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BACKGROUND/OBJECTIVES: Studies suggest that the Mediterranean-style diet (MSD) may improve glucose metabolism in patients with type 2 diabetes (T2D), but the results are inconsistent. We conducted a meta-analysis of randomized controlled trials (RCTs) to explore the effects of MSD on glycemic control, weight loss and cardiovascular risk factors in T2D patients. SUBJECTS/METHODS: We performed searches of EMBASE, Cochrane Library and PubMed databases up to February 2014. We included RCTs that compared the MSD with control diets in patients with T2D. Effect size was estimated as mean difference with 95% confidence interval (CI) by using random effect models. RESULTS: The meta-analysis included nine studies with 1178 patients. Compared with control diets, MSD led to greater reductions in hemoglobin A1c (mean difference, -0.30;95% CI, -0.46 to -0.14), fasting plasma glucose (-0.72 mmol/l; CI, -1.24 to -.21), fasting insulin (-0.55 [micro]U/ml; CI,-0.81 to -0.29), body mass index (-0.29 kg/[m.sup.2]; CI, -0.46 to -0.12) and body weight (-0.29 kg; CI, -0.55 to -0.04). Likewise, concentrations of total cholesterol and triglyceride were decreased (-0.14 mmol/l; CI, -0.19 to -0.09 and -0.29 mmol/l; CI, -0.47 to -0.10, respectively), and high-density lipoprotein was increased (0.06 mmol/l; CI, 0.02 to 0.10). In addition, MSD was associated with a decline of 1.45 mm Hg (CI, -1.97 to -0.94) for systolic blood pressure and 1.41 mm Hg (CI, -1.84 to -0.97) for diastolic blood pressure. CONCLUSIONS: The present meta-analysis provides evidence that MSD improves outcomes of glycemic control, body weight and cardiovascular risk factors in T2D patients. European Journal of Clinical Nutrition (2015) 69, 1200-1208; doi: 10.1038/ejcn.2014.243; published online 5 November 2014, INTRODUCTION Type 2 diabetes (T2D) is a global epidemic and a main threat to human health. It is estimated that about 552 million cases worldwide will suffer from T2D by [...]

Author(s): Maarten J. G. Leening 1,2,3, M. Arfan Ikram 1,* Shortly after World War II, coronary heart disease was recognized as an epidemic. Cardiovascular disease (CVD) had become the leading [...]

Background Clinical practice guidelines have traditionally recommended blood pressure treatment based primarily on blood pressure thresholds. In contrast, using predicted cardiovascular risk has been advocated as a more effective strategy to guide treatment decisions for cardiovascular disease (CVD) prevention. We aimed to compare outcomes from a blood pressure-lowering treatment strategy based on predicted cardiovascular risk with one based on systolic blood pressure (SBP) level. Methods and findings We used individual participant data from the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) from 1995 to 2013. Trials randomly assigned participants to either blood pressure-lowering drugs versus placebo or more intensive versus less intensive blood pressure-lowering regimens. We estimated 5-y risk of CVD events using a multivariable Weibull model previously developed in this dataset. We compared the two strategies at specific SBP thresholds and across the spectrum of risk and blood pressure levels studied in BPLTTC trials. The primary outcome was number of CVD events avoided per persons treated. We included data from 11 trials (47,872 participants). During a median of 4.0 y of follow-up, 3,566 participants (7.5%) experienced a major cardiovascular event. Areas under the curve comparing the two treatment strategies throughout the range of possible thresholds for CVD risk and SBP demonstrated that, on average, a greater number of CVD events would be avoided for a given number of persons treated with the CVD risk strategy compared with the SBP strategy (area under the curve 0.71 [95% confidence interval (CI) 0.70-0.72] for the CVD risk strategy versus 0.54 [95% CI 0.53-0.55] for the SBP strategy). Compared with treating everyone with SBP [greater than or equal to] 150 mmHg, a CVD risk strategy would require treatment of 29% (95% CI 26%-31%) fewer persons to prevent the same number of events or would prevent 16% (95% CI 14%-18%) more events for the same number of persons treated. Compared with treating everyone with SBP [greater than or equal to] 140 mmHg, a CVD risk strategy would require treatment of 3.8% (95% CI 12.5% fewer to 7.2% more) fewer persons to prevent the same number of events or would prevent 3.1% (95% CI 1.5%-5.0%) more events for the same number of persons treated, although the former estimate was not statistically significant. In subgroup analyses, the CVD risk strategy did not appear to be more beneficial than the SBP strategy in patients with diabetes mellitus or established CVD. Conclusions A blood pressure-lowering treatment strategy based on predicted cardiovascular risk is more effective than one based on blood pressure levels alone across a range of thresholds. These results support using cardiovascular risk assessment to guide blood pressure treatment decision-making in moderate- to high-risk individuals, particularly for primary prevention., Author(s): Kunal N. Karmali 1, Donald M. Lloyd-Jones 1, Joep van der Leeuw 2, David C. Goff 3, Salim Yusuf 4, Alberto Zanchetti 5, Paul Glasziou 6, Rodney Jackson 7, [...]

Elevated phosphate (P) levels are seen in advanced renal failure and, together with dysregulated calcium, parathyroid hormone and vitamin D levels, contribute to the complex of chronic kidney disease-mineral and bone disease (CKD-MBD). Converging evidence from in vitro, clinical and epidemiological studies suggest that increased P is associated with vascular calcification and mortality. When vessels are exposed to high P conditions in vitro, they develop apoptosis, convert to bone-like cells and develop extensive calcification. Clinical studies in children on dialysis show that high P is associated with increased vessel wall thickness, arterial stiffness and coronary calcification. Epidemiological studies in adult dialysis patients demonstrate a significant and independent association between raised P and mortality. Importantly, raised P is associated with cardiovascular changes even in pre-dialysis CKD, and also in subjects with normal renal function but high P. All P binders can effectively reduce serum P, and this decrease is linked to improved survival. Raised serum P triggers the release of fibroblast growth factor 23 (FGF-23), which has the beneficial effect of increasing P excretion in early CKD, but is increased several 1,000-fold in dialysis, and may be an independent cardiovascular risk factor. Both FGF-23 and its co-receptor Klotho may have direct effects on the vasculature leading to calcification. Fascinatingly, disturbances in FGF-23-Klotho and raised P have also been associated with premature aging. These data suggest that high P levels have adverse vascular effects and that maintaining the serum P levels in the normal range reduces cardiovascular risk and mortality. Keywords Phosphate * Chronic kidney disease * Cardiovascular disease * Vascular calcification * Dialysis, Introduction Phosphorus is an essential element that forms a key component of nucleic acids and cell membranes and is required for maintaining the normal homeostatic control of the cell, including [...]

The objective of the study was to evaluate the efficacy of an interdisciplinary intervention known as Educoeur in reducing cardiovascular risk and improving health behaviors in people without evidence of cardiovascular disease and to compare the Educoeur program to interventions in a specialized clinic and in usual care family practice. In a parallel, randomized, controlled trial of 185 adults with at least two modifiable cardiovascular risk factors, patients were randomly assigned to either Educoeur, specialized clinic or usual care. Cardiovascular risk, biological and lifestyle measures were assessed at baseline and at 2 years. In Educoeur, measurements were also taken before and after the lifestyle group treatment program. In 12 weeks, patients in Educoeur significantly lowered their cardiovascular risk, weight, body mass index, waist circumference, systolic blood pressure, kilocalories intake and improved their V[O.sub.2] Max and mental health. Changes remained significant at 2 years. Between group comparisons at 2 years demonstrated that Educoeur was significantly better in reducing cardiovascular risk than interventions in usual care. Together, these results highlight the importance of providing interdisciplinary programs that optimize cardiovascular risk reduction and promote active lifestyles in patients at risk of cardiovascular disease. Keywords Cardiovascular risk factors * Primary prevention * Cardiovascular disease * Hypertension * Interdisciplinary lifestyle intervention * Health behavior * Nutritional intervention * Exercise, Introduction An estimated 16.7 million of total global deaths result from various forms of cardiovascular disease (World Health Organization, 2003), and several very well-identified lifestyle factors influence the development of [...]

ARTICLE INFO Keywords: Saiko-ka-ryukotsu-borei-To Endothelial progenitor cell Oxidative stress IL-6 Spontaneously hypertensive rat ABSTRACT Endothelial progenitor cells (EPCs) are known to repair vascular injuries. Recent studies suggest that Saiko-ka-ryukotsu-borei-To (SKRBT), [...]

Resveratrol (RS), a polyphenol compound found in grapes and grape products, including wine, peanuts and berries, exists in cis- and trans-isomeric forms. RS is believed to decrease circulating low-density lipoprotein cholesterol levels and reduce cardiovascular disease (CVD) risk. However, it is possible that RS has other mechanisms to reduce the risk of CVD without altering lipid levels. The objective of this review is to critically examine results from recent research concerning potential effects of RS on CVD. RS exerts several health benefits including anti-atherogenic, anti-inflammatory and anti-cancer effects. RS may also prevent lipid oxidation, platelet aggregation, arterial vasodilation and modulates the levels of lipids and lipoproteins. As a potent, anti-oxidant RS reduces oxidative stress and regenerates a-tocopherol, which further strengthens the anti-oxidant defense mechanism. RS has been considered safe as no significant toxic effects have been identified, even when consumed at higher concentrations. This evidence identified RS as an effective anti-atherogenic agent, which could be used in the prevention and treatment of CVD. European Journal of Clinical Nutrition (2010) 64, 660-668; doi: 10.1038/ejcn.2010.77; published online 19 May 2010 Keywords: resveratrol; atherosclerosis; lipids; anti-inflammatory; anti-oxidant, Introduction Resveratrol (RS) naturally occurs as a polyphenol found in grapes and grape products, including wine, as well as other sources including nuts (Cavallaro et al., 2003). RS is also [...]

Author(s): Stella Stabouli [sup.[[dagger]]] [sup.1] , Vasilios Kotsis [sup.2] Childhood obesity has become an important health issue worldwide [sup.[1]] . It is associated with several risk factors for later cardiovascular [...]

Blood pressure assessment in children has acquired special relevance to prevent cardiovascular diseases later in life, therefore, there is a need to implement appropriate measurement techniques and suitable and accurate support instruments. Traditionally, blood pressure has been measured with mercury sphygmomanometers using the auscultatory technique and, at present, it is even considered to be the gold standard. Nevertheless, this device has a number of measurement pitfalls that, combined with its potential ecological risk owing to accidental mercury pollution, has stimulated the development and design of automated devices, which mainly use the oscillometric method for blood pressure measurement. Automated devices are mercury free and they have abolished some measurement procedures errors, mainly those related to the observer. However, these instruments are not better than mercury sphygmomanometers when accuracy parameters regarding blood pressure measurement are taken into consideration; on the other hand, at present, there are scarce validated automated devices for children. It is expected that mercury sphygmomanometers will be superseded in the near future, but only if automated devices are validated by international protocols and, of course, also considering the fact that they will be affordable., Author(s): Samuel Flores Huerta [sup.[[dagger]]] [sup.1] , Miguel Klünder Klünder [sup.2] , Patricia Medina Bravo [sup.3] Keywords: Keywords accuracy; auscultation; automated devices; blood pressure; children; mercury sphygmomanometer; oscillometric; validation The [...]

CORRELATIONS BETWEEN CALCIUM, MAGNESIUM AND HARDNESS OF WATER IN THE DRINKING WATERS OF DECATUR COUNTY GEORGIA AND THE INCIDENCE OF CARDIOVASCULAR AND CEREBROVASCULAR DISEASES, Abe A. Ojo (1) and Manju [...]

Inflammation early in the rheumatoid arthritis (RA) disease course is associated with 2 measures of arterial stiffness, increased pulse-wave velocity (PWV) and augmentation index (AIx), after 15 years. Early, active [...]

Background: Insurance coverage of tobacco cessation medications increases their use and reduces smoking prevalence in a population. However, uncertainty about the impact of this coverage on health care utilization and costs is a barrier to the broader adoption of this policy, especially by publicly funded state Medicaid insurance programs. Whether a publicly funded tobacco cessation benefit leads to decreased medical claims for tobacco-related diseases has not been studied. We examined the experience of Massachusetts, whose Medicaid program adopted comprehensive coverage of tobacco cessation medications in July 2006. Over 75,000 Medicaid subscribers used the benefit in the first 2.5 years. On the basis of earlier secondary survey work, it was estimated that smoking prevalence declined among subscribers by 10% during this period. Methods and Findings: Using claims data, we compared the probability of hospitalization prior to use of the tobacco cessation pharmacotherapy benefit with the probability of hospitalization after benefit use among Massachusetts Medicaid beneficiaries, adjusting for demographics, comorbidities, seasonality, influenza cases, and the implementation of the statewide smoke-free air law using generalized estimating equations. Statistically significant annualized declines of 46% (95% confidence interval 2%-70%) and 49% (95% confidence interval 6%-72%) were observed in hospital admissions for acute myocardial infarction and other acute coronary heart disease diagnoses, respectively. There were no significant decreases in hospitalizations rates for respiratory diagnoses or seven other diagnostic groups evaluated. Conclusions: Among Massachusetts Medicaid subscribers, use of a comprehensive tobacco cessation pharmacotherapy benefit was associated with a significant decrease in claims for hospitalizations for acute myocardial infarction and acute coronary heart disease, but no significant change in hospital claims for other diagnoses. For low-income smokers, removing the barriers to the use of smoking cessation pharmacotherapy has the potential to decrease short-term utilization of hospital services. Please see later in the article for the Editors' Summary., Introduction Cigarette smoking is the leading preventable cause of death in the United States. It also contributes to health disparities, as tobacco use is highest in individuals with less education [...]

Cancer has long been known to be associated with obesity, and one of the most surprising and welcome benefits of successful bariatric surgery has been the near halving of cancer [...]

High levels of high-density lipoprotein (HDL) in the blood are associated with protection from cardiovascular disease. How HDL also exerts anti-inflammatory properties is now shown in mouse models of acute [...]

There is a common perception among physicians and the general public that obesity is behavioral7 and that weight reduction can be achieved by deciding to eat less and exercise more. [...]

If you have to listen to your partner snore throughout the night, you are perfectly aware of how annoying this condition can be. What you may not realize, however, is [...]

'Impact of Electron Beam Tomography With or Without Case Management, on Motivation, Behavioral Change, and Cardiovascular Risk Profile' (JAMA. 2002;289:2215-2223), by Patrick G. O'Malley, MD, MPH, Irwin M. Feverstein, MD, [...]