1
|
Singhato A, Booranasuksakul U, Khongkhon S, Rueangsri N. Effectiveness of the Therapeutic Lifestyle Change Diet Intervention to Improve Biochemical Markers of Cardiovascular Diseases in HIV-Infected Patients with Dyslipidemia. ANNALS OF NUTRITION & METABOLISM 2024; 80:202-210. [PMID: 38631311 DOI: 10.1159/000538578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION This randomized controlled trial study aimed to investigate the effectiveness of therapeutic lifestyle change (TLC) diet intervention by the registered dietitians. METHODS Eighty-two people living with HIV (PLHIV) with dyslipidemia were randomly allocated to the intervention group as well as another 82 PLHIV with dyslipidemia to the control group. Participants in the intervention group were instructed to meet the registered dietitians every 2 weeks at weeks 0, 2, 4, 6, and 12 (a totally of 12 weeks) to receive individual medical nutrition therapy according to the TLC diet principles, while the participants in the control group only received routine health care service. RESULTS Triglycerides, total cholesterol, and LDL cholesterol of the intervention group were significantly lower than those of the control group at the endpoint (p < 0.05). In addition, these biomarkers and C-reactive protein of the intervention group were significantly lower when compared with their baseline (p < 0.05). The overall dietary habits of participants in the intervention group were significantly improved at the end of the study (p < 0.05). CONCLUSION The medical nutrition therapy intervention based on the TLC diet is effective in improving blood lipid profiles among PLHIV with dyslipidemia.
Collapse
Affiliation(s)
- Alongkote Singhato
- Nutrition and Dietetics Division, Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand
| | - Uraiporn Booranasuksakul
- Nutrition and Dietetics Division, Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand
| | - Somjet Khongkhon
- Thai Traditional Medicine Division, Faculty of Thai Traditional and Alternative Medicine, Ubon Ratchathani Rajabhat University, Ubon Ratchathani, Thailand
| | - Narisa Rueangsri
- Nutrition and Dietetics Division, Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand
| |
Collapse
|
2
|
Clinical Evaluation of a Novel Tablet Formulation of Traditional Thai Polyherbal Medicine Named Nawametho in Comparison with Its Decoction in the Treatment of Hyperlipidemia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2530266. [PMID: 35966727 PMCID: PMC9365582 DOI: 10.1155/2022/2530266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022]
Abstract
In the traditional medical system in Thailand, medicinal plants and polyherbal medicines have been prescribed as lipid-lowering agents, including Nawametho decoction. This polyherbal formulation is described in the Worayokasan scripture. It consists of nine medicinal plants (Aegle marmelos (L.), Carthamus tinctorius L., Hibiscus sabdariffa Linn., Phyllanthus emblica L., Piper longum L., Piper nigrum L., Terminalia bellirica (Gaertn.) Roxb., Terminalia chebula Retz., and Zingiber officinale Roscoe). Apart from its utilization in Thai traditional medicine, there is a lack of evidence supporting its use. This research work thereby aims to formulate and evaluate the tablet containing Nawametho decoction. The feasibility of Nawametho decoction and NawaTab for patients with borderline hyperlipidemia was additionally examined using a prospective, open-label, randomized, parallel-group design. The dry granulation technique was employed to formulate the polyherbal tablets. The tablets were developed using the spray-dried Nawametho decoction as the active ingredient in addition to other excipients. The chosen formulation, the FB (NawaTab), consisted of 385 milligrams of the extract, 12% w/w of a diluent (lactose), 8% w/w of a lubricant (magnesium stearate), 5% w/w of a disintegrant (microcrystalline cellulose), and 5% w/w of an anti-adherent (talcum). Their hardness, friability, and disintegration time were 4.4 ± 0.32 kg, 0.05 ± 0.02%, and 4.60 ± 0.05 min, respectively. Accelerated stability study results revealed that NawaTab was stable for six months at 40°C/75% RH and 25°C/60% RH. Even though taking NawaTabs (500 mg twice daily) for eight consecutive weeks was unable to improve the lipid profile of the patients, the administration of Nawametho decoction (30 mL twice daily) was associated with a significant decrease in serum triglycerides of the patients. The results show that the dry granulation technique is suitable for the formulation of NawaTab based on the tablet evaluation. Furthermore, the triglyceride-lowering effect of Nawametho decoction was reported for the first time.
Collapse
|
3
|
Karimian J, Farrokhzad A, Jalili C. The effect of cumin (Cuminum cyminum L.) supplementation on glycemic indices: A systematic review and meta-analysis of randomized controlled trials. Phytother Res 2021; 35:4127-4135. [PMID: 33720457 DOI: 10.1002/ptr.7075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/14/2021] [Accepted: 02/24/2021] [Indexed: 01/07/2023]
Abstract
We aimed to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the effect of cumin supplementation on markers of glycemic control in adults. A comprehensive literature search was conducted up from inception to November 2020 on PubMed, Scopus, Web of Sciences, and Cochrane electronic databases. Studies that compared the effect of cumin with placebo on fasting blood sugar (FBS), serum insulin, and homeostasis model assessment-estimated insulin resistance (HOMA-IR) index in adults were considered eligible. Weighted mean difference (WMD) (with 95% confidence intervals) for endpoints were calculated using the random-effects model. Finally, a total of eight RCT studies involving 552 participants were included in the review. The results of the meta-analysis suggest that cumin supplementation did not significantly alter serum FBS (WMD: -17.77 mg/dl; 95% CI: -36.42 to 0.87, p = .06), insulin (WMD: -0.49 Hedges' g; 95% CI: -1.19 to 0.21, p =.16) levels and HOMA-IR (WMD: -0.06; 95% CI: -0.21 to 0.10, p = 0.48) index. These results do not support the use of cumin supplementation for improving glycemic markers in adults. However, further high-quality trials are still needed to confirm these results.
Collapse
Affiliation(s)
- Jahangir Karimian
- Department of General Courses, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Cyrus Jalili
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
4
|
Pasarica M, Kay D. Teaching lifestyle medicine competencies in undergraduate medical education: active collaborative intervention for students at multiple locations. ADVANCES IN PHYSIOLOGY EDUCATION 2020; 44:488-495. [PMID: 32795122 DOI: 10.1152/advan.00148.2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aims of this study are to 1) design feasible active collaborative educational approaches to teach and assess three of the newly described lifestyle medicine (LM) competencies to students at multiple locations; and 2) determine whether a mixed, flexible instructional delivery approach impacts students' learning and perception of confidence in LM. The educational interventions were part of the undergraduate clinical medical education curriculum and have two parts: 1) an asynchronous session [online self-learning module (SLM)], and 2) a synchronous session using case-based collaborative learning delivered either mostly face to face, as determined by the instructor (approach A) or mostly virtual, as determined by the student (approach B). Both approaches were delivered in the curriculum as planned to 27 students in approach A (26% attending virtually) and 31 students in approach B (90% attending virtually). Approach B required more planning time. Approach A students (26 of 27) agreed that the SLM was valuable as an educational tool. The performance in the summative assessment was similar (P = 0.49) in both approaches [means (SD): 33.2 points (SD 10.6) approach A vs. 33.2 points (SD 10.1) approach B]. Students reported a similar increase in confidence (P = 0.33) with setting lifestyle change goals. The two educational approaches presented here address three of the new LM competencies using active collaborative learning. Both approaches are feasible for synchronous delivery to students located at local and distant sites, either face to face or virtual. The increase in the proportion of students attending virtually did not decrease the measured outcomes of learning and perceptions of confidence.
Collapse
Affiliation(s)
- Magdalena Pasarica
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, Florida
| | - Denise Kay
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, Florida
| |
Collapse
|
5
|
Opina AD, Cephus C, Wang Y, Younan S, Moodie D. The effects of lifestyle changes on serum lipid levels in children in a real life setting. CONGENIT HEART DIS 2018; 13:327-333. [PMID: 29345123 DOI: 10.1111/chd.12580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/28/2017] [Accepted: 12/22/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Studies have shown improvement in lipid levels after institution of lifestyle changes in children enrolled in closely monitored programs. There programs are difficult to mimic in real world clinics. We aim to determine if diet and exercise result in improvement in lipid levels in patients seen in a designated lipid clinic in a real life setting. DESIGN Retrospective review of patients followed for dyslipidemia at the Texas Children's Hospital Lipid Clinic from May 1, 2012 to May 1, 2015. Patients included were seen more than once, had repeat lipid testing, and abnormal baseline lipid levels. Multivariate analysis using mixed models were performed to compare outcomes in patients who did and did not participate in lifestyle change. RESULTS Of the 268 patients seen within the study period, 174 (56% male, 44% female) met inclusion criteria. Median age was 11 years. Compared to patients who did not make lifestyle changes: patients who made only diet changes demonstrated significant improvement in weight only (slope = -1.55, P-value = .014), and those who made only exercise changes demonstrated significant improvements in serum cholesterol (slope = -22.8, P-value = .017) and non-HDL cholesterol (slope = -28.7, P-value = < .01) levels. Patients who participated in both diet and exercise demonstrated significant improvement in weight (slope = -1.13, P-value = .011), diastolic blood pressure (slope = -1.82, P-value = < .01), and serum lipid levels: LDL (slope = -10.8, P-value = 0.017), HDL (slope = 1.52, P-value = .24), Triglycerides (slope = -0.11, P-value = .033) compared to those who did not make lifestyle changes. CONCLUSIONS Outpatient management of dyslipidemia is difficult. Only patients who participated in both diet and exercise showed significant improvement in outcomes when compared to those who did not make lifestyle changes.
Collapse
Affiliation(s)
- Angeline D Opina
- Lillie Frank Abercrombie Section of Cardiology Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Constance Cephus
- Lillie Frank Abercrombie Section of Cardiology Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Yunfei Wang
- Lillie Frank Abercrombie Section of Cardiology Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Samuel Younan
- Lillie Frank Abercrombie Section of Cardiology Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Douglas Moodie
- Lillie Frank Abercrombie Section of Cardiology Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| |
Collapse
|
6
|
Turan TN, Al Kasab S, Nizam A, Lynn MJ, Harrell J, Derdeyn CP, Fiorella D, Janis LS, Lane BF, Montgomery J, Chimowitz MI. Relationship between Risk Factor Control and Compliance with a Lifestyle Modification Program in the Stenting Aggressive Medical Management for Prevention of Recurrent Stroke in Intracranial Stenosis Trial. J Stroke Cerebrovasc Dis 2017; 27:801-805. [PMID: 29169967 DOI: 10.1016/j.jstrokecerebrovasdis.2017.10.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/13/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Lifestyle modification programs have improved the achievement of risk factor targets in a variety of clinical settings, including patients who have previously suffered a stroke or transient ischemic attack and those with multiple risk factors. Stenting Aggressive Medical Management for Prevention of Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) was the first vascular disease prevention trial to provide a commercially available lifestyle modification program to enhance risk factor control. We sought to determine the relationship between compliance with this program and risk factor control in SAMMPRIS. METHODS SAMMPRIS aggressive medical management included a telephonic lifestyle modification program provided free of charge to all subjects (n = 451) during their participation in the study. Subjects with fewer than 3 expected lifestyle-coaching calls were excluded from these analyses. Compliant subjects (n = 201) had greater than or equal to 78.5% of calls (median % of completed/expected calls). Noncompliant subjects (n = 200) had less than 78.5% of calls or refused to participate. Mean risk factor values or % in-target for each risk factor was compared between compliant versus noncompliant subjects, using t tests and chi-square tests. Risk factor changes from baseline to follow-up were compared between the groups to account for baseline differences. RESULTS Compliant subjects had better risk factor control throughout follow-up for low-density lipoprotein, systolic blood pressure (SBP), hemoglobin A1c (HgA1c), non-high-density lipoprotein, nonsmoking, and exercise than noncompliant subjects, but there was no difference for body mass index. After adjusting for baseline differences between the groups, compliant subjects had a greater change from baseline than noncompliant subjects for SBP did at 24 months and HgA1c at 6 months. CONCLUSION SAMMPRIS subjects who were compliant with the lifestyle modification program had better risk factor control during the study for almost all risk factors.
Collapse
Affiliation(s)
- Tanya N Turan
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina.
| | - Azhar Nizam
- Department of Public Health, Emory University, Atlanta, Georgia
| | - Michael J Lynn
- Department of Public Health, Emory University, Atlanta, Georgia
| | - Jamie Harrell
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Colin P Derdeyn
- Department of Radiology, University of Iowa, Iowa City, Iowa
| | - David Fiorella
- Department of Neurosurgery, State University of New York at Stony Brook, Stony Brook, New York
| | - L Scott Janis
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Bethany F Lane
- Department of Public Health, Emory University, Atlanta, Georgia
| | - Jean Montgomery
- Department of Public Health, Emory University, Atlanta, Georgia
| | - Marc I Chimowitz
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | | |
Collapse
|
7
|
Gordon NF, Salmon RD, Wright BS, Faircloth GC, Reid KS, Gordon TL. Clinical Effectiveness of Lifestyle Health Coaching: Case Study of an Evidence-Based Program. Am J Lifestyle Med 2017; 11:153-166. [PMID: 30202328 PMCID: PMC6125027 DOI: 10.1177/1559827615592351] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/08/2015] [Accepted: 05/11/2015] [Indexed: 11/15/2022] Open
Abstract
We have developed, tested, and successfully implemented an affordable, evidence-based, technology-enabled, data-driven, outcomes-oriented, comprehensive lifestyle health coaching (LHC) program. The LHC program has been used primarily to provide services to employees of larger employers (ie, with at least 3000 employees) but has also been implemented in a variety of other settings, including hospitals, cardiac rehabilitation centers, physician practices, and as part of multicenter clinical trials. The program is delivered mainly using the telephone and Internet. Health coaches are guided by a Web-based participant management and tracking system. Lifestyle management interventions are based on several behavior change models and strategies, especially adult learning theory, social learning theory, the stages of change model, single concept learning theory, and motivational interviewing. The program is administered by nonphysician health professionals whose services are integrated with the care provided by participants' physicians. Outcomes data from published studies, including randomized clinical trials and independent third-party conducted research, have documented the clinical effectiveness of this evidence-based approach in terms of modification of multiple risk factors in healthy persons as well as those with certain common chronic diseases.
Collapse
|
8
|
Gopalan A, Paramanund J, Shaw PA, Patel D, Friedman J, Brophy C, Buttenheim AM, Troxel AB, Asch DA, Volpp KG. Randomised controlled trial of alternative messages to increase enrolment in a healthy food programme among individuals with diabetes. BMJ Open 2016; 6:e012009. [PMID: 27903559 PMCID: PMC5168560 DOI: 10.1136/bmjopen-2016-012009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We compared the effectiveness of diabetes-focused messaging strategies at increasing enrolment in a healthy food programme among adults with diabetes. METHODS Vitality is a multifaceted wellness benefit available to members of Discovery Health, a South Africa-based health insurer. One of the largest Vitality programmes is HealthyFood (HF), an incentive-based programme designed to encourage healthier diets by providing up to 25% cashback on healthy food purchases. We randomised adults with type 2 diabetes to 1 of 5 arms: (1) control, (2) a diabetes-specific message, (3) a message with a recommendation of HF written from the perspective of a HF member with diabetes, (4) a message containing a physician's recommendation of HF, or (5) the diabetes-specific message from arm 2 paired with an 'enhanced active choice'(EAC). In an EAC, readers are asked to make an immediate choice (in this case, to enrol or not enrol); the pros and cons associated with the preferred and non-preferred options are highlighted. HF enrolment was assessed 1 month following the first emailed message. RESULTS We randomised 3906 members. After excluding those who enrolled in HF or departed from the Vitality programme before the first intervention email, 3665 (94%) were included in a modified intent-to-treat analysis. All 4 experimental arms had significantly higher HF enrolment rates compared with control (p<0.0001 for all comparisons). When comparing experimental arms, the diabetes-specific message with the EAC had a significantly higher enrolment rate (12.6%) than the diabetes-specific message alone (7.6%, p=0.0016). CONCLUSIONS Messages focused on diabetes were effective at increasing enrolment in a healthy food programme. The addition of a framed active choice to a message significantly raised enrolment rates in this population. These findings suggest that simple, low-cost interventions can enhance enrolment in health promoting programmes and also be pragmatically tested within those programmes. TRIAL REGISTRATION NUMBER NCT02462057.
Collapse
Affiliation(s)
- A Gopalan
- Corporal Michael J. Cresencz VA Medical Center, Philadelphia, Pennsylvania, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | | | - P A Shaw
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - D Patel
- Discovery Vitality, Johannesburg, South Africa
| | - J Friedman
- LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Departments of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - C Brophy
- Vitality USA, New York, New York, USA
| | - A M Buttenheim
- LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Community and Family Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - A B Troxel
- LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Population Health, NYU School of Medicine, New York, New York, USA
| | - D A Asch
- Corporal Michael J. Cresencz VA Medical Center, Philadelphia, Pennsylvania, USA
- LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Departments of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - K G Volpp
- Corporal Michael J. Cresencz VA Medical Center, Philadelphia, Pennsylvania, USA
- LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Departments of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
9
|
Ye Z, Liu Y, Deng X, Chen X, Lin C, Tang Y, Su Y, Fang L, Wu Y, Qin C. Simultaneous Bilateral Carotid Stenting for Symptomatic Bilateral High-Grade Carotid Stenosis: A Retrospective Clinical Investigation. Med Sci Monit 2016; 22:2924-33. [PMID: 27542158 PMCID: PMC4994931 DOI: 10.12659/msm.896505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background This retrospective clinical investigation aimed to evaluate the short-term effectiveness and safety of SBCAS for symptomatic bilateral high-grade CS. Material/Methods From 2009 to 2014, 145 patients were recruited. Among them, 70 underwent SBCAS, and other 75 patients underwent SAMM and served as controls. The immediate postprocedural complications and postprocedural neurological evaluation, as well as restenosis at 6-month and 1-year follow-ups in the SBCAS group are reported. Additionally, baseline risk factors for ischemic stroke, adverse effects of drugs, and outcomes at 30-day, 6-month, and 1-year follow-ups were compared between the 2 groups. Results Our data did not reveal significant differences between the 2 groups in baseline risk factors for ischemic stroke. In the SBCAS group, both HPS (5.7%) and HD (40%) occurred, but they were not very severe, and no patients had postprocedural neurological deficit. Moreover, restenosis only occurred in 3 patients at 3 stent placement sites (4.3%) at 1-year follow-up. Adverse effects of drugs did not occur in SBCAS group, but adverse effects of Bayer aspirin and Lipitor occurred in 4 patients (5.4%) and 18 patients (24.3%), respectively, at 6-month follow-up in the control group. Furthermore, there were significant differences in outcomes between the 2 groups at 30-day, 6-month, and 1-year follow-ups, in that NIHSS, CS ratio, and incidence of endpoint events, as well as 1-year cumulative probability of endpoint events, were all lower in the SBCAS group than in the control group (p<0.05). Conclusions Compared to SAMM, we found that SBCAS was more effective and safer for symptomatic bilateral high-grade CS.
Collapse
Affiliation(s)
- Ziming Ye
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Ying Liu
- Department of Rehabilitation, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Xiao Deng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Xiangren Chen
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Cuiting Lin
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Yanyan Tang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Ying Su
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Lanji Fang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Yuan Wu
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Chao Qin
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| |
Collapse
|
10
|
Coetzee O, Filatova D. Metabolic syndrome reversal through nutrition: A case report. ADVANCES IN INTEGRATIVE MEDICINE 2016. [DOI: 10.1016/j.aimed.2016.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
11
|
Waters MF, Hoh BL, Lynn MJ, Kwon HM, Turan TN, Derdeyn CP, Fiorella D, Khanna A, Sheehan TO, Lane BF, Janis S, Montgomery J, Chimowitz MI. Factors Associated With Recurrent Ischemic Stroke in the Medical Group of the SAMMPRIS Trial. JAMA Neurol 2016; 73:308-15. [PMID: 26747792 PMCID: PMC5576955 DOI: 10.1001/jamaneurol.2015.4315] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) Trial showed that aggressive medical therapy was more effective than stenting for preventing stroke in patients with symptomatic intracranial stenosis. However, 15% of patients in the medical group still experienced a primary end point during a median follow-up of 32.7 months. OBJECTIVE To determine baseline features that were associated with a high rate of a primary end point in the medical arm of the SAMMPRIS Trial. DESIGN, SETTING, AND PARTICIPANTS A post hoc analysis of patients in the medical arm only of the SAMMPRIS trial. Enrollment occurred between October 2008 and April 2013 and included 227 patients randomized to medical management alone. Baseline demographic features, vascular risk factors, qualifying event, brain imaging, and angiographic features were analyzed. Bivariate and multivariable proportional hazard regression modeling was performed to relate baseline features to the time until a primary end point. The post hoc analysis was conducted from November 2014 to June 2015. INTERVENTIONS The SAMMPRIS Trial compared stenting with aggressive medical management in patients with a stroke or transient ischemic attack attributed to 70% to 99% stenosis of a major intracranial artery. MAIN OUTCOMES AND MEASURES The primary outcome was any of the following: stroke or death within 30 days of enrollment, ischemic stroke in the territory of the symptomatic intracranial artery beyond 30 days after enrollment, or any stroke or death within 30 days after stenting a patient in the medical group during follow-up. RESULTS A total of 227 patients were included in the study, 82 of whom were female, and the mean (SD) age was 59.5 (11.8) years. Being female (hazard ratio [HR], 1.9; 95% CI, 0.96-3.7), having diabetes mellitus (HR, 1.8; 95% CI, 0.9-3.5), not taking a statin at enrollment (HR, 2.6; 95% CI, 1.2-5.7), stroke as the qualifying event (HR, 2.5; 95% CI, 1.03-6.0), Rankin grade of 1 or greater (HR, 2.3; 95% CI, 0.9-5.5), old infarct in the territory of the stenotic artery (HR, 2.6; 95% CI, 1.3-5.1), and greater than 80% stenosis (HR, 1.9; 95% CI, 0.9-3.7) were associated (P < .10) with higher risk on bivariate analysis. Factors that were significantly associated with a primary end point on multivariable analyses were old infarct in the territory (HR, 2.6; 95% CI, 1.3-5.3; P = .006), stroke as the qualifying event (HR, 3.0; 95% CI, 1.1-7.7; P = .03), and no statin use at enrollment (HR, 2.4; 95% CI, 1.1-5.2; P = .03). CONCLUSIONS AND RELEVANCE Old infarct in the territory of the stenosis, new stroke presentation, and absence of statin use at enrollment were independently associated with high rates of the primary end point in the medical group in the SAMMPRIS Trial. These features may be useful for selecting high-risk patients for future clinical trials evaluating alternative therapies for intracranial stenosis. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00576693.
Collapse
Affiliation(s)
- Michael F Waters
- Department of Neurology, McKnight Brain Institute, University of Florida College of Medicine, Gainesville2Department of Neuroscience, McKnight Brain Institute, University of Florida College of Medicine, Gainesville
| | - Brian L Hoh
- Department of Neurosurgery, McKnight Brain Institute, University of Florida College of Medicine, Gainesville
| | - Michael J Lynn
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Hyung-Min Kwon
- Department of Neurosciences, Medical University of South Carolina, Charleston6Department of Neurology, Seoul Metropolitan Government-Seoul National University, Boramae Medical Center, Seoul, South Korea
| | - Tanya N Turan
- Department of Neurosciences, Medical University of South Carolina, Charleston
| | - Colin P Derdeyn
- Mallinckrodt Institute of Radiology and the Departments of Neurology and Neurosurgery, Washington University School of Medicine, St Louis, Missouri
| | - David Fiorella
- Department of Neurosurgery, State University of New York, Stony Brook
| | - Anna Khanna
- Department of Neurology, McKnight Brain Institute, University of Florida College of Medicine, Gainesville
| | - Tiffany O Sheehan
- Department of Neurology, McKnight Brain Institute, University of Florida College of Medicine, Gainesville
| | - Bethany F Lane
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Scott Janis
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Jean Montgomery
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Marc I Chimowitz
- Department of Neurosciences, Medical University of South Carolina, Charleston
| |
Collapse
|
12
|
Liu Z, Chen S, Zhang G, Lin A. Mobile Phone-Based Lifestyle Intervention for Reducing Overall Cardiovascular Disease Risk in Guangzhou, China: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:15993-6004. [PMID: 26694436 PMCID: PMC4690973 DOI: 10.3390/ijerph121215037] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/10/2015] [Accepted: 12/12/2015] [Indexed: 02/07/2023]
Abstract
With the rapid and widespread adoption of mobile devices, mobile phones offer an opportunity to deliver cardiovascular disease (CVD) interventions. This study evaluated the efficacy of a mobile phone-based lifestyle intervention aimed at reducing the overall CVD risk at a health management center in Guangzhou, China. We recruited 589 workers from eight work units. Based on a group-randomized design, work units were randomly assigned either to receive the mobile phone-based lifestyle interventions or usual care. The reduction in 10-year CVD risk at 1-year follow-up for the intervention group was not statistically significant (-1.05%, p = 0.096). However, the mean risk increased significantly by 1.77% (p = 0.047) for the control group. The difference of the changes between treatment arms in CVD risk was -2.83% (p = 0.001). In addition, there were statistically significant changes for the intervention group relative to the controls, from baseline to year 1, in systolic blood pressure (-5.55 vs. 6.89 mmHg; p < 0.001), diastolic blood pressure (-6.61 vs. 5.62 mmHg; p < 0.001), total cholesterol (-0.36 vs. -0.10 mmol/L; p = 0.005), fasting plasma glucose (-0.31 vs. 0.02 mmol/L; p < 0.001), BMI (-0.57 vs. 0.29 kg/m²; p < 0.001), and waist hip ratio (-0.02 vs. 0.01; p < 0.001). Mobile phone-based intervention may therefore be a potential solution for reducing CVD risk in China.
Collapse
Affiliation(s)
- Zhiting Liu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
| | - Songting Chen
- Department of Infection Management, First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan, China.
| | - Guanrong Zhang
- Health Management Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510180, China.
| | - Aihua Lin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
| |
Collapse
|
13
|
Baudet M, Daugareil C. [Therapeutic education in primary cardiovascular prevention. Interests and limits]. Ann Cardiol Angeiol (Paris) 2014; 63:235-9. [PMID: 24679981 DOI: 10.1016/j.ancard.2014.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/02/2014] [Indexed: 01/22/2023]
Abstract
GOAL OF THE STUDY Lifestyle improvement is useful in the prevention of cardiovascular disease, but its practical implementation in the general population is limited. Patient therapeutic education can help go beyond these limits. PATIENTS AND METHODS In primary prevention, we propose a personalized program including one or several individual and collective sessions to help the participants towards a healthier lifestyle. This includes better education about six risk factors (tobacco, sedentary lifestyle, overweight, high blood pressure, high cholesterol, diabetes) as well as advice on better eating habits. The first recommendation is to limit processed meats, the other recommendations advise more fish, green vegetables, whole grains and beans, and fruits. Scores are attributed to six risk factors and five eating habits. These scores are given at the time of the first session and again a year later, thus permitting time comparisons. RESULTS For the first 291 participants in the program, we observed at one year a significant improvement in physical activities of endurance and in the consumption of the recommended food groups (fish, green vegetables, fruits, whole grains and beans). CONCLUSION The patient's lifestyle has improved as a whole, certain parameters more than others. Assessed patient therapeutic education should be offered to a larger number of people.
Collapse
Affiliation(s)
- M Baudet
- Maison du Cœur, centre hospitalier de Dax-Côte-d'Argent, 3, place du Présidial, 40100 Dax, France.
| | - C Daugareil
- Maison du Cœur, centre hospitalier de Dax-Côte-d'Argent, 3, place du Présidial, 40100 Dax, France
| |
Collapse
|
14
|
Derdeyn CP, Chimowitz MI, Lynn MJ, Fiorella D, Turan TN, Janis LS, Montgomery J, Nizam A, Lane BF, Lutsep HL, Barnwell SL, Waters MF, Hoh BL, Hourihane JM, Levy EI, Alexandrov AV, Harrigan MR, Chiu D, Klucznik RP, Clark JM, McDougall CG, Johnson MD, Pride GL, Lynch JR, Zaidat OO, Rumboldt Z, Cloft HJ. Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial. Lancet 2014; 383:333-41. [PMID: 24168957 PMCID: PMC3971471 DOI: 10.1016/s0140-6736(13)62038-3] [Citation(s) in RCA: 555] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Early results of the Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis trial showed that, by 30 days, 33 (14·7%) of 224 patients in the stenting group and 13 (5·8%) of 227 patients in the medical group had died or had a stroke (percentages are product limit estimates), but provided insufficient data to establish whether stenting offered any longer-term benefit. Here we report the long-term outcome of patients in this trial. METHODS We randomly assigned (1:1, stratified by centre with randomly permuted block sizes) 451 patients with recent transient ischaemic attack or stroke related to 70-99% stenosis of a major intracranial artery to aggressive medical management (antiplatelet therapy, intensive management of vascular risk factors, and a lifestyle-modification programme) or aggressive medical management plus stenting with the Wingspan stent. The primary endpoint was any of the following: stroke or death within 30 days after enrolment, ischaemic stroke in the territory of the qualifying artery beyond 30 days of enrolment, or stroke or death within 30 days after a revascularisation procedure of the qualifying lesion during follow-up. Primary endpoint analysis of between-group differences with log-rank test was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT 00576693. FINDINGS During a median follow-up of 32·4 months, 34 (15%) of 227 patients in the medical group and 52 (23%) of 224 patients in the stenting group had a primary endpoint event. The cumulative probability of the primary endpoints was smaller in the medical group versus the percutaneous transluminal angioplasty and stenting (PTAS) group (p=0·0252). Beyond 30 days, 21 (10%) of 210 patients in the medical group and 19 (10%) of 191 patients in the stenting group had a primary endpoint. The absolute differences in the primary endpoint rates between the two groups were 7·1% at year 1 (95% CI 0·2 to 13·8%; p=0·0428), 6·5% at year 2 (-0·5 to 13·5%; p=0·07) and 9·0% at year 3 (1·5 to 16·5%; p=0·0193). The occurrence of the following adverse events was higher in the PTAS group than in the medical group: any stroke (59 [26%] of 224 patients vs 42 [19%] of 227 patients; p=0·0468) and major haemorrhage (29 [13%]of 224 patients vs 10 [4%] of 227 patients; p=0·0009). INTERPRETATION The early benefit of aggressive medical management over stenting with the Wingspan stent for high-risk patients with intracranial stenosis persists over extended follow-up. Our findings lend support to the use of aggressive medical management rather than PTAS with the Wingspan system in high-risk patients with atherosclerotic intracranial arterial stenosis. FUNDING National Institute of Neurological Disorders and Stroke (NINDS) and others.
Collapse
Affiliation(s)
- Colin P Derdeyn
- Mallinckrodt Institute of Radiology and the Departments of Neurology and Neurosurgery, Washington University School of Medicine, St Louis, MO, USA.
| | - Marc I Chimowitz
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - Michael J Lynn
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public, Health, Atlanta, GA, USA
| | - David Fiorella
- Department of Neurosurgery, State University of New York, Stony Brook, NY, USA
| | - Tanya N Turan
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - L Scott Janis
- National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, USA
| | - Jean Montgomery
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public, Health, Atlanta, GA, USA
| | - Azhar Nizam
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public, Health, Atlanta, GA, USA
| | - Bethany F Lane
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public, Health, Atlanta, GA, USA
| | - Helmi L Lutsep
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Stanley L Barnwell
- Department of Neurological Surgery and the Dotter Interventional Institute, Oregon Health Sciences University, Portland, OR, USA
| | - Michael F Waters
- Departments of Neurology and Neuroscience, University of Florida, Gainesville, FL, USA
| | - Brian L Hoh
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | | | - Elad I Levy
- Department of Neurosurgery, University of Buffalo, NY, USA
| | | | - Mark R Harrigan
- Department of Neurosurgery, University of Alabama, Birmingham, AL, USA
| | - David Chiu
- Department of Neurology, Houston Methodist Hospital, Houston, TX, USA
| | | | - Joni M Clark
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | | | - Mark D Johnson
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - G Lee Pride
- Departments of Radiology and Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John R Lynch
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Osama O Zaidat
- Departments of Neurology, Radiology, and Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Zoran Rumboldt
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Harry J Cloft
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
15
|
Saffi MAL, Polanczyk CA, Rabelo-Silva ER. Lifestyle interventions reduce cardiovascular risk in patients with coronary artery disease: a randomized clinical trial. Eur J Cardiovasc Nurs 2013; 13:436-43. [PMID: 24021286 DOI: 10.1177/1474515113505396] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nurse-led interventions have proven beneficial to reduce estimated cardiovascular risk. AIM The purpose of this study was to evaluate the effect of systematic, nurse-led individual lifestyle counseling sessions on the reduction of 10-year cardiovascular risk scores in patients with coronary artery disease (CAD). METHODS This was a randomized clinical trial of CAD patients treated at a tertiary referral hospital. The intervention group received nurse-led guidance by means of five face-to-face sessions and telephone contact over the course of one year, starting three months after hospital discharge. Exercise and dietary goals were set for each patient and monitored at each session. The control group received standard medical advice. Patients were stratified by Framingham risk score and compared at the end of the follow-up period. RESULTS The final sample comprised 74 patients, 38 in the intervention group and 36 in the control group. Mean age was 58 ± 9 years; 74% of patients were male. A 1.7 point (-13.6%) reduction in risk score was recorded in the intervention group, vs a 1.2 point increase in risk score (+11%) in the control group (p=0.011). Significant between-group differences were detected for weight (intervention, 78 ± 14 kg at baseline vs 77 ± 14 kg at study end; control, 78 ± 15 kg vs 79 ± 15 kg; p=0.04), systolic blood pressure (intervention, 136 ± 22 mm Hg vs 124 ± 15 mm Hg; control, 126 ± 15 mm Hg vs 129 ± 16 mm Hg; p=0.005), and diastolic blood pressure (intervention, 82 ± 10 mm Hg vs 77 ± 09 mm Hg; control, 79 ± 09 mm Hg vs 80 ± 10 mm Hg; p=0.02). CONCLUSION Structured and systematic nurse-led lifestyle counseling effectively reduced cardiovascular risk score.
Collapse
Affiliation(s)
- Marco Aurélio Lumertz Saffi
- Graduate Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Brazil Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Brazil
| | - Carisi Anne Polanczyk
- Graduate Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Brazil Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Brazil
| | - Eneida Rejane Rabelo-Silva
- Graduate Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Brazil Nursing School, Federal University of Rio Grande do Sul, Brazil
| |
Collapse
|
16
|
Chimowitz MI. The Feinberg Award Lecture 2013: treatment of intracranial atherosclerosis: learning from the past and planning for the future. Stroke 2013; 44:2664-9. [PMID: 23821232 DOI: 10.1161/strokeaha.113.001290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marc I Chimowitz
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
| |
Collapse
|
17
|
Turan TN, Lynn MJ, Nizam A, Lane B, Egan BM, Le NA, Lopes-Virella MF, Hermayer KL, Benavente O, White CL, Brown WV, Caskey MF, Steiner MR, Vilardo N, Stufflebean A, Derdeyn CP, Fiorella D, Janis S, Chimowitz MI. Rationale, design, and implementation of aggressive risk factor management in the Stenting and Aggressive Medical Management for Prevention of Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial. Circ Cardiovasc Qual Outcomes 2012; 5:e51-60. [PMID: 22991350 PMCID: PMC3500085 DOI: 10.1161/circoutcomes.112.966911] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tanya N Turan
- Medical University of South Carolina, Charleston, SC 29425, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2012; 55:1577-96. [PMID: 22526604 DOI: 10.1007/s00125-012-2534-0] [Citation(s) in RCA: 989] [Impact Index Per Article: 82.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 02/24/2012] [Indexed: 12/11/2022]
Affiliation(s)
- S E Inzucchi
- Section of Endocrinology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012; 35:1364-79. [PMID: 22517736 PMCID: PMC3357214 DOI: 10.2337/dc12-0413] [Citation(s) in RCA: 2554] [Impact Index Per Article: 212.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Silvio E Inzucchi
- Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Wu XQ, Kong X, Zhou Y, Huang K, Yang JR, Li XL. Sesamin exerts renoprotective effects by enhancing NO bioactivity in renovascular hypertensive rats fed with high-fat-sucrose diet. Eur J Pharmacol 2012; 683:231-7. [PMID: 22314221 DOI: 10.1016/j.ejphar.2012.01.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 01/18/2012] [Accepted: 01/21/2012] [Indexed: 11/15/2022]
Abstract
In the present study, we aimed to evaluate the protective effect of sesamin on kidney damage and renal endothelial dysfunction in two-kidney, one-clip renovascular hypertensive rats fed with a high-fat-sucrose diet (2K1C rats on HFS diet). Sesamin was intragastrically administered to 2K1C rats on HFS diet for eight weeks. Then, we measured the levels of serum hydrogen peroxide (H₂O₂), total antioxidant capability (T-AOC), renal malonaldehyde (MDA), total-erythrocuprein (T-SOD) and glutathione peroxidase (GSH-P(X)). The expressions of endothelial nitric oxide synthase (eNOS), nitrotyrosine and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase subunit p47(phox) in the left and right renal cortexes were detected by Western blotting. Pathological changes in the left and right renal cortexes were observed by periodic acid-schiff staining (PAS) and Masson's staining. Treatment with sesamin (120 and 60mg/kg⁻¹·d⁻¹) in 2K1C rats on HFS diet improved renal function, corrected structural abnormalities, and attenuated renal oxidative stress. Furthermore, sesamin increased eNOS protein expression and reduced nitrotyrosine and p47phox protein expression. These results demonstrated that long-term treatment with sesamin had renoprotective effect and improved renal endothelial dysfunction via upregulation of eNOS expression and reduction of NO oxidative inactivation in both clipped and contralateral kidneys of 2K1C rats on HFS diet, and sesamin may have a favorably therapeutic value in treating chronic kidney disease in patients with hypertension and hyperlipemia.
Collapse
Affiliation(s)
- Xiang-Qi Wu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | | | | | | | | | | |
Collapse
|
21
|
Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, Janis LS, Lutsep HL, Barnwell SL, Waters MF, Hoh BL, Hourihane JM, Levy EI, Alexandrov AV, Harrigan MR, Chiu D, Klucznik RP, Clark JM, McDougall CG, Johnson MD, Pride GL, Torbey MT, Zaidat OO, Rumboldt Z, Cloft HJ. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 2011; 365:993-1003. [PMID: 21899409 PMCID: PMC3552515 DOI: 10.1056/nejmoa1105335] [Citation(s) in RCA: 1247] [Impact Index Per Article: 95.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Atherosclerotic intracranial arterial stenosis is an important cause of stroke that is increasingly being treated with percutaneous transluminal angioplasty and stenting (PTAS) to prevent recurrent stroke. However, PTAS has not been compared with medical management in a randomized trial. METHODS We randomly assigned patients who had a recent transient ischemic attack or stroke attributed to stenosis of 70 to 99% of the diameter of a major intracranial artery to aggressive medical management alone or aggressive medical management plus PTAS with the use of the Wingspan stent system. The primary end point was stroke or death within 30 days after enrollment or after a revascularization procedure for the qualifying lesion during the follow-up period or stroke in the territory of the qualifying artery beyond 30 days. RESULTS Enrollment was stopped after 451 patients underwent randomization, because the 30-day rate of stroke or death was 14.7% in the PTAS group (nonfatal stroke, 12.5%; fatal stroke, 2.2%) and 5.8% in the medical-management group (nonfatal stroke, 5.3%; non-stroke-related death, 0.4%) (P=0.002). Beyond 30 days, stroke in the same territory occurred in 13 patients in each group. Currently, the mean duration of follow-up, which is ongoing, is 11.9 months. The probability of the occurrence of a primary end-point event over time differed significantly between the two treatment groups (P=0.009), with 1-year rates of the primary end point of 20.0% in the PTAS group and 12.2% in the medical-management group. CONCLUSIONS In patients with intracranial arterial stenosis, aggressive medical management was superior to PTAS with the use of the Wingspan stent system, both because the risk of early stroke after PTAS was high and because the risk of stroke with aggressive medical therapy alone was lower than expected. (Funded by the National Institute of Neurological Disorders and Stroke and others; SAMMPRIS ClinicalTrials.gov number, NCT00576693.).
Collapse
Affiliation(s)
- Marc I Chimowitz
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC 29425, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Chimowitz MI, Lynn MJ, Turan TN, Fiorella D, Lane BF, Janis S, Derdeyn CP. Design of the stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis trial. J Stroke Cerebrovasc Dis 2011; 20:357-68. [PMID: 21729789 PMCID: PMC3506385 DOI: 10.1016/j.jstrokecerebrovasdis.2011.05.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 05/03/2011] [Accepted: 05/03/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with recent transient ischemic attack (TIA) or stroke caused by 70% to 99% stenosis of a major intracranial artery are at high risk of recurrent stroke on usual medical management, suggesting the need for alternative therapies for this disease. METHODS The Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis trial is an ongoing, randomized, multicenter, 2-arm trial that will determine whether intracranial angioplasty and stenting adds benefit to aggressive medical management alone for preventing the primary endpoint (any stroke or death within 30 days after enrollment or after any revascularization procedure of the qualifying lesion during follow-up, or stroke in the territory of the symptomatic intracranial artery beyond 30 days) during a mean follow-up of 2 years in patients with recent TIA or stroke caused by 70% to 99% stenosis of a major intracranial artery. Aggressive medical management in both arms consists of aspirin 325 mg per day, clopidogrel 75 mg per day for 90 days after enrollment, intensive risk factor management primarily targeting systolic blood pressure <140 mm Hg (<130 mm Hg in diabetics) and low density cholesterol <70 mg/dL, and a lifestyle modification program. The sample size required to detect a 35% reduction in the rate of the primary endpoint from angioplasty and stenting based on the log-rank test with an alpha of 0.05, 80% power, and adjusting for a 2% loss to follow-up and 5% crossover from the medical to the stenting arm is 382 patients per group. RESULTS Enrollment began in November 2008 and 451 patients have been enrolled as of March 31, 2011. CONCLUSIONS This is the first randomized stroke prevention trial to compare angioplasty and stenting with medical therapy in patients with intracranial arterial stenosis and to incorporate intensive management of multiple risk factors and a lifestyle modification program in the study design. Hopefully, the results of the trial will lead to more effective therapy for this high-risk disease.
Collapse
Affiliation(s)
- Marc I Chimowitz
- Department of Neurosciences, Stroke Center, Medical University of South Carolina, Charleston, USA.
| | | | | | | | | | | | | |
Collapse
|
23
|
Ford ES, Li C, Zhao G. Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US. J Diabetes 2010; 2:180-93. [PMID: 20923483 DOI: 10.1111/j.1753-0407.2010.00078.x] [Citation(s) in RCA: 287] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Recently, a Joint Scientific Statement bridged differences between previous definitions of metabolic syndrome. Our objective was to estimate the prevalence of metabolic syndrome in a representative sample of US adults and to examine its correlates. METHODS We analyzed data for up to 3461 participants aged ≥ 20 years of the 2003-2006 National Health and Nutrition Examination Survey. RESULTS Using waist circumference thresholds of ≥ 102 cm for men and ≥ 88 cm for women, the age-adjusted prevalence of metabolic syndrome was 34.3% among all adults, 36.1% among men, and 32.4% among women. Using racial- or ethnic-specific International Diabetes Federation criteria for waist circumference, the age-adjusted prevalence of metabolic syndrome was 38.5% for all participants, 41.9% for men, and 35.0% for women. Prevalence increased with age, peaking among those aged 60-69 years. Prevalence was lower among African American men than White or Mexican American men, and lower among White women than among African American or Mexican American women. In a multivariate regression model, significant independent associations were noted for age (positive), gender (men higher than women), race or ethnicity (African Americans and participants of another race lower than Whites), educational status (inverse), hypercholesterolemia (positive), concentrations of C-reactive protein (positive), leisure time physical activity (inverse), microalbuminuria (positive), and hyperinsulinemia (positive). Additional adjustment for body mass index weakened many of the associations, with educational status and microalbuminuria no longer significant contributors to the model. CONCLUSION Metabolic syndrome continues to be highly prevalent among adults in the US.
Collapse
Affiliation(s)
- Earl S Ford
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| | | | | |
Collapse
|
24
|
Thanavaro JL, Thanavaro S, Delicath T. Health promotion behaviors in women with chest pain. Heart Lung 2010; 39:394-403. [DOI: 10.1016/j.hrtlng.2009.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Revised: 10/25/2009] [Accepted: 10/30/2009] [Indexed: 10/19/2022]
|
25
|
Abstract
Women have a 20% lifetime risk of stroke. In addition, the majority of stroke-related deaths occur in women. Reducing the burden of stroke in women through prevention would positively affect public health. Unfortunately, most of the data used to develop specific evidence-based guidelines for stroke prevention in women were derived from coronary heart disease studies. Stroke was a secondary and less common outcome, if it was included at all. In addition, women have traditionally been underrepresented in stroke prevention trial cohorts. Stroke prevention in women offers many challenges, not only related to data extrapolated from clinical trials primarily composed of men, but also because physicians may underestimate cardiovascular risk in women, and therefore prevention strategies may not be appropriately undertaken. The opportunities to improve stroke prevention in women include increasing patient and physician awareness of risk and optimizing management of key modifiable risk factors (eg, hypertension, hyperlipidemia, physical inactivity, obesity, and diabetes).
Collapse
Affiliation(s)
- Cheryl Bushnell
- Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC, USA.
| |
Collapse
|
26
|
Chiu YW, Huang CT, Chuang HY, Chang YT, Wu MT, Liu HW. Sex Differences in Metabolic Morbidities: Influenced by Diet or Exercise Habits? Kaohsiung J Med Sci 2009; 25:647-55. [DOI: 10.1016/s1607-551x(09)70570-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
|
27
|
Rowe DO, DeFilippis A, Dantzler DM, Kripalani S, Doyle J, Sperling L. Assessment of gender-specific preventive cardiovascular knowledge among house staff: Potential impact on cardiovascular management. GENDER MEDICINE 2009; 6:471-478. [PMID: 19850243 DOI: 10.1016/j.genm.2009.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/21/2009] [Indexed: 05/28/2023]
Abstract
BACKGROUND Gender differences in cardiovascular prevention and treatment may be related to physicians' level of postgraduate training and gender. OBJECTIVES This study was designed to assess resident physician knowledge concerning general and gender-specific preventive cardiology topics and to determine whether there were differences in that knowledge based on the physicians' level of postgraduate training or gender. METHODS A 29-item true/false questionnaire was administered to residents in a large, university-based internal medicine residency program. All questions were drawn from evidence-based practice guidelines, and a subset of questions pertained to gender-specific issues in cardiovascular disease prevention. Scores on the overall test and gender-specific subset were computed as a percentage of correct answers. Differences were compared by postgraduate year (PGY) of training and physician gender. RESULTS Of the 190 eligible residents, 159 (88 men, 67 women, 4 not specified) completed the questionnaire. Overall test scores differed significantly by PGY (PGY-1, 83.4% correct answers; PGY-2, 52.9%; PGY-3, 65.3%; P < 0.001 for each paired comparison), but did not differ significantly by physician gender (males, 73.5%; females, 70.0%). Performance on gender-specific items also differed by PGY (PGY-1, 72.2% vs PGY-2, 20.0%; P < 0.001; and PGY-1, 72.2% vs PGY-3, 45.1%; P < 0.001). Knowledge of gender-specific preventive cardiology did not differ significantly by physician gender (males, 56.4%; females, 49.0%). CONCLUSIONS Residents in PGY-1 had better knowledge of preventive cardiology as assessed using this questionnaire than did residents in PGY-2 or PGY-3. Knowledge of general and gender-specific cardiology topics was not related to physician gender.
Collapse
Affiliation(s)
- Don O Rowe
- Division of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
| | | | | | | | | | | |
Collapse
|
28
|
Decewicz DJ, Neatrour DM, Burke A, Haberkorn MJ, Patney HL, Vernalis MN, Ellsworth DL. Effects of cardiovascular lifestyle change on lipoprotein subclass profiles defined by nuclear magnetic resonance spectroscopy. Lipids Health Dis 2009; 8:26. [PMID: 19563671 PMCID: PMC2713234 DOI: 10.1186/1476-511x-8-26] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 06/29/2009] [Indexed: 02/02/2023] Open
Abstract
Background Low-density lipoprotein (LDL) cholesterol lowering is a primary goal in clinical management of patients with cardiovascular disease, but traditional cholesterol levels may not accurately reflect the true atherogenicity of plasma lipid profiles. The size and concentration of lipoprotein particles, which transport cholesterol and triglycerides, may provide additional information for accurately assessing cardiovascular risk. This study evaluated changes in plasma lipoprotein profiles determined by nuclear magnetic resonance (NMR) spectroscopy in patients participating in a prospective, nonrandomized lifestyle modification program designed to reverse or stabilize progression of coronary artery disease (CAD) to improve our understanding of lipoprotein management in cardiac patients. Results The lifestyle intervention was effective in producing significant changes in lipoprotein subclasses that contribute to CAD risk. There was a clear beneficial effect on the total number of LDL particles (-8.3%, p < 0.05 compared to matched controls), small dense LDL particles (-9.5%, p < 0.05), and LDL particle size (+0.8%; p < 0.05). Likewise, participants showed significant improvement in traditional CAD risk factors such as body mass index (-9.9%, p < 0.01 compared to controls), total cholesterol (-5.5%, p < 0.05), physical fitness (+37.2%, p < 0.01), and future risk for CAD (-7.9%, p < 0.01). Men and women responded differently to the program for all clinically-relevant variables, with men deriving greater benefit in terms of lipoprotein atherogenicity. Plasma lipid and lipoprotein responses to the lifestyle change program were not confounded by lipid-lowering medications. Conclusion In at risk patients motivated to participate, an intensive lifestyle change program can effectively alter traditional CAD risk factors and plasma lipoprotein subclasses and may reduce risk for cardiovascular events. Improvements in lipoprotein subclasses are more evident in men compared to women.
Collapse
Affiliation(s)
- David J Decewicz
- Integrative Cardiac and Metabolic Health Program, Windber Research Institute, Windber, Pennsylvania, USA.
| | | | | | | | | | | | | |
Collapse
|
29
|
López EP, Rice C, Weddle DO, Rahill GJ. The relationship among cardiovascular risk factors, diet patterns, alcohol consumption, and ethnicity among women aged 50 years and older. ACTA ACUST UNITED AC 2008; 108:248-56. [PMID: 18237573 DOI: 10.1016/j.jada.2007.10.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death among women of all races and ethnicities. The risk of developing the disease is greater in postmenopausal women. OBJECTIVE The purpose of this study was to use cluster analysis to examine diet patterns and to examine the association between diet patterns and the presence of major cardiovascular disease risk factors. DESIGN Data from the cross-sectional National Health and Nutrition Examination Survey (NHANES) 2001-2002 were used. SUBJECTS/SETTING Women aged 50 years and older were included (n=1,313). MAIN OUTCOME MEASURES The following major CVD risk factors were examined: being overweight or obese (body mass index >24.9), having elevated systolic blood pressure (>120 mm Hg), and having low levels of high-density lipoprotein cholesterol (<50 mg/dL [<1.30 mmol/L]). Dietary patterns were derived by cluster analysis using data from a 24-hour dietary recall. STATISTICAL ANALYSES PERFORMED Odds Ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression to determine the probability of having a risk factor according to diet pattern while accounting for race/ethnicity, physical activity, age, and smoking. RESULTS Cluster analysis generated six nonoverlapping diet patterns labeled: Pasta and Yellow Vegetables; Sweets; Beef, Starches, Fruits, and Milk; Frozen Meals, Burritos, and Pizza; Meat Dishes; and Soft Drinks and Poultry. The majority of the women were grouped in the Sweets diet pattern. Factors associated with adequate levels of high-density lipoprotein cholesterol included being non-Hispanic African American (OR 0.59, 95% CI 0.44 to 0.81; P<0.0001), alcohol consumption (OR 0.76, 95% CI 0.69 to 0.84; P<0.0001), and being assigned to the Sweets diet pattern (OR 0.27, 95% CI 0.14 to 0.50; P<0.0001) or Meat dishes diet pattern (OR 0.94, 95% CI 0.54 to 1.65; P<0.0075). The Sweets pattern was also associated with having normal systolic blood pressure levels (OR 0.51, 95% CI 0.34 to 0.76; P<0.0001). Individuals grouped in the Beef, Starches, and Milk diet pattern were more likely to have an adequate body mass index (OR 0.42, 95% CI 0.23 to 0.77; P<0.0032). CONCLUSIONS Significant associations between dietary patterns and major CVD risk factors were observed. Food and nutrition professionals can use this information to assess unhealthful food choices observed in the dietary patterns to guide nutrition recommendations and help reduce the incidence of CVD risk factors. Future research should aim to evaluate dietary intake via complementary methods (ie, dietary patterns and nutrient assessment) to better understand diet-disease relationships.
Collapse
Affiliation(s)
- Elsa Pinto López
- Stempel School of Public Health, Dietetics and Nutrition Department, Florida International University, Miami, FL, USA.
| | | | | | | |
Collapse
|
30
|
Wister A, Loewen N, Kennedy-Symonds H, McGowan B, McCoy B, Singer J. One-year follow-up of a therapeutic lifestyle intervention targeting cardiovascular disease risk. CMAJ 2007; 177:859-65. [PMID: 17923653 DOI: 10.1503/cmaj.061059] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In this study, we tested the efficacy of a low-intensity lifestyle intervention aimed at reducing the risk of cardiovascular disease among mid-life individuals. METHODS We conducted a randomized controlled trial in which participants were randomly assigned either to receive a health report card with counselling (from a Telehealth nurse) on smoking, exercise, nutrition and stress or to receive usual care. The patients were divided into 2 groups on the basis of risk: the primary prevention group, with a Framingham risk score of 10% or higher (intervention, n = 157; control, n = 158), and the secondary prevention group, who had a diagnosis of coronary artery disease (intervention, n = 153; control, n = 143). The primary outcome was a change in the Framingham global risk score between baseline and 1-year follow-up. Data were analyzed separately for the 2 prevention groups using an intention-to-treat analysis controlling for covariates. RESULTS Within the primary prevention group, there were statistically significant changes for the treatment group relative to the controls, from baseline to year 1, in Framingham score (intervention, -3.10 [95% confidence interval (CI) -3.98 to -2.22]; control, -1.30 [95% CI -2.18 to -0.42]; p < 0.01) and scores for total cholesterol (intervention, -0.41 [95% CI -0.59 to -0.23]; control, -0.14 [95% CI -0.32 to 0.04]; p < 0.05), systolic blood pressure (intervention, -7.49 [95% CI -9.97 to -5.01]; control, -3.58 [95% CI -6.08 to -1.08]; p < 0.05), nutrition level (intervention, 0.30 [95% CI 0.13 to 0.47]; control, -0.05 [95% CI -0.22 to 0.12]; p < 0.01), and health confidence (intervention, 0.20 [95% CI 0.09 to 0.31]; control, 0.04 [95% CI -0.07 to 0.15]; p < 0.05), with adjustment for covariates. No significant changes in outcome variables were found for the secondary prevention group. INTERPRETATION We found evidence for the efficacy of an intervention addressing multiple risk factors for primary prevention at 1 year using Framingham risk score report cards and telephone counselling. (Requirement for clinical trial registration waived [enrolment completed before requirement became applicable].).
Collapse
Affiliation(s)
- Andrew Wister
- Department of Gerontology, Simon Fraser University, Vancouver, BC.
| | | | | | | | | | | |
Collapse
|
31
|
Salyer J, Lyon DE, Settle J, Elswick RK, Rackley D. Coronary Heart Disease Risks and Lifestyle Behaviors in Persons With HIV Infection. J Assoc Nurses AIDS Care 2006; 17:3-17. [PMID: 16829358 DOI: 10.1016/j.jana.2006.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Metabolic complications such as HIV-associated lipodystrophy syndrome are common in patients with HIV-1 infection who are taking highly active antiretroviral therapy. HIV-associated lipodystrophy syndrome is characterized by dyslipidemia, fat redistribution, and altered glucose metabolism; however, there has been little study of relationships between these risk factors for coronary heart disease (CHD) and lifestyle risks. The aims of this study were to (a) describe the physical activity levels, nutrition habits, and smoking behaviors of persons with HIV-1 infection; (b) describe their CHD risks and estimate 10-year risk for CHD outcomes; and (c) examine the relationship between potentially modifiable lifestyle behaviors and risk factors for atherosclerotic cardiovascular disease in persons with HIV-1 infection receiving highly active antiretroviral therapy. Variables included lipid profile and other metabolic indices, body fat distribution, body mass index, blood pressure, and lifestyle behaviors (physical activity, dietary habits, smoking). A cross-sectional design and convenience sampling (n = 95) was used. Participants had multiple modifiable risk factors: 20% had a 10-year risk of 10% or higher of developing CHD. Results underscore the need for health promotion interventions to target lifestyle risks in persons with HIV-1 infection taking highly active retroviral therapy.
Collapse
Affiliation(s)
- Jeanne Salyer
- Virginia Commonwealth University School of Nursing, USA
| | | | | | | | | |
Collapse
|