Optimal Cardiometabolic Health Research Articles

Regularity of bedtime, wake-up time, and time in bed in mid-life: associations with cardiometabolic health markers with adjustment for physical activity and sedentary time

BackgroundInsufficient sleep has been linked to the accumulation of cardiometabolic risks while physical activity acts as a protective factor. Also, sleep regularity may play a critical role in maintaining optimal cardiometabolic health. This cross-sectional study examined the association between device-based sleep regularity, waking activity behaviors, and cardiometabolic health markers, including blood pressure level; abdominal adiposity level; and blood glucose, insulin, and cholesterol.MethodsWe included 3698 members of the Northern Finland Birth cohort 1966 who participated in the follow-up study at the age of 46 years between 2012 and 2014 (women 61%). We used seven-day standard deviations of device-based bedtime, wake-up time, and time in bed to reflect sleep regularities. As covariates in linear regression models, we used commonly known potential risk factors in (gender, education, marital status, work schedule, smoking status, alcohol risk use, seven-day time in bed mean, chronotype). In addition to the previous, we used either sedentary time or total physical activity as a covariate (B coefficients with 95% confidence intervals CI).ResultsWhen we considered sedentary time with other covariates, irregularities in bedtime, wake-up time, and time in bed were associated with unfavorable cardiometabolic health markers, such as higher body mass index (bedtime regularity: 0.194, 95% CI [0.072, 0.316], p = 0.002); higher diastolic blood pressure levels (time in bed regularity: 0.175, 95% CI [0.044, 0.306], p = 0.009); and higher 2-h glucose levels (wake-up time regularity: 0.107, 95% CI [0.030, 0.184], p = 0.006). When we considered total physical activity with other covariates, only irregular bedtime was associated with higher waist circumference (B 0.199, 95% CI [0.042, 0.356], p = 0.013). Irregularities in bedtime and wake-up time were not associated with higher diastolic blood pressure, higher visceral fat area or higher fasting insulin level after considering sedentary time or total physical activity with other covariates (in all, p > 0.05).ConclusionsIn middle-aged, physical activity appears to weaken the adverse relationship between irregular sleep and cardiometabolic health markers, although the interpretation of the impact of sedentary time remains less conclusive. The clinical significance and extent of the observed associations warrant further investigation.

Diet Quality, Microbial Lignan Metabolites, and Cardiometabolic Health among US Adults.

The gut microbiome has been shown to play a role in the relationship between diet and cardiometabolic health. We sought to examine the degree to which key microbial lignan metabolites are involved in the relationship between diet quality and cardiometabolic health using a multidimensional framework. This analysis was undertaken using cross-sectional data from 4685 US adults (age 43.6 ± 16.5 years; 50.4% female) participating in the National Health and Nutrition Examination Survey for 1999-2010. Dietary data were collected from one to two separate 24-hour dietary recalls and diet quality was characterized using the 2015 Healthy Eating Index. Cardiometabolic health markers included blood lipid profile, glycemic control, adiposity, and blood pressure. Microbial lignan metabolites considered were urinary concentrations of enterolignans, including enterolactone and enterodiol, with higher levels indicating a healthier gut microbial environment. Models were visually examined using a multidimensional approach and statistically analyzed using three-dimensional generalized additive models. There was a significant interactive association between diet quality and microbial lignan metabolites for triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, insulin, oral glucose tolerance, adiposity, systolic blood pressure, and diastolic blood pressure (all p < 0.05). Each of these cardiometabolic health markers displayed an association such that optimal cardiometabolic health was only observed in individuals with both high diet quality and elevated urinary enterolignans. When comparing effect sizes on the multidimensional response surfaces and model selection criteria, the strongest support for a potential moderating relationship of the gut microbiome was observed for fasting triglycerides and oral glucose tolerance. In this study, we revealed interactive associations of diet quality and microbial lignan metabolites with cardiometabolic health markers. These findings suggest that the overall association of diet quality on cardiometabolic health may be affected by the gut microbiome.

Daily accelerometer-measured physical activity patterns and associations with cardiometabolic health among Canadian working adults.

Previous studies examining the cardiometabolic risks associated with physical activity (PA) in workers have predominantly used self-reported measures. Little is known about workers' distinct daily PA patterns and whether these are linked with cardiometabolic risks. This study examined associations between patterns of workers' accelerometer-measured daily PA and four markers of cardiometabolic health. Working adults (N=8,229; 47% women; average age: 42 years; standard deviation = 0.3) were sampled from the Canadian Health Measures Survey (five cycles: 2007 to 2017). Accelerometer devices measured daily PA, and hierarchical cluster analysis identified distinct activity patterns. Multiple linear regression analyses examined associations between activity patterns and cardiometabolic risk markers (waist circumference, systolic and diastolic blood pressure, and non-high-density lipoprotein [HDL] cholesterol). Workers were classified into six distinct activity patterns. On average, compared with workers classified in the "lowest activity" pattern, workers with the "moderate consistent activity," "fluctuating moderate activity," "high daytime activity" and "highest activity" patterns were associated with lower waist circumferences; workers with the "fluctuating moderate activity" and "highest activity" patterns were associated with lower systolic blood pressure; the "moderate evening activity" pattern was associated with lower diastolic blood pressure; and workers with the "fluctuating moderate activity," "high daytime activity" and "highest activity" patterns were associated with lower non-HDL cholesterol. "High daytime activity" was associated with lower waist circumference in women, compared with men, and the "moderate consistent activity" and "fluctuating moderate activity" patterns were associated with lower diastolic blood pressure in younger workers (40 years or younger). Workers with high daily PA levels tended to have the most optimal cardiometabolic health. Some evidence suggested that there are benefits to moderate levels of PA, particularly for lowering waist circumference and non-HDL cholesterol. Findings may assist in identifying workers for PA initiatives to promote cardiometabolic health benefits.

Optimal cardiometabolic health and risk of heart failure in type 2 diabetes: an analysis from the Look AHEAD trial.

To evaluate the contribution of baseline and longitudinal changes in cardiometabolic health (CMH) towards heart failure (HF) risk among adults with type 2 diabetes (T2D). Participants of the Look AHEAD trial with T2D and without prevalent HF were included. Adjusted Cox models were used to create a CMH score incorporating target levels of parameters weighted based on relative risk for HF. The associations of baseline and changes in the CMH score with risk of overall HF, HF with preserved (HFpEF) and reduced ejection fraction (HFrEF) were assessed using Cox models. Among the 5080 participants, 257 incident HF events occurred over 12.4 years of follow-up. The CMH score included 2 points each for target levels of waist circumference, glomerular filtration rate, urine albumin-to-creatinine ratio, and 1 point each for blood pressure and glycated haemoglobin at target. High baseline CMH score (6-8) was significantly associated with lower overall HF risk (adjusted hazard ratio [HR], ref=low score (0-3): 0.31, 95% confidence interval [CI] 0.21-0.47) with similar associations observed for HFpEF and HFrEF. Improvement in CMH was significantly associated with lower risk of overall HF (adjusted HR per 1-unit increase in score at 4 years: 0.80, 95% CI 0.70-0.91). In the ACCORD validation cohort, the baseline CMH score performed well for predicting HF risk with adequate discrimination (C-index 0.70), calibration (chi-square 5.53, p=0.70), and risk stratification (adjusted HR [high (6-8) vs. low score (0-3)]: 0.35, 95% CI 0.26-0.46). In the Look AHEAD subgroup with available biomarker data, incorporating N-terminal pro-B-type natriuretic peptide to the baseline CMH score improved model discrimination (C-index 0.79) and risk stratification (adjusted HR [high (8-10) vs. low score (0-4)]: 0.18, 95% CI 0.09-0.35). Achieving target levels of more CMH parameters at baseline and sustained improvements were associated with lower HF risk in T2D.

Trends and Disparities in Cardiometabolic Health Among U.S. Adults, 1999-2018

BackgroundFew studies have assessed U.S. cardiometabolic health trends—optimal levels of multiple risk factors and absence of clinical cardiovascular disease (CVD)—or its impact on health disparities. ObjectivesThe purpose of this study was to investigate U.S. trends in optimal cardiometabolic health from 1999 to 2018. MethodsWe assessed proportions of adults with optimal cardiometabolic health, based on adiposity, blood glucose, blood lipids, blood pressure, and clinical CVD; and optimal, intermediate, and poor levels of each component among 55,081 U.S. adults in the National Health and Nutrition Examination Survey. ResultsIn 2017-2018, only 6.8% (95% CI: 5.4%-8.1%) of U.S. adults had optimal cardiometabolic health, declining from 1999-2000 (P trend = 0.02). Among components of cardiometabolic health, the largest declines were for adiposity (optimal levels: from 33.8% to 24.0%; poor levels: 47.7% to 61.9%) and glucose (optimal levels: 59.4% to 36.9%; poor levels: 8.6% to 13.7%) (P trend <0.001 for each). Optimal levels of blood lipids increased from 29.9% to 37.0%, whereas poor decreased from 28.3% to 14.7% (P trend <0.001). Trends over time for blood pressure and CVD were smaller. Disparities by age, sex, education, and race/ethnicity were evident in all years, and generally worsened over time. By 2017-2018, prevalence of optimal cardiometabolic health was lower among Americans with lower (5.0% [95% CI: 2.8%-7.2%]) vs higher education (10.3% [95% CI: 7.6%-13.0%]); and among Mexican American (3.2% [95% CI: 1.4%-4.9%]) vs non-Hispanic White (8.4% [95% CI: 6.3%-10.4%]) adults. ConclusionsBetween 1999 and 2000 and 2017 and 2018, U.S. cardiometabolic health has been poor and worsening, with only 6.8% of adults having optimal cardiometabolic health, and disparities by age, sex, education, and race/ethnicity. These novel findings inform the need for nationwide clinical and public health interventions to improve cardiometabolic health and health equity.

Conjoint Associations of Adherence to Physical Activity and Dietary Guidelines With Cardiometabolic Health: The Framingham Heart Study.

BackgroundThe conjoint associations of adherence to the recent physical activity and dietary guidelines with the metabolic syndrome (MetS) are incompletely understood.Methods and ResultsWe evaluated 2379 FHS (Framingham Heart Study) Third Generation participants (mean age, 47 years; 54.4% women) attending examination cycle 2. We examined the cross‐sectional relations of adherence to the 2018 Physical Activity Guidelines for Americans (binary; moderate‐to‐vigorous physical activity ≥150 versus <150 min/wk) and 2015 Dietary Guidelines for Americans (binary; 2015 Dietary Guidelines for Americans Adherence Index ≥median versus <median [score, 62.1/100]) with prevalence of the MetS using generalized linear models. We also related adherence to guidelines with the incidence of MetS prospectively, using Cox proportional hazards regression with discrete time intervals. Adherence rates to the 2018 Physical Activity Guidelines for Americans (odds ratio [OR], 0.49; 95% CI, 0.40–0.60) and 2015 Dietary Guidelines for Americans (OR, 0.67; 95% CI, 0.51–0.90) were individually associated with lower odds of prevalent MetS, whereas conjoint adherence to both guidelines was associated with the lowest odds of MetS (OR, 0.35; 95% CI, 0.26–0.47) compared with the referent group (nonadherence to both guidelines). Adherence rates to the 2018 Physical Activity Guidelines for Americans (hazard ratio [HR], 0.66; 95% CI, 0.50–0.88) and 2015 Dietary Guidelines for Americans (HR, 0.68; 95% CI, 0.51–0.90) were associated with lower risk of MetS, prospectively. In addition, we observed a 52% lower risk of MetS in individuals who adhered to both guidelines compared with the referent group.ConclusionsMaintaining both regular physical activity and a healthy diet in midlife may be required for optimal cardiometabolic health in later life.

Prevalence of Optimal Metabolic Health in U.S. Adolescents, NHANES 2007-2016.

Background: While the overweight and obesity epidemic in the adolescent population is well described, a comprehensive evaluation of cardiometabolic health markers has not been reported. Our purpose was therefore to determine the prevalence of cardiometabolic risk factors among non-diabetic individuals 12 to19 years of age in the United States. Methods: We analyzed data from nationally representative samples of U.S. adolescents (NHANES, 2007-2016). Optimal cardiometabolic health was defined as an absence of risk factors, that is, at least normal values on each of the following 11 measures: body mass index (BMI) percentile, waist circumference percentile, blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, non-HDL cholesterol, triglycerides, fasting plasma glucose, alanine aminotransferase, and insulin resistance. Domain analyses were conducted with Rao-Scott chi-square tests of independence. Multivariable linear/logistic regressions examined sociodemographic associations with cardiometabolic health. Results: Less than a quarter of the population (22.0%; 95% CI; 19.4%-24.8%) was found to have no cardiometabolic risk factors. Among individuals with a normal BMI, 35.7% (95% CI; 31.6%-40.1%) had no cardiometabolic risk factors. Family poverty-to-income ratio was identified as an independent predictor of cardiometabolic health (P = 0.01). A consistent trend was present between increasing BMI percentile and number of cardiometabolic risk markers. Conclusions: The overall prevalence of U.S. adolescents with no cardiometabolic risk factors is less than 25%. Even among those without increased BMI, less than half meet all metabolic health criteria. In addition, socioeconomic disparities are predictors of metabolic health.

Genetic Variants in Lipid Metabolism Pathways Interact with Diet to Influence Blood Lipid Concentrations in Adults with Overweight and Obesity (P15-015-19)

ObjectivesThere is substantial controversy regarding the role of saturated (SFA) and unsaturated fat intake for optimal cardiometabolic health due to the heterogeneity of blood lipid changes in clinical trials. This variance may be due to genetic differences. Studying physiologically relevant variants can elucidate the mechanisms between genotype and metabolism. The objective of this study was to determine relationships between genetic variation, fat intake, and blood lipid concentrations. MethodsDNA, blood lipid concentrations (total cholesterol, high-density lipoprotein cholesterol [HDL], and triglycerides [TG]), and 7-day diet records were obtained from 87 adults (25–45 years) with overweight or obesity. Resting energy expenditure (REE) was measured using indirect calorimetry and used to determine implausible intake using a modified Goldberg method (kilocalories/REE). Genetic variants included 22 single nucleotide polymorphisms (SNPs) from genes in lipid metabolism pathways. Variants were analyzed with dietary fat intake (total fat, SFA, monounsaturated fat [MUFA], and polyunsaturated fat) via regression analyses. ResultsNine SNPs (ANGPTL3 rs10889337, ANGPTL4 rs7255436, APOE rs1044250, CETP rs5882, FADS1 rs174548 and rs174550, LPL rs13702 and rs328, PPARG rs12639162) were associated with one or more blood lipid traits. Two significant diet-gene interactions were detected: the interaction of total fat intake and LPL rs13702 was associated with HDL concentrations (P = 0.01), and the interaction of MUFA intake and CETP rs5882 was associated with TG concentrations (P = 0.01). Carriers of the minor allele that reported higher total fat intake exhibited higher HDL concentrations, while minor allele carriers with higher MUFA intake exhibited lower TG concentrations. ConclusionsInteractions between diet and genes in lipid metabolism pathways were predictors of blood lipid concentrations in adults. Fat intake may not affect blood lipid concentrations uniformly across all individuals. Therefore, personalized diet recommendations for chronic disease prevention are warranted. Funding SourcesSupport is provided by the Hass Avocado Board, the Division of Nutritional Sciences at the University of Illinois at Urbana-Champaign, the USDA National Institute of Food and Agriculture Hatch Project, and the Agriculture and Food Research Initiative. Supporting Tables, Images and/or Graphs▪▪

Childhood Assets and Cardiometabolic Health in Adolescence.

Research shows that the development of cardiometabolic disease can begin early in life with risk factors accumulating over time, but less is known about protective pathways to positive health. In this study, we use prospective data to test whether childhood assets predict a greater likelihood of being in optimal cardiometabolic health by age 17. Data are from 3074 participants in the Avon Longitudinal Study of Parents and Children (mean age = 17.8). Four childhood assets were prospectively assessed via cognitive tests and parent report when children were between ages 8 and 10: strong executive functioning skills, prosocial behaviors, and low levels of internalizing and externalizing problems. Cardiometabolic health was assessed at ages 9 and 17 by using a composite dysregulation score derived from multiple biological parameters, including cholesterol, blood pressure, C-reactive protein, insulin resistance, and BMI. Associations between assets and optimal health at age 17 (ie, a dysregulation score of ≤1) were evaluated with Poisson regression models with robust error variances. After controlling for covariates (including sociodemographics, correlates of cardiometabolic health, and dysregulation scores at age 9), participants with multiple assets were 1.08 to 1.27 times more likely to be in optimal cardiometabolic health at age 17 compared with those with 0 or 1 asset. Each additional asset conferred a 6% greater likelihood of optimal health over time (relative risk = 1.06 [95% confidence interval: 1.01 to 1.11]). Childhood assets predicted cardiometabolic health with seemingly cumulative impacts. Identifying early assets may provide novel targets for prevention and elucidate pathways to positive adult health.

Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009-2016.

Several guidelines for cardiometabolic risk factor identification and management have been released in recent years, but there are no estimates of current prevalence of metabolic health among adults in the United States. We estimated the proportion of American adults with optimal cardiometabolic health, using different guidelines. Data from the National Health and Nutrition Examination Survey 2009-2016 were analyzed (n = 8721). Using the most recent guidelines, metabolic health was defined as having optimal levels of waist circumference (WC <102/88 cm for men/women), glucose (fasting glucose <100 mg/dL and hemoglobin A1c <5.7%), blood pressure (systolic <120 and diastolic <80 mmHg), triglycerides (<150 mg/dL), and high-density lipoprotein cholesterol (≥40/50 mg/dL for men/women), and not taking any related medication. Changing from ATP III (Adult Treatment Panel III) guidelines to more recent cut points decreased the proportion of metabolically healthy Americans from 19.9% (95% confidence interval [CI]: 18.3-21.5) to 12.2% (95% CI: 10.9-13.6). Dropping WC from the definition increased the percentage of adults with optimal metabolic health to 17.6%. Characteristics associated with greater prevalence of metabolic health were female gender, youth, more education, never smoking, practicing vigorous physical activity, and low body mass index. Less than one-third of normal weight adults were metabolically healthy and the prevalence decreased to 8.0% and 0.5% in overweight and obese individuals, respectively. Prevalence of metabolic health in American adults is alarmingly low, even in normal weight individuals. The large number of people not achieving optimal levels of risk factors, even in low-risk groups, has serious implications for public health.

Associations of context-specific sitting time with markers of cardiometabolic risk in Australian adults

BackgroundHigh volumes of sitting time are associated with an elevated risk of type 2 diabetes and cardiovascular disease, and with adverse cardiometabolic risk profiles. However, previous studies have predominately evaluated only total sitting or television (TV) viewing time, limiting inferences about the specific cardiometabolic health impacts of sitting accumulated in different contexts. We examined associations of sitting time in four contexts with cardiometabolic risk biomarkers in Australian adults.MethodsParticipants (n = 3429; mean ± SD age 58 ± 10 years) were adults without clinically diagnosed diabetes or cardiovascular disease from the 2011–2012 Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Multiple linear regressions examined associations of self-reported context-specific sitting time (occupational, transportation, TV-viewing and leisure-time computer use) with a clustered cardiometabolic risk score (CMR) and with individual cardiometabolic risk biomarkers (waist circumference, BMI, resting blood pressure, triglycerides, HDL- and LDL-cholesterol, and fasting and 2-h post-load plasma glucose).ResultsHigher CMR was significantly associated with greater TV-viewing and computer sitting time (b [95%CI] = 0.07 [0.04, 0.09] and 0.06 [0.03, 0.09]), and tended to be associated with higher occupational and transport sitting time (0.01 [− 0.01, 0.03] and 0.03 [− 0.00, 0.06]), after adjustment for potential confounders. Furthermore, keeping total sitting time constant, accruing sitting via TV-viewing and computer use was associated with significantly higher CMR (0.05 [0.02, 0.08] and 0.04 [0.01, 0.06]), accruing sitting in an occupational context was associated with significantly lower CMR (− 0.03 [− 0.05, − 0.01]), while no significant association was seen for transport sitting (0.00 [− 0.03, 0.04]). Results varied somewhat between the respective biomarkers; however, higher sitting time in each domain tended to be associated detrimentally with individual biomarkers except for fasting glucose (non-significant associations) and systolic blood pressure (a beneficial association was observed). Overall, associations were stronger for TV-viewing and computer use, and weaker for occupational sitting.ConclusionsHigher context-specific sitting times tended to be detrimentally associated, albeit modestly, with CMR and several cardiometabolic risk biomarkers. There was some evidence suggesting that the context in which people sit is relevant above and beyond total sitting time. Methodological issues notwithstanding, these findings may assist in identifying priorities for sitting-reduction initiatives, in order to achieve optimal cardiometabolic health benefits.

Abstract P246: Dietary Minerals and Metabolic Syndrome: Results From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Introduction: Minerals play an integral role in lipid and carbohydrate metabolism and defense against oxidative damage, and thus mineral-poor diets may be an important risk factor for cardiometabolic disease. Little is known about the relationship between dietary mineral intake and metabolic health in Hispanics/Latinos - the largest ethnic minority in the U.S. Hypothesis: Individuals consuming less than recommended amounts of certain minerals may have a greater burden of metabolic syndrome, independent of individual-level risk factors. Methods: We studied 15,051 Hispanic/Latino individuals, aged 18-74 years, from the Hispanic Community Health Study/Study of Latinos, a population-based epidemiologic study of adults enrolled from 4 U.S. communities in 2008-2011. Daily intakes of selected minerals (copper, manganese, selenium, and zinc) from up to two dietary recalls were averaged, and combined with self-reported supplemental intakes. Copper, selenium, and zinc intake levels were dichotomized at the estimated average requirement (EAR); for manganese, the adequate intake (AI) was used as a cutoff point as an EAR has not been established. Metabolic syndrome and its component abnormalities were defined per the harmonized American Heart Association/National Heart, Lung, and Blood Institute criteria as at least 3 of the following 5 criteria: high blood pressure, high triglycerides, low HDL cholesterol, high fasting glucose, or abdominal obesity. Associations of mineral intakes with prevalent metabolic syndrome and its individual components were evaluated using logistic regression models accounting for the complex sampling design of the study. Results: Intakes of copper, manganese, selenium, and zinc were below the EAR/AI in 15%, 29%, 4%, and 13% of individuals, respectively. Copper intake below the EAR was positively associated with metabolic syndrome (OR: 1.23, 95% CI: 1.05-1.44) after adjustment for energy intake, age, gender, and Hispanic/Latino background, and was primarily driven by an association with high blood pressure (1.24, CI: 1.04-1.47). Manganese intake below the AI was also associated with metabolic syndrome (1.16, CI: 1.01-1.32), with the strongest associations observed for high fasting glucose levels (1.20, CI: 1.04-1.38) and abdominal obesity (1.19, CI: 1.05-1.36). Conclusion: Consuming less than the recommended amounts of copper and manganese was associated with a greater prevalence of metabolic syndrome. Future prospective studies are needed to confirm the importance of achieving copper and manganese adequacy and synergistic aspects of foods containing these minerals for optimal cardiometabolic health.

Sleep duration and the associated cardiometabolic risk scores in adults

ObjectivesTo identify the sleep duration associated with the lowest cardiometabolic risk score in adults and to determine if the association varies by subgroups (eg, sex, age groups, ethnicity, and smoking status). DesignCross-sectional data from the 2005–2012 National Health and Nutrition Examination Survey. SettingNon-institutionalized civil sample from the United States. ParticipantsAge ≥20 y (N=8827) with sleep and cardiometabolic health data. InterventionsN/A. MeasurementsSleep duration from the Sleep Disorders Questionnaire was categorized as ≤3, 4, 5, 6, 7, 8, 9, and ≥10 h per night. HDL cholesterol (HDL) and waist circumference (WC) were stratified by sex first, while fasting insulin, fasting plasma glucose (Glu), triglycerides (TG), body max index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were standardized without stratifications. The standardized scores were summed for each participant using the following formula: −zHDL + zInsulin + zGlu + zTG + (zBMI + zWC)/2+(zSBP + zDBP)/2. ResultsSeven hours of sleep was associated with the lowest cardiometabolic risk score (−0.30 (95% CI: −0.43, −0.18)), which remained similar after adjusting for age, sex, ethnicity, education, family income, alcohol intake and smoking status. However, 8 hours of sleep was associated with the lowest score in non-Hispanic Blacks. ConclusionsThis study supports recent sleep duration recommendations in adults, and provides evidence that in general 7 hours of sleep per night is associated with optimal cardiometabolic health of adults. Longitudinal studies using objective measures of sleep would help further clarify this association.

Comprehensive management of cardiometabolic risk factors

Comprehensive management of cardiometabolic risk requires management of a patient's underlying risk factors. The initial approach to treatment demands a careful assessment of patient risk, using formal risk assessment tools (eg, the Framingham Risk Score and the National Cholesterol Education Program Adult Treatment Panel III definition of metabolic syndrome), combined with comprehensive knowledge of the patient. There is increasing evidence that lifestyle modification and pharmacotherapy can delay or prevent the progression of insulin resistance to diabetes and cardiovascular disease. Periodic reassessment of a patient's risk can assist in guiding long-term therapy to achieve optimal cardiometabolic health.