Orlistat and cardiovascular risk profile in hypertensive patients with metabolic syndrome: the ARCOS study

Weight loss improves metabolic abnormalities and reduces cardiovascular risk in obese hypertensive patients. To evaluate the impact of a sustained weight loss on coronary risk, 181 hypertensive patients with metabolic syndrome underwent to orlistat therapy, 120 mg, t.i.d., plus diet for 36 weeks. During therapy, Framingham risk scores (FRS) were calculated for determination of coronary heart disease risk in ten years. Body mass index decreased from 35.0 ± 4.2 to 32.6 ± 4.5 kg/m² (p< 0.0001) and waist circumference from 108.1 ± 10.1 to 100.5 ± 11.1 cm (p< 0.0001), at the end of the study period (week 36). Systolic and diastolic blood pressure showed reductions after the two first weeks, which were maintained up to the end of the study. A clear shift to the left in FRS distribution curve occurred at the end of the study, compared to baseline, indicating a reduction in coronary risk. Over all patients at risk, 49.2% moved to a lower risk category. A weight loss > 5% occurred in 64.6% of all patients, associated with improvement in glucose metabolism. Among those with abnormal glucose metabolism, 38 out 53 patients (71.7%) improved their glucose tolerance (p< 0.0005). In conclusion, long-term orlistat therapy helps to reduce and maintain a lower body weight, decreasing risk of coronary disease and improving glucose metabolism, thus protecting against type 2 diabetes.

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Comparing the Keyto App and Device with Weight Watchers’ WW App for Weight Loss: Protocol for a Randomized Trial

JMIR Research Protocols ◽

10.2196/19053 ◽

2020 ◽

Vol 9 (8) ◽

pp. e19053

Author(s):

Sean R Locke ◽

Kaja Falkenhain ◽

Dylan A Lowe ◽

Terry Lee ◽

Joel Singer ◽

...

Keyword(s):

Weight Loss ◽

Cardiovascular Risk ◽

Randomized Trial ◽

Ketogenic Diet ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Ketogenic Diets ◽

Phone Calls ◽

Weight Watchers ◽

The Impact

Background Obesity and being overweight are major contributing factors for many diseases. Calorie restricted diets often fail to result in sustained long-term weight loss. Very low–carbohydrate, high-fat ketogenic diets have been suggested to have superior metabolic and weight loss effects. Keyto is a low-cost, highly scalable mobile health (mHealth) app paired with a noninvasive biofeedback tool aimed at facilitating weight loss through a personalized healthy and predominantly plant- and fish-based ketogenic diet. Objective This protocol describes a randomized trial comparing the efficacy of the Keyto mHealth app and device intervention to that of Weight Watchers’ WW app in individuals who are overweight or obese. The primary outcome is weight loss after 12 weeks. Secondary and exploratory outcomes, including metabolic and cardiovascular risk factors, will be assessed at 12, 24, and 48 weeks. Methods A total of 144 participants will be recruited and randomized to either the Keyto program or Weight Watchers program. Study participants will be guided through the study via video conference or phone calls and will undergo a fasting blood analysis performed by a third-party diagnostic lab at weeks 0 and 12 to assess metabolic and cardiovascular risk markers. All participants will be asked to weigh themselves daily on a study-provided Bluetooth-enabled scale. Participants randomized to the Keyto arm will also be asked to measure their breath acetone levels, a measure of ketosis, with the Keyto device 3 times per day. Results Recruitment started in December 2019. Rolling recruitment is expected to be completed by July 2020. Data collection and analysis of the primary intervention phase is expected to be completed in October 2020. The 24- and 48-week follow-ups are expected to be completed in January 2021 and July 2021, respectively. Conclusions This trial will provide high-quality evidence regarding the efficacy of the Keyto weight loss program in individuals who are overweight and obese in a free-living condition. This study also fills a gap by examining the impact of a ketogenic diet emphasizing plant- and fish-based fats on blood lipid profile and cardiovascular disease risk. Trial Registration ClinicalTrials.gov NCT04165707; https://clinicaltrials.gov/ct2/show/NCT04165707. International Registered Report Identifier (IRRID) DERR1-10.2196/19053

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Comparing the Keyto App and Device with Weight Watchers’ WW App for Weight Loss: Protocol for a Randomized Trial (Preprint)

10.2196/preprints.19053 ◽

2020 ◽

Author(s):

Sean R Locke ◽

Kaja Falkenhain ◽

Dylan A Lowe ◽

Terry Lee ◽

Joel Singer ◽

...

Keyword(s):

Weight Loss ◽

Cardiovascular Risk ◽

Randomized Trial ◽

Ketogenic Diet ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Ketogenic Diets ◽

Phone Calls ◽

Weight Watchers ◽

The Impact

BACKGROUND Obesity and being overweight are major contributing factors for many diseases. Calorie restricted diets often fail to result in sustained long-term weight loss. Very low–carbohydrate, high-fat ketogenic diets have been suggested to have superior metabolic and weight loss effects. Keyto is a low-cost, highly scalable mobile health (mHealth) app paired with a noninvasive biofeedback tool aimed at facilitating weight loss through a personalized healthy and predominantly plant- and fish-based ketogenic diet. OBJECTIVE This protocol describes a randomized trial comparing the efficacy of the Keyto mHealth app and device intervention to that of Weight Watchers’ WW app in individuals who are overweight or obese. The primary outcome is weight loss after 12 weeks. Secondary and exploratory outcomes, including metabolic and cardiovascular risk factors, will be assessed at 12, 24, and 48 weeks. METHODS A total of 144 participants will be recruited and randomized to either the Keyto program or Weight Watchers program. Study participants will be guided through the study via video conference or phone calls and will undergo a fasting blood analysis performed by a third-party diagnostic lab at weeks 0 and 12 to assess metabolic and cardiovascular risk markers. All participants will be asked to weigh themselves daily on a study-provided Bluetooth-enabled scale. Participants randomized to the Keyto arm will also be asked to measure their breath acetone levels, a measure of ketosis, with the Keyto device 3 times per day. RESULTS Recruitment started in December 2019. Rolling recruitment is expected to be completed by July 2020. Data collection and analysis of the primary intervention phase is expected to be completed in October 2020. The 24- and 48-week follow-ups are expected to be completed in January 2021 and July 2021, respectively. CONCLUSIONS This trial will provide high-quality evidence regarding the efficacy of the Keyto weight loss program in individuals who are overweight and obese in a free-living condition. This study also fills a gap by examining the impact of a ketogenic diet emphasizing plant- and fish-based fats on blood lipid profile and cardiovascular disease risk. CLINICALTRIAL ClinicalTrials.gov NCT04165707; https://clinicaltrials.gov/ct2/show/NCT04165707. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/19053

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Clinical and Seasonal Variations of Nutritional Risk Screening in Patients Scheduled for Rehabilitation after Heart Surgery

The Heart Surgery Forum ◽

10.1532/hsf98.2013240 ◽

2013 ◽

Vol 16 (6) ◽

pp. 336

Author(s):

Marko Boban ◽

Viktor Persic ◽

Zeljko Jovanovic ◽

Niksa Drinkovic ◽

Milan Milosevic ◽

...

Keyword(s):

Weight Loss ◽

Heart Surgery ◽

Nutritional Risk ◽

Risk Scores ◽

Risk Screening ◽

Climate Effects ◽

Seasonal Climate ◽

Nrs 2002 ◽

The Impact ◽

Nutritional Risk Screening

Background: Current knowledge on the pervasiveness of increased nutritional risk in cardiovascular diseases is limited. Our aim was to analyze the characteristics of nutritional risk screening in patients scheduled for rehabilitation after heart surgery. Prevalence and extent of nutritional risk were studied in connection with patients' characteristics and seasonal climate effects on weight loss dynamics.Methods: The cohort included 65 consecutive patients with an age range of 25-84 years, 2-6 months after surgical treatment for ischemic or valvular heart disease. Nutritional risk screening was appraised using a standardized NRS-2002 questionnaire. Groups were analyzed according to a timeline of rehabilitation according to the "cold" and "warm" seasons of the moderate Mediterranean climate in Opatija, Croatia.Results: Increased nutritional risk scores (NRS-2002) of >3 were found in 96% of studied patients. Mean NRS-2002 of patients was 5.0 � 1.0, with a percentage weight loss history of 11.7% � 2.2% (4.6-19.0). Risk was found to be more pronounced during the warmer season, with NRS-2002 scores of 5.3 � 0.7 versus 4.8 � 1.1 (P = 0.136) and greater loss of weight of 13.0% � 3.2% versus 10.6% � 3% (P = 0.005), respectively. Increased nutritional risk correlated significantly with creatinine concentrations (rho = 0.359; P = 0.034 versus 0.584; P = 0.001, respectively). Significant discordance in correlations was found between NRS-2002 and the decrease in left ventricle systolic function (rho correlation coefficient [rho-cc] = -0.428; P = 0.009), the increase in glucose concentrations (cc = 0.600; P < 0.001), and the decrease in erythrocyte counts (cc = -0.520; P = 0.001) during the colder season.Conclusion: Increased nutritional risk was found to be frequently expressed in the course of rehabilitation after heart surgery. Although seasonal climate effects influenced the weight loss dynamics, the impact on reproducibility of NRS-2002 was clinically less important. Further studies on the connection of nutritional risk with composited end points might offer improvements in overall quality of treatment.

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THE IMPACT OF UNCONTROLLED HYPERTENSION ON CARDIOVASCULAR RISK IN PATIENTS WITH METABOLIC SYNDROME: PP.28.114

Journal of Hypertension ◽

10.1097/01.hjh.0000379652.78438.1f ◽

2010 ◽

Vol 28 ◽

pp. e483

Author(s):

D Tsounis ◽

N Brellas ◽

G Stamos ◽

V Laschos ◽

D Voutsela ◽

...

Keyword(s):

Metabolic Syndrome ◽

Cardiovascular Risk ◽

Uncontrolled Hypertension ◽

The Impact

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Dairy Fat Consumption and the Risk of Metabolic Syndrome: An Examination of the Saturated Fatty Acids in Dairy

Nutrients ◽

10.3390/nu11092200 ◽

2019 ◽

Vol 11 (9) ◽

pp. 2200 ◽

Cited By ~ 8

Author(s):

Unger ◽

Torres-Gonzalez ◽

Kraft

Keyword(s):

Metabolic Syndrome ◽

Fatty Acids ◽

Disease Risk ◽

Saturated Fatty Acids ◽

Saturated Fat ◽

Dietary Guidelines ◽

The Body ◽

Specific Chemical ◽

Dairy Consumption ◽

The Impact

Lifestyle is a key modifiable risk factor involved in the manifestation of metabolic syndrome and, in particular, diet plays a pivotal role in its prevention and development. Current dietary guidelines discourage the consumption of saturated fat and dietary sources rich in saturated fat, such as dairy products, despite data suggesting that full-fat dairy consumption is protective against metabolic syndrome. This narrative review assessed the recent epidemiological and clinical research that examined the consumption of dairy-derived saturated fatty acids (SFA) on metabolic syndrome risk. In addition, this review evaluated studies of individual SFA to gain insight into the potential mechanisms at play with intake of a diet enriched with these dairy-derived fatty acids. This work underscores that SFA are a heterogenous class of fatty acids that can differ considerably in their biological activity within the body depending on their length and specific chemical structure. In summary, previous work on the impact of dairy-derived SFA consumption on disease risk suggests that there is currently insufficient evidence to support current dietary guidelines which consolidate all dietary SFA into a single group of nutrients whose consumption should be reduced, regardless of dietary source, food matrix, and composition.

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Development and Validation of a Novel Dementia Risk Score in the UK Biobank Cohort

10.31234/osf.io/5yvjr ◽

2021 ◽

Author(s):

Melis Anatürk ◽

Raihaan Patel ◽

Georgios Georgiopoulos ◽

Danielle Newby ◽

Anya Topiwala ◽

...

Keyword(s):

At Risk ◽

Cardiovascular Risk ◽

Risk Score ◽

Disease Risk ◽

Risk Index ◽

Risk Scores ◽

Uk Biobank ◽

Dementia Risk ◽

History Of ◽

The Uk

INTRODUCTION: Current prognostic models of dementia have had limited success in consistently identifying at-risk individuals. We aimed to develop and validate a novel dementia risk score (DRS) using the UK Biobank cohort.METHODS: After randomly dividing the sample into a training (n=166,487, 80%) and test set (n=41,621, 20%), logistic LASSO regression and standard logistic regression were used to develop the UKB-DRS.RESULTS: The score consisted of age, sex, education, apolipoprotein E4 genotype, a history of diabetes, stroke, and depression, and a family history of dementia. The UKB-DRS had good-to-strong discrimination accuracy in the UKB hold-out sample (AUC [95%CI]=0.79 [0.77, 0.82]) and in an external dataset (Whitehall II cohort, AUC [95%CI]=0.83 [0.79,0.87]). The UKB-DRS also significantly outperformed four published risk scores (i.e., Australian National University Alzheimer’s Disease Risk Index (ANU-ADRI), Cardiovascular Risk Factors, Aging, and Dementia score (CAIDE), Dementia Risk Score (DRS), and the Framingham Cardiovascular Risk Score (FRS) across both test sets.CONCLUSION: The UKB-DRS represents a novel easy-to-use tool that could be used for routine care or targeted selection of at-risk individuals into clinical trials.

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Polygenic Hyperlipidemias and Coronary Artery Disease Risk

10.1101/735167 ◽

2019 ◽

Author(s):

Pietari Ripatti ◽

Joel T Rämö ◽

Nina J Mars ◽

Sanni Söderlund ◽

Christian Benner ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Genome Wide Association Study ◽

Disease Risk ◽

Cumulative Exposure ◽

Risk Scores ◽

Lipid Levels ◽

Artery Disease ◽

The Impact ◽

Cad Risk

AbstractBackgroundHyperlipidemia is a highly heritable risk factor for coronary artery disease (CAD). Monogenic familial hypercholesterolemia associates with higher increase in CAD risk than expected from a single LDL-C measurement, likely due to lifelong cumulative exposure to high LDL-C. It remains unclear to what extent a high polygenic load of LDL-C or TG-increasing variants associates with increased CAD risk.Methods and ResultsWe derived polygenic risk scores (PRS) with ∼6M variants for LDL-C and TG with weights from a UK biobank-based genome-wide association study with ∼500K samples. We evaluated the impact of polygenic hypercholesterolemia and hypertriglyceridemia to lipid levels in 27 039 individuals from the FINRISK cohort, and to CAD risk in 135 300 individuals (13 695 CAD cases) from the FinnGen project.In FINRISK, LDL-C ranged from 2.83 (95% CI 2.79-2.89) to 3.80 (3.72-3.88) and TG from 0.99 (0.95-1.01) to 1.52 (1.48-1.58) mmol/l between the lowest and highest 5% of the respective PRS distributions. The corresponding CAD prevalences ranged from 8.2% to 12.7% for the LDL-C PRS and from 8.2% to 12.1% for the TG PRS in FinnGen. Furthermore, CAD risk was 1.36-fold higher (OR, 95% CI 1.24-1.49) for the LDL-C PRS and 1.31-fold higher (1.20-1.44) for the TG PRS for those with the PRS >95th percentile vs those without. These estimates were only slightly attenuated when adjusting for a CAD PRS (OR 1.26 [95% CI 1.15-1.39] for LDL-C and 1.21 [1.10-1.32] for TG PRS).ConclusionsThe CAD risk associated with a high polygenic load for lipid-increasing variants was proportional to their impact on lipid levels and mostly independent of a CAD PRS. In contrast with a PRS for CAD, the lipid PRSs point to known and directly modifiable risk factors providing more direct guidance for clinical translation.

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Nutrients in Fish and Possible Associations with Cardiovascular Disease Risk Factors in Metabolic Syndrome

Nutrients ◽

10.3390/nu10070952 ◽

2018 ◽

Vol 10 (7) ◽

pp. 952 ◽

Cited By ~ 25

Author(s):

Christine Tørris ◽

Milada Cvancarova Småstuen ◽

Marianne Molin

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Metabolic Syndrome ◽

Fatty Acids ◽

Fish Consumption ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Protective Role ◽

Cvd Risk ◽

The Impact

Non-communicable diseases (NSDs) are responsible for two-thirds of all deaths globally, whereas cardiovascular disease (CVD) alone counts for nearly half of them. To reduce the impact of CVD, targeting modifiable risk factors comprised in metabolic syndrome (e.g., waist circumference, lipid profile, blood pressure, and blood glucose) is of great importance. Beneficial effects of fish consumption on CVD has been revealed over the past decades, and some studies suggest that fish consumption may have a protective role in preventing metabolic syndrome. Fish contains a variety of nutrients that may contribute to health benefits. This review examines current recommendations for fish intake as a source of various nutrients (proteins, n-3 fatty acids, vitamin D, iodine, selenium, and taurine), and their effects on metabolic syndrome and the CVD risk factors. Fatty fish is recommended due to its high levels of n-3 fatty acids, however lean fish also contains nutrients that may be beneficial in the prevention of CVD.

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The impact of a Post-Take Ward Round Pharmacist on the Risk Score and Enactment of Medication-Related Recommendations

Pharmacy ◽

10.3390/pharmacy8010023 ◽

2020 ◽

Vol 8 (1) ◽

pp. 23

Author(s):

Brooke Bullock ◽

Peter J Donovan ◽

Charles Mitchell ◽

Jennifer A Whitty ◽

Ian Coombes

Keyword(s):

Intervention Group ◽

Study Groups ◽

Ward Round ◽

Risk Scores ◽

Risk Category ◽

Post Intervention ◽

Inpatient Ward ◽

Extreme Risk ◽

The Impact ◽

Very High

There is a scarcity of published research describing the impact of a pharmacist on the post-take ward round (PTWR) in addition to ward-based pharmacy services. The aim of this paper was to evaluate the impact of clinical pharmacists’ participation on the PTWR on the risk assessment scores of medication-related recommendations with and without a pharmacist. This includes medication-related recommendations occurring on the PTWR and those recommendations made by the ward-based pharmacist on the inpatient ward. A pre–post intervention study was undertaken that compared the impact of adding a pharmacist to the PTWR compared with ward-based pharmacist services alone. A panel reviewed the risk of not acting on medication recommendations that was made on the PTWR and those recorded by the ward-based pharmacist. The relationship between the risk scores and the number and proportion of recommendations that led to action were compared between study groups. There were more medication-related recommendations on the PTWR in the intervention group when a pharmacist was present. Proportionately fewer were in the ’very high and extreme’ risk category. Although there was no difference in the number of ward pharmacist recommendations between groups, there was a significantly higher proportion of ward pharmacist recommendations in the “very high and extreme” category in those patients who had been seen on a PTWR attended by a pharmacist than when a pharmacist was not present. There were a greater proportion of “low and medium” risk actionable medication recommendations actioned on the PTWR in the intervention group; and no difference in the risk scores in ward pharmacist recommendations actioned between groups. Overall, the proportion of recommendations that were actioned was higher for those made on the PTWR compared with the ward. The addition of a pharmacist to the PTWR resulted in an increase in low, medium, and high risk recommendations on the PTWR, more very high and extreme risk recommendations made by the ward-based pharmacist, plus an increased number of recommendations being actioned during the patients’ admission.

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