Disease Risk Factors In People Research Articles

Prevalence of Cardiometabolic Disease Risk Factors in People With HIV Initiating Antiretroviral Therapy at a High-Volume HIV Clinic in Kampala, Uganda.

Cardiometabolic diseases are a leading cause of HIV-related morbidity and mortality, yet routine screening is not undertaken in high-burden countries. We aimed to assess the prevalence and risk factors of the metabolic syndrome (MetS) and its components in adult Ugandan people with HIV (PWH) initiating dolutegravir-based antiretroviral therapy (ART). We conducted a cross-sectional study using baseline sociodemographic and clinical data of PWH aged ≥18 years enrolled in the Glucose metabolism changes in Ugandan HIV patients on Dolutegravir (GLUMED) study from January to October 2021. MetS was defined as having ≥3 of the following: abdominal obesity, hypertension (HTN), hyperglycemia, elevated triglycerides, and low high-density lipoprotein cholesterol. Multiple logistic regression was used to assess associations between potential risk factors and MetS and its components. Three hundred nine PWH were analyzed (100% ART-naïve, 59.2% female, median age 31 years, and median CD4 count 318 cells/mm3). The prevalence of MetS was 13.9%. The most common cardiometabolic condition was dyslipidemia (93.6%), followed by abdominal obesity (34.0%), hyperglycemia (18.4%), and HTN (8.1%). In adjusted analysis, MetS was associated with age >40 years (adjusted odds ratio [aOR], 3.33; 95% CI, 1.45-7.67) and CD4 count >200 cells/mm3 (aOR, 3.79; 95% CI, 1.23-11.63). HTN was associated with age >40 years (aOR, 2.96; 95% CI, 1.32-6.64), and dyslipidemia was associated with urban residence (aOR, 4.99; 95% CI, 1.35-18.53). Cardiometabolic risk factors were common in this young Ugandan cohort of PWH initiating dolutegravir-based ART, underscoring the need for programmatic implementation of surveillance and management of comorbidities in Uganda and similar settings.

Applying Care Coordination Principles to Reduce Cardiovascular Disease Risk Factors in People With Serious Mental Illness: A Case Study Approach.

People with serious mental illness (SMI) have a 2–3-fold higher mortality than the general population, much of which is driven by largely preventable cardiovascular disease. One contributory factor is the disconnect between the behavioral and physical health care systems. New care models have sought to integrate physical health care into primary mental health care settings. However, few examples of successful care coordination interventions to improve health outcomes with the SMI population exist. In this paper, we examine challenges faced in coordinating care for people with SMI and explore pragmatic, multi-disciplinary strategies for overcoming these challenges used in a cardiovascular risk reduction intervention shown to be effective in a clinical trial.

Associations of galectin-3 expression and LGALS-3 (rs4652) gene variant with coronary artery disease risk in diabetics.

BackgroundGalectin-3 protein encoded by lectin galactoside-binding soluble-3 (LGALS-3) gene is an important genetic factor in type 2 diabetes mellitus (T2DM) and its cardiovascular obstacles in various populations. We aimed to elicit the pro-inflammatory effect of galectin-3 as determined by interleukin-6 (IL-6) serum levels and to explore the relationship between galectin-3 (LGALS-3 rs4652) gene variant and its expression levels with coronary artery disease (CAD) risk among T2DM Egyptian patients.Methods112 lean subjects were compared to 100 T2DM without CAD and 84 T2DM with CAD. A tetra-primer amplification refractory mutation system polymerase chain reaction was used to test LGALS-3 (rs4652), and galectin3 expression was tested with a quantitative real-time polymerase chain reaction. Serum IL-6 was measured using an enzyme-linked immunosorbent assay.ResultsWe found that the prevalence of LGALS-3 (rs4652) AC genotype and galectin-3 gene expression levels in T2DM with CAD were significantly higher than the additional 2 groups and were correlated positively to IL-6 circulating levels. Also, the C allele carriers (AC+CC) had significantly higher relative Galectin-3 expression levels compared to the A allele carriers (AA).ConclusionsWe concluded that galectin-3 expression levels and LGALS-3 (rs4652) AC genotype were coronary artery disease risk factors in people with type two diabetes among an Egyptian sample.

Musculoskeletal conditions may increase the risk of chronic disease: a systematic review and meta-analysis of cohort studies

BackgroundChronic diseases and musculoskeletal conditions have a significant global burden and frequently co-occur. Musculoskeletal conditions may contribute to the development of chronic disease; however, this has not been systematically synthesised. We aimed to investigate whether the most common musculoskeletal conditions, namely neck or back pain or osteoarthritis of the knee or hip, contribute to the development of chronic disease.MethodsWe searched CINAHL, Embase, Medline, Medline in Process, PsycINFO, Scopus and Web of Science to February 8, 2018, for cohort studies reporting adjusted estimates of the association between baseline musculoskeletal conditions (neck or back pain or osteoarthritis of the knee or hip) and subsequent diagnosis of a chronic disease (cardiovascular disease, cancer, diabetes, chronic respiratory disease or obesity). Two independent reviewers performed data extraction and assessed study quality. Adjusted hazard ratios were pooled using the generic inverse variance method in random effect models, regardless of the type of musculoskeletal condition or chronic disease. PROSPERO: CRD42016039519.ResultsThere were 13 cohort studies following 3,086,612 people. In the primary meta-analysis of adjusted estimates, osteoarthritis (n = 8 studies) and back pain (n = 2) were the exposures and cardiovascular disease (n = 8), cancer (n = 1) and diabetes (n = 1) were the outcomes. Pooled adjusted estimates from these 10 studies showed that people with a musculoskeletal condition have a 17% increase in the rate of developing a chronic disease compared to people without (hazard ratio 1.17, 95% confidence interval 1.13–1.22; I2 52%, total n = 2,686,113 people).ConclusionsThis meta-analysis found that musculoskeletal conditions may increase the risk of chronic disease. In particular, osteoarthritis appears to increase the risk of developing cardiovascular disease. Prevention and early treatment of musculoskeletal conditions and targeting associated chronic disease risk factors in people with long standing musculoskeletal conditions may play a role in preventing other chronic diseases. However, a greater understanding about why musculoskeletal conditions may increase the risk of chronic disease is needed.

The Association Between Healthy Lifestyle Behaviors and Level of Knowledge About Cardiovascular Disease Risk Factors in People With Type 2 Diabetes

The Association Between Healthy Lifestyle Behaviors and Level of Knowledge About Cardiovascular Disease Risk Factors in People With Type 2 Diabetes

Evaluating the clinical and cost effectiveness of a behaviour change intervention for lowering cardiovascular disease risk for people with severe mental illnesses in primary care (PRIMROSE study): study protocol for a cluster randomised controlled trial.

BackgroundPeople with severe mental illnesses die up to 20 years earlier than the general population, with cardiovascular disease being the leading cause of death. National guidelines recommend that the physical care of people with severe mental illnesses should be the responsibility of primary care; however, little is known about effective interventions to lower cardiovascular disease risk in this population and setting. Following extensive peer review, funding was secured from the United Kingdom National Institute for Health Research (NIHR) to deliver the proposed study. The aim of the trial is to test the effectiveness of a behavioural intervention to lower cardiovascular disease risk in people with severe mental illnesses in United Kingdom General Practices.Methods/DesignThe study is a cluster randomised controlled trial in 70 GP practices for people with severe mental illnesses, aged 30 to 75 years old, with elevated cardiovascular disease risk factors. The trial will compare the effectiveness of a behavioural intervention designed to lower cardiovascular disease risk and delivered by a practice nurse or healthcare assistant, with standard care offered in General Practice. A total of 350 people will be recruited and followed up at 6 and 12 months. The primary outcome is total cholesterol level at the 12-month follow-up and secondary outcomes include blood pressure, body mass index, waist circumference, smoking status, quality of life, adherence to treatments and services and behavioural measures for diet, physical activity and alcohol use. An economic evaluation will be carried out to determine the cost effectiveness of the intervention compared with standard care.DiscussionThe results of this pragmatic trial will provide evidence on the clinical and cost effectiveness of the intervention on lowering total cholesterol and addressing multiple cardiovascular disease risk factors in people with severe mental illnesses in GP Practices.Trial registrationCurrent Controlled Trials ISRCTN13762819. Date of Registration: 25 February 2013.Date and Version Number: 27 August 2014 Version 5.

The effect of physical activity modification on ischaemic heart disease risk factors in people living with HIV: randomised control trial

The effect of physical activity modification on ischaemic heart disease risk factors in people living with HIV: randomised control trial

Effects of hybrid cycle and handcycle exercise on cardiovascular disease risk factors in people with spinal cord injury: A randomized controlled trial.

To examine the effects of a 16-week exercise programme, using either a hybrid cycle or a handcycle, on cardiovascular disease risk factors in people with spinal cord injury. Nineteen individuals with spinal cord injury ≥ 8 years. Multicentre randomized controlled trial. Both the hybrid cycle group (n = 9) and the handcycle group (n = 10) trained twice a week for 16 weeks on the specific cycle. Outcome measures obtained pre and post the programme were: metabolic syndrome components (waist circumference, systolic and diastolic blood pressure, high-density lipoprotein cholesterol, triglycerides and insulin resistance), inflammatory status (C-reactive protein (CRP), interleukin (IL)-6 and -10), and visceral adiposity (trunk and android fat). For all outcome measures, there were no significant differences over time between the 2 training groups. Overall significant reductions were found for waist circumference (p = 0.001), diastolic blood pressure (p = 0.03), insulin resistance (p = 0.006), CRP (p = 0.05), IL-6 (p = 0.04), IL-6/IL-10 ratio (p = 0.03), and trunk (p = 0.04) and android (p = 0.02) fat percentage. No significant main effects for time were observed for systolic blood pressure, triglycerides, high-density lipoprotein cholesterol, IL-10, and trunk and android fat mass. The 16-week exercise programme, using either a hybrid cycle or a handcycle, found similar beneficial effects on metabolic syndrome components, inflammatory status and visceral adiposity, indicating that there were no additional benefits of functional electrical stimulation-induced leg exercise over handcycle exercise alone.

Trends in cardiovascular disease risk factors in people with and without diabetes mellitus: a Middle Eastern cohort study.

Aims/HypothesisTo investigate secular trends in cardiovascular disease (CVD) risk factors during a decade of follow-up in a Middle Eastern cohort, and to compare observed trends between diabetic and non-diabetic populations.MethodsIn a population of 6181 participants (2622 males and 3559 females), diabetes status and CVD risk factors were evaluated in 4 study phases from 1999–2011. 1045 subjects had type 2 diabetes mellitus at baseline and 5136 participants were diabetes-free. To examine the trends of CVD risk factors, generalized estimation equation models were constructed. The interaction between the diabetes status and each phase of the study was checked in a separate model.ResultsDuring the follow-up period diabetic females significantly gained better control of their blood pressure, serum low density lipoprotein cholesterol and general and central obesity measures compared to non-diabetic counterparts, although 60% of them had high BP and 64% had high serum LDL-C levels till the end of the study. Diabetic males however, experienced significantly better control on their serum LDL-C and general and central obesity measures compared to their non-diabetic controls; but 24% of them were still smoker, 63% had high BP and 60% had high serum LDL-C levels at the end of the follow-up (all Ps interaction <0.05). Use of lipid-lowering and antihypertensive medications increased consistently in both diabetic and non-diabetic populations.Conclusions/InterpretationAlthough CVD risk factors have been controlled to some extent among diabetic population in Iran, still high numbers of people with diabetes have uncontrolled CVD risk factors that prompt more attention.

The diabetes pandemic: is structured education the solution or an unnecessary expense?

AbstractStructured education is a recommended clinical and cost‐effective approach that adds value to traditional medical care. A clinical trial demonstrated that the X‐PERT Diabetes Programme significantly improves health and quality of life. In order to determine if the national implementation of the X‐PERT Programme meets standards identified in the published trial, it is necessary to conduct continuous audit.To meet the key criteria to implement National Institute for Health and Clinical Excellence guidance, educators are trained to deliver X‐PERT Diabetes and X‐PERT Insulin Programmes and submit baseline, six‐month and annual results onto the X‐PERT Audit Database.Forty‐seven percent of X‐PERT centres (55/118) have submitted data for 16 031 people with diabetes. Audit standards have been met with excellent attendance, evaluation and empowerment scores. All outcomes improved at one year: glycated haemoglobin (‐0.6%); body weight (‐3.0kg); waist circumference (‐2.1cm); systolic (‐0.9mmHg) and diastolic (‐2.2mmHg) blood pressure; total (‐0.2mmol/L) and LDL (‐0.1mmol/L) cholesterol; triglycerides (‐0.2mmol/L); HDL cholesterol (+0.1mmol/L); requirement for prescribed diabetes medication (23% less likely to increase medication, number needed to treat [NNT] = 4; 5% more likely to reduce medication, NNT = 19).National implementation of the X‐PERT Programme has met audit standards. X‐PERT increases skills, knowledge and confidence for diabetes self‐management, resulting in intensification of glycaemic control and reducing cardiovascular disease risk factors in people with newly diagnosed and existing diabetes. Structured education is a clinical and cost‐effective approach that should be offered to all people with diabetes as an integral part of their diabetes treatment and management, potentially saving the NHS £367 million per annum. Copyright © 2011 John Wiley &amp; Sons.This paper was presented as the 2011 Janet Kinson lecture at the 2011 Diabetes UK Annual Professional Conference held in London

Prevalence of cardiovascular disease risk factors in people of Asian Indian origin: Age and sex variation

Background:No study has been undertaken on people of Asian Indian origin to investigate the age and sex variation in the prevalence of cardiovascular disease (CVD) risk factors.Objectives:To investigate the age and sex variation in the prevalence of CVD risk factors among the people of Asian Indian origin.Materials and Methods:A total of 682 (302 males and 380 females) participants aged 25–85 years took part in the study. The subjects were categorized into 4 groups, namely, Group I (25–34 years), Group II (35–44 years), Group III (45–54 years), and Group IV (55 years and above). Height, weight, and the circumferences of minimum waist (MWC) and maximum hip were collected using standard techniques. Waist–hip ratio (WHR) was then calculated. Percentage of body fat (%BF) and body mass index (BMI) were measured using an Omron body fat analyzer. Left arm systolic (SBP) and diastolic (DBP) blood pressure were taken from each participant with the help of an Omron MI digital electronic blood/pulse monitor. Metabolic profiles, namely, total cholesterol (TC), triglyceride (TG), high (HDL), low (LDL), very low-density lipoprotein (VLDL), and fasting blood glucose (FBG) were also measured using an autoanalyzer.Results:One-way analysis of variance revealed significant differences for age, BMI, MWC, WHR, SBP, DBP, TC, TG, LDL, VLDL, and TC:HDL and TG:HDL ratios across the groups. It was observed that there were significant sex-specific group differences (male [χ2 (12)] =29.22, P < 0.01 and female [χ2 (12)] =56.69, P < 0.001) for obesity, high BP, high TC, high TG, and high FBG. But no significant group-specific sex difference was evident for either of the risk factors, except for Group IV.Conclusion:Age irrespective of sex modulates CVD risk factors and warranted prevention as early as middle age.

Impact of deprivation on cardiovascular risk factors in people with diabetes: an observational study

To examine the influence of deprivation on prevalence of diabetes and of cardiovascular disease risk factors in people with diabetes. Cross-sectional study of 52 280 people in diabetes registers of Greater Glasgow and Lothian NHS Board areas linked to hospital admission data. Results Age- and sex-adjusted prevalence of diabetes increased from 2.3% in the least deprived quintile (Q1) to 3.3% in the most deprived quintile (Q5; P < 0.001), as did prevalence of vascular disease (Q1 20%, Q5 27%; P < 0.001). Prevalence of current smoking (Q1 13%, Q5 32%; P < 0.001), obesity (Q1 38%, Q5 51%; P < 0.001) and above-target glycated haemoglobin (HbA(1c); > or = 7.5%: Q1 46% vs. Q5 47%; P = 0.01) were higher in the most deprived quintile. In contrast, the proportion of people with above-target cholesterol were similar (proportion > or = 5.0 mmol/l: Q1 26%, Q5 24%; P = 0.07) and the proportion of people with above-target systolic blood pressure (SBP) was lower (SBP > or = 140 mmHg: Q1 44%, Q5 37%; P = 0.02) in the most deprived quintile. In people with diabetes and prevalent vascular disease, deprivation was associated with failure to reach cholesterol target [odds ratio cholesterol > or = 5.0 mmol/l: Q5 vs. Q1 1.23 (1.04-1.45) P = 0.013]. SBP and cholesterol were markedly lower compared with previous population surveys. The burden of diabetes and vascular disease is greater in more deprived populations. Our data confirm a major advance in management of cholesterol and blood pressure management. Deprivation is still associated with failure to reach cholesterol targets in secondary prevention as well as higher prevalence of obesity and smoking.