Prevalence Of Cardiometabolic Diseases Research Articles

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

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 Results Data were obtained from 49 published and 3 unpublished studies which reported on 29 755 individuals.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

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

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

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

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

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

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

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

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

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

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

Interferon regulatory factor signalings in cardiometabolic diseases.

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

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

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

Cardiometabolic Comorbidity in Bipolar Disorder

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

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

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

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

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

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

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

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

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

Cardiovascular and Metabolic Comorbidities in Patients with Plaque-Type Psoriasis Never Treated with Systemic Antipsoriatic Drugs: a Case-Control Study

Abstract Previous studies have shown a higher prevalence of cardiometabolic diseases among patients with psoriasis compared to non-psoriatics. However, little attention has been paid to the effects of systemic antipsoriatic drugs. The aim of this study was to investigate the association between psoriasis and these comorbidities, comparing untreated patients with psoriasis and population-based control non-psoriatic patients. A hospital-based case-control study included 122 patients with plaque-type psoriasis and 122 age- and gender-matched controls. Patients who ever received systemic antipsoriatic drugs were excluded. There were no significant differences between psoriatic patients and controls regarding the prevalence of hypertension (p=0.311), coronary heart disease (p=0.480), diabetes (p=0.641), myocardial infarction (p=0.71), stroke (2.4% vs. 2.4%, p=1.00) and metabolic syndrome (p=0.764). The prevalence of hypertriglyceridemia in patients with psoriasis and controls was 41.8% and 28.7%, respectively (OR 1.78, 95% CI 1.04-3.04, p=0.032). Furthermore, significant differences were observed in mean triglyceride levels (p=0.013). Smoking was significantly more often reported in psoriatic patients compared to controls. Patients with psoriasis also had a higher mean BMI (26.24, SD 4.42) compared with controls (24.73, SD 3.86), p=0.005. Psoriasis showed a statistically significant association with BMI obesity classification [χ2(4)=11.560, p=0.02]. The prevalence of cardiovascular and metabolic comorbidities was not significantly higher in patients with plaquetype psoriasis who were never treated with systemic antipsoriatic drugs, compared to population-based non-psoriatic controls. Our data suggest that systemic antipsoriatic drugs may play an important role in the development of these comorbidities. However, this study confirms that untreated psoriasis patients have three major modifiable increased cardiovascular risk factors, such as smoking, obesity and hypertriglyceridemia.

Triglyceride-Based Screening Tests Fail to Recognize Cardiometabolic Disease in African Immigrant and African-American Men

The prevalence of cardiometabolic disease in Africa now rivals that of Western nations. Therefore, screening programs that lead to effective prevention of cardiometabolic disease in Africans is imperative. Most screening tests for cardiometabolic disease use triglyceride (TG) levels as a criterion. However, the failure rate of TG-based screening tests in African Americans is high. In Africans, the efficacy of TG-based screening tests is unknown. Our goal was to determine the association between hypertriglyceridemia (TG ≥150 mg/dL) and cardiometabolic disease in African and African-American men. This was a cross-sectional study of 155 men (80 African immigrants, 75 African Americans) [age, 35±9 years, mean±standard deviation (SD), body mass index (BMI) 28.5±5.2 kg/m(2)] who self-identified as healthy. Lipid profiles were performed. Glucose tolerance and insulin resistance was determined by oral glucose tolerance tests (OGTT) and the insulin sensitivity index (S(I)), respectively. Cardiometabolic disease was defined by four possible subtypes--prediabetes, diabetes, insulin resistance, or metabolic triad [hyperinsulinemia, hyperapolipoprotein B, small low-density lipoprotein (LDL) particles]. TG levels were higher in men with cardiometabolic disease than without (88±43 versus 61±26 mg/dL, P<0.01). However, <10% of men with cardiometabolic disease had TG ≥150 mg/dL. Even within each cardiometabolic disease subtype, the prevalence of TG ≥150 mg/dL was <10%. Furthermore, TG levels in the 5% of men identified by OGTT as diabetic were ≤100 mg/dL (mean 71±24, range 45-100 mg/dL). Hypertriglyceridemia is a poor marker of cardiometabolic disease in men of African descent. Therefore TG-based screening tests fail to identify both African immigrants and African-American men with cardiometabolic disease. As a consequence, the opportunity for early intervention and prevention is lost.

Eight-year trends of cardiometabolic morbidity and mortality in patients with schizophrenia

ObjectiveWe examined cardiometabolic disease and mortality over 8 years among individuals with and without schizophrenia. MethodWe compared 65,362 patients in the Veteran Affairs (VA) health system with schizophrenia to 65,362 VA patients without serious mental illness (non-SMI) matched on age, service access year and location. The annual prevalence of diagnosed cardiovascular disease, diabetes, dyslipidemia, hypertension, obesity, and all-cause and cause-specific mortality was compared for fiscal years 2000–2007. Mean years of potential life lost (YPLLs) were calculated annually. ResultsThe cohort was mostly male (88%) with a mean age of 54 years. Cardiometabolic disease prevalence increased in both groups, with non-SMI patients having higher disease prevalence in most years. Annual between-group differences ranged from <1% to 6%. Annual mortality was stable over time for schizophrenia (3.1%) and non-SMI patients (2.6%). Annual mean YPLLs increased from 12.8 to 15.4 in schizophrenia and from 11.8 to 14.0 for non-SMI groups. ConclusionsVA patients with and without schizophrenia show increasing but similar prevalence rates of cardiometabolic diseases. YPLLs were high in both groups and only slightly higher among patients with schizophrenia. The findings highlight the complex population served by the VA while suggesting a smaller mortality impact from schizophrenia than previously reported.

The metabolic syndrome in Bulgaria

The prevalence of the metabolic syndrome (MetS), a cluster of central obesity, hyper/dyslipiemia, hyperglycemia, and hypertension is constantly increasing worldwide. Although, the exact mechanisms underlying the development of the MetS are not completely understood, modern lifestyle of physical inactivity and unhealthy nutrition, obesity, and their interaction with genetic factors are considered largely responsible. It has been convincingly demonstrated that the metabolic syndrome is associated with substantially increased risk for the development of type 2 diabetes mellitus, as well as, with increased cardiovascular disease (CVD) morbidity and mortality. The prevalence of obesity and type 2 diabetes in Bulgaria has dramatically increased in the last decades. For the same period CVD mortality in the country have also gradually increased and Bulgaria is nowadays among the countries with the highest macrovascular disease death rates in Europe. A number of epidemiological studies have demonstrated that the prevalence of the MetS and of its individual components has also increased during the last decades and is nowadays relatively high among the general population in Bulgarian and extremely high among high-risk individuals. Surprisingly, the prevalence of the MetS is also high among the low risk population in the country and most of its components that are independent predictors of CVD mortality are largely undiagnosed. Furthermore, the presence of the MetS is associated with history of myocardial infarction in the country. Although objective data is somewhat scarce, several studies have reported association of the low physical activity level and the unhealthy nutritional habits with the prevalence of cardiometabolic diseases among the Bulgarian population. Taking into account these observations it may be suggested that indeed the high metabolic syndrome prevalence that results as a consequence of unhealthy lifestyle is responsible for the extremely high CVD mortality rates in Bulgaria. Therefore, large-scale screening programmes should be undertaken within this population in combination with health prevention strategies promoting regular physical activity and improvement of nutritional habits.

Hypertension and Diabetes in Obesity

The epidemic-like rise in the prevalence of obesity constitutes an undoubted and serious global health problem. Importantly, hypertension and diabetes are frequently associated with obesity and, together, constitute a significant burden in terms of patients' morbidity and escalating health care costs. When considered in isolation, obesity, hypertension, and diabetes are all associated with increased risk of the development of cardiovascular and renal complications; however, the coexistence of this triumvirate generates a substantial elevation in disease risk. The driving forces linking obesity, hypertension, and diabetes remain to be clarified due, in part, to the complex and multifactorial nature of the conditions that involve combinations of environmental, genetic, life style, and behavioural confounders. Additionally, it is recognized that neuroendocrine mechanisms, including insulin resistance, sympathetic nervous activation, and stimulation of the renin-angiotensin-aldosterone system (RAAS), are also involved [1–4]. This special issue on hypertension and type 2 diabetes related to obesity includes several epidemiological studies focusing on the prevalence of metabolic syndrome, type 2 diabetes, and hypertension. New data emanating from Peru, Ethiopia, Sudan, Egypt, and Nepal documents the prevalence of cardiometabolic disease in these countries as being similar to that reported in westernized countries such as the USA, Canada, Australia, and European countries as well as Japan [5, 6]. Importantly, an emerging body of data, such as that presented by Professor C. Brufani et al., highlights the importance of obesity in children. They reported the contribution of birth weight to central fat depot and insulin sensitivity in metabolic syndrome in obese Italian children. The challenge will be in designing and implementing effective strategies to arrest and reverse this pattern. The strong linkage between hypertension and type 2 diabetes was reviewed by Professor E. Dean which provides insight into the mechanisms involved. Dr. S. Horita et al. reviewed the contribution of the kidneys, especially renal sodium transport, to the development of insulin resistance and hypertension in obesity. Diabetic patients and obese individuals frequently present with different circadian patterns of blood pressure compared to nondiabetic or nonobese subjects. A nondipping pattern is very common in obese hypertensive patients. In diabetic patients, ambulatory blood pressure monitoring provides a more robust measure in predicting future cardiovascular events than clinic blood pressure. Dr. C. Anigbogu et al. provided evidence that in rats the circadian rhythm of blood pressure and heart rate changes with progression of diabetes. Professor K. Eguchi reviewed recent epidemiological studies in diabetes and obesity using ambulatory blood pressure monitoring. Taken together, these observations demonstrate the importance of ambulatory blood pressure monitoring. The first line of therapy for the treatment of type 2 diabetes and obesity-related hypertension is weight loss with lifestyle modifications such as diet and exercise. Nonpharmacological treatments were outlined by Dr. J. Pappachan et al. Another article by S. Guy et al. indicated that video gaming provided some benefit in initiating lifestyle modifications that aided in weight loss. Patients with diabetes and hypertension frequently present with atherogenic diseases and dyslipidemia. Dr. E. Morales-Villegas and colleagues provided a review indicating that statins are very effective in treating dyslipidemia and reducing overall cardiovascular risk. This special issue covered a wide range of materials with a focus on type 2 diabetes and hypertension. Articles included epidemiology, physiology, and treatments. In summary, this issue demonstrated that (i) abdominal obesity is related to the high prevalence of hypertension and type 2 diabetes regardless of ethnicity, (ii) insulin resistance is a major mechanism linking the onset and development of hypertension and type 2 diabetes, and (iii) weight loss with diet and exercise is an important aspect in treating hypertension in type 2 diabetes and aids in increasing the efficacy of antihypertensive medications. Further investigations on mechanisms and genetics are needed in order to develop appropriate and effective therapeutic regimens in order to prevent and limit obesity-related illnesses such as hypertension and type 2 diabetes. Early intervention is vital, given emerging evidence of end-organ dysfunction in young overweight or obese individuals [7, 8].

Human insulin/IGF-1 and familial longevity at middle age

Recently, we have shown that compared to controls, long-lived familial nonagenarians (mean age: 93.4 years) from the Leiden Longevity Study displayed a lower mortality rate, and their middle-aged offspring displayed a lower prevalence of cardio-metabolic diseases, including diabetes mellitus. The evolutionarily conserved insulin/IGF-1 signaling (IIS) pathway has been implicated in longevity in model organisms, but its relevance for human longevity has generated much controversy. Here, we show that compared to their partners, the offspring of familial nonagenarians displayed similar non-fasted serum levels of IGF-1, IGFBP3 and insulin but lower non-fasted serum levels of glucose, indicating that familial longevity is associated with differences in insulin sensitivity.

Comparison of Meal Frequency and Macronutrient Composition on Changes in Total and Regional Body Composition in Men and Women

The rising obesity epidemic is associated with an increasing prevalence of cardiometabolic disease. Plasma leptin levels are highly related to the degree of obesity and are influenced by dietary macronutrient content. Combined effects of varying macronutrient composition and meal frequency on body composition and plasma leptin (LEP) are not well known. PURPOSE: To compare the effects of consuming 3 vs. 6 meals/ day, with higher versus lower protein, on body composition and LEP. METHODS: Twenty-seven healthy male and female subjects completed an eight week dietary intervention consisting of two four-week phases: a weight maintenance phase (Phase I, energy balance) followed by a weight loss phase (Phase II, 25% energy deficit). The two high-protein groups (40% protein, 40% carbohydrate, 20% fat) consumed either 6 meals (HP6) or 3 meals (HP3) per day. The third group consumed 3 meals/ day (AHA) in compliance with the American Heart Association (15% protein, 60% carbohydrate, 25% fat). Total and abdominal body fat (DXA), body water (BIS), and fasting LEP were assessed at baseline and end of Phase I, and Phase II. RESULTS: Body weight remained stable in HP6 and HP3 but declined 0.8 kg in AHA (p = 0.04). Body weight significantly decreased in all groups from baseline to end of phase II (p<0.005). Body fat decreased significantly at end of Phase I in all groups (1.9 kg HP6, 2.0 kg AHA, 1.9 kg HP3; p<0.001), despite consumption of 100% of estimated energy needs (RMR, indirect calorimetry plus activity factor). Lean mass increased in HP6 by end of Phase I (45.7 vs. 46.6 kg; p = 0.05) and tended to remain higher at end of Phase II (46.3 kg, p = 0.06) and was unchanged in AHA and HP3. HP3 and AHA lost significant abdominal fat during Phase I (p<0.05) whereas HP6 lost significant abdominal fat (0.4 kg, p = 0.001) during Phase II. Total body water did not change in any of the groups during the eight week intervention (p = 0.22). LEP tended to increase in HP6 (13,565 vs. 17,975 pg/ml, p = 0.076) at the end of Phase I but decreased significantly during Phase II (17,975 vs. 10,842 pg/ml, p = 0.001). LEP concentrations were unchanged in AHA and HP3. CONCLUSION: All diet interventions resulted in significant reductions in fat mass during Phase I (energy balance), however, HP6 experienced further reduction in total and abdominal fat mass during Phase II (energy deficit). LEP responded in a similar fashion in HP6 decreasing during phase II. These results indicate that increased meal frequency and increased dietary protein may have a beneficial effect on reducing of total and abdominal fat mass, which is associated with a reduced LEP.