cardiovascular-agents and Overweight

Different intervention strategies can prevent type 2 diabetes (T2DM). Aim of the present systematic review and meta-analysis was to evaluate the effectiveness of different strategies.. Studies were grouped into 15 different strategies: 1: diet plus physical activity; 2: physical activity; 3-6: anti-diabetic drugs [glitazones, metformin, beta-cell stimulating drugs (sulphanylureas, glinides), alfa-glucosidase inhibitors]; 7-8: cardiovascular drugs (ACE inhibitors, ARB, calcium antagonists); 9-14 [diets, lipid-affecting drugs (orlistat, bezafibrate), vitamins, micronutrients, estrogens, alcohol, coffee]; 15: bariatric surgery. Only controlled studies were included in the analysis, whether randomized, non-randomized, observational studies, whether primarily designed to assess incident cases of diabetes, or performed with other purposes, such as control of hypertension, of ischemic heart disease or prevention of cardiovascular events. Appropriate methodology [preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement] was used. Seventy-one studies (490 813 subjects), published as full papers, were analysed to identify predictors of new cases of T2DM, and were included in a meta-analysis (random-effects model) to study the effect of different strategies. Intervention effect (new cases of diabetes) was expressed as odds ratio (OR), with 95% confidence intervals (C.I.s). Publication bias was formally assessed.. Body mass index was in the overweight range for 13 groups, obese or morbidly obese in lipid-affecting drugs and in bariatric surgery. Non-surgical strategies, except for beta-cell stimulating drugs, estrogens and vitamins, were able to prevent T2DM, with different effectiveness, from 0.37 (C.I. 0.26-0.52) to 0.85 (C.I. 0.77-0.93); the most effective strategy was bariatric surgery in morbidly obese subjects [0.16 (C.I. 0.11,0.24)]. At meta-regression analysis, age of subjects and amount of weight lost were associated with effectiveness of intervention.. These data indicate that several strategies prevent T2DM, making it possible to make a choice for the individual subject.

Topics: Anti-Obesity Agents; Bariatric Surgery; Cardiovascular Agents; Combined Modality Therapy; Controlled Clinical Trials as Topic; Diabetes Mellitus, Type 2; Diet, Reducing; Evidence-Based Medicine; Humans; Hypoglycemic Agents; Life Style; Motor Activity; Obesity; Obesity, Morbid; Overweight; Weight Loss

Between the years 1993 and 2008, mortality rates from coronary heart disease (CHD) in the Slovak Republic have decreased by almost one quarter. However, this was a smaller decline than in neighbouring countries. The aim of this modelling study was therefore to quantify the contributions of risk factor changes and the use of evidence-based medical therapies to the CHD mortality decline between 1993 and 2008.. We identified, obtained and scrutinised the data required for the model. These data detailed trends in the major population cardiovascular risk factors (smoking, blood pressure, total cholesterol, diabetes prevalence, body mass index (BMI) and physical activity levels), and also the uptake of all standard CHD treatments. The main data sources were official statistics (National Health Information Centre and Statistical Office of the Slovak Republic) and national representative studies (AUDIT, SLOVAKS, SLOVASeZ, CINDI, EHES, EHIS). The previously validated IMPACT policy model was then used to combine and integrate these data with effect sizes from published meta-analyses quantifying the effectiveness of specific evidence-based treatments, and population-wide changes in cardiovascular risk factors. Results were expressed as deaths prevented or postponed (DPPs) attributable to risk factor changes or treatments. Uncertainties were explored using sensitivity analyses.. Between 1993 and 2008 age-adjusted CHD mortality rates in the Slovak Republic (SR) decreased by 23% in men and 26% in women aged 25-74 years. This represented some 1820 fewer CHD deaths in 2008 than expected if mortality rates had not fallen. The IMPACT model explained 91% of this mortality decline. Approximately 50% of the decline was attributable to changes in acute phase and secondary prevention treatments, particularly acute and chronic treatments for heart failure (≈12%), acute coronary syndrome treatments (≈9%) and secondary prevention following AMI and revascularisation (≈8%). Changes in CHD risk factors explained approximately 41% of the total mortality decrease, mainly reflecting reductions in total serum cholesterol. However, other risk factors demonstrated adverse trends and thus generated approximately 740 additional deaths.. Our analysis suggests that approximately half the CHD mortality fall recently observed in the SR may be attributable to the increased use of evidence-based treatments. However, the adverse trends observed in all the major cardiovascular risk factors (apart from total cholesterol) are deeply worrying. They highlight the need for more energetic population-wide prevention policies such as tobacco control, reducing salt and industrial trans fats content in processed food, clearer food labelling and regulated marketing of processed foods and sugary drinks.

Topics: Adult; Aged; Angioplasty; Cardiovascular Agents; Cardiovascular Diseases; Cholesterol; Coronary Artery Bypass; Coronary Disease; Diabetes Mellitus; Diet; Evidence-Based Medicine; Exercise; Female; Humans; Male; Meta-Analysis as Topic; Middle Aged; Models, Cardiovascular; Mortality; Overweight; Risk Factors; Slovakia; Smoking

This study aimed to assess the prevalence, the change, and the determinants of change in polypharmacy in a population-based sample.. Baseline (2003-2006) and follow-up (2009-2012) data are from 4679 participants aged between 35 and 75 years (53.5% women, mean age 52.6 ± 10.6 years) from the population of Lausanne, Switzerland. Polypharmacy was defined by the regular use of ≥5 drugs. Four categories of change were defined: never (no polypharmacy at baseline and follow-up), initiating (no polypharmacy at baseline but at follow-up), maintaining, or quitting.. Polypharmacy increased from 7.7% at baseline to 15.3% at follow-up. Cardiovascular drugs were the most prescribed medicines at baseline and follow-up. Gender, age, obesity, smoking, previously diagnosed hypertension, or diabetes or dyslipidemia were significantly and independently associated with initiating and maintaining polypharmacy.. In a population-based sample, prevalence of polypharmacy doubled over a 5.6-year period. The main determinants of initiating polypharmacy were age, overweight and obesity, smoking status, and previously diagnosed cardiovascular risk factors.

Topics: Adult; Aged; Analgesics; Cardiovascular Agents; Diabetes Mellitus; Dyslipidemias; Female; Humans; Hypertension; Hypoglycemic Agents; Life Style; Male; Middle Aged; Overweight; Polypharmacy; Prevalence; Psychotropic Drugs; Risk Factors; Smoking; Switzerland

The aim of this study was to examine the effects of a Western diet (WD) and supplementation with Fuzhuan tea on large artery stiffness, as determined by aortic pulse wave velocity (aPWV).. Mice were subjected to a standard diet (SD; n = 12) or WD (n = 10) for 7 mo, and were then separated to receive nonsupplemented drinking water (SD-W and WD-W) or water supplemented with Fuzhuan tea (SD-T and WD-T) (200 mg/kg daily); mice were then maintained on their respective diets for an additional 2 mo.. After the initial 7-mo feeding period, WD elicited a modest and significantly greater increase in body weight than did SD (39.6 ± 0.71 versus 34.5 ± 1.16 g; P < 0.01). PWV was significantly elevated in WD but not in SD (459.3 ± 4.8 versus 422.4 ± 6.4 cm/s; P < 0.001). Following an additional 2 mo, PWV continued to increase in WD-W, but returned to control levels in WD-T (WD-W: 519.8 ± 12.8; WD-T: 426.5 ± 18.6; SD-W: 429.7 ± 8.6; SD-T: 429.1 ± 6.1 cm/s; P < 0.001, WD-W versus all groups). The increase in PWV in WD-W was accompanied by an increase in aortic collagen (WD-W: 38.8 ± 4.6 versus SD-W: 17.5 ± 5.1 percent cross-sectional area; P < 0.05).. The results of the present study suggest that the increase in arterial stiffness after modest, diet-induced weight gain can be reversed by supplementation with Fuzhuan tea.

Topics: Animals; Aorta; Camellia sinensis; Cardiovascular Agents; Collagen; Diet, Western; Dietary Supplements; Elastin; Endothelium, Vascular; Fermentation; Male; Mice, Inbred C57BL; Overweight; Plant Extracts; Plant Leaves; Pulse Wave Analysis; Random Allocation; Vascular Stiffness; Weight Gain

Topics: Cardiovascular Agents; Cardiovascular Diseases; China; Dyslipidemias; Humans; Motor Activity; Nutritional Status; Overweight; Prevalence; Renal Insufficiency, Chronic; Risk Factors; Smoking; Time Factors

Topics: Angioplasty, Balloon, Coronary; Cardiomyopathy, Dilated; Cardiovascular Agents; Coronary Angiography; Coronary Artery Disease; Diabetes Mellitus, Type 2; False Negative Reactions; Follow-Up Studies; Humans; Hypertension; Internal Mammary-Coronary Artery Anastomosis; Magnetic Resonance Imaging; Male; Middle Aged; Myocardial Infarction; Myocardial Perfusion Imaging; Myocardial Stunning; Overweight; Reoperation; Stents; Stroke Volume

Topics: Blood Pressure; Cardiovascular Agents; Cardiovascular Diseases; Diabetes Mellitus; Dyslipidemias; Europe; Female; Genetic Predisposition to Disease; Guideline Adherence; Health Promotion; Heart Rate; Humans; Hypertension; Hypoglycemic Agents; Hypolipidemic Agents; Inflammation; Kidney Diseases; Life Style; Lipids; Male; Metabolic Syndrome; Motor Activity; Nutritional Physiological Phenomena; Obesity; Overweight; Primary Prevention; Risk Assessment; Risk Factors; Sex Factors; Smoking; Smoking Cessation; Stress, Psychological; Treatment Outcome

Topics: Blood Pressure; Cardiovascular Agents; Cardiovascular Diseases; Diabetes Mellitus; Dyslipidemias; Female; Genetic Predisposition to Disease; Guideline Adherence; Health Promotion; Heart Rate; Humans; Hypertension; Hypoglycemic Agents; Hypolipidemic Agents; Inflammation; Kidney Diseases; Life Style; Lipids; Male; Metabolic Syndrome; Motor Activity; Nutritional Physiological Phenomena; Obesity; Overweight; Primary Prevention; Risk Assessment; Risk Factors; Sex Factors; Smoking; Smoking Cessation; Stress, Psychological; Treatment Outcome