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Després JP, Alméras N. Brain versus cardiometabolic health: a delicate balance in need of precision lifestyle medicine approaches. Obesity (Silver Spring) 2024; 32:1795-1796. [PMID: 39315413 DOI: 10.1002/oby.24119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 09/25/2024]
Affiliation(s)
- Jean-Pierre Després
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec City, Québec, Canada
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Québec, Canada
| | - Natalie Alméras
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec City, Québec, Canada
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
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Fu L, Tai S, Sun J, Zhang N, Zhou Y, Xing Z, Wang Y, Zhou S. Remnant Cholesterol and Its Visit-to-Visit Variability Predict Cardiovascular Outcomes in Patients With Type 2 Diabetes: Findings From the ACCORD Cohort. Diabetes Care 2022; 45:2136-2143. [PMID: 35834242 PMCID: PMC9472497 DOI: 10.2337/dc21-2511] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/31/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Remnant cholesterol (remnant-C) predicts atherosclerotic cardiovascular disease, regardless of LDL-cholesterol (LDL-C) levels. This study assessed the associations between remnant-C and cardiovascular outcomes in type 2 diabetes. RESEARCH DESIGN AND METHODS This post hoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial used patient (type 2 diabetes >3 months) remnant-C and major adverse cardiovascular event (MACE) data from the study database. The associations between remnant-C and MACEs were evaluated using Cox proportional hazards regression analyses. We examined the relative MACE risk in remnant-C versus LDL-C discordant/concordant groups using clinically relevant LDL-C targets by discordance analyses. RESULTS The baseline analysis included 10,196 participants, with further visit-to-visit variability analysis including 9,650 participants. During follow-up (median, 8.8 years), 1,815 patients (17.8%) developed MACEs. After adjusting for traditional cardiovascular risk factors, each 1-SD increase in remnant-C was associated with a 7% higher MACE risk (hazard ratio [HR] 1.07, 95% CI 1.02-1.12, P = 0.004). In the fully adjusted model, the visit-to-visit remnant-C variability calculated using logSD (HR 1.41, 95% CI 1.18-1.69, P < 0.001) and logARV (HR 1.45, 95% CI 1.22-1.73, P < 0.001) was associated with MACEs. Residual lipid risk (remnant-C ≥31 mg/dL) recognized individuals at a higher MACE risk, regardless of LDL-C concentrations. Within each LDL-C subgroup (>100 or ≤100 mg/dL), high baseline remnant-C was associated with a higher MACE risk (HR 1.37, 95% CI 1.09-1.73, P = 0.007; HR 1.22, 95% CI 1.04-1.41, P = 0.015, respectively). CONCLUSIONS Remnant-C levels were associated with MACEs in patients with type 2 diabetes independent of LDL-C, and visit-to-visit remnant-C variability helped identify those with higher cardiovascular risk.
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Affiliation(s)
- Liyao Fu
- Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi Tai
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jiaxing Sun
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ningjie Zhang
- Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ying Zhou
- Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhenhua Xing
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yongjun Wang
- Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shenghua Zhou
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
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Overweight, Obesity, and CVD Risk: a Focus on Visceral/Ectopic Fat. Curr Atheroscler Rep 2022; 24:185-195. [PMID: 35235165 DOI: 10.1007/s11883-022-00996-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Despite its prevalence and well-documented impact on population health, obesity has not emerged as a strong independent risk factor for cardiovascular disease after control for intermediate risk factors. The purpose of this brief narrative review is to highlight results from imaging studies that have not only documented the remarkable heterogeneity of body fat topography but also the importance of visceral adiposity as a key body fat depot associated with cardiovascular disease risk and type 2 diabetes. RECENT FINDINGS Simple tools are also discussed in order to refine cardiometabolic risk assessment in persons with overweight/obesity. It is proposed that four lifestyle vital signs should be considered in clinical practice to improve discrimination of health risk in individuals with overweight/obesity: waist circumference as a simple marker of abdominal adiposity, cardiorespiratory fitness, overall diet quality, and level of reported physical activity. Heterogeneity of obesity is proposed as an example of a condition that would benefit from a precision lifestyle medicine approach.
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Targeting Diet Quality at the Workplace: Influence on Cardiometabolic Risk. Nutrients 2021; 13:nu13072283. [PMID: 34209458 PMCID: PMC8308315 DOI: 10.3390/nu13072283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
The American Heart Association criteria for cardiovascular health include overall diet quality (DQ). The present study evaluated the effect of a workplace health promotion program targeting DQ and physical activity on features of cardiometabolic risk (CMR). Before and after the 3-month intervention, 2260 employees (1462 men and 798 women) completed a health and fitness evaluation including assessment of DQ using a validated food-based questionnaire. After the 3-month lifestyle modification program, DQ increased significantly in both sexes (p < 0.0001) as well as physical activity level (p < 0.0001). A reduction in waist circumference (p < 0.0001) and improved lipid levels were also observed. Significant associations were found between changes in DQ index and changes in CMR variables in both men (standardized regression coefficients ranged from −0.19 (95% confidence interval: −0.26 to −0.12) to −0.29 (95% confidence interval: −0.34 to −0.25)) and women (standardized regression coefficients ranged from −0.18 (95% confidence interval: −0.25 to −0.11) to −0.27 (95% confidence interval: −0.41 to −0.13)). Multiple linear regression analyses showed a significant contribution of changes in the DQ index to the variation in some CMR variables, independent from changes in physical activity level and cardiorespiratory fitness. This study provides evidence that targeting DQ at the workplace is relevant to improve cardiometabolic health.
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Xu H, Schwander K, Brown MR, Wang W, Waken RJ, Boerwinkle E, Cupples LA, de las Fuentes L, van Heemst D, Osazuwa-Peters O, de Vries PS, van Dijk KW, Sung YJ, Zhang X, Morrison AC, Rao DC, Noordam R, Liu CT. Lifestyle Risk Score: handling missingness of individual lifestyle components in meta-analysis of gene-by-lifestyle interactions. Eur J Hum Genet 2021; 29:839-850. [PMID: 33500576 PMCID: PMC8110957 DOI: 10.1038/s41431-021-00808-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/30/2020] [Accepted: 01/05/2021] [Indexed: 01/29/2023] Open
Abstract
Recent studies consider lifestyle risk score (LRS), an aggregation of multiple lifestyle exposures, in identifying association of gene-lifestyle interaction with disease traits. However, not all cohorts have data on all lifestyle factors, leading to increased heterogeneity in the environmental exposure in collaborative meta-analyses. We compared and evaluated four approaches (Naïve, Safe, Complete and Moderator Approaches) to handle the missingness in LRS-stratified meta-analyses under various scenarios. Compared to "benchmark" results with all lifestyle factors available for all cohorts, the Complete Approach, which included only cohorts with all lifestyle components, was underpowered due to lower sample size, and the Naïve Approach, which utilized all available data and ignored the missingness, was slightly inflated. The Safe Approach, which used all data in LRS-exposed group and only included cohorts with all lifestyle factors available in the LRS-unexposed group, and the Moderator Approach, which handled missingness via moderator meta-regression, were both slightly conservative and yielded almost identical p values. We also evaluated the performance of the Safe Approach under different scenarios. We observed that the larger the proportion of cohorts without missingness included, the more accurate the results compared to "benchmark" results. In conclusion, we generally recommend the Safe Approach, a straightforward and non-inflated approach, to handle heterogeneity among cohorts in the LRS based genome-wide interaction meta-analyses.
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Affiliation(s)
- Hanfei Xu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
| | - Karen Schwander
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael R Brown
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, the University of Texas School of Public health, Houston, TX, USA
| | - Wenyi Wang
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - R J Waken
- Field and Environmental Data Science, Benson Hill Inc, St. Louis, MO, USA
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, the University of Texas School of Public health, Houston, TX, USA
- The Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - L Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- NHLBI and Boston University Framingham Heart Study, Framingham, MA, USA
| | - Lisa de las Fuentes
- Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Diana van Heemst
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Paul S de Vries
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, the University of Texas School of Public health, Houston, TX, USA
| | - Ko Willems van Dijk
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Leiden Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Yun Ju Sung
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Xiaoyu Zhang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Alanna C Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, the University of Texas School of Public health, Houston, TX, USA
| | - D C Rao
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Raymond Noordam
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
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Besharat MA, Hosseini SA, Jahed HA, Bahrami Ehsan H, Dortaj F. Introduce a New Intervention Model Based on Islamic Lifestyle for Decreasing the Risk of Cardiovascular Disease in People at Risk: A Comparative Study. JOURNAL OF RELIGION AND HEALTH 2021; 60:736-751. [PMID: 32072448 DOI: 10.1007/s10943-020-00996-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The main purpose of the present study was designing and assessing the common lifestyle and Islamic lifestyle interventions and comparison of them. Sample of the study was thirty-nine subjects participated in a healthy lifestyle program. The Islamic group were received the Islamic healthy lifestyle program. In comparison with common, in the Islamic group the CVD risk was significantly lower; the psychological well-being was increased significantly; the psychological distress was decreased significantly; and the spiritual well-being was increased significantly. The most powerful element of Islamic lifestyle was to strengthen the spirituality that can positively affect the life.
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Affiliation(s)
| | - Seyedeh Asma Hosseini
- Department of Psychology, Faculty of Educational Sciences and Psychology, AlZahra University, Tehran, PO Box 1997966741, Iran.
| | - Hossein Ali Jahed
- Department of Educational Science, Islamic Azad University of Yadegare Imam Khomeini (RAH) Branch, Tehran, Iran
| | | | - Fariborz Dortaj
- Department of Educational Psychology, Allameh Tabatabe'i University, Tehran, Iran
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Abstract
This review addresses the interplay between obesity, type 2 diabetes mellitus, and cardiovascular diseases. It is proposed that obesity, generally defined by an excess of body fat causing prejudice to health, can no longer be evaluated solely by the body mass index (expressed in kg/m2) because it represents a heterogeneous entity. For instance, several cardiometabolic imaging studies have shown that some individuals who have a normal weight or who are overweight are at high risk if they have an excess of visceral adipose tissue-a condition often accompanied by accumulation of fat in normally lean tissues (ectopic fat deposition in liver, heart, skeletal muscle, etc). On the other hand, individuals who are overweight or obese can nevertheless be at much lower risk than expected when faced with excess energy intake if they have the ability to expand their subcutaneous adipose tissue mass, particularly in the gluteal-femoral area. Hence, excessive amounts of visceral adipose tissue and of ectopic fat largely define the cardiovascular disease risk of overweight and moderate obesity. There is also a rapidly expanding subgroup of patients characterized by a high accumulation of body fat (severe obesity). Severe obesity is characterized by specific additional cardiovascular health issues that should receive attention. Because of the difficulties of normalizing body fat content in patients with severe obesity, more aggressive treatments have been studied in this subgroup of individuals such as obesity surgery, also referred to as metabolic surgery. On the basis of the above, we propose that we should refer to obesities rather than obesity.
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Affiliation(s)
- Marie-Eve Piché
- From the Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (M.-E.P., A.T., J.-P.D.), Université Laval, Québec, QC, Canada.,Department of Medicine, Faculty of Medicine (M.-E.P.), Université Laval, Québec, QC, Canada
| | - André Tchernof
- From the Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (M.-E.P., A.T., J.-P.D.), Université Laval, Québec, QC, Canada.,School of Nutrition (A.T.), Université Laval, Québec, QC, Canada
| | - Jean-Pierre Després
- From the Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (M.-E.P., A.T., J.-P.D.), Université Laval, Québec, QC, Canada.,Vitam - Centre de recherche en santé durable, CIUSSS - Capitale-Nationale (J.-P.D.), Université Laval, Québec, QC, Canada.,Department of Kinesiology, Faculty of Medicine (J.-P.D.), Université Laval, Québec, QC, Canada
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Claes J, Cornelissen V, McDermott C, Moyna N, Pattyn N, Cornelis N, Gallagher A, McCormack C, Newton H, Gillain A, Budts W, Goetschalckx K, Woods C, Moran K, Buys R. Feasibility, Acceptability, and Clinical Effectiveness of a Technology-Enabled Cardiac Rehabilitation Platform (Physical Activity Toward Health-I): Randomized Controlled Trial. J Med Internet Res 2020; 22:e14221. [PMID: 32014842 PMCID: PMC7055834 DOI: 10.2196/14221] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/13/2019] [Accepted: 10/01/2019] [Indexed: 12/29/2022] Open
Abstract
Background Cardiac rehabilitation (CR) is highly effective as secondary prevention for cardiovascular diseases (CVDs). Uptake of CR remains suboptimal (30% of eligible patients), and long-term adherence to a physically active lifestyle is even lower. Innovative strategies are needed to counteract this phenomenon. Objective The Physical Activity Toward Health (PATHway) system was developed to provide a comprehensive, remotely monitored, home-based CR program for CVD patients. The PATHway-I study aimed to investigate its feasibility and clinical efficacy during phase III CR. Methods Participants were randomized on a 1:1 basis to the PATHway (PW) intervention group or usual care (UC) control group in a single-blind, multicenter, randomized controlled pilot trial. Outcomes were assessed at completion of phase II CR and 6-month follow-up. The primary outcome was physical activity (PA; Actigraph GT9X link). Secondary outcomes included measures of physical fitness, modifiable cardiovascular risk factors, endothelial function, intima-media thickness of the common carotid artery, and quality of life. System usability and patients’ experiences were evaluated only in PW. A mixed-model analysis of variance with Bonferroni adjustment was used to analyze between-group effects over time. Missing values were handled by means of an intention-to-treat analysis. Statistical significance was set at a 2-sided alpha level of .05. Data are reported as mean (SD). Results A convenience sample of 120 CVD patients (mean 61.4 years, SD 13.5 years; 22 women) was included. The PATHway system was deployed in the homes of 60 participants. System use decreased over time and system usability was average with a score of 65.7 (SD 19.7; range 5-100). Moderate-to-vigorous intensity PA increased in PW (PW: 127 [SD 58] min to 141 [SD 69] min, UC: 146 [SD 66] min to 143 [SD 71] min; Pinteraction=.04; effect size of 0.42), while diastolic blood pressure (PW: 79 [SD 11] mmHg to 79 [SD 10] mmHg, UC: 78 [SD 9] mmHg to 83 [SD 10] mmHg; Pinteraction=.004; effect size of −0.49) and cardiovascular risk score (PW: 15.9% [SD 10.4%] to 15.5% [SD 10.5%], UC: 14.5 [SD 9.7%] to 15.7% [SD 10.9%]; Pinteraction=.004; effect size of −0.36) remained constant, but deteriorated in UC. Conclusions This pilot study demonstrated the feasibility and acceptability of a technology-enabled, remotely monitored, home-based CR program. Although clinical effectiveness was demonstrated, several challenges were identified that could influence the adoption of PATHway. Trial Registration ClinicalTrials.gov NCT02717806; https://clinicaltrials.gov/ct2/show/NCT02717806 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2017-016781
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Affiliation(s)
- Jomme Claes
- Physiotherapy Department, University Hospitals Leuven, Leuven, Belgium
| | | | - Clare McDermott
- Department of Health & Human Performance, Dublin City University, Dublin, Ireland
| | - Niall Moyna
- Department of Health & Human Performance, Dublin City University, Dublin, Ireland
| | - Nele Pattyn
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - Nils Cornelis
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - Anne Gallagher
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ciara McCormack
- Department of Health & Human Performance, Dublin City University, Dublin, Ireland
| | | | - Alexandra Gillain
- Physiotherapy Department, University Hospitals Leuven, Leuven, Belgium
| | - Werner Budts
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Kaatje Goetschalckx
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Catherine Woods
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Kieran Moran
- Department of Health & Human Performance, Dublin City University, Dublin, Ireland
| | - Roselien Buys
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
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Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Atherosclerosis 2020; 290:140-205. [PMID: 31504418 DOI: 10.1016/j.atherosclerosis.2019.08.014] [Citation(s) in RCA: 585] [Impact Index Per Article: 146.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41:111-188. [PMID: 31504418 DOI: 10.1093/eurheartj/ehz455] [Citation(s) in RCA: 4501] [Impact Index Per Article: 1125.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Côté CE, Rhéaume C, Poirier P, Després JP, Alméras N. Deteriorated Cardiometabolic Risk Profile in Individuals With Excessive Blood Pressure Response to Submaximal Exercise. Am J Hypertens 2019; 32:945-952. [PMID: 31136645 DOI: 10.1093/ajh/hpz087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/19/2018] [Accepted: 05/27/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early identification of individuals at increased cardiometabolic risk is an essential step to improve primary preventive interventions. Excessive maximal exercise blood pressure (EBP) has been associated with several adverse outcomes. We examined how submaximal EBP could help us to identify individuals with a deteriorated cardiometabolic risk profile. METHODS Data from an observational study of 3,913 participants from a convenience sample were used. Subjects included in the analyses completed a comprehensive cardiometabolic health assessment (resting blood pressure [BP]; waist circumference; lipid profile; HbA1c; submaximal treadmill exercise test including a standardized stage [3.5 mph and 2% slope] with BP and heart rate measurements). Participants were classified on BP response at the standardized stage (Normal or Excessive Response). Excessive response was defined as systolic BP ≥ 80th percentile or diastolic BP ≥ 90 mmHg. Subjects were also classified into five resting BP subgroups according to current guidelines. RESULTS The Excessive Response group had more deteriorated cardiometabolic and cardiorespiratory profiles than the Normal Response group (P ≤ 0.01). The Excessive Response group also showed a greater proportion of carriers of the hypertriglyceridemic waist phenotype in most resting BP subgroups (P ≤ 0.05). Finally, excessive BP response to submaximal exercise showed an independent contribution on cardiometabolic and cardiorespiratory factors beyond age, sex, and resting BP. CONCLUSIONS This study demonstrates that an excessive BP response to a submaximal exercise is associated with a deteriorated cardiometabolic risk profile beyond resting BP profile. Therefore, submaximal EBP represents a simple screening tool to better identify at-risk individuals requiring aggressive preventive lifestyle interventions.
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Affiliation(s)
- Charles-Emanuel Côté
- Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, QC, Canada
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Caroline Rhéaume
- Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, QC, Canada
| | - Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, QC, Canada
- Faculty of Pharmacy, Université Laval, QC, Canada
| | - Jean-Pierre Després
- Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, QC, Canada
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Natalie Alméras
- Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, QC, Canada
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada
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Abstract
Although the first description of a syndrome defined by the co-existence of atherogenic and diabetogenic metabolic abnormalities is debated in the literature, it was Gerald Reaven who proposed, in his landmark 1988 Banting award lecture, that a significant proportion of individuals (with diabetes or not) were characterised by insulin resistance causing prejudice to cardiovascular health. However, Reaven was influenced by seminal observations made more than 50 years earlier by Himsworth who proposed that there were two forms of diabetes (insulin resistant v. insulin sensitive). Reaven went further in proposing the theory that insulin resistance was the most prevalent cause of CVD associated with metabolic abnormalities that he named syndrome X. Because there was a syndrome X documented in cardiology, the term evolved to insulin resistance syndrome. As Reaven could also find insulin-resistant individuals in non-obese subjects, he did not include obesity as a feature of syndrome X. Imaging studies then revealed that excess adipose tissue in the abdominal cavity, a condition described as visceral obesity, was the form of overweight/obesity associated with insulin resistance and its related abnormalities. As obesity risk assessment and management remain largely based on body weight (BMI) and weight loss, it is proposed that our clinical approaches and public health messages should be revisited. First, patients should be educated about the importance of monitoring their waistline as a crude index of abdominal adiposity. Secondly, public health approaches focussing on 'lifestyle vital signs' including achieving healthy waistlines rather than healthy body weights should be developed.
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Garshick MS, Vaidean GD, Vani A, Underberg JA, Newman JD, Berger JS, Fisher EA, Gianos E. Cardiovascular Risk Factor Control and Lifestyle Factors in Young to Middle-Aged Adults with Newly Diagnosed Obstructive Coronary Artery Disease. Cardiology 2019; 142:83-90. [PMID: 31079098 DOI: 10.1159/000498891] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/11/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND While progress in the prevention of cardiovascular disease (CVD) has been noted over the past several decades, there are still those who develop CVD earlier in life than others. OBJECTIVE We investigated traditional and lifestyle CVD risk factors in young to middle-aged patients compared to older ones with obstructive coronary artery disease (CAD). METHODS A retrospective analysis of patients with a new diagnosis of obstructive CAD undergoing coronary intervention was performed. Young to middle-aged patients were defined as those in the youngest quartile (n = 281, mean age 50 ± 6 years, 81% male) compared to the other three older quartiles combined (n = 799, mean age 69 ± 7.5 years, 71% male). Obstructive CAD was determined by angiography. RESULTS Young to middle-aged patients compared to older ones were more likely to be male (p < 0.01), smokers (21 vs. 9%, p < 0.001), and have a higher body mass index (31 ± 6 vs. 29 ± 6 kg/m2, p < 0.001). Younger patients were less likely to eat fruits, vegetables, and fish and had fewer controlled CVD risk factors (2.7 ± 1.2 vs. 3.0 ± 1.0, p < 0.001). Compared to older patients, higher levels of psychological stress (aOR 1.6, 95% CI 1.1-2.4), financial stress (aOR 1.8, 95% CI 1.3-2.5), and low functional capacity (aOR 3.3, 95% CI 2.4-4.5) were noted in the young to middle-aged population as well. CONCLUSION Lifestyle in addition to traditional CVD risk factors should be taken into account when evaluating risk for development of CVD in a younger population.
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Affiliation(s)
- Michael S Garshick
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA,
| | - Georgeta D Vaidean
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA.,Fairleigh Dickinson University School of Pharmacy and Health Sciences, Florham Park, New Jersey, USA
| | - Anish Vani
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA
| | - James A Underberg
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA
| | - Jonathan D Newman
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA
| | - Jeffrey S Berger
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA
| | - Edward A Fisher
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA
| | - Eugenia Gianos
- Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, New York, USA
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