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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...

Vitamin D & Mortality in Metabolic Syndrome

In patients with metabolic syndrome, both all-cause and cardiovascular disease mortality appear to be substantially lowered in those with optimal 25-hydroxyvitamin D (25[OH]D) levels when compared with those with suboptimal levels, according to a study from European researchers. Future investigations should assess the role of vitamin D supplementation in optimizing 25(OH)D levels to reduce mortality in these individuals. Abstract: Diabetes Care, May...

Reducing Triglyceride Levels in Patients at Risk for CVD

Almost one-third of adults in the United States have elevated triglyceride levels (>150 mg/dL), and these levels are continuing to rise in adults aged 20 to 49 at rates that mirror those of obesity and diabetes diagnoses among the young. Observational and epidemiologic studies have demonstrated that high triglycerides (200-500 mg/dL) are associated with increased risk of cardiovascular disease (CVD), with the highest levels (≥1,000 mg/dL) associated with an increased risk of pancreatitis. “High triglyceride levels indicate that patients have high levels of circulating cholesterol-rich remnants,” explains Michael Miller, MD. “Cholesterol-rich remnants are highly atherogenic.” Dr. Miller chaired an American Heart Association (AHA) writing committee that published a scientific statement on triglycerides and CVD in the April 18, 2011 issue of Circulation. “There has been little consensus in the literature about the role of triglycerides in coronary disease,” he says. “There has been no detailed statement on triglycerides that has systematically reviewed both the pathophysiologic and clinical trial evidence to date. For this reason, the AHA felt it was necessary to educate healthcare providers about the importance of triglycerides as a biomarker of cardiovascular risk.” He adds that the 2011 AHA position statement analyzed more than 500 international studies from the past 30 years. Helpful Strategies in Reducing Triglycerides Dr. Miller says it is well known that dietary and other lifestyle interventions can help patients lose weight and have a strong effect on triglyceride levels. “These improvements also translate into salutary effects on systolic blood pressure and glucose, reduced insulin resistance, and systemic inflammation, thereby resulting in an improved metabolic profile.” According to the guidelines, substituting unsaturated dietary fats...

New Guidelines for Assessing Adiposity

The rate of obesity in the United States has reached the epidemic level despite efforts by healthcare providers and patients to improve health-related behaviors and increased efforts to better understand its pathophysiology. “Assessment for excess adiposity is of critical importance,” says Marc-Andre Cornier, MD. To address the issue of assessing adiposity, the American Heart Association (AHA) released a scientific statement to help clinicians. The statement, which was published in the November 1, 2011 issue of Circulation, provides practical guidance for clinical researchers who seek to identify precise measurements for their patients. It also provides recommendations for clinicians who care for patients whose excess weight is a clinical problem. “Before clinicians can recommend treatment options or talk to patients about obesity prevention, they need to know whether a patient is obese,” says Dr. Cornier, who was the lead author of the AHA scientific statement. He adds that there are also new Medicare guidelines for covering obesity treatment that require clinicians to identify whether or not patients are obese. Medicare will cover provider visits for weight loss counseling in patients who screen “positive” for obesity. Reviewing the Methodologies for Assessing Adiposity Healthcare providers and systems are not regularly assessing for excess adiposity with even the simplest, least costly methods, says Dr. Cornier. “Most methods for assessing excess adiposity are not ready for routine clinical use,” he says. “Measuring BMI and waist circumference is currently best to assess adiposity. These are strategies all clinicians should be practicing on a regular basis for patients. Other newer, complex, and more expensive tools are currently available, but physicians need to do a better job utilizing...

Establishing Clear Criteria for Metabolic Syndrome

Metabolic syndrome is characterized by interrelated risk factors for cardiovascular disease (CVD) and diabetes, including dysglycemia, hypertension, raised triglyceride levels, low HDL cholesterol levels, and obesity, specifically central adiposity. Patients with metabolic syndrome are twice as likely to develop CVD over the next 5 to 10 years when compared with those without it. In addition, metabolic syndrome has been associated with a five-fold increase in risk for type 2 diabetes. Clarifying the Definition To unify the diagnostic criteria for metabolic syndrome, the International Diabetes Federation (IDF) recently issued a scientific statement in conjunction with the National Heart, Lung, and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, and International Association for the Study of Obesity. The statement, published in the October 19, 2009 issue of Circulation, defines terminology and criteria related to metabolic syndrome in an effort to clarify incongruencies presented by different organizations over the past decade. “It’s our hope that this joint statement will eliminate confusion and assist physicians with the identification and treatment of patients who have metabolic syndrome,” says Robert H. Eckel, MD, FAHA, a co-author of the scientific statement. Metabolic syndrome was first defined by a group at the World Health Organization in 1998; it emphasized insulin resistance as the major underlying risk factor. In 2001, the National Cholesterol Education Program Adult Treatment Panel-III (ATP III) characterized the syndrome as the presence of three of five risk factors (abdominal obesity, elevated triglycerides, low HDL cholesterol, high blood pressure, and elevated fasting glucose) with or without evidence of insulin resistance. Subsequently, the IDF established an alternative definition that required a threshold waist...
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