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Objective: To investigate the comorbidity status of hypertension, diabetes, and dyslipidemia (the"three diseases") among residents aged≥40 in Liaoning Province, and to explore the correlation between the comorbidity and cardiovascular disease mortality. Methods: This investigation was a prospective cohort study. From February 2017 to March 2019, a multi-stage stratified cluster random sampling method was used to carry out a baseline survey of 18 758 permanent residents aged≥40 years in Liaoning Province. Demographic information and history of hypertension, diabetes, and dyslipidemia were collected and followed up every year. Death was mainly identified by linkage to the Population Death Information Registration Management System. Cox proportional hazard regression model was used to analyze the association between the comorbidity of the "three diseases" and cardiovascular disease mortality risk. Results: A total of 18 758 residents aged≥40 in Liaoning Province were included, with an age of (60.3±9.9) years and 7 325 males (39.1%). The comorbidity rate of hypertension, diabetes, and dyslipidemia was 6.7% (1 256/18 758), and the standardized prevalence rate was 5.4%. The comorbidity rate increased with age (P<0.001), which was higher in women than in men, and more significant in urban areas than in rural areas (all P <0.001). The comorbidity of "three diseases" accounted for 39.3% (1 256/3 198), 18.7% (1 256/6 710), and 11.8% (1 256/10 653) in patients with diabetes, dyslipidemia, and hypertension, respectively. With a follow-up of (4.3±0.6) years, 463 people died of cardiovascular disease. The mortality rate of cardiovascular disease in the comorbidity of hypertension, diabetes, and dyslipidemia was 8.74/1 000 person-years. After adjusting potential confounders, Cox proportional hazard regression model analysis showed that compared with normal individuals, the hazard ratio of cardiovascular disease mortality in patients with the "three diseases" was 2.55 (95% CI : 1.63-3.99). Conclusion: The prevalence of comorbidity of hypertension, diabetes, and dyslipidemia among residents aged≥40 in Liaoning Province was relatively high, and the risk of cardiovascular disease mortality in patients with the "three diseases" was increased.

Background: Undiagnosed hypertension (HTN) and diabetes mellitus (DM) are major public health challenges worldwide. We aimed to investigate the prevalence of undiagnosed HTN and DM, and their correlates, in a large-scale population-based cohort study., Methods: In this cross-sectional study, data collected during the enrollment phase of the Tabari Cohort study (TCS) were utilized. Data were collected in the TCS using a standard questionnaire, blood collection, and measurement of anthropometric indices and blood pressure. Data were analyzed using the chi-squared test and univariate and multivariate logistic regression analyses. Undiagnosed HTN included those who were not aware of HTN at the time of enrollment but had systolic and diastolic blood pressures ≥ 140 mm or ≥ 90 mmHg, respectively. Undiagnosed DM included participants who were unaware of their DM at the time of enrollment and had FBS levels ≥ 126 mg/dL., Results: The total prevalence of undiagnosed HTN and DM were 5% (508) and 4.7% (485), respectively. The findings of multivariable logistic regression analysis showed that young age (OR: 0.40, P < 0.001), residents of urban regions (OR: 0.70, P = 0.03), lower Body Mass Index kg/m2 (BMI) (OR: 0.51, P = 0.002), waist-to-hip ratio (WHR)(OR: 0.70, P = 0.023), total cholesterol (TC) ≥ 200 mg/dL (OR: 0.1.83, P < 0.001), lack of history of DM (OR: 0.38,P < 0.001), cardiovascular diseases (CVD)(OR: 0.12, P < 0.001), and lack of a positive family history of HTN in first-(OR: 0.39, P < 0.001) and second-degree(OR: 0.56, P = 0.009) relatives were the main predictors of undiagnosed HTN. Accordingly, male sex(OR: 0.52, P = 0.004), young age(OR: 0.28, P < 0.001), residence in urban regions(OR: 0.30, P < 0.001), BMI ≥ 30 (OR: 1.51, P = 0.044), low-density lipoprotein (LDL) ≥ 130 mg/dL (OR:1.93, P < 0.001), TC ≥ 200 mg/dL (95% CI, 1.47-2.51, P < 0.001), positive history of chronic kidney disease (OR:1.39, P = 0.010 ), and lack of family history of first-(OR: 0.38, P < 0.001) and second-degree (OR: 0.62, P < 0.015) DM were the main predictors of undiagnosed DM., Conclusion: Overall, younger participants, those residing in urban areas, those with TC ≥ 200 mg/dL, and those without a positive family history of HTN or DM were at a greater risk of undiagnosed HTN/DM., Competing Interests: Declarations Ethics approval and consent to participate This article is the result of two studies entitled the prevalence of undiagnosed HTN in the Tabari cohort population and the prevalence of undiagnosed DM in the Tabari cohort population, both of which were approved by the Research Ethics Committees of Mazandran University of Medical Sciences (Approval ID: IR.MAZUMS.REC.1402.603 and IR.MAZUMS.REC.1402.604, respectively ). Informed consent was obtained from all participants of TCS. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: In 2016, Uganda introduced services for hypertension and diabetes in selected HIV clinics. We evaluated the costs associated with scaling up these services in HIV clinics in Mbarara and Ibanda districts, Uganda., Methods: We estimated the annual costs of providing hypertension and diabetes services using an activity-based costing approach from the health system perspective in ten randomly selected HIV clinics in Mbarara and Ibanda districts. Cost inputs included 2023 data on costs of medications, health provider time, salaries, training costs, and monitoring costs. We determined the average annual cost and medication costs for hypertension and diabetes treatment per enrolled adult patient, stratified by type of health facility., Results: The total annual cost of hypertension and diabetes management services in ten selected HIV clinics was estimated to be $413,850 (range: $8,386 - 186,973). The annual average clinic-level cost per enrolled patient was estimated at $14 (range: $7 - 31). Of the total annual cost, the cost of provider time for initial and follow-up visits represented the largest cost component in 5/10 clinics (mean: 37%, range [13-58%]). In 4/10 clinics, the major cost components were the costs of medication, diagnostic tests, and related supplies (mean: 37%, range [10-75%]). The average cost per enrolled adult patient was $11 at public facilities and $21 in private not-for-profit facilities. The average medication cost per patient for hypertension was $24 (range: $7 - 97) annually; $13 at public facilities and $50 at private not-for-profit facilities. For diabetes treatment, the average annual medication cost per patient was estimated at $14 (range: $6 - 35); $11 at public facilities and $22 at private not-for-profit facilities., Conclusion: Adding hypertension and diabetes management to routine HIV care might be feasible based on the estimated annual cost per patient. Hypertension and diabetes treatment was more costly in private not-for-profit facility-based clinics than at public facilities. This variation was primarily driven by higher medication procurement prices at private facilities, revealing a potential area for optimizing costs through improved procurement practices., Competing Interests: Declarations Ethics approval and consent to participate The Uganda National Institute of Public Health (UNIPH) operates under the Ministry of Health (MoH); in essence, the UNIPH is a subordinate authority to MoH. The MoH authorized the cost analysis to inform HIV programming, and UNIPH approved the study and its protocols. We extracted health facility cost data and other parameters that did not require individual participant consent. This analysis was classified as non-research, and as per our memorandum of understanding, it was exempt from full Institutional Review Board review, primarily aimed at public health practice. We obtained administrative clearance from the District Health Officers of Mbarara and Ibanda districts, as well as from the in-charges of selected HIV clinics. All methods were conducted in accordance with the approval and administrative clearance without any ethical breach. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy. §§See e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. § 241(d); 5 U.S.C. § 552a; 44 U.S.C. § 3501 et seq. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Aim: The prevalence of hypertension (HTN) and diabetes mellitus (DM) is increasing worldwide, and their coexistence is well-documented. Managing both conditions is challenging due to shared pathophysiological mechanisms and the need to balance blood pressure (BP) control with glycemic management. The objective of this protocol was to consider the prescribing pattern and effectiveness of antihypertensive agents in hypertensive and diabetic patients, with and without compelling indications, at tertiary care hospital. Materials and methods: A prospective, observational study was conducted over 6 months in total 226 diabetic hypertensive patients from a tertiary care hospital. Demographic and medication history data were collected using a self-designed patient profile form. Descriptive statistics were used to analyze the data, and the results were expressed as percentages or means with standard deviations. Results: A total of 226 patients were included in the study, with 62% males and 38% females. 73% of patients were classified as stage 1 and 27% as stage 2 HTN. Among the prescribed antihypertensive agents, β-blockers (BBs) were the most prescribed, followed by angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), diuretics, and other classes. Combination therapy was predominantly used, with dual-drug therapy being the most common. Compelling indications for antihypertensive treatment included ischemic heart disease (IHD) (38.49%), chronic kidney disease (CKD) (12.38%), and stroke (6.63%). The choice of antihypertensive agents varied based on the presence of compelling indications, with BBs and ARBs being frequently prescribed. BP control was achieved in 93% of the patients, with 85.96% of patients with HTN + DM, and 82.84% of patients with additional compelling indications having controlled BP. Conclusion: Therefore, it can be concluded that the antihypertensive medications prescribed to the study adhered to guidelines and that long-term use of these combinations proved to be more effective, safe, and well-tolerated for patients with HTN and DM with or without convincing indications. Adopting the best approach to managing HTN in people with diabetes is crucial for ameliorating patient outcomes and enhancing overall quality of life., (© Journal of the Association of Physicians of India 2024.)

The relationship between socioeconomic status (SES) and health outcomes has garnered significant attention. However, there is a limited amount of research exploring the association between SES and the risk of metabolic syndrome in Malaysian adults. This study aimed to determine the association between SES and risk of hypertension, diabetes and obesity. By using data from the National Health and Morbidity Survey (NHMS), SES was derived through principal component analysis involving six variables. Two different SES components were identified and labeled as "social status" and "wealth status." Among the participants, 36% were diagnosed with hypertension, 18% with obesity, and 21% with diabetes. Adults with high wealth and social status showed a significantly increased risk of obesity. Meanwhile, high social status was significantly associated with a reduction in the risk of hypertension and diabetes. A comprehensive understanding of the associations between SES and noncommunicable diseases could facilitate initiatives that promote healthy lifestyle behaviors, thereby enhancing the holistic well-being of Malaysians., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Existing literature has emphasized the utility of the five-item modified frailty index (mFI-5) in predicting postoperative outcomes after surgical procedures. However, in breast reconstruction, a primarily elective post-oncologic procedure for otherwise relatively healthy patients, several components of the index may be sparse and not strongly contribute to predictive value., Methods: Breast reconstruction cases were identified in the 2012-2022 National Surgical Quality Improvement Program. Three metrics were compared in this cohort: 1) the mFI-5, 2) a simplified two-item index comprising diabetes and/or hypertension, and 3) American Society of Anesthesiologists (ASA) class. Each metric was incorporated into three multivariate logistic regression models for occurrence of at least one postoperative complication. Predictive performance among metrics was compared over fifty iterations (p < 0.05). Performance was compared between autologous and implant-based modalities in a supplementary analysis., Results: 134,983 breast reconstruction cases were identified in the final cohort. In multivariate regression, both MFI and the two-item index of diabetes and hypertension were significant predictors of postoperative complications (p < 0.001). The mFI-5 (average AUC: 0.6106) and two-item index (average AUC: 0.6105) performed without significant difference (p = 0.93). Discriminatory performance of ASA class (average AUC: 0.6115), was not significantly different from the other metrics (p > 0.05)., Conclusions: In the context of a population of mainly elective breast reconstruction procedures, the five-item modified frailty index does not outperform an index of diabetes and hypertension alone. Such findings may motivate the selection of other variables that may be more useful for prediction of postoperative outcomes., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Impaired glomerular filtration rate is common health problem in diabetic mellitus patients (DM) with hypertension (HTN). It is a major cause of morbidity, mortality, and poor quality of life. There is limited data on the prevalence and associated factors of impaired glomerular filtration among diabetic mellitus patients with hypertension in Ethiopia. Therefore, this study aimed to determine the prevalence of impaired glomerular filtration rate and associated factors among diabetic patients with hypertension in referral hospitals in Amhara Regional State, Ethiopia, 2020. An institution-based cross-sectional study was conducted in Amhara Regional referral hospitals from February 20 to April 30, 2020. Systemic sampling techniques were used to select diabetic mellitus patients with hypertension. Epi data version 3.0 was used to enter the coded data and then exported to STATA 14 for analysis. Glomerular filtration rate was estimated using the equations of collaboration with chronic kidney disease (CKD-EPI), diet modification in renal disease (MDRD-4), and creatinine clearance (CrCl). In bi-variable logistic regression, variables with a p-value of < 0.25 were included in multi-variable logistic regression. Using a 95% confidence interval, variables having a p-value ≤ 0.05 in multi-variable logistic regression were declared as statistically significant variables. In this study, a total of 326 study participants were involved, with a 100% response rate. The prevalence of an impaired glomerular filtration rate among diabetic patients with hypertension was 30.1% (95% CI 25.1%-35.1%), 36.6% (95% CI 30.1%-40.8%) and 45.4% (95% CI 39.9%-50.8%), using the equations CKD-EPI, MDRD-4, and CrCl, respectively. Being ≥ 55 years old (CKD-EPI AOR = 2.9, 95%: 1.5-5.5, MDRD-4 AOR = 2.1, 95% CI: 1.2-3.7, CrCl AOR = 5.9, 95% CI: 3.5-10.1), proteinuria (CKD-EPI AOR = 2.7, 95% CI: 1.4-5.3, MDRD-4 AOR = 1.9, 95% CI: 1.1-3.4, CrCl AOR = 1.7, 95% CI: 1.0-2.9), duration of the disease (≥ 5 years) (CKD-EPI AOR = 7.9, 95% CI: 4.2-13.0, MDRD-4 AOR = 7.4, 95% CI: 4.2-13.0, CrCl AOR = 1.9, 95% CI: 1.2-3.3), a glucose level of ≥ 150 mg/dl (CKD-EPI AOR = 2.3, 95% CI: 1.3-4.4, MDRD-4 AOR = 2.1, 95% CI: 1.2-3.8) were variables significantly associated with impaired glomerular filtration rate. The prevalence of impaired glomerular filtration rate among diabetic mellitus patients with hypertension was high. Independent predictors of impaired glomerular filtration rate were older age, duration of the disease, proteinuria, and higher blood glucose levels., (© 2024. The Author(s).)

Purpose: Diminished bone levels or the lack of osseointegration can lead to higher rates of failure of dental implants. The present study is aimed to evaluate the correlation between hypertension, diabetes mellitus and hyperlipidemia, on the marginal bone loss (MBL) surrounding dental implants among patients attending the University of Nevada, Las Vegas dental clinics., Methods: Clinical notes from patients at the University of Nevada, Las Vegas (UNLV) dental clinics were analyzed using AxiUm™ software. The study included patients with dental implants diagnosed with hypertension, diabetes mellitus, and hyperlipidemia who attended the UNLV School of Dental Medicine clinics from 2012 to 2022. Exclusions were made for patients with acquired immune deficiency syndrome and those with a limited number of radiographs. A search was conducted using keywords such as 'systemic disease,' 'marginal bone loss,' 'dental implant,' 'high cholesterol,' 'hypertension,' and 'diabetes' within the system., Results: Out of 1,310 potentially eligible patients, 57 fulfilled the inclusion criteria. The total number of evaluated implants was 165. 18% of the sample patients were 55 to 64 years of age, and 79% were 65 or above. 45.6% of patients reported having more than four systemic diseases and 67% of patients had four or more prescription medications. Patients diagnosed with hypertension (78.95%) or hyperlipidemia (73.68%) had the highest presence of marginal bone loss surrounding the dental implant(s) while those with diabetes (40.35%) had the least amount of MBL. Patients diagnosed with both hypertension and hyperlipidemia (29.82%) experienced the highest incidence of MBL around implants. The medications prescribed to combat these health issues, such as statins and antihypertensive, also showed the same trends and corresponded with a higher prevalence of MBL., Conclusions: Within the limitations of the present investigation, patients diagnosed with hyperlipidemia and hypertension were more likely to exhibit MBL surrounding dental implants., (© 2024. The Author(s).)

Background: Hypertension (HTN) and diabetes mellitus (DM) are two common comorbidities of heart failure with reduced ejection fraction (HFrEF), each of which can cause right ventricular (RV) dysfunction. The aim of this study was to investigate the impact of DM on RV dysfunction and ventricular interdependence in hypertensive HFrEF patients via cardiac magnetic resonance imaging (MRI) feature tracking., Methods: This study included 249 patients with HFrEF: 77 HFrEF controls, 97 with hypertensive HFrEF (HTN-HFrEF [DM-]) and 75 with hypertensive HFrEF and comorbid DM (HTN-HFrEF [DM+]). The cardiac MRI-derived biventricular global radial (GRS), circumferential (GCS) and longitudinal (GLS) peak strains were obtained and compared among the groups. Multivariable linear regression and mediation analyses were used to evaluate the effects of DM and left ventricular (LV) strain on RV strain., Results: The biventricular GLS and GLS of segments 8, 9 and 14 of the interventricular septum (IVS) decreased gradually from the HFrEF control group to the HTN-HFrEF (DM-) group to the HTN-HFrEF (DM+) group (all P < 0.05). Patients with DM had even lower biventricular GCS and IVS strains in all directions in specific segments than did those without DM and the HFrEF controls (all P < 0.05). DM was independently associated with impaired RVGLS and RVGCS (both P < 0.05) in hypertensive HFrEF patients. The difference in RVGLS between the hypertensive HFrEF subgroups was partly mediated by LVGLS [β = 0.80, 95% CI (0.39-1.31)], and that of RVGCS was partly mediated by LVGCS [β = 0.28, 95% CI (0.01-0.62)]., Conclusions: In hypertensive HFrEF patients, comorbid DM may have aggravated RV dysfunction and was an independent determinant of impaired RV strain. RV dysfunction might be directly affected by DM and partially mediated by LV strain through unfavorable ventricular independence., (© 2024. The Author(s).)

Insulin resistance is a key factor in diabetes development. This study aimed to investigate the association between baseline triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, and the onset of hyperglycemia in Chinese individuals with hypertension. Using the Rich Healthcare Group database, this retrospective cohort study included 28,687 hypertensive individuals without preexisting diabetes. A wide range of demographic information and baseline biochemical indicators was collected and rigorously analyzed. This study utilized the Cox proportional hazards model and smooth curve fitting to explore the link between TyG index and the risk of developing hyperglycemia. The robustness of the findings was validated by sensitivity and subgroup analyses. During longitudinal monitoring of hypertensive patients in our retrospective cohort study, we observed that 5.31% (1524/28,687) progressed to diabetes, while 21.66% (4620/21,326) developed prediabetes. After adjusting for confounding variables, a statistically significant positive association was observed between the TyG index and the risk of hyperglycemia. Subgroup and sensitivity analyses further supported these findings, demonstrating consistent outcomes and reinforcing the robustness of our conclusions. The TyG index, which is significantly linked to hyperglycemia in hypertensives, can aid early risk identification and intervention., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: The intersection of infectious diseases, such as HIV, with chronic conditions like hypertension and diabetes poses a significant challenge in global health. While advancements in antiretroviral therapy have transformed HIV into a manageable chronic condition, a growing number of individuals with HIV now grapple with coexisting non-communicable diseases, impacting their Health-Related Quality of Life (HRQoL). Despite strides in HIV care, there is a notable policy gap that undermines efforts to address HIV-associated co-morbidities, particularly hypertension and diabetes, especially efforts to improve access, early detection, and ultimately HRQoL for individuals with HIV and co-morbidities. This study seeks to explore policy interventions aimed at improving the quality of life of HIV patients with hypertension or diabetes., Methods: The study utilized a qualitative descriptive design to explore the experiences and perspectives of healthcare professionals and support staff regarding policy interventions for managing HIV patients with hypertension and/or diabetes co-morbidities in three regions of Ghana. The research was conducted in the Upper West, Ashanti, and Greater Accra regions among 11 participants, chosen purposively from professions involved in HIV patient care to understand their views on the implementation of policy interventions to HRQoL for individuals with HIV and co-morbidities. In-depth interviews were conducted face-to-face and tape-recorded. Thematic analysis approach was used to analyze the data., Results: The study involved 11 participants from three regions with varied years of experience. Implemented policies that potentially improve the HRQoL for individuals with HIV and co-morbidities involve support groups, home visits, provision of free drugs, and counselling. Barriers to policy implementation included non-adherence to medication, stigma, cost of non-communicable diseases (NCDs) medications, accessibility issues to NCDs services, lack of interest or understanding among implementers, and high staff turnover. Facilitators encompassed in-service training, guidelines in common platforms, knowledge sharing, external resources, regular check-ups, and motivational packages for patients., Conclusion: Individuals with HIV and comorbidities face complex challenges impacting their HRQoL, including emotional and financial dimensions. The study identifies critical policies and barriers, underscoring the need for tailored, patient-centered approaches. Facilitators like in-service training and regular check-ups offer actionable insights for effective policy implementation, emphasizing improved health outcomes for those with comorbid conditions. The study recommends integrated care approach and adherence support programs that address the unique challenges faced by people living with HIV., Competing Interests: The auhtors have declared that no competing interess exist., (Copyright: © 2024 Owusu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Multiple sclerosis (MS) is a chronic, immune mediated demyelinating illness of the central nervous system. This study looks at various comorbidities associated with MS, focusing on their impact on disease progression. Understanding comorbidities in MS is important as it can impact treatment selection and overall disease management and prognosis., Aims and Objectives: Our aim is to show the prevalence of comorbidities along with MS. This research focuses on the comorbidities associated with MS and their impact on disease progression in the Arab Gulf region, with a special emphasis on Jeddah, Saudi Arabia., Material and Methods: A retrospective record review was conducted from July 2022 to July 2023. The study included 286 patients, selected based on a definitive MS diagnosis in accordance with McDonald's 2017 criteria. Data collected included demographic information, MS type, duration of diagnosis, type of disease modifying therapy (DMT) used, Expanded Disability Status Scale (EDSS) score, and type of comorbidities., Results: The majority of the patients were female (70%) with an average age of 36 years. Most patients had relapsing remitting MS, and the majority were on DMTs, with fingolimod being the most common. Nearly half of the patients had comorbidities, with mood disorders, diabetes mellitus (DM), migraine, and hypertension (HTN) being prevalent. A significant positive association was found between the EDSS scores and both DM and HTN, but there was no significant link with migraine., Conclusion: The findings indicate that individuals with MS have an increased risk of developing comorbidities such as migraine, DM, and HTN. Emphasizing a healthy lifestyle could potentially reduce the incidence of DM and HTN and their related vascular complications. The research also notes the prevalence of mood disorders among the MS population, although it remains inconclusive whether these are separate comorbid conditions or inherent symptoms of MS., (Copyright © 2024 Copyright: © 2024 Annals of African Medicine.)

Aim: The prevalence of diabetes and hypertension according to body mass index (BMI) status in Brazilian adults has not been described yet. Herein, we aimed to identify the time trends in hypertension and diabetes, individually and combined (multimorbidity), by BMI in Brazilian adults., Methods: In this time series cross-sectional study, we retrieved self-reported data from 806 169 adults between 2006 and 2023, using the Surveillance System of Risk and Protective Factors from Chronic Diseases by Telephone Survey (Vigitel). Weight and height were used to classify participants into normal/underweight (<25 kg/m 2 ), pre-obesity (25 to 29.9 kg/m 2 ), and obesity (≥ 30 kg/m 2 ). We calculated the prevalence of medical diagnoses of hypertension and diabetes, individually and combined, by BMI categories, and by sociodemographic characteristics (sex, age group, educational attainment) for participants with obesity. We performed Prais-Winsten linear regression models to identify temporal trends., Results: The prevalence of hypertension and diabetes increased between 2006 and 2023. Among adults with obesity, we observed a slight decrease in the prevalence of hypertension (from 44.5% in 2006 to 41.7% in 2023) and the prevalence of either hypertension or diabetes (47.1% to 45.5%); an increase in the prevalence of diabetes (12.8% to 15.13) and both conditions combined (10.2% to 11.2%). Participants with obesity had more than twice the prevalence of hypertension and diabetes compared with those who were normal/underweight. We observed a differential time trend by sex, age group, and educational attainment., Conclusion: Our findings indicate the need for differentiated approaches for interventions for hypertension and diabetes, considering variations over time by sociodemographic characteristics., (© 2024 John Wiley & Sons Ltd.)

Objectives: To investigate how the co-occurrence of diabetes, hypertension and overweight/obesity is associated with pain following an exercise intervention for knee and hip osteoarthritis (OA)., Methods: Register-based cohort study. We included people from the Swedish Osteoarthritis Register who underwent education and exercise for knee or hip OA. Diabetes and hypertension were defined using medical records and dispensation of medication. Body Mass Index (BMI) was used to identify people with overweight (≥25 to <30), and obesity (≥30). We used linear mixed-effect models with patients nested into clinics to estimate the associations between the exposures and pain (Numeric Rating Scale 0-10), adjusting for age, sex, education, and physical activity., Results: We analysed 80,893 patients with knee or hip OA. The accumulation of metabolic conditions was associated with worse pain at baseline and follow-ups. When obesity, hypertension and diabetes coexisted, patients treated for knee OA reported more pain at baseline (adjusted mean pain difference 0.9 [95 %CI: 0.8; 1.0]), 3 months (1.0 [0.9; 1.1]) and 12 months (1.3 [1.1; 1.4]) compared to those without any of the conditions. Similar results were observed for patients treated for hip OA when obesity, hypertension and diabetes coexisted (baseline (0.7 [0.5; 0.8], 3 (0.8[0.6; 1.0]) and 12 months (1.1[0.8; 1.3])., Conclusions: When diabetes, hypertension and obesity coexist with OA, patients not only experience heightened baseline pain compared to metabolically healthy individuals, but the disparity increases after an education and exercise intervention suggesting that a one-size-fits-all approach may be inadequate in addressing the complex interplay between metabolic health and OA., Competing Interests: Declaration of Competing Interest AD, JV, AT, and ME have no conflict of interest to declare. AA is a member of the Swedish Osteoarthritis Register steering group. TJ is the director of the Swedish Osteoarthritis Register and a board member of the Swedish Arthroplasty Register. KA and LS are scientific consultants for Arthro Therapeutics. OR is the director of the Swedish Arthroplasty register., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Research into the pivotal role of potassium in chronic diseases and their comorbidities remains scarce. Our aim is to elucidate the relationship between potassium and chronic diseases, including comorbid conditions, and to provide evidence-based recommendations for potassium intake in patients., Methods: This study is anchored in a representative, population-based survey conducted in Zhejiang Province, China, in 2017, encompassing participants aged 18 to 69 years. Data collection included questionnaire responses, physical measurements, and biological samples, obtained through a multistage cluster random sampling method. A subset of 1496 participants provided complete 24 h urine samples., Results: The median age of the participants was 48.0 years (interquartile range [IQR] 24.0), with 51.1% being female, and hypertension was identified in more than one third (35.6%) of the participants. The prevalence of diabetes was approximately 9.0%, dyslipidemia was found in 34.2%, and microalbuminuria in 8.8%. The 24 h urinary excretion levels were 3613.3 mg/24 h (IQR 2161.7) for sodium and 1366.0 mg/24 h (IQR 824.9) for potassium, respectively. Potassium excretion exhibited an inverse relationship with blood pressure. Furthermore, a positive correlation was observed between potassium excretion and high-density lipoprotein cholesterol (HDL-C) levels, with an elevation of 0.03 mmol/L (95% confidence interval [CI] 0.00 to 0.05). In binary logistic regression analysis, individuals in the fourth quartile of potassium excretion (Q4) exhibited an odds ratio (OR) of 0.56 (95% CI 0.36-0.87) for hypertension compared to those in the first quartile (Q1). Urinary potassium excretion was inversely associated with low HDL-C levels, with Q4 individuals having 0.62 times the odds of having low HDL-C levels (OR, 0.62; 95% CI 0.39-1.00) compared to Q1., Conclusions: Potassium excretion demonstrated a direct negative correlation with certain comorbidities. This study underscores the pivotal role of potassium in the management of chronic diseases and associated comorbidities, thereby highlighting the significance of potassium in both public health initiatives and clinical practice.

Objectives: Gout is associated with several comorbidities. This study aimed to evaluate the prevalence of comorbidities in the Korean adult population with gout and investigated the association of gout with these comorbidities., Methods: Data from 15,935 (weighted n = 39,049,167) participants aged 19 years and older in the Korean National Health and Nutrition Examination Survey from 2019 to 2021 were used for analysis. Weighted prevalence and odds ratios (OR) of comorbidities in individuals with gout were compared to a non-gout population., Results: The weighted prevalence of gout was 2.1% (weighted n = 808,778). Among individuals with gout, 66.5% had metabolic syndrome, 54.9% had hypertension, 41.2% had hypercholesterolemia, 19.1% had diabetes, 13.5% had chronic kidney disease (CKD), 4.1% had myocardial infarction or angina, 3.8% had stroke, and 2.8% had rheumatoid arthritis (RA). After adjusting for socioeconomic and lifestyle characteristics, gout was independently associated with the increased prevalence of metabolic syndrome (male OR = 2.0, 95% confidence interval (CI): 1.5-2.8; female OR = 3.7, 95% CI: 1.5-9.2), hypercholesterolemia (male OR = 1.9, 95% CI: 1.4-2.5; female OR = 3.1, 95% CI: 1.3-7.5), CKD (male OR = 4.5, 95% CI: 2.7-7.3; female OR = 11.5, 95% CI: 4.1-32.1), and RA (male OR = 2.8, 95% CI: 1.1-7.1; female OR = 3.1, 95% CI: 1.1-8.7) compared to the non-gout population., Conclusions: Gout was associated with several comorbidities, including RA, in both males and females. These results suggest that the prevention and treatment of comorbidities at the individual level, carried out by clinicians, and knowledge of these comorbidities would help guide health policies for the Korean population., (© 2024. The Author(s).)

Importance: Racial and ethnic disparities in chronic disease are a major public health priority., Objective: To determine if the amount of federal grant funding to federally-qualified health centers (FQHCs) was associated with baseline overall prevalence of uncontrolled hypertension and uncontrolled diabetes, as well as prevalence by racial and ethnic subgroup., Design: Cross-sectional multivariate regression analysis of Uniform Data System 2014-2019, which includes clinic-level data from each FQHC regarding demographics, chronic disease control by race and ethnicity, and grant funding., Exposures: Our main exposure were the average values of the prevalence of uncontrolled hypertension and uncontrolled diabetes among the overall population and by racial and ethnic group from 2014-2016., Main Outcomes: Average federal grant funding per patient from 2017-2019, as measured by annual health center funding from the Bureau of Primary Health Care (BPHC) and overall federal grant funding., Results: We analyzed 1,205 FQHCs from 2014-2019; the average BPHC grant per patient across all FQHCs in 2019 was $168 while the average total federal grant was $184 per patient. Increasing shares of total patients with uncontrolled hypertension or uncontrolled diabetes were not associated with increased total federal grant funding in either unadjusted or adjusted analysis. Increased shares of patients who are American Indian or Alaskan Native (AI-AN) with uncontrolled hypertension and diabetes were associated with increasing total federal grant funding in both unadjusted and adjusted analysis (adjusted beta hypertension $168.3, p <0.001; adjusted beta diabetes 59.44, p = 0.02). However, cardiovascular clinical need among other racial and ethnic groups was not significantly associated with grant funding., Conclusions: FQHCs with higher overall rates of uncontrolled hypertension or diabetes do not receive more federal funds, and there is no significant association between federal funding levels and rates of uncontrolled blood pressure or diabetes within most racial and ethnic groups, with the exception of AI-AN populations. To narrow inequities in cardiovascular disease, HRSA should consider more explicitly targeting federal grants to clinics with higher levels of clinical need., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kishore et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To investigate the current comorbidity status among hypertension, diabetes, and dyslipidemia in residents aged 35-75 years in Tianjin and to explore the main influencing factors to provide a scientific basis for the prevention and treatment of chronic disease comorbidity. Methods: From June 2019 to November 2023, 10 districts (Hedong, Hexi, Dongli, Beichen, Nankai, Xiqing, Wuqing, Baodi, Jizhou, and Binhai New District) in Tianjin were selected as the project sites. The community and natural village was used as the primary sampling unit, and each project site selected the screening sites by cluster random sampling method. Residents aged 35-75 who lived in the screening sites for 6 months and above were surveyed by questionnaire, physical examination, and biochemical tests. The chi-square test, analysis of variance, and multivariate unconditional logistic regression analysis were used for statistical analysis. Age-standardized prevalence was based on the data of the sixth national census. Results: A total of 146 832 participants were included in this study, including 61 994 males (42.22%) and 84 838 females (57.78%), with an age of (56.83±8.84) years. The number of people with only one disease was 55 485 (37.79%), the number of people with two diseases was 36 942 (25.16%), and the number of people with three diseases was 9 683 (6.59%). The prevalence of hypertension combined with dyslipidemia was the highest (17.23%), and the standardized prevalence were 14.44%. The prevalence rates of three diseases and hypertension combined with diabetes was 6.59% and 4.98%, respectively, and the standardized prevalence was 5.42% and 4.11%, respectively. The prevalence of diabetes combined with dyslipidemia was 2.95%, and the standardized prevalence was 2.45%. Multivariate unconditional logistic regression analysis showed that advanced age (65- 75 years old: OR =2.69, 95% CI : 2.28-3.18), overweight/obesity (overweight: OR =2.21, 95% CI : 2.02-2.41; obesity: OR =4.50, 95% CI : 4.03-5.02), daily smoking ( OR =1.96, 95% CI : 1.72-2.24), regular and heavy drinking ( OR =1.63, 95% CI : 1.18-2.27), family history of hypertension/diabetes/hyperlipidemia (family history of hypertension: OR =81.17, 95% CI : 74.68-88.22; family history of diabetes: OR =15.26, 95% CI : 13.71-16.99; family history of hyperlipidemia: OR =7.13, 95% CI : 5.92-8.59), tea drinking (occasional tea drinking group: OR =1.74, 95% CI : 1.52-2.00; frequent tea drinking group: OR =2.23, 95% CI : 1.92-2.59) were risk factors for the comorbidity of hypertension, diabetes and dyslipidemia (all P <0.05), while higher education level was a protective factor (senior high school/technical secondary school: OR =0.79, 95% CI : 0.72-0.86; college/bachelor's degree and above: OR =0.60, 95% CI : 0.53-0.68, all P <0.001). Conclusions: The comorbidity rate of hypertension, diabetes, and dyslipidemia is high in residents aged 35-75 years in Tianjin. It is necessary to strengthen the co-management of blood pressure, blood glucose, and blood lipid in key populations with old age, overweight/obesity, junior high school education or below, daily smoking, daily drinking, occasional or frequent tea drinking, and family history of hypertension/diabetes/dyslipidemia, and promote a healthy lifestyle.

Background: India is facing triple epidemic of Non communicable diseases (NCDs) including high body mass index (BMI), high blood pressure and high blood glucose, contributing to more than half of deaths of all mortality, however, information in different demographics is limited, especially, in India. The aim of the study is to compare the prevalence of overweight, obesity, hypertension, and diabetes, along with the occurrence of multi-morbidity, across gender-specific populations in rural, suburban, and urban regions of India., Methods: This was a cross-sectional, population-based study including adults aged 20 and above in rural, suburban, and urban areas near Coimbatore, India. All participants were interviewed using a detailed questionnaire and had their anthropometric measurements, including height, weight, blood pressure, and blood samples collected. Gender specific and location specific prevalence of overweight, obesity, hypertension, diabetes, and multimorbidity were assessed., Results: This study included 2976 individuals, of which 865 were from rural areas, 1030 from sub-urban areas, and 1081 from metropolitan areas. The mean systolic and diastolic blood pressure were higher in rural participants than in sub-urban and urban participants, despite the fact that the prevalence of hypertension was higher in sub-urban (47.1%) than in rural (36.4%) and urban (39.7%, p < 0.001). In sub-group analysis, sub-urban areas had a greater prevalence of hypertension in both men and women (53.5% and 41.7%, p < 0.001) than rural areas (41.9% and 31.3%, p = 0.001) or urban areas (45.9% and 35.5%, p < 0.001). Compared to rural (16.1%) and urban (23%), sub-urban areas had a greater prevalence of diabetes (25.8%, p < 0.001). Urban residents (47.5%) had higher rates of overweight and obesity than rural (31.4%) and sub-urban (34.1%, p < 0.001) residents. The association between diabetes and hypertension was present in the unadjusted model and persisted even after age and BMI adjustments. Though not in men, higher levels of education were associated to a higher prevalence of diabetes in women. Diabetes was associated to being overweight or obese in women, however this association was significantly reduced once BMI was taken into account. The overall multimorbidity was 3.8%, however, women had a higher overlapping prevalence (2.8%) compared to men (1%, p < 0.001)., Conclusions: Diabetes and hypertension were prevalent comorbidities across all demographics, with higher rates in suburban and urban areas. Women exhibited higher rates of multimorbidity than men, regardless of the demographic area., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Purpose: To investigate the risk of visual impairment (VI) based on the presence or absence of four diseases: hypertension (HTN), diabetes mellitus (DM), glaucoma, and diabetic retinopathy (DR)., Methods: This retrospective population-based study included 1,000,000 randomly selected participants from the National Health Checkup Program database between 2015 and 2016. VI was defined as a presenting visual acuity ≤ 0.5 in the better eye. The participants were divided into 12 groups according to the presence or absence of disease. Adjusting for age and sex, the risk of VI in each disease group was analyzed and compared with the others., Results: Among the 1,000,000 participants, 88,931 (8.89%) had VI. The odds ratios (ORs) of age, male sex, HTN, DM, glaucoma, and DR for VI were 1.06 (95% CI, 1.05-1.06), 0.52 (95% CI, 0.52-0.53), 1.11 (95% CI, 1.09-1.13), 1.07 (95% CI, 1.05-1.09), 0.92 (95% CI, 0.90-0.74), and 1.29 (95% CI, 1.25-1.34), respectively (all P < 0.001). The group with HTN, DM, glaucoma, and DR had the highest OR of 1.98 (P < 0.001) compared to the healthy group. HTN, DM, and DR were positively correlated with VI in all groups. Glaucoma was positively correlated in the group with DM and DR and in the group with HTN, DM, and DR (ORs 1.18, 1.11, all P < 0.05); however, it demonstrated a negative correlation in the other groups (ORs 0.85-0.93, all P < 0.05)., Conclusion: HTN, DM, and DR, either alone or in combination, increase the risk of VI. Glaucoma also increases the risk when combined with DR; however, it has a negative correlation with VI in the absence of DR. Periodic ophthalmologic examinations for glaucoma, which primarily affects the peripheral visual field and not central visual acuity, might help prevent VI caused by other diseases., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Choi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Non-communicable diseases (NCDs) are a major public health challenge globally, including in Saudi Arabia. However, measuring the true extent of NCD prevalence has been hampered by a paucity of nationally representative epidemiological studies., Objectives: Assess the prevalence of selected NCDs, using population-based electronic health records and applying novel analytical methods to identify cases of NCDs., Design: Retrospective., Settings: A large healthcare network in Saudi Arabia., Patients and Methods: We included all beneficiaries aged 16 years or older (n=650 835[a]) and used the International Classification of Disease (ICD-10) codes, laboratory results, and associated medications to identify individuals with diabetes, obesity, hypertension, dyslipidemia, mental disorders, and injuries. For diabetes and hypertension, we used natural language processing (NLP) on clinical notes in the electronic health records. The prevalence of multimorbidity across age groups was also tabulated, and logistic regression was used to examine its association with glycemic control., Main Outcome Measures: The primary outcomes measured were the prevalence of diabetes, hypertension, and multimorbidity, and their association with glycemic control., Sample Size: 650 835 individuals aged 16 years or older., Results: The study population was relatively young, with 41.2% aged between 26 and 45 years, and around two-thirds were married. The prevalence of diabetes and hypertension was 18.5% (95% CI: 18.5-18.7) and 13.0% (95% CI: 12.9-13.1), respectively. Approximately 26.7% (95% CI: 26.7-26.8) of the population had multimorbidity, with levels increasing to 62.9% for those aged 65 or older. Multimorbidity was associated with a four-fold increase in the likelihood of poor glycemic control. NLP analysis suggested that the prevalence of diabetes or hypertension may be underestimated by no more than 1.5%., Conclusions: The study suggests a higher prevalence of NCDs than earlier national estimates. Electronic health records with regular analysis provide an opportunity to estimate changes in the prevalence of NCDs in Saudi Arabia. Health policies and interventions are needed to address the high levels of multimorbidity, which adversely impact glycemic control., Limitations: Retrospective design and reliance on electronic health records, which may not capture all cases of NCDs.

Background: Limited evidence exists on the patterns of medication use for hypertension, diabetes mellitus (DM), and dyslipidemia after bariatric surgery among Asian patients., Objectives: To investigate the patterns in the use of blood pressure-lowering, glucose-lowering, and lipid-lowering medications following BS in Korean patients with morbid obesity., Setting: This study is a retrospective cohort study using the Health Insurance Review and Assignment claims database of South Korea (from 2019 to 2021)., Methods: We included patients who underwent BS between 2019 and 2020 in South Korea. We evaluated the treatment patterns of blood pressure-lowering, glucose-lowering, and lipid-lowering medications at 3-month intervals for 1-year following BS, including medication use, individual medication classes, and the number of medications prescribed. Furthermore, we estimated remission rates for each disorder based on patient characteristics by defining patients who discontinued their medications for at least 2 consecutive quarters as remission., Results: A total of 3810 patients were included in this study. For 1-year following BS, a marked decrease in the number of patients using blood pressure-lowering, glucose-lowering, and lipid-lowering medications was observed. The most remarkable decrease occurred in glucose-lowering medications, which decreased by approximately -75.1% compared with that at baseline. This tendency was consistently observed when analyzing both the number of medications prescribed and the specific medication classes. Regarding remission rates, patients who were female, younger, and received the biliopancreatic diversion-duodenal switch as their BS showed a relatively higher incidence of remission than other groups., Conclusions: BS was associated with a decrease in the use of medications for hypertension, diabetes mellitus (DM), and dyslipidemia., (Copyright © 2024 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Hypertension and diabetes are major risk factors for cardiovascular diseases, stroke, and chronic kidney disease (CKD). Disparities in hypertension control persist among Black and Hispanic adults and persons living in poverty in the United States. The "LINKED-HEARTS Program" (a Cardiometabolic Health Program LINKED with Community Health WorkErs and Mobile HeAlth TelemonitoRing To reduce Health DisparitieS"), is a multi-level intervention that includes home blood pressure (BP) monitoring (HBPM), blood glucose telemonitoring, and team-based care. This study aims to examine the effect of the LINKED-HEARTS Program intervention in improving BP control compared to enhanced usual care (EUC) and to evaluate the reach, adoption, sustainability, and cost-effectiveness of the program., Methods: Using a hybrid type I effectiveness-implementation design, 428 adults with uncontrolled hypertension (systolic BP ≥ 140 mm Hg) and diabetes or CKD will be recruited from 18 primary care practices, including community health centers, in Maryland. Using a cluster-randomized trial design, practices are randomly assigned to the LINKED-HEARTS intervention arm or EUC arm. Participants in the LINKED-HEARTS intervention arm receive training on HBPM, BP and glucose telemonitoring, and community health worker and pharmacist telehealth visits on lifestyle modification and medication management over 12 months. The primary outcome is the proportion of participants with controlled BP (<140/90 mm Hg) at 12 months., Conclusions: The study tests a multi-level intervention to control multiple chronic diseases. Findings from the study may be leveraged to reduce disparities in the management and control of chronic diseases and make primary care more responsive to the needs of underserved populations., Trial Registration: ClinicalTrials.gov. Identifier: NCT05321368., Competing Interests: Conflict of interest The authors declare they have no financial interests. The authors have no conflict of interest to declare., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: Obesity may promote kidney damage through hemodynamic and hormonal effects. We investigated the association between body mass index (BMI), total body fat (TBF) and chronic kidney disease (CKD) and whether hypertension, diabetes, leptin and adiponectin mediated these associations., Methods: In this cross-sectional analysis of the Netherlands Epidemiology of Obesity study, 6671 participants (45-65 y) were included. We defined CKD as eGFR <60 ml/min/1.73 m 2 and/or moderately increased albuminuria. The percentage of mediation was calculated using general structural equation modeling, adjusted for potential confounding factors age, sex, smoking, ethnicity, physical activity and Dutch healthy diet index., Results: At baseline mean (SD) age was 56 (6), BMI 26.3 (4.4), 44% men, and 4% had CKD. Higher BMI and TBF were associated with 1.08 (95%CI 1.05; 1.11) and 1.05-fold (95%CI 1.02; 1.08) increased odds of CKD, respectively. As adiponectin was not associated with any of the outcomes, it was not studied further as a mediating factor. The association between BMI and CKD was 8.5% (95%CI 0.5; 16.5) mediated by diabetes and 22.3% (95%CI 7.5; 37.2) by hypertension. In addition, the association between TBF and CKD was 9.6% (95%CI -0.4; 19.6) mediated by diabetes and 22.4% (95%CI 4.2; 40.6) by hypertension. We could not confirm mediation by leptin in the association between BMI and CKD (35.6% [95%CI -18.8; 90.3]), nor between TBF and CKD (59.7% [95%CI -7.1; 126.6])., Conclusion: Our results suggest that the relations between BMI, TBF and CKD are in part mediated by diabetes and hypertension., (© 2024. The Author(s).)

Objectives: This study aimed to examine age, period, and cohort effects contributing to the prevalence of diabetes and hypertension among older Koreans. Additionally, it sought to investigate how sociodemographic characteristics interact with period and cohort effects to influence the disease prevalence., Methods: Using the 2004-2020 data from the National Survey of Older Koreans, a nationally representative sample of older adults aged 65 or older, hierarchical age-period-cohort cross-classified random effects models (HAPC-CCREMs) were employed to estimate separate age, period, and cohort components of the recent trends in diabetes and hypertension. Sociodemographic characteristics were tested for their interactions with period and cohort effects., Results: Significant period effects were observed, indicating a steady increase in the likelihood of being diagnosed with diabetes and hypertension over time. Age effects revealed a quadratic trend, with disease risks generally increasing with age, but the rate of increase diminishing at older ages. Cohort effects exhibited an inverted U-shaped pattern, with higher risks observed in the 1930s and early 1940s cohorts compared to earlier and later cohorts. Gender and educational attainment emerged as significant moderators. Women than men born in the early 1930s exhibited higher risks of diabetes and hypertension, whereas individuals with lower educational attainment showed a steadily increasing risk of hypertension over time., Discussion: The results underscore the complex interplay of age, period, and cohort effects in shaping disease prevalence among older Koreans. Our findings highlight the importance of considering historical context and sociodemographic factors in understanding disease trends and designing targeted interventions to mitigate health disparities., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objectives: Chronic diseases contribute significantly to healthy years lost (HYLs). It is critical to investigate which are the most contributing diseases to enable enhancing health programs' effectiveness in improving health expectancy. This paper investigates disease-specific contributions to years lived with chronic diseases in Algeria and examines their recent evolution., Methods: We used morbidity data from the last three waves of the Multiple Indicator Cluster Surveys of 2006, 2012-13, and 2018-19. The studied chronic diseases included hypertension, cardiovascular diseases (CVDs), joint diseases, respiratory diseases, and diabetes. We calculated disease-specific contributions using the cause-deleted health expectancy approach. Then, we analyzed time changes and gender-based differences in contributions., Results: The leading cause of HYLs in women is hypertension, followed by diabetes, joint diseases, CVDs, and respiratory diseases. The same ranking applies to men, with joint diseases coming last. The time evolution of relative disease-specific contributions shows an increase in CVDs for women and diabetes for both genders, against a decrease for the other diseases., Discussion: To improve chronic disease-free life expectancy in Algeria, effective prevention programs must be implemented, with an emphasis on hypertension and diabetes. Further investigation into the risk factors affecting the prevalence and incidence of these diseases is also required., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: The clinical aspects of lung cancer patients are well-studied. However, healthcare charge patterns have yet to be explored through a large-scale representative population-based sample investigating differences by socioeconomic factors and comorbidities., Aim: To identify how comorbidities associated with healthcare charges among lung cancer patients., Methods: We examined the characteristics of the patient sample and the association between comorbidity status (diabetes, hypertension, or both) and healthcare charge. Multivariate survey linear regression models were used to estimate the association. We also investigated sub-group association through various patient and socioeconomic factors., Results: Of 212,745 lung cancer patients, 68.5% had diabetes and/or hypertension. Hospital charges were higher in the population with comorbidities. The results showed that lung cancer patients with comorbidities had 9.4%, 5.1%, and 12.0% (with diabetes, hypertension, and both, respectively) higher hospital charges than those without comorbidities. In sub-group analysis, Black patients also showed a similar trend across socioeconomic (i.e. household income and primary payer) and racial (i.e. White, Black, Hispanic, and Asian/Pacific Islander) factors., Discussion: Black patients may be significantly financially burdened because of the prevalence of comorbidities and low-income status. More work is required to ensure healthcare equality and promote access to care for the uninsured, low-income, and minority populations because comorbidities common in these populations can create more significant financial barriers., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Although hypertension and diabetes are known to increase cardiovascular disease risk, the influencing and underlying factors remain unclear., Objective: To examine the mediating effect of location of residence and the moderating effects of recommended lifestyle practices in the hypertension/diabetes and cardiovascular disease nexus., Material and Methods: Data were drawn from 4,563 participants in Steps 1 and 2 of the 2020 World Health Organization's STEPS survey in Cabo Verde, with a subsample of 2,436 individuals completing Step 3. A logit regression model was employed to examine the correlations of cardiovascular disease, while structural equation modeling and interaction analysis were used to identify mediators and moderators within the explored relationships., Results: Living with hypertension and diabetes were both observed to increase the likelihood of having a cardiovascular disease [Coeff. (RSE), 0.46, (0.12), p  < 0.001; 1.26, (0.14), p  < 0.001, respectively]. We identify urbanicity as a potential mediator through which hypertension/diabetes leads to a cardiovascular disease and waist circumference as a moderator of hypertension/diabetes-cardiovascular nexus., Conclusion: These findings add to the toolset of public health practitioners and policymakers in formulating policies and interventions aimed at managing cardiovascular diseases, particularly in developing nations.

Objective: The relationship between vitiligo and cardiovascular diseases remains controversial. This study aimed to systematically review the evidence comparing cardiovascular disease risk factors between patients with vitiligo and controls and to perform a meta-analysis of the results., Data Sources: A comprehensive database search was performed for all studies in PubMed, EMBASE, and Cochrane Central Register databases from inception to November, 2023. The main keywords used were vitiligo, hypertension, diabetes, hyperlipidemia, metabolic syndrome, obesity, smoking, alcohol consumption, C-reactive protein, and homocysteine., Study Selection: Only observational studies and no randomized controlled trials were included. Of the 1269 studies initially selected, the full texts of 108 were assessed for eligibility, and 74 were ultimately included in the analysis., Data Extraction and Synthesis: Three reviewers independently extracted the following data: study design, number and characteristics of participants, inclusion indicators, and disease duration. A meta-analysis of the single-group rates was performed for the diabetes, hypertension, hyperlipidemia, and obesity groups. Random-effects or fixed-effects models were used to calculate the sample-size weighted averages for the indicators included in the studies., Main Outcomes and Measures: The primary outcomes were co-morbidity analysis and co-morbidity rates of vitiligo with metabolic syndrome, obesity, hyperlipidemia, hypertension, and diabetes mellitus. Secondary outcomes were factors associated with vitiligo and cardiovascular disease., Results: This meta-analysis concluded that comorbidities in patients with vitiligo included metabolic syndrome, diabetes, obesity, hyperlipidemia, and hypertension, with comorbidity rates of 28.3%, 6.0%, 38.5%, 43.0%, and 15.8%, respectively. Simultaneously, we showed that the vitiligo group differed significantly from the control group in the following aspects: fasting blood glucose, insulin, systolic and diastolic blood pressure, total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, homocysteine, C-reactive protein, smoking, and alcohol consumption. However, no significant differences were observed between the vitiligo and control groups in terms of waist circumference, body mass index, or phospholipid levels., Limitations: The vast majority of the studies were from Eastern countries; therefore, extrapolation of these results to Western populations is questionable. The significant heterogeneity may be due to different protocols, doses, durations, center settings, population registries, etc., which severely compromise the validity of the results., Conclusion: This study summarized not only the factors associated with, but also those not associated with, cardiovascular disease in patients with vitiligo. This study provides a foundation for the prevention and treatment of cardiovascular disease in patients with vitiligo.

Objective: To study cumulative incidence and predictors of myocardial infarction (MI) in two random general population samples consisting of middle-aged Swedish men born 30 years apart., Method: Results from the "Study of Men Born In 1913" and the "Study of Men Born In 1943", two longitudinal cohort studies performed in the same geographic area and using the same methodology were compared. Both cohorts were followed prospectively from 50 to 70 years of age. MI was defined as first myocardial infarction, fatal or non-fatal., Results: Men born in 1943 had a 34% lower cumulative risk of first MI [HR 0.66 (0.50-0.88), p = 0.0051] during follow-up as compared to men born in 1913. Interaction analysis showed that hypertension had a significantly higher impact on risk of MI in cohort 1943 than in cohort 1913 [HR 2.33 (95% CI 1.41-3.83)] and [HR 1.10 (0.74-1.62)], p = 0.0009 respectively. The population attributable risk for hypertension was 2.5-fold higher in the cohort of men born in 1943 as compared to men born in 1913, and diabetes mellitus and sedentary lifestyle attributed more to MI risk in cohort 1943 than in cohort 1913. On the contrary, smoking and total cholesterol have less attributable risk to MI in cohort 1943 than in cohort 1913., Conclusion: Despite declining incident MI and improved cardiovascular prevention in general, hypertension remains an increasingly important attributable risk factor to MI together with diabetes mellitus and sedentary lifestyle over time., Competing Interests: Declarations. Competing interests: None declared. Ethics approval: The study complies with the Helsinki Declaration. Written informed consent was obtained from all participants, except for the screening examination in 1963 where only oral informed consent was given (standard procedure at the time). The Research Ethics Board in Gothenburg, later the National Research Ethics Authority, approved the study protocol on several occasions (DNR 157–93, 0067–03, and DNR 649–13). Patient and public involvement: Patient and/or public were not involved in the design, conduct, reporting, or dissemination plans of this research. Patient consent for publication: Not applicable. Provenance and peer review: Not commissioned, externally peer reviewed., (© 2023. The Author(s).)

The anthropometric index that best predicts cardiometabolic risk remains inconclusive. This study therefore assessed the prevalence of obesity using six indices and compared their associations with obesity-related cardiometabolic disorders. We determined obesity prevalence according to body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio (WHtR), body fat percentage and fat mass index (FMI) using data from the Know Your Heart study ( n  = 4495, 35-69 years). The areas under the receiver operating characteristic curves (AUCs) provided predictive values of each index for detecting the presence of hypertension, hypercholesterolaemia and diabetes. Age-standardised obesity prevalence significantly varied according to anthropometric index: from 17.2% (FMI) to 75.8% (WHtR) among men and from 23.6% (FMI) to 65.0% (WHtR) among women. WHtR had the strongest association with hypertension (AUC = 0.784; p  < 0.001) and with a combination of disorders (AUC = 0.779; p  < 0.001) in women. In women, WHtR also had the largest AUCs for hypercholesterolaemia, in men - for hypertension, diabetes and a combination of disorders, although not all the differences from other obesity indices were significant. WHtR exhibited the closest association between hypertension and a combination of disorders in women and was non-inferior compared to other indices in men.

Background: Numerous studies have linked the inflammatory pathway in psoriasis and metabolic disease, while no specific marker defined it. It is worth exploring the association of β2-microglobulin (β2M) in psoriasis severity and comorbidities., Objectives: To investigate the correlation between blood β2M level and psoriasis severity, to explore the inflammatory factors influencing the occurrence of psoriasis comorbidities such as arthritis, diabetes, and hypertension., Methods: Ninety-seven psoriasis patients were analyzed in the cohort retrospective study during 12 weeks., Results: Significantly higher levels of blood β2M and ESR were observed in the group that patients' PASI ≥10 than in the group that PASI <10. Blood β2M level had strong significantly positive correlations with the PASI in Pearson's correlation analysis. In the model that systemic inflammatory factors to find psoriasis comorbidity risk factors, logistic regression analysis showed that blood β2M level was the significant risk factor associated with diabetes and hypertension. High-sensitivity C-reactive protein (hsCRP) was the significant risk factor associated with arthritis., Conclusions: Patients with a severer psoriasis tended to have higher blood β2M levels and severer inflammatory state. In the systemic inflammation indexes, the level of blood β2M affected the risk of hypertension and diabetes, and hsCRP affected the risk of arthritis in patients with psoriasis.

Purpose: To assess the interactive relationship between blood pressure status and diabetic mellitus (DM) with ganglion cell complex (GCC) thickness in elderly individuals in rural China., Methods: Participants aged 50 years and older in a rural area of Daxing District, Beijing, were recruited in this study from October 2018 to November 2018. All subjects underwent a comprehensive systemic and ocular examination. Blood pressure status was graded as normotension, controlled hypertension and uncontrolled hypertension according to blood pressure measurements and the use of any medication for hypertension treatment. GCC parameters were measured by spectral-domain optical coherence tomography (SD-OCT). Generalized linear models (GLM) adjusted for related potential confounders were used to assess the interaction between DM and blood pressure status., Results: Among 1415 screened subjects (2830 eyes), a total of 1117 eyes were enrolled in the final analysis. GLM analysis showed a significant interactive relationship between DM with uncontrolled hypertension status (β = 3.868, p = 0.011). GCC thickness would decrease 0.255 μm per year as the age increased (β=-0.255, p < 0.001). In a subgroup of 574 subjects with uncontrolled hypertension, DM was associated with an increased average of GCC thickness (β = 1.929, p = 0.022)., Conclusions: The present results revealed a significant interactive relationship between blood pressure status and DM. The average GCC thickness increased in individuals with DM combined with uncontrolled hypertension, which should be considered in the measurement of GCC. Further studies are warranted to explore ganglion cells changes as a non-invasive method to detect neuron alterations in individuals with DM and uncontrolled hypertension., Trail Registration: The registration number of the present trial in the Chinese Clinical Trial Registry is ChiCTR2000037944., (© 2024. The Author(s).)

Introduction: Preventing Atherosclerotic Cardiovascular Diseases (ASCVD) can best be achieved by promoting a healthy lifestyle through improvements in diet, physical activity, and avoidance of tobacco use and exposure to second-hand smoke. The study aimed to determine the association between physical activity as well as obesity and the risk of atherosclerotic cardiovascular diseases among patients with hypertension and diabetes attending Irrua Specialist Teaching Hospital (ISTH), Irrua, Nigeria., Methodology: The research was a descriptive, cross-sectional study of 394 systematically selected consenting patients with hypertension and diabetes presenting to a teaching hospital in Irrua, Edo State, Nigeria. The Cardiovascular risk assessment was determined using the Framingham 10year Risk of General Cardiovascular Disease. Anthropometric assessment, blood pressure and blood glucose were determined. Data was collected with a semi-structured questionnaire and analysed with Stata version 16. Chi square and logistic regression was used to test for association and significance level was set at p = 0.05., Results: The study included 394 participants with a mean age of 54±15.47years. Respondents were mostly females (55.3%), physically inactive (70.3%), overweight (42.4%) and had a high risk (41.8%) of developing CVD in 10 years using Framingham categorisation. There was a significant association between physical activity (P<0.01; OR 2.45; CI: 1.53-3.92), obesity (P<0.01; OR 2.52; CI: 1.64-3.86) and risk of developing CVD., Conclusion: The study found a statistically significant relationship between physical inactivity, obesity, and the risk of atherosclerotic cardiovascular diseases. Increasing physical activity levels need to be a top priority at all levels of healthcare as well as the general population., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Oseni et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background and Aims: Guidelines suggest similar blood pressure (BP) targets in patients with and without diabetes and recommend ambulatory BP monitoring (ABPM) to diagnose and classify hypertension. It was explored whether different levels of ambulatory and office BP and different hypertension phenotypes associate with differences of risk in diabetes and no diabetes., Methods: This analysis assessed outcome data from the Spanish ABPM Registry in 59 124 patients with complete available data. The associations between office, mean, daytime, and nighttime ambulatory BP with the risk in patients with or without diabetes were explored. The effects of diabetes on mortality in different hypertension phenotypes, i.e. sustained hypertension, white-coat hypertension, and masked hypertension, compared with normotension were studied. Analyses were done with Cox regression analyses and adjusted for demographic and clinical confounders., Results: A total of 59 124 patients were recruited from 223 primary care centres in Spain. The majority had an office systolic BP >140 mmHg (36 700 patients), and 23 128 (40.6%) patients were untreated. Diabetes was diagnosed in 11 391 patients (19.2%). Concomitant cardiovascular (CV) disease was present in 2521 patients (23.1%) with diabetes and 4616 (10.0%) without diabetes. Twenty-four-hour mean, daytime, and nighttime ambulatory BP were associated with increased risk in diabetes and no diabetes, while in office BP, there was no clear association with no differences with and without diabetes. While the relative association of BP to CV death risk was similar in diabetes compared with no diabetes (mean interaction P = .80, daytime interaction P = .97, and nighttime interaction P = .32), increased event rates occurred in diabetes for all ABPM parameters for CV death and all-cause death. White-coat hypertension was not associated with risk for CV death (hazard ratio 0.86; 95% confidence interval 0.72-1.03) and slightly reduced risk for all-cause death in no diabetes (hazard ratio 0.89; confidence interval 0.81-0.98) but without significant interaction between diabetes and no diabetes. Sustained hypertension and masked hypertension in diabetes and no diabetes were associated with even higher risk. There were no significant interactions in hypertensive phenotypes between diabetes and no diabetes and CV death risk (interaction P = .26), while some interaction was present for all-cause death (interaction P = .043) and non-CV death (interaction P = .053)., Conclusions: Diabetes increased the risk for all-cause death, CV, and non-CV death at every level of office and ambulatory BP. Masked and sustained hypertension confer to the highest risk, while white-coat hypertension appears grossly neutral without interaction of relative risk between diabetes and no diabetes. These results support recommendations of international guidelines for strict BP control and using ABPM for classification and assessment of risk and control of hypertension, particularly in patients with diabetes., Clinical Trial Registration: Not applicable., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Purpose: Hypertension (HT), dyslipidemia (DL), and diabetes mellitus (DM) are major risk factors for cardiovascular diseases. Despite the wide availability of medications to reduce this risk, poor adherence to medications remains an issue. The aim of this study is to evaluate medication adherence of prevalent users in these disease medications (HT, DL, DM) using claims data. Factors associated with non-adherence were also examined., Methods: Of 7538 participants of the Tsuruoka Metabolomics Cohort Study, 3693 (HT: 2702, DL: 2112, DM: 661) were identified as prevalent users of these disease medications. Information on lifestyle was collected through a questionnaire. Adherence was assessed by a proportion of days covered (PDC) and participants with PDC ≥0.8 were defined as adherent. Predictors of non-adherence were determined by performing multivariable logistic regression., Results: Medication adherence differed by treatment status. Among those without comorbidities, those with HT-only showed the highest adherence (90.2%), followed by those with DM-only (81.2%) and those with DL-only (80.8%). Factors associated with non-adherence in each medication group were skipping breakfast and poor understanding of medications among those with HT medications, females, having comorbidities, having a history of heart disease, and drinking habit among those with DL medications, and good sleep quality and skipping breakfast among those with DM medications., Conclusion: While participants showed high medication adherence, differences were observed across medication groups. The identified predictors of non-adherence could help target those in need of adherence support., (© 2024 The Author(s). Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.)

Background: Strokes represent a major global health challenge, as they now affect up to 15 million people annually, with increasing mortality rates accompanying growing prevalence. In Saudi Arabia, hypertension (HTN) and diabetes mellitus (DM) have been identified as major contributors to stroke risk, with a combination of HTN and DM significantly magnifying the risk of strokes. While there have been global improvements in stroke prevention, recently knowledge levels vary significantly worldwide, and multiple studies in Saudi Arabia show inconsistent awareness levels., Objectives: This study seeks to develop insights for the development of tailored prevention programs that align with Saudi Vision 2030 in terms of enhancing quality of life. Thus, the aim of the study is to assess knowledge levels of stroke risk factors, warning signs, symptoms, and prevention methods among high-risk groups (HTN and DM patients) at King Saud University Medical City (KSUMC)., Methods: This was an analytical cross-sectional study conducted among 422 participants from June 2022 to January 2023, using a validated Arabic questionnaire taken, with permission, from previous studies. All HTN and T2DM patients in the waiting areas of the outpatient clinics at KSUMC, Riyadh were included as part of the random sampling, though patients below 20-years-old and those with other endocrine disorders were then excluded., Results: The majority of participants were male (64.5 %). The analysis showed that 66.1 % of participants had "poor total knowledge" of stroke factors. Half of the participants (50.5 %) had "poor knowledge" about stroke risk factors, though the most commonly identified risk factor was "hypertension". Additionally, the findings showed that 46.4 % of participants had "poor knowledge" of stroke warning signs and symptoms, with the most commonly identified warning sign being "difficulty in speaking." Nearly half of participants (46.4 %) had "good knowledge" of stroke prevention methods; however, "regular exercise" was the most commonly identified prevention method., Conclusion: Although the participants displayed decent knowledge of stroke prevention methods, several notable deficits in overall knowledge of stroke factors emerged. In particular, knowledge of stroke risk factors and warning signs and symptoms among participants was inadequate. This implies that healthcare providers should seek to launch campaigns addressing stroke knowledge mainly among high-risk groups, potentially distributing brochures about stroke knowledge in the relevant clinics and seeking to provide a range of educational content by means of social media., Competing Interests: Declaration of competing interest The authors declare that they have no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: The purpose of this research was to assess overall medication adherence as an indicator for emergency room (ER) visits, hospitalizations, and mortality among elderly patients., Methods: The study included individuals aged 75-90 years, diagnosed with diabetes or hypertension, who were treated with at least 1 antihypertensive, or antidiabetic medication in 2017. We determined personal adherence rates by calculating the mean adherence rates of the medications prescribed to each individual. We retrieved information on all ER visits and hospitalizations in internal medicine and surgical wards from 2017 to 2019 and mortality in 2019., Results: Of the 171,097 individuals included in the study, 60% were women. The mean age was 81.2 years. 93% had hypertension, 46% had diabetes, and 39% had both diabetes and hypertension. In 2017, 61,668 (36.0%) patients visited the ER, 44,910 (26.2%) were hospitalized in internal medicine wards, and 13,305 (7.8%) were hospitalized in surgical wards. Comparing the highest adherence quintile to the lowest, ORs were 0.69 (0.63, 0.76) for ER visits, 0.40 (0.36, 0.45) for hospitalization in internal medicine wards, and 0.61 (0.52, 0.72) for hospitalization in surgery wards. ORs were similar for the 3 consecutive years 2017, 2018, and 2019. The adjusted OR for all-cause mortality in 2019 comparing the highest adherence quintile to the lowest was 0.60 (0.54, 0.66)., Conclusions: Better medication adherence was associated with fewer ER visits and hospitalizations among elderly patients with diabetes and hypertension and lower mortality rates. Overall medication adherence is an indicator for health outcomes unrelated to the patient's underlying health status., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: During the COVID-19 pandemic, Trinidad and Tobago's government implemented lockdowns and limited the availability of outpatient clinics to curb virus transmission. Subsequently, telemedicine via telephone calls was utilized to address infection control and continuity of care for chronic disease patients. Methods: An observational study was conducted at three primary care facilities in Eastern Trinidad using convenience sampling to review retrospectively telemedicine patients' medical records from October 2019 to February 2020 (before telemedicine) and from March 2020 to September 2020 (during telemedicine) for comparative analysis. Data were analyzed using IBM SPSS Statistics 28.0 software and Microsoft Excel. Results: A total of 199 patient files were analyzed; 57.3% of these were female; 52.3% were 60 years and older. A Wilcoxon signed-rank test demonstrated no statistically significant differences between random blood sugar (RBS) readings (0.355), weight (0.621), or systolic and diastolic blood pressure (BP; 0.239 and 0.232, respectively) before and during the 6-month period of telemedicine consultation. Patients compliant with medication before the use of telemedicine were 14 times more likely to attain target BPs. There was no significant association between compliance with prescribed therapy and BP control (0.335) during the period of telemedicine. Discussion: The findings support the use of telemedicine to manage chronic diseases such as hypertension, diabetes mellitus, and coronary heart disease, as the standard of care was preserved, and no inferiority of recorded outcomes was demonstrated. Although there was an overall decrease in compliance during the telemedicine period compared with before, comparative analysis exhibited no statistically significant differences in BP or RBS readings.

Exposure to environmental contaminants and the development of hypertension and diabetes represent crucial risk factors for chronic kidney disease (CKD). Toxicological studies have revealed that organophosphate esters (OPEs) impair kidney function. However, the joint effects of OPE exposure on kidney injury and the interactions of OPE exposure with hypertension or diabetes on kidney injury remain unclear. Our study aimed to investigate the individual and joint effects of OPE exposure on renal injury, as well as the potential interaction between OPE exposure and hypertension or diabetes on kidney injury. The study enrolled 1938 participants from Wuhan, China. To explore the relationship between OPE exposure and renal injury, we conducted multivariate linear and logistic regression analysis. The results indicated that each unit increase in 4-hydroxyphenyl diphenyl phosphate (4-HO-DPHP), bis(2-butoxyethyl) phosphate (BBOEP), and tris(2-chloroethyl) phosphate (TCEP) (1 μg/L-ln transformed) was associated with a decreased 0.57 mL/min/1.73 m 2 (95%CI: -1.05, -0.09), 0.85 mL/min/1.73 m 2 (95%CI: -1.52, -0.19) and 1.24 mL/min/1.73 m 2 (95%CI: -2.26, -0.23) of estimated glomerular filtration rate (eGFR), while each unit increase in 4-HO-DPHP and BBOEP (1 μg/L-ln transformed) was associated with 14% and 20% elevation of incident impaired renal function (IRF) risk. Notably the highest tertile of BCIPHIPP was positively associated with eGFR, although the p for trend ＞ 0.05. We employed Bayesian kernel machine regression (BKMR) and quartile-based g-computation (qgcomp) models to explore the joint effects of OPE mixtures on eGFR and IRF. Both the results of BKMR and qgcomp model consistently demonstrated negative associations between OPE mixtures and eGFR, and TCEP and 4-HO-DPHP were major contributors. Furthermore, we observed multiplicative interactions of diphenyl phosphate (DPHP), BBOEP, di-ocresyl phosphate (DoCP) & di-p-cresyl phosphate (DpCP), 1-hydroxy-2-propyl bis(1-chloro-2-propyl) phosphate (BCIPHIPP) and hypertension or diabetes on kidney injury (all P＜0.05). Those with diabetes or hypertension and higher OPE metabolite concentrations had increased risk of kidney function impairment compared to those who did not have diabetes or hypertension. These findings suggest that specific OPE exposure may elevate the risk of renal injury, particularly among hypertensive and diabetic populations., Competing Interests: Declaration of competing interest The authors declare no competing interests in this paper., (Copyright © 2024 Elsevier GmbH. All rights reserved.)

Previous studies investigated the association of body weight and hypertension with risk of incident cardiometabolic multimorbidity. Our aim was to estimate the risk of diabetes and cardiovascular disease later in life for subjects with different progression patterns of overweight, obesity, and hypertension in mid-life. This was a prospective cohort study in which data from 12,784 participants in the Australian Longitudinal Study on Women's Health were used. Multistate model was used to study the progression pattern of overweight, obesity, hypertension, diabetes, and cardiovascular disease over the life course. The cumulative incidence of diabetes and cardiovascular disease up to the age of 73 was estimated for women with different patterns of other conditions. The six most common paths and corresponding cumulative incidences for diabetes were overweight 5.1%, obesity 11.5%, hypertension 6.9%, progression from overweight to obesity 8.2%, overweight and hypertension 12.1%, and obesity and hypertension 36.8%. For women with diabetes and other conditions, the cumulative incidence of cardiovascular disease (heart disease or stroke) as the next immediate condition was 22.4%. The corresponding figure for women who only had a report of diabetes but did not have high body weight or hypertension was 8.3%. The higher risk of transition from healthy state to a cardiometabolic condition was associated with low education, income stress, smoking, not drinking alcohol (compared to low drinkers), physical inactivity, and high perceived stress. Women with obesity and hypertension in middle-age had a substantially higher risk of developing diabetes and cardiovascular disease than women without these potentially preventable conditions., (© 2024. The Author(s).)

Objectives: To assess the prevalence of metabolic syndrome (MS) and association of central obesity measures such as body mass index (BMI), visceral fat adiposity (VFA) and superficial fat adiposity (SFA) with MS, diabetes (DM) and hypertension (HTN)., Design: Cross-sectional study design., Setting: Tertiary care hospital in Pakistan., Participants: 165 participants. There were 124 male participants and 41 female participants of Pakistani population. All participants above 18 years, who had unenhanced CT abdomen examination and relevant blood workup, were included. Patients with a known clinical history of coronary artery disease, HTN and DM as well as pregnant patients were excluded., Interventions: VFA and SFA were estimated, at the level of the umbilicus. Data of BMI, MS, DM and HTN were extracted from patient files. Data for MS, DM and HTN were recorded as binary variables., Outcome Measures: The primary outcome measures were the prevalence of MS and the association of MS, DM and HTN with gender, VFA, SFA and BMI. P value of <0.05 was taken as significant with CI of 95%., Results: The prevalence of MS was 29.7%. There was a significant association of MS, DM and HTN with VFA, SFA and BMI. In gender-based analysis 48.7% of the female participants had MS. In subset analysis, 47% of male subjects in the third tertile of VFA revealed significant association with MS (p value <0.05) while only 32.7% of subjects in the obesity category of BMI had MS. SFA revealed a significant association with DM only (p value <0.5)., Conclusion: In conclusion, VFA shows a significant association with MS, DM and HTN. Considering these results, further studies with a larger sample size are warranted to generate gender-based cut-offs for VFA for obesity screening purposes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Both diabetes mellitus (DM) and hypertension (HTN) have been on the rise in recent decades all over the world more remarkably in developing countries like India. We intend to measure the prevalence of DM and HTN in the Indian population and to compare the trends and various correlates of these diseases in NFHS (National Family Health Survey)-4 and 5. Data of NFHS-4 and 5 were accessed from dhs program website. All statistical analyses were done in SAS (version 9.4). Mixed effects survey logistic regression models were used for estimating odds ratio (OR).p-values <0.05 were considered significant .1,637,762 individual case entries were evaluated. Both the diseases showed an increasing trend as per the advancing age in both sexes. The highest prevalence of DM is seen in the age group of 45-49 years (7.8%) in females and > 50 years (11.9%) in males as per NFHS-5. Similarly, the highest prevalence of HTN was seen in the age group of45-49 years (31.2%) in females and > 50 years (41.4%) in males as per NFHS-5. The OR (95% CI) of prevalence of DM, HTN and both the diseases in age group >50 years was 14.46 (13.14-15.7), 16.65 (15.78-17.6), 79.5 (64.76-97.73) respectively when compared to reference age group15-19 years. Highest odds for having both DM, HTN concurrently was in age >50 years with aOR(95% CI) 65.32 (52.26-72.63) in NFHS 4 and 35.57 (97.47-45.53) in NFHS 5.Rise in prevalence of DM, HTN and concurrent presence is noted with an apparent increase in cases., Competing Interests: No conflicting interest., (Copyright: © 2024 Rana et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: There is a growing epidemic of chronic non-communicable diseases in low and middle-income countries, often attributed to urbanization, although there are limited data from marginalized rural populations. This study aimed to estimate prevalence of cardiometabolic diseases and associated risk factors in transitional rural communities., Methods: A cross-sectional study of Montubio adults aged 18-94 years living in agricultural communities in a tropical coastal region of Ecuador. Data were collected by questionnaires and anthropometry, and fasting blood was analyzed for glucose, glycosylated hemoglobin, insulin, and lipid profiles. Population-weighted prevalences of diabetes, hypertension, and metabolic syndrome were estimated. Associations between potential risk factors and outcomes were estimated using multilevel regression techniques adjusted for age and sex., Results: Out of 1,010 adults recruited, 931 were included in the analysis. Weighted prevalences were estimated for diabetes (20.4%, 95% CI 18.3-22.5%), hypertension (35.6%, 95% CI 29.0-42.1%), and metabolic syndrome (54.2%. 95% CI 47.0-61.5%) with higher prevalence observed in women. Hypertension prevalence increased with age while diabetes and metabolic syndrome peaked in the 6th and 7th decades of life, declining thereafter. Adiposity indicators were associated with diabetes, hypertension, and metabolic syndrome., Conclusion: We observed an unexpectedly high prevalence of diabetes, hypertension, and metabolic syndrome in these marginalized agricultural communities. Transitional rural communities are increasingly vulnerable to the development of cardiometabolic risk factors and diseases. There is a need for targeted primary health strategies to reduce the burden of premature disability and death in these communities., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Gualan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The majority of people with long-term, non-communicable medical conditions experience significant psychological anguish. Poor mental health or psychological distress influences low lifestyle decisions that result in obesity, inactivity, and cigarette use as well as poor health literacy and limited access to health promotion activities., Objectives: The study's purpose was to measure the prevalence of psychological distress and it's predictors in patients with chronic non-communicable diseases who were being treated in selected hospitals in the Sidama region of southern Ethiopia in 2022., Methodology: Institutional based cross-sectional study was carried out using a sample of 844 patients receiving medication for either high blood pressure or diabetes mellitus or both between May1 and August 31, 2022. To gauge psychiatric distress, the Amharic translation and Ethiopian validation of the Kessler 6 scale (K-6) was employed. The analysis was done using binary logistic regression and an odds ratio with the corresponding 95% confidence interval was estimated to measure the strength of the association. P value <0.05 was considered to declare the significance., Result: Patients with diabetic mellitus, hypertension or both had a 49.6% prevalence of psychological distress at selected Sidama hospitals. Age, drug side effects, history medical complications following diabetic mellitus/hypertension, and body mass index of the patient were all significantly linked with psychological distress (P<0.05)., Conclusion: According to the results of this study, psychological distress is far more prevalent than it was in past studies in Ethiopia and other African countries. To lessen the problem, all stakeholders must cooperate, but health agencies, policymakers, and NGOs particularly need to put in extra effort. The study also showed a significant association between body mass index, patient age, drug side effects, and history of medical complications following diabetic mellitus /hypertension., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Borie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: Obesity is a well-established risk factor for disease. Controversy exists regarding the relative risk of morbidity and mortality in individuals who are overweight or underweight compared with individuals with a normal body mass index (BMI). In this study, we investigated the associations between BMI and three non-communicable diseases (hypertension, diabetes and heart disease) in older adults., Design: Cohort study., Setting: This study used data from the China Health and Retirement Longitudinal Study. The baseline survey was carried out in 2011, and follow-up surveys were conducted in 2013, 2015 and 2018., Participants: Participants who reported having no doctor-diagnosed chronic disease at baseline were included in this study., Main Outcome Measures: We analysed the association between baseline BMI and disease incidence using Cox proportional hazards models. Disease information included self-reported diagnosed conditions. BMI was categorised according to the standard Chinese criteria: underweight (<18.5 kg/m 2 ), normal body weight (18.5-23.9 kg/m 2 ), overweight (24.0-27.9 kg/m 2 ) and obese (≥28.0 kg/m 2 )., Results: A total of 5605 participants were included at baseline. Based on the Kaplan-Meier estimation, the participants who were obese had the highest incidence of all three diseases. Compared with normal weight participants, overweight participants had a greater disease incidence (log-rank tests are p<0.01). Cox regression models showed that with increasing BMI, the HRs of diseases increased accordingly (eg, for hypertension, compared with the BMI group <18.5 kg/m 2 , the HRs for the BMI groups 18.5-23.9, 24.0-27.9 and ≥28.0 were 1.43 (95% CI 1.00 to 2.05), 2.19 (95% CI 1.51 to 3.18) and 2.89 (95% CI 1.91 to 4.36), respectively)., Conclusion: A higher BMI was associated with an increased risk of hypertension, diabetes and heart disease in the population aged 45 years and older. Even within normal BMI ranges, a higher BMI was associated with an increased risk of disease. Actions are urgently needed at the population level to address the growing public health challenge of excess weight in the context of an ageing population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The relationship between aspirin usage and the risk of colorectal cancer (CRC) among individuals with both hypertension (HTN) and diabetes mellitus (DM) remains unclear. This study aims to explore the impact of aspirin use on the site-specific CRC risk in patients with metabolic comorbidity., Methods: A case-control study was conducted among 1,331 CRC patients and 2,771 controls recruited from the Nation Cancer Center in Korea. Multinomial logistic regression analyses were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the association between aspirin use, metabolic disease status, and site-specific CRC risk., Results: Among the 4,102 participants, 1,191 individuals had neither HTN nor DM, 2,044 were diagnosed with HTN, 203 with DM, and 664 presented with HTN and DM comorbidity. An increasing number of HTN and DM was associated with an increased risk of overall CRC (HTN or DM: OR, 1.70; 95% CI, 1.39-2.07; HTN and DM: OR, 8.43; 95% CI, 6.37-11.16), while aspirin use was associated with a decreased risk of overall CRC (OR, 0.31; 95% CI, 0.21-0.46). These results remained consistent across anatomical sites. Among individuals with HTN and DM comorbidity, aspirin use notably associated with lower risk of overall CRC (OR, 0.39; 95% CI, 0.21-0.72), proximal colon (OR, 0.32; 95% CI, 0.13-0.71) and rectal cancer (OR, 0.27; 95% CI, 0.08-0.97), but not distal colon cancer (OR, 0.58; 95% CI, 0.27-1.24)., Conclusion: This study showed that aspirin use is negatively associated with overall and site-specific CRC, even among individuals with HTN and DM comorbidity., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2024 The Korean Academy of Medical Sciences.)

Background: Individuals with substance use disorders (SUDs) have increased risk for developing chronic conditions, though few studies assess rates of diagnosis of these conditions among patients with SUDs., Objective: To compare rates of undiagnosed hypertension and diabetes among patients with and without an SUD., Design: Cross-sectional analysis using electronic health record (EHR) data from 58 primary care clinics at a large, urban, healthcare system in New York., Participants: Patients who had at least two primary care visits from 2019-2022 were included in our patient sample. Patients without an ICD-10 hypertension diagnosis or prescribed hypertension medications and with at least two blood pressure (BP) readings ≥ 140/90 mm were labeled 'undiagnosed hypertension,' and patients without a diabetes diagnosis or prescribed diabetes medications and with A1C/hemoglobin ≥ 6.5% were labeled 'undiagnosed diabetes.', Main Measures: We calculated the mean number of patients with and without an ICD-10 SUD diagnosis who were diagnosed and undiagnosed for each condition. We used multivariate logistic regression to assess the association between being undiagnosed for each condition, and having an SUD diagnosis, patient demographic characteristics, clinical characteristics (body mass index, Elixhauser comorbidity count, diagnosed HIV and psychosis), the percentage of visits without a BP screening, and the total number of visits during the time period., Key Results: The percentage of patients with undiagnosed hypertension (2.74%) and diabetes (22.98%) was higher amongst patients with SUD than patients without SUD. In multivariate models, controlling for other factors, patients with SUD had significantly higher odds of having undiagnosed hypertension (OR: 1.81; 95% CI: 1.48, 2.20) and undiagnosed diabetes (OR: 1.93; 1.72, 2.16). Being younger, female, and having an HIV diagnosis was also associated with significantly higher odds for being undiagnosed., Conclusions: We found significant disparities in rates of undiagnosed chronic diseases among patients with SUDs, compared with patients without SUDs., (© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.)