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Marcia Nery
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Maria do Carmo Arruda-Marques
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Luiz E Calliari
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Renata M Noronha
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Thais D Manna
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Lenita Zajdenverg
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Roberta Salvodelli
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Fernanda G Penha
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Milton C Foss
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Maria C Foss-Freitas
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Antonio C Pires
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Fernando C Robles
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - MariadeFátimaS Guedes
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Sergio A Dib
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Patricia Dualib
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Saulo C Silva
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Janice Sepulvida
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Henriqueta G Almeida
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Emerson Sampaio
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Rosangela Rea
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Ana Cristina R Faria
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Balduino Tschiedel
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Suzana Lavigne
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Gustavo A Cardozo
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Mirela J Azevedo
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Luis Henrique Canani
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Alessandra T Zucatti
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Marisa Helena C Coral
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Daniela Aline Pereira
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Luiz Antonio Araujo
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Monica Tolentino
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Hermelinda C Pedrosa
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Flaviane A Prado
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Nelson Rassi
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Leticia B Araujo
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Reine Marie C Fonseca
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Alexis D Guedes
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Odelissa S Matos
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Manuel Faria
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Rossana Azulay
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Adriana C Forti
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Cristina Façanha
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Ana Paula Montenegro
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Renan Montenegro
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Naira H Melo
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Karla F Rezende
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Alberto Ramos
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - João Sooares Felicio
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Flavia M Santos
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Deborah L Jezini
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Marilena M Cordeiro
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
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867
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Abstract
Critical limb ischemia is found in 12% of the U.S. adult population. Its clinical presentation varies from no symptoms to intermittent claudication, atypical leg pain, rest pain, ischemic ulcers, or gangrene. Those with critical limb ischemia have a high incidence of cardiovascular comorbidities that reflect a significant systemic atherosclerotic burden; they have increased functional impairment and increased rates of functional decline compared with persons without critical limb ischemia. Interventions for critical limb ischemia and the impact of major amputation have a significant social and economic impact. At 1 year, 25% of patients will be dead, 30% will have undergone amputation, and only 45% will remain alive with both limbs. At 5 years, more than 60% of patients with critical limb ischemia will be dead.
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Affiliation(s)
- Mark G Davies
- Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, Texas, USA
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868
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Abstract
The metabolic syndrome (MetS) is an increasingly prevalent condition in people with schizophrenia. It remains highly prevalent in the general population in developed countries, but recently health promotion campaigns and greater awareness of the high associated mortality rates have resulted in improvements in the rates of cardiovascular risk factors. This is not the case for people with schizophrenia who continue to have more than twice the rates of MetS and significantly higher mortality rates than the general population. Various behavioural and pharmacological interventions have been used to improve conditions that are linked to MetS, mainly smoking and obesity. This review aims to provide an update of the latest knowledge about the behavioural, pharmacological and other interventions that might help to combat this life-threatening problem in people with schizophrenia.
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Affiliation(s)
- Evangelos Papanastasiou
- CSI Lab, Department of Psychosis Studies, Institute of Psychiatry, KCL, De Crespigny Park, PO63, Denmark Hill, London SE5 8AF, UK
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869
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Sivri N, Yalta T, Sayın C, Yalta K, Ozpuyan F, Taştekin E, Yetkin E. Evaluation of cardiovascular risk factors in women with uterine leimyoma: is there a link with atherosclerosis? Balkan Med J 2012; 29:320-3. [PMID: 25207023 DOI: 10.5152/balkanmedj.2012.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 02/11/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Both uterine leimyoma (UL) and cardiovascular disease are public health problems affecting women at different age ranges. Smoking, obesity, and hypertension have been shown to be associated with UL in different random studies. However cardiovascular risk factors have not been evaluated systematically in patients with UL. Accordingly, we aimed to evaluate the cardiovascular risk factors and their relation with the presence of UL. MATERIAL AND METHODS One hundred and eighty nine patients with the pathological diagnosis of UL and one hundred and eighty nine age matched control subjects without UL were retrospectively included in the study from our data base of the pathology and gynecology departments. Controls were patients with intact uteri who had visited the same physicians for a routine checkup that included a pelvic examination and uterine sonogram and without mention of physical findings consistent with UL. The following clinical and demographic parameters were recorded; age, sex, hypertension, diabetes mellitus, and hypercholesterolemia. Current cigarette smoking was defined as active smoking within the past 12 months. RESULTS Comparison of cardiovascular risk factors between with and without UL revealed that the presence of hypertension (80 (42.3%) vs 53 (28%) p=0.004) diabetes mellitus (33 (17.4%) vs. 16 (8.4%) p=0.009), smoking (31 (16.4%) vs. 11 (5.8%) p=0.001), were significantly higher in patients with UL than in control subjects. The mean-age and presence of hyperlipidemia were comparable between the two groups. Logistic regression analysis revealed an independent and positive association of UL with the presence of hypertension (odds ratio 2.02 CI: 1.25-3.27 p=0.004), diabetes mellitus (odds ratio 2.43 CI: 1.23-4.79 p=0.010), and smoking status (odds ratio 3.46 CI: 1.65-7.22 p=0.001). CONCLUSION We have shown that major cardiovascular risk factors namely, hypertension, diabetes mellitus and smoking are significantly and independently associated with UL. Our findings highlight the possible association of UL with atherosclerosis.
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Affiliation(s)
- Nasir Sivri
- Department of Cardiology, Faculty of Medicine, Trakya Univeristy, Edirne, Turkey
| | - Tülin Yalta
- Department of Pathology, Faculty of Medicine, Trakya Univeristy, Edirne, Turkey
| | - Cenk Sayın
- Department of Gynecology and Obstetrics, Faculty of Medicine, Trakya Univeristy, Edirne, Turkey
| | - Kenan Yalta
- Department of Cardiology, Faculty of Medicine, Trakya Univeristy, Edirne, Turkey
| | - Fulya Ozpuyan
- Department of Pathology, Faculty of Medicine, Trakya Univeristy, Edirne, Turkey
| | - Ebru Taştekin
- Department of Pathology, Faculty of Medicine, Trakya Univeristy, Edirne, Turkey
| | - Ertan Yetkin
- Department of Cardiology, IMC Hospital, Mersin Turkey
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870
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Abstract
OBJECTIVE Despite the high prevalence of risk factors for obstructive sleep apnea (OSA) among individuals with bipolar disorder, the presence of sleep-disordered breathing has not been systematically assessed in this population. In this study, we sought to determine the level of risk for OSA in a population of remitted individuals with a diagnosis of bipolar I disorder. METHODS A total of 72 individuals with a diagnosis of bipolar I disorder, all of whom were overweight by the World Health Organization criteria, completed the Berlin Questionnaire, a self-assessment tool to establish risk for OSA. RESULTS Over half of this study population (54.1%) was found to be in the high-risk category for OSA. Participants at high risk for OSA scored significantly higher on measures of both depression and mania, even when sleep items were not counted in the total scores. CONCLUSIONS Sleep apnea may be prevalent in patients with bipolar I disorder. Considering the substantial overlap of symptoms between OSA and depression and the potentially harmful effects of sleep disruption in patients with mood disorders, a systematic screening to assess prevalence and associated features of OSA in patients with bipolar disorder is warranted.
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Affiliation(s)
- Isabella Soreca
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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871
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Ho SS, Dhaliwal SS, Hills AP, Pal S. The effect of 12 weeks of aerobic, resistance or combination exercise training on cardiovascular risk factors in the overweight and obese in a randomized trial. BMC Public Health 2012; 12:704. [PMID: 23006411 PMCID: PMC3487794 DOI: 10.1186/1471-2458-12-704] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 08/23/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Evidence suggests that exercise training improves CVD risk factors. However, it is unclear whether health benefits are limited to aerobic training or if other exercise modalities such as resistance training or a combination are as effective or more effective in the overweight and obese. The aim of this study is to investigate whether 12 weeks of moderate-intensity aerobic, resistance, or combined exercise training would induce and sustain improvements in cardiovascular risk profile, weight and fat loss in overweight and obese adults compared to no exercise. METHODS Twelve-week randomized parallel design examining the effects of different exercise regimes on fasting measures of lipids, glucose and insulin and changes in body weight, fat mass and dietary intake. Participants were randomized to either: Group 1 (Control, n = 16); Group 2 (Aerobic, n = 15); Group 3 (Resistance, n = 16); Group 4 (Combination, n = 17). Data was analysed using General Linear Model to assess the effects of the groups after adjusting for baseline values. Within-group data was analyzed with the paired t-test and between-group effects using post hoc comparisons. RESULTS Significant improvements in body weight (-1.6%, p = 0.044) for the Combination group compared to Control and Resistance groups and total body fat compared to Control (-4.4%, p = 0.003) and Resistance (-3%, p = 0.041). Significant improvements in body fat percentage (-2.6%, p = 0.008), abdominal fat percentage (-2.8%, p = 0.034) and cardio-respiratory fitness (13.3%, p = 0.006) were seen in the Combination group compared to Control. Levels of ApoB48 were 32% lower in the Resistance group compared to Control (p = 0.04). CONCLUSION A 12-week training program comprising of resistance or combination exercise, at moderate-intensity for 30 min, five days/week resulted in improvements in the cardiovascular risk profile in overweight and obese participants compared to no exercise. From our observations, combination exercise gave greater benefits for weight loss, fat loss and cardio-respiratory fitness than aerobic and resistance training modalities. Therefore, combination exercise training should be recommended for overweight and obese adults in National Physical Activity Guidelines.This clinical trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number: ACTRN12609000684224.
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Affiliation(s)
- Suleen S Ho
- School of Public Health; Curtin Health Innovation Research Institute, Curtin University of Technology, GPO Box U1987, Perth, Western Australia, Australia, 6845
| | - Satvinder S Dhaliwal
- School of Public Health; Curtin Health Innovation Research Institute, Curtin University of Technology, GPO Box U1987, Perth, Western Australia, Australia, 6845
| | - Andrew P Hills
- Mater Mother’s Hospital, Mater Medical Research Institute. Conjoint appointment with Griffith Health Institute, Griffith University, Brisbane, Australia
| | - Sebely Pal
- School of Public Health; Curtin Health Innovation Research Institute, Curtin University of Technology, GPO Box U1987, Perth, Western Australia, Australia, 6845
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872
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Syvänen K, Korhonen P, Jaatinen P, Vahlberg T, Aarnio P. High-sensitivity C-reactive protein and ankle brachial index in a finnish cardiovascular risk population. Int J Angiol 2012; 20:43-8. [PMID: 22532770 DOI: 10.1055/s-0031-1272551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
High-sensitivity C-reactive protein (hsCRP) has been previously linked to different forms of vascular disease. However, some studies have not found any relationship between hsCRP and atherosclerosis. Also, studies investigating correlation between hsCRP and ankle brachial index (ABI) are scarce. We studied hsCRP in a cardiovascular risk population with a special interest in correlation between hsCRP and ABI. All men and women aged 45 to 70 years from a rural town Harjavalta, Finland were invited to participate in a population survey. Diabetics and people with known vascular disease were excluded. Seventy-three percent (n = 2085) of the invited persons participated and 70% of the respondents (n = 1496) had at least one risk factor to cardiovascular diseases. These subjects were invited to further examinations. From them we measured ABI, hsCRP, leukocyte count, glucose tolerance, systemic coronary risk evaluation (SCORE), body mass index (BMI), and waist circumference. Mean hsCRP was 1.9 mg/L. Smokers had higher hsCRP (mean 2.2 mg/L) than nonsmokers (mean 1.8 mL/L). hsCRP in women was higher than in men (mean 2.0 mg/L versus 1.8 mg/L). Mean ABI was 1.10, and the prevalence of peripheral arterial disease was 3.1%. ABI correlated weakly with hsCRP (r = -0.077, p = 0.014), leukocyte count (r = -0.107, p = 0.001), and SCORE (r = -0.116, p = 0.001). It did not have correlation between age, weight, BMI, or waist circumference. hsCRP correlated with BMI (r = 0.208, p < 0.0001) and waist circumference (r = 0.325, p < 0.0001). When we excluded subjects with hsCRP >10 mg/L, ABI no longer correlated with hsCRP. In a cardiovascular risk population, hsCRP has only a weak correlation with ABI, and this correlation disappeared when we excluded subject with hsCRP >10 mg/L. Instead, hsCRP was correlated to the measures of obesity (waist circumference and BMI), indicating its role as a marker of adipose tissue-driven inflammation. hsCRP does not seem to be a suitable screening method for peripheral arterial disease.
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873
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Reibis R, Treszl A, Wegscheider K, Bestehorn K, Karmann B, Völler H. Disparity in risk factor pattern in premature versus late-onset coronary artery disease: a survey of 15,381 patients. Vasc Health Risk Manag 2012; 8:473-81. [PMID: 22930639 PMCID: PMC3425343 DOI: 10.2147/vhrm.s33305] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There are few data available regarding the specificity and modifiability of major cardiovascular (CV) risk factors in patients with premature versus (vs) late-onset coronary artery disease (CAD). This study was designed to analyze and compare these risk factors. PATIENTS AND METHODS Data from 15,381 consecutive patients (mean age, 62.3 ± 11.7 years; female, 33.8%) hospitalized with CAD were collected from a large-scale registry (Transparency Registry to Objectify Guideline-Oriented Risk Factor Management) and analyzed. The patients were divided into two groups, depending on age at inclusion: group 1 patients (n = 5725; mean age, 50.5 ± 7.2 years) were males aged < 55 years and females aged < 65 years; group 2 patients (n = 9656; mean age, 69.4 ± 7.4 years) were males aged > 55 years and females aged > 65 years and had a low-density lipoprotein cholesterol level of >100 mg/dL on admission to cardiac rehabilitation. Besides the conventional risk factors, lipoprotein(a) concentrations and glucose tolerance were measured facultatively. Univariate (chi-square test) and multivariate logistic regression models were used. RESULTS Cigarette smoking (group 1 at 31.5% vs group 2 at 9.4%; P < 0.001), family history of CAD (group 1 at 43.6% vs group 2 at 26.5%; P < 0.001), and dyslipidemia (group 1 at 92.7% vs group 2 at 91.8%; P < 0.001) were dominant risk factors in the younger group. Arterial hypertension (group 1 at 71.4% vs group 2 at 87.0%; P < 0.001) and diabetes (group 1 at 23.5% vs group 2 at 30.1%; P < 0.001) were dominant risk factors in the older group. Impaired glucose tolerance and diabetes were less frequent in the younger group (P(trend) = 0.038), and identical lipoprotein(a) concentration levels of >30 mg/dL were found in both groups (8.0%; P = 0.810). Modification of lipid profile and blood pressure was more effective in the younger group (low-density lipoprotein cholesterol < 100 mg/dL: group 1 at 66.3% vs group 2 at 61.1%; systolic blood pressure < 140 mmHg: group 1 at 91.7% vs group 2 at 83.0%; P < 0.001). CONCLUSION CV risk factors differ markedly between premature and non-premature CAD. Cardiac rehabilitation provides an opportunity to reinforce secondary prevention after acute coronary syndrome.
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Affiliation(s)
- Rona Reibis
- Department of Cardiology, Klinik am See, Rehabilitation Center of Cardiovascular Diseases, Rüdersdorf, Germany.
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874
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Kivimäki M, Shipley MJ, Allan CL, Sexton CE, Jokela M, Virtanen M, Tiemeier H, Ebmeier KP, Singh-Manoux A. Vascular risk status as a predictor of later-life depressive symptoms: a cohort study. Biol Psychiatry 2012; 72:324-30. [PMID: 22425413 PMCID: PMC3539141 DOI: 10.1016/j.biopsych.2012.02.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 02/02/2012] [Accepted: 02/02/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND Common etiology of vascular diseases and later-life depression may provide important synergies for prevention. We examined whether standard clinical risk profiles developed for vascular diseases also predict depressive symptoms in older adults. METHODS Data were drawn from the Whitehall II study with baseline examination in 1991; follow-up screenings in 1997, 2003, and 2008; and additional disease ascertainment from hospital data and registry linkage on 5318 participants (mean age 54.8 years, 31% women) without depressive symptoms at baseline. Vascular risk was assessed with the Framingham Cardiovascular, Coronary Heart Disease, and Stroke Risk Scores. New depressive symptoms at each follow-up screening were identified by General Health Questionnaire caseness, a Center for Epidemiologic Studies Depression Scale score ≥16, and use of antidepressant medication. RESULTS Diagnosed vascular disease (that is, coronary heart disease or stroke) was associated with an increased risk for depressive symptoms, age- and sex-adjusted odds ratios from 1.5 (95% confidence interval 1.0-2.2) to 2.0 (1.4-3.0), depending on the indicator of depressive symptoms. Among participants without manifest vascular disease, the Stroke Risk Score was associated with Center for Epidemiologic Studies Depression Scale depressive symptoms before age 65 (age- and sex-adjusted odds ratio per 10% absolute change in the score = 3.1 [1.5-6.5]), but none of the risk scores predicted new-onset depressive symptoms in those aged ≥65 (odds ratios from .8 to 1.2). CONCLUSIONS These data suggest that public health measures to improve vascular risk status will influence the incidence of later-life depressive symptoms via reduced rates of manifest vascular disease.
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Affiliation(s)
- Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, United Kingdom.
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875
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Fernandes R, Braun KL, Spinner JR, Sturdevant C, Ancheta SJ, Yoshimura SR, Compton M, Wang JH, Lee CJ. Healthy Heart, Healthy Family: a NHLBI/HRSA collaborative employing community health workers to improve heart health. J Health Care Poor Underserved 2012; 23:988-99. [PMID: 24212152 PMCID: PMC4698457 DOI: 10.1353/hpu.2012.0097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Kokua Kalihi Valley, a federally qualified health center in Hawaii, collaborated with the National Heart, Lung, and Blood Institute to test the efficacy of community health workers (CHWs) to deliver the Healthy Heart, Healthy Family curriculum to low-income Filipinos with cardiovascular disease (CVD) risk factors. At 12 months, significant improvements were seen in health behaviors, knowledge, and self-efficacy in managing chronic diseases. We also observed decreases in total cholesterol from 186.25 mg/dl to 170.88 mg/dl (p=.001), low-density lipoprotein from 114.43 mg/dl to 103.04 mg/dl (p=.013), and fasting blood glucose from 117.95 mg/dl to 109.07 mg/dl (p=.034). Although these changes were statistically significant, they are small and not clinically meaningful in reducing CVD risk. The high-density lipoprotein was 3.3 mg/dl lower (worse) at 12 months (p=.003), mean values for blood pressure, BMI, and waist circumference increased. Community health workers can be trained to deliver evidence-based curricula that improve health behaviors and increase self-efficacy in managing chronic diseases.
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876
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Abstract
Dietary intervention is an important approach in the prevention of cardiovascular disease. Over the last decade, some studies have suggested that a calcium-rich diet could help to control body weight, with anti-obesity effects. The potential mechanism underlying the impact of calcium on body fat has been investigated, but it is not fully understood. Recent evidence has also suggested that a calcium-rich diet could have beneficial effects on other cardiovascular risk factors, such as insulin resistance, dyslipidemia, hypertension and inflammatory states. In a series of studies, it was observed that a high intake of milk and/or dairy products (the main sources of dietary calcium) is associated with a reduction in the relative risk of cardiovascular disease. However, a few studies suggest that supplemental calcium (mainly calcium carbonate or citrate) may be associated with an increased risk of cardiovascular events. This review will discuss the available evidence regarding the relationship between calcium intake (dietary and supplemental) and different cardiovascular risk factors and/or events.
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877
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Sharma D, Vatsa M, Lakshmy R, Narang R, Bahl VK, Gupta SK. Study of cardiovascular risk factors among tertiary hospital employees and their families. Indian Heart J 2012; 64:356-63. [PMID: 22929817 PMCID: PMC3861102 DOI: 10.1016/j.ihj.2012.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 06/15/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The aim of the present study was to estimate the prevalence of cardiovascular risk factors among administrative employees working at a tertiary hospital (All India Institute of Medical Sciences, New Delhi) and their families. METHODS AND RESULTS A cross-sectional survey was conducted among a total of 453 individuals aged 30 years and above. The mean age of the study group was 43.3 ± 9.5 years. There was a high prevalence of major cardiovascular risk factors - current smoking 58 (12.8%), tobacco consumption 26 (5.7%), family history of coronary artery disease 79 (17.4%), diabetes mellitus 25 (5.8%), hypertension 94 (20.7%), hypercholesterolemia 110 (25.7%), hypertriglyceridemia 148 (34.5%), physical inactivity 180 (39.7%), body mass index ≥23 kg/m(2) 350 (77.3%), central obesity 201 (80.1%) of males and 163 (80.7%) of females, inadequate fruit and vegetable consumption 387 (85.4%), heavy drinking 12 (2.6%), and stress 58 (12.7%). CONCLUSION This indicates an urgent need to initiate a comprehensive health promotion and cardiovascular disease prevention programme at workplace and community level.
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Affiliation(s)
- Divya Sharma
- All India Institute of Medical Sciences, New Delhi, India.
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878
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Ferreira-González I, Pinar-Sopena J, Ribera A, Marsal JR, Cascant P, González-Alujas T, Evangelista A, Brotons C, Moral I, Permanyer-Miralda G, García-Dorado D, Tornos P. Prevalence of calcific aortic valve disease in the elderly and associated risk factors: a population-based study in a Mediterranean area. Eur J Prev Cardiol 2012; 20:1022-30. [PMID: 22679252 DOI: 10.1177/2047487312451238] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To determine the prevalence of aortic valve sclerosis (ASC) and stenosis (AS) in the elderly in a Mediterranean area and to identify associated clinical factors. METHODS AND RESULTS Population cross-sectional study in a random sample of 1068 people ≥65 years in a Mediterranean area. ASC was categorized as absent, mild-to-moderate, or moderate-to-severe depending on the severity of thickening and calcification. The relation between the severity of ASC and potential risk factors was assessed by multinomial logistic regression analysis. Some degree of thickening and/or calcification was present in 45.4%, of the sample, 73.5% in >85 years. AS prevalence was 3% for the total cohort and 7.4% in >85 years. Adjusting for gender it was found that age, smoking habit, hypertension, waist circumference, and ankle-brachial index <0.9 were associated with degrees of ASC. Except for waist circumference, there was a gradient between the magnitude of association and the severity of ASC. The OR for age was 1.56 (95% CI 1.39-1.76) for mild-to-moderate ASC and 2.03 (95% CI 1.72-2.4) for moderate-to-severe ASC, and for smoking habit 1.59 (95% CI 1.08-2.34) for mild-to-moderate ASC and 2.13 (95% CI 1.19-3.78) for moderate-to-severe ASC. Diabetes and renal impairment were associated with advanced but not with early stages of ASC. CONCLUSIONS The prevalence of ASC and AS in people ≥65 years is similar to that reported in other regions. The gradient in the association of cardiovascular risk factors with the severity of ASC suggests that they may be causally implied in the pathogenesis of the disease.
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879
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Abstract
Background: Chronic kidney disease (CKD) is increasingly recognized as a global public health problem. Cardiovascular disease (CVD) is a major cause of mortality in patients with mild-to-moderate CKD and end-stage renal disease. There is accumulating evidence that the increase in CVD burden is present in CKD patients prior to dialysis, due both to conventional risk factors and kidney-specific disease. Detection and initiation of treatment for CVD risk factors at early stages of CKD should be effective in reducing CVD events before as well as after the onset of kidney failure. Materials and Methods: The study sample consisted of a total of 112 subjects aged ≤12 years: 60 CKD patients and 52 healthy control individuals. All subjects were investigated for a group of CVD risk factors such as: Hypertension, diabetes, dyslipidemia, physical inactivity, body mass index (BMI), family history of CVD, hypoalbuminemia, albuminuria, anemia, Ca x P product, and inflammation in terms of C-reactive protein (CRP). Results: Patients (40 males and 20 females) were categorized into four CKD stages (2, 3, 4, and 5) where, Stage 4 had the highest frequency, followed by Stages 3, 5 and 2. Evaluation of the patients indicated that they were shorter, had lower weight and had higher systolic and diastolic blood pressure as compared with control subjects. Frequency of physical inactivity among patients was two-fold higher than controls (50% vs. 25%). The patients showed significantly higher levels of cholesterol (163.6±39.8 vs. 141.8±24.2 mg/dL, P<0.0001), triglycerides (145.5±67.1 vs. 82.9±39.8 mg/dL, P<0.0001), low-density lipoprotein (92.6±31.9 vs. 72.5±19 mg/dL, P<</i>0.0001) and albumin/creatinine ratio (1792±3183 vs. 11.1±6.6 mg/g, P<0.0001). Moreover, the patients had lower levels of high-density lipoprotein (41.9±11.0 vs. 52.7±11.7 mg/dL, P<0.0001), hemoglobin (9.8±1.4 vs. 11.9±0.8 g/dL, P<0.0001) and albumin (4.6±0.6 vs. 4.8±0.2 g/dL, P=0.012). The CRP showed higher occurrence among patients (40% were positive for CRP). Calcium and phosphorus evaluation showed significantly lower calcium and higher phosphorus among patients. However, the difference in Ca X P product was not statistically significant. Conclusions: The study indicates that many of the CVD risk factors are associated with the different stages of CKD in children patients prior to dialysis, and that some of these factors are exacerbated as CKD progresses.
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Affiliation(s)
- Rafat M Muhaisen
- Human Resource Development (HRD), Ministry of Health, Gaza, Palestine
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880
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Çanga A, Kocaman SA, Durakoglugil ME, Çetin M, Erdogan T, Çiçek Y, Şatıroglu Ö. Increased carotid and brachial intima-media thickness is related to diffuse coronary involvement rather than focal lesions. Angiology 2012; 64:356-63. [PMID: 22584246 DOI: 10.1177/0003319712445373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated whether an increased carotid intima-media thickness (cIMT) and brachial artery IMT (bIMT) are related to diffuse coronary involvement rather than focal lesions. Patients (n = 88) with at least 1 significant lesion of the main epicardial coronary arteries (≥50%) were included in the present study. We used a novel score based on length and mean narrowing of all lesions in order to predict diffuse coronary involvement. Both cIMT and bIMT were higher in patients with long coronary lesion than focal lesion (P < .001). The patients with long coronary lesion had a higher rate of total coronary involvement than patients with focal lesion (P < .001). The cIMT had a higher correlation with total atherosclerotic burden in the coronary vasculature (r = .495, P < .001) and the longest lesion length (r = .489, P < .001) than cardiovascular risk factor score (r = .453, P < .001 and r = .324, P = .012, respectively). These findings may be valuable for clarifying the prognostic value of IMT measurements.
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Affiliation(s)
- Aytun Çanga
- Department of Cardiology, Rize Education and Research Hospital, Rize, Turkey.
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881
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Wong K, Glovaci D, Malik S, Franklin SS, Wygant G, Iloeje U, Kan H, Wong ND. Comparison of demographic factors and cardiovascular risk factor control among U.S. adults with type 2 diabetes by insulin treatment classification. J Diabetes Complications 2012; 26:169-74. [PMID: 22502939 PMCID: PMC3931306 DOI: 10.1016/j.jdiacomp.2012.03.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 02/22/2012] [Accepted: 03/06/2012] [Indexed: 12/17/2022]
Abstract
AIMS Data on glucose and cardiovascular disease (CVD) risk factor control among persons with type 2 diabetes mellitus (DM) according to insulin treatment status are lacking. We examined DM control, risk factors, and comorbidities among U.S. persons according to insulin treatment status. METHODS In the U.S. National Health and Nutrition Examination Surveys 2003-2006, we examined in 10,637 adults aged ≥30 with type 2 DM the extent of control of A1c, LDL-C, HDL-C, triglycerides, and blood pressure (BP) and composite goal attainment by insulin use status. RESULTS 6.6% (n=889, projected to 14.3 million) had type 2 DM; of these, 22.9% were insulin users and 57.2% were treated only by other diabetes medications. Overall, 58.2% had an A1c<7% (53 mmol/mol) (insulin users 33.1%, non-insulin treated 66.1%, and 77.9% of those not on medication, p<0.0001). Overall, 44.2% were at a BP goal of <130/80 mmHg, 43.8% had an LDL-C<100 mg/dl (2.6 mmol/L), and 13.9% a BMI<25 kg/m(2). Only 10.2% were simultaneously at A1c, LDL, and BP goals (5.4% of those on insulin). CONCLUSIONS U.S. adults with type 2 DM, especially those treated with insulin remain inadequately controlled for A1c and CVD risk factors and have a high prevalence of comorbidities.
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Affiliation(s)
- Kalina Wong
- Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, University of California, Irvine, CA
| | - Diana Glovaci
- Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, University of California, Irvine, CA
| | - Shaista Malik
- Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, University of California, Irvine, CA
| | - Stanley S. Franklin
- Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, University of California, Irvine, CA
| | - Gail Wygant
- Global Health Economics & Outcomes Research, Bristol-Myers Squibb, Princeton, NJ
| | - Uchenna Iloeje
- Global Health Economics & Outcomes Research, Bristol-Myers Squibb, Princeton, NJ
| | - Hongjun Kan
- Global Health Economics & Outcomes Research, Bristol-Myers Squibb, Princeton, NJ
| | - Nathan D. Wong
- Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, University of California, Irvine, CA
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882
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Urbina EM, Gao Z, Khoury PR, Martin LJ, Dolan LM. Insulin resistance and arterial stiffness in healthy adolescents and young adults. Diabetologia 2012; 55:625-31. [PMID: 22193511 PMCID: PMC3269756 DOI: 10.1007/s00125-011-2412-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 11/21/2011] [Indexed: 12/26/2022]
Abstract
AIMS/HYPOTHESIS Increased arterial stiffness is a risk factor for adverse cardiovascular events in adults with obesity-related insulin resistance (IR) or type 2 diabetes mellitus. Adolescents with type 2 diabetes have stiffer vessels. Whether stiffness is increased in obesity/IR in youth is not known. We sought to determine if IR was a determinant of arterial stiffness in youth, independent of obesity and cardiovascular risk factors. METHODS We measured cardiovascular risk factors, IR, adipocytokines and arterial stiffness (brachial artery distensibility [BrachD], pulse wave velocity [PWV]) and wave reflection (augmentation index [AIx]) in 343 adolescents and young adults without type 2 diabetes (15-28 years old, 47% male, 48% non-white). Individuals <85th percentile of BMI were classified as lean (n = 232). Obese individuals were grouped by HOMA index as not insulin resistant (n = 46) or insulin resistant (n = 65) by the 90th percentile for HOMA for lean. Mean differences were evaluated by ANOVA. Multivariate models evaluated whether HOMA was an independent determinant of arterial stiffness. RESULTS Risk factors deteriorated from lean to obese to obese/insulin resistant (all p ≤ 0.017). Higher AIx, lower BrachD and higher PWV indicated increased arterial stiffness in obese and obese/insulin-resistant participants. HOMA was not an independent determinant. Age, sex, BMI and BP were the most consistent determinants, with HDL-cholesterol playing a role for BrachD and leptin for PWV (AIx R²= 0.34; BrachD R² = 0.37; PWV R² = 0.40; all p ≤ 0.02). CONCLUSIONS/INTERPRETATION Although IR is associated with increased arterial stiffness, traditional cardiovascular risk factors, especially obesity and BP, are the major determinants of arterial stiffness in healthy young people.
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Affiliation(s)
- E M Urbina
- Department of Pediatrics, Preventive Cardiology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, 3333 Burnet Avenue, MLC-7002, Cincinnati, OH 45229, USA.
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883
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Abstract
Countries in Africa and the Middle East bear a heavy burden from cardiovascular disease. The prevalence of coronary heart disease is promoted in turn by a high prevalence of cardiovascular risk factors, particularly smoking, hypertension, dyslipidemia, diabetes, and sedentary lifestyles. Patients in Africa and the Middle East present with myocardial infarction at a younger age, on average, compared with patients elsewhere. The projected future burden of mortality from coronary heart disease in Africa and the Middle East is set to outstrip that observed in other geographical regions. Recent detailed nationally representative epidemiological data are lacking for many countries, and high proportions of transient expatriate workers in countries such as Saudi Arabia and the United Arab Emirates complicate the construction of such datasets. However, the development of national registries in some countries is beginning to reveal the nature of coronary heart disease. Improving lifestyles (reducing calorie intake and increasing physical activity) in patients in the region will be essential, although cultural and environmental barriers will render this difficult. Appropriate prescribing of pharmacologic treatments is essential in the prevention and management of cardiovascular disease. In particular, recent controversies relating to the therapeutic profile of beta-blockers may have reduced their use. The current evidence base suggests that beta-blockers are as effective as other therapies in preventing cardiovascular disease and that concerns relating to their use in hypertension and cardiovascular disease have been overstated.
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Affiliation(s)
- Wael Almahmeed
- Heart and Vascular Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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884
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Davis JN, Ventura EE, Tung A, Munevar MA, Hasson RE, Byrd-Williams C, Vanni AK, Spruijt-Metz D, Weigensberg M, Goran MI. Effects of a randomized maintenance intervention on adiposity and metabolic risk factors in overweight minority adolescents. Pediatr Obes 2012; 7:16-27. [PMID: 22434736 PMCID: PMC3313084 DOI: 10.1111/j.2047-6310.2011.00002.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 09/09/2011] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of this study was to assess the effects of a maintenance programme (monthly newsletters vs. monthly group classes and telephone behavioural sessions) on obesity and metabolic disease risk at 1 year in overweight minority adolescents. METHODS After a 4-month nutrition and strength training intervention, 53 overweight Latino and African-American adolescents (15.4 ± 1.1 years) were randomized into one of two maintenance groups for 8 months: monthly newsletters (n = 23) or group classes (n = 30; monthly classes + individualized behavioural telephone sessions). The following outcomes were measured at months 4 (immediately following the intense intervention) and 12: height, weight, blood pressure, body composition via BodPod™ (Life Measurement Instruments, Concord, CA, USA), lipids and glucose/insulin indices via frequently sampled intravenous glucose tolerance test. RESULTS There were no significant group by time interactions for any of the health outcomes. There were significant time effects in several outcomes for both groups from months 4 to 12: bench press and leg press decreased by 5% and 14%, respectively (P = 0.004 & P = 0.01), fasting insulin and acute insulin response decreased by 26% and 16%, respectively (P < 0.001 & P = 0.046); while high-density lipoprotein cholesterol and insulin sensitivity improved by 5% and 14% (P = 0.042 & P = 0.039). CONCLUSIONS Newsletters as opposed to group classes may suffice as follow-up maintenance programmes to decrease type 2 diabetes and cardiovascular risk in overweight minority adolescents.
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Affiliation(s)
- J N Davis
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089-9008, USA.
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885
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Wysocki M, Luo X, Schmeidler J, Dahlman K, Lesser GT, Grossman H, Haroutunian V, Beeri MS. Hypertension is associated with cognitive decline in elderly people at high risk for dementia. Am J Geriatr Psychiatry 2012; 20:179-87. [PMID: 21814158 DOI: 10.1097/JGP.0b013e31820ee833] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiovascular risk factors including hypertension (HTN) have been shown to increase the risk of Alzheimer disease. The current study investigated whether individuals with HTN are more susceptible to increased cognitive decline and whether the influence of HTN on cognitive decline varied as a function of dementia severity. A total of 224 nursing home and assisted living residents, with a mean age of 84.9 (±7.6) years, were assessed longitudinally with Mini Mental State Exams (MMSEs) and Clinical Dementia Ratings (CDR). Baseline dementia status was defined by the CDR score. As described in , MMSE scores in persons with HTN and questionable dementia (CDR = 0.5) declined significantly faster than nonhypertensive questionably demented persons. Hypertensive participants did not decline significantly faster than nonhypertensive participants in persons with intact cognition (CDR = 0) or frank dementia (CDR ≥ 1). These results suggest an increased risk of subsequent cognitive decline in hypertensive individuals who are especially vulnerable to developing dementia and raises the possibility that avoiding or controlling HTN might reduce the rate of cognitive decline in cognitively vulnerable individuals, potentially delaying their conversion to full-fledged dementia.
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886
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Laux TS, Bert PJ, González M, Unruh M, Aragon A, Lacourt CT. Prevalence of hypertension and associated risk factors in six Nicaraguan communities. Ethn Dis 2012; 22:129-135. [PMID: 22764632 PMCID: PMC4387575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE Describe the prevalence of hypertension. DESIGN Population based cross-sectional survey. SETTING Six Nicaraguan communities with varying economies. PARTICIPANTS 1,355 adults aged 20-60 years who completed both self-reported and quantitative measures of health. MAIN OUTCOME MEASURES Prevalence of hypertension (systolic > or = 140 mm Hg, diastolic > or = 90 mm Hg, or self-reported medical history with diagnosis by a health care professional), uncontrolled hypertension (systolic > or = 140 mm Hg or diastolic > or = 90 mm Hg), diabetes (urinary glucose excretion > or = 100 mg/ dL or self-reported medical history diagnosed by a health care professional), and uncontrolled diabetes (urinary glucose excretion > or =100 mg/dL only). RESULTS The prevalence of hypertension was 22.0% (19.2% in men, 24.2% in women). Blood pressure was controlled in 31.0% of male hypertensives and 55.1% of female hypertensives (odds ratio [OR] 2.86; 95% confidence interval [Cl] 1.74-4.69). Older age and higher body mass index were strongly associated with hypertension. Women who completed primary school had a lower risk of hypertension (OR .40; 95% Cl .19-.85) compared to those with no formal education. A history of living in both urban and rural settings was associated with lower prevalence of hypertension (OR .52; 95% CI .34-.79). Diabetes mellitus was found in 1.2% of men and 4.3% of women. Male sex was independently associated with decreased risk of diabetes (OR .31; 95% Cl .11-.86). CONCLUSIONS At least one cardiovascular risk factor was found in half of this Nicaraguan sample. Cardiovascular risk factors should be the target of educational efforts, screening, and treatment.
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Affiliation(s)
- Timothy S Laux
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA.
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887
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Farris JW, Taylor L, Williamson M, Robinson C. A 12-week Interdisciplinary Intervention Program for Children who are Obese. Cardiopulm Phys Ther J 2011; 22:12-20. [PMID: 22163176 PMCID: PMC3223421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED Childhood obesity is a growing problem, for which multi-disciplinary interventions are needed. PURPOSE This interdisciplinary intervention program was designed to improve the health of children who were obese. METHODS Twenty-five children, mean age 8.1 (1.5) years; body mass index (BMI)> 98(th) percentile, and their parents completed the 12-week (3 days/wk) intervention consisting of aerobic and resistance exercise appropriate to age and developmental levels. Baseline and posttest measures of blood values, fitness, and cardiovascular risk factors were performed. Data were analyzed using paired t-tests with significance accepted at P ≤ .05. RESULTS Significant differences between means (SD) for pre- and post-measurements were, respectively: BMI 30.31 (4.56), 27.80 (4.54), body-fat percent 43.7 (11.5), 40.7 (10.9), waist circumference 82.1 (7.1), 80.4(6.1) cm, calf circumference 34.2 (3.1), 35.2 (3.1) cm; step-test heart rate 137 (20), 126 (12) bpm, push-ups 1.0 (1.8), 5.6 (3.8), sit-ups 23.6 (12.7), 33.2 (13.8), sit-and-reach 35.1 (7.4), 41.2 (5.8) cm; systolic BP 102 (10), 108 (9) mmHg, glucose 4.9(0.3), 4.8 (0.4) mmol/L, total cholesterol 4.6 (1.0), 4.2 (0.8) mmol/L, ALT 41 (9), 35 (8) U/L, bilirubin 6.3 (2.4), 5.6 (2.1) μmol/L, and BUN 4.9 (1.1), 4.3 (0.9) mmol/L. CONCLUSIONS This interdisciplinary intervention program positively affected the fitness and health status of children who were obese by involving the children and parents.
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Affiliation(s)
- James W Farris
- Associate Professor, Doctor of Physical Therapy Program, A.T. Still University, Mesa, AZ
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888
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Graversen L, Christensen B, Borch-Johnsen K, Lauritzen T, Sandbaek A. Lipid-lowering drugs as primary prevention in general practice: do patients reach guideline goals and continue treatment? ADDITION Denmark. Scand J Prim Health Care 2011; 29:216-21. [PMID: 22126220 PMCID: PMC3308460 DOI: 10.3109/02813432.2011.629148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe lipid-lowering treatment in a primary care setting and how well target levels are reached. Furthermore, the aim is to describe long-term adherence to treatment. DESIGN Population-based cross-sectional study with follow-up. SETTING A total of 139 general practices from three of five Danish regions, taking part in the ADDITION study from 2001 to 2006. SUBJECTS The study population comprises 1468 patients who started lipid-lowering drugs and were followed for a minimum of one year after starting treatment. Median time of follow-up after starting drug therapy was 936 days (range: 366-2068). RESULTS Of 1468 patients starting treatment, a total of 781 (53%) reached the treatment goal of total cholesterol <5.0 and low-density lipoprotein <3 mmol/l within one year after drug therapy start. The percentage increased throughout the study period from 27% of patients initiating treatment in 2001 to 66% of patients initiating treatment in 2005. Age over 50, repeated cholesterol measurements within three months after treatment start, larger initial dose, and calendar year of treatment start were associated with reaching the goal within the first year, and most recent total cholesterol measurement before start of treatment >7 mmol/L was associated with not reaching the goal in the first year. Among patients followed for a minimum of three years after drug therapy started (n = 536), adherence was 77%, 72%, 75% in the first, second, and third year respectively. CONCLUSION Initial doses and the percentage reaching their goal increased substantially throughout the study period. Adherence to lipid-lowering treatment is relatively high in a primary care setting. However, current practice shows room for improvement if treatment recommendations are to be met.
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Affiliation(s)
- Lise Graversen
- Department of Public Health, Section for General Practice, University of Aarhus, Denmark.
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889
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Abstract
Background Vitamin D deficiency has recently been implicated as a contributory factor in the development of peripheral arterial disease (PAD). Methods A review of the published literature on PAD and vitamin D was undertaken using Medline, PubMed, and Embase, and cross-referenced. All relevant published papers on the subject were reviewed. Results Published studies have shown that there is a significant association between vitamin D and PAD. Populations with lower vitamin D levels are more likely to develop PAD in a graded manner. Higher amputation rates are also observed among patients with PAD and lower vitamin D levels. In addition, vitamin D deficiency is significantly associated with increased risk of cardiovascular adverse events. This was also observed in the mouse model where low vitamin D led to the development of atherosclerosis. Conclusion This study shows that vitamin D deficiency could be an independent risk factor for the development of PAD and that this risk factor is easily correctable. Further studies should look into the effects of vitamin D supplementation in patients with PAD.
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Affiliation(s)
- G T Chua
- Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong
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890
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Ickenroth MHP, Grispen JEJ, Ronda G, Tacken M, Dinant GJ, de Vries NK, van der Weijden T. Motivation and experiences of self-testers regarding tests for cardiovascular risk factors. Health Expect 2011; 17:60-72. [PMID: 22032617 DOI: 10.1111/j.1369-7625.2011.00733.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In recent years, self-tests have become increasingly available to the general public, though their value is still being debated. Because these tests are available, consumers should have access to clear information about self-testing. Examining experiences of self-testers could contribute to the development of consumer information. OBJECTIVE Detailed exploration of consumers' experiences with self-testing for cardiovascular risk factors. METHODS Semi-structured interviews with 20 consumers who had performed a self-test for glucose, cholesterol or albuminuria. The main topics of the interviews were reasons for self-testing, performing the self-test, follow-up behaviour and perceived need for information on self-testing. Data were analysed using thematic content analysis. RESULTS Regarding the reason for self-testing, three types of users were distinguished: those who engaged in self-testing when a test was offered, either with or without previous knowledge about the disease or risk factor, and those who had actively decided to test and had searched for a self-test themselves. Self-testers had generally experienced no problems performing the test or interpreting the result and had considerable confidence in the result. They were easily reassured by a normal result, while an abnormal result did not automatically mean they consulted a doctor. Most participants did not feel the need for more information. CONCLUSIONS Self-testers often perform tests for reassurance, without considering the disadvantages, such as the absence of professional counselling and the risk of false-positive or false-negative results. Consumer information should promote more informed and deliberate choices for self-testing.
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Affiliation(s)
- Martine H P Ickenroth
- PhD Student/General Practitioner trainee,PhD Student,Senior Researcher,Medical student,Professor of General Practice, Department of General Practice, CAPHRI, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the NetherlandsProfessor of Health Promotion, Department of Health Promotion, CAPHRI, School for Public Health and Primary Care, Faculty of Health, Medicine, Life Sciences, Maastricht University, Maastricht, the NetherlandsProfessor of Implementation of Clinical Practice Guidelines, Department of General Practice, CAPHRI, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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891
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Koebnick C, Black MH, Smith N, Der-Sarkissian JK, Porter AH, Jacobsen SJ, Wu JJ. The association of psoriasis and elevated blood lipids in overweight and obese children. J Pediatr 2011; 159:577-83. [PMID: 21524758 PMCID: PMC3168116 DOI: 10.1016/j.jpeds.2011.03.006] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 01/18/2011] [Accepted: 03/02/2011] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate whether obesity and cardiovascular risk factors are associated with psoriasis in children and adolescents. STUDY DESIGN For this population-based, cross-sectional study, measured weight and height, laboratory data, and psoriasis diagnoses were extracted from electronic medical records of 710,949 patients age 2 to 19 years enrolled in an integrated health plan. Weight class was assigned on the basis of body mass index-for-age. RESULTS The OR for psoriasis was 0.68, 1.00, 1.31, 1.39, and 1.78 (95% CI, 1.49 to 2.14) for underweight, normal-weight, overweight, moderately obese, and extremely obese children, respectively (P for trend < .001). The OR for psoriasis treated with systemic therapy or phototherapy as an indicator of severe or widespread psoriasis was 0.00, 1.00, 2.78, 2.93, and 4.19 (95% CI, 1.81 to 9.68) for underweight, normal-weight, overweight, moderately obese, and extremely obese children, respectively (P for trend < .003). In adolescents, mean total cholesterol, low-density lipoprotein cholesterol, triglycerides, and alanine aminotransferase were significantly higher in children with psoriasis compared with children without psoriasis after adjustment for body mass index. CONCLUSION Overweight and obesity are associated with higher odds of psoriasis in youths. Independent of body weight, adolescent patients with psoriasis have higher blood lipids. These data suggest that pediatricians and dermatologists should screen youths with psoriasis for cardiovascular disease risk factors.
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Affiliation(s)
- Corinna Koebnick
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Mary Helen Black
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Ning Smith
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Amy H Porter
- Kaiser Permanente Baldwin Park Medical Center, Southern California Permanente Medical Group, Baldwin Park, CA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Jashin J Wu
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
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892
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Abstract
We are presenting a review of Isolated Systolic Hypertension (ISH) as a cardiovascular risk factor with emphasis on the perioperative period. Isolated systolic hypertension is associated with aging and is the most frequent subtype (65%) among patients with uncontrolled hypertension. ISH is strongly associated with increased risks of cardiac and cerebrovascular events exceeding those in comparably aged individuals with diastolic hypertension. Patients with ISH show an increase in left ventricular (LV) mass and an increase in the prevalence of left ventricular hypertrophy (LVH). These LV changes increase cardiovascular events and frequently lead to diastolic dysfunction (DD). Treatment to reduce elevated systolic blood pressure has been shown to reduce the risk of cardiovascular events. In the perioperative setting, essential hypertension has not been found to be a significant risk factor for cardiac complications. Most of the studies were based on the definition of essential hypertension and underpowered in sample size. The significance of perioperative ISH, however, is not well studied, partly due to its recognition only fairly recently as a cardiovascular risk factor in the non-surgical setting, and partly due to the evolving definition of ISH. Perioperative cardiac complications remain a significant problem to the healthcare system and to the patient. Although the incidence of perioperative cardiac complications is prominent in high-risk patients as defined by the Revised Cardiac Risk Index (RCRI), the bulk of the cardiac complications actually occur in low-risk group. Currently, little understanding exists on the occurrence of perioperative cardiac complications in low- risk patients. A factor such as ISH, with its known pathophysiological changes, is a potential perioperative risk factor. We believe ISH is an under-recognized perioperative risk factor and deserves further studying. Our research group has recently been funded by the Heart Stroke Foundation (HSF) to examine ISH as a perioperative risk factor (PROMISE Study).
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Affiliation(s)
- Ashraf Fayad
- Department of Anesthesiology and Perioperative Medicine, University of Ottawa, 1053 Carling Ave. (B3), The Ottawa Hospital, Ottawa, Ontario, Canada, K1Y 4E9
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893
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Li L, Pinot de Moira A, Power C. Predicting cardiovascular disease risk factors in midadulthood from childhood body mass index: utility of different cutoffs for childhood body mass index. Am J Clin Nutr 2011; 93:1204-11. [PMID: 21430113 PMCID: PMC3308204 DOI: 10.3945/ajcn.110.001222] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Identifying adults at increased risk of cardiovascular disease (CVD) on the basis of childhood body mass index (BMI) could be informative for disease prevention but depends on the utility of childhood BMI cutoffs. OBJECTIVE We aimed to establish how well the International Obesity Task Force (IOTF) and population-specific cutoffs for childhood BMI predict CVD risk factors in midadulthood. DESIGN We used the 1958 British birth cohort, whose BMI measures were collected at 7, 11, and 16 y and whose CVD risk factors (obesity, hypertension, adverse lipid concentrations, and type 2 diabetes risk) were collected at 45 y. The sensitivity and specificity of IOTF and population-specific cutoffs for childhood BMI were calculated for each CVD risk factor. RESULTS The prevalence of overweight or obesity was low in childhood (<11%, IOTF cutoffs) compared with that in adulthood (75% men, 56% women). The IOTF cutoffs had high specificities (91.6-97.9%) but low sensitivities (7.1-31.5%) for predicting adult outcomes. In comparison, population-specific cutoffs identified large groups of children (eg, >38% for predicting adult obesity) who had improved sensitivities (17.3-67.3%) but lower specificities (52.9-84.6%) compared with IOTF cutoffs. Accelerated BMI gains in childhood predicted adult obesity and type 2 diabetes risk, but prediction was no greater than that for childhood BMI at one age (area under the curve: 0.55-0.65 compared with 0.59-0.75). Childhood BMI and BMI gain were weak predictors of adult hypertension and adverse lipid concentrations. CONCLUSION Neither the IOTF cutoffs nor our population-specific cutoffs for childhood BMI are adequate diagnostic tools for adult CVD risk factors in a population experiencing rapid changes in obesity prevalence over their lifetime.
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Affiliation(s)
- Leah Li
- MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, United Kingdom.
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894
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Abstract
Endothelial cells exert an enormous influence on blood vessels throughout the circulation, but their impact is particularly pronounced in the brain. New concepts have emerged recently regarding the role of this cell type and mechanisms that contribute to endothelial dysfunction and vascular disease. Activation of the renin-angiotensin system plays a prominent role in producing these abnormalities. Both oxidative stress and local inflammation are key mechanisms that underlie vascular disease of diverse etiology. Endogenous mechanisms of vascular protection are also present, including antioxidants, anti-inflammatory molecules, and peroxisome proliferator-activated receptor-γ. Despite their clear importance, studies of mechanisms that underlie cerebrovascular disease continue to lag behind studies of vascular biology in general. Identification of endogenous molecules and pathways that protect the vasculature may result in targeted approaches to prevent or slow the progression of vascular disease that causes stroke and contributes to the vascular component of dementia and Alzheimer's disease.
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Affiliation(s)
- Frank M Faraci
- Dept. of Internal Medicine, Carver College of Medicine, Univ. of Iowa, Iowa City, Iowa 52242-1081, USA.
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895
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Huffman MD, Prabhakaran D, Osmond C, Fall CHD, Tandon N, Lakshmy R, Ramji S, Khalil A, Gera T, Prabhakaran P, Biswas SKD, Reddy KS, Bhargava SK, Sachdev HS. Incidence of cardiovascular risk factors in an Indian urban cohort results from the New Delhi birth cohort. J Am Coll Cardiol 2011; 57:1765-74. [PMID: 21511113 PMCID: PMC3408699 DOI: 10.1016/j.jacc.2010.09.083] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 09/10/2010] [Accepted: 09/30/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Mark D. Huffman
- Centre for Chronic Disease Control, New Delhi, India
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Clive Osmond
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Caroline H. D. Fall
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Siddharth Ramji
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | | | - Tarun Gera
- Department of Pediatrics, Sunder Lal Jain Hospital, New Delhi, India
| | - Poornima Prabhakaran
- Initiative for Cardiovascular Health Research in Developing Countries, New Delhi, India
| | | | - K. Srinath Reddy
- All India Institute of Medical Sciences, New Delhi, India
- Public Health Foundation of India, New Delhi, India
| | | | - Harshpal S. Sachdev
- Department of Pediatrics, Sitaram Bhartiya Institute for Science and Research, New Delhi, India
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896
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Abstract
Obesity is now a major public health concern worldwide with increasing prevalence and a growing list of comorbidities and complications. The morbidity, mortality and reduced productivity associated with obesity and its complications result in a major burden to health care costs. Obesity is a complex chronic medical syndrome often with multiple different etiologic factors in individual patients. The long term successful management of obesity remains particularly challenging and invariably requires a multifaceted approach including lifestyle and behavioral modification, increased physical activity, and adjunctive pharmacotherapy. Bariatric surgery remains a last resort though at present it has the best results for achieving sustained robust weight loss. Obesity pharmacotherapy has been very limited in its role for long term obesity management because of the past history of several failed agents as well as the fact that presently available agents are few, and generally utilized as monotherapy. The recent FDA approval of the fixed drug combination of phentermine and extended release topiramate (topiramate-ER) (trade name Qsymia™) marks the first FDA approved combination pharmacotherapeutic agent for obesity since the Phen-Fen combination of the 1990s. This review details the history and clinical trial basis for the use of both phentermine and topiramate in obesity therapeutics as well as the results of clinical trials of their combination for obesity treatment in humans. The initial clinical approval trials offer evidence that this fixed drug combination offers synergistic potential for effective, robust and sustained weight loss with mean weight loss of at least 10% of baseline achieved and sustained for up to 2 years in over 50% of subjects treated. It is anticipated that this agent will be the first in a new trend of multi-agent combination therapy for the chronic adjunctive management of obesity.
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Affiliation(s)
- Gina Cosentino
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Ariane O Conrad
- Xavier University of Louisiana College of Pharmacy, New Orleans, LA, USA
| | - Gabriel I Uwaifo
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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897
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Abstract
PURPOSE OF REVIEW Dyslipidemia is highly prevalent among patients living with chronic HIV infection and may confer increased risk of cardiovascular disease in this patient population. This review summarizes recent data investigating lipid abnormalities and its management in HIV-infected patients. RECENT FINDINGS Studies in the last year have evaluated the effects of various lipid-lowering therapies not previously investigated in the HIV patient population. Rosuvastatin is a potent statin that appears to be well tolerated and effective in HIV-infected patients with hypercholesterolemia. SUMMARY Dyslipidemia is common in HIV-infected individuals. Medical therapy of lipid disorders needs to take potential drug-drug interactions of lipid-lowering medications and antiretroviral agents into consideration.
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Affiliation(s)
- Janet Lo
- Department of Medicine, Harvard Medical School, Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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898
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Suka M, Miwa Y, Ono Y, Yanagisawa H. BMI, waist circumference, and clustering of cardiovascular risk factors in Japanese adults. Environ Health Prev Med 2011; 16:90-6. [PMID: 21432223 PMCID: PMC3047660 DOI: 10.1007/s12199-010-0169-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 07/14/2010] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To examine whether the association between waist circumference (WC) and clustering of cardiovascular risk factors varies with obesity (BMI) status. METHODS Using the 2008 health examination data of a Japanese health service association, eligible 57,141 adults aged 20-65 years without coronary heart disease or stroke, whose blood sample had been taken in the fasting state, were enrolled in the study. The participants were classified as being underweight (BMI <18.5), normal weight (BMI 18.5-24.9), and overweight (BMI ≥25.0). Multiple logistic regression analysis was performed to calculate adjusted odds ratios (OR) for clustering of cardiovascular risk factors. Receiver operating characteristic analysis was performed to assess the ability of WC to discriminate subjects with and without a clustering of cardiovascular risk factors. RESULTS Clustering of cardiovascular risk factors was found in 16.0% of men and 3.4% of women. The adjusted OR [95% confidence intervals (CI)] per 5-cm increase in WC of the underweight, normal weight, and overweight groups was 1.57 (1.12-2.20), 1.55 (1.49-1.62), and 1.34 (1.30-1.38), respectively, for men and 1.50 (0.84-2.69), 1.53 (1.40-1.68), and 1.32 (1.23-1.41), respectively, for women. The area under curve (95% CI) of the underweight, normal weight, and overweight groups was 0.68 (0.59-0.77), 0.70 (0.69-0.71), and 0.62 (0.61-0.63), respectively, for men and 0.70 (0.53-0.86), 0.75 (0.73-0.78), and 0.64 (0.61-0.68), respectively, for women. CONCLUSION High WC was associated with increased risk of clustering of cardiovascular risk factors independent of BMI. As well as the magnitude of the association, the ability of WC to discriminate subjects with and without a clustering of cardiovascular risk factors varied with obesity (BMI) status.
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Affiliation(s)
- Machi Suka
- Department of Public Health and Environmental Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
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899
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Healy GN, Matthews CE, Dunstan DW, Winkler EAH, Owen N. Sedentary time and cardio-metabolic biomarkers in US adults: NHANES 2003-06. Eur Heart J 2011; 32:590-7. [PMID: 21224291 PMCID: PMC3634159 DOI: 10.1093/eurheartj/ehq451] [Citation(s) in RCA: 955] [Impact Index Per Article: 73.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 09/27/2010] [Accepted: 11/04/2010] [Indexed: 12/23/2022] Open
Abstract
AIMS Prolonged sedentary time is ubiquitous in developed economies and is associated with an adverse cardio-metabolic risk profile and premature mortality. This study examined the associations of objectively assessed sedentary time and breaks (interruptions) in sedentary time with continuous cardio-metabolic and inflammatory risk biomarkers, and whether these associations varied by sex, age, and/or race/ethnicity. METHODS AND RESULTS Cross-sectional analyses with 4757 participants (≥ 20 years) from the 2003/04 and 2005/06 US National Health and Nutrition Examination Survey (NHANES). An Actigraph accelerometer was used to derive sedentary time [< 100 counts per minute (cpm)] and breaks in sedentary time. Independent of potential confounders, including moderate-to-vigorous exercise, detrimental linear associations (P for trends < 0.05) of sedentary time with waist circumference, HDL-cholesterol, C-reactive protein, triglycerides, insulin, HOMA-%B, and HOMA-%S were observed. Independent of potential confounders and sedentary time, breaks were beneficially associated with waist circumference and C-reactive protein (P for trends <0.05). There was limited evidence of meaningful differences in associations with biomarkers by age, sex, or race/ethnicity. Notable exceptions were sex-differences in the associations of sedentary time and breaks with HDL-cholesterol, and race/ethnicity differences in the association of sedentary time with waist circumference with associations detrimental in non-Hispanic whites, null in Mexican Americans, and beneficial in non-Hispanic blacks. CONCLUSION These are the first population-representative findings on the deleterious associations of prolonged sedentary time with cardio-metabolic and inflammatory biomarkers. The findings suggest that clinical communications and preventive health messages on reducing and breaking up sedentary time may be beneficial for cardiovascular disease risk.
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Affiliation(s)
- Genevieve N Healy
- Cancer Prevention Research Centre, School of Population Health, The University of Queensland, Herston, QLD 4006, Australia.
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900
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Sasakabe T, Haimoto H, Umegaki H, Wakai K. Effects of a moderate low-carbohydrate diet on preferential abdominal fat loss and cardiovascular risk factors in patients with type 2 diabetes. Diabetes Metab Syndr Obes 2011; 4:167-74. [PMID: 21779148 PMCID: PMC3138148 DOI: 10.2147/dmso.s19635] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Reports have shown that visceral adipose tissue (VAT) is more closely linked to cardiovascular risk factors (CRFs) than subcutaneous adipose tissue (SAT). We aimed to elucidate preferential abdominal fat loss and the correlations between abdominal fat reductions and changes in CRFs achieved with a moderate low-carbohydrate diet (LCD) in patients with type 2 diabetes (T2DM). PATIENTS AND METHODS Fifty-two outpatients (28 men and 24 women, mean age ± SD: 60.0 ± 10.5 years) with hemoglobin A(1c) (HbA(lc)) levels ≥ 6.5% were on an LCD for 6 months. Over a 6-month period, we measured their abdominal fat distribution (using CT) and assessed CRFs, including body mass index (BMI), HbA(1c), fasting blood glucose (FBG), serum insulin, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride levels. RESULTS The patients showed good compliance with the LCD (1812 ± 375 kcal/day, % carbohydrate:fat:protein = 35:40:19 for men; 1706 ± 323 kcal/day, % carbohydrate:fat:protein = 41:36:21 for women). Significant decreases (P = 0.05) in BMI and HbA(1c) levels were observed, along with an increase in HDL-C (P = 0.021) in men and a decrease in LDL-C (P = 0.001) in women. VAT (-21.6 cm(2), P < 0.001 in men; -19.6 cm(2), P < 0.001 in women) and SAT (-13.5 cm(2), P = 0.004 in men; -19.1 cm(2), P = 0.003 in women) significantly decreased. The loss of VAT (%ΔVAT) was greater than that of SAT (%ΔSAT) in women (P = 0.022). A similar but not significant predominance of VAT loss was detected in men (P = 0.111). In women, the %ΔSAT significantly correlated with changes in FBG (ΔFBG) (r = 0.417) and HDL-C (ΔHDL) (r = -0.720), as was %ΔVAT with changes in triglyceride (ΔTG) (r = 0.591). CONCLUSION Six months of a moderate LCD resulted in preferential VAT loss only in women, with significant correlations between %ΔSAT and both ΔHDL and ΔFBG, as well as between %ΔVAT and ΔTG. Our results suggest that an LCD has the potential to reduce abdominal fat in patients with T2DM and deterioration of serum lipid profiles.
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Affiliation(s)
- Tae Sasakabe
- Department of Clinical Nutrition, Haimoto Clinic, Yayoi, Kasugai, Aichi, Japan
- Correspondence: Tae Sasakabe, Haimoto Clinic, 1-80 Yayoi, Kasugai, Aichi 486-0838, Japan, Tel +81 568 85 8226, Fax +81 568 85 8315, Email
| | - Hajime Haimoto
- Department of Internal Medicine, Haimoto Clinic, Yayoi, Kasugai, Aichi, Japan
| | - Hiroyuki Umegaki
- Department of Geriatrics, Nagoya University Graduate School of Medicine, Tsurumai, Showa, Nagoya, Aichi, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Tsurumai, Showa, Nagoya, Aichi, Japan
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