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Cholesterol & Cardiorespiratory Fitness

Cholesterol & Cardiorespiratory Fitness

Published research suggests that cholesterol levels commonly rise as people age and then decrease later in life. “Abnormal lipids are important risk factors that play a critical role in the development of cardiovascular disease (CVD),” says Xuemei Sui, MD, MPH, PhD. “Therefore, identifying modifiable risk factors that can affect lipid profiles might help reduce the burden of CVD.” Some previous analyses have explored the effect of cardiorespiratory fitness (CRF) on changes in blood glucose and blood pressure and have shown beneficial changes with higher CRF levels. However, few studies have looked at the effect of CRF on age-related longitudinal changes of lipids and lipoproteins. “With the high percentage of sedentary people living in the United States, it is particularly important to understand the specific benefits of exercise and fitness and the roles they play in health,” says Dr. Sui. New Data In a study published in the Journal of the American College of Cardiology, Dr. Sui and colleagues used data from health exams performed during the Aerobics Center Longitudinal Study. The long-term study ran from 1970 to 2006 and included more than 11,400 men between the ages of 20 and 90. Patients did not have known high cholesterol, high triglycerides, CVD, and cancer at baseline. Each participant took a treadmill exercise test to determine their baseline CRF level and had their total cholesterol, LDL cholesterol, triglycerides, HDL cholesterol, and non-HDL cholesterol levels recorded. Important Findings Men with lower CRF levels had a greater risk of developing high cholesterol in their early 30s, according to the results. Men with higher levels of CRF did not develop high cholesterol develop until...

Statin Non-Adherence & Treatment Intensification

A review of more than 125,000 patients on stable statin therapy suggests that nearly half (44%) of those who had their treatment intensified were non-adherent to their treatment. When compared with adherent patients, those who were not were 30% more likely to have had their statin therapy intensified. Those with statin therapy intensification were more likely to be younger, female, and have coronary artery disease, diabetes, hypertension, dyslipidemia, stroke, peripheral arterial disease, heart failure, or depression. Abstract: American Journal of Cardiology, November 15,...

Managing Common Diabetes Comorbidities: Going Beyond Standard Care

This Physician’s Weekly feature covering the management of common diabetes comorbidities was completed in cooperation with the experts at the American Diabetes Association. Throughout the medical literature, it has been well documented that patients with type 2 diabetes are at increased risk for developing cardiovascular disorders, including coronary artery disease and stroke. The constellation of symptoms that includes insulin resistance and obesity greatly increases the likelihood of additional comorbidities emerging. “In addition to the commonly appreciated comorbidities of obesity, hypertension, and dyslipidemia,” says Medha N. Munshi, MD, “diabetes is also associated with other diseases or conditions at rates higher than those of people without diabetes.” In keeping with patient-centered approaches to care, physicians should be aware of the wide spectrum of comorbidities their patients face when managing them throughout their disease course. When the risk for these comorbidities is elevated, patients should be treated accordingly. The American Diabetes Association reports that some of the more common comorbidities outside the realm of obesity, hypertension, and dyslipidemia include obstructive sleep apnea (OSA), fatty liver disease, cancer, and fractures (Table 1). “Clinicians should consider these other comorbidities during their care of patients with diabetes to optimize outcomes,” says Dr. Munshi. Obstructive Sleep Apnea OSA is the most common form of sleep-disordered breathing in patients with type 2 diabetes, accounting for over 80% of cases. In people with diabetes, the prevalence of OSA has been documented to be as high as 23% and the prevalence of some form of sleep disordered breathing may be as high as 58%. “Treating sleep apnea can significantly improve quality of life and blood pressure control,” Dr. Munshi...

Metabolic Syndrome, Catheter Ablation, & AF

Atrial fibrillation (AF) is increasingly being viewed by clinicians as a modern-day epidemic, affecting more than 2.2 million adults in the United States. AF is strongly age-dependent, affecting 4% of people older than 60 and 8% of those older than 80. Alarmingly, about one-quarter of people aged 40 and older are expected to develop AF during their lifetime. Another growing problem is the continued emergence of metabolic syndrome (MS), which is estimated to affect 21% to 24% of U.S. adults. Coexistence of MS and AF is common. Studies suggest that different components of MS, including hypertension, diabetes, dyslipidemia, and obesity, increase the likelihood of AF. Catheter ablation has been a major treatment advance for the condition, offering a new spectrum of options for drug-refractory AF patients. However, this procedure is yet to be a total success in maintaining long-term sinus rhythm, even in the best hands. Little is known about the role of MS on the long-term outcome of AF ablation, such as restoration of sinus rhythm and improvement in quality of life (QOL). Taking a Deeper Look at Atrial Fibrillation In the April 3, 2012 Journal of the American College of Cardiology, we had a study published that prospectively analyzed 1,496 patients with AF who were undergoing a first ablation. About 45% of our study group had long-standing persistent AF, while 29% had paroxysmal AF and 26% had persistent AF. Patients were classified as either having MS or not having MS. They were followed for AF recurrence and QOL at 12 months after their ablation procedure. At follow-up, 39% of patients with MS had experienced arrhythmia recurrence, compared...

Protecting Against CVD in Type 2 Diabetes

Clinicians should take an active role in helping their patients with type 2 diabetes protect themselves from developing cardiovascular disease, or CVD, in the future. Cardiovascular disease (CVD) has been well documented as a major cause of morbidity and mortality for individuals with diabetes. Adults with diabetes have a two- to four-fold higher risk of CVD when compared with those without diabetes. “The common conditions coexisting with type 2 diabetes—especially hypertension and dyslipidemia— are clear risk factors for CVD,” says Craig D. Williams, PharmD. “Diabetes itself also confers independent risk of CVD.” The association among diabetes, hypertension, and dyslipidemia has been known for many decades, and researchers are continuing to collect more data about the interconnectedness of diabetes and heart disease. There has also been an increased appreciation of the impact of obesity on CVD. The concept that these metabolic abnormalities can cluster in many individuals has led to greater efforts to prevent and treat these conditions, especially in patients with diabetes. Assessing Risk of CVD in Diabetes There are many approaches for estimating the risk of diabetes and CVD. One such tool—Diabetes PHD (Personal Health Decisions), which is available online at www.diabetes.org—is of particular value for this task for both clinicians and patients. Diabetes PHD is an easy-to-use internet program made available by the American Diabetes Association. It can be used to explore the effects of a wide variety of interventions, including weight loss, smoking cessation, and the addition of medications. It has been studied and validated extensively across many types of clinical trials, and it incorporates most known CVD risk factors. Research suggests that such risk assessment tools are rarely used...
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