Cardiometabolic Risk Screening Research Articles

Cardiometabolic screening and intervention in psychiatric inpatients: A quality improvement project

Abstract: BACKGROUND: Patients with severe mental illness have an increased risk for cardiometabolic diseases. Cardiometabolic risk screening is suggested at admission to psychiatric hospitals to identify and intervene; however, usually, these are not adequately undertaken. AIM: In a quality improvement project, we aimed to find out the usefulness of having an assigned member of the medical team as a “champion” to oversee the completeness of the screening and intervention process. METHODS: Retrospective and prospective audits were carried out which looked into the completion rate of cardiometabolic screening and intervention forms for psychiatric inpatients. The rates of completion for current inpatients following the contribution from a “cardiometabolic champion” were recorded. RESULTS: The results show that the cardiometabolic screening completion rate in the retrospective audit was 69.7%, similar to the rate in the prospective audit at 66.7%. However, following the intervention of the “cardiometabolic champion,” the rate of completion within the prospective audit increased by 21.2% to a total of 87.9%. Reasons for noncompletion in most patients were not documented. CONCLUSION: It appeared that input from a “cardiometabolic champion” may improve cardiometabolic screening and intervention in psychiatric inpatients. However, further efforts should be taken, such as staff training, to emphasize the need for the intervention.

Cardiometabolic risk in young adults with Down syndrome.

Studies regarding cardiometabolic risk (CMR) for individuals with Down syndrome (DS) conflict. Our previous research in youth with DS, aged 10-20 years, found increased prevalence of dyslipidemia and prediabetes compared to matched peers without DS. Herein, we compare CMR in young adults with DS, aged 18-35 years, to a similar population-based sample from the 2001-2018 National Health and Nutrition Examination Survey (NHANES). The group with DS had higher NonHDL-C (mean DS 131.9 mg/dL; NHANES 126.1 p < 0.001), lower HDL-C (DS 47.5 mg/dL; NHANES 52.2 p < 0.001), higher LDL-C (DS 109.3 mg/dL; NHANES 105.4 p < 0.001), higher triglycerides (DS 102.9 mg/dL; NHANES 86.9 p < 0.001), but lower fasting glucose (DS 85.8 mg/dL; NHANES 95.2 p < 0.0001), lower HOMA-IR (DS 2.17; NHANES 2.24 p = 0.0006), lower systolic (DS 109.7 mmHg; NHANES 114.6 p < 0.0001) and lower diastolic (DS 60.9 mmHg; NHANES 67.8 p < 0.0001) blood pressures. There was relationship of higher HDL-C, triglycerides, glucose, systolic, and diastolic blood pressure with increasing BMI in the NHANES cohort which was dampened in the group with DS. These results indicate that more information is needed to guide clinicians in screening for CMR in individuals with DS.

The Lester Tool : An audit of its use on an acute psychiatry inpatient wards.

IntroductionPeople with severe mental illness have an increased vulnerability to cardiovascular disease due to multilple biopsychosocial factors and a potential adverse effects of longer term treatment with anti-psychotic medications. Treatment of severe and enduring mental illness with antipsychotic medications is likely to cause metabolic changes leading to weight gain and dyslipidaemia, thus increasing risk of cardiovascular disease. Cardiometabolic risk screening can be done using Lester Tool which also provides recommendations for interventions.ObjectivesTo identify the compliance to Lester Tool in the monitoring of cardiometabolic risk factors and intervention provided on acute psychiatry inpatients.MethodsWe carried out a retrospective audit of 30 patients on regular antipsychotic medication on an adult inpatient ward in Macclesfield, United Kingdom. Electronic records were reviewed to establish whether the smoking status, lifestyle, BMI, blood pressure, blood glucose and blood lipid were documented with evidence of interventions being provided.ResultsOf all 30 patients, none had shown compliance to all the parameters within the Lester Tool. 100% of the smoking status was documented, amongst which 78% were provided with interventions. 7% has lifestyle and diet status documented, of which 50% were given dietary advice. 80% had BMI documented, amongst which none were provided with any intervention. 90% had blood pressure documented, of which 50% were given any intervention. 40% had blood glucose documented, of which all were provided with intervention. 57% had blood lipid documented, of which none were provided with any intervention.ConclusionsOur results have shown the need of further awareness on the usefulness of the Lester Tool in an acute inpatient ward. Our recommendation would be to regularly train and educate inpatient staff to ensure that all the necessary parameters be monitored and provided with interventions.Disclosure of InterestNone Declared

Overfat cutoffs and the optimal combination of body fat indices for detecting cardiometabolic risk among school-aged children.

This study aimed to develop cutoffs and the optimal combination for body fat indices for screening cardiometabolic risk (CMR) among the pediatric population. This cross-sectional study consisted of 8710 (50.3% boys) Chinese children aged 6to 18 years. Body fat indices, including fat mass index (FMI), body fat percentage, trunk to leg fat ratio (TLR), and android to gynoid fat ratio, were derived from dual-energy x-ray absorptiometry scans. The area under the receiver operating characteristic curve was used to determine the best combination and optimal cutoffs of body fat indices to identify CMR. Compared with anthropometry-based obesity measures, i.e., BMI and waist circumference, the FMI + TLR combination presented statistically higher area under the receiver operating characteristic curve values for discriminating CMR and its clustering. The optimal overfat cutoffs of FMI and TLR were respectively determined at the 75th percentile in boys and at the 80th percentile of FMI and the 75th percentile of TLR in girls. Moreover, simplified thresholds derived from age-group-merged cutoffs showed similar performance as optimal cutoffs in detecting CMR. Both the optimal and simplified overfat cutoffs were provided for the Chinese pediatric population. The use of FMI and TLR together allows for adequate screening of CMR and its clustering.

Rising Prediabetes, Undiagnosed Diabetes, and Risk Factors in Young Women

Women of reproductive age are less prone to cardiovascular disease than men. However, diabetes mellitus negates this female advantage. The prevalence change of prediabetes (prediabetes mellitus) and diabetes mellitus and diabetes mellitus‒associated cardiovascular risk factors have not been clearly described in women before menopause. Using National Health and Nutrition Examination Survey data (1999-2018), this study estimated the age-adjusted prevalence of prediabetes mellitus (2005-2018), diagnosed diabetes mellitus, and undiagnosed diabetes mellitus in premenopausal women. Logistic regression was used to examine cardiovascular risk factors, including obesity, central obesity, hypercholesterolemia, hypertension, and hypertriglyceridemia, associated with prediabetes mellitus, diagnosed diabetes mellitus, or undiagnosed diabetes mellitus in premenopausal women. The magnitude of the association among age-matched men and postmenopausal women was compared. The analysis was conducted in 2022. Premenopausal women experienced an increased prevalence of prediabetes mellitus and undiagnosed diabetes mellitus, contrasting with steady trends in all U.S. adults over the last 2 decades. Premenopausal women with prediabetes mellitus or diabetes mellitus (versus those with normoglycemia) have significant obesity risk, and the risk is equivalent to that among age-matched men and higher than that among postmenopausal women. The association between prediabetes mellitus and hypercholesterolemia or hypertriglyceridemia was significant in premenopausal women only. Hypercholesterolemia and hypertension associated with undiagnosed diabetes mellitus were significant in premenopausal women and men of the same age, respectively. Diagnosed and undiagnosed diabetes mellitus was associated with hypertriglyceridemia in men and postmenopausal women, respectively. Premenopausal women had increased prediabetes mellitus and undiagnosed diabetes mellitus in the past 2 decades. They face a considerable cardiovascular risk burden associated with prediabetes mellitus and diabetes mellitus. Cardiometabolic risk screening and patient education should be improved in young and early middle-aged adults, particularly in women.

Correlation of salivary biomarkers with anthropometric indices for cardio-metabolic risk screening in professional undergraduates

Introduction and Aim: The onset of cardio metabolic disorders in the later parts of adult life requires development of early screening techniques. The current study is an approach to design and evaluate the easy-to-use method for the diagnosis of cardio metabolic disorders. Materials and Methods: The current study was performed after the institutional ethical approval. Fifty-two healthy but, obese volunteers aged 17-25 years with BMI ?25.0 were included. Salivary cortisol level was estimated by ELISA. Salivary ?-amylase was measured by kinetic enzyme assay. Data was expressed as Mean ± SD. The association between anthropometric parameters with salivary cortisol and salivary amylase was done by Pearson correlation test. p value&lt; 0.05 was considered statistically significant. Results: Salivary cortisol in male and female subjects did not show significant correlation (p&gt;0.05) with anthropometric parameters except BMI. Similarly, salivary amylase did not show significant correlation (p&gt;0.05) with Waist-to-height ratio (WHtR), A body shape index (ABSI), Body Round Index (BRI) and Physical Fitness Index (PFI). The correlation of Waist to hip ratio (WHR) was found to be significantly correlated (p=0.01) with salivary amylase level whereas, the BMI and Body fat % was negatively correlated with salivary amylase level. Conclusion: The newly proposed anthropometric parameters such as WHtR, ABSI, BRI, and PFI did not proved as ideal parameters for early prediction of cardio metabolic disorders in both genders.

Validity assessment of the single-point insulin sensitivity estimator (spise) for diagnosis of cardiometabolic risk in post-pubertal hispanic adolescents

Insulin measurements are not advised for cardiometabolic risk screening in large groups. Here we assessed the accuracy of the single-point insulin sensitivity estimator (SPISE) to diagnose cardiometabolic risk in Chilean adolescents. In 678 post-pubertal adolescents (52% males, M(SD) age = 16.8 (0.2) years), height, weight, waist circumference, blood lipids, glucose, insulin, and blood pressure were measured. BMI, HOMA-IR, and SPISE were estimated; HOMA-IR values ≥ 2.6 were considered insulin resistance (IR). Metabolic syndrome (MetS) was defined with the joint IDF/AHA/NHBLI standard. Using receiver operating characteristic curves, we obtained optimal SPISE cutpoints for IR and MetS diagnosis. The prevalence of MetS and IR was 8.2% and 17.1%, respectively. In males, the optimal cutoff for MetS diagnosis was 5.0 (sensitivity: 97%; specificity: 82%), and the optimal cutoff for IR diagnosis was 5.9 (sensitivity: 71%; specificity: 83%). In females, a SPISE of 6.0 had the highest sensitivity (90%) and specificity (74%) for MetS diagnosis. A SPISE of 6.4 was the optimal cutoff for IR diagnosis; however, sensitivity and specificity were 61% and 75%. In males and female post-pubertal adolescents, SPISE had a very good and good diagnostic performance, respectively, in predicting MetS. It was an accurate diagnostic tool for IR prediction in males, but not necessarily in females.

Body fat indicators for cardiometabolic risk screening among shift workers.

BackgroundIn view of the costly methods currently available for the assessment of body adiposity, anthropometric obesity indicators have proven effective in predicting cardiovascular risk.ObjectiveTo investigate the discriminatory power of body fat indicators for cardiovascular risk screening among shift workers.MethodsCross-sectional study with male employees of an iron ore extraction company. The predictive power of body fat indicators relative to cardiovascular risk was analyzed based on the Framingham risk score and metabolic syndrome by means of receiver operating characteristic curves, sensitivity, specificity, positive and negative predictive values, area under the receiver operating characteristic curve and Youden’s index.ResultsThe prevalence of cardiovascular risk was 14.2% in the metabolic syndrome risk model. According to the Framingham score, 95.0%, 4.1% and 0.9% of the participants exhibited low, moderate and high risk, respectively. All the analyzed body fat indicators exhibited satisfactory discriminatory power for the tested cardiovascular risk models.ConclusionWaist-height ratio exhibited the highest ability to predict cardiometabolic risk in both risk models.

Hypertriglyceridaemic waist is associated with hyperuricaemia and metabolic syndrome in rheumatoid arthritis patients

Background/Aim: The hypertriglyceridaemic waist (HTGW) phenotype has been described and suggested in general population as a cardiovascular risk marker. The aim of the present study was to evaluate the HTGW phenotype as a marker related to HUC and MetS in rheumatoid arthritis (RA). Materials and methodsThis was a cross-sectional study was designed in 250 RA Mexicans patients. The HTGW phenotype was defined as elevated waist circumference and elevated triglyceride concentration. Logistic regression analysis was used to evaluate the association between the HTGW phenotype, HUC and MetS in its traditional NCEP/ATPIII versions and modified (HTGWm and MetSm). ResultsThe prevalence of HTGW and HTGWm it was 20.4% and 32%, respectively. All patients with HTGW presented MetS (P < 0.001), and in a multivariate model, the HTGW phenotype was the marker most closely related to HUC in comparison to components of MetS. ConclusionThe HTGW may represent a marker for screening of cardiometabolic risk in RA patients, so in clinical practice can be implemented as a low-cost marker in the evaluation of the patient regardless of clinical characteristics of disease.

Central adiposity markers, plasma lipid profile and cardiometabolic risk prediction in overweight-obese individuals

Waist circumference (WC) is the currently recommended marker of central fat for cardiometabolic risk screening. Alternative surrogate markers have been recently proposed to better reflect the metabolic impact of central fat accumulation per se, based on WC normalization by height (Weight-to-Height Ratio - WtoH; Body Roundness Index - BRI) or body mass index (BMI) without (A Body Shape Index - ABSI) or with inclusion of plasma triglyceride and HDL-cholesterol concentrations (Visceral Adiposity Index - VAI). We investigated associations between WtoH, BRI, ABSI or VAI and insulin resistance (HOMA-index) or metabolic syndrome (MetS) in a general population cohort from the North-East Italy Mo.Ma. study (n=1965, age=49±13 years, BMI=26.7±5.2kg/m2). Baseline values were also evaluated as predictors of future insulin resistance and MetS in overweight-obese individuals undergoing 5-year follow-up (Ow-Ob) (n=263; age=54±9, BMI=30,7±4,1). Compared to WC or BMI, basal WtoH and BRI were similarly associated with baseline HOMA and MetS prevalence after multiple adjustments (P<0.001) and all markers similarly predicted 5-year HOMA and MetS (P<0.001). Under basal conditions, superimposable results were observed for VAI whereas ABSI was less accurate or unable to identify baseline HOMA and MetS (p<0.05 vs WtoH-BRI-VAI-WC-BMI). VAI had highest 5-year risk predictive value in Ow-Ob [ROC Area Under the Curve (AUC) VAI>WtoH-BRI-WC-BMI; p<0.05] while no predictive value was in contrast observed for ABSI (ROC AUC ABSI<WtoH-BRI-WC-BMI; p<0.05). Using alternate formulae with plasma lipid inclusion in ABSI and removal from VAI calculations completely reversed their 5-year predictive value and AUC. The current findings do not support replacement of WC with height-normalized anthropometric central fat surrogate markers to predict cardiometabolic risk in the general and overweight-obese population. BMI-normalization impairs risk assessment unless plasma lipid concentrations are available and included in calculations.

Polycystic ovary syndrome in Central Australia: Diagnosis and screening of cardiometabolic risk and emotional wellbeing

Polycystic ovary syndrome (PCOS) is a common condition that affects fertility, body image and emotional wellbeing in women, as well as significantly increasing a woman’s likelihood of developing type 2 diabetes mellitus (T2DM) and other cardiovascular disease risk factors. The objective of this study was to assess how management of PCOS in an Aboriginal primary care setting aligns with national standards for diagnosis and screening of cardiometabolic risk and emotional wellbeing. We conducted a retrospective clinical audit of 63 women who had PCOS listed as a diagnosis in their clinical record. Most women (95%) were correctly diagnosed, the most common trigger being menstrual irregularity (83%). Screening for cardiometabolic complications and emotional wellbeing as recommended by the national guideline was applied inconsistently, including 38% of eligible women not being screened for T2DM in the previous 12 months, and no woman being formally screened for emotional wellbeing. Discussion of lifestyle management was nearly universal; most women (75%) were referred to a dietician, although a third did not attend their appointment. Some components of recommended PCOS care were provided at high levels, including correct application of diagnostic criteria. However, PCOS management and screening for complications are being applied inconsistently in a population with high levels of cardiometabolic and emotional wellbeing risk.

Sex differences in pericardial adipose tissue assessed by PET/CT and association with cardiometabolic risk

Background Recent studies suggest that pericardial adipose tissue (PAT) is associated with whole body adiposity and insulin resistance. Moreover, the incidence of cardiovascular disease (CVD) differs between men and women. Although CVD is more prevalent in men, women suffering from CVD have a higher mortality compared to men. Differences in PAT may account for some of the observed sex differences in manifestations of CVD. Purpose To assess pericardial adipose tissue (PAT) as a biomarker for cardiometabolic risk and to assess potential sex differences. Material and Methods We studied 303 individuals (151 women, 152 men; mean age = 57 ± 17 years) across the weight spectrum. PAT and abdominal adipose tissue were quantified using clinical computed tomography (CT) scans obtained as part of a positron emission tomography (PET)/CT. Cardiometabolic risk factors were assessed from medical records. Linear regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate associations between PAT and cardiometabolic risk. Results PAT was higher in overweight and obese individuals compared to lean individuals and higher in men compared to women. PAT was positively associated with body mass index, abdominal fat ( P < 0.0001), fasting glucose, and serum lipids ( P < 0.05) with stronger associations in women than in men. PAT was accurate in detecting the prevalence of the metabolic syndrome with 74% sensitivity and 76% specificity (AUC = 0.80). Conclusion PAT is associated with measures of cardiometabolic risk and these associations are stronger in women compared to men. PAT could serve as a biomarker for opportunistic screening for cardiometabolic risk in patients undergoing chest CT.

The Association between Parity and Inflammation among Mexican-American Women of Reproductive Age Varies by Acculturation Level: Results of the National Health and Nutrition Examination Survey (1999–2006)

IntroductionParity and acculturation are linked with cardiometabolic risk. Their joint association with cardiometabolic health among Mexican-American women is less established, even though immigrant Mexican-American women have the highest fertility rate in the United States. We examined the modifying role of acculturation on the association of parity with a cardiometabolic risk biomarker, C-reactive protein (CRP). MethodsParticipants (n = 1,002) were women of Mexican background, ages 16 to 39 years, in the National Health and Nutrition Examination Survey (NHANES) from 1999 through 2006. The association between parity and elevated CRP was examined using logistic regression adjusted for age, household food security, access to health care, hemoglobin A1c, total cholesterol, high-density lipoprotein cholesterol, waist circumference, physical activity, acculturation, and a product term of parity and acculturation. Acculturation was measured on a 6-point score based on nativity status and duration of residence in the United States (0, Mexico born, U.S. resident <10 years; 1, Mexico born, U.S. resident 10–19 years; 2-Mexico born, U.S. resident ≥20 years; and 3, U.S. born), and language used at home (0, Spanish; 1, bilingual; 2, English). Scores of 0 or 1, 2 or 3, and 4 or 5 represented low, moderate, and high acculturation, respectively. ResultsThe association of parity with elevated CRP varied by acculturation level (pinteraction = 0.10). Parity was associated with elevated CRP among women with low (adjusted odds ratio [OR], 2.26; 95% CI, 1.07–4.80) and moderate acculturation (adjusted OR, 2.79; 95% CI, 1.16–6.73), compared with nulliparous women. ConclusionsHigher odds of elevated CRP associated with parity in immigrant Mexican-American women of reproductive age indicate the need for greater use of maternal/women's health care services for cardiometabolic risk screening and interventions.

Abstract P152: Cardiometabolic Risk Factors in Adolescent Blood Donors

Objective: Cardiometabolic risk factors have been extensively studied in adults, but to a lesser extent in adolescents. We assessed potential cardiometabolic risk factors in a large cohort of adolescent blood donors. Methods: Glycated hemoglobin (HbA 1c ), blood pressure (BP), and total cholesterol were measured in 10,756 blood donors aged 16-19 years at school blood drives conducted by Carter BloodCare, a large North Texas blood center. Borderline values were defined as HbA 1c 5.7-6.4%, BP (systolic/diastolic) 120-139/80-89 mm Hg, and total cholesterol 170-199 mg/dL. Elevated values were defined as HbA 1c ≥6.5%, BP ≥140/90, and total cholesterol ≥200 mg/dL. Subjects were classified into one of three subcohorts: (A) no borderline or elevated values (“healthy” subcohort); (B) one borderline value; (C) either two borderline values or one elevated value. The subcohorts were further stratified as shown in the Table. Results: Of the 10,756 blood donors, 35.2% had one borderline cardiometabolic risk factor, and 17.9% had either two borderline or one elevated risk factor. There were more girls than boys in the “healthy” subcohort (p&lt;0.0001). Girls had a higher prevalence of borderline or elevated total cholesterol (p&lt;0.0001), whereas boys had higher prevalence of borderline or elevated BP (p&lt;0.0001). Other differences between subcohorts are summarized in the Table. Conclusion: More than half of adolescents in this study had at least one cardiometabolic risk factor that was either borderline or elevated. Blood donation programs can serve as highly efficient and cost-effective gateways for cardiometabolic risk screening in adolescents, with potential for the development of targeted interventions aimed at promoting healthy behaviors early in life, specifically among those at increased risk.

Don’t just screen intervene; a quality improvement initiative to improve physical health screening of young people experiencing severe mental illness

Purpose – The purpose of this paper is to improve the quality of monitoring of risk factors that predict the likelihood of people with severe mental illness (SMI) developing cardiovascular disease (CVD), diabetes and obesity, major contributors to poor physical health and risk of premature mortality. Design/methodology/approach – The first phase of the AQuA “Don’t just screen-intervene” initiative supported five specialised community-based Early Intervention for Psychosis services in North West England to assess the effectiveness of monitoring of cardiometabolic risk in their patients using standards derived from the Lester Positive Cardiometabolic Health Resource, a nationally acknowledged framework for people with psychosis receiving antipsychotic medication. The initial findings formed the basis for a quality improvement programme which ran from November 2012 until May 2013. Findings – By the end of a six month quality improvement programme the likelihood of a patient receiving a comprehensive cardiometabolic risk screening (evidenced by recorded measurement of body mass index or waist circumference, blood pressure, blood glucose and lipid profile, assessment of smoking status and enquiry of relevant family history) had increased from 10 to between 63 and 80 per cent. Research limitations/implications – Cardiometabolic risk monitoring from the onset of psychosis and its treatment can be improved utilising quality improvement methodology in real-world specialist mental health services. Earlier identification and treatment of risk factors that predict higher rates of obesity, diabetes and SMI may help people with SMI avoid life-restricting and life-shortening physical disorders. Practical implications – Given the National Audit of Schizophrenia findings of inadequate screening in those with established SMI alongside evidence that CVD risk can emerge early in the course of psychosis, a group of early intervention in psychosis services in North West England decided to examine this aspect of their routine clinical practice. This service evaluation describes the effectiveness of a quality improvement programme based on the Lester Positive Cardiometabolic Health Resource (referred to as Lester resource henceforth) to improve the effectiveness of monitoring of risk factors that predict the likelihood of people experiencing psychosis and schizophrenia developing CVD diabetes and obesity. Social implications – A combination of social disadvantage and unhealthy lifestyles, adverse cardiometabolic impacts of antipsychotic medication and inequitable access to physical healthcare combine to put people with SMI at particular risk from CVD, the single biggest cause of premature death, and much more common than suicide (Brown et al., 2010). Despite higher rates of potentially modifiable CVD risk factors (De Hert et al., 2009) people with SMI appear to be missing out on opportunities to actively prevent conditions like CVD and diabetes compared to the general population. Originality/value – People with SMI such as schizophrenia die 15-20 years earlier on average than the general population. Around 20 per cent of premature deaths can be explained by suicide and injury, but the remainder arise from a variety of natural causes such as CVD, chronic obstructive pulmonary disorder and certain cancers and infections (Nordentoft et al., 2013). The authors worked with five mental health trusts in the North West of England covering a sample of over 500 cases within early intervention services.

A quality improvement initiative – increasing cardiometabolic risk screening in adult outpatient psychiatry clinics

In the USA, People with serious and persistent mental illness (SPMI) die 25 years earlier than the general population! Sixty percent of the increased mortality is due to cardiovascular disease. In NYS, type 2 diabetes is twice as common in people with mental illness on Medicaid compared to the general Medicaid population. In a study of over 10,000 clients with schizophrenia or depression, 52% had metabolic syndrome, and 92% had at least one risk factor. Forty-three percent of clinical antipsychotic trials of intervention effectiveness (CATIE) participants had metabolic syndrome on enrollment.In this quality improvement project, we worked on 3348 adult outpatient psychiatry patients, used techniques like FOCUS-PDCA, brain storming, root cause analysis to address cardiometabolic risk screening and reducing the risk among these patients. We used interventions like prescriber and patient education, streamlining the cardiovascular screening process in the clinic and multidisciplinary team discussions. We collected and analyzed data regarding clinical characteristics of such patients before and after the clinical interventions. HEDIS scores were used to measure the outcomes of the project.In this talk, we want to discuss about quality improvement projects – the methods and processes involved. Also, we wanted to give a glimpse of our project – the plan, work flow processing and the data.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Betel-quid and alcohol use were associated with lipid accumulation product among male factory workers in Taiwan.

In this study, cardiometabolic risk associated with betel-quid, alcohol and cigarette use, based on a simple index-lipid accumulation product (LAP), was investigated in Taiwanese male factory workers. Male factory workers were recruited during their annual routine health examination at a hospital in south Taiwan. The risk of cardiometabolic disorders was estimated by the use of LAP, calculated as (waist circumference [cm]-65)×(triglyceride concentration [mmol/l]). Multiple linear regression analyses were conducted to assess the risk factors of natural logarithm-transformed LAP. Of the 815 participants, 40% (325/815) were current alcohol users, 30% (248/815) were current smokers and 7% (53/815) were current betel-quid users. Current betel-quid use, alcohol use, older age, lack of exercise and higher body mass index were found to be significant and independent factors associated with natural logarithm-transformed LAP. Betel-quid and alcohol, but not cigarette use, were independent risk factors of logarithm-transformed LAP, adjusting for age, exercise and body mass index in male Taiwanese factory workers. LAP can be considered as a simple and useful method for screening of cardiometabolic risk.

Waist Circumference Provides an Indication of Numerous Cardiometabolic Risk Factors in Adults With Cerebral Palsy

ObjectiveTo report the prevalence of cardiometabolic risk factors in a cohort of adults with cerebral palsy (CP) and to investigate the ability of anthropometric measures to predict these factors. DesignCross-sectional study. SettingTesting took place in a laboratory setting. ParticipantsAdults with CP (N=55; mean age, 37.5±13.3y; Gross Motor Function Classification System levels, I–V) participated in this study. InterventionsNot applicable. Main Outcome MeasuresTotal cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, glucose, insulin, and C-reactive protein levels were measured from a fasting venous blood sample. Insulin resistance was calculated using the Homeostasis Model Assessment (HOMA-IR) index. Blood pressure, body mass index (BMI), waist circumference (WC), waist-hip ratio, and waist-height ratio were also measured. The metabolic syndrome (MetS) was defined according to the 2009 Joint Interim Statement. ResultsThe prevalence of the MetS was 20.5% in ambulatory adults and 28.6% in nonambulatory adults. BMI was associated with HOMA-IR only (β=.451; P<.01). WC was associated with HOMA-IR (β=.480; P<.01), triglycerides (β=.450; P<.01), and systolic blood pressure (β=.352; P<.05). Receiver operating characteristic curve analysis revealed that WC provided the best indication of hypertensive blood pressure, dyslipidemia, HOMA-IR, and the presence of multiple risk factors (area under the curve, .713–.763). ConclusionsA high prevalence of the MetS was observed in this relatively young sample of adults with CP. WC was a better indicator of a number of risk factors than was BMI and presents as a clinically useful method of screening for cardiometabolic risk among adults with CP.

Circulating cf-DNA: A promising, noninvasive tool for assessment of early cardio-metabolic risk

In 1948, Mandel and colleagues were the first group to report the presence of circulating nucleic acids in the human bloodstream [1]. The origin of cell-free DNA (cf-DNA) is not fully understood, but apoptosis, necrotic death, cell lysis and active release are possible mechanisms of cf-DNA release into the blood circulation [2]. Circulating cf-DNA is a recent area of increased research interest, with nearly 9000 related papers in the PubMed library. This research has explored a wide range of topics, including the uses of circulating cf-DNA as a cancer prognostic factor, an indicator for intensive care unit admission, and a diagnostic marker of carcinogenesis, injury, sepsis and autoimmune disease [2e5]. The pathophysiological significance of circulating cf-DNA in cardiovascular disease has not received much attention until recently. However, scattered experimental and clinical studies have shed light upon this interesting issue [6e8]. Ten years ago, a clinical study by Chang et al. showed elevated circulating cf-DNA in patients with myocardial infarction [6]. Recently, an observational cohort study clearly demonstrated that plasma cf-DNA levels are a useful biomarker for predicting the outcome after out-of-hospital

Screening for Metabolic Risk Among Patients With Severe Mental Illness and Diabetes: A National Comparison

People with severe mental illness have a higher risk of developing cardiovascular disease and die sooner than the general population. This study of a national sample of primary care patients in the United Kingdom compared screening for cardiometabolic risk factors among patients with severe mental illness and diabetes. Screening for cardiovascular disease among 2,488,948 patients with diabetes (2010-2011) and 422,966 patients with severe mental illness (2011-2012) at 8,123 primary care practices was compared. The percentage of patients who received screening across four parameters (body mass index, blood pressure, blood glucose, and cholesterol) in the previous 15 months was higher among patients with diabetes than among those with severe mental illness (97.3% versus 74.7%, p<.001). The proportion of patients in primary care who were given screening for cardiometabolic risk was much lower among those with severe mental illness than among those with diabetes.