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Reddy TK, Villavaso CD, Pulapaka AV, Ferdinand KC. Achieving equitable access to incretin-based therapies in cardiovascular care. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 46:100455. [PMID: 39315291 PMCID: PMC11417191 DOI: 10.1016/j.ahjo.2024.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 08/29/2024] [Accepted: 08/30/2024] [Indexed: 09/25/2024]
Abstract
The role of incretin-based therapies, including glucagon-like peptide-1 receptor agonists (GLP1RAs) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, in the management of type 2 diabetes mellitus (T2DM) and obesity has been increasingly recognized, along with significant cardiovascular (CV) benefits. Despite the clinical efficacy of incretin-based therapies, high costs, suboptimal access, limited insurance coverage, and therapeutic inertia present substantial barriers to widespread adoption. Overcoming these obstacles is essential for the equitable initiation, access, and utilization of incretin-based therapies. Clinicians must make targeted efforts to ensure health equity in the use of these and other advanced therapies.
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Affiliation(s)
- Tina K. Reddy
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chloé D. Villavaso
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Anuhya V. Pulapaka
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Keith C. Ferdinand
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
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Santos-Beneit G, Bodega P, de Cos-Gandoy A, de Miguel M, Rodríguez C, Orrit X, Carral V, Haro D, Carvajal I, Peyra C, Martínez-Gómez J, Fernández-Alvira JM, Fernández-Jiménez R, Fuster V. Effect of Time-Varying Exposure to School-Based Health Promotion on Adiposity in Childhood. J Am Coll Cardiol 2024; 84:499-508. [PMID: 39084824 DOI: 10.1016/j.jacc.2024.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND The results of most school-based health promotion initiatives are inconclusive. OBJECTIVES This trial assessed the effect of time-varying exposures to a multicomponent school-based health promotion intervention (SI! Program) on adiposity markers. METHODS A total of 48 schools in Madrid (Spain) were cluster randomized to receive the SI! Program through elementary education grades 1 to 6 (E1-6, 12 schools, 459 children), 1 to 3 (E1-3, 12 schools, 513 children), or 4 to 6 (E4-6, 12 schools, 419 children) or to receive the standard curriculum (control, 12 schools, 379 children). The primary endpoint was the between-group difference at 3- and 6-year follow-up in the change from baseline in adiposity markers and the overall knowledge-attitudes-habits (KAH) score. RESULTS At 3-year follow-up, children who had the intervention showed significantly lower increases than the control group in z-scores for body mass index (BMI), waist-to-height ratio (WHtR), and waist circumference (WC) (zBMI: -0.09; 95% CI: -0.16 to -0.03; P = 0.003; zWC and zWHtR: -0.19; 95% CI: -0.28 to -0.10; P < 0.001). At 6-year follow-up, the beneficial trend in zWC and zWHtR was maintained in the E1-6 and E1-3 groups: difference zWC control vs E1-6 (-0.19; 95% CI: -0.36 to -0.03; P = 0.020), control vs E1-3 (-0.22; 95% CI: -0.38 to -0.06; P = 0.009); difference zWHtR control vs E1-6 (-0.24; 95% CI: -0.41 to -0.06; P = 0.009), and control vs E1-3 (-0.29; 95% CI: -0.47 to -0.11; P = 0.001). No significant between-group differences were found in the change of overall KAH score. CONCLUSIONS Early elementary school interventions may be more effective than later interventions on abdominal adiposity. Further research should assess the sustainability effects of school-based health promotion programs.
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Affiliation(s)
- Gloria Santos-Beneit
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain
| | - Patricia Bodega
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain
| | - Amaya de Cos-Gandoy
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain
| | - Mercedes de Miguel
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain
| | - Carla Rodríguez
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Xavier Orrit
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Vanesa Carral
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Domingo Haro
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Isabel Carvajal
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Carlos Peyra
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jesús Martínez-Gómez
- National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain
| | - Juan Miguel Fernández-Alvira
- National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain
| | - Rodrigo Fernández-Jiménez
- National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain; Center for Biomedical Network Research: Cardiovascular Diseases (Centro de Investigación Biomédica En Red en enfermedades CardioVasculares [CIBERCV]), Madrid, Spain; Department of Cardiology, Hospital Clínico San Carlos, Health Research Institute of Hospital Clinico San Carlos (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos [IdISSC]), Madrid, Spain.
| | - Valentin Fuster
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Timóteo AT, Cachulo MC, Dinis P, Negrão L, Barreiros-Mota I, Dores H, Gonçalves L. "O meu coração bate saudável" - Results from a pilot project for health education in Portuguese children. Rev Port Cardiol 2024; 43:301-310. [PMID: 37952926 DOI: 10.1016/j.repc.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 11/14/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Childhood offers an excellent window of opportunity to start interventions to promote behavioral changes before unhealthy lifestyles become established, leading to cardiovascular diseases. The goal of this pilot educational project for children is the promotion of healthy lifestyles and cardiovascular health. METHODS This project was implemented in 4th grade children and included teacher-led classroom activities, a lesson given by a cardiologist and a practical lesson with dietitians. The teacher received a manual containing information on the topics to be discussed in class with the pupils and the children received a book that addresses cardiovascular risk factors and prevention. The components included were diet (D), physical activity (PA) and human body and heart awareness (BH). At the beginning and at the end of the schoolyear, a questionnaire was applied to the children to assess knowledge (K), attitudes (A) and habits (H) on these topics. RESULTS A total of 73 children from two schools from an urban district public school in Lisbon, in a low to medium income area, participated in the project. Following the intervention, there was a 9.5% increase in the overall KAH score, mainly driven by the PA component (14.5%) followed by the BH component (12.3%). No improvement was observed for component D. The benefits were also more significant in children from a lower income area, suggesting that socioeconomic status is a determinant in the response obtained. CONCLUSIONS An educational project for cardiovascular health can be implemented successfully in children aged 9 years, but longer and larger studies are necessary.
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Affiliation(s)
- Ana Teresa Timóteo
- Serviço de Cardiologia, Hospital Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; CHRC - Comprehensive Health Research Center, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; Sociedade Portuguesa de Cardiologia (Biénio 2021-2023), Portugal.
| | - Maria Carmo Cachulo
- Sociedade Portuguesa de Cardiologia (Biénio 2021-2023), Portugal; Fundação Portuguesa de Cardiologia, Portugal
| | - Paulo Dinis
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coinbra, Portugal; Centro de Saúde Militar de Coimbra, Coimbra, Portugal
| | - Luís Negrão
- Fundação Portuguesa de Cardiologia, Portugal
| | - Inês Barreiros-Mota
- CHRC - Comprehensive Health Research Center, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; Nutrition & Metabolism Department, NOVA Medical School, Faculdade de Ciências Médicas (NMS|FCM), Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Hélder Dores
- NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; CHRC - Comprehensive Health Research Center, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; Sociedade Portuguesa de Cardiologia (Biénio 2021-2023), Portugal; Hospital da Luz, Lisboa, Portugal
| | - Lino Gonçalves
- Sociedade Portuguesa de Cardiologia (Biénio 2021-2023), Portugal; Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coinbra, Portugal; ICBR, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
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Venkatesh KK, Perak AM, Wu J, Catalano P, Josefon JL, Costantine MM, Landon MB, Lancki N, Scholtens D, Lowe W, Khan SS, Grobman WA. Impact of hypertensive disorders of pregnancy and gestational diabetes mellitus on offspring cardiovascular health in early adolescence. Am J Obstet Gynecol 2024:S0002-9378(24)00563-5. [PMID: 38703941 DOI: 10.1016/j.ajog.2024.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Adverse pregnancy outcomes, including hypertensive disorders of pregnancy and gestational diabetes mellitus, influence maternal cardiovascular health long after pregnancy, but their relationship to offspring cardiovascular health following in-utero exposure remains uncertain. OBJECTIVE To examine associations of hypertensive disorders of pregnancy or gestational diabetes mellitus with offspring cardiovascular health in early adolescence. STUDY DESIGN This analysis used data from the prospective Hyperglycemia and Adverse Pregnancy Outcome Study from 2000 to 2006 and the Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study from 2013 to 2016. This analysis included 3317 mother-child dyads from 10 field centers, comprising 70.8% of Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study participants. Those with pregestational diabetes and chronic hypertension were excluded. The exposures included having any hypertensive disorders of pregnancy or gestational diabetes mellitus vs not having hypertensive disorders of pregnancy or gestational diabetes mellitus, respectively (reference). The outcome was offspring cardiovascular health when aged 10-14 years, on the basis of 4 metrics: body mass index, blood pressure, total cholesterol level, and glucose level. Each metric was categorized as ideal, intermediate, or poor using a framework provided by the American Heart Association. The primary outcome was defined as having at least 1 cardiovascular health metric that was nonideal vs all ideal (reference), and the second outcome was the number of nonideal cardiovascular health metrics (ie, at least 1 intermediate metric, 1 poor metric, or at least 2 poor metrics vs all ideal [reference]). Modified poisson regression with robust error variance was used and adjusted for covariates at pregnancy enrollment, including field center, parity, age, gestational age, alcohol or tobacco use, child's assigned sex at birth, and child's age at follow-up. RESULTS Among 3317 maternal-child dyads, the median (interquartile) ages were 30.4 (25.6-33.9) years for pregnant individuals and 11.6 (10.9-12.3) years for children. During pregnancy, 10.4% of individuals developed hypertensive disorders of pregnancy, and 14.6% developed gestational diabetes mellitus. At follow-up, 55.5% of offspring had at least 1 nonideal cardiovascular health metric. In adjusted models, having hypertensive disorders of pregnancy (adjusted risk ratio, 1.14 [95% confidence interval, 1.04-1.25]) or having gestational diabetes mellitus (adjusted risk ratio, 1.10 [95% confidence interval, 1.02-1.19]) was associated with a greater risk that offspring developed less-than-ideal cardiovascular health when aged 10-14 years. The above associations strengthened in magnitude as the severity of adverse cardiovascular health metrics increased (ie, with the outcome measured as ≥1 intermediate, 1 poor, and ≥2 poor adverse metrics), albeit the only statistically significant association was with the "1-poor-metric" exposure. CONCLUSION In this multinational prospective cohort, pregnant individuals who experienced either hypertensive disorders of pregnancy or gestational diabetes mellitus were at significantly increased risk of having offspring with worse cardiovascular health in early adolescence. Reducing adverse pregnancy outcomes and increasing surveillance with targeted interventions after an adverse pregnancy outcome should be studied as potential avenues to enhance long-term cardiovascular health in the offspring exposed in utero.
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Affiliation(s)
- Kartik K Venkatesh
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH.
| | - Amanda M Perak
- Department of Preventive Medicine, Northwestern University, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jiqiang Wu
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | - Patrick Catalano
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Tufts University, Boston, MA
| | - Jami L Josefon
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Maged M Costantine
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | - Mark B Landon
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | - Nicola Lancki
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Denise Scholtens
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - William Lowe
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Tufts University, Boston, MA
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University, Chicago, IL; Department of Medicine, Northwestern University Feinberg School of Medicine Chicago, IL
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
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Martínez-Gómez J, de Cos-Gandoy A, Fernández-Alvira JM, Bodega P, de Miguel M, Tresserra-Rimbau A, Laveriano-Santos EP, Ramirez-Garza SL, Orrit X, Carvajal I, Estruch R, Lamuela-Raventós RM, Santos-Beneit G, Fuster V, Fernández-Jiménez R. Cardiovascular Health Trajectories in Adolescence and Their Association With Sociodemographic and Cardiometabolic Outcomes in Spain. J Adolesc Health 2024; 74:1039-1048. [PMID: 38323971 DOI: 10.1016/j.jadohealth.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/24/2023] [Accepted: 12/13/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE To determine cardiovascular health (CVH) trajectories and their association with sociodemographic and cardiometabolic outcomes in adolescence. METHODS One thousand eighty adolescents attending 24 secondary schools enrolled in the SI! Program for Secondary Schools trial in Spain were assessed at approximately 12, 14, and 16 years of age. CVH was assessed according to American Heart Association criteria based on seven metrics (smoking status, body mass index, physical activity, diet, blood pressure, total cholesterol, and blood glucose), and CVH trajectories were identified by latent class trajectory modeling. Associations between CVH trajectories, sociodemographic characteristics, and cardiometabolic outcomes were analyzed using generalized linear and Poisson models. RESULTS Five CVH trajectory groups were identified: poor-stable (27 adolescents [2.5%]), intermediate-substantial rise (79 [7.3%]), intermediate-substantial decline (63 [5.8%]), intermediate-mild decline (403 [37.3%]), and intermediate-mild rise (508 [47.1%]). Boys and adolescents from families with low-average income, low-intermediate educational attainment, and a migrant background more frequently belonged to groups with lower baseline CVH and poor or declining trajectories. The intermediate-substantial decline group had the highest prevalence ratio for overweight/obesity (3.84; 95% confidence interval: 2.86-5.16) and metabolic syndrome (4.93; 95% confidence interval: 1.21-20.04) at age 16, whereas prevalence was lowest in the intermediate-mild rise group. DISCUSSION Adolescent CVH trajectories differ according to socioeconomic characteristics and are associated with cardiometabolic outcomes. Primordial prevention interventions should be implemented early in life, taking into account CVH trajectories and with a particular focus on vulnerable populations.
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Affiliation(s)
| | - Amaya de Cos-Gandoy
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | | | - Patricia Bodega
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Mercedes de Miguel
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Anna Tresserra-Rimbau
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XIA, INSA, University of Barcelona, Barcelona, Spain
| | - Emily P Laveriano-Santos
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XIA, INSA, University of Barcelona, Barcelona, Spain
| | - Sonia L Ramirez-Garza
- Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XIA, INSA, University of Barcelona, Barcelona, Spain
| | - Xavier Orrit
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Isabel Carvajal
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Ramón Estruch
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Rosa María Lamuela-Raventós
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XIA, INSA, University of Barcelona, Barcelona, Spain
| | - Gloria Santos-Beneit
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Department of Cardiology, Hospital Universitario Clinico San Carlos, Madrid, Spain; Centro de Investigación Biomédica En Red en enfermedades CardioVasculares (CIBERCV), Madrid, Spain.
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Santos-Beneit G, Fernández-Jiménez R, Fuster V. Education and Information to Improve Cardiovascular Health-Reply. JAMA Cardiol 2024; 9:306-307. [PMID: 38265786 DOI: 10.1001/jamacardio.2023.5248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Gloria Santos-Beneit
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Centro de Investigación Biomédica En Red en enfermedades CardioVasculares (CIBERCV), Madrid, Spain
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Valentín Fuster
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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