Improvement In Systolic Blood Pressure Research Articles

Light-intensity and high-intensity interval training improve cardiometabolic health in rats

Physical activity has the potential to reduce cardiometabolic risk factors but evaluation of different intensities of physical activity and the mechanisms behind their health effects still need to be fully established. This study examined the effects of sedentary behaviour, light-intensity training, and high-intensity interval training on biometric indices, glucose and lipid metabolism, inflammatory and oxidative stress markers, and vascular and cardiac function in adult rats. Rats (12 weeks old) were randomly assigned to 1 of 4 groups: control (CTL; no exercise), sedentary (SED; no exercise and housed in small cages to reduce activity), light-intensity trained (LIT; four 30-min exercise bouts/day at 8 m/min separated by 2-h rest period, 5 days/week), and high-intensity interval trained (HIIT, four 2.5-min work bouts/day at 50 m/min separated by 3-min rest periods, 5 days/week). After 12 weeks of intervention, SED had greater visceral fat accumulation (p < 0.01) and slower cardiac conduction (p = 0.04) compared with the CTL group. LIT and HIIT demonstrated beneficial changes in body weight, visceral and epididymal fat weight, glucose regulation, low-density lipoprotein cholesterol, total cholesterol, and mesenteric vessel contractile response compared with the CTL group (p < 0.05). LIT had significant improvements in insulin sensitivity and cardiac conduction compared with the CTL and SED groups whilst HIIT had significant improvements in systolic blood pressure and endothelium-independent vasodilation to aorta and mesenteric artery compared with the CTL group (p < 0.05). LIT and HIIT induce health benefits by improving traditional cardiometabolic risk factors. LIT improves cardiac health while HIIT promotes improvements in vascular health.

Physiological And Cognitive Adaptations To 8 Weeks Of Training On A Movement-based Video Game

Cognitive and physical training are two approaches that successfully enhance deficient cognitive control abilities. A synergistic effect may be attainable through the combination of each training approach. PURPOSE: Assess physiological and cognitive adaptations from 8-weeks of training on a novel video game (Body-Brain Trainer “BBT”) combining both cognitive and physical training in a proportional fashion. Positive adaptations in each domain were expected to be greater as compared to an expectancy-matched placebo control group. METHODS: At the halfway mark of this study, ten lightly active young participants (24.2 +/- 1.62 yrs) completed 8 weeks of training (24 sessions total) on BBT, a video game comprised of nine 4-minute game play sessions. An age-matched (24.75 +/- 3.64 yrs) placebo group (n=16) trained on a non-physical video game. Physical task difficulty adapted during game play based on real-time heart rate measurements and titrated participants to 70-80% of VO2 max. Cognitive task difficulty was adaptive, based on cognitive performance metrics. Physiological assessments performed at baseline and follow-up included BMI, resting blood pressure, body composition, vertical jump, Hexagon Agility Test, and VO2 max. Cognitive assessments performed included behavioral and neural measures of working memory, sustained attention, and goal management. RESULTS: Preliminary findings revealed a significant improvement in systolic blood pressure in the BBT group (108.33 + 8.17 mmHg, p=.001) compared to placebo (114.31 + 7.39 mmHg, p=.774). Vertical jump also showed a significant improvement in the BBT group (15.25 + 2.64 inches, p=.003). VO2 max showed no improvement in either group, but BBT participants were in their prescribed heart rate zone for only 35% of training sessions. 80% of BBT participants showed an improvement in working memory abilities as compared to 62.5% in Placebo, although to date no significant group differences exist. CONCLUSIONS: This novel video game proportionally integrating both exercise and cognitive challenges revealed potential improvements in both cognitive and physiological measures. Future endeavors include doubling the number of participants as well as the enrollment of control groups to assess training either on a “Brain-only” or “Body-only” version of BBT.

Abstract 11927: Theracurmin Attenuates Cardiac NLRP3 Inflammasome Activation in a Rodent Model of Chronic Kidney Disease

Background: Theracurmin is a novel formulation of the polyphenolic compound curcumin, which has been shown to have anti-inflammatory properties in a wide range of diseases. In chronic kidney disease (CKD), NLRP3 and inflammasome-dependent cytokines IL-1β and IL-18 have been shown to contribute significantly to disease progression and ensuing cardiovascular complications. Here, we investigate the cardio-renal effects of theracurmin in a rodent model of CKD and assess its impact on NLRP3 inflammasome activation. Methods: Sprague-Dawley rats were randomized to undergo sham or subtotal nephrectomy (SNx) surgery at 8 weeks of age. At 3 weeks post surgery, SNx animals were randomized to received 100mg/kg/day of theracurmin via once daily oral gavage. At 8 weeks post surgery, cardiac function was assessed, followed by LV and renal tissue collection for analysis. Results: Renal dysfunction, evidenced by elevated blood pressure and proteinuria, was confirmed in SNx animals. Treatment with theracurmin had no significant effect on renal function; however, an improvement in systolic blood pressure was observed (p&lt;0.05). Cardiac function of SNx animals was improved with theracurmin treatment. Chamber compliance, as measured by the slope of the end diastolic pressure volume relationship was improved (p&lt;0.05). SNx-induced LV hypertrophy and fibrosis was attenuated with theracurmin treatment (p&lt;0.05). Cardiac NLRP3 inflammasome activation, characterized by an overexpression of NLRP3 inflammasome components in SNx animals, was also attenuated in theracurmin treated animals (p&lt;0.001). Conclusions: Theracurmin may be an effective compound to ameliorate cardiovascular events in the setting of CKD. The noted improvements to cardiac structure and function, albeit in the absence of significant changes to renal function, suggests a cardioprotective effect of the compound and raises the possibility of a dose-specific effect of theracurmin in the setting of CKD.

Treatment of Hypertensive Patients with a Fixed-Dose Combination of Bisoprolol and Amlodipine: Results of a Cohort study with More Than 10,000 Patients.

IntroductionMany patients need more than one antihypertensive agent for effective blood pressure (BP) control. Prescription of a fixed-dose combination (FDC) of bisoprolol and amlodipine in one tablet has been shown to significantly improve patient adherence. This non-interventional study investigated the effects on adherence and BP control of switching from a free-dose combination of the two antihypertensive substances to a FDC in a larger patient population.MethodsPatients aged ≥18 years with essential hypertension were switched at least 4 weeks prior to study initiation from a free-dose combination of bisoprolol and amlodipine to the FDC. Dosage adjustment was implemented only if medically indicated. Adherence was assessed on the basis of the ratio of pills used to pills dispensed (%) at each visit (pill count). BP and key laboratory values were determined at baseline, 3 and 6 months.Results10,532 patients (average age 59 years; 48% female) were recruited between 2013 and 2014; 22% of patients had type 2 diabetes and 38% had cardiovascular disease. The mean doses of the freely combined drugs prior to switching were 5.5 mg bisoprolol and 6.1 mg amlodipine once daily. The mean daily doses prescribed in the FDC were 5.8 and 6.4 mg, respectively. Pill counts at 6 months revealed a good to excellent adherence in >95% of the patients. Comparison of BP at baseline and at 6 months showed substantial changes (mean systolic BP: 147.3 vs. 130.9 mmHg; mean diastolic BP: 87.9 vs. 79.1 mmHg). Clinically relevant improvement in systolic BP was established for 82% of patients. In patients with comorbidities, switching to FDC produced a substantial improvement in BP. A total of 89 (0.7%) adverse events (AEs) were reported, including edema, headache, dizziness, bradycardia, nausea, and skin reactions. Only three AEs were classified as serious.ConclusionThese data from a non-interventional study in a large patient population demonstrate the benefits of prescribing a FDC of bisoprolol–amlodipine in terms of an excellent adherence and an associated improvement in control of previously elevated BP, which may be relevant in real-life practice.FundingMerck KGaA.Electronic supplementary materialThe online version of this article (doi:10.1007/s40119-015-0045-z) contains supplementary material, which is available to authorized users.

Outcomes of The BODY Project: A Program to Halt Obesity and Its Medical Consequences in High School Students.

Adolescent obesity continues to be a major public health issue with a third of American adolescents being overweight or obese. Excess weight is associated with cardiovascular risk factors and pre-diabetes. High school students identified as carrying excess weight [body mass index (BMI) ≥25kg/m(2), or BMI percentile ≥85%] were invited to participate in The BODY Project, an intervention that included a medical evaluation and a personalized medical report of the results of that evaluation sent to the parent/guardian at home. The medical evaluation and report was repeated 12months later. The reports also contained advice on how the individual student could modify their lifestyle to improve the specific medical parameters showing abnormalities. Outcomes were change in BMI, blood pressure, high-density lipoprotein (HDL), low-density lipoprotein (LDL), fasting glucose, and fasting insulin. Students participating in The BODY Project intervention demonstrated modest, yet significant, reductions in BMI (p<0.001) 1year later, and also had significant improvements in systolic blood pressure (p<0.001) and cholesterol profile (HDL p=0.002; LDL p<0.001) at follow-up. The BODY Project, by means of a minimal educational program anchored on the principle of teachable moments around the students' increased perception of their own risk for disease from the medical abnormalities uncovered, demonstrates evidence of potential effectiveness in addressing adolescent obesity.

Do we need another SGLT2 inhibitor?

Do we need another <scp>SGLT2</scp> inhibitor?

Effect of yogasanas on glycaemic, haemodynamic and lipid profile in newly diagnosed subjects with type 2 diabetes

This study was designed to evaluate the effect of yogasanas on glycaemic control, haemodynamic and lipid profile in newly diagnosed subjects with type 2 diabetes prescribed with oral hypoglycaemic agents (OHA). Three hundred and three (M:F 199:104) subjects were recruited in this prospective study and were divided into two groups. Group 1 (N = 149) were prescribed OHA alone, while group 2 subjects (N = 154) were prescribed OHA and received training individually once for regular yoga practice for 30 min daily. Baseline data on anthropometric, haemodynamic and biochemical details were collected, and subjects were asked to report for review after 3 months. All investigations were repeated after 3 months. A total of 241 subjects were available for follow-up. Diabetes treatment regimen was unchanged in both the groups during the study period. Both the groups were matched with respect to body mass index (BMI), glycaemic level, lipid profile and diet calorie consumption at baseline. BMI did not differ significantly at follow-up in both the groups. Glucose levels and HbA1c % showed greater reduction in group 2 practising yoga. Total and low-density lipoprotein (LDL) cholesterol alone improved in group 1, whereas improvement was seen in all lipid parameters in group 2. High-density lipoprotein (HDL) cholesterol was not statistically significant in both groups. Group 1 showed improvement in systolic blood pressure (P = 0.027), whereas group 2 subjects showed improvement in both systolic and diastolic blood pressures (P < 0.0001). In conclusion, regular practice of yoga along with conventional medicines could be beneficial for better control of diabetes.

CorrelationBetween Baseline Characteristics and Clinical Outcomes in a Large Population of Diabetes Patients Treated with Liraglutide in a Real-World Setting in Italy

PurposeTreatment with liraglutide in randomized controlled trials is associated with significant reductions in glycated hemoglobin (HbA1c) and weight loss in type 2 diabetes patients. The aim of this retrospective observational study was to investigate correlations of glycemic control and weight outcomes with baseline characteristics of patients starting liraglutide in outpatient clinics in Italy. MethodsType 2 diabetes patients were followed from baseline to 4, 8, and 12 months. Changes in glycemic parameters, weight, blood pressure, and lipids were assessed. Subanalyses were performed according to baseline characteristics. Multivariate linear and logistic regressions were used to assess correlations between glycemic efficacy, weight reduction, and liraglutide discontinuation after 12 months and baseline characteristics. FindingsFour hundred and eighty-one patients were included. Mean (SD) age at baseline was 57.3 (9.2) years, diabetes duration was 9.5 (6.8) years, weight was 106.7 (20.8) kg, body mass index (BMI; calculated as kg/m2) was 37.1 (6.6), HbA1c was 8.7% (1.3%), fasting plasma glucose was 168.5 (45.3) mg/dL; 38.2% were treated previously with insulin and 52.2% were treated with metformin alone. After 12 months, mean (SD) changes were HbA1c −1.2% (1.4%), fasting plasma glucose −28.3 (41.1) mg/dL, weight −3.5 (5.8) kg, BMI −1.3 (2.1), waist circumference −2.6 (6.7) cm (all, P < 0.001). Drop in weight and HbA1c did not differ between baseline BMI classes ≤30 or >30. Weight loss was unchanged among diabetes duration quartiles, and HbA1c reduction was significantly greater in patients with ≤4 years of diabetes duration (P = 0.01). Non−insulin-treated patients reached HbA1c ≤7% significantly more often than treated patients (44.2% vs 21.2%; odds ratio = 2.94; P < 0.001) and had significantly greater weight loss (−4.5 [8.2] kg vs −2.6 [5.4] kg; P = 0.03). Patients on metformin reached HbA1c target more frequently than others (43.1% vs 29.7%; odds ratio = 1.80; 95% CI, 1.05−3.07). Significant positive determinants for HbA1c reduction after 12 months were baseline HbA1c, age, and prior metformin monotherapy, and weight loss at 12 months was positively correlated with baseline weight, and negatively correlated with prior insulin treatment. Overall, 5.0% of patients interrupted liraglutide before the 12th month due to lack of glycemic control; they were less frequently treated with metformin only before liraglutide (29.2% vs 50.2%; P = 0.04). ImplicationsTreatment with liraglutide in a real-world setting is associated with low therapy failure, good glycemic response, weight loss, and improvement in systolic blood pressure and lipid profile. The HbA1c drop did not differ among baseline BMI classes, indicating that efficacy is maintained in patients with lower BMI. The probability of reaching HbA1c ≤7% was significantly higher in patients previously treated with metformin alone and without any previous insulin. This could reinforce the hypothesis that better results with liraglutide could be achieved in patients after early metformin failure.

Beneficial effects of ethanol extracts of Red Liriope platyphylla on vascular dysfunction in the aorta of spontaneously hypertensive rats.

Some biological effects of Red Liriope platyphylla (RLP) on various chronic diseases including Alzheimer's disease, diabetes and obesity were suggested after a report of the production from Liriope platyphylla (L. platyphylla, LP) roots using a steaming process. To examine the beneficial effects of ethanol extracts RLP (EEtRLP) on the vascular dysfunction of hypertension, alterations in key factors related to vascular regulation and antioxidant conditions were investigated in spontaneously hypertensive rats (SHR) after EEtRLP treatment for 2 weeks. High levels of 2,2-diphenyl-1-picrylhydrazyl (DPPH) scavenging activity were detected in 500 or 1,000 mg/mL EEtRLP. Although no significant improvement of systolic blood pressure or aortic wall thickness were observed in the EEtRLP treated group, the expression level of angiotensin converting enzyme (ACE) and ACE2 increased significantly after EEtRLP treatment. Moreover, the concentration of aldosterone and K ion in serum rapidly recovered in the EEtRLP treated group relative to the vehicle treated group. Furthermore, the endothelial nitric oxide synthase (eNOS) expression and superoxide dismutase (SOD) activity were significantly increased in the EEtRLP treated group relative to the vehicle treated group, while the level of malondialdehyde (MDA) and NOx in the serum of the same group were recovered to the level of Wistar Kyoto (WKY) rats. Overall, the results presented herein provide novel evidence that EEtRLP treatment may improve vascular dysfunction in the aorta of the SHR through up regulation of the antioxidant state and down regulation of aldosterone and K ion concentration. These results also suggest that EEtRLP may be a potential candidate for treatment of various chronic diseases showing vascular dysfunction.

기마사지요법이 고혈압 환자의 생리·심리적 상태에 미치는 효과

Purpose: This research aims to identify the physio-psychological effects of applying a qi massage program as an independent complementary intervention for employees with hypertension in a workplace. Methods: A quasi-experimental design was employed using a nonequivalent control group with preand post-tests. The study was performed from August 18 to October 10, 2008 on hypertensive employees being treated with a qi massage program in a company. The control group was recruited first to prevent treatment diffusion. The experimental group was subsequently recruited and received individual treatment for 30 minutes. Collected data was analyzed using SPSS16.0 version. χ2-test, Mann-Whitney U test, Wilcoxon signed ranks test, Fisher’s exact test and paired t-test were implemented in order to examine the effects of individual intervention on patients who are treated with the qi massage program. Results: The experimental group showed a greater improvement in systolic blood pressure, diastolic pressure, stress, and quality of life than did the control group. Conclusion: A qi massage program may be implemented as a complementary intervention to effectively treat hypertensive persons.

Mobile health, exercise and metabolic risk: a randomized controlled trial.

BackgroundIt was hypothesized that a mobile health (mHealth) intervention would elicit greater improvements in systolic blood pressure and other cardiometabolic risk factors at 12 weeks, which would be better maintained over 52 weeks, compared to the active control intervention.MethodsEligible participants (≥2 metabolic syndrome risk factors) were randomized to the mHealth intervention (n = 75) or the active control group (n = 74). Blood pressure and other cardiometabolic risk factors were measured at baseline and at 12, 24 and 52 weeks. Both groups received an individualized exercise prescription and the intervention group additionally received a technology kit for home monitoring of biometrics and physical activity.ResultsAnalyses were conducted on 67 participants in the intervention group (aged 56.7 ± 9.7 years; 71.6% female) and 60 participants in the active control group (aged 59.1 ± 8.4 years; 76.7% female). At 12 weeks, baseline adjusted mean change in systolic blood pressure (primary outcome) was greater in the active control group compared to the intervention group (-5.68 mmHg; 95% CI -10.86 to -0.50 mmHg; p = 0.03), but there were no differences between groups in mean change for secondary outcomes. Over 52-weeks, the difference in mean change for systolic blood pressure was no longer apparent between groups, but remained significant across the entire population (time: p < 0.001).ConclusionsIn participants with increased cardiometabolic risk, exercise prescription alone had greater short-term improvements in systolic blood pressure compared to the mHealth intervention, though over 52 weeks, improvements were equal between interventions.Trial registrationClinicalTrials.gov http://NCT01944124Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1082) contains supplementary material, which is available to authorized users.

고혈압환자의 폭염 적응력 증진을 위한 프로그램 효과

Purpose: The purpose of this study was to identify the effects of an extreme heat Adaptation Program on the blood pressure, stress response, self-efficacy, and knowledge of management of hypertension and extreme heat of patients who suffered from hypertension. Methods: A quasi-experimental study with a non-equivalent control group pretest-posttest design was used. The data collection period was between July 2 and August 20, 2012. Thirty-seven patients participated in the study (18 in the experimental group and 19 in the control group). Data were analyzed using χ²-test, t-test, and Cronbach’s alpha coefficients with SPSS/WIN 19.0. Results: Patients who participated in the program showed statistically significant improvements in systolic blood pressure (SBP), self-efficacy, and knowledge of management of hypertension and extreme heat. Conclusion: The results indicate that this extreme heat adaptation program can be utilized for patients suffering from hypertension in order to reduce their SBP and to increase self-efficacy and knowledge of management of hypertension and extreme heat. Therefore, it is recommended that this program be used for elderly patients suffering from chronic disease.

Glucagon-like peptide-1 receptor agonists for diabetes mellitus: a role in cardiovascular disease.

Diabetes mellitus, defined as a fasting plasma glucose of ≥126 mg/dL or a glycosylated hemoglobin A1c level (HbA1c) of ≥6.5%, afflicts ≈12.9% of adults in the United States and nearly 285 million adults worldwide.1,2 Diabetes mellitus is a major risk factor for the development of cardiovascular disease, independently conferring a 2-fold excess risk of coronary heart disease and stroke.3 Macrovascular events in diabetes mellitus remain the leading cause of mortality, and the burden of cardiovascular disease attributable to diabetes mellitus has increased over the past decade.4 An increase in the prevalence of obesity has contributed to the rise in diabetes mellitus. Additionally, obesity independently increases the risk of cardiovascular disease in patients with diabetes mellitus.5 Although strict glycemic control unequivocally reduces the microvascular complications of diabetes mellitus, the macrovascular benefits of intensive therapy have been difficult to establish, with conflicting results from large clinical trials.6–9 Multifactorial strategies are recommended to reduce cardiovascular risk in diabetes mellitus through enhanced glycemic control, blood pressure reduction, lipid management, weight loss, and physical activity.10 Unfortunately, despite aggressive interventions for hyperglycemia, <50% of patients achieve standard HbA1c targets with conventional therapy.11 Polypharmacy is required to achieve glycemic control in the majority of patients within 3 years of diagnosis.12 Although combinations of drug classes can synergistically target multiple pathophysiological defects, novel therapies are required to manage diabetes mellitus and mitigate cardiovascular risks. Dipeptidyl-peptidase IV (DPP-IV) inhibitor and glucagon-like peptide-1 (GLP-1) receptor agonist incretin therapies were developed to complement conventional treatment options for diabetes mellitus. Despite promising initial reports of cardioprotective effects, DPP-IV inhibitors have failed to demonstrate improved cardiovascular outcomes in large clinical trials.13–15 Randomized studies to evaluate cardiovascular outcomes associated with GLP-1 receptor agonists are currently underway. This review presents …

Treating diabetes in underserved populations using an interprofessional care team

Community Health Centers that provide diabetic care for underserved patients have unique challenges. This study describes how interprofessional care improves outcomes and results in cost savings. Interprofessional diabetes education and structured team building are discussed. The team consisted of a physician, nurse practitioner, clinical pharmacist, and a number of pre-medicinal, nursing, and pharmacy students. The outcomes were measured at one year intervals for a total of three years. During the two year period with the interprofessional care team, the diabetic patients in this study achieved a 10% improvement in HgA1c, and 9% improvement in systolic blood pressure, a 5% improvement in diastolic blood pressure, and a 62.6% reduction in triglycerides. These findings suggest that this interprofessional care model in a free clinic significantly improved the HgA1c, triglycerides, and blood pressure.

THE EFFECT OF THE BLOOD PRESSURE FEEDBACK INTERVENTION TO PHYSICIANS ON THE IMPROVEMENT OF THE BLOOD PRESSURE CONTROL

The study aimed to assess the effect of the blood pressure (BP) feedback intervention to physicians on the improvement of the blood pressure control of hypertension subjects. The study was done with controlled repeated intervention design. The adult hypertensive non-hemodialysis subjects from 4 Indonesian hospitals were included as intervention and control subjects. Outcomes were measured as the improvement of systolic BP (SBP). The subjects in intervention (n=385) vs. non-intervention (n=271) groups had similar age and proportion of males (p&gt;0.05); proportion of cardiovascular comorbid 78.7% vs. 91.5% (p&lt;0.01) and the baseline SBP at 144.1±15.8 vs. 139.6±13.8mmHg (p&lt;0.01). The final SBP 138.2±17.2 vs.140.6±15.4mmHg (adjusted p&lt;0.01); the difference between (∆) final-baseline SBP: 5.9±20.3 vs. (-)0.9±20.0mmHg (adjusted p&lt;0.01); ∆final-target SBP: (-)6.1±17.3 vs. (-)9.6±15.5 (adjusted p&lt;0.01). There were more intervention subjects with good controlled final SBP; odds ratio (OR) 1.4(CI95%:1.0-1.9, adjusted p&lt;0.05). Based on the ∆final-baseline SBP, the ∆final-target SBP, and OR SBP reached the target; theintervention subjects had significant SBP improvement.

Does Pomegranate intake attenuate cardiovascular risk factors in hemodialysis patients?

BackgroundAtherosclerotic cardiovascular disease (CVD) is the most common cause of morbidity and mortality among hemodialysis (HD) patients. It has been attributed, among other causes, to hypertension and dyslipidemia. The aim of the present study was to investigate the effect of a year-long consumption of Pomegranate juice (PJ), on two traditional cardiovascular (CV) risk factors: hypertension and lipid profile, as well as on cardiovascular events.Methods101 HD patients were randomized to receive 100 cc of PJ (0.7 mM polyphenols) or matching placebo juice, three times a week for one year. The primary endpoints were traditional CV risk factors; blood pressure and lipid profile. Systolic, diastolic and pulse pressure, plasma levels of triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and total cholesterol were monitored quarterly during the study year. Secondary endpoint was incidence of cardiovascular events.ResultsPJ consumption yielded a significant time response improvement in systolic blood pressure, pulse pressure, triglycerides and HDL level; an improvement that was not observed in the placebo intake group. These beneficial outcomes were more pronounced among patients with hypertension, high level of triglycerides and low levels of HDL.ConclusionRegular PJ consumption by HD patients reduced systolic blood pressure and improved lipid profile. These favorable changes may reduce the accelerated atherosclerosis and high incidence of CVD among HD patients.Trial registrationClinicalTrials.gov registry, Identifier number: NCT00727519

Roll-in Experience from the Cardiovascular Outcomes with Renal Atherosclerotic Lesions (CORAL) Study

PurposeTo describe the experience and results from the roll-in phase of the Cardiovascular Outcomes with Renal Atherosclerotic Lesions (CORAL) study. Materials and MethodsThe CORAL roll-in database was used to describe the baseline characteristics of the patients in the roll-in cohort, all of whom underwent renal artery stent placement; to evaluate CORAL site performance; to compare estimates of lesion (stenosis) severity made by site interventionalists with the central CORAL angiographic core laboratory readings; and to report outcomes after renal artery stent placement. During the roll-in phase, 239 patients (mean age, 70.2 y ± 9.0; 49% male) underwent renal artery stent procedures. Angiographic core laboratory analysis of renal arteriograms was done, and participants were followed at 1 month and 9 months. ResultsMajor angiographic complications were identified in 28 (13%) subjects. Kidney function remained unchanged at the short (2–4 weeks) follow-up interval. Improvement in systolic blood pressure with use of distal embolic protection devices (n = 161) did not show any clinical benefit over nonuse of such devices (n = 78) in this small series. At 9 months, there were significantly more endpoints reported by site in subjects with bilateral renal artery stenosis (P = .01) and prior history of stroke (P = .03). ConclusionsIn the roll-in phase of the CORAL study, a significant number of angiographic complications were identified. No effect was seen on estimated glomerular filtration rate after renal artery stent placement, but systolic blood pressure decreased significantly.

Breastfeeding and Cardiometabolic Profile in Childhood

Although the observed association between breastfeeding and cardiometabolic profile in childhood and adolescence in previous studies has biological plausibility, the precise mechanism and magnitude remain far from being fully understood.1 Early nutrition and epigenetic programming,2 anti-inflammatory properties,3 and cardiorespiratory fitness4 are among numerous hypotheses that are currently being actively investigated. In this issue of Circulation, Martin et al5 report on this subject. Their intervention study began in 1996 to 1997 in 31 Belarussian maternity hospitals and affiliated outpatient clinics with an enrollment of 17046 breastfeeding mothers of healthy term infants. The trial was originally designed to assess the effects of a breastfeeding promotion and support intervention on duration of breastfeeding. Duration of both exclusive (infant only receives breast milk without any additional food or drink, not even water) and any breastfeeding (includes nonexclusive and exclusive) was assessed in the intervention and nonintervention groups.6 The planned 11.5-year follow-up of ≈80% of study participants who had fasted for the follow-up assessment and did not have diabetes mellitus allowed the authors to test whether an intervention to improve breastfeeding duration and exclusivity also influenced cardiometabolic risk factors in childhood. No significant differences between the intervention and control groups were found in levels of blood pressure, fasting insulin, adiponectin, glucose, apolipoprotein A1, or metabolic syndrome.

A Family-Based Diabetes Intervention for Hispanic Adults and Their Family Members

The purpose of this quasi-experimental, 1-group longitudinal study is to examine the effects of a family-based intervention program on diabetes self-management behaviors, A1C, other biomarkers, psychosocial factors, and health-related quality of life in Hispanics with diabetes. Adult patients with diabetes (n = 36) and family members (n = 37) were recruited from a community clinic in rural central North Carolina. Patients and family members attended an 8-week culturally tailored diabetes educational program taught in Spanish. Data were collected pre- and post-intervention for both patients and family members, with an additional data collection for patients 1 month post-intervention. Most patients and family members were female, and almost all were immigrants. A1C decreased by 4.9% on average among patients from pre-intervention to 1 month post-intervention. Patients showed significant improvements in systolic blood pressure, diabetes self-efficacy, diabetes knowledge, and physical and mental components of health-related quality of life. Higher levels of intake of healthy foods and performance of blood glucose tests and foot inspections were reported. Family members significantly lowered body mass index and improved diabetes knowledge from pre-intervention to immediately post-intervention. No significant changes in levels of physical activity were found among patients with diabetes or family members. Findings suggest that including family members in educational interventions may provide emotional and psychological support to patients with diabetes, help to develop healthy family behaviors, and promote diabetes self-management.

Research in brief

Two multicentre, double-blind, randomised, placebo-controlled studies report that the DPP4 inhibitors alogliptin (n=5380) and saxagliptin (n=16 492) are effective anti-diabetes drugs and do not increase the risk of cardiovascular events in patients with type 2 diabetes. After a median follow-up of 18 months in the alogliptin study and 2·1 years in the saxagliptin study, the occurrence of the primary endpoint—a composite of cardiovascular death, myocardial infarction, or ischaemic stroke—was not increased by the drug treatment compared with placebo in either study. Moreover, the drug-treated patients had better glycaemic control than did those given placebo. These data provide important insights into the safety and efficacy of these drugs for patients with type 2 diabetes who have a high cardiovascular risk. The richness of gut microbiota could be associated with metabolic disease and might predict responsiveness to dietary interventions in patients with obesity, suggest two new studies. In one study, low microbial richness in the gut (<480 000 bacterial genes) was associated with increased adiposity, insulin resistance, dyslipidaemia, and inflammation in 292 Danish individuals, 169 of whom had obesity. Patients with obesity and low microbial richness were prone to metabolic disease and tended to gain more weight than those with obesity and high microbial richness. In the second study, an association was found between low richness of gut microbiome (<480 000 bacterial genes) and response to dietary interventions in 38 obese and 11 overweight individuals. 6-week diet-induced weight loss followed by 6-week weight-maintenance improved microbial richness, adiposity, and circulating cholesterol concentrations in patients with low microbial richness at baseline. However, diet was less effective at improving inflammation in these patients. Altogether, these data highlight the importance of a healthy gut microbiome for metabolic health, and indicate that the level of microbial richness could be a predictive marker for treatment of patients with obesity and related complications. Adherence to long-term medical treatment is a major challenge for patients with cardiovascular disease. A fixed-dose combination drug of aspirin, a statin, and two blood pressure-lowering drugs has now been reported to increase long-term treatment adherence and to improve cardiovascular benefits compared with standard care. 2004 patients in India and Europe were randomly assigned to the combination treatment or to standard care for a median of 15 months. At the end of the study, 86·3% of those receiving the combination were adherent to treatment vs 64·7% of those on standard care. Combination treatment also resulted in greater improvement of systolic blood pressure and low-density cholesterol concentration than did standard care; these differences were small, albeit statistically significant. These results are encouraging and further research will help elucidate the effect of combination treatment on cardiovascular outcomes. Researchers now suggest that assessment of the risk of thyroid cancer based on ultrasound imaging could reduce the number of unnecessary biopsies for patients with a low risk of cancer. In a retrospective case-control study, 8806 patients underwent ultrasound imaging between 2000 and 2005 at the University of California, San Francisco (CA, USA). During this time, 105 patients were diagnosed with thyroid cancer. Thyroid nodules were found in 96·9% of patients with thyroid cancer and in 56·4% of those not diagnosed with cancer, indicating that nodules were common in most patients who were screened. Interestingly, the nodules associated with thyroid cancer had only three ultrasound characteristics in common (microcalcifications, an entirely solid composition, and size of more than 2 cm). The investigators state that if one ultrasound feature is used to prompt biopsy, 56 biopsies would be done per cancer diagnosed, whereas, if two characteristics were required, this number would be reduced to 16 and the risk of cancer would be very low in those for whom biopsy is deferred. New research shows that children and adolescents with type 1 diabetes could have an increased risk of multiple sclerosis). In a cohort study, data from 5653 patients with type 1 diabetes collected from January 1995, to October 2012, in 248 German and Austrian centres were analysed for multiple sclerosis. Regression analyses showed that the prevalence of multiple sclerosis was higher in paediatric and adolescent patients with type 1 diabetes compared with published data for German and mid-European prevalence. Additional risk factors for multiple sclerosis included thyroid antibodies (in men only), and being born in spring or summer. The role of environmental factors in the risk for co-occurrence of multiple sclerosis and type 1 diabetes should be further investigated.