Reduction Of Cardiometabolic Risk Factors Research Articles

Blockade of the Endocannabinoid System for the Reduction of Cardiometabolic Risk Factors

Blockade of the Endocannabinoid System for the Reduction of Cardiometabolic Risk Factors

A randomized lifestyle intervention with 5-year follow-up in subjects with impaired glucose tolerance: Pronounced short-term impact but long-term adherence problems

To compare data on cardiovascular risk factor changes in lipids, insulin, proinsulin, fibrinolysis, leptin and C-reactive protein, and on diabetes incidence, in relation to changes in lifestyle. The study was a randomized lifestyle intervention trial conducted in northern Sweden between 1995 and 2000, in 168 individuals with impaired glucose tolerance (IGT) and body mass index above 27 at start. The intensive intervention group (n = 83) was subjected to a 1-month residential lifestyle programme. The usual care group (n = 85) participated in a health examination ending with a single counselling session. Follow-up was conducted at 1, 3 and 5 years. At 1-year follow-up, an extensive cardio-metabolic risk factor reduction was demonstrated in the intensive intervention group, along with a 70% decrease of progress to type 2 diabetes. At 5-year follow-up, most of these beneficial effects had disappeared. Reported physical activity and fibre intake as well as high-density lipoprotein cholesterol were still increased, and fasting insulin and proinsulin were lower. The intervention affected several important cardio-metabolic risk variables beneficially, and reduced the risk for type 2 diabetes, but the effects persisted only as long as the new lifestyle was maintained. Increased physical activity seemed to be the behaviour that was most easy to preserve.

The Role of the Diabetes Educator

Therapeutic lifestyle intervention, with a focus on weight loss, is the cornerstone of cardiometabolic risk factor reduction, but many patients find it difficult to make the changes that are needed to achieve meaningful improvements in risk markers. There are a variety of pharmacologic options for the management of individual risk factors, such as hypertension, dyslipidemia, and insulin resistance. However, agents that are currently available to assist patients in their weight loss efforts are limited by their potential for adverse effects. The American Association of Diabetes Educators (AADE) has identified 7 behavioral targets of self-management, the AADE7™ Self-Care Behaviors, which include healthy eating, being active, monitoring, taking medications, problem solving, healthy coping, and reducing risk factors. The case scenarios in the article illustrate some of the challenges clinicians face in managing cardiometabolic risk factor reduction in the context of these recommended behaviors. A common theme among these cases is the importance of assessing patients' understanding, beliefs, and readiness to change their behaviors.

Harnessing endocrine physiology for better clinical outcomes

Diabetes is a highly prevalent and costly disease with debilitating vascular and metabolic complications. The effects of both fasting plasma glucose (FPG) and postprandial glucose (PPG) excursions independently lead to an increased risk of morbidity and mortality. In patients with glucose levels that are fairly well controlled (ie, glycosylated hemoglobin [HbA1c] 8.5%), the pattern is one of both elevated FPG and PPG levels, with the predominant contribution resulting from an increase in fasting hyperglycemia. These data point to the need for a physiologically based basal-bolus insulin replacement strategy, with administration of basal insulin working to restore interprandial glucose levels and bolus insulin to simulate mealtime actions of the pancreas. Insulin also may offer beneficial anti-inflammatory, vasodilatory, antithrombotic, and antiapoptotic effects. Reductions in cardiometabolic risk factors and other parameters, therefore, focus attention on the early use of a basal-bolus insulin strategy. Challenges faced in the treatment of diabetes, including barriers and myths associated with the use of insulin, represent an area that urgently needs to be addressed. Patients and their caregivers need to be educated about the progressive nature of diabetes and the benefits of insulin to help them make informed decisions to ensure optimal diabetes care.

The Endocannabinoid System: Novel Pathway for Cardiometabolic Risk-Factor Reduction

Although rimonabant has been approved for use in several countries, the Food and Drug Administration has expressed concern about the potential for adverse neurologic and psychiatric effects, considering the widespread distribution of CB1 receptors in the brain. While more research is clearly needed, the clinical evidence shows that CB1-receptor blockade with rimonabant improves multiple cardiovascular and metabolic variables, including body weight and waist circumference, HDL-C, triglycerides, and glucose metabolism. Furthermore, these effects, which are probably mediated by both peripheral and central actions in the ECS, appear to be greater than the improvements that would be expected from weight loss alone. There are multiple ongoing and planned studies with rimonabant as well as several other CB-receptor blockers (e.g., taranabant, CP-945,598). While diet and exercise are the cornerstones of cardiometabolic risk-factor reduction, improved pharmacotherapies are urgently needed. The ECS has provided us with new insights and a promising new avenue for the management of obesity and its associated cardiometabolic risk factors.

Clinical Aspects of Cardiometabolic Risk-Factor Reduction: A Case-based Approach

President, American Society of Endocrine PAsAdjunct Clinical Professor, James Madison UniversityPA ProgramClinical Instructor, George Washington UniversitySchool of Medicine and Health Sciences PA ProgramDiabetes and Thyroid Associates,Fredericksburg, VA

Clinical Aspects of Cardiometabolic Risk-Factor Reduction: A Case-based Approach

Clinical Aspects of Cardiometabolic Risk-Factor Reduction: A Case-based Approach