Prevalence Of Cardiometabolic Diseases Research Articles

Health and Cardiometabolic Disease in Transgender Adults in the United States: Behavioral Risk Factor Surveillance System 2015.

ContextLittle is known about the health of transgender adults in the United States, a growing population. There have been no large reports examining differences in health status and cardiometabolic disease in subgroups of transgender adults [female-to-male (FTM), male-to-female (MTF), and gender nonconforming (GNC)] in the United States.ObjectiveCompare the health status and prevalence of cardiometabolic disease among specific subgroups of transgender adults (FTM, MTF, GNC) with those of cisgender adults in the United States.DesignSecondary data analysis based on the 2015 Behavioral Risk Factor Surveillance System survey.SettingThe 22 states in the United States that asked about transgender identity.ParticipantsNoninstitutionalized adults age ≥18 years who reside in the United States, identified through telephone-based methods.Main Outcome MeasuresData were extracted for respondents who answered the transgender identity question. Weighted percentages are given for all measures. Adjusted odds ratios (ORs) are reported for health status and cardiometabolic disease measures.ResultsFTM adults have a higher odds of being uninsured than both cisgender women [OR 3.8; 95% confidence interval (CI), 2.1 to 7.1] and cisgender men (OR 2.5; 95% CI, 1.4 to 4.7). MTF adults have a higher odds of reporting myocardial infarction than cisgender women (OR 2.9; 95% CI, 1.6 to 5.3) but not cisgender men.ConclusionsThere are significant differences in health status measures and cardiometabolic health between subgroups of transgender adults and cisgender adults. There is a need for additional research to understand the societal and medical (e.g., hormone therapy) effects on these outcomes.

<b>Prevalence of major cardiometabolic diseases in the riverine populations from the interior of the State of Amazonas, Brazil

This study aimed to estimate the prevalence of major cardiometabolic diseases according to the sociodemographic characteristics and lifestyle in the riverine communities of the municipalities of Tefé and Santa Isabel do Rio Negro, State of Amazonas, Brazil. Descriptive tests and logistic regression models were used to estimate the effect of age, gender, marital status, education, smoking, alcohol consumption and sedentary lifestyle on the prevalence of cardiometabolic diseases in 552 adults aged from 18 to 78 years. The prevalence of hypertension, diabetes and obesity in Tefé and Santa Isabel do Rio Negro were respectively 28 / 30.7%; 28.2/ 8.9%; and 22.3 / 42%. In Tefé, married men, aged over 35 years, were more susceptible to the cardiometabolic diseases. In Santa Isabel do Rio Negro, smoking men aged over 35 with low education level were more prone to diabetes and hypertension. Such data reinforce the need to monitor the risk indicators as a preventive measure and early detection of some cardiometabolic diseases.

Metabolically healthy obesity and subclinical atherosclerosis in persons with spinal cord injury.

Despite preserved metabolic function, metabolically healthy obesity may increase the risk of subclinical atherosclerosis. Given the high prevalence of cardiometabolic diseases in individuals with spinal cord injury, the aim of this study was to investigate the association of insulin resistance, systemic low-grade inflammation, and markers of subclinical atherosclerosis with metabolically healthy obesity in individuals with spinal cord injury. Insulin resistance index (HOMA-IR), high-sensitivity C-reactive protein, carotid artery intima-media thickness and carotid-femoral pulse wave velocity were measured in individuals with spinal cord injury classified with metabolically healthy obesity (n = 12), metabolically unhealthy obesity (n = 8), or metabolically healthy normal-weight (n = 18). Metabolically healthy obesity was defined as spinal cord injury-specific cut-off of body mass index ≥ 22 kg/m2 with < 3 metabolic abnormalities. There were no differences in HOMA-IR or high-sensitivity C-reactive protein in metabolically healthy obesity compared with metabolically healthy normal-weight (p > 0.05). Pulse wave velocity was higher in metabolically healthy obesity than in metabolically healthy normal-weight (p ≤ 0.05), but lower than in metabolically unhealthy obesity (p ≤ 0.05). Metabolically healthy obesity had similar carotid artery intima-media thickness vs metabolically healthy normal-weight (p > 0.05), but lower carotid artery intima-media thickness compared with metabolically unhealthy obesity (p ≤ 0.05). Despite a somewhat preserved metabolic and inflammatory status, individuals with spinal cord injury with metabolically healthy obesity present with an intermediate subclinical atherosclerotic phenotype, as evidenced by increased aortic stiffness but not carotid thickness.

Introduction of "Sugar Tax" in South Africa: Placebo or panacea to curb the onset of cardio-metabolic diseases?

During 2016 an announcement was made that South Africans will be obliged to pay a 20% “sugar tax’’ that will soon be implemented in order to help curb the rising prevalence of cardio-metabolic diseases. This announcement was met with mixed responses, with strong support from some quarters while others questioned whether it would indeed lead to improved health and well-being of South Africans. As sugar-sweetened beverages (SSBs) constitute a significant portion of added sugars in modern-day diets, it is firmly in the cross-hairs of the new taxation. This perspective article reflects on the proposed sugar tax by exploring the nature of SSB consumption patterns, evaluating epidemiological evidence associating SSB intake to cardio-metabolic diseases risk and by considering examples where a similar tax had previously been introduced. Here data reveal that there is robust evidence supporting a detrimental link between high SSB consumption patterns and the onset of cardiometabolic diseases. It is therefore our strong opinion that the sugar tax option should be pursued in parallel with well-designed, long-term studies to evaluate whether it decreases SSB intake and lowers the prevalence of cardio-metabolic diseases within the South African context.

Insulin Resistance and Hypertension in Obese Youth With Sleep-Disordered Breathing Treated With Positive Airway Pressure: A Prospective Multicenter Study.

There is evidence that cardiometabolic disease associated with obesity and sleep-disordered breathing (SDB) in adults is present in youth. SDB is often treated with positive airway pressure (PAP) in youth with obesity. Our aims were to determine: (1) the prevalence of cardiometabolic disease and (2) whether PAP improves markers of cardiometabolic disease, in youth with obesity and newly diagnosed moderate-severe SDB. A prospective multicenter cohort study was conducted in youth (8 to 16 years old) with obesity, prescribed PAP therapy for newly diagnosed moderate-severe SDB. Assessments occurred at baseline and at 6 and 12 months. Outcomes included markers of insulin resistance (change in homeostasis model assessment of insulin resistance (HOMA-IR) at 6 months = primary outcome), hypertension (24-hour ambulatory/blood pressure) and inflammation (high-sensitivity C-reactive protein: hs-CRP). Twenty-seven participants were enrolled. Of those with baseline testing available, 10/25 (40%) had HOMA-IR above the 97th percentile, 10/23 (44%) were hypertensive, 16/23 (70%) had loss of nocturnal blood pressure dip and hs-CRP was elevated in 16/27 (64%). There were no significant changes over time in markers of metabolic dysfunction or blood pressure, nor between PAP-adherent and non-adherent subgroups. In youth with obesity and SDB, metabolic dysfunction and hypertension were highly prevalent. There were no statistically significant improvements in cardiometabolic markers 1 year after the prescription of PAP therapy, although clinically relevant improvements were seen in insulin resistance and systolic blood pressure load, important predictors of future risk of cardiovascular disease. Larger, longer-term studies are needed to determine whether PAP improves cardiometabolic outcomes in obese youth. A commentary on this article appears in this issue on page 1025.

The relationship between duration of psoriasis, vascular inflammation, and cardiovascular events

Psoriasis is associated with risk of cardiovascular (CV) disease (CVD) and a major adverse CV event (MACE). Whether psoriasis duration affects risk of vascular inflammation and MACEs has not been well characterized. We utilized two resources to understand the effect of psoriasis duration on vascular disease and CV events: (1) a human imaging study and (2) a population-based study of CVD events. First, patients with psoriasis (N=190) underwent fludeoxyglucose F 18 positron emission tomography/computed tomography (duration effect reported as a β-coefficient). Second, MACE risk was examined by using nationwide registries (adjusted hazard ratios in patients with psoriasis (n=87,161) versus the general population (n=4,234,793). In the human imaging study, patients were young, of low CV risk by traditional risk scores, and had a high prevalence of cardiometabolic diseases. Vascular inflammation by fludeoxyglucose F 18 positron emission tomography/computed tomography was significantly associated with disease duration (β=0.171, P=.002). In the population-based study, psoriasis duration had strong relationship with MACE risk (1.0% per additional year of psoriasis duration [hazard ratio, 1.010; 95% confidence interval, 1.007-1.013]). These studies utilized observational data. We found detrimental effects of psoriasis duration on vascular inflammation and MACE, suggesting that cumulative duration of exposure to low-grade chronic inflammation may accelerate vascular disease development and MACEs. Providers should consider inquiring about duration of disease to counsel for heightened CVD risk in psoriasis.

Screening for Risk Factors of Cardiometabolic Disease Among Female University Students in Riyadh, Saudi Arabia

Background:Prevalence of cardiometabolic diseases (CMD), especially among the youth, is a growing public health concern in both developed and developing countries.Objective:To examine cardiovascular and metabolic disease risk factors among a cohort of female university students in Riyadh, Saudi Arabia.Method:Two hundred and twenty-three (223) female students aged 17-25 years participated in the study. Both physical and physiological parameters were assessed using standard procedures and equipment. The study also evaluated the extent to which body mass index (BMI) could predict CMD risk factors among the participants. Alpha level was set at α =0.05.Results:The results showed that 22.4%, 8.5% and 11.2% of the women were overweight, obese, and underweight, respectively. Hemodynamic results indicated that of those overweight and obese, 9.4%and 21.1% were pre-hypertensive, respectively, while only 3 (1.3%) were hypertensive. Blood glucose results showed that 30 (13.5%) participants were pre-diabetic. Also, the BMI for overweight (26.9±1.54 kg/m2)and obese (33.5±3.17 kg/m2) categories indicated participants at the risk of CMD. Further analysis showed a statistically significant correlation between BMI and the following dependent measures: systolic (r = 0.352, p = 0.001) and diastolic (r = 0.136, p = 0.043) BP, waist circumference (r = 0.791, p = 0.001), and fasting blood glucose (r = 0.157, p = 0.019). BMI and age yielded a non-significant association (r = 0.023, p = 0.728). Results of adjusted regression coefficients indicated that BMI accounted for 65.6% of the variance in the women’s physiological variables.Conclusion:It was concluded that although many of the women screened had healthy CMD risk profiles, a few presented with excessively high levels which require follow-up clinical investigation and intervention. The need to undertake large scale surveillance of CMD risk factors among this relatively less studied population is recommended as it will promote early detection of risk profiles and health enhancing behaviours among the youth.

Residential proximity to abandoned uranium mines and serum inflammatory potential in chronically exposed Navajo communities.

Members of the Navajo Nation, who possess a high prevalence of cardiometabolic disease, reside near hundreds of local abandoned uranium mines (AUM), which contribute uranium, arsenic and other metals to the soil, water and air. We recently reported that hypertension is associated with mine waste exposures in this population. Inflammation is a major player in the development of numerous vascular ailments. Our previous work establishing that specific transcriptional responses of cultured endothelial cells treated with human serum can reveal relative circulating inflammatory potential in a manner responsive to pollutant exposures, providing a model to assess responses associated with exposure to these waste materials in this population. To investigate a potential link between exposures to AUM and serum inflammatory potential in affected communities, primary human coronary artery endothelial cells were treated for 4 h with serum provided by Navajo study participants (n=145). Endothelial transcriptional responses of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and chemokine ligand 2 (CCL2) were measured. These transcriptional responses were then linked to AUM exposure metrics, including surface area-weighted AUM proximity and estimated oral intake of metals. AUM proximity strongly predicted endothelial transcriptional responses to serum including CCL2, VCAM-1 and ICAM-1 (P<0.0001 for each), whereas annual water intakes of arsenic and uranium did not, even after controlling for all major effect modifiers. Inflammatory potential associated with proximity to AUMs, but not oral intake of specific metals, additionally suggests a role for inhalation exposure as a contributor to cardiovascular disease.

Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: a systematic review and meta-analysis.

Background Sub-Saharan Africa (SSA) has the highest burden of HIV in the world and a rising prevalence of cardiometabolic disease; however, the interrelationship between HIV, antiretroviral therapy (ART) and cardiometabolic traits is not well described in SSA populations. Methods We conducted a systematic review and meta-analysis through MEDLINE and EMBASE (up to January 2012), as well as direct author contact. Eligible studies provided summary or individual-level data on one or more of the following traits in HIV+ and HIV-, or ART+ and ART- subgroups in SSA: body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TGs) and fasting blood glucose (FBG) or glycated hemoglobin (HbA1c). Information was synthesized under a random-effects model and the primary outcomes were the standardized mean differences (SMD) of the specified traits between subgroups of participants. Results Data were obtained from 49 published and 3 unpublished studies which reported on 29 755 individuals. HIV infection was associated with higher TGs [SMD, 0.26; 95% confidence interval (CI), 0.08 to 0.44] and lower HDL (SMD, −0.59; 95% CI, −0.86 to −0.31), BMI (SMD, −0.32; 95% CI, −0.45 to −0.18), SBP (SMD, −0.40; 95% CI, −0.55 to −0.25) and DBP (SMD, −0.34; 95% CI, −0.51 to −0.17). Among HIV+ individuals, ART use was associated with higher LDL (SMD, 0.43; 95% CI, 0.14 to 0.72) and HDL (SMD, 0.39; 95% CI, 0.11 to 0.66), and lower HbA1c (SMD, −0.34; 95% CI, −0.62 to −0.06). Fully adjusted estimates from analyses of individual participant data were consistent with meta-analysis of summary estimates for most traits. Conclusions Broadly consistent with results from populations of European descent, these results suggest differences in cardiometabolic traits between HIV-infected and uninfected individuals in SSA, which might be modified by ART use. In a region with the highest burden of HIV, it will be important to clarify these findings to reliably assess the need for monitoring and managing cardiometabolic risk in HIV-infected populations in SSA.

Metabolic and Body Composition Risk Factors Associated with Metabolic Syndrome in a Cohort of Women with a High Prevalence of Cardiometabolic Disease.

BackgroundThe aetiology of the metabolic syndrome and the inter-relationship between risk factors for this syndrome are poorly understood. The purpose of this investigation was to determine the risk factors for metabolic syndrome and their interactions in a cohort of women with a high prevalence of metabolic syndrome.Materials and MethodsAbdominal and whole body composition (ultrasound and dual-energy X-ray absorptiometry), blood pressure, and cardiometabolic and demographic factors were measured in a cross-sectional study of 702 black African women from Soweto, Johannesburg. Data was analysed using multivariate logistic regression.ResultsMetabolic syndrome was present in 49.6% of the study cohort. Logistic regression analysis demonstrated that adiponectin (odds ratio [95% CIs]: 0.84 [0.77, 0.92], p<0.0005) and abdominal subcutaneous fat (0.56 [0.39, 0.79], p = 0.001) reduced metabolic syndrome risk whilst insulin resistance (1.31 [1.16, 1.48], p<0.0005) and trunk fat-free soft-tissue mass (1.34 [1.10, 1.61], p = 0.002) increased risk. Within this group of risk factors, the relationship of adiponectin with metabolic syndrome risk, when analysed across adiponectin hexiles, was the least affected by adjustment for the other risk factors.ConclusionsAdiponectin has a significant protective role against metabolic syndrome and is independent of other risk factors. The protective and possible augmentive effects of abdominal subcutaneous fat and lean trunk mass, respectively on metabolic syndrome risk demonstrate the existence of novel interactions between body composition and cardiometabolic disease.

Can milk proteins be a useful tool in the management of cardiometabolic health? An updated review of human intervention trials

The prevalence of cardiometabolic diseases is a significant public health burden worldwide. Emerging evidence supports the inverse association between greater dairy consumption and reduced risk of cardiometabolic diseases. Dairy proteins may have an important role in the favourable impact of dairy on human health such as blood pressure (BP), blood lipid and glucose control. The purpose of this review is to update and critically evaluate the evidence on the impacts of casein and whey protein in relation to metabolic function. Evidence from short-term clinical studies assessing postprandial responses to milk protein ingestion suggests benefits on vascular function independent of BP, as well as improvement in glycaemic homeostasis. Long-term interventions have been less conclusive, with some showing benefits and others indicating a lack of improvement in vascular function. During chronic consumption BP appears to be lowered and both dyslipidaemia and hyperglacaemia seem to be controlled. Limited number of trials investigated the effects of dairy proteins on oxidative stress and inflammation. Although the underlying mechanisms of milk proteins on cardiometabolic homeostasis remains to be elucidated, the most likely mechanism is to improve insulin resistance. The incorporation of meals enriched with dairy protein in the habitual diet may result in the beneficial effects on cardiometabolic health. Nevertheless, future well-designed, controlled studies are needed to investigate the relative effects of both casein and whey protein on BP, vascular function, glucose homeostasis and inflammation.

Abstract P119: Isotemporal Substitution Modeling of Daily Physical Activity Intensity and Cardiometabolic Diseases Among South Asians: The Centre for Cardiometabolic Risk Reduction in South-Asia (CARRS) Study

Objective: Several studies have shown that engaging in moderate-to-vigorous physical activity (MVPA) and avoiding prolonged sedentary time leads to beneficial effects on cardiometabolic disease risk. However, the associations between physical activity (PA) intensity and cardiometabolic risk have not been examined in population-based studies in South Asian populations. Hypothesis: We hypothesize that substituting sedentary time for MVPA will be associated with reduced cardiometabolic risks in South Asians. Methods: Cross-sectional data of 6,428 participants aged from 30 to 59 years (53.2% female) from New Delhi, India and Karachi, Pakistan that were enrolled in the CARRS Cohort study in 2010-11 were analyzed. We used the International Physical Activity Questionnaire (IPAQ, short form) culturally adapted to South Asian context, to classify respondent’s activities as sedentary, light activity (walking), and MVPA. We examined associations between time spent at different PA intensities and cardiometabolic diseases (defined as heart disease (including heart attack, angina and heart failure), stroke or Type 2 diabetes). Relevant risk factors (body weight, HDL-C and HbA1c) were examined using isotemporal substitution models, which drops one of three PA intensities and adjusts for total time of PA and covariates (i.e. outcome=PA 1+ PA 2 + total time for PA + covariates). Linear regression models were used to examine the associations between different PA intensities with risk factors of cardiometabolic diseases, and logistic regression models were used to examine the association between different types of PA intensities and prevalence of cardiometabolic diseases, adjusted for age, sex, sleep duration, status of depression, hypertension, hyperlipidemia and chronic kidney disease. Results: Isotemporal substitution models showed that replacing 1-hour/day sedentary time with a similar amount of MVPA at the population level was associated with 0.35 kilograms lower in body weight (95% CI: -0.50, -0.20, p&lt;0.0001), 0.02% lower in HbA1c (95% CI: -0.04, -0. 003, p=0.02) and 0.20 mg/dl higher level in HDL-C (95% CI: 0.08, 0.32, p=0.003). Replacing 1-hour sedentary time with a similar amount of MVPA was associated with a lower prevalence of cardio-metabolic diseases (POR=0.95, 95% CI=0.91 to 0.98, p=0.01), while replacing 1-hour MVPA with an amount of sedentary time was associated with a higher prevalence of cardiometabolic diseases (POR=1.06, 95% CI=1.02 to 1.10, p=0.01). Conclusion: Substituting sedentary time with MVPA was associated with favorable cardiometabolic health, while time spent sedentary may be detrimental to cardiometabolic health among young and middle-aged South Asians. Future intervetions aiming at promoting increases in MVPA and reductions in sedentary time may show benefits in terms of preventing cardiometabolic diseases in South Asia.

Burden attributable to Cardiometabolic Diseases in Zimbabwe: a retrospective cross-sectional study of national mortality data.

BackgroundCardiometabolic diseases (CMDs) are an important cause of mortality worldwide and the burden associated with them is increasing in Sub-Saharan Africa. The tracking of mortality helps support evidence based health policy and priority setting. Given the growing prevalence of non-communicable diseases in Zimbabwe, a study was designed to determine the mortality attributable to CMDs in Zimbabwe.MethodsThe study design was a retrospective cross-sectional analysis of national mortality from 1996 to 2007, collated by the Ministry of Health and Child Welfare in Zimbabwe. We employed generalized additive models to flexibly estimate the trend of the CMD mortality and a logistic regression model was used to find significant factors (cause of death according to the death certificate) of the CMD mortality and predict CMD mortality to 2040.ResultsCMDs accounted for 8.13 % (95 % CI: 8.08 % - 8.18 %) of all deaths during 1996 to 2007 (p = 0.005). During the study period CMD mortality rate increased by 29.4 % (95 % CI: 19.9 % - 41.1 %). The association between gender and CMD mortality indicated female mortality was higher for diabetes (p < 0.001), hypertensive disease (p < 0.001), CVD (p < 0.001) and pulmonary disease (p < 0.001), while male mortality was higher for ischaemic (p = 0.010) and urinary diseases (p < 0.001). There was no gender difference for endocrine disease (p = 0.893). Overall, females have 1.65 % higher mortality than males (p < 0.001). CMD mortality is predicted to increase from 9.6 % (95 % CI: 8.0 % - 11.1 %) in 2015 to 13.7 % (95 % CI: 10.2 % - 17.2 %) in 2040 for males, and from 11.6 % (95 % CI: 10.2 % - 12.9 %) in 2015 to 16.2 % (95 % CI: 13.1 % - 19.3 %) in 2040 in females.ConclusionThe findings of this study indicate a growing prevalence of CMDs and related mortality in Zimbabwe. Health policy decisions and cost-effective preventive strategies to reduce the burden of CMDs are urgently required.

Obesity is associated with race/sex disparities in diabetes and hypertension prevalence, but not cardiovascular disease, among HIV-infected adults.

Race/sex differences are observed in cardiometabolic disease (CMD) risk and prevalence in the context of treated, chronic HIV infection, and these differences could be exacerbated by disparities in obesity prevalence. We sought to determine the effect of obesity on these disparities among people living with HIV. Prevalence of CMD (dyslipidemia, cardiovascular disorders, hypertension, diabetes, chronic kidney disease) was determined for patients seen at the University of Alabama at Birmingham HIV clinic between 7/2010 and 6/2011. Staged logistic regression was used to examine the impact of race/sex on comorbidities adjusting for key confounders including/excluding obesity (body mass index ≥30 kg/m(2)). Of 1,800 participants, 77% were male, 54% were black, and 25% were obese. Obesity prevalence differed by race/sex: black women 49%, black men 24%, white women 24%, white men 15% (p<0.01). Compared to white men, other groups had reduced odds for dyslipidemia and cardiovascular disorders (p<0.01). Black men had increased odds for hypertension and chronic kidney disease, while black women had a nearly 2-fold increased odds for diabetes and hypertension (all at p<0.01). The associations of black women with diabetes and hypertension were attenuated when obesity was included in the models. Other group differences remained significant. Disparities in obesity prevalence do not explain race/sex differences in all CMD among people with HIV. Obesity accounted for associations with diabetes/hypertension for black women, who may benefit from weight reduction to decrease disease risk. Further investigations into the etiology and treatment of CMD in people living with HIV should consider unique race/sex treatment issues.

Interferon regulatory factor signalings in cardiometabolic diseases.

Cardiometabolic diseases comprise a spectrum of interconnected pathological alterations in metabolic organs and in the cardiovascular system that occur alone or simultaneously.1 Although great efforts have been undertaken to develop therapeutic agents (eg, statins and tissue-type plasminogen activator) for these unfavorable conditions, epidemiological data demonstrate that the prevalence of cardiometabolic diseases is continuously increasing and constitutes the heaviest burden on global health and economic development.2 An ambiguous understanding of the latent pathogenesis of cardiometabolic diseases might be responsible for their consistently high morbidity and mortality. In recent years, the discovery of a close interaction between the inflammatory response and the various cardiometabolic disorders has provided novel insight into the cause of these pathological conditions. Chronic low-grade inflammation has been identified as an important mediator of various cardiometabolic dysfunctions and has been shown to be involved in the entire process of lipid profile disturbance and the resultant hepatic steatosis, obesity, and hyperlipidemia, leading to severe cardiovascular disease.3–5 However, the inhibition of inflammation unfortunately failed to block the long-term development of cardiometabolic diseases and rendered the host susceptible to infection,6 suggesting that inflammation might only represent an outcome or a regulator of these diseases rather than the principal pathogenic factor. Therefore, what is the actual cause of cardiometabolic diseases? Innate immunity, an evolutionarily ancient and universal response of the host to defend against infection and injury, underlies inflammatory responses that is triggered by innate immune molecular cascades.7 Most recently, these immune signaling cascades have been not only found to extend beyond the purview of the immune system but also involved in or even play a central mechanistic role in broader physiological functions, including the function in the cardiometabolic system. A clear understanding of the mechanistic basis for the link between innate immunity and cardiometabolic diseases …

Genetically determined prospect to become long-lived is associated with less abdominal fat and in particular less abdominal visceral fat in men.

familial longevity is marked by an exceptionally healthy metabolic profile and low prevalence of cardiometabolic disease observed already at middle age. We aim to investigate whether regional body fat distribution, which has previously shown to be associated with cardiometabolic risk, is different in offspring of long-lived siblings compared with controls. our institutional review board approved the study, and all participants (n = 344, average age in years 65.6) gave written informed consent. Offspring (n = 175) of non-agenarian siblings were included. Their partners (n = 169) were enrolled as controls. For abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) measurements, a single-slice 8.0 mm computed tomography (CT) acquisition was planned at the level of the 5th lumbar vertebra. In addition, participants underwent prospectively electrocardiography-triggered unenhanced volumetric CT of the heart. Abdominal VAT and SAT areas (cm(2)) and epicardial adipose tissue (EAT) volumes (ml) were acquired by semi-automated segmentation techniques. Linear regression analysis was performed adjusting for cardiovascular risk factors. total abdominal fat areas were smaller in male offspring compared with controls (353.0 versus 382.9 cm(2), P = 0.022). The association between low abdominal VAT areas in male offspring (149.7 versus 167.0 cm(2) in controls, P = 0.043) attenuated after additional adjustment for diabetes (P = 0.078). Differences were not observed for females. EAT volumes were similar between offspring of long-lived siblings and controls. males who have genetically determined prospect to become long-lived have less abdominal fat and in particular less abdominal VAT compared with controls.

Cardiometabolic Comorbidity in Bipolar Disorder

In the last years, there has been increased concerning about cardiometabolic morbidity and mortality in bipolar patients. To review the literature about prevalence, risk factors and treatment of cardiometabolic diseases in patients with bipolar disorder. Searches were undertaken in PubMed and other databases, from 2009 to 2014, using keywords ‘bipolar disorder', ‘cardiometabolic', ‘riskfactors', ‘treatment'. Several studies have shown that diabetes, obesity, dyslipidemia and hypertension are more prevalent among patients with bipolar disorder than in the general population, and that they are under-diagnosed andunder-treated in these patients. Their higher risk is related to several factors, including medications (e.g. second generation of antipsychotics) and changes in hypothalamic-pituitary-adrenal axis and inflammatory pathways. The mechanisms underlying these alterations are the focus for new treatments. Recent interventions in these population integrates psychiatric and medical care. Availabe data support the high prevalence of cardiometabolic diseases in bipolar patients. New and future interventions to reduce cardiovascular risks are very important concerns of psychiatric and medical approaches.

Abstract 13783: Paradigms to Predict Cardiometabolic Disease in African Descent Populations Should Focus on HDL-Cholesterol Rather than Triglyceride

Paradigms for the early detection of cardiometabolic disease usually incorporate both elevated triglyceride (TG) and low high density lipoprotein -cholesterol (HDL-C). However, African-Americans with cardiometabolic disease usually have normal TG levels. The HDL-C pattern of African-Americans with cardiometabolic disease is uncertain. The TG and HDL-C pattern in Africans with cardiometabolic disease is unknown. To clarify the TG and HDL-C pattern in African descent populations with cardiometabolic disease, 377 blacks (167 African-Americans, 210 African immigrants, 59% male, age 36±9y, mean±SD, range 20-64y, BMI 29.0±6.3 kg/m2, range 18.5-54.7) had glucose tolerance status determined by OGTT, lipid profiles and insulin resistance determined by the insulin sensitivity index (SI). Insulin resistance was defined as the lowest quartile of SI (&lt;2.18 L/mU - 1min- 1). Metabolic triad was defined as hyperinsulinemia (fasting insulin≥3.7 μU/mL), hyperapolipoproteinB (≥64 mg/dL) and sdLDL(≥21.5 nm) based on the median values of the group with normal BMI. Cardiometabolic disease was defined as one or more of the following: pre-diabetes, diabetes, insulin resistance or metabolic triad. The frequency with which hypertriglyceridemia (TG≥150 mg/dL) or low HDL-C (&lt;40 mg/dL in men or &lt;50 mg/dL in women) occurred in the presence of cardiometabolic disease was determined. The prevalence of cardiometabolic disease did not differ in African-Americans and African immigrants (63% vs. 60%, P=0.51). TG and HDL-C levels in blacks with cardiometabolic disease did not differ by African ancestry. In the presence of cardiometabolic disease, TG levels were 80±40 vs. 87±43, P=0.24, resp. while HDL-C levels in men were: 45±11 vs. 44±12, P=0.63, and in women: 48±10 vs. 49±10, P=0.86). Less than 10% of people with cardiometabolic disease had TG≥150 mg/dL. However, 42% of people with cardiometabolic disease had low HDL-C. If HDL-C levels were low, the odds of having cardiometabolic disease was 2.84 (95% CI 1.76, 4.59. P&lt;0.001). Overall, more than 40% of people with cardiometabolic disease had low HDL while &lt;10% had elevated TG levels. Therefore, paradigms to detect cardiometabolic disease in African descent populations should focus on HDL-C rather than TG.

Very low rates of screening for metabolic syndrome among patients with severe mental illness in Durban, South Africa.

BackgroundSub Saharan African is experiencing the largest increase in the prevalence of type 2 diabetes mellitus and cardiovascular disease globally. Metabolic syndrome (MetS) is a cluster of risk factors for these conditions. There is a consistently higher prevalence of cardiometabolic disease among individuals with severe mental illness (SMI) compared to the general population worldwide .However, it is known from research in high income countries that screening for MetS in patients with SMI is low. The objective of this study was to document the extent of the expected low frequency of testing for all the components of the metabolic syndrome (MetS) in patients with SMI in a low middle income country.MethodsThis was a cross sectional study, undertaken from January to June 2012 on out-patients with SMI who were treated with antipsychotic medication for at least 6 months. The study measured the proportion of participants who were tested for MetS in the previous year.ResultsThe study included 331 (M: F; 167:164) participants with a mean age of 35.2 ± 11.98 years. The majority (78.8%) were black South Africans. Only 2 subjects (0.6%) were screened for all five components of MetS. Regarding the individual components, 99%, 0.6%, 3.9% and 1.8% were screened for raised blood pressure, abdominal obesity, hyperglycaemia, hypertriglyceridaemia and decreased high density lipoprotein cholesterol respectively.ConclusionIt is unacceptable that less than one percent of our participants were adequately screened for modifiable risk factors for type 2 diabetes mellitus and cardiovascular disease which are the most common causes of mortality among patients with SMI. These results highlight the need for translating guidelines into action in low and middle income countries.

Design of the INTEGRATE study: effectiveness and cost-effectiveness of a cardiometabolic risk assessment and treatment program integrated in primary care.

BackgroundThe increasing prevalence of cardiometabolic disease (CMD) in combination with an ageing population is a major public health problem. Early detection and management of individuals at risk for CMD is required to prevent future health problems with associated costs. General practice is the optimal health care setting to accomplish this goal. Prevention programs for identification and treatment of patients with an increased risk for CMD in primary care have been proven feasible. However, the effectiveness and cost-effectiveness have yet to be demonstrated. The ‘Personalized Prevention Approach for CardioMetabolic Risk’ (PPA CMR) is such a prevention program. The objective of the INTEGRATE study is to investigate the effectiveness and cost-effectiveness of PPA CMR, as well as to establish determinants for participation and compliance.MethodsThe INTEGRATE study is designed as a stepped-wedge randomized controlled trial with a waiting list control group. In approximately 40 general practices, all enlisted patients without CMD aged 45–70 years, are invited to participate in PPA CMR. After an online risk estimation, patients with a score above risk threshold are invited to the GP for additional measurements, detailed risk profiling and tailored treatment of risk factors through medication and/or lifestyle counseling. At baseline and after twelve months of follow-up lifestyle, health and work status of all participants are established with online questionnaires. Additionally after twelve months, we will determine health care utilization, costs of PPA CMR and compliance. Primary endpoints are the number of newly detected patients with CMD and changes in individual risk factors between the intervention and waiting list control group. Medical data will be extracted from the GPs’ electronic medical records. In order to assess factors related to participation, we will send questionnaires to non-participants and assess characteristics of participating practices. For all participants, additional demographic characteristics will be available through Statistics Netherlands.DiscussionThe INTEGRATE study will provide insight into the effectiveness and cost-effectiveness of PPA CMR as well as determinants for participation and compliance, which represents essential information to guide further large-scale implementation of primary prevention programs for CMD.Trial registration numberNTR4277, The Netherlands National Trial Register, 26-11-2013.