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Gregory EF, Maddox AI, Tindall A, Ibarra JL, Virudachalam S. Comparison of Cardiovascular Health Between Parents and Non-Parents in NHANES 2011-2018. FAMILY & COMMUNITY HEALTH 2024; 47:231-238. [PMID: 38713758 DOI: 10.1097/fch.0000000000000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
BACKGROUND AND OBJECTIVES We compared cardiovascular health for parents and non-parents using the American Heart Association's Life's Essential 8 (LE8). METHODS This cross-sectional cohort analyzed 2011-2018 NHANES participants aged 20 to 54. The exposure was parenting, defined as living with a child. Logistic regression assessed whether parenting was associated with odds of ideal LE8 total or sub-scores. Regression adjusted for age, sex, race and ethnicity, educational attainment, marital status, and income. Subgroups included female sex, male sex, income <150% federal poverty levels, and parents of younger children. RESULTS 6847 participants represented a weighted population of 79 120 285 (57% parents). Parenting was not associated with adjusted odds of ideal total LE8 (OR 0.91, 95% CI 0.76-1.09). Parenting was associated with decreased odds of ideal body mass index (BMI) (OR 0.81, 95% CI 0.72-0.91) and increased odds of smoking avoidance (OR 1.22, 95% CI 1.09-1.38). Associations varied by subgroup. Only the subgroup with lower incomes demonstrated reduced odds of ideal total LE8 for parents (OR 0.58, 95% CI 0.41-0.82). CONCLUSIONS Parents and non-parents differed in smoking and BMI, though not in LE8 total. Families with low incomes may particularly benefit from dual generation cardiovascular risk reduction.
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Affiliation(s)
- Emily F Gregory
- Author Affiliations: Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (Drs Gregory and Tindall, Mr Ibarra, and Dr Virudachalam); Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA (Dr Gregory, Ms Maddox, and Drs Tindall and Virudachalam); PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA (Dr Gregory, Ms Maddox, and Drs Tindall and Virudachalam)
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Niedermayer F, Schauberger G, Rathmann W, Klug SJ, Thorand B, Peters A, Rospleszcz S. Clusters of longitudinal risk profile trajectories are associated with cardiometabolic diseases: Results from the population-based KORA cohort. PLoS One 2024; 19:e0300966. [PMID: 38547172 PMCID: PMC10977748 DOI: 10.1371/journal.pone.0300966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/07/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Multiple risk factors contribute jointly to the development and progression of cardiometabolic diseases. Therefore, joint longitudinal trajectories of multiple risk factors might represent different degrees of cardiometabolic risk. METHODS We analyzed population-based data comprising three examinations (Exam 1: 1999-2001, Exam 2: 2006-2008, Exam 3: 2013-2014) of 976 male and 1004 female participants of the KORA cohort (Southern Germany). Participants were followed up for cardiometabolic diseases, including cardiovascular mortality, myocardial infarction and stroke, or a diagnosis of type 2 diabetes, until 2016. Longitudinal multivariate k-means clustering identified sex-specific trajectory clusters based on nine cardiometabolic risk factors (age, systolic and diastolic blood pressure, body-mass-index, waist circumference, Hemoglobin-A1c, total cholesterol, high- and low-density lipoprotein cholesterol). Associations between clusters and cardiometabolic events were assessed by logistic regression models. RESULTS We identified three trajectory clusters for men and women, respectively. Trajectory clusters reflected a distinct distribution of cardiometabolic risk burden and were associated with prevalent cardiometabolic disease at Exam 3 (men: odds ratio (OR)ClusterII = 2.0, 95% confidence interval: (0.9-4.5); ORClusterIII = 10.5 (4.8-22.9); women: ORClusterII = 1.7 (0.6-4.7); ORClusterIII = 5.8 (2.6-12.9)). Trajectory clusters were furthermore associated with incident cardiometabolic cases after Exam 3 (men: ORClusterII = 3.5 (1.1-15.6); ORClusterIII = 7.5 (2.4-32.7); women: ORClusterII = 5.0 (1.1-34.1); ORClusterIII = 8.0 (2.2-51.7)). Associations remained significant after adjusting for a single time point cardiovascular risk score (Framingham). CONCLUSIONS On a population-based level, distinct longitudinal risk profiles over a 14-year time period are differentially associated with cardiometabolic events. Our results suggest that longitudinal data may provide additional information beyond single time-point measures. Their inclusion in cardiometabolic risk assessment might improve early identification of individuals at risk.
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Affiliation(s)
- Fiona Niedermayer
- Chair of Epidemiology, IBE, Faculty of Medicine, LMU Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Gunther Schauberger
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Wolfgang Rathmann
- German Center for Diabetes Research (DZD), München-Neuherberg, Neuherberg, Germany
- Department for Biometrics and Epidemiology, German Diabetes Research Institute, Leibniz Institute for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Stefanie J. Klug
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Neuherberg, Germany
| | - Annette Peters
- Chair of Epidemiology, IBE, Faculty of Medicine, LMU Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Neuherberg, Germany
- German Center for Cardiovascular Disease Research (DZHK), Munich Heart Alliance, Munich, Germany
| | - Susanne Rospleszcz
- Chair of Epidemiology, IBE, Faculty of Medicine, LMU Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Cardiovascular Disease Research (DZHK), Munich Heart Alliance, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Yeoh A, Cheung R, Ahmed A, Chitnis AS, Do A, Wong RJ. Cardiovascular Disease Risk and Statin Use Among Adults with Metabolic Dysfunction Associated Fatty Liver Disease. Am J Med 2023; 136:669-676.e1. [PMID: 37001720 DOI: 10.1016/j.amjmed.2023.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/07/2023] [Accepted: 03/13/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND A leading cause of mortality in fatty liver disease is cardiovascular disease. Metabolic dysfunction-associated fatty liver disease (MAFLD) is new terminology that classifies fatty liver due to metabolic dysfunction attributable to obesity and associated complications. We evaluated atherosclerotic cardiovascular disease (ASCVD) risk and statin use in adults with MAFLD. METHODS This was a retrospective study of the 2011-2018 National Health and Nutrition Examination Survey. Adults with MAFLD were identified using established criteria: presence of hepatic steatosis (US Fatty Liver Index>30) plus ≥1 of the following: 1) body mass index >25 kg/m2 in non-Asians or >23 kg/m2 in Asians, 2) diabetes mellitus, and 3) ≥2 metabolic risk factors. Cardiovascular disease risk was estimated using the validated 10-year ASCVD risk score. Statin use was assessed in intermediate and high 10-year ASCVD risk groups. RESULTS Prevalence of MAFLD was 34.8% (95% confidence interval [CI], 33.9%-35.8%), comprising 54.4% males, 27.9% aged 65 years and older, and 38.2% non-Hispanic white. Among adults with MAFLD, 23.3% and 23.0% had intermediate and high 10-year ASCVD risk, respectively. Compared with females, males were more likely to have high 10-year ASCVD risk (28.7% vs 16.1%, adjusted odds ratio 5.24, 95% CI, 3.87-7.10, P < .01). In intermediate and high ASCVD risk groups, overall statin use was 48.3% (95% CI, 46.1-51.3). CONCLUSIONS Over 46% of adults with MAFLD had intermediate or high 10-year ASCVD risk. Statin use was underutilized at 48.3% in those meeting statin criteria. These findings are alarming given the high cardiovascular disease risk and low statin use in this cohort.
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Affiliation(s)
- Aaron Yeoh
- Division of Gastroenterology, Department of Medicine, Stanford, Calif.
| | - Ramsey Cheung
- Division of Gastroenterology, Department of Medicine, Stanford, Calif; Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, Calif
| | - Aijaz Ahmed
- Division of Gastroenterology, Department of Medicine, Stanford, Calif
| | - Amit S Chitnis
- Tuberculosis Control Section, Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, Calif
| | - Albert Do
- Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, Conn
| | - Robert J Wong
- Division of Gastroenterology, Department of Medicine, Stanford, Calif; Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, Calif
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Wang JS, Xia PF, Ma MN, Li Y, Geng TT, Zhang YB, Tu ZZ, Jiang L, Zhou LR, Zhang BF, Tong WW, Shan Z, Liu G, Yang K, Pan A. Trends in the Prevalence of Metabolically Healthy Obesity Among US Adults, 1999-2018. JAMA Netw Open 2023; 6:e232145. [PMID: 36892842 PMCID: PMC9999245 DOI: 10.1001/jamanetworkopen.2023.2145] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
IMPORTANCE Improved understanding of trends in the proportion of individuals with metabolically healthy obesity (MHO) may facilitate stratification and management of obesity and inform policy efforts. OBJECTIVES To characterize trends in the prevalence of MHO among US adults with obesity, overall and by sociodemographic subgroups. DESIGN, SETTING, AND PARTICIPANTS This survey study included 20 430 adult participants from 10 National Health and Nutrition Examination Survey (NHANES) cycles between 1999-2000 and 2017-2018. The NHANES is a series of cross-sectional and nationally representative surveys of the US population conducted continuously in 2-year cycles. Data were analyzed from November 2021 to August 2022. EXPOSURES National Health and Nutrition Examination Survey cycles from 1999-2000 to 2017-2018. MAIN OUTCOMES AND MEASURES Metabolically healthy obesity was defined as a body mass index of 30.0 (calculated as weight in kilograms divided by height in meters squared) without any metabolic disorders in blood pressure, fasting plasma glucose (FPG), high-density lipoprotein cholesterol (HDL-C), or triglycerides based on established cutoffs. Trends in the age-standardized prevalence of MHO were estimated using logistic regression analysis. RESULTS This study included 20 430 participants. Their weighted mean (SE) age was 47.1 (0.2) years; 50.8% were women, and 68.8% self-reported their race and ethnicity as non-Hispanic White. The age-standardized prevalence (95% CI) of MHO increased from 3.2% (2.6%-3.8%) in the 1999-2002 cycles to 6.6% (5.3%-7.9%) in the 2015-2018 cycles (P < .001 for trend). There were 7386 adults with obesity. Their weighted mean (SE) age was 48.0 (0.3) years, and 53.5% were women. The age-standardized proportion (95% CI) of MHO among these 7386 adults increased from 10.6% (8.8%-12.5%) in the 1999-2002 cycles to 15.0% (12.4%-17.6%) in the 2015-2018 cycles (P = .02 for trend). Substantial increases in the proportion of MHO were observed for adults aged 60 years or older, men, non-Hispanic White individuals, and those with higher income, private insurance, or class I obesity. In addition, there were significant decreases in the age-standardized prevalence (95% CI) of elevated triglycerides (from 44.9% [40.9%-48.9%] to 29.0% [25.7%-32.4%]; P < .001 for trend) and reduced HDL-C (from 51.1% [47.6%-54.6%] to 39.6% [36.3%-43.0%]; P = .006 for trend). There was also a significant increase in elevated FPG (from 49.7% [95% CI, 46.3%-53.0%] to 58.0% [54.8%-61.3%]; P < .001 for trend) but no significant change in elevated blood pressure (from 57.3% [53.9%-60.7%] to 54.0% [50.9%-57.1%]; P = .28 for trend). CONCLUSIONS AND RELEVANCE The findings of this cross-sectional study suggest that the age-standardized proportion of MHO increased among US adults from 1999 to 2018, but differences in trends existed across sociodemographic subgroups. Effective strategies are needed to improve metabolic health status and prevent obesity-related complications in adults with obesity.
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Affiliation(s)
- Jiang-Shui Wang
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Peng-Fei Xia
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Meng-Nan Ma
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yue Li
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Ting-Ting Geng
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yan-Bo Zhang
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Zhou-Zheng Tu
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Limiao Jiang
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Li-Rong Zhou
- Department of Endocrinology, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Bing-Fei Zhang
- Department of Endocrinology, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Wen-Wei Tong
- Department of Endocrinology, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Zhilei Shan
- Hubei Key Laboratory of Food Nutrition and Safety, Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Gang Liu
- Hubei Key Laboratory of Food Nutrition and Safety, Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Kun Yang
- Department of Endocrinology, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - An Pan
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Yin T, Zhu X, Cheang I, Zhou Y, Liao S, Lu X, Zhou Y, Yao W, Li X, Zhang H. Urinary phenols and parabens metabolites associated with cardiovascular disease among adults in the United States. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:25093-25102. [PMID: 34345987 DOI: 10.1007/s11356-021-15589-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/19/2021] [Indexed: 06/13/2023]
Abstract
The field of environmental health has begun to examine the effects of higher-order chemical combinations. The current literature lacks studies exploring associations between multiple organic chemical mixtures and cardiometabolic diseases (CVDs). This study aimed to evaluate associations between urinary phenols, parabens metabolites, and total and individual CVDs among a nationally representative sample of adults in the US. This cross-sectional study analyzed 7 urinary chemicals detected among the general population from the 2005-2016 National Health and Nutrition Examination Survey (NHANES, n=10,428). Multivariate logistic regression and weighted quantile sum (WQS) regression were applied to examine relationships between phenols and parabens metabolites, alone and in combination, and total and individual CVDs prevalence. Compared with the lowest quartile, URBPA (OR: 1.52; 95% CI: 1.20-1.91; P=0.001) levels in the highest quartile were independently associated with increased total CVD. The WQS index of phenols and parabens mixtures were independently correlated with total CVD (adjusted odds ratios [OR]: 1.16; 95% confidence interval [CI]:1.06-1.28; P=0.002), angina (adjusted OR: 1.30; 95% CI: 1.07-1.59; P=0.009), and heart attack (adjusted OR: 1.30; 95% CI: 1.12-1.51, P<0.001). Urinary bisphenol A (URBPA, weight=0.636) was the most heavily weighted component in the total CVD model. Restricted cubic spline regression demonstrated positive correlations and nonlinear associations between URBPA and both total CVD (P for nonlinearity=0.032) and individual CVD (heart attack; P for nonlinearity=0.031). Our findings suggested that high combined levels of phenols, and parabens are associated with an increased CVD risk, with URBPA contributing the highest risk.
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Affiliation(s)
- Ting Yin
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Xu Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Iokfai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Yufei Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Shengen Liao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Xinyi Lu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Yanli Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Wenming Yao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.
| | - Haifeng Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 215002, China.
- Gusu School, Nanjing Medical University, Suzhou, 215002, China.
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Scholes S, Fat LN, Mindell JS. Trends in cardiovascular disease risk factors by BMI category among adults in England, 2003-2018. Obesity (Silver Spring) 2021; 29:1347-1362. [PMID: 34155827 DOI: 10.1002/oby.23184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/24/2021] [Accepted: 03/25/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study aimed to estimate trends in cardiovascular disease risk factors by BMI category among adults in England (n = 115,860). METHODS Risk factors included cigarette smoking, hypertension, total diabetes, and raised total cholesterol. Risk factor prevalence was computed in the following four 4-year time periods: 2003-2006; 2007-2010; 2011-2014; and 2015-2018. Change was computed as the difference between the first and last time periods, expressed in percentage points (PP). RESULTS Hypertension remained at a stable level among men with normal weight but decreased among men with obesity (-4.1 PP; 95% CI: -7.1 to -1.0). Total diabetes remained at a stable level among adults with normal weight but increased among adults with obesity (men: 3.5 PP, 95% CI: 1.2 to 5.7; women: 3.6 PP, 95% CI: 1.8 to 5.4). Raised total cholesterol decreased in all BMI groups but fell more sharply among women with obesity (-21 PP; 95% CI: -25 to -17) versus their counterparts with normal weight (-16 PP; 95% CI: -18 to -14). CONCLUSIONS Greater reductions in hypertension and raised total cholesterol among adults with overweight and obesity partially reflect improvements in screening, treatment, and control among those at highest cardiovascular risk. Higher levels of risk factor prevalence among adults with overweight and obesity, in parallel with rising diabetes, highlight the importance of national prevention efforts to combat the public health impact of excess adiposity.
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Affiliation(s)
- Shaun Scholes
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Linda Ng Fat
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Jennifer S Mindell
- Department of Epidemiology and Public Health, University College London, London, UK
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Abstract
PURPOSE OF REVIEW The high burden of cardiovascular disease and the simultaneous obesity pandemic is placing an extraordinary strain on the health care system. In the current siloed care model, patients with cardiometabolic disease receive only fractionated care from multiple specialists, leading to insufficient treatment, higher costs, and worse outcomes. RECENT FINDINGS The imminent need for a new care model calls for the creation of a distinct cardiometabolic specialty in conjunction with a cardiometabolic outpatient clinic dedicated to the comprehensive cardiometabolic care. The cardiometabolic clinic would consist of a diverse range of professionals relevant to comprehensive treatment. The outpatient clinic we envision here would facilitate an interdisciplinary collaboration between specialists and deliver prevention-focused treatment to patients at risk/established cardiometabolic disease.
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Affiliation(s)
- Cara Reiter-Brennan
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Radiology and Neuroradiology, Charité, Berlin, Germany
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Radiology and Neuroradiology, Charité, Berlin, Germany
| | - Dorothy Davis
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Mike Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD USA
| | - Robert H. Eckel
- Division of Endocrinology, Metabolism and Diabetes and Division of Cardiology, University of Colorado School of Medicine, 18582 Stone Gate Dr., Morrison, CO 80465 USA
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Abstract
A new cardiometabolic-based chronic disease (CMBCD) model is presented that provides a basis for early and sustainable, evidence-based therapeutic targeting to promote cardiometabolic health and mitigate the development and ravages of cardiovascular disease. In the first part of this JACC State-of-the-Art Review, a framework is presented for CMBCD, focusing on 3 primary drivers (genetics, environment, and behavior) and 2 metabolic drivers (adiposity and dysglycemia) with applications to 3 cardiovascular endpoints (coronary heart disease, heart failure, and atrial fibrillation). Specific mechanistic pathways are presented configuring early primary drivers with subsequent adiposity, insulin resistance, β-cell dysfunction, and metabolic syndrome, leading to cardiovascular disease. The context for building this CMBCD model is to expose actionable targets for prevention to achieve optimal cardiovascular outcomes. The tactical implementation of this CMBCD model is the subject of second part of this JACC State-of-the-Art Review.
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Cardiometabolic-Based Chronic Disease, Adiposity and Dysglycemia Drivers: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75:525-538. [PMID: 32029136 DOI: 10.1016/j.jacc.2019.11.044] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/06/2019] [Accepted: 11/17/2019] [Indexed: 02/07/2023]
Abstract
A new cardiometabolic-based chronic disease (CMBCD) model is presented that provides a basis for early and sustainable, evidence-based therapeutic targeting to promote cardiometabolic health and mitigate the development and ravages of cardiovascular disease. In the first part of this JACC State-of-the-Art Review, a framework is presented for CMBCD, focusing on 3 primary drivers (genetics, environment, and behavior) and 2 metabolic drivers (adiposity and dysglycemia) with applications to 3 cardiovascular endpoints (coronary heart disease, heart failure, and atrial fibrillation). Specific mechanistic pathways are presented configuring early primary drivers with subsequent adiposity, insulin resistance, β-cell dysfunction, and metabolic syndrome, leading to cardiovascular disease. The context for building this CMBCD model is to expose actionable targets for prevention to achieve optimal cardiovascular outcomes. The tactical implementation of this CMBCD model is the subject of second part of this JACC State-of-the-Art Review.
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Reiter-Brennan C, Cainzos-Achirica M, Soroosh G, Saxon DR, Blaha MJ, Eckel RH. Cardiometabolic medicine - the US perspective on a new subspecialty. Cardiovasc Endocrinol Metab 2020; 9:70-80. [PMID: 32803138 PMCID: PMC7410029 DOI: 10.1097/xce.0000000000000224] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/03/2020] [Indexed: 12/19/2022]
Abstract
The high prevalence of cardiovascular disease and worldwide diabetes epidemic has created an ever-increasing burden on the healthcare system. This calls for the creation of a new medicine subspecialty: cardiometabolic medicine. Using information from review articles listed on PubMed and professional society guidelines, the authors advocate for a cardiometabolic medicine specialization training program. The curriculum would integrate relevant knowledge and skills of cardiology and endocrinology as well as content of other disciplines essential to the optimal care of cardiometabolic patients, such as epidemiology, biostatistics, behavioral science and psychology. Cardiometabolic medicine should be seen as an opportunity for life-long learning, with core concepts introduced in medical school and continuing through CME courses for practicing physicians. To improve care for complex patients with multiple co-morbidities, a paradigm shift must occur, transforming siloed education, and treatment and training to interdisciplinary and collaborative work.
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Affiliation(s)
- Cara Reiter-Brennan
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Radiology and Neuroradiology, Charité, Berlin, Germany
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Garshasb Soroosh
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David R. Saxon
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine
- Division of Endocrinology, Rocky Mountain Veterans Affairs Medical Center, Aurora, Colorado
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Robert H. Eckel
- Division of Endocrinology, Metabolism and Diabetes and Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Yang G, Han YY, Forno E, Yan Q, Rosser F, Chen W, Celedón JC. Glycated Hemoglobin A 1c, Lung Function, and Hospitalizations Among Adults with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3409-3415.e1. [PMID: 32569755 DOI: 10.1016/j.jaip.2020.06.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/16/2020] [Accepted: 06/05/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Insulin resistance and metabolic dysfunction have been associated with asthma risk and asthma severity. OBJECTIVE To examine the association between glycated hemoglobin A1c (HbA1c), asthma-related hospitalizations, and lung function measures among adults in the United Kingdom. METHODS A cross-sectional study was conducted of 47,606 adults aged 40 to 69 years who participated in the UK Biobank and had asthma but no diagnosis of diabetes mellitus. HbA1c level was analyzed as a continuous measure and also categorized as normal (<42 mmol/mol) or as consistent with prediabetes/diabetes (≥42 mmol/mol). An asthma-related hospitalization was defined as ever having had a hospitalization with an International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification code of a main diagnosis compatible with asthma (International Classification of Diseases, Ninth Revision, Clinical Modification code 493.x or International Classification of Diseases, Tenth Revision, Clinical Modification codes J45.x and J46.x). Logistic or linear regression was used for the multivariable analysis of asthma hospitalizations and lung function measures (FEV1, forced vital capacity [FVC], and FEV1/FVC). All models were adjusted for age, sex, ethnic background, body mass index, average annual household income, current smoking status, pack-years of smoking, fasting time, and C-reactive protein level. RESULTS Both HbA1c level (odds ratio, 1.03; 95% CI, 1.01-1.04) and an HbA1c level in the prediabetes/diabetes range (odds ratio, 1.68; 95% CI, 1.18-2.41) were associated with 1 or more asthma hospitalizations. Moreover, both HbA1c level and an HbA1c level in the prediabetes/diabetes range were significantly and inversely associated with FEV1 and FVC. CONCLUSIONS HbA1c is linked to asthma-related hospitalizations and small decrements in FEV1 and FVC among British adults with asthma but no diagnosis of diabetes mellitus.
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Affiliation(s)
- Ge Yang
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa; Department of Neonatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yueh-Ying Han
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Qi Yan
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Franziska Rosser
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Wei Chen
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa.
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Telehealth Use among Community Health Centers and Cardio-Metabolic Health Outcomes. Healthcare (Basel) 2020; 8:healthcare8020165. [PMID: 32532120 PMCID: PMC7348805 DOI: 10.3390/healthcare8020165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 01/10/2023] Open
Abstract
Public health interventions to manage the cardio-metabolic syndrome (CMS) have had modest success, necessitating the expansion of telehealth services to where people live. This effort analyzes the association between telehealth provision and the management of CMS-related quality measures (hypertension, diabetes, weight assessment and related counseling, lipid therapy for coronary artery disease, and antiplatelet therapy for ischemic vascular disease) using the Uniform Data System administrative database during the period 2016–2018. A total of 523, 600, and 586 community health centers (CHCs) were documented using telehealth, out of the 1367, 1373, and 1362 total CHCs, in the respective three years. Our primary analysis showed that there was no association between telehealth use and the outcomes. A difference in difference approach that compared the CHCs which transitioned from not using it to using it with those that did not use telehealth in two consecutive years also produced null results. However, among rural areas, the odds of better managing the outcomes were greater for certain outcomes. Our study provides limited support that the adoption of telehealth is potentially beneficial in improving certain outcomes in the CHCs setting that are based in rural areas. More specificity in data regarding the nature of telehealth implementation in the CHC setting could bring clarity in these associations.
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13
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Mechanick JI, Farkouh ME, Newman JD, Garvey WT. Cardiometabolic-Based Chronic Disease, Adiposity and Dysglycemia Drivers: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75:525-538. [PMID: 32029136 PMCID: PMC7187687 DOI: 10.1016/j.jacc.2019.11.044,+10.1016/s0735-1097(20)31152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/06/2019] [Accepted: 11/17/2019] [Indexed: 02/01/2024]
Abstract
A new cardiometabolic-based chronic disease (CMBCD) model is presented that provides a basis for early and sustainable, evidence-based therapeutic targeting to promote cardiometabolic health and mitigate the development and ravages of cardiovascular disease. In the first part of this JACC State-of-the-Art Review, a framework is presented for CMBCD, focusing on 3 primary drivers (genetics, environment, and behavior) and 2 metabolic drivers (adiposity and dysglycemia) with applications to 3 cardiovascular endpoints (coronary heart disease, heart failure, and atrial fibrillation). Specific mechanistic pathways are presented configuring early primary drivers with subsequent adiposity, insulin resistance, β-cell dysfunction, and metabolic syndrome, leading to cardiovascular disease. The context for building this CMBCD model is to expose actionable targets for prevention to achieve optimal cardiovascular outcomes. The tactical implementation of this CMBCD model is the subject of second part of this JACC State-of-the-Art Review.
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Affiliation(s)
- Jeffrey I Mechanick
- Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Michael E Farkouh
- Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan D Newman
- Division of Cardiology and Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University Medical Center, New York, New York
| | - W Timothy Garvey
- Department of Nutrition Sciences and Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama; Geriatric Research Education and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
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14
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Mechanick JI, Farkouh ME, Newman JD, Garvey WT. Cardiometabolic-Based Chronic Disease, Adiposity and Dysglycemia Drivers: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75. [PMID: 32029136 PMCID: PMC7187687 DOI: 10.1016/j.jacc.2019.11.044, 10.1016/s0735-1097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
A new cardiometabolic-based chronic disease (CMBCD) model is presented that provides a basis for early and sustainable, evidence-based therapeutic targeting to promote cardiometabolic health and mitigate the development and ravages of cardiovascular disease. In the first part of this JACC State-of-the-Art Review, a framework is presented for CMBCD, focusing on 3 primary drivers (genetics, environment, and behavior) and 2 metabolic drivers (adiposity and dysglycemia) with applications to 3 cardiovascular endpoints (coronary heart disease, heart failure, and atrial fibrillation). Specific mechanistic pathways are presented configuring early primary drivers with subsequent adiposity, insulin resistance, β-cell dysfunction, and metabolic syndrome, leading to cardiovascular disease. The context for building this CMBCD model is to expose actionable targets for prevention to achieve optimal cardiovascular outcomes. The tactical implementation of this CMBCD model is the subject of second part of this JACC State-of-the-Art Review.
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Affiliation(s)
- Jeffrey I. Mechanick
- Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael E. Farkouh
- Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan D. Newman
- Division of Cardiology and Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University Medical Center, New York, New York
| | - W. Timothy Garvey
- Department of Nutrition Sciences and Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama;,Geriatric Research Education and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
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Metabolic syndrome and metabolically healthy status in adults with overweight or obesity, expressing no desire to lose weight. Obes Res Clin Pract 2019; 14:47-53. [PMID: 31883739 DOI: 10.1016/j.orcp.2019.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/14/2019] [Accepted: 11/28/2019] [Indexed: 12/27/2022]
Abstract
AIM To examine the prevalence of metabolic syndrome (MetS) and metabolically healthy status (MHS) in adults with excess weight, who express no desire to lose weight (DLW). METHODS We used the National Health and Nutrition Examination Survey (2011-2016) to conduct a cross-sectional analysis of 4509 adults with excess weight. The prevalence of MetS and MHS was estimated by a DLW status. The prevalence ratios (PRs) were estimated, adjusting for demographic characteristics, to compare the prevalence of MetS and MHS between those with and without a DLW. RESULTS Among adults who were overweight, the crude prevalence of MetS was 28.9% (95% CI 23.7, 34.1) in the no-DLW group and 36.0% (95% CI 31.9, 40.0) in the DLW group (adjusted PR 0.88; 95% CI 0.70, 1.11). Among adults with obesity, the crude prevalence of MetS was 60.0% (95% CI 52.3, 67.6) in the no-DLW group and 63.2% (95% CI 60.0, 66.4) in the DLW group (adjusted PR 1.00; 95% CI 0.88, 1.14). Among adults who were overweight, the prevalence of MHS was 17.5% (95% CI 13.4, 22.2) in the no-DLW group, and 9.5% (95% CI 7.6, 11.6) in the DLW group (adjusted PR 1.27; 95% CI 0.96, 1.69). Nearly all adults with obesity had at least one component of MetS regardless of DSW status. CONCLUSIONS One in four overweight adults and three in five obese adults without a DLW had MetS in the U.S. A majority of adults who were overweight or obese without a DSW had at least one component of MetS.
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Association of longitudinal risk profile trajectory clusters with adipose tissue depots measured by magnetic resonance imaging. Sci Rep 2019; 9:16972. [PMID: 31740739 PMCID: PMC6861315 DOI: 10.1038/s41598-019-53546-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/31/2019] [Indexed: 12/20/2022] Open
Abstract
The objective of the study was to identify associations of longitudinal trajectories of traditional cardiometabolic risk factors with abdominal and ectopic adipose tissue depots measured by magnetic resonance imaging (MRI). We measured total abdominal, visceral, and subcutaneous adipose tissue in liter and intrahepatic, intrapancreatic and renal sinus fat as fat fractions by MRI in 325 individuals free of cardiovascular disease at Exam 3 of a population-based cohort. We related these MRI measurements at Exam 3 to longitudinal risk profile trajectory clusters, based on risk factor measurements from Exam 3, Exam 2 (seven years prior to MRI) and Exam 1 (14 years prior to MRI). Based on the levels and longitudinal trajectories of several risk factors (blood pressure, lipid profile, anthropometric measurements, HbA1c), we identified three different trajectory clusters. These clusters displayed a graded association with all adipose tissue traits after adjustment for potential confounders (e.g. visceral adipose tissue: βClusterII = 1.30 l, 95%-CI:[0.84 l;1.75 l], βClusterIII = 3.32 l[2.74 l;3.90 l]; intrahepatic: EstimateClusterII = 1.54[1.27,1.86], EstimateClusterIII = 2.48[1.93,3.16]. Associations remained statistically significant after additional adjustment for the risk factor levels at Exam 1 or Exam 3, respectively. Trajectory clusters provided additional information in explaining variation in the different fat compartments beyond risk factor profiles obtained at individual exams. In conclusion, sustained high risk factor levels and unfavorable trajectories are associated with high levels of adipose tissue; however, the association with cardiometabolic risk factors varies substantially between different ectopic adipose tissues. Trajectory clusters, covering longitudinal risk profiles, provide additional information beyond single-point risk profiles. This emphasizes the need to incorporate longitudinal information in cardiometabolic risk estimation.
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Mendoza-Herrera K, Pedroza-Tobías A, Hernández-Alcaraz C, Ávila-Burgos L, Aguilar-Salinas CA, Barquera S. Attributable Burden and Expenditure of Cardiovascular Diseases and Associated Risk Factors in Mexico and other Selected Mega-Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4041. [PMID: 31652519 PMCID: PMC6843962 DOI: 10.3390/ijerph16204041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/13/2019] [Accepted: 10/17/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND This paper describes the health and economic burden of cardiovascular diseases (CVD) in Mexico and other mega-countries through a review of literature and datasets. METHODS Mega-countries with a low (Nigeria), middle (India), high (China/Brazil/Mexico), and very high (the U.S.A./Japan) human development index were included. The review was focused on prevalence of dyslipidemias and CVD economic impact and conducted according to the PRISMA statement. Public datasets of CVD indicators were explored. RESULTS Heterogeneity in economic data and limited information on dyslipidemias were found. Hypertriglyceridemia and hypercholesterolemia were higher in Mexico compared with other countries. Higher contribution of dietary risk factors for cardiovascular mortality and greater probability of dying prematurely from CVD were observed in developing countries. From 1990-2016, a greater decrease in cardiovascular mortality in developed countries was registered. In 2015, a CVD expense equivalent to 4% of total health expenditure was reported in Mexico. CVD ranked first in health expenditures in almost all these nations and the economic burden will remain significant for decades to come. CONCLUSIONS Resources should be assured to optimize CVD risk monitoring. Educational and medical models must be improved to enhance CVD diagnosis and the prescription and adherence to treatments. Long-term benefits could be attained by modifying the food system.
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Affiliation(s)
- Kenny Mendoza-Herrera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico.
| | - Andrea Pedroza-Tobías
- Institute for Global Health Sciences, University of California, San Francisco, CA 94158, USA.
| | - César Hernández-Alcaraz
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico.
| | - Leticia Ávila-Burgos
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico.
| | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabolicas, Mexico City 14080, Mexico.
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City 14080, Mexico.
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey 64710, N.L., Mexico.
| | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico.
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18
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Wiss DA. The Relationship Between Alcohol and Glycohemoglobin: A Biopsychosocial Perspective. Biores Open Access 2019; 8:146-154. [PMID: 31588381 PMCID: PMC6776959 DOI: 10.1089/biores.2019.0009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
With the rising prevalence of type 2 diabetes mellitus (T2DM), there is debate regarding biological and psychosocial risk factors. While it is well established that alcohol lowers glycohemoglobin (HbA1c) levels, it is less clear whether alcohol consumption is protective of T2DM. It is also unclear how gender and ethnicity influence the utility of HbA1c screening as a tool for T2DM diagnosis, particularly in the context of alcohol use. This cross-sectional study utilized the National Health and Nutrition Examination Survey 2013–2014 dataset and was restricted to adults 20 years and older, nonpregnant, and not on antihypertensive medication (n = 4299) to evaluate the relationship between alcohol use and HbA1c. A multilinear regression model controlled for gender, ethnicity, education level, body mass index, and age. After controlling for covariates, both moderate (β = −0.073; p = 0.033) and heavy drinking (β = −0.167; p < 0.001) are associated with reduced HbA1c levels. Additionally, female gender is a significant negative predictor of HbA1c (β = −0.052; p = 0.024) and all ethnic groups have higher levels of HbA1c compared with non-Hispanic whites. Plausible biological mechanisms are discussed. The clinical utility of HbA1c as a screening tool for T2DM without considering alcohol use, gender, and ethnicity may lead to diagnostic errors. Individualized approaches and focused efforts toward health equity are needed to address rising rates of T2DM.
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Affiliation(s)
- David A. Wiss
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
- Address correspondence to: David A. Wiss, MS, RDN, Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, 650 Young Drive South, Los Angeles, CA 90025
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Müller TD, Clemmensen C, Finan B, DiMarchi RD, Tschöp MH. Anti-Obesity Therapy: from Rainbow Pills to Polyagonists. Pharmacol Rev 2019; 70:712-746. [PMID: 30087160 DOI: 10.1124/pr.117.014803] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
With their ever-growing prevalence, obesity and diabetes represent major health threats of our society. Based on estimations by the World Health Organization, approximately 300 million people will be obese in 2035. In 2015 alone there were more than 1.6 million fatalities attributable to hyperglycemia and diabetes. In addition, treatment of these diseases places an enormous burden on our health care system. As a result, the development of pharmacotherapies to tackle this life-threatening pandemic is of utmost importance. Since the beginning of the 19th century, a variety of drugs have been evaluated for their ability to decrease body weight and/or to improve deranged glycemic control. The list of evaluated drugs includes, among many others, sheep-derived thyroid extracts, mitochondrial uncouplers, amphetamines, serotonergics, lipase inhibitors, and a variety of hormones produced and secreted by the gastrointestinal tract or adipose tissue. Unfortunately, when used as a single hormone therapy, most of these drugs are underwhelming in their efficacy or safety, and placebo-subtracted weight loss attributed to such therapy is typically not more than 10%. In 2009, the generation of a single molecule with agonism at the receptors for glucagon and the glucagon-like peptide 1 broke new ground in obesity pharmacology. This molecule combined the beneficial anorectic and glycemic effects of glucagon-like peptide 1 with the thermogenic effect of glucagon into a single molecule with enhanced potency and sustained action. Several other unimolecular dual agonists have subsequently been developed, and, based on their preclinical success, these molecules illuminate the path to a new and more fruitful era in obesity pharmacology. In this review, we focus on the historical pharmacological approaches to treat obesity and glucose intolerance and describe how the knowledge obtained by these studies led to the discovery of unimolecular polypharmacology.
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Affiliation(s)
- T D Müller
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany (T.D.M., C.C., M.H.T.); German Center for Diabetes Research, Neuherberg, Germany (T.D.M., C.C., M.H.T.); Department of Chemistry, Indiana University, Bloomington, Indiana (B.F., R.D.D.); and Division of Metabolic Diseases, Technische Universität München, Munich, Germany (M.H.T.)
| | - C Clemmensen
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany (T.D.M., C.C., M.H.T.); German Center for Diabetes Research, Neuherberg, Germany (T.D.M., C.C., M.H.T.); Department of Chemistry, Indiana University, Bloomington, Indiana (B.F., R.D.D.); and Division of Metabolic Diseases, Technische Universität München, Munich, Germany (M.H.T.)
| | - B Finan
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany (T.D.M., C.C., M.H.T.); German Center for Diabetes Research, Neuherberg, Germany (T.D.M., C.C., M.H.T.); Department of Chemistry, Indiana University, Bloomington, Indiana (B.F., R.D.D.); and Division of Metabolic Diseases, Technische Universität München, Munich, Germany (M.H.T.)
| | - R D DiMarchi
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany (T.D.M., C.C., M.H.T.); German Center for Diabetes Research, Neuherberg, Germany (T.D.M., C.C., M.H.T.); Department of Chemistry, Indiana University, Bloomington, Indiana (B.F., R.D.D.); and Division of Metabolic Diseases, Technische Universität München, Munich, Germany (M.H.T.)
| | - M H Tschöp
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany (T.D.M., C.C., M.H.T.); German Center for Diabetes Research, Neuherberg, Germany (T.D.M., C.C., M.H.T.); Department of Chemistry, Indiana University, Bloomington, Indiana (B.F., R.D.D.); and Division of Metabolic Diseases, Technische Universität München, Munich, Germany (M.H.T.)
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Garrett BE, West JH, Crookston BT, Hall PC. Perceptions of Body Mass Index as a Valid Indicator of Weight Status among Adults in the United States. Health (London) 2019. [DOI: 10.4236/health.2019.115049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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21
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Brown AF, Liang LJ, Vassar SD, Escarce JJ, Merkin SS, Cheng E, Richards A, Seeman T, Longstreth WT. Trends in Racial/Ethnic and Nativity Disparities in Cardiovascular Health Among Adults Without Prevalent Cardiovascular Disease in the United States, 1988 to 2014. Ann Intern Med 2018; 168:541-549. [PMID: 29554692 PMCID: PMC6499476 DOI: 10.7326/m17-0996] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Trends in cardiovascular disparities are poorly understood, even as diversity increases in the United States. OBJECTIVE To examine U.S. trends in racial/ethnic and nativity disparities in cardiovascular health. DESIGN Repeated cross-sectional study. SETTING NHANES (National Health and Nutrition Examination Survey), 1988 to 2014. PARTICIPANTS Adults aged 25 years or older who did not report cardiovascular disease. MEASUREMENTS Racial/ethnic, nativity, and period differences in Life's Simple 7 (LS7) health factors and behaviors (blood pressure, cholesterol, hemoglobin A1c, body mass index, physical activity, diet, and smoking) and optimal composite scores for cardiovascular health (LS7 score ≥10). RESULTS Rates of optimal cardiovascular health remain below 40% among whites, 25% among Mexican Americans, and 15% among African Americans. Disparities in optimal cardiovascular health between whites and African Americans persisted but decreased over time. In 1988 to 1994, the percentage of African Americans with optimal LS7 scores was 22.8 percentage points (95% CI, 19.3 to 26.4 percentage points) lower than that of whites in persons aged 25 to 44 years and 8.0 percentage points (CI, 6.4 to 9.7 percentage points) lower in those aged 65 years or older. By 2011 to 2014, differences decreased to 10.6 percentage points (CI, 7.4 to 13.9 percentage points) and 3.8 percentage points (CI, 2.5 to 5.0 percentage points), respectively. Disparities in optimal LS7 scores between whites and Mexican Americans were smaller but also decreased. These decreases were due to reductions in optimal cardiovascular health among whites over all age groups and periods: Between 1988 to 1994 and 2011 to 2014, the percentage of whites with optimal cardiovascular health decreased 15.3 percentage points (CI, 11.1 to 19.4 percentage points) for those aged 25 to 44 years and 4.6 percentage points (CI, 2.7 to 6.5 percentage points) for those aged 65 years or older. LIMITATION Only whites, African Americans, and Mexican Americans were studied. CONCLUSION Cardiovascular health has declined in the United States, racial/ethnic and nativity disparities persist, and decreased disparities seem to be due to worsening cardiovascular health among whites rather than gains among African Americans and Mexican Americans. Multifaceted interventions are needed to address declining population health and persistent health disparities. PRIMARY FUNDING SOURCE National Institute of Neurological Disorders and Stroke and National Center for Advancing Translational Sciences of the National Institutes of Health.
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Affiliation(s)
- Arleen F Brown
- University of California, Los Angeles, Los Angeles, California; Olive View-UCLA Medical Center (A.F.B.)
| | - Li-Jung Liang
- University of California, Los Angeles, Los Angeles, California (L.L., S.D.V., J.J.E., S.S.M., E.C., A.R., T.S.)
| | - Stefanie D Vassar
- University of California, Los Angeles, Los Angeles, California (L.L., S.D.V., J.J.E., S.S.M., E.C., A.R., T.S.)
| | - Jose J Escarce
- University of California, Los Angeles, Los Angeles, California (L.L., S.D.V., J.J.E., S.S.M., E.C., A.R., T.S.)
| | - Sharon Stein Merkin
- University of California, Los Angeles, Los Angeles, California (L.L., S.D.V., J.J.E., S.S.M., E.C., A.R., T.S.)
| | - Eric Cheng
- University of California, Los Angeles, Los Angeles, California (L.L., S.D.V., J.J.E., S.S.M., E.C., A.R., T.S.)
| | - Adam Richards
- University of California, Los Angeles, Los Angeles, California (L.L., S.D.V., J.J.E., S.S.M., E.C., A.R., T.S.)
| | - Teresa Seeman
- University of California, Los Angeles, Los Angeles, California (L.L., S.D.V., J.J.E., S.S.M., E.C., A.R., T.S.)
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Gliniak CM, Brown JM, Noy N. The retinol-binding protein receptor STRA6 regulates diurnal insulin responses. J Biol Chem 2017; 292:15080-15093. [PMID: 28733465 DOI: 10.1074/jbc.m117.782334] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/17/2017] [Indexed: 01/06/2023] Open
Abstract
It has long been appreciated that insulin action is closely tied to circadian rhythms. However, the mechanisms that dictate diurnal insulin sensitivity in metabolic tissues are not well understood. Retinol-binding protein 4 (RBP4) has been implicated as a driver of insulin resistance in rodents and humans, and it has become an attractive drug target in type II diabetes. RBP4 is synthesized primarily in the liver where it binds retinol and transports it to tissues throughout the body. The retinol-RBP4 complex (holo-RBP) can be recognized by a cell-surface receptor known as stimulated by retinoic acid 6 (STRA6), which transports retinol into cells. Coupled to retinol transport, holo-RBP can activate STRA6-driven Janus kinase (JAK) signaling and downstream induction of signal transducer and activator of transcription (STAT) target genes. STRA6 signaling in white adipose tissue has been shown to inhibit insulin receptor responses. Here, we examined diurnal rhythmicity of the RBP4/STRA6 signaling axis and investigated whether STRA6 is necessary for diurnal variations in insulin sensitivity. We show that adipose tissue STRA6 undergoes circadian patterning driven in part by the nuclear transcription factor REV-ERBα. Furthermore, STRA6 is necessary for diurnal rhythmicity of insulin action and JAK/STAT signaling in adipose tissue. These findings establish that holo-RBP and its receptor STRA6 are potent regulators of diurnal insulin responses and suggest that the holo-RBP/STRA6 signaling axis may represent a novel therapeutic target in type II diabetes.
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Affiliation(s)
- Christy M Gliniak
- From the Department of Cellular and Molecular Medicine and.,the Department of Nutrition, Case Western Reserve University, Cleveland, Ohio 44106
| | - J Mark Brown
- From the Department of Cellular and Molecular Medicine and .,the Department of Nutrition, Case Western Reserve University, Cleveland, Ohio 44106.,the Center for Microbiome and Human Health, Cleveland Clinic, Cleveland, Ohio 44195 and
| | - Noa Noy
- From the Department of Cellular and Molecular Medicine and
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23
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Klompas M, Cocoros NM, Menchaca JT, Erani D, Hafer E, Herrick B, Josephson M, Lee M, Payne Weiss MD, Zambarano B, Eberhardt KR, Malenfant J, Nasuti L, Land T. State and Local Chronic Disease Surveillance Using Electronic Health Record Systems. Am J Public Health 2017; 107:1406-1412. [PMID: 28727539 DOI: 10.2105/ajph.2017.303874] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To assess the feasibility of chronic disease surveillance using distributed analysis of electronic health records and to compare results with Behavioral Risk Factor Surveillance System (BRFSS) state and small-area estimates. METHODS We queried the electronic health records of 3 independent Massachusetts-based practice groups using a distributed analysis tool called MDPHnet to measure the prevalence of diabetes, asthma, smoking, hypertension, and obesity in adults for the state and 13 cities. We adjusted observed rates for age, gender, and race/ethnicity relative to census data and compared them with BRFSS state and small-area estimates. RESULTS The MDPHnet population under surveillance included 1 073 545 adults (21.8% of the state adult population). MDPHnet and BRFSS state-level estimates were similar: 9.4% versus 9.7% for diabetes, 10.0% versus 12.0% for asthma, 13.5% versus 14.7% for smoking, 26.3% versus 29.6% for hypertension, and 22.8% versus 23.8% for obesity. Correlation coefficients for MDPHnet versus BRFSS small-area estimates ranged from 0.890 for diabetes to 0.646 for obesity. CONCLUSIONS Chronic disease surveillance using electronic health record data is feasible and generates estimates comparable with BRFSS state and small-area estimates.
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Affiliation(s)
- Michael Klompas
- Michael Klompas, Noelle M. Cocoros, John T. Menchaca, and Jessica Malenfant are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Diana Erani, Ellen Hafer, and Mark Josephson are with the Massachusetts League of Community Health Centers, Boston. Brian Herrick and Michelle D. Payne Weiss are with Cambridge Health Alliance, Cambridge, MA. Michael Lee is with Atrius Health, Boston. Bob Zambarano and Karen R. Eberhardt are with Commonwealth Informatics Inc, Waltham, MA. Laura Nasuti and Thomas Land are with the Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston
| | - Noelle M Cocoros
- Michael Klompas, Noelle M. Cocoros, John T. Menchaca, and Jessica Malenfant are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Diana Erani, Ellen Hafer, and Mark Josephson are with the Massachusetts League of Community Health Centers, Boston. Brian Herrick and Michelle D. Payne Weiss are with Cambridge Health Alliance, Cambridge, MA. Michael Lee is with Atrius Health, Boston. Bob Zambarano and Karen R. Eberhardt are with Commonwealth Informatics Inc, Waltham, MA. Laura Nasuti and Thomas Land are with the Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston
| | - John T Menchaca
- Michael Klompas, Noelle M. Cocoros, John T. Menchaca, and Jessica Malenfant are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Diana Erani, Ellen Hafer, and Mark Josephson are with the Massachusetts League of Community Health Centers, Boston. Brian Herrick and Michelle D. Payne Weiss are with Cambridge Health Alliance, Cambridge, MA. Michael Lee is with Atrius Health, Boston. Bob Zambarano and Karen R. Eberhardt are with Commonwealth Informatics Inc, Waltham, MA. Laura Nasuti and Thomas Land are with the Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston
| | - Diana Erani
- Michael Klompas, Noelle M. Cocoros, John T. Menchaca, and Jessica Malenfant are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Diana Erani, Ellen Hafer, and Mark Josephson are with the Massachusetts League of Community Health Centers, Boston. Brian Herrick and Michelle D. Payne Weiss are with Cambridge Health Alliance, Cambridge, MA. Michael Lee is with Atrius Health, Boston. Bob Zambarano and Karen R. Eberhardt are with Commonwealth Informatics Inc, Waltham, MA. Laura Nasuti and Thomas Land are with the Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston
| | - Ellen Hafer
- Michael Klompas, Noelle M. Cocoros, John T. Menchaca, and Jessica Malenfant are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Diana Erani, Ellen Hafer, and Mark Josephson are with the Massachusetts League of Community Health Centers, Boston. Brian Herrick and Michelle D. Payne Weiss are with Cambridge Health Alliance, Cambridge, MA. Michael Lee is with Atrius Health, Boston. Bob Zambarano and Karen R. Eberhardt are with Commonwealth Informatics Inc, Waltham, MA. Laura Nasuti and Thomas Land are with the Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston
| | - Brian Herrick
- Michael Klompas, Noelle M. Cocoros, John T. Menchaca, and Jessica Malenfant are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Diana Erani, Ellen Hafer, and Mark Josephson are with the Massachusetts League of Community Health Centers, Boston. Brian Herrick and Michelle D. Payne Weiss are with Cambridge Health Alliance, Cambridge, MA. Michael Lee is with Atrius Health, Boston. Bob Zambarano and Karen R. Eberhardt are with Commonwealth Informatics Inc, Waltham, MA. Laura Nasuti and Thomas Land are with the Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston
| | - Mark Josephson
- Michael Klompas, Noelle M. Cocoros, John T. Menchaca, and Jessica Malenfant are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Diana Erani, Ellen Hafer, and Mark Josephson are with the Massachusetts League of Community Health Centers, Boston. Brian Herrick and Michelle D. Payne Weiss are with Cambridge Health Alliance, Cambridge, MA. Michael Lee is with Atrius Health, Boston. Bob Zambarano and Karen R. Eberhardt are with Commonwealth Informatics Inc, Waltham, MA. Laura Nasuti and Thomas Land are with the Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston
| | - Michael Lee
- Michael Klompas, Noelle M. Cocoros, John T. Menchaca, and Jessica Malenfant are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Diana Erani, Ellen Hafer, and Mark Josephson are with the Massachusetts League of Community Health Centers, Boston. Brian Herrick and Michelle D. Payne Weiss are with Cambridge Health Alliance, Cambridge, MA. Michael Lee is with Atrius Health, Boston. Bob Zambarano and Karen R. Eberhardt are with Commonwealth Informatics Inc, Waltham, MA. Laura Nasuti and Thomas Land are with the Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston
| | - Michelle D Payne Weiss
- Michael Klompas, Noelle M. Cocoros, John T. Menchaca, and Jessica Malenfant are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Diana Erani, Ellen Hafer, and Mark Josephson are with the Massachusetts League of Community Health Centers, Boston. Brian Herrick and Michelle D. Payne Weiss are with Cambridge Health Alliance, Cambridge, MA. Michael Lee is with Atrius Health, Boston. Bob Zambarano and Karen R. Eberhardt are with Commonwealth Informatics Inc, Waltham, MA. Laura Nasuti and Thomas Land are with the Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston
| | - Bob Zambarano
- Michael Klompas, Noelle M. Cocoros, John T. Menchaca, and Jessica Malenfant are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Diana Erani, Ellen Hafer, and Mark Josephson are with the Massachusetts League of Community Health Centers, Boston. Brian Herrick and Michelle D. Payne Weiss are with Cambridge Health Alliance, Cambridge, MA. Michael Lee is with Atrius Health, Boston. Bob Zambarano and Karen R. Eberhardt are with Commonwealth Informatics Inc, Waltham, MA. Laura Nasuti and Thomas Land are with the Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston
| | - Karen R Eberhardt
- Michael Klompas, Noelle M. Cocoros, John T. Menchaca, and Jessica Malenfant are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Diana Erani, Ellen Hafer, and Mark Josephson are with the Massachusetts League of Community Health Centers, Boston. Brian Herrick and Michelle D. Payne Weiss are with Cambridge Health Alliance, Cambridge, MA. Michael Lee is with Atrius Health, Boston. Bob Zambarano and Karen R. Eberhardt are with Commonwealth Informatics Inc, Waltham, MA. Laura Nasuti and Thomas Land are with the Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston
| | - Jessica Malenfant
- Michael Klompas, Noelle M. Cocoros, John T. Menchaca, and Jessica Malenfant are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Diana Erani, Ellen Hafer, and Mark Josephson are with the Massachusetts League of Community Health Centers, Boston. Brian Herrick and Michelle D. Payne Weiss are with Cambridge Health Alliance, Cambridge, MA. Michael Lee is with Atrius Health, Boston. Bob Zambarano and Karen R. Eberhardt are with Commonwealth Informatics Inc, Waltham, MA. Laura Nasuti and Thomas Land are with the Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston
| | - Laura Nasuti
- Michael Klompas, Noelle M. Cocoros, John T. Menchaca, and Jessica Malenfant are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Diana Erani, Ellen Hafer, and Mark Josephson are with the Massachusetts League of Community Health Centers, Boston. Brian Herrick and Michelle D. Payne Weiss are with Cambridge Health Alliance, Cambridge, MA. Michael Lee is with Atrius Health, Boston. Bob Zambarano and Karen R. Eberhardt are with Commonwealth Informatics Inc, Waltham, MA. Laura Nasuti and Thomas Land are with the Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston
| | - Thomas Land
- Michael Klompas, Noelle M. Cocoros, John T. Menchaca, and Jessica Malenfant are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Diana Erani, Ellen Hafer, and Mark Josephson are with the Massachusetts League of Community Health Centers, Boston. Brian Herrick and Michelle D. Payne Weiss are with Cambridge Health Alliance, Cambridge, MA. Michael Lee is with Atrius Health, Boston. Bob Zambarano and Karen R. Eberhardt are with Commonwealth Informatics Inc, Waltham, MA. Laura Nasuti and Thomas Land are with the Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston
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24
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Guo F, Garvey WT. Cardiometabolic Disease Staging Predicts Effectiveness of Weight-Loss Therapy to Prevent Type 2 Diabetes: Pooled Results From Phase III Clinical Trials Assessing Phentermine/Topiramate Extended Release. Diabetes Care 2017; 40:856-862. [PMID: 28455281 PMCID: PMC5481985 DOI: 10.2337/dc17-0088] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/28/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the ability of medication-assisted weight loss to prevent diabetes as a function of the baseline weighted Cardiometabolic Disease Staging (CMDS) score. RESEARCH DESIGN AND METHODS We pooled data from 3,040 overweight and obese participants in three randomized controlled trials-CONQUER, EQUIP, and SEQUEL-assessing efficacy and safety of phentermine/topiramate extended release (ER) for weight loss. In these double-blind phase III trials, overweight/obese adult patients were treated with a lifestyle intervention and randomly assigned to placebo versus once-daily oral phentermine/topiramate ER. The weighted CMDS score was calculated using baseline quantitative clinical data including waist circumference, blood glucose, blood pressure, and blood lipids. Incident diabetes was defined based on serial measures of fasting glucose, 2-h oral glucose tolerance test glucose, and/or HbA1c. RESULTS The absolute decrease in 1-year diabetes incidence rates in subjects treated with medication versus placebo was greatest in those with high-risk CMDS scores at baseline (10.43-6.29%), intermediate in those with moderate CMDS risk (4.67-2.37%), and small in the low-risk category (1.51-0.67%). The number of participants needed to treat to prevent one new case of diabetes over a 56-week period was 24, 43, and 120 in those with baseline CMDS scores of ≥60, 30-59, and 0-29, respectively. CONCLUSIONS Numbers needed to treat to prevent one case of type 2 diabetes are markedly lower in patients with high-risk scores. CMDS can be used to quantify risk of diabetes in overweight/obese individuals and predict the effectiveness of weight-loss therapy to prevent diabetes.
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Affiliation(s)
- Fangjian Guo
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX .,Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX
| | - W Timothy Garvey
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL .,Birmingham Veterans Affairs Medical Center, Birmingham, AL
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25
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Rådholm K, Tengblad A, Dahlén E, Länne T, Engvall J, Nystrom FH, Östgren CJ. The impact of using sagittal abdominal diameter to predict major cardiovascular events in European patients with type 2 diabetes. Nutr Metab Cardiovasc Dis 2017; 27:418-422. [PMID: 28390663 DOI: 10.1016/j.numecd.2017.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/05/2017] [Accepted: 02/08/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Obesity is associated with diabetes type 2 and one of the most important risk factors for cardiovascular disease. We explored if sagittal abdominal diameter (SAD) is a better predictor of major cardiovascular events than waist circumference (WC) and body mass index (BMI) in type 2 diabetes. METHODS AND RESULTS The CARDIPP study consists of a cohort of patients with type 2 diabetes. In this study we used data from 635 participants with no previous myocardial infarction or stroke, with a mean follow-up time of 7.1 years. SAD, WC and BMI were measured at baseline and the end-point was first cardiovascular event, measured as a composite of ICD-10 codes for acute myocardial infarction, stroke or cardiovascular mortality. SAD was significantly higher in the major cardiovascular event group compared to participants that did not suffer a major cardiovascular event during follow-up (p < 0.001). SAD >25 cm was the only anthropometric measurement that remained associated with major cardiovascular events when adjusted for modifiable and non-modifiable factors (hazard ratio 2.81, 95% confidence interval 1.37-5.76, p = 0.005). CONCLUSION SAD with the cut off level of >25 cm, if confirmed in larger studies, may be used as a more independent risk-assessment tool compared with WC in clinical practice, to identify persons with type 2 diabetes at high cardiovascular risk. ClinicalTrials.gov: NCT01049737.
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Affiliation(s)
- K Rådholm
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Department of Local Care West, County Council of Östergötland, SE-581 83 Linköping, Sweden.
| | - A Tengblad
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Department of Local Care West, County Council of Östergötland, SE-581 83 Linköping, Sweden
| | - E Dahlén
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Department of Local Care West, County Council of Östergötland, SE-581 83 Linköping, Sweden
| | - T Länne
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, SE-58185 Linköping, Sweden
| | - J Engvall
- Department of Clinical Physiology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, SE-58183, Sweden
| | - F H Nystrom
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, SE-58185 Linköping, Sweden
| | - C J Östgren
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Department of Local Care West, County Council of Östergötland, SE-581 83 Linköping, Sweden
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