Cardiovascular Risk Factors In Subjects Research Articles

Flavonoid-rich beverage effects on lipid profile and blood pressure in diabetic patients.

To compare freeze-dried strawberry (FDS) beverage and strawberry-flavored drink effects on lipid profile and blood pressure in type 2 diabetic (T2D) patients. In a randomized, double-blind, controlled trial, 36 subjects with T2D (23 females; mean ± SE age: 51.57 ± 10 years) were randomly divided into two groups. Participants consumed two cups of either pure FDS beverage (each cup containing 25 g freeze-dried strawberry powder equivalent to one serving of fresh strawberries; intervention group) or an iso-caloric drink with strawberry flavoring (similar to the FDS drink in fiber content and color; placebo group) daily for 6 wk. Anthropometric measurements, 3 d, 24 h dietary recall, and fasting blood samples were collected at baseline and at weeks 6 intervention. After lying down and relaxing for approximately 10 min, each participant's blood pressure was recorded in triplicate with 5 min intervals; recordings were made at baseline and the trial end-point. Each participant's lipid profile was assessed before and after intervention. Assessment at the weeks 6 intervention showed a significant reduction from baseline in total cholesterol levels and total cholesterol to high-density lipoprotein cholesterol (HDL-C) ratio in the intervention group (179.01 ± 31.86 to 165.9 ± 32.4 mg/L; P = 0.00 and 3.9 ± 0.88 to 3.6 ± 0.082 mg/L; P = 0.00 respectively), but the change was not significantly different between the two groups (P = 0.07, P = 0.29 respectively). Systolic blood pressure levels were significantly reduced from baseline in both the FDS and placebo drink groups (129.95 ± 14.9 to 114.3 ± 27.5 mmHg; P = 0.02 and 127.6 ± 15.6 to 122.9 ± 14.47 mmHg; P = 0.00 respectively), but the reduction was not significantly different between the two groups. Diastolic blood pressure was significantly reduced post-intervention in the FDS drink group compared to placebo group (78.7 ± 7.2 vs 84.4 ± 5.8; P = 0.01), the reduction was also significant within the FDS drink group (84.2 ± 8.03 to 78.7 ± 7.2; P = 0.00). Triglycerides, HDL-C concentrations and anthropometric indices showed no significant differences between or within groups. Short-term FDS supplementation improved selected cardiovascular risk factors in subjects with T2D. Long-term effects on other metabolic biomarkers need to be investigated in future trials.

Safety Of Splenectomy In Hematological Diseases

Introduction Splenectomy is a diagnostic tool and an option of treatment for some diseases. After splenectomy, the risk of infection is not clear in adult populations, therefore designing and implementing the best prevention and management strategys is of upmost importance. Splenectomized patients also have an increased risk of venous thromboembolism. Perioperative anticoagulant prophylaxis with subcutaneous heparin should be administered to all patients and in high risk patients prolonged anticoagulant prophylaxis (at least 4 weeks) should be used. There is not much information about infection and thromboembolic risk after splenectomy in hematological patients. Aims To evaluate the efficacy and safety of splenectomy in adult patients with hematological diseases. Methods Splenectomies performed in our hospital between March 2003 and February 2013 in adults with hematological disease were reviewed. Diagnosis, age at time of splenectomy, cardiovascular risk factors (CVRF), immunosuppressive therapy, type of surgery, immunization against encapsulated bacteria, antibiotic and thromboembolic prophylaxis, serious infections and thromboembolic events were considered. Severe infection was defined as one that required emergency consultation or admission and antibiotic, antiviral and antifungal treatment. Results A total of 65 splenectomies were performed in patients with hematologic disorders. Underlying diseases were primary immune thrombocytopenia (ITP) in 24 patients, splenic marginal zone lymphoma in 13, other lymphoproliferative disorders in 13, microspherocytosis in 10, Evans syndrome (ES) in 2 and immune hemolytic anemia (AIHA) in 2. The median age at splenectomy was 51 years old (r, 18-78). A laparoscopic procedure was performed in 83% of patients, with a median admission duration of 5 days (r, 3-33) vs 10 days (r, 5-12) for laparotomic procedures. All patients received prior immunization although in two cases the administration was postoperative. Twenty eight percent of subjects received steroids for ≥ 2 months prior to surgery and 12.5 % rituximab. Fifty percent of patients suffered a severe infection after a median of 16 months (r, 0-84 months), 75% of which received antibiotic prophylaxis. There was no difference in the incidence of infection between different hematological diagnoses. The most frequent locations were respiratory and urinary infections, 27.1% and 18.6% respectively. The most commonly isolated germs were Candida, E.Coli, P. Aeruginosa, VEB and P.Mirabillis. Six patients developed thrombotic events, after a median of 10 days (r, 1-93 days). Of these, 50% had not received thromboembolic prophylaxis. The locations were pulmonary thromboembolism (1), subclavian vein thrombosis (2), portal vein thrombosis (1) and stroke (2). We found no significant differences in the platelet count and cardiovascular risk factors in subjects with and without thromboembolic events. There were 8 (12.3%) cases of exitus, 3 of which were due to infectious events (2 septic shock, 1 respiratory infection). After a median follow-up of 35 months (r, 1-106 months) 100% of AIHA and ES and 82.6% of PTI are in remission. Conclusions In our experience splenectomy is a safe and effective procedure and continues to have an important role in the management of certain hematological disorders. Due to sample size, it is difficult to draw conclusions on the impact of antibiotic prophylaxis maintenance, although, as in our series the risk of infection is present until 84 months after surgery, we believe prophylaxis should be maintained for at least 3 to 5 years. Furthermore, our results support the recommendations provided in the literature on thromboprophylaxis for at least 4 weeks after surgery. Disclosures: No relevant conflicts of interest to declare.

Vitamin B12 deficiency and hyperhomocysteinemia as correlates of cardiovascular risk factors in Indian subjects with coronary artery disease

Background and purposeFolate and vitamin B12 are essential components in the metabolism of homocysteine (Hcy). Hyperhomocysteinemia has been implicated in endothelial dysfunction and cardiovascular disease. However, the association of Hcy, vitamin B12, and folic acid with cardiovascular risk factors in patients with coronary artery disease (CAD) has not been studied in Indian patients. This study was conducted with the aim to evaluate the relationship of vitamin B12, folic acid, and Hcy levels with cardiovascular risk factors in subjects with known CAD. Methods and subjectsThree hundred patients (216 men; 84 women; aged 25–92 years) who had CAD on angiography were included in this study consecutively. All patients were evaluated for anthropometry and cardiovascular risk factors, and blood samples were collected for biochemical, nutritional, and inflammatory markers. ResultsPercentage of vitamin B12 and folate deficiency was 86.7% and 2.7%, respectively. Hyperhomocysteinemia was present in 95.3% patients. Vitamin B12 levels were significantly lower and Hcy levels were significantly higher in subjects with dyslipidemia, DM, and/or hypertension. Serum vitamin B12 was inversely associated with triglyceride and very low-density lipoprotein (VLDL) and positively with high-density lipoprotein (HDL). Hcy was positively associated with triglyceride and VLDL and negatively with HDL. Vitamin B12 was inversely correlated with inflammatory markers (high-sensitivity C-reactive protein and interleukin-6) directly related to insulin resistance whereas Hcy showed the opposite pattern. ConclusionsSerum vitamin B12 deficiency and hyperhomocysteinemia are related with cardiovascular risk factors in Indian patients with CAD.

Uric acid levels, even in the normal range, are associated with increased cardiovascular risk: The Guangzhou Biobank Cohort Study

To examine the association between serum uric acid (UA) levels and cardiovascular risk factors in subjects without diabetes or hyperuricemia. 6172 women and 2662 men aged 50+ years without diabetes from Phase 1 of the Guangzhou Biobank Cohort Study were included. Data on personal history, physical examination and biochemical parameters were collected. Subjects were categorized by serum UA concentration, and the association between UA levels and cardiovascular risk factors was examined using generalized linear models. In both men and women with normouricemia (UA<420 μmol/l in men and <360 μmol/l in women), tertiles of UA levels were adversely associated with body mass index, waist circumference, waist-to-hip ratio, total- and HDL-cholesterol, apolipoprotein A1, systolic and diastolic blood pressures, pulse pressure, fasting plasma glucose and white blood cell count (P value for trend ranged from 0.04 to <0.001), and also consistently associated with metabolic disorders including obesity, hypertension, hypertension treatment, dyslipidemia, waist circumference increased since the age of 18 years and the metabolic syndrome (P value for trend ranged from 0.02 to <0.001). Increasing UA levels, even in subjects with normouricemia and without diabetes, were associated with increasing prevalence of cardiovascular risk factors, suggesting that clinically dichotomous definition of hyperuricemia may be inadequate and high-normal value of UA may warn of metabolic disorders.

The prevalence of hyperuricemia and its correlates in an inland Chinese adult population, urban and rural of Jinan

Economy has developed rapidly in China, and the clustering of cardiovascular risk factors in subjects increased remarkably over the past two decades. However, no data are available regarding the temporal prevalence of hyperuricemia and its correlates in this rapidly developing area, especially in the inland area. The cross-sectional survey was based on a random sample of 4,218 residents aged 35-64 years in the Jinan area. Hyperuricemia was defined as serum uric acid ≥ 416 μmol/L in men and ≥ 357 μmol/L in women. Subjects underwent physical examination and fasting blood testing. Complete data were available for analysis from 1,979 men and 2,062 women. The age-adjusted prevalence of hyperuricemia was 6.4 % for men and 2.1 % for women. The prevalence of hyperuricemia was greater in urban (6.7 %) than in rural areas (1.7 %) of Jinan city. Multivariate logistic regression models revealed hyperuricemia associated with hypertriglyceridemia [men: odds ratio (OR) = 6.101, 95 % confidence interval (CI) 4.064-9.159; women: OR = 7.103, 95 % CI 3.578-14.099] and high serum creatinine level (men: OR = 2.603, 95 % CI 1.602-4.230; women: OR = 5.237, 95 % CI 2.667-10.284). Hyperuricemia was also significantly associated with male sex, urban residence, hypertension, obesity, and hypercholesterolemia. Age (1-year increase) was negatively associated with hyperuricemia in men but positively associated with hyperuricemia in women. In conclusion, the prevalence of hyperuricemia is higher in urban than rural areas of Jinan, China. Male sex, urban residence, hypertension, obesity, hypercholesterolemia, hypertriglyceridemia, and high serum creatinine level contributed to hyperuricemia in this population.

Visceral obesity and cardiometabolic risks: lessons from the VACTION.J study

Atherosclerosis, the underlying cause of atherosclerotic cardiovascular disease, develops not only due to a single cardiovascular risk factor, but to a variety of complex factors. Body fat distribution, especially visceral fat accumulation, is a major correlate of a cluster of metabolic abnormalities and atherosclerotic cardiovascular disease in Japanese metabolic syndrome. Reduction of visceral fat through individualized lifestyle recommendations by medical personnel (health guidance ‘Hoken-shido’ in Japanese) contributes to changes in the number of obesity-related cardiovascular risk factors in subjects with, but not without, visceral fat accumulation. For the prevention of atherosclerotic cardiovascular disease in Japan, it might be practical to stratify subjects with multiple risk factors based on visceral fat accumulation and conduct health education (‘Hoken-shido’) based on conceptualization of visceral fat accumulation, from the results of the VACATION-J study, a Japanese population-based cohort study. This article discusses visceral adiposity as a target for the management of metabolic syndrome, including lessons learned from the VACATION-J study.

Miglitol, α-glycosidase inhibitor, reduces visceral fat accumulation and cardiovascular risk factors in subjects with the metabolic syndrome: A randomized comparable study

Background/objectivesVisceral fat obesity plays an essential role in the clustering of cardiovascular risk factors. This study aimed to clarify the effects of miglitol, α-glycosidase inhibitor, on body weight, fat distribution and cardiovascular risk factors in patients with the metabolic syndrome. Methods and resultsOne hundred and eleven drug naive patients with the metabolic syndrome were continuously recruited and randomly allocated to a group of life style modification (LSM) alone or a group of LSM with miglitol per os 50mg×3 (LSM+miglitol). After 12weeks of treatment, body weight (5.1%), body mass index (4.9%) and waist circumference were greatly reduced in miglitol group (n=42) than in LSM group (n=43). Plasma levels of insulin and glucose during an oral 75g glucose loading were decreased only in miglitol group. Visceral fat area, determined by abdominal computed tomography, was greatly reduced in miglitol group (baseline 188 vs 12weeks 161cm2, p<0.0001) than in LSM group (184 vs 174cm2, p<0.05). Subcutaneous fat area was reduced only in miglitol group (p<0.001). Systolic blood pressure was reduced in miglitol group (142 vs 133mm Hg, p<0.001), but not in control group (137 vs 134mm Hg). Serum levels of triglyceride, LDL-cholesterol, γ-GTP, and high-sensitive CRP were decreased and adiponectin was increased only in miglitol group. ConclusionsOur results indicated that miglitol showed an anti-obesity potential, which was achieved by reducing abdominal fat accumulation and/or enhanced insulin requirement, and then corrected both the metabolic and hemodynamic aberrations seen in patients with the metabolic syndrome (UMIN Clinical Trial Registry UMIN000007650).

Changes in Physical Fitness Predict Improvements in Modifiable Cardiovascular Risk Factors Independently of Body Weight Loss in Subjects With Type 2 Diabetes Participating in the Italian Diabetes and Exercise Study (IDES)

OBJECTIVEPhysical fitness is inversely related to mortality in the general population and in subjects with type 2 diabetes. Here, we present data concerning the relationship between changes in physical fitness and modifiable cardiovascular risk factors in subjects with type 2 diabetes from the Italian Diabetes and Exercise Study.RESEARCH DESIGN AND METHODSSedentary patients with type 2 diabetes (n = 606) were enrolled in 22 outpatient diabetes clinics and randomized to twice-a-week supervised aerobic and resistance training plus exercise counseling versus counseling alone for 12 months. Baseline to end-of-study changes in cardiorespiratory fitness, strength, and flexibility, as assessed by Vo2max estimation, a 5–8 maximal repetition test, and a hip/trunk flexibility test, respectively, were calculated in the whole cohort, and multiple regression analyses were applied to assess the relationship with cardiovascular risk factors.RESULTSChanges in Vo2max, upper and lower body strength, and flexibility were significantly associated with the variation in the volume of physical activity, HbA1c, BMI, waist circumference, high-sensitivity C-reactive protein (hs-CRP), coronary heart disease (CHD) risk score, and inversely, HDL cholesterol. Changes in fitness predicted improvements in HbA1c, waist circumference, HDL cholesterol, hs-CRP, and CHD risk score, independent of study arm, BMI, and in case of strength, also waist circumference.CONCLUSIONSPhysical activity/exercise-induced increases in fitness, particularly muscular, predict improvements in cardiovascular risk factors in subjects with type 2 diabetes independently of weight loss, thus indicating the need for targeting fitness in these individuals, particularly in subjects who struggle to lose weight.

Cardiovascular risk factors in subjects with psoriasis: a cross‐sectional general population study

Epidemiological data have established an association between cardiovascular disease and psoriasis. Only one general population study has so far compared prevalences of cardiovascular risk factors among subjects with psoriasis and control subjects. We aimed to determine the prevalence of cardiovascular risk factors in subjects with and without psoriasis in the general population. During 2006-2008, a cross-sectional study was performed in the general population in Copenhagen, Denmark. A total of 3471 subjects participated in a general health examination that included assessment of current smoking status, weight, height, waist and hip circumferences, systolic and diastolic blood pressures, resting heart rate, and plasma lipids, hemoglobin A1c, fasting glucose, and insulin levels. Physician-diagnosed psoriasis was reported by 238 (7.1%) of 3374 participants. There were no differences between subjects with and without psoriasis with regard to traditional cardiovascular risk factors. Our results contrast with the hitherto-reported increased prevalence of metabolic syndrome in subjects with psoriasis in the general U.S. population. However, our results agree with those of other previous studies in which the association between mild psoriasis and cardiovascular risk factors is often non-significant. Further controlled research is needed to describe the prevalence of cardiovascular risk factors in subjects with mainly mild to moderate psoriasis in the general population.

Effect of an Intensive Exercise Intervention Strategy on Modifiable Cardiovascular Risk Factors in Subjects with Type 2 Diabetes Mellitus

Introduction: Low cardiorespiratory fitness (CRF) and physical inactivity are associated with higher rates of cardiovascular disease (CVD), morbidity, and mortality among individuals with type 2 diabetes mellitus (T2DM). Lifestyle modification interventions, including physical activity, have proven effective in glycemic control and reducing cardiovascular risk factors within this population. The American Diabetes Association follows the same recommendations for individuals with impaired glucose tolerance (IGT) or T2DM as is recommended for the general population, which is 150 min/wk of moderate intensity, 75 min/wk of vigorous physical activity, or a combination of moderate and vigorous with 1 min of vigorous being equal to 2 min of moderate. However, it is uncertain whether this physical activity volume is optimal to reduce the CVD burden among individuals with IGT or T2DM.

Effect of Muscadine Grape Seed Supplementation on Vascular Function in Subjects with or at Risk for Cardiovascular Disease: A Randomized Crossover Trial

Background: Muscadine grape seeds have high concentrations of polyphenolic compounds with antioxidant and other properties that would be expected to have favorable effects on endothelial function.Objectives: To evaluate the effect of muscadine grape seed supplementation on endothelial function and cardiovascular risk factors in subjects with increased cardiovascular risk.Design: In a randomized, double-blind, placebo-controlled crossover trial, 50 adults with coronary disease or ≥1 cardiac risk factor received muscadine grape seed supplementation (1300 mg daily) and placebo for 4 weeks each, with a 4-week washout. Resting brachial diameter and brachial flow-mediated dilation (FMD) and biomarkers of inflammation, lipid peroxidation, and antioxidant capacity were determined at the beginning and end of each period and compared in mixed linear models.Results: There was no evidence of improved FMD (% change) with muscadine grape seed (muscadine grape seed: pre 5.2% ± 0.3%, post 4.6% ± 0.3%, p = 0.06; placebo: pre 5.3% ± 0.4%, post 5.2% ± 0.4%, p = 0.82; p for muscadine grape seed vs. placebo = 0.25). However, there was a significant increase in baseline diameter (mm) with muscadine grape seed supplementation (muscadine grape seed: pre 4.05 ± 0.09, post 4.23 ± 0.10, p = 0.002; placebo: pre 4.12 ± 0.11, post 4.12 ± 0.10, p = 0.93; p for muscadine grape seed vs. placebo = 0.026). All other biomarkers were not significantly altered by muscadine grape seed supplementation.Conclusions: Four weeks of muscadine grape seed supplementation in subjects with increased cardiovascular risk did not produce a statistically significant increase in brachial flow-mediated vasodilation or a significant change in other biomarkers of inflammation, lipid peroxidation, or antioxidant capacity. However, the muscadine grape seed supplement did result in a significant increase in resting brachial diameter. The clinical significance of the effect on resting diameter is not yet established. More research is warranted to fully characterize the vascular effects of this and other grape-derived nutritional supplements and to determine whether these vascular effects translate into important clinical benefits.

Weight Reduction May Be Beneficial for Japanese Men With Cardiometabolic Risk Factors Even if They Are Not Abdominally Obese

A consensus statement (1) for the criteria of metabolic syndrome (MetS) where abdominal obesity is not a necessary component was jointly issued by the International Diabetes Federation Task Force on Epidemiology and Prevention; the National Heart, Lung, and Blood Institute; the American Heart Association; the World Heart Federation; the International Atherosclerosis Society; and the International Association for the Study of Obesity. However, abdominal or visceral fat obesity is a necessary component in Japanese criteria of MetS (2), and some Japanese investigators insist that weight reduction is ineffective to reduce cardiovascular risk factors in subjects without abdominal obesity. Therefore, I investigated whether …

Effects of freeze‐dried blueberries on cardiovascular risk factors in subjects with metabolic syndrome

Blueberries are a good source of polyphenolic flavonoids and are known to be antioxidants and anti‐inflammatory agents. We tested the hypothesis that freeze‐dried blueberry supplementation may lower lipid peroxidation, inflammation, and other features of the metabolic syndrome (MeS). Thirty‐seven subjects with MeS (NCEP, ATP III) were randomized to receive either two cups of blueberry beverage daily or an equal amount of water, as control, for 8 weeks. Each cup of blueberry beverage contained 25g freeze‐dried blueberries blended with 1.5 cups water, 0.5 cup ice and 1 teaspoon vanilla essence. Blood draws, blood pressure and anthropometrics were performed at baseline and after 4 and 8 weeks. After 8 weeks, blueberry supplementation significantly decreased systolic blood pressure (blueberry: 130.1±3.3 to 122.3±2.6 mm Hg, p&lt;0.05) and diastolic blood pressure (blueberry: 84.0±1.8 to 81.2±1.6 mm Hg, p&lt;0.05). Blueberry supplementation was also associated with significant decreases in plasma oxidized‐LDL (blueberry: 106.3±3.3 U/l at baseline, 76.6±4.4 U/l at 8 weeks, p&lt;0.05; control: 103.8±10.6 U/l at baseline, 96.4±7.6 U/l at 8 weeks, NS) and the lipid peroxidation product malondialdehyde (blueberry: 1.17±0.02 μM at baseline, 1.02±0.03 μM at 8 weeks, p&lt;0.05; control: 1.14±0.02 μM at baseline, 1.1±0.01 μM at 8 weeks, NS). No effects were noted on body weight, waist circumference, glucose, lipid profiles and biomarkers of inflammation. Thus, blueberries may be included as part of a healthy diet in lowering selected CVD risk factors. Supported by US Highbush Blueberry Council

Coronary Flow Reserve Is a Comprehensive Indicator of Cardiovascular Risk Factors in Subjects With Chest Pain and Normal Coronary Angiogram

The aim of the present study was to analyze the parameters related to baseline coronary flow velocity (CFV) and coronary flow reserve (CFR) using Doppler transthoracic echocardiography (TTE), and to assess their associations with components of the Framingham risk score (FRS), which estimates 10-year risk of coronary heart disease, in subjects with chest pain and a normal coronary angiogram. A total of 354 individuals (mean age: 55+/-11 years, M:F ratio =186:168) with angina or angina-like chest pain and a normal coronary arteriogram were enrolled. CFR, using TTE and adenosine or dipyridamole, was measured within 2 weeks after coronary angiogram. The clinical, electrocardiographic, echocardiographic and laboratory parameters related to baseline CVF and CFR were analyzed, and CFR was compared with FRS. There was an inverse correlation between baseline CFV and CFR (r=-0.374, P<0.001). On multivariate analysis the fulfilling of left ventricular hypertrophy criteria on electrocardiography was an independent predictor of baseline CFV for the upper 75% quartile (23.2> or =cm/s; odds ratio (OR) = 2.840, 95% confidence interval (CI) =1.155-6.983, P=0.023). On multivariate analysis hemoglobin A(1c) level was independently related to a CFR <2.0 (OR = 2.195, 95%CI = 0.920-1.005, P=0.013). CFR had an inverse correlation with FRS (r=-0.222, P<0.001). On multiple regression analysis among the components of the FRS system (FRSS), independent factors related to a CFR <2.0 included age (OR =1.033, 95%CI =1.000-1.067, P=0.041), high-density lipoprotein-cholesterol level (OR = 0.961, 95%CI = 0.933-0.991, P=0.012) and smoking status (OR = 2.461, 95%CI =1.078-5.618, P=0.033), respectively. CFR can be a comprehensive indicator of cardiovascular risk factors, including parameters of the FRSS, in subjects with chest pain and a normal coronary angiogram.

A 12-week worksite health promotion program reduces cardiovascular risk factors in male workers with the apolipoprotein E2 and apolipoprotein E3 genotypes, but not in apolipoprotein E4 genotype

Worksite health promotion programs focusing on diet and lifestyle modification have been shown to improve health outcomes in workers. The purpose of this study was to investigate whether a 12-week worksite health promotion program shows different response of cardiovascular risk factors in subjects according to apolipoprotein E (Apo E) genotype and obesity level in 141 male Korean industrial workers. We hypothesized that the health changes of a 12-week intervention may not be the same within Apo E genotypes in nonobese and obese subjects. They received 5 face-to-face meetings based on their health profiles. In obese group carrying Apo E3 genotype, body mass index, body fat (%), waist circumference, waist-hip ratio, and systolic blood pressure were decreased, as well as intakes of energy (P = .000) and carbohydrate (P = .005). High-density lipoprotein cholesterol (P = .004) level was improved in individuals with the Apo E2 genotype. These beneficial effects were only observed in individuals with the Apo E2 or Apo E3 genotype. Multiple linear regression revealed that obesity was strongly correlated with waist circumference (P = .002), plasma total cholesterol (P = .037), and changes in dietary cholesterol intake (P = .011) in individuals with the Apo E3 genotype, whereas only changes in dietary fat intake (P = .044) was correlated in those with the Apo E4 genotype. Overall, the results of this study suggest that a health promotion program can be a useful method of improving cardiovascular risk factors and dietary intake in industrial workers with certain genotypes only. Therefore, further research is needed to develop a tailored, long-term worksite health promotion program based on genetic background.

Cardiovascular risk factors in restless legs syndrome

We conducted a population-based cross-sectional study to assess prevalence of cardiovascular risk factors in subjects with and without restless legs syndrome (RLS). Adults attending their annual checkup completed the International RLS Study Group questionnaire and underwent an interview by a neurologist. Data from the annual checkup were compared between subjects with and without RLS. The prevalence of RLS was 6.7% (95% CI 5.45-7.95) among 1,537 responders. RLS subjects' blood tests showed significantly higher fasting blood glucose level (P = 0.029), higher prevalence of hypercholesterolemia (P = 0.029) and reduced renal function (P = 0.013), and increased prevalence of low hematocrit (P = 0.008). RLS subjects weighed more (P = 0.029), had a higher BMI (P = 0.033), larger hip circumference (P = 0.033), and were less fit (P = 0.010). To control for interactions among statistical predictors, we also employed multivariate logistic regression models adjusted for age, gender, smoking, BMI, hemoglobin, glucose, HDL/LDL cholesterol, triglycerides, and creatinine. We found that female gender (OR 2.16; 95% CI 1.11-4.17), smoking (OR 1.82; 95% CI, 1.10-3.00), and HDL/LDL cholesterol (OR 0.18; 95% CI 0.034-0.90) were significantly associated with RLS compared with subjects without RLS. RLS was associated with cardiovascular risk factors.

Small, dense low‐density lipoproteins (LDL) are predictors of cardio‐ and cerebro‐vascular events in subjects with the metabolic syndrome

Small, dense low-density lipoproteins (LDL) are a feature of the metabolic syndrome (MS) but their predictive role still remains to be established. We performed a 2-year follow-up study in 124 subjects with MS (63 +/- 6 years), as defined by the American Heart Association/National Heart, Lung and Blood Institute guidelines, to assess clinical and biochemical predictors of cerebro- and cardio-vascular events. Beyond traditional cardiovascular risk factors, we measured LDL size and subclasses by gradient gel electrophoresis. Clinical events were registered in the 25% of subjects. At univariate analysis subjects with events had increased prevalence of elevated fasting glucose (P = 0.0117), smoking (P = 0.0015), family history of coronary artery disease (P = 0.0033) and higher levels of total- and LDL-cholesterol (P = 0.0027 and P = 0.0023, respectively); LDL size was lower (P < 0.0001), due to reduced larger subclasses and increased small, dense LDL (all P < 0.0001). At multivariate analysis the following were independent predictors of events (univariate odd ratios were calculated): low HDL-cholesterol (OR 15.4, P = 0.0238), elevated fasting glucose (OR 12.1, P = 0.0102), elevated small, dense LDL (OR 11.7, P = 0.0004), elevated blood pressure (OR 9.2, P = 0.0392), smoking (OR 4.8, P = 0.0054). This is the first study that assessed the predictive role of small, dense LDL beyond traditional cardiovascular risk factors in subjects with MS.

Effects of fatty and lean fish intake on blood pressure in subjects with coronary heart disease using multiple medications

Intake of fish and long-chain n-3 fatty acids has been of wide interest due to their beneficial effects on cardiovascular risk factors and lower coronary heart disease (CHD) risk. The aim of this pilot study was to examine the effects of fatty fish and lean (white) fish on fatty acid composition of serum lipids and cardiovascular risk factors in subjects with CHD using multiple drugs for this condition. The study was an 8-week controlled, parallel intervention. Inclusion criteria were myocardial infarction or unstable ischemic attack, age under 70 years, use of betablockers and presence of sinus rhythm. The subjects were randomized to one of the following groups: 4 meals/week fatty fish (n = 11), 4 meals/week lean fish (n = 12) and control diet including lean meat (n = 10). The mean (+/-SD) of reported fish meals per week was 4.3 +/- 0.4, 4.7 +/- 1.1 and 0.6 +/- 0.4 in the groups, respectively. The proportions of eicosapentaenoic and docosahexaenoic acids in serum lipids increased in the fatty fish group only (P < 0.05). Systolic and diastolic blood pressure levels decreased in the lean fish group (0 vs. 8 week: 3.5 +/- 3.2 and 4.6 +/- 3.6%, respectively, P < 0.05). Serum total triglyceride concentration did not significantly change. HDL cholesterol concentration change differed among groups but without significant post hoc differences. Apolipoprotein A-1 concentration decreased in the control group (0 vs. 8 week, P < 0.05). Coagulation factors, 25-hydroxy vitamin D, and heart rate variability (24 h Holter) did not change among the groups. Our results suggest that intake of lean fish at least four times per week could reduce blood pressure levels in CHD patients.

Reduction of cardiovascular risk factors in subjects with type 2 diabetes by Pycnogenol supplementation

Patients with type 2 diabetes are at considerable risk of excessive morbidity and mortality from cardiovascular disease (CVD). We investigated the clinical effectiveness of Pycnogenol, a flavonoid-rich dietary supplement, in reducing antihypertensive medication use and CVD risk factors in subjects with type 2 diabetes. Forty-eight individuals were enrolled in a randomized, double-blind, placebo-controlled trial with parallel-group design. Patients were diagnosed with both type 2 diabetes and mild to moderate hypertension and were undergoing treatment with angiotensin-converting enzyme (ACE) inhibitors. Subjects were randomly assigned to receive either Pycnogenol pill (125 mg daily) or matched placebo for 12 weeks. According to the values of blood pressure (BP) measured at 2-week intervals, the pretrial ACE inhibitor dosage was left unchanged, reduced by 50%, or brought back to the pretrial dosage until a stable BP was obtained. Fasting plasma glucose, low-density lipoprotein (LDL) cholesterol, glycosylated hemoglobin (HbA1c), serum endothelin-1, and urinary albumin were evaluated monthly. Pycnogenol treatment achieved BP control in 58.3% of subjects at the end of the 12 weeks with 50% reduction in individual pretrial dose of ACE-inhibitors (P <.05). Plasma endothelin-1 decreased by 3.9 pg/mL in Pycnogenol-treated group vs 0.5 pg/mL increase in control group (P < .001). Mean HbA1c dropped by 0.8% in Pycnogenol-treated group (P < .05), whereas it decreased by 0.1% in control group. Fasting plasma glucose declined by 23.7 mg/dL in Pycnogenol-treated group vs 5.7 mg/dL in control group (P < .0001). Low-density lipoprotein cholesterol improved significantly in Pycnogenol-treated group, declining by 12.7 mg/dL (P < .001). A significant decrease in urinary albumin level was observed at week 8 compared with the control group (P < .05). However, this reduction was not significant at 12th week. After 12 weeks of supplementation, Pycnogenol resulted in improved diabetes control, lowered CVD risk factors, and reduced antihypertensive medicine use vs controls.

Reduction of Cardiovascular Risk Factors in Subjects with Type 2 Diabetes by Pycnogenol® Supplementation

The purpose of this study was to evaluate the clinical effectiveness of Pycnogenol® (Pyc) in reducing use of antihypertensive medicines and cardiovascular disease (CVD) risk factors in subjects with hypertension and type 2 diabetes. In a randomized, placebo controlled trial, 48 individuals, aged 40–75 yrs, with type 2 diabetes and being treated for hypertension with ACE‐inhibitors, were randomly assigned to receive either Pyc pill (125 mg daily) or matched placebo. Pycnogenol® treatment achieved blood pressure control in 58.3% of subjects at the end of the 12 weeks with 50% reduction in individual pretrial dose of ACE‐inhibitors (P &lt; 0.05). Plasma endothelin‐1 decreased 3.9 pg/mL in Pyc‐treated group versus 0.5 pg/mL increase in control group (P &lt; 0.001). Mean HbA1c dropped from 7.9 to 7.1% in Pyc group (P &lt; 0.05), while the control group decreased from 8.1 to 8.0%. Serum fasting glucose level declined by 23.7 mg/dL in Pyc group versus 5.7 mg/dL in control group (P &lt; 0.0001). LDL‐cholesterol improved significantly in Pyc group, declining by 12.7 mg/dL (P &lt; 0.001). A significant decrease in urinary albumin level was observed at week 8 compared to the control group (P &lt;0.05). However this reduction was not significant at 12th week. In summary after 12 weeks of supplementation, Pycnogenol® resulted in improved diabetes control, lowered CVD risk factors, and reduced antihypertensive medicine use versus controls.