The efficacy of behavioral interventions on cardiovascular risk factors in patients with type 2 diabetes: a systematic review and network meta-analysis of randomized trials.

Type 2 diabetes mellitus (T2DM) is prevalent worldwide, often manageable through lifestyle changes like physical activity. This meta-analysis aimed to determine the effect of resistance training (RT) on cardiovascular risk factors in adults with T2DM. Four databases were searched up to March 2024. The mean difference (MD) was calculated by a random effect model with 95% confidence interval (CI). Forty-eight articles were included in the review. There was a significant pooled effect size for the meta-analysis comparing RT vs. control on hemoglobin A1C (MD = -0.49, 95% CI: -0.66, -0.33; P < 0.00001), fasting blood sugar (MD = -11.58, 95% CI: -18.61, -4.55; P = 0.001), insulin (ES = -1.65, 95% CI: -2.87, -0.42; P = 0.008), HOMA-IR (MD = -1.20, 95% CI: -1.85, -0.55; P = 0.0003), triglyceride (MD = -18.14, 95% CI: -30.32, -5.96; P = 0.004), and high-density lipoprotein (MD = 2.71, 95% CI: 0.78, 4.64; P = 0.006). Moreover, RT was effective for reducing body weight (MD = -0.81, 95% CI: -1.50, -0.13; P = 0.02), fat percentage (MD = -0.92, 95% CI: -1.62, -0.22; P = 0.010), and waist circumference (MD = -2.14, 95% CI: -3.00, -1.28; P < 0.00001). RT effectively improves cardiovascular risk factors in T2DM adults, suggesting potential as treatment or prevention. Future studies can consider investigating the optimal RT regimen to achieve effective T2DM management in adults.

Background. Cardiovascular morbidity increases notably among patients with diabetes. A correlation between leptin resistance and cardiovascular risk was found in patients with arterial hypertension and metabolic syndrome. However, there are no data about the influence of empagliflozin on leptin level; empagliflozin effectiveness against key cardiovascular risk factors in diabetic patients with normal weight and overweight has not been studied yet. The purpose of this work was to study the impact of comprehensive treatment using metformin and empagliflozin on the main cardiovascular risk factors in patients with type 2 diabetes mellitus with different body weights. Materials and methods. Ninety-seven patients with type 2 diabetes with normal weight, overweight and obesity were examined. Anthropometric indicators were taken. The parameters of carbohydrate and lipid metabolism, the level of leptin in blood serum were determined and the HOMA-IR was calculated. Results. Insulin resistance in all groups of patients was associated with abdominal obesity, hyperleptinemia (r=0.505, p&lt;0.05; r=0.846, p&lt;0.05; r=0.886, p&lt;0.05 in patients of groups I–III). After a 6-month course of treatment with metformin and empagliflozin, body weight and waist circumference significantly decreased in overweight and obese patients, and no significant changes between groups were found in those with a normal body mass index. A reliable positive effect of comprehensive treatment on indicators of carbohydrate metabolism, systolic blood pressure, regardless of the patient’s weight, was noted. Under the influence of comprehensive treatment with the use of empagliflozin, the level of leptin (p&lt;0.05) and HOMA-IR (p&lt;0.05) also decreased significantly in patients of all groups, regardless of body mass index. Conclusions. It was found that the combined use of metformin and empagliflozin for 6 months had a reliable effect on the modified cardiovascular risk factors in patients with type 2 diabetes of different weights.

Motivational interviewing may reduce substance use compared with no intervention up to a short follow-up period. MI probably reduces substance use slightly compared with assessment and feedback over medium- and long-term periods. MI may make little to no difference to substance use compared to treatment as usual and another active intervention. It is unclear if MI has an effect on readiness to change and retention in treatment. The studies included in this review were heterogeneous in many respects, including the characteristics of participants, substance(s) used, and interventions. Given the widespread use of MI and the many studies examining MI, it is very important that counsellors adhere to and report quality conditions so that only studies in which the intervention implemented was actually MI are included in evidence syntheses and systematic reviews. Overall, we have moderate to no confidence in the evidence, which forces us to be careful about our conclusions. Consequently, future studies are likely to change the findings and conclusions of this review.

D. et al. (1 more author) (2020) Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis. Cochrane Database of Systematic Reviews.

Probiotic supplementation for management of cardiovascular risk factors in adults with type II diabetes: A systematic review and meta-analysis

Introduction: Secondary dyslipidemia is a common metabolic disturbance that contributes to the development of cardiovascular disease (CVD). Liver enzymes such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) are increasingly recognized as potential markers of metabolic and cardiovascular risk. However, their associations with established cardiovascular risk factors in adults with secondary dyslipidemia remain unclear. Objective: This study aimed to evaluate the relationships between serum liver enzyme levels and traditional cardiovascular risk factors in adults presenting with secondary dyslipidemia. Methods: This cross-sectional observational study was conducted over one year at Raiganj Government Medical College and Hospital. The study enrolled 50 adult patients diagnosed with secondary dyslipidemia. Key variables assessed included age, gender, body mass index (BMI), smoking status, presence of hypertension, liver enzyme levels, lipid profile and other relevant risk factors. Data were collected through clinical evaluation and laboratory investigations. The objective was to analyze the demographic and clinical profile of patients with secondary dyslipidemia and identify associated risk factors. Results: This study of 50 adults with secondary dyslipidemia (mean age 45.6 ± 8.7 years; 56% male) found that most participants were overweight (mean BMI 27.4 ± 3.2 kg/m²), 30% were smokers, and 36% had hypertension. Liver enzyme levels (ALT, AST, GGT, ALP) were generally within normal ranges, though GGT was toward the upper limit. Lipid profiles showed elevated total and LDL cholesterol, low HDL cholesterol, and borderline-high triglycerides. Correlation analysis revealed significant associations: ALT with LDL cholesterol and triglycerides; AST inversely with HDL cholesterol; and GGT with both systolic and diastolic blood pressure. Hypertensive individuals had significantly higher ALT, AST, and GGT levels compared to normotensive participants, while ALP differences were not significant. Conclusion: In adults with secondary dyslipidemia, serum GGT and ALT levels are significantly associated with key cardiovascular risk factors such as obesity, dysglycemia, and hypertriglyceridemia. These liver enzymes may serve as accessible biomarkers for early cardiovascular risk stratification in this population. Further longitudinal studies are warranted to confirm their predictive value for cardiovascular events.

Hyperprolactinaemia is suggested to be associated with metabolic and hormonal complications. No previous study has compared the effect of different dopamine agonists on plasma lipids, carbohydrate metabolism markers and cardiovascular risk factors in patients with elevated prolactin levels. The study included eight bromocriptine-resistant women with prolactinoma (group 1) and twelve matched women with hyperprolactinaemia unrelated to prolactinoma (group 2). Group 1 was then treated with cabergoline, while group 2 with bromocriptine. Plasma lipids, glucose homeostasis markers and plasma levels of prolactin, insulin-like growth factor-1 (IGF-1) and cardiovascular risk factors were assessed before and after 6 months of therapy. Both treatments normalized plasma prolactin levels. Cabergoline reduced triglycerides, 2-hr post-challenge plasma glucose, the homeostatic model assessment of insulin resistance (HOMA-IR), and circulating levels of IGF-1, free fatty acids (FFA), uric acid, high-sensitivity C-reactive protein (hsCRP), homocysteine and fibrinogen, as well as increased HDL cholesterol and 25-hydroxyvitamin D. With the exception of a reduction in HOMA-IR, bromocriptine treatment produced no significant effect on the investigated biomarkers. Cabergoline was superior to bromocriptine in affecting 2-hr post-challenge plasma glucose levels, HOMA-IR, as well as circulating levels of IGF-1, FFA, uric acid, hsCRP, homocysteine, fibrinogen and 25-hydroxyvitamin D. Our results may suggest that cabergoline is superior to bromocriptine when it comes to affecting atherogenic dyslipidaemia, insulin sensitivity and circulating levels of cardiovascular risk factors in hyperprolactinaemic patients. These findings seem to support previous observations that cabergoline may be a better treatment for patients with elevated prolactin levels than bromocriptine.

Physical activity is an important non-drug-related method to prevent and treat cardiovascular diseases, but how exercise duration affects the cardiovascular metabolic risk factors in adults remains uncertain. This review systematically examines the time-dependent effects of physical activity on cardiovascular risk factors in adults and aims to further the understanding of the temporal therapeutics of exercise. Following the PRISMA guidelines, the PubMed, Web of Science, EMBASE, and CNKI databases were systematically searched for relevant scientific studies from January 2000 to June 2022. A total of 16 studies met the inclusion criteria and were included in the systematic review. The sample size ranged from 11-275 participants who were diagnosed with obesity, hypertension, diabetes mellitus type 2 (T2DM), and Coronary Heart Disease (CAD), while the subjects in four studies did not report any metabolic or cardiovascular disease. Four studies conducted trials of acute exercise interventions, while the remaining intervention periods ranged from 12 days to 12 weeks. The exercise interventions included aerobic training, resistance training, aerobic training that was combined with resistance training, compound exercise, and high-intensity interval exercise, and the training frequency varied from 2-5 times/week. Overall, this review found some evidence that the cardiovascular risk factors in adults may be time-dependent in response to physical activity. However, it is limited by the small sample size for each of the outcomes and several methodological issues, leading to poor comparability between studies. A randomized controlled trial with a larger sample size is supposed to be designed for the relevant population to completely test whether synchronizing the exercise time point in the day with the individual's circadian rhythm can amplify the benefits of the exercise for improving cardiovascular health.

The effect of sumac on cardiovascular risk factors in adults: A systematic review and meta-analysis of randomized controlled trials

Mindfulness-based interventions for adults with type 2 diabetes mellitus: A systematic review and meta-analysis.

Psychiatric co-morbidities and cardiovascular risk factors in people with lifetime history of epilepsy of an urban community

BackgroundCardiovascular disease (CVD) is the major cause of mortality in type 1 diabetes (T1D). The objective of this study is to evaluate fibroblast growth factor 23 (FGF23) and calcium‐phosphate metabolism in relation to cardiovascular risk factors in adults with and without T1D.MethodsA case–control study was conducted using data from patients with T1D and age‐ and sex matched controls without T1D from the Lifelines Cohort Study.ResultsWe included 302 adults in the T1D group and 302 adults in the control group. Median age was 42 years. Median glycosylated hemoglobin (HbA1c) in the T1D group was 7.8%. FGF23 of all patients with T1D was not significantly different from controls. Females with T1D had significantly higher FGF23 than males with T1D (83.3 vs 69.3 U/mL, p = 0.002), this was not observed in controls. Serum phosphate, calcium, and alkaline phosphatase were higher and parathyroid hormone was lower in patients with T1D, compared to controls (all p < .001), all within normal range. In the T1D group, FGF23 was positively correlated with serum phosphate (p < .001), alkaline phosphatase (p = .01), and calcium (p = .030), these correlations were not observed in controls. Median FGF23 was significantly higher in current smokers than in nonsmokers with T1D (84.9 vs 73.5 U/mL, p < .05).ConclusionsSerum calcium, phosphate, and alkaline phosphatase were higher in patients with T1D than in controls and were positively correlated to FGF23 in patients with T1D. Current smokers with T1D had higher FGF23 than nonsmokers with T1D. These findings may contribute to the increased risk of CVD in patients with T1D.

The purpose of the study is to evaluate the effects of biologic therapy on cardiovascular risk factors in rheumatoid arthritis patients to determine its clinical efficacy. Relevant literature was systematically searched in PubMed, Embase, and Cochrane Library databases. Meta-analysis was conducted using standardized mean differences (SMDs) and 95% confidence intervals (CIs) to evaluate cardiovascular risk factors and atherosclerosis. Heterogeneity, sensitivity analysis, and publication bias were assessed. Statistical significance was set at P<0.05. The meta-analysis revealed that biologic treatment in RA patients was associated with decreased high-density lipoprotein cholesterol (HDL-C) levels compared to controls (MD: -0.10, 95% CI: [-0.14, -0.05], P<0.0001). Subgroup analysis based on treatment duration showed heterogeneity and a potential decrease in total cholesterol levels after 12 months of treatment (MD = -0.03, 95% CI [-0.21, -0.15], P = 0.76). Biologic therapy significantly reduced triglyceride levels compared to controls (MD = -0.23, 95% CI [-0.37, -0.09], P = 0.001), as observed in subgroup analysis. Moreover, biologics effectively decreased low-density lipoprotein cholesterol (LDL-C) levels (MD: -0.10, 95% CI: [-0.14, -0.05], P<0.0001). However, biologic treatment was associated with increased inner carotid artery thickness (MD: 0.05, 95% CI: [0.03, 0.07], P<0.0001), indicating potential adverse effects on cardiovascular health. No significant effect on pulse wave velocity (PWV) was observed (MD: -0.23, 95% CI: [-0.80, 0.34], P = 0.43, I2 = 0%, P = 0.55). Biologic agents may improve lipid profiles in RA patients but could also have adverse effects on cardiovascular health. Further research is needed to comprehensively understand the impact of biologic therapy on lipid metabolism and cardiovascular outcomes in RA patients. https://www.crd.york.ac.uk/PROSPERO/, CRD42024504911.

Aim. To assess the coverage of preventive counseling on the main modifiable cardiovascular risk factors (RFs) in patients after myocardial infarction (MI) and to identify factors associated with increased counseling activity within a year after the coronary event.Material and methods. The study included 1107 patients with MI aged 35-75 years using a special randomization approach. After 6 months, 889 people were interviewed, and after 12 months — 703 people. At the hospital stage, the smoking status and alcohol consumption were clarified using the Cut down, Annoyed, Guilty, Eye-opener (CAGE) questionnaire. After 6 and 12 months, we clarified whether preventive counseling on the main cardiovascular RFs had been carried out. Social status, changes in life history and disease were also clarified to identify factors associated with receiving preventive counseling.Results. Six and twelve months after MI, preventive counseling on smoking cessation was carried out in 63,8 and 58,4% of smoking patients, respectively; on alcohol cessation — in 16,5 and 14,9%. Patients with obesity (odds ratio (OR) 0,7; confidence interval (CI): 0,48-1,0; p=0,053) and type 2 diabetes (OR 0,49; CI: 0,29-0,82; p=0,008) received counseling on smoking cessation significantly less frequently. Smoking patients (OR 2,87; CI: 1,79-4,66; p&lt;0,001) and those with left ventricular ejection fraction &lt;50% (OR 1,6; CI: 1,01-2,56; p=0,048) received counseling on alcohol cessation more frequently. After 6 and 12 months, 71,5 and 71,6% of patients were consulted on dietary issues, while 56,8 and 31,6% of patients on physical activity, respectively. On dietary issues, obese patients received consultations significantly more often (OR 1,51; CI: 1,02-2,25; p=0,04). Patients observed by a cardiologist more often received consultations on healthy eating (OR 2,1; CI: 1,423,12; p&lt;0,001) and physical activity (OR 2,0; CI: 1,35-2,97; p&lt;0,001).Conclusion. The study results revealed a deficit in preventive counseling on the main modifiable cardiovascular risk factors and their complications.

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