Cardiometabolic risk reduction in an intensive cardiovascular health program

Efficacy of cognitive-behavioural therapy for lifestyle modification in metabolic syndrome: a randomised controlled trial with a 18-months follow-up

OBJECTIVE

To test the efficacy of cognitive-behavioural therapy (CBT) for lifestyle modification in patients with metabolic syndrome (MetS).

DESIGN

76 MetS patients completed this clinical trial, with 18 months follow-up. 45 participants from the experimental group (EG - CBT) and 31 to the control group (CG - usual care). The CBT programme was performed by a psychologist in a face-to-face group format, during 12 weekly sessions lasting 90 minutes. The intervention for the CG consisted of workshops with basic information about MetS and it's associated cardiovascular risk.

MAIN OUTCOME MEASURES

Efficacy of (CBT) in (MetS) patients.

RESULTS

Results showed reduction in weight (mean difference - MD -2.633, 95%CI [-4.322, -0.943]; p<.003), waist circumference (MD -2.944, 95%CI [-5.090, -0.798]; p<.008), body mass index (MD -0.915, 95%CI [-1.494, -0.335]; p<.003), systolic (MD -0.046, 95%CI [-0.685, -0.023]; p<.0002) diastolic blood pressure (MD -4.777, 95%CI [-7.750, -1.804]; p<.002), and cardiovascular risk score after 18 months. An increase in adherence to the Mediterranean diet and assertiveness and a reduction in anger were observed in EG. The CG did not show any significant differences.

CONCLUSION

The CBT focused on changes in lifestyle seems to be effective in the reduction of MetS and cardiovascular risk factors.

TRIAL REGISTRATION

Registered at clinicaltrials.gov (NCT02949622) - PROMETS (Multimodal Intervention Program for Patients with Metabolic Syndrome).

Effects of a vegetarian diet combined with exercise on lipid profiles and blood pressure: A systematic review and meta-analysis

We aimed to evaluate the combined effects of a vegetarian diet (VD) and exercise on total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), systolic blood pressure (SBP), and diastolic blood pressure (DBP) parameters. A literature search was conducted in electronic databases from build to February 27, 2022. Data were synthesized using random effects model and were expressed as standardized mean difference (SMD)/weighted mean difference (WMD) and 95% confidence interval (CI). Overall, 27 trials with 9,251 participants were included. Pooled results indicated that the combination of a VD and exercise significantly reduced TC (SMD: -0.524; 95% CI: -0.602, -0.446; p < 0.001), LDL-C (SMD: -0.379; 95% CI: -0.471, -0.287; p < 0.001), HDL-C (SMD: -0.213; 95% CI: -0.299, -0.126; p < 0.001), TG (SMD: -0.090; 95% CI: -0.160, -0.020; p = 0.012), SBP (WMD: -7.664 mm Hg; 95% CI: -9.219, -6.109 mm Hg; p < 0.001), and DBP (WMD: -4.347 mm Hg; 95% CI: -5.099, -3.596 mm Hg; p < 0.001). These parameters were reduced more following a low-fat VD, or a mixed high-frequency exercise, especially under strict supervision. Surprisingly, the decreased HDL-C due to VD was observed to recover with the prolongation of exercise.

Association between body fat parameters and arterial stiffness

The influence of body fat on arterial stiffness remains controversial. This study was performed to investigate the associations between four different types of body fat parameters and brachial-ankle pulse wave velocity (baPWV). A total of 3758 subjects (mean age, 53.4 ± 8.8 years; females, 36.3%) who underwent health check-up were retrospectively analyzed. Anthropometric parameters including body mass index (BMI), waist circumference (WC) and waist–hip ratio (WHR) were assessed, and visceral fat area (VFA) was calculated by bioelectrical impedance analysis. In simple linear correlation analyses, baPWV was associated with WC, WHR and VFA (P < 0.001 for each), but not with BMI (P = 0.175). In multivariable analyses, BMI and WC were not associated with baPWV (P > 0.05 for each). Even after controlling for potential confounders, higher baPWV was significantly associated not only with higher WHR [for > 0.90 in men and > 0.85 in women: odds ratio (OR), 1.23; 95% confidence interval (CI), 1.06–1.42; P = 0.005; for the highest tertile compared to the lowest tertile: OR, 1.38; 95% CI, 1.15–1.66; P < 0.001], but also with higher VFA (for ≥ 100 cm²: OR, 1.39; 95% CI, 1.20–1.60; P < 0.001; for the highest tertile compared to the lowest tertile: OR, 1.77; 95% CI, 1.48–2.12; P < 0.001). Our study showed that baPWV was correlated with WHR and VFA, but not with BMI and WC. This implies that arterial stiffness may be more strongly associated with abdominal obesity than overall obesity.

Clustering of major cardiovascular risk factors is associated with arterial stiffness in adults

Objective

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity worldwide. Previous studies have indicated that clustering of major CVD risk factors is common. We aimed to explore the association of clustering of CVD risk factors with arterial stiffness in adults.

Methods

A total of 9984 adults were enrolled. We investigated clustering of four major CVD risk factors (defined as two or more of the following: hypertension, diabetes, dyslipidemia, and high body mass index) and their association with arterial stiffness. Arterial stiffness was evaluated using the carotid-femoral pulse wave velocity (cfPWV).

Results

In the study group (52.2% men, the mean age was 55.4 ± 10.5 years; only 11.9% of participants were free of any pre-defined CVD risk factors and 61.8% of participants had clustering of CVD risk factors. The cfPWV was significantly higher in the clustered risk factors group than in the no risk factor or the single risk factor groups (16.1 ± 3.1, 13.4 ± 2.2, and 14.3 ± 2.6 m/s, respectively; P < 0.001). Multiple linear regression analysis revealed that age, gender, clustering of CVD risk factors, serum uric acid, and decreased renal function positively correlated with cfPWV. For a categorical outcome, the highest cfPWV quartile (cfPWV ≥ 16.9 m/s) was compared with the lower three quartiles. After adjusting for potential confounders, clustering of CVD risk factors significantly correlated with increased cfPWV compared with that in the no risk factor group, with an odds ratio of 5.76 (95% confidence interval: 4.46–7.44).

Conclusions

Clustering of CVD risk factors significantly correlated with arterial stiffness; this confirms the importance of lifestyle modification to reduce the burden of CVD.

Decrease in serum chemerin through aerobic exercise plus dieting and its association with mitigation of cardio-metabolic risk in obese female adolescents

BACKGROUND

The objective of this study was to determine the effects of a 4-week aerobic exercise plus dieting intervention on serum chemerin in obese female adolescents and its possible role in mitigating cardio-metabolic risk including glucose and lipid metabolism, central fat and inflammation.

METHODS

Fifty obese female adolescents were randomly divided into two groups: exercise plus dieting group (n=30) and dieting group (n=20). The participants in the exercise plus dieting group completed 4 weeks of moderate aerobic exercise combined with dieting, while the subjects in the dieting group undertook only dieting. Before and after the experiments, anthropometric index, parameters of glucose and lipid metabolism, serum chemerin and classic inflammatory indicators (C-reactive protein [CRP], tumor necrosis factor-α [TNF-α], interleukin-1β [IL-1β], IL-6, leptin and adiponectin) were measured.

RESULTS

Compared with the dieting group, a decrease in serum chemerin was found in the exercise plus dieting group, accompanied by significant improvements in anthropometric index, glucose and lipid metabolism and inflammatory factors. In addition, a higher serum chemerin level was found in obese adolescents with metabolic syndrome (MetS), and the disappearance of MetS induced by exercise plus dieting might be related to the decrease in chemerin. Correlation analysis showed the correlations of the decrease in chemerin with the changes in body fat, glucose and lipid metabolic index, leptin and adiponectin/leptin ratio.

CONCLUSIONS

This is the first report that as short a duration as 4-week aerobic exercise plus dieting decreased serum chemerin in obese female adolescents, which might be associated with the improvement in glucose and lipid metabolism, mitigation of inflammation and decrease in MetS incidence, thus lowering cardio-metabolic risk, while no health benefit resulted from slight dieting.

Dietary changes associated with improvement of metabolic syndrome components in postmenopausal women receiving two different nutrition interventions

Objective

This study aims to examine the association between dietary changes and improvement of metabolic syndrome components in Mexican postmenopausal women receiving two different nutrition interventions.

Methods

Women (n = 118) with metabolic syndrome were randomly assigned to group 1 (n = 63; structured hypocaloric diet) or group 2 (n = 55; behavioral therapy). Metabolic and nutrition assessment was performed at baseline and after 2, 4, and 6 months of intervention. Dietary changes throughout the study and achievement of cardioprotective dietary goals were assessed at the end of the intervention.

Results

There was a significant increase in the number of women who met recommended servings for fruits/vegetables, low-fat dairy, and sugars in both groups. In group 1, elimination of high-energy refined grains increased the probability of having normal fasting glucose (relative risk, 1.514; 95% CI, 0.989-2.316; P = 0.035). In this group, women who met the low-fat dairy goal at the end of the study had lower diastolic blood pressure (P = 0.012) and higher high-density lipoprotein cholesterol (P = 0.001). In group 2, women who met the high-fat dairy goal had greater probability of having normal fasting glucose (relative risk, 1.915; 95% CI, 1.123-3.266; P = 0.026). In all women, exclusion of high-fat dairy decreased by 60% the probability of having impaired fasting glucose (relative risk, 0.40; 95% CI, 0.181-0.906; P = 0.028).

Conclusions

Both strategies promote achievement of cardioprotective dietary goals for fruits/vegetables, sugars, soda and sweetened beverages, low-fat dairy, and high-energy refined grains, and improve some metabolic syndrome components. Elimination of high-fat dairy decreases the risk of impaired fasting glucose. Dietary strategies should be flexible and individualized based on metabolic profile.

Abdominal obesity is associated with arterial stiffness in middle-aged adults

BACKGROUND AND AIMS

The relation between adiposity and arterial stiffness remains controversial. We determined whether abdominal and visceral adipose tissue may be a better predictor of arterial stiffness than general obesity in middle-aged adults.

METHODS AND RESULTS

A total of 146 participants (76 men, 70 women; 50 years) were studied. The automatic vascular screening device (Omron VP-1000plus) was used to measure blood pressure simultaneously in the arms and ankles and to determine arterial stiffness by pulse wave velocity (PWV). Using multiple linear regressions, the relations between indicators of obesity and arterial stiffness were examined after adjustment for confounders. Both carotid-femoral PWV and brachial-ankle PWV were significantly associated with BMI (both P < 0.05) but not with body fat percentage. Measures of abdominal obesity, including waist circumference and visceral fat mass (via DXA), were strongly associated with PWV and remained positively associated with arterial stiffness after adjustment for age and gender. Cardiovascular fitness as assessed by maximal oxygen consumption was related to body fat percentage but not with visceral fat. More favorable cardiovascular health profile was associated with both lower visceral fat mass and PWV (both P < 0.001).

CONCLUSION

Abdominal obesity and visceral fat are associated with large artery stiffness. These findings support the importance of adiposity measures as a risk factor for arterial stiffening in middle-aged adults.

National lipid association recommendations for patient-centered management of dyslipidemia: part 1--full report

The leadership of the National Lipid Association convened an Expert Panel to develop a consensus set of recommendations for patient-centered management of dyslipidemia in clinical medicine. An Executive Summary of those recommendations was previously published. This document provides support for the recommendations outlined in the Executive Summary. The major conclusions include (1) an elevated level of cholesterol carried by circulating apolipoprotein B-containing lipoproteins (non-high-density lipoprotein cholesterol and low-density lipoprotein cholesterol [LDL-C], termed atherogenic cholesterol) is a root cause of atherosclerosis, the key underlying process contributing to most clinical atherosclerotic cardiovascular disease (ASCVD) events; (2) reducing elevated levels of atherogenic cholesterol will lower ASCVD risk in proportion to the extent that atherogenic cholesterol is reduced. This benefit is presumed to result from atherogenic cholesterol lowering through multiple modalities, including lifestyle and drug therapies; (3) the intensity of risk-reduction therapy should generally be adjusted to the patient's absolute risk for an ASCVD event; (4) atherosclerosis is a process that often begins early in life and progresses for decades before resulting a clinical ASCVD event. Therefore, both intermediate-term and long-term or lifetime risk should be considered when assessing the potential benefits and hazards of risk-reduction therapies; (5) for patients in whom lipid-lowering drug therapy is indicated, statin treatment is the primary modality for reducing ASCVD risk; (6) nonlipid ASCVD risk factors should also be managed appropriately, particularly high blood pressure, cigarette smoking, and diabetes mellitus; and (7) the measurement and monitoring of atherogenic cholesterol levels remain an important part of a comprehensive ASCVD prevention strategy.

Gene expression profiling during intensive cardiovascular lifestyle modification: Relationships with vascular function and weight loss

Heart disease and related sequelae are a leading cause of death and healthcare expenditure throughout the world. Although many patients opt for surgical interventions, lifestyle modification programs focusing on nutrition and exercise have shown substantial health benefits and are becoming increasing popular. We conducted a year-long lifestyle modification program to mediate cardiovascular risk through traditional risk factors and to investigate how molecular changes, if present, may contribute to long-term risk reduction. Here we describe the lifestyle intervention, including clinical and molecular data collected, and provide details of the experimental methods and quality control parameters for the gene expression data generated from participants and non-intervention controls. Our findings suggest successful and sustained modulation of gene expression through healthy lifestyle changes may have beneficial effects on vascular health that cannot be discerned from traditional risk factor profiles. The data are deposited in the Gene Expression Omnibus, series GSE46097 and GSE66175.

Intensive Cardiovascular Risk Reduction Induces Sustainable Changes in Expression of Genes and Pathways Important to Vascular Function

Background—

Healthy lifestyle changes are thought to mediate cardiovascular disease risk through pathways affecting endothelial function and progression of atherosclerosis; however, the extent, persistence, and clinical significance of molecular change during lifestyle modification are not well known. We examined the effect of a rigorous cardiovascular disease risk reduction program on peripheral blood gene expression profiles in 63 participants and 63 matched controls to characterize molecular responses and identify regulatory pathways important to cardiovascular health.

Methods and Results—

Dramatic changes in dietary fat intake (−61%; P <0.001 versus controls) and physical fitness (+34%; P <0.001) led to significant improvements in cardiovascular disease risk factors. Analysis of variance with false discovery rate correction for multiple testing ( P <0.05) identified 26 genes after 12 weeks and 143 genes after 52 weeks that were differentially expressed from baseline in participants. Controls showed little change in cardiovascular disease risk factors or gene expression. Quantitative reverse transcription polymerase chain reaction validated differential expression for selected transcripts. Lifestyle modification effectively reduced expression of proinflammatory genes associated with neutrophil activation and molecular pathways important to vascular function, including cytokine production, carbohydrate metabolism, and steroid hormones. Prescription medications did not significantly affect changes in gene expression.

Conclusions—

Successful and sustained modulation of gene expression through lifestyle changes may have beneficial effects on the vascular system not apparent from traditional risk factors. Healthy lifestyles may restore homeostasis to the leukocyte transcriptome by downregulating lactoferrin and other genes important in the pathogenesis of atherosclerosis.

Clinical Trial Registration—

URL: www.clinicaltrials.gov . Unique identifier: NCT01805492