The prevalence of obesity and metabolic syndrome in Tibetan immigrants living in high altitude areas in Ladakh, India

Genetic variants and type 2 diabetes in India: a systematic review and meta-analysis of associated polymorphisms in case-control studies

Background

India, with the largest population and second-highest type 2 diabetes mellitus (T2DM) prevalence, presents a unique genetic landscape. This study explores the genetic profiling of T2DM, aiming to bridge gaps in existing research and provide insights for further explorations.

Methods

We conducted a systematic review and meta-analysis of literature published up to September 2024 using databases like PubMed, Web of Science, Scopus, and Google Scholar to identify SNPs associated with T2DM in case-control studies within the Indian population. Data extraction followed a rigorously designed checklist independently verified by two reviewers. The quality of the studies assessed by utilizing Newcastle Ottawa scale, and heterogeneity through Cochran's Q, τ2, H2 and I 2 statistics. Fixed effect and random effect model was employed for meta-analysis based on heterogeneity, and publication bias was assessed by funnel plot analysis, Egger's and Begg's statistical test. In SNPs with adequate studies meta-regression was used to assess source of heterogeneity. Statistical analyses were performed using Stata 18.0 software.

Findings

Our search identified 1309 articles, with 67 included in the systematic review and 35 in the meta-analysis. These 67 case-control studies, involving 33,407 cases and 30,762 controls, analyzed 167 SNPs across 61 genes. Of these, 89 SNPs mapped to 46 genes showed significant associations with T2DM risk (P < 0.05), including 67 linked to increased risk and 16 with protective effects. Geographical analysis highlighted inter- and intra-regional variations. Meta-analysis of 25 SNPs revealed 12 SNPs with high T2DM risk compatibility. TCF7L2 gene exhibited a strong compatibility with an overall OR of 1.44 (95% CI 1.36-1.52) and S-value 112.41, while TCF7L2 variants rs7903146 and rs12255372, with OR 1.56 (95% CI 1.43-1.66) and S-value 89.036, OR of 1.36 (95% CI 1.17-1.35) with an S-value of 15.45 respectively.

Interpretation

Our study highlights the importance of considering the diverse ethnic groups of India for development of targeted and effective T2DM management strategies.

Funding

Department of Biotechnology (DBT) and Indian Council of Medical Research (ICMR), Government of India.

Prevalence of metabolic syndrome and its components according to altitude levels: a systematic review and meta-analysis

Metabolic syndrome has a multifactorial origin; however, epidemiological data correspond to populations located at sea level. It has been reported that the altitude can affected the prevalence due to physiological changes. The aim of this study is to show the global prevalence of metabolic syndrome at altitude and its components. We use four databases, all studies published up to November 2023. The prevalences from studies were meta-analyzed using a random-effects model. To assess sources of heterogeneity, subgroup analyses were performed. We included 28 studies. The number of participants was 29 195. The prevalence of metabolic syndrome was 30.3% (95% CI 22.8-38.4%). According to the altitude level, at 1500-2500 was 36.5%, 2500-3500 (21.8%), and > 3500 (30.9%), also it was higher in women (35.5%) that men (26.8%). It was observed that there is an inverse relationship between higher altitude and the prevalence of metabolic syndrome. Among its components, abdominal obesity and low HDL were present in more than 40.0%, while high blood pressure, high triglycerides and impaired glucose were present in less than 30.0%. We recommend that our results be considered for future research in populations living at altitude since they have different characteristics from populations at sea level.

Sex differences in genotype frequency and the risk of polycythemia associated with rs13419896 and rs2790859 among Tibetan highlanders living in Tsarang, Mustang, Nepal

BACKGROUND

Tibetan highlanders have adapted to hypoxic environments through genetic mechanisms that avoid hemoglobin concentration increases and prevent polycythemia. Recently, sex differences in hemoglobin dynamics with age have been reported among Tibetan highlanders living in Tsarang. Additionally, concerns have been raised that dietary changes associated with modernization may increase the risk of polycythemia and lifestyle-related diseases among Tibetan highlanders. However, the relationship between genetic polymorphisms and the risk of lifestyle-related diseases in Tibetan highlanders has been investigated in only a few regions. This study aims to elucidate whether polymorphisms in genes related to hypoxic adaptation are associated with the incidence of lifestyle-related diseases and polycythemia and whether these polymorphisms affect hemoglobin dynamics in the residents of Tsarang, Mustang, Nepal.

METHODS

Health checkup data from individuals living in Tsarang in Mustang District, Nepal, collected in 2017, were used to determine the prevalence of obesity, hypertension, diabetes, hypoxemia, and polycythemia. DNA was extracted from whole-blood samples, and data for the single-nucleotide polymorphisms (SNPs) rs13419896 (EPAS1), rs12619696 (EPAS1), and rs2790859 (EGLN1) were obtained using real-time PCR. The health checkup data were statistically analyzed to determine the associations of these diseases with polymorphisms in genes related to hypoxic adaptation.

RESULTS

A total of 168 participants, comprising 78 males and 90 females, were included in the final analysis. In terms of the prevalence of each disease, only the prevalence of polycythemia significantly differed between sexes (p < 0.01). Additionally, among the three analyzed SNPs, significant sex differences in genotype frequency were observed for rs13419896 and rs2790859. For rs2790859 in females, Tibetan highlanders with the adaptive genotype had a significantly lower incidence of polycythemia (p < 0.01) and significantly lower hemoglobin concentrations (p < 0.01).

CONCLUSIONS

This study revealed that there are sex differences in the genotype frequency of gene-related hypoxic adaptations among the residents of Tsarang. The findings also suggested that the rs2790859 polymorphism might be involved in the recent incidence of polycythemia among Tsarang residents. If the frequency of non-Tibetan genotypes increases due to intermixing with other populations in the Mustang District, polycythemia may emerge as a modern disease. It is essential to continue investigating the health status of Mustang residents to elucidate various aspects of hypoxic adaptation and disease susceptibility.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Human adaptation to cold and warm climatic conditions: A comparison between two geographically diverse Indigenous populations

OBJECTIVES

The present study aims to compare body adiposity and blood pressure (BP) in two climatically and ethnically diverse populations, examining whether thermoregulatory adaptive mechanism may protect Indigenous populations from exhibiting adverse consequences of increased adiposity.

METHODS

A cross sectional sample of 404 subjects, of which 200 were Monpa and 204 were Santhal, from two ethnically and geographically distinct populations of India were studied. Body mass index (BMI; kg/m2 ), fat mass (FM; kg), fat free mass (kg), and percent body fat (%BF) were calculated for evaluation of body adiposity. Multivariate multiple regression analysis was adopted to examine the influence of age and sex of populations under study, on body adiposity and BP variables.

RESULTS

BMI, %BF, and FM were found to be significantly higher (p ˂ .001) among the Monpa males and females compared with their Santhal counterparts. In contrast, the prevalence of hypertension among Monpa and Santhal is comparable (3.5%Monpa vs. 3.9%Santhal for systolic BP; 8.5%Monpa vs. 8.3%Santhal for diastolic BP). Adiposity, as quantitated by the fat mass index and %BF was significantly (p ˂ .001) correlated to age and sex of study population, explaining ~75.3% and ~75.4% of total variations of these variables, respectively.

CONCLUSIONS

Overall the present study suggests that modern human populations follow thermoregulatory mechanism for adaptation to different climatic conditions. Consequently, greater adiposity was evident among the Monpa who adapt to the cold climate, in comparison to their Santhal counterparts who dwell in warm climate.

Factors Affecting Carotid Artery Stenosis in the Elderly Living at High Altitudes

BACKGROUND

Factors affecting carotid artery stenosis have been generally investigated. However, considering the protective effect of altitude, studies on elderly individuals at high altitudes are few. Our aim is to investigate the systematic adaptive changes caused by high-altitude exposure through the causes of carotid artery stenosis.

MATERIALS AND METHODS

Carotid Doppler ultrasound was performed on 250 patients over the age of 50 years. The patients' age, gender, height, weight, smoking history, place of residence, and presence of comorbidities were questioned. Those with diabetes, hypertension, hyperlipidemia, and coronary disease were excluded from the study. Those who did not reside at high altitudes were excluded from the study. One hundred and thirty-five patients were included in the study. Carotid artery Doppler findings and biochemical parameters were recorded. Factors affecting stenosis in the carotid arteries were compared.

RESULTS

In our study, the factors affecting carotid stenosis were determined to be age, gender, presence of plaque, plaque type, and mean carotid intima-media thickness (CIMT). The mean CIMT of the patients was calculated as 0.71±0.14 mm. The mean CIMT measurement level was significantly higher in patients with plaque in the carotid artery (p<0.05). According to receiver operating characteristic curves, CIMT values higher than 0.72 mm increase plaque and stenosis formation in the common carotid artery (CCA) and internal carotid artery (ICA) in elderly people living at high altitudes (p<0.05, area under the curve [AUC]: 0.71-0.83).

CONCLUSIONS

The most important factors affecting carotid stenosis in individuals living at high altitudes are age, gender, CIMT, plaque, and plaque type. When soft plaques were detected, the risk of stenosis was found to be higher than in calcific plaques. Additionally, the number of factors affecting stenosis was greater on the left (ICA). This suggests that the left carotid system is more vulnerable. It can be said that in elderly individuals living at high altitudes, a CIMT higher than 0.72 mm is a cutoff value in the presence of plaque and stenosis in the carotid arteries.

Associations of three thermogenic adipokines with metabolic syndrome in obese and non-obese populations from the China plateau: the China Multi-Ethnic Cohort

OBJECTIVES

High altitude exposure decreases the incidence of obesity and metabolic syndrome, but increases the expression of the thermogenic adipokines (leptin, fat cell fatty acid-binding protein (A-FABP) and visfatin). This study investigated the correlation of these adipokines with obesity and metabolic syndrome (MetS) in populations residing in a plateau-specific environment.

DESIGN

Case-control study.

SETTING

We cross-sectionally analysed data from the China Multi-Ethnic Cohort.

PARTICIPANTS

A total of 475 obese (OB, body mass index (BMI)≥28.0 kg/m²) plateau Han people and 475 age, sex and region-matched non-obese (NO, 18.5≤BMI<24.0 kg/m²) subjects were recruited. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III guidelines.

PRIMARY AND SECONDARY OUTCOME MEASURES

Data with normal distributions were expressed as the mean (Stanard Deviation, SD), and data with skewed distributions were expressed as the median (Interquartile Range, IQR). The participants were grouped and the rank-sum test, χ² test or t-tests was used for comparing groups. Spearman correlation coefficients were estimated to assess the relationships among leptin, A-FABP, visfatin and the components of MetS in each group.

RESULTS

A-FABP was an independent predictor of OB (OR, 1.207; 95% CI, 1.170 to 1.245; p<0.05), ABSI (OR, 1.035; 95%CI, 1.019 to 1.052; p<0.05) and MetS (OR, 1.035; 95% CI, 1.013 to 1.057; p<0.05). Leptin was an independent predictor of MetS in the NO group. Visfatin was an independent predictor of increased ABSI, but not for OB or MetS.

CONCLUSION

An abnormally elevated plasma A-FABP level, but not leptin or visfatin is a potential risk factor for MetS in high-altitude populations.

Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Rate and risk factors of metabolic components and component combinations according to hypertension status in Tibetans in a cross-sectional study

To estimate the prevalence of metabolic syndrome (MS) and metabolic components and their associated factors and component combinations according to hypertension status in Tibetans living at high altitude. Multistage sampling of 1473 participants (799 hypertensive patients and 674 normotensive subjects). MS prevalence and the number of metabolic components ≥ 3 were significantly higher in the hypertensive than normotensives. In hypertensive patients, the most common component was central obesity and it combined with: high blood pressure, in those with 2 risk factors, plus fasting hyperglycemia, in those with 3 risk factors, and high triglyceride, in those with 4 risk factors. In normotensive subjects, the most common single component was low high-density-lipoprotein cholesterol, and most component combination included central obesity and hyperglycemia in those with 2 risk factors, plus high blood pressure in those with 3 risk factors, and high triglycerides in those with 4 risk factors. Body mass index and female both were associated with increased possibilities of MS in hypertensive and normotensive participants. Low incoming, and high educational levels were associated with an elevated probability of MS in normotensive Tibetans also. The priority of prevention from cardiovascular diseases by targeting metabolic components in the hypertensive was different from normotensives. Different MS components had various lifestyle and socioeconomic factors.

Prevalence, Management, and Associated Factors of Obesity, Hypertension, and Diabetes in Tibetan Population Compared with China Overall

Tibetans’ life expectancy lags behind China’s average. Obesity and noncommunicable diseases (NCDs) contribute to health disparity, but NCD patterns among Tibetans are unknown. To examine the prevalence, management, and associated factors for obesity, hypertension, and diabetes among Tibetans, compared with China’s average, we systematically searched PubMed and China National Knowledge Infrastructure databases for studies between January 2010 and April 2021. Thirty-nine studies were included for systematic review, among thirty-seven that qualified for meta-analysis, with 115,403 participants. Pooled prevalence was 47.9% (95% CI 38.0–57.8) for overweight/obesity among adults (BMI ≥ 24 kg/m²) and 15.4% (13.7–17.2) among children using Chinese criteria, which are lower than the national rates of 51.2% and 19.0%, respectively. The estimate for hypertension (31.4% [27.1–35.7]) exceeded China’s average (27.5%), while diabetes (7.5% [5.2–9.8]) was lower than average (11.9%). Men had a higher prevalence of the three conditions than women. Residents in urban areas, rural areas, and Buddhist institutes had monotonically decreased prevalence in hypertension and diabetes. Awareness, treatment, and control rates for hypertension and diabetes were lower than China’s average. Urban residence and high altitude were consistent risk factors for hypertension. Limited studies investigated factors for diabetes, yet none exist for obesity. Tibetans have high burdens of obesity and hypertension. Representative and longitudinal studies are needed for tailored interventions. There are considerable variations in study design, study sample selection, and data-analysis methods, as well as estimates of reviewed studies.

Prevalence of hypertension and its relationship with altitude in highland areas: a systematic review and meta-analysis

This systematic review and meta-analysis synthesized the pooled prevalence of hypertension at high altitudes and explored its correlation with altitude using studies published in Chinese and English from database inception to February 2021. A systematic literature search was conducted among bibliographic databases (PubMed, Embase, and Web of Science) and three Chinese databases (CNKI, VIP, and Wanfang data) to identify eligible studies. A random-effects model was used to calculate the overall pooled prevalence of hypertension. The I² statistic was used to assess heterogeneity across studies. Random-effects meta-regression was conducted to investigate covariates that may have influenced between-study heterogeneity. The pooled prevalence of hypertension among the general population in high-altitude areas was 33.0% (95% CI: 29.0-38.0%), with high between-study heterogeneity (I² = 99.4%, P < 0.01). Subgroup analyses showed the pooled prevalence of hypertension in Tibetan individuals was significantly higher than that in non-Tibetan individuals living in the Himalayas and Pamir Mountains (41% vs. 18%). A trend toward an increase in the prevalence of hypertension was found with every 100-m increase in elevation (coefficient: 0.012, 95% CI: -0.001 to 0.025, P = 0.069) only in Tibetan individuals. In addition, in these individuals, we found an increase in mean diastolic BP with each 100-m increase in altitude (coefficient: 0.763, 95% CI: 0.122-1.403, P = 0.025). Our meta-analysis suggests that the pooled prevalence of hypertension among the general population in high-altitude areas is 33.0%. Subjects of Tibetan ethnicity were more prone to developing hypertension at high altitudes. However, a very weak relationship between altitude and the prevalence of hypertension was found only in Tibetan individuals.

Diagnostic Criteria for Metabolic Syndrome in High-Altitude Regions: A Systematic Review

Background and Objectives: Metabolic syndrome (MS) has many risk factors that are important to investigate in populations living at sea level and in high-altitude geographic regions. The aim was to identify the components of MS that cross-sectional studies use to assess in adult populations residing in high-altitude regions. Materials and Methods: A systematic review study was conducted. The Pubmed database was used. The search for original articles (cross-sectional) was performed from January 2013 to December 2020. The procedure was carried out by two researchers. The keywords used were metabolic syndrome, adults, and altitude regions. The search strategy considered the components of the PICOS tool. Results: Ten cross-sectional studies were identified in the Pubmed database from 2014 to 2020. Altitude levels varied between countries and regions, from 2060 to 4900 m above sea level. Three studies were conducted in both China and Peru, two studies in Ecuador, and one in Bolivia and India. The age ranges studied were from 18 to ~80 years of age, approximately. The components used to assess MS in most studies (between 9 to 10 studies) were body mass index (BMI), waist circumference (WC), blood pressure (BP), triglycerides (TG), high-density lipoproteins (HDL) and serum glucose (SG). Conclusions: This systematic review verified that the most commonly used domains in adult populations in various moderate- and high-altitude regions of the world are BMI, WC, BP, TG, HDL, and SG. These results suggest that in order to evaluate and/or investigate MS in subjects residing in high-altitude populations, at least four diagnostic domains should be considered in their protocols.

Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Health Risk Assessment of Heavy Metals Through Cow Milk Consumption in Trans-Himalayan High-Altitude Region

Consumption of heavy metals contaminated dairy milk may affect human health. No such studies have been carried out at the high-altitude region to assess the human health risk after consuming dairy milk. To this end, this study reveals the evaluation of selected heavy metals in dairy milk in the summer and winter seasons, followed by the assessment of heavy metals health risk. Analysis of Jersey crossbred cattle's milk showed that only the zinc level was significantly higher in the summer season. All the non-carcinogenic and carcinogenic parameters were below the permissible limits. However, the carcinogenic risk (CR) level of arsenic and cadmium showed near the threshold level. Based on these findings, it might be concluded that all the studied metals do not have any significant role in health risk. In the near future, CR could be a health concern due to cow milk consumption at a high-altitude region.

Hematological Parameters, Lipid Profile, and Cardiovascular Risk Analysis Among Genotype-Controlled Indigenous Kiwcha Men and Women Living at Low and High Altitudes

Introduction: Human adaptation to high altitude is due to characteristic adjustments at every physiological level. Differences in lipid profile and cardiovascular risk factors in altitude dwellers have been previously explored. Nevertheless, there are no reports available on genotype-controlled matches among different altitude-adapted indigenous populations.

Objective: To explore the possible differences in plasma lipid profile and cardiovascular risk among autochthonous Kiwcha people inhabitants of low and high-altitude locations.

Methodology: A cross-sectional analysis of plasmatic lipid profiles and cardiovascular risk factors in lowland Kiwchas from Limoncocha (230 m) and high-altitude Kiwchas from Oyacachi (3,800 m).

Results: In the low altitude group, 66% were women (n = 78) and 34% (n = 40) were men, whereas in the high altitude group, 59% (n = 56) were women and 41% (n = 41%) were men. We found the proportion of overweight and obese individuals to be higher among low altitude dwellers (p < 0.05). Red blood cells (RBCs), hemoglobin concentration, and SpO₂% were higher among high altitude dwellers and the erythrocyte size was found to be smaller at high altitude. The group located at low altitude also showed lower levels of plasma cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL), but most of these differences are not influenced by gender or elevation.

Conclusions: Living at an altitude elicits well-known adaptive physiological changes such as erythrocyte count, hemoglobin concentration, hematocrit level, and serum glucose level. We also report clinical differences in the plasma lipid profile, with higher levels of cholesterol, HDL, and LDL in inhabitants of the Andes Mountain vs. their Amazonian basin peers. Despite this, we did not find significant differences in cardiovascular risk.

Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease.

RESULTS

Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Adapting a Prediction Rule for Metabolic Syndrome Risk Assessment Suitable for Developing Countries

Background: Metabolic syndrome (MetS) is a cluster of cardiometabolic disturbances that increases the risk of cardiovascular diseases (CVD) and type 2 diabetes mellitus (DM). The early identification of high-risk individuals is the key for halting these conditions. The world is facing a growing epidemic MetS although the magnitude in Egypt is unknown. Objectives: To describe MetS and its determinants among apparently healthy individuals residing in urban and rural communities in Egypt and to establish a model for MetS prediction. Methods: A cross-sectional study was conducted with 270 adults from rural and urban districts in Alexandria, Egypt. Participants were clinically evaluated and interviewed for sociodemographic and lifestyle factors and dietary habits. MetS was defined according to the harmonized criteria set by the AHA/NHLBI. The risk of ischemic heart diseases (IHDs), DM and fatty liver were assessed using validated risk prediction charts. A multiple risk model for predicting MetS was developed, and its performance was compared. Results: In total, 57.8% of the study population met the criteria for MetS and were at high risk for developing IHD, DM, and fatty liver. Silent CVD risk factors were identified in 20.4% of the participants. In our proposed multivariate logistic regression model, the predictors of MetS were obesity [OR (95% CI) = 16.3 (6.03-44.0)], morbid obesity [OR (95% CI) = 21.7 (5.3-88.0)], not working [OR (95% CI) = 2.05 (1.1-3.8)], and having a family history of chronic diseases [OR (95% CI) = 4.38 (2.23-8.61)]. Consumption of caffeine once per week protected against MetS by 27.8-fold. The derived prediction rule was accurate in predicting MetS, fatty liver, high risk of DM, and, to a lesser extent, a 10-year lifetime risk of IHD. Conclusion: Central obesity and sedentary lifestyles are accountable for the rising rates of MetS in our society. Interventions are needed to minimize the potential predisposition of the Egyptian population to cardiometabolic diseases.

Metabolic syndrome and its relation to dietary patterns among a selected urbanised and semi-urbanised Tibetan population in transition from nomadic to settled living environment

OBJECTIVE

To explore the scope of metabolic syndrome (MetS) and its relationship to the major dietary patterns among an urbanised and semi-urbanised Tibetan population in transition from nomadic to settled settings.

DESIGN

Cross-sectional.

SETTING

Community-based.

PARTICIPANTS

Urbanised and semi-urbanised Tibetan adults (n 920, aged 18-90 years), who have moved from nomadic to settled living environments, answered questionnaires on food consumption frequency and lifestyle characteristics through structured face-to-face interviews and completed anthropometric measurement and metabolic biomarker tests.

RESULTS

MetS prevalence was 30·1 % in males and 32·1 % in females. Low HDL-cholesterol and central obesity were the leading metabolic abnormalities (86·3 and 55·8 %, respectively). Three major dietary patterns - urban, western and pastoral - were identified. Beef/mutton was an important food group for all three identified dietary patterns. In addition, the urban dietary pattern was characterised by frequent consumption of vegetables, tubers/roots and refined carbohydrates; the western pattern was characterised by sweetened drinks, snacks and desserts; and the pastoral pattern featured tsamba (roasted Tibetan barley), Tibetan cheese, butter tea/milk tea and whole-fat dairy foods. Individuals in the highest quintile of urban dietary pattern scores were found to be at a higher risk of developing MetS (OR 2·43, 95 % CI 1·41, 4·18) and central obesity (OR 1·91, 95 % CI 1·16, 3·14) after controlling for potential confounders.

CONCLUSIONS

MetS was common among urbanised and semi-urbanised Tibetan adult population in transition. The urban dietary pattern, in particular, was a risk factor for MetS. To prevent MetS, nutrition interventions need to be tailored to address the variety of local diet patterns to promote healthy eating.

Prevalence of metabolic syndrome among ethnic groups in China

Background

Metabolic syndrome (MetS) is common in China, which has a multi-ethnic population of 1·3 billion. We set out to determine the prevalence of MetS and its components in different ethnic groups.

Methods

This nationwide cross-sectional survey involved 24,796 participants from eight ethnicities in six provinces in China from 2008 to 2011. MetS was defined using the modified National Cholesterol Education Program Adult Treatment Panel III criteria. Results were analysed using SPSS version 22·0 in 2018. Logistic regression was used for deriving odds ratios and 95% confidence intervals of risk factors for the MetS.

Results

The prevalence of MetS increased with age from 3·60% to 21·68%. After age standardization, the prevalence of MetS, in descending order, was 35·42% (Korean), 22·82% (Hui), 19·80% (Han), 13·72% (Miao), 12·90% (Tujia), 12·04% (Li), 11·61% (Mongolian), 6·17% (Tibetan). Korean ethnicity was associated with a higher prevalence in five components of MetS, while Tibetan ethnicity was associated with lower prevalence except decreased HDL cholesterol. Logistic regression analyses showed that age, drinking and being non-Tibetan were associated with a higher risk of MetS.

Conclusions

Within one country, albeit a large one, the prevalence of MetS can vary greatly. Chinese of Korean ethnicity had a much higher prevalence than Tibetan ethnicity. Measures to tackle MetS should be tailored to the ethnic groups within a population.

Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals.

RESULTS

Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Metabolic syndrome in native populations living at high altitude: a cross-sectional survey in Derong, China

OBJECTIVE

The metabolic syndrome is a major risk factor for cardiovascular disease. Little information exists on the prevalence of the metabolic syndrome at high-altitude areas in China. We aimed to estimate the prevalence of metabolic syndrome and its individual components at high altitude.

METHODS

A cross-sectional survey of 5053 adults living in Derong from elevation of 2060 to 3820 m was carried out in 2013. Metabolic syndrome was defined according to the Chinese Diabetes Society criteria.

RESULTS

The overall prevalence of metabolic syndrome was 3.6% (5.9% in men and 1.8% in women) in Derong, China. Obesity and hypertension were more prevalent among adults than dyslipidaemia and hyperglycaemia at high altitude. The prevalence of metabolic syndrome was higher in township than countryside residents (6.6%, 11.9% in men and 1.5% in women vs 3.0%, 4.6% in men and 1.8% in women). Men with age 30-59 years old had a much higher prevalence of metabolic syndrome than women. Men, township, middle and old age residents had a higher risk of metabolic syndrome. The risk of obesity and dyslipidaemia decreased and the risk of hypertension increased in very high altitude (≥3000 m) residents.

CONCLUSION

In Derong, despite the relatively low prevalence of metabolic syndrome, hypertension and obesity are more prevalent in adult residents. And metabolic syndrome is more concentrated in township and male residents. These people also have a higher risk of metabolic syndrome. Therefore, it is necessary to develop a national strategy for the prevention and treatment of metabolic syndrome for high-risk population at high altitude in China.

Screening for obesity in the offspring of first-cousin consanguineous couples: A Phase-I study in Saudi Arabia

Consanguineous or cousin marriages are very common in Saudi Arabia. However, owing to limited studies and insufficient knowledge about genetic diseases/disorders, many couples are unaware of the increased health risks for their offspring. Among the inherited and complex diseases from parents’ consanguinity, obesity is common; therefore, we examined the prevalence of obesity in the offspring of first-cousin consanguineous couples in Saudi Arabia. In this questionnaire-based study, 657 individuals (mean age = 18.7 ± 10.2 years; age range = 2–65 years) who were residing in Riyadh, Saudi Arabia participated. Among them, almost 90% were native Saudis. Participants mean body mass index (BMI) was 24.5 ± 9.1 kg/m2. Sex- stratified demographic details confirmed a significant association between age and BMI (p < .001). We confirmed that adolescents and adults were more prone to develop obesity. Adults and non-Saudi participants were three times more likely to develop obesity if they had first-cousin consanguineous parents than those who did not. Of the 30% of participants who were obese, 100 will be selected for Phase II, in which we plan to perform exome sequencing.

Risk management of free radicals involved in air travel syndromes by antioxidants

Frequent air travelers and airplane pilots may develop various types of illnesses. The environmental risk factors associated with air travel syndromes (ATS) or air travel-related adverse health outcomes raised concerns and need to be assessed in the context of risk management and public health. Accordingly, the aim of the present review was to determine ATS, risk factors, and mechanisms underlying ATS using scientific data and information obtained from Medline, Toxline, and regulatory agencies. Additional information was also extracted from websites of organizations, such as the International Air Transport Association (IATA), International Association for Medical Assistance to Travelers (IAMAT), and International Civil Aviation Organization (ICAO). Air travelers are known to be exposed to environmental risk factors, including circadian rhythm disruption, poor cabin air quality, mental stress, high altitude conditions, hormonal dysregulation, physical inactivity, fatigue, biological infections, and alcoholic beverage consumption. Consequences of ATS attributed to air travel include sleep disturbances (e.g., insomnia), mental/physical stress, gastrointestinal disorders, respiratory diseases, circulatory-related dysfunction, such as cardiac arrest and thrombosis and, at worst, mechanical and terrorism-related airplane crashes. Thus safety measures in the cabin before or after takeoff are undertaken to prevent illnesses or accidents related to flight. In addition, airport quarantine systems are strongly recommended to prepare for any ultimate adverse circumstances. Routine monitoring of environmental risk factors also needs to be considered. Frequently, the mechanisms underlying these adverse manifestations involve free radical generation. Therefore, antioxidant supplementation may help to reduce or prevent adverse outcomes by mitigating health risk factors associated with free radical generation.