Risk factors and predictive biomarkers of early cardiovascular disease in obese youth

Obesity in childhood and adolescence continues to be a major health issue due to significant health implications and to the economic burden that arise from treating this disease and its complications. Current data show that childhood obesity is no longer just a concern for developed countries, but more significantly affecting developing countries. In adult population, cardiovascular disease is the main cause of mortality and morbidity among obese patients. It is therefore believed that risk factors found in adult patients could also be observed in obese youth. These risk factors will then persist and become progressively worse if obese youth remain obese as they reach adulthood. However, risk reduction is achievable through various prevention and management strategies of obesity and obese children who become nonobese in adulthood have a significant reduction in their risk of developing cardiovascular disease. New biomarkers to improve risk assessment in obese youth are an open research field, which will eventually lead to a more targeted approach in prevention and treatment. Nevertheless, there is still a need for continuous research in understanding the roles of these biomarkers and their potential in risk prediction. Cardiovascular risk modification of childhood obesity depends on a more concerted effort among the various parties involved and particularly a global collaboration to stop the rising prevalence of the epidemic in developing countries.     

Socioeconomic inequalities in cardiovascular disease mortality; an international study.

BACKGROUND: Differences between socioeconomic groups in mortality from and risk factors for cardiovascular diseases have been reported in many countries. We have made a comparative analysis of these inequalities in the United States and 11 western European countries. The aims of the analysis were (1) to compare the size of inequalities in cardiovascular disease mortality between countries, and (2) to explore the possible contribution of cardiovascular risk factors to the explanation of between-country differences in inequalities in cardiovascular disease mortality. DATA AND METHODS: Data on ischaemic heart disease, cerebrovascular disease and total cardiovascular disease mortality by occupational class and/or educational level were obtained from national longitudinal or unlinked cross-sectional studies. Data on smoking, alcohol consumption, overweight and infrequent consumption of fresh vegetables by occupational class and/or educational level were obtained from national health interview or multipurpose surveys and from the European Union's Eurobarometer survey. Age-adjusted rate ratios for mortality were correlated with age-adjusted odds ratios for the behavioural risk factors. RESULTS: In all countries mortality from cardiovascular diseases is higher among persons with lower occupational class or lower educational level. Within western Europe, a north-south gradient is apparent, with relative and absolute inequalities being larger in the north than in the south. For ischaemic heart disease, but not for cerebrovascular disease, an even more striking north-south gradient is seen, with some 'reverse' inequalities in southern Europe. The United States occupy intermediate positions on most indicators. Inequalities in cardiovascular disease mortality are associated with inequalities in some risk factors, especially cigarette smoking and excessive alcohol consumption. CONCLUSIONS: Socioeconomic inequalities in cardiovascular disease mortality are a major public health problem in most industrialized countries. Closing the gap between low and high socioeconomic groups offers great potential for reducing cardiovascular disease mortality. Developing effective methods of behavioural risk factor reduction in the lower socioeconomic groups should be a top priority in cardiovascular disease prevention.     

The obesity epidemic and its impact on hypertension

Global obesity rates have increased steadily in both developed and emerging countries over the past several decades with little signs of slowing down. Over 1.5 billion people worldwide are overweight or obese and over 40 million children under the age of 5 are overweight. Obesity is associated with increased morbidity, disability, and premature mortality from cardiovascular disease, diabetes, cancers, and musculoskeletal disorders. The personal and societal health and economic burden of this preventable disease pose a serious threat to our societies. Obesity is a major risk factor for hypertension and cardiovascular disease. Weight loss, through health behaviour modification and dietary sodium restriction, is the cornerstone in the treatment of obesity-related hypertension. Pharmacotherapy and bariatric surgery for obesity are adjunctive measures when health behaviour interventions fail to achieve the body weight and health targets. Successful management of overweight and obese persons requires a comprehensive, multifaceted framework that integrates population health, public health, and medical health models to dismantle the proximal and distal drivers of the obesogenic environment in which we live. Prevention of obesity is no longer a lofty but rather necessary goal that urgently calls for action from governments at all levels, in conjunction with all public and private sector stakeholders, in order to combat a serious and growing public health concern.     

Quantifying Risk of Death and Disability Associated with Raised Blood Pressure

Raised blood pressure is one of the most important underlying risk factors for morbidity and mortality in the world today, ranking alongside tobacco in estimates of the worldwide attributable burden of mortality. It is a major risk factor for coronary heart disease and the major risk factor for stroke. Taken together, the cardiovascular diseases are estimated to account for some 28% of all deaths in the world. Already many more of such deaths are occurring in the developing than the developed world, and this burden of disease is set to worsen as a result of demographic changes in the poorer countries, together with adoption of Western lifestyle. The development of unfavourable blood pressure patterns in populations is a key factor underlying this worldwide epidemic. Both primary prevention (for example through improved diet) and secondary prevention (through drug treatment and non-pharmacologic approaches) are needed.     

Quantifying risk of death and disability associated with raised blood pressure.

Raised blood pressure is one of the most important underlying risk factors for morbidity and mortality in the world today, ranking alongside tobacco in estimates of the worldwide attributable burden of mortality. It is a major risk factor for coronary heart disease and the major risk factor for stroke. Taken together, the cardiovascular diseases are estimated to account for some 28% of all deaths in the world. Already many more of such deaths are occurring in the developing than the developed world, and this burden of disease is set to worsen as a result of demographic changes in the poorer countries, together with adoption of Western lifestyle. The development of unfavourable blood pressure patterns in populations is a key factor underlying this worldwide epidemic. Both primary prevention (for example through improved diet) and secondary prevention (through drug treatment and non-pharmacologic approaches) are needed.     

Bridging science and health policy in cardiovascular disease: focus on lipid management: A Report from a Session held during the 7th International Symposium on Multiple Risk Factors in Cardiovascular Diseases: Prevention and Intervention – Health Policy,in Venice,Italy, on 25 October, 2008

In Europe, cardiovascular disease (CVD) represents the main cause of morbidity and mortality, costing countries € 190 billion yearly (2006). CVD prevention remains unsatisfactory across Europe largely due to poor control of CVD risk factors (RFs), growing incidence of obesity and diabetes, and sedentary lifestyle/poor dietary habits. Hypercholesterolaemia is a proven CVD RF, and LDL-C lowering slows atherosclerotic progression and reduces major coronary events. Lipid-lowering therapy is cost-effective, and intensive treatment of high-risk patients further improves cost effectiveness. In Italy, models indicate that improved cholesterol management translates into potential yearly savings of € 2.9–4 billion. Identifying and eliminating legislative and administrative barriers is essential to providing optimal lipid care to high-risk patients. Public health and government policy can influence clinical practice rapidly, and guideline endorsement via national health policy may reduce the CVD burden and change physician and patient behaviour. Action to reduce CVD burden should ideally include the integration of strategies to lower the incidence of major CV events, improvement in total CV risk estimation, database monitoring of CVD trends, and development of population educational initiatives on CVD prevention. Failure to bridge the gap between science and health policy, particularly in relation to lipid management, could result in missed opportunities to reverse the burgeoning epidemic of CVD in Europe.     

Obesity and cardiovascular disease: pathogenic mechanisms and potential benefits of weight reduction

The prevalence of obesity in industrialized countries has reached epidemic proportions, with about one in three people being obese and another one in three people being overweight and at risk of developing obesity. In recent years, obesity has gained the traditional tetrad of cardiovascular risk factors of smoking: hypertension, dyslipidemia, and dysglycemia. Attention has also focused on the importance of abdominal (or central) obesity as a determinant of cardiovascular risk, independent of the body mass index. In addition to effects on coronary artery disease, obesity has an effect on cardiovascular disease, including stroke, ventricular function, peripheral arterial disease, and venous thromboembolism. The objectives of this review are to summarize the effects of obesity on cardiovascular disease, and the possible mechanisms for these associations, and to investigate the effects of weight-loss interventions on the burden of cardiovascular disease. Large ongoing clinical outcome trials, such as the SOS study, the Look-AHEAD trial, or the SCOUT study, should provide important information on the effects of surgical and nonsurgical obesity treatment on cardiovascular morbidity and mortality.     

Comprehensive Strategies for the Prevention and Control of Diabetes and Cardiovascular Diseases in Africa: Future Directions

The countries of the Sub Saharan African region have insufficient resources and healthcare systems that are poorly adapted to cope with the longstanding burden associated with communicable diseases and the ongoing HIV/AIDS pandemic. In addition, the rising burden of non-communicable diseases, including diabetes, cardiovascular diseases, and their risk factors, poses additional challenges. These countries need to urgently develop strategies to address these challenges of disease prevention and control. These strategies will require a new vision and more relevant and ‘suitable’ vocabulary in dealing with healthcare design, planning and implementation (using a cross-sectorial approach). Lessons learnt from the past (e.g. primary health care) in sub-Saharan Africa and other regions of the world may equally prove useful in developing strategies for the prevention and control of non-communicable diseases. Any potential strategy must emphasize the crucial role of economic, social, and environmental health determinants as well as the use of appropriate health technology.     

Epidemiology of the metabolic syndrome

The clustering of cardiovascular risk factors, known as the metabolic syndrome, greatly increases the risk of developing diabetes, kidney disease, and cardiovascular disease. Individuals with the metabolic syndrome are also at increased risk for premature death from cardiovascular disease or all-cause mortality. Cross-sectional and longitudinal epidemiologic studies provide prevalence data on the syndrome based on criteria proposed by the World Health Organization and the National Cholesterol Education Program Adult Treatment Panel III. Owing to differences in the criteria, estimates of the prevalence of the syndrome vary according to the criteria used. Generally, the syndrome is more common in older people and in the United States and it is more prevalent among Mexican Americans. Obesity and sedentary lifestyles are major contributing factors to the syndrome and provide opportunities for interventions. Recent data from a randomized controlled trial indicate that a weight loss and exercise intervention reduced the incidence of the metabolic syndrome by 41% among individuals with impaired glucose tolerance. Pharmacologic treatment of the individual components of the metabolic syndrome provides an alternate strategy for managing the syndrome. The rising global epidemics of overweight and obesity will likely lead to increases in the prevalence of the metabolic syndrome posing a serious burden for clinicians and public health officials.     

Descriptive Epidemiology of Cardiovascular Risk Factors and Diabetes in Sub-Saharan Africa

Reliable data on risk factor levels, exposure history, and population distribution can help inform policies and programs for disease prevention and control. With rare exception however, ideal local data on major risk factors and causes of death and disease burden have been scarce in sub-Saharan Africa (SSA). Basic community surveys in some countries and recent systematic analysis of disease burden attributable to 67 risk factors and risk factor clusters in 21 regions of the world provide an opportunity to examine and relate diabetes and cardiovascular risk factors to mortality and burden in SSA. Rising body mass index, especially in women in Southern Africa; and rising systolic blood pressure in East Africa for both sexes, and in West Africa for women are the major cardiometabolic risk factors. Harmful use of alcohol, especially in Southern SSA, tobacco use, and physical inactivity are also important. Improving vital registration and risk factor surveillance remain major challenges.     

“Obesity paradox” in coronary artery disease

Obesity used to be among the more neglected public health problems, but has unfolded as a growing medical and socioeconomic burden of epidemic proportions. Morbid obesity is linked to traditional cardiovascular risk factors like, hypertension, hyperlipidemia and diabetes, and suspected to incur increased morbidity and mortality in the Western and even third world populations. This patient cohort is also at greater risk to develop coronary artery disease. Recent population-based registries revealed that 43% and 24% of all cases of coronary revascularization were carried out in overweight and obese patients, respectively. However, despite evidence of a positive correlation between obesity and increased cardiovascular morbidity, some authors have described a better clinical outcome in overweight and obese patients, a phenomenon they coined “obesity paradoxon”. Thus, there is an ongoing debate in light of conflicting data and the possibility of confounding bias causing misconception and challenging the “obesity paradox”. In this review article we present the current evidence and throughly discuss the validity of the “obesity paradoxon” in a variety of clinical settings.     

Epidemiologic trends in overweight and obesity.

Obesity in adults is associated with excess mortality and excess risk of coronary heart disease, hypertension, hyperlipidemia, diabetes, gallbladder disease, certain cancers, and osteoarthritis. Overweight children often become overweight adults, and overweight in adulthood is a health risk. Although childhood overweight may not always result in excess adult health risk, immediate consequences of overweight in childhood are psychosocial and also include cardiovascular risk factors such as hypertension, high cholesterol, and abnormal glucose tolerance. The causes of obesity are poorly understood, and both the prevention and the treatment of obesity are difficult. In this context, the ability to track epidemiologic trends in overweight and obesity is important.     

Burden of Cardio- and Cerebro-vascular Diseases and the Conventional Risk Factors in South Asian Population

Similar to most populations, South Asian countries are also witnessing the dramatic transitions in health during the last few decades with the major causes of adverse health shifting from a predominance of nutritional deficiencies and infectious diseases to chronic diseases such as cardio and cerebrovascular disease (CVD). We summarized the available information of the burden of CVD and risk factors in the South Asian populations. The prevalence of conventional cardiovascular has been increasing among all South Asian populations. Extensive urbanization, shift in dietary pattern and sedentary daily life style is contributing towards the worsening of the CVD risk factor scenario. The burdens of the chronic cardiovascular risk factors are much prevalent in the South Asian populations. These are also rising alarmingly which ought to influence the already existed heavy CVD burden. Similar to the rest of the world, management for the conventional cardiovascular risk factors is very important for the prevention of CVD in South Asia.     

Current status of hypertension control around the world

It is well established that hypertension is an important risk factor for cardiovascular disease. Data from epidemiological and observational studies have demonstrated increasing risk of stroke, myocardial infarction, cardiovascular death and all cause mortality associated with high blood pressure. Despite the significance of the problem with respect to overall health, control of high blood pressure is far from being optimal. Data from the National Health and Nutrition Survey have shown that those achieving target blood pressure values less than 140/90 mmHg are only 34% of the hypertensive population. The situation is no better in the rest of the world and even worse in the developing countries. Epidemiological transition taking place in developing countries with a decline in communicable diseases and an increase in noncommunicable have resulted in an improvement in life expectancy, thus causing predictable shifts in causes of death. Aging of the populations, urbanization and socioeconomic changes in the developing world have led to an increase in the prevalence of hypertension, with low control rates due to scarce health resources and insufficient health infrastructure. Thus prevention, detection, treatment and control of hypertension play a crucial role in protection of cardiovascular disease, not only in the developed countries but also in the developing world and implementation of hypertension guidelines should be reinforced around the world.     

Obesity and the risk of cardiovascular disease and diabetes mellitus

The increasing prevalence of obesity worldwide has many experts concerned about the worsening health of a large proportion of the population. It is well recognized that obesity is associated with a higher mortality, an increased risk of hypertension and hyperlipidemia, cardiovascular disease, diabetes mellitus, osteoarthritis, gall bladder disease and possibly some cancers. Currently it is estimated that over two thirds of adults in the United States are overweight and nearly one third are clinically obese.1 Of special concern is the rapid increase in obesity among children. Other countries both developed and developing are experiencing similar trends.……     

中国多中心急性冠脉综合征患者高血压控制现况

背景冠状动脉疾病（CAD）是目前世界范围内危害人类健康的主要疾病，降低CAD的发病率进而减轻相关的疾病负担成为心血管疾病防治领域的重点，有效地实施冠心病二级预防的指南已成为许多国家改善心脏病临床实践的主要目标。中国冠心病二级预防架桥工程（BRIG）研究基线调查旨在全面如实地反映中国CAD诊疗及二级预防现状，发现、确定当前中国CAD二级预防在临床实践中存在的问题、障碍和主要影响因素。目的了解中国多省市急性冠脉综合征（ACS）患者危险因素控制现况-高血压的治疗、控制情况。方法以3223例急性冠脉综合征住院病人为研究对象。2006年在中国31个省市自治区选择32家三级医院和32家二级医院。本研究主要分析患者入院前的高血压患病、治疗及控制情况。结果1）在3223例ACS患者中，男性占67．7％（2183例），女性占32．3％（1040例），年龄（65±11）岁；其中ST段抬高心肌梗死占39．8％，非ST段抬高心肌梗死9．2％，不稳定心绞痛占51．0％；既往有ACS病史者27．1％。2）ACS患者中既往有高血压病史者52．7％，女性（57．8％）高于男性（50．3％，P〈0．01）；按地理位置分为7个地区（华北、华东、华南、华中、东北、西北和西南），其中东北地区既往有高血压病史者比例最高（61．7％），华南地区最低（43．0％），各地区间的差异具有非常显著意义（P〈0．01）。3）既往有高血压病史者，其治疗率为85．4％，治疗率最高的是华南地区（90．0％），最低是西南地区（78．3％）；在治疗者中控制率为38．5％，其中控制率最高的是西南地区（46．7％），最低是东北地区（28．2％）。4）既往有ACS的患者中高血压的患病率为58．1％，治疗率为90．0％，治疗者的控制率为42．2％，上述三率均高于既往无ACS病史者（50．8％、83．5％、36．8％）。结论急性冠脉综合征患者中近55％伴有高血压病史；高血压治疗率、控制率存在地区间差异；虽然高血压治疗率较高，但控制率仍处于较低水平，这在冠心病二级预防中应当引起重视。     

中国冠心病二级预防架桥工程基线研究设计原理

目的:冠状动脉疾病(CAD)是目前世界范围内危害人类健康的主要疾病,降低CAD的发病率进而减轻相关的疾病负担成为心血管疾病防治领域的重点,有效地实施冠心病二级预防的指南已成为许多国家改善心脏病临床实践的主要目标,中国冠心病二级预防架桥工程(BRIG)研究基线调查旨在全面如实地反映中国冠心病(CAD)诊疗及二级预防现状,发现、确定当前中国CAD二级预防在临床实践中存在的问题、障碍和主要影响因素。方法:在中国31个省市自治区选择32家三级医院和32家二级医院,每家医院选择住院患者和门诊患者各50例,采用问卷回顾和门诊访谈形式,收集住院患者和门诊患者二级预防信息。结论:BRIG基线调查资料最大程度地涵盖了中国不同地区生产总值(GDP)水平、不同级别医院,从而使我们获得较为全面的反映全国范围不同地区,不同级别医院急性冠脉综合征(ACS)的诊断治疗和二级预防的状况;基线资料将比较全面地展示中国目前CAD诊疗、预防中存在的问题及与指南间的差距,为问题的分析和改善提供依据。     

Obesity and cholangiocarcinoma

It is estimated that about half of the population in developed countries are either overweight or obese.In some developing nations obesity rates have increased to surpass those seen in Western countries.This rate increase in obesity has many implications as obesity has been associated with numerous negative health effects including increased risks of hypertension,diabetes,cardiovascular disease,stroke,liver disease,apnea,and some cancer types.Obesity is now considered to be one of the major public health concerns facing the society.Cholangiocarcinomas(bile duct cancers) are malignant tumors arising from cholangiocytes inside or outside of the liver.Although cholangiocarcinomas are relatively rare,they are highly lethal.The low survival rate associated with cholangiocarcinoma is due to the advanced stage of the disease at the time of diagnosis.Prevention is therefore especially important in this cancer type.Some data suggest that the incidence of cholangiocarcinoma in the western world is on the rise.Increasing rate of obesity may be one of the factors responsible for this increase.Determining whether obesity is a risk factor for cholangiocarcinoma has significant clinical and societal implications as obesity is both prevalent and modifiable.This paper seeks to provide a summary of the current knowledge linking obesity and cholangiocarcinoma,and encourage further research on this topic.