Association of novel risk factors with the ankle brachial index in African American and non-Hispanic white populations

OBJECTIVES: To investigate whether novel risk factors, including C-reactive protein (CRP), fibrinogen, lipoprotein(a) [Lp(a)], and homocysteine levels, are associated with the ankle brachial index (ABI) in African American and non-Hispanic white populations and whether novel risk factors account for ethnic differences in peripheral arterial disease (PAD). PARTICIPANTS AND METHODS: Between December 2000 and October 2004, original participants in the Genetic Epidemiology Network of Arteriopathy study returned for a second study visit to undergo measurement of risk factors and ABI. The CRP, Lp(a), and homocysteine levels were log transformed to reduce skewness. Multivariable regression analyses were used to assess whether a novel risk factor was associated with ABI after adjustment for conventional risk factors and whether ethnicity was associated with PAD (ABI, 相似文献   

Cardiovascular disease and modifiable cardiometabolic risk factors

Cardiovascular disease (CVD) is the leading cause of death in the United States and many parts of the world. Potentially modifiable risk factors for CVD include tobacco use, physical inactivity, hypertension, elevated low-density lipoprotein cholesterol, and a cluster of interrelated metabolic risk factors. Over the last several decades, efforts to prevent or treat CVD risk factors have resulted in significantly lower rates of CVD-related mortality. However, many patients never achieve adequate control of CVD risk factors even when these factors have been identified. In addition, the growing prevalence of obesity and type 2 diabetes mellitus (DM) threatens to undermine the improvements in CVD that have been achieved. In the United States, approximately two thirds of adults are overweight or obese, and even modest excess body weight is associated with a significantly increased risk of CVD-related mortality. Lifestyle interventions to promote weight loss reduce the risk of CVD-related illness but are difficult for patients to sustain over long periods of time. The increased incidence of obesity has also contributed to significant increases in the prevalence of other important CVD risk factors, including hypertension, dyslipidemia, insulin resistance, and type 2 DM. Pharmacologic therapies are currently available to address individual CVD risk factors, and others are being evaluated, including endocannabinoid receptor antagonists, inhibitors of peroxisome proliferator-activated receptor subtypes alpha and gamma, and several agents that modulate the activity of glucagon-like peptide-1. The new agents have the potential to significantly improve several CVD risk factors with a single medication and may provide clinicians with several new strategies to reduce the long-term risk of CVD.     

Comprehensive management of cardiometabolic risk factors

Comprehensive management of cardiometabolic risk requires management of a patient's underlying risk factors. The initial approach to treatment demands a careful assessment of patient risk, using formal risk assessment tools (eg, the Framingham Risk Score and the National Cholesterol Education Program Adult Treatment Panel III definition of metabolic syndrome), combined with comprehensive knowledge of the patient. There is increasing evidence that lifestyle modification and pharmacotherapy can delay or prevent the progression of insulin resistance to diabetes and cardiovascular disease. Periodic reassessment of a patient's risk can assist in guiding long-term therapy to achieve optimal cardiometabolic health.     

Cardiovascular risk factors and socioeconomic status in African American and Caucasian women

Self-reported cardiovascular risk factors of obesity, physical inactivity, and smoking in African American and Caucasian women in North Carolina were compared, controlling for socioeconomic status (SES). Participants were 1,945 women aged 23 to 53 years; 20.1% African American and 79.9% Caucasian. Of the African American women, 38.8% were obese, 51.7% were inactive, and 31.2% smoked; of the Caucasians, 19.9% were obese, 31.2% were inactive, and 33.8% smoked. SES differed significantly by race (p < 0.001). Low and middle SES African American women were much more likely than high SES African Americans to be obese, inactive, and smokers. Among Caucasian women, those with low SES had the greatest prevalence for all three risk factors. After controlling for income and education, African American women were more than twice as likely as Caucasian women to be obese and to be inactive, but were only half as likely to smoke. © 1998 John Wiley & Sons, Inc. Res Nurs Health 21: 285–295, 1998     

Frailty, health-related quality of life and mental well-being in older adults with cardiometabolic risk factors

Objective: Frailty is an emergent health‐related problem in older adults. The aim of this study was to examine the health‐related quality of life (HRQOL) and the effect of frailty in elderly patients with cardiometabolic risk factors. Methods: One‐hundred and one patients 65 years or older responded to an HRQOL assessment using the World Health Organization Quality of Life (WHOQOL)‐26 questionnaire. Frailty was assessed using two indices: the Hebrew Rehabilitation Center for Aged (HRCA) vulnerability index and the Vulnerable Elders Survey (VES) index. In addition, these patients completed self‐rating questionnaires assessing mental well‐being [the 28‐item version of the General Health Questionnaire (GHQ‐28)] and depression (Geriatric Depression Scale). Results: Based on the combination of HRCA and VES indices, 24 subjects (23.7%) met the criteria of frail. Persons ≥ 75 years old and those with depressive mood or lower creatinine clearance had significantly lower WHOQOL‐26 scores than their counterparts. Diabetes and macrovascular complications did not associate with the WHOQOL‐26 scores. Compared with non‐frail patients, the frail scored lower on the WHOQOL‐26 questionnaire after adjusting for age, kidney dysfunction and depressive mood. Frail patients also reported significantly higher the GHQ‐28 scores compared with non‐frail patients. Conclusions: Frail older adults had a significant lower HRQOL, as well as lower mental well‐being, independent of age, diabetes, macrovascular complication, kidney dysfunction and depressed mood.     

Prevalence of behavioral and physiological risk factors of hypertension in African American adolescents

African American (AA) adolescents are twice as likely to develop high blood pressure in early adulthood as other groups. Continuous existence of risk factors in adolescents may be precursors to adult cardiovascular changes. The purpose of this study was to describe the prevalence of cardiovascular risk factors in a sample of AA adolescents. METHOD: A secondary analysis was conducted on data obtained from a sample of AA adolescents (N = 48; 32 males and 16 females) ages 14-17 years from a larger study. Factors included family history of hypertension (FHH), diet, exercise, blood pressure, and cortisol levels before and after physiologic stress. FINDINGS: Thirty-one participants (65%) had positive FHH, 35 (73%) had three or less serving of fruits/vegetables per day, 41 (85%) reported exercising less than three times per week. Of the participants, 14 (29%) had elevated blood pressure, 30 (63%) had cardiovascular reactivity, 32 (67%) had elevated cortisol, and 23 (48%) had cortisol hyper-responsivity. Ninety-four percent had four or more risk factors and 44% had six or more. DISCUSSION: This study demonstrates the increased prevalence of physiological and behavioral risk factors in this adolescent population.     

Predictors of cardiometabolic risk among adults with cerebral palsy

Peterson MD, Haapala HJ, Hurvitz EA. Predictors of cardiometabolic risk among adults with cerebral palsy.ObjectiveTo examine the independent association between various anthropometric indicators and standard clinical markers of cardiometabolic health risk among adults with cerebral palsy (CP).DesignCross-sectional study.SettingClinical center for CP treatment and rehabilitation.ParticipantsAdults with CP (N=43) with a mean age ± SD of 37.3±13.2 years, and Gross Motor Function Classification System (GMFCS) levels of I?V.InterventionsNot applicable.Main Outcome MeasuresAdults with CP were assessed for body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), waist-to-height ratio (WtHR), and serum lipid profiles. Data were analyzed with multiple regression analysis and general linear models, and are reported as means ± SDs.ResultsMean BMI was 29.1±7.8kg/m². BMI was not associated with any measures of cardiometabolic risk. Using GMFCS categories (2 groups: GMFCS levels I–III and IV–V), BMI was significantly lower among GMFCS levels IV–V (24.2±6.2kg/m²) versus GMFCS levels I–III (30.1±7.6kg/m²). WC and WtHR were not correlated with any cardiometabolic outcomes. Conversely, measures of WHR were independently associated with various indices of risk, including total cholesterol to high-density lipoprotein (HDL) cholesterol ratio (r=.45; P<.05), HDL cholesterol (r=–.51; P<.01), and triglycerides (r=.40; P<.05), suggesting that greater WHR was indicative of elevated risk.ConclusionsIt is likely that WHR represents a stronger predictor of risk, because this measure was robustly and independently associated with 3 primary clinical markers of cardiometabolic health in adults with CP.     

Effect of obesity on cardiovascular disease risk factors in African American women

Obesity is a growing health care concern with implications for cardiovascular disease (CVD). Obesity and CVD morbidity and mortality are highly prevalent among African American women. This pilot study examined the association between obesity and the traditional and emerging CVD risk factors in a sample of African American women. Participants comprised 48 women (27 obese, 21 normal weight) aged 18-45. with no known history of CVD. The women completed demographic and 7-day physical activity recall questionnaires. Height and weight were used to determine body mass index (BMI). Hypertension risk was assessed using the average of two resting blood pressure (BP) measurements. Lipid profile, blood glucose, fibrinogen, high-sensitivity C-reactive protein (hs-CRP), plasminogen activator inhibitor-1 (PAI-1), soluble intercellular adhesion molecule-1 (sICAM-1), and E-selectin (eSel) levels were assessed using fasting blood samples. Laboratory findings were interpreted using the American Diabetes Association (ADA) and Adult Treatment Panel (ATP) III reference guidelines as well as manufacturers' reference ranges for the novel CVD risk factors. The most common traditional risk factors were physical inactivity (72.9%), positive family history of CVD (58.3%), and obesity (56.3%). Obese individuals had elevated systolic BP (p = .0002), diastolic BP (p = .0007) and HDL-cholesterol (p = .01), triglyceride (p = .02), hs-CRP (p = .002), and fibrinogen (p = .01), when compared with normal-weight women. The findings suggest an association between obesity and higher prevalence of both traditional and emerging CVD risk factors in young African American women.     

Cyclosporine pharmacokinetics and pharmacodynamics in African American and white subjects

BACKGROUND: Renal allograft survival is lower in African American patients compared with white patients. Interethnic differences in cyclosporine (INN, ciclosporin) pharmacokinetics in renal transplant recipients have been described but have not been well characterized. Pharmacodynamic responses to cyclosporine have not been compared among ethnic groups. METHODS: Healthy men were studied after 5 days on a controlled diet. Cyclosporine concentrations were determined in whole blood drawn at intervals over 24 hours after administration of a microemulsion cyclosporine formulation (4 mg/kg; 9 African American subjects and 9 white subjects) and after a standard cyclosporine formulation (4 mg/kg; 10 African American subjects and 10 white subjects). Inhibition of phytohemagglutinin-P-stimulated interleukin-2 production in whole blood drawn 4 hours after cyclosporine was used as a pharmacodynamic measure to compare the effect of cyclosporine in African American and white subjects. RESULTS: The microemulsion cyclosporine formulation (area under the cyclosporine concentration-time curve, 7432 +/- 560 ng. h/mL in African American subjects and 7043 +/- 454 ng. h/mL in white subjects) was more bioavailable than the standard formulation (area under the cyclosporine concentration-time curve, 4828 +/- 319 ng. h/mL in African American subjects and 4538 +/- 301 ng. h/mL in white subjects); this resulted in an approximately 50% greater area under the cyclosporine concentration-time curve (P < .001 in both ethnic groups). There were no differences between African American subjects and white subjects in any pharmacokinetic measurement, with both the standard and the microemulsion cyclosporine formulations. Inhibition of phytohemagglutinin-P-stimulated interleukin-2 production 4 hours after the administration of cyclosporine was similar in African American subjects (70% +/- 5% inhibition) and white subjects (64% +/- 7% inhibition; P = .5). CONCLUSIONS: The pharmacokinetics and pharmacodynamics of cyclosporine were similar in a matched group of African American and white subjects studied under controlled conditions. Environmental factors may contribute more than genetic variability to the lower bioavailability of cyclosporine reported in African American renal transplant recipients.     

Comparison of lifestyle behaviors and related factors between Asian American and white adults with prediabetes

This study compares lifestyle behaviors and related factors between Asian American and white adults with self‐reported prediabetes and identifies covariates/predictors for regular physical activity and adequate intake of fruits/vegetables. Using data from the United States of America Behavioral Risk Factor Surveillance System, 302 Asian Americans and 9558 white adults were analyzed. There were no significant differences for participating in regular physical activity or consumption of adequate fruits/vegetables between the two groups. Overall, 40% of the respondents engaged in regular physical activity, whereas less than 25% reported an adequate intake of fruits/vegetables. In the adjusted models, compared to white, Asian Americans were less likely to have impaired physical (OR = 0.54, 95% CI: 0.36 0.80) or mental health (OR = 0.36, 95% CI: 0.21, 0.61), or cardiovascular diseases (OR = 0.59, 95% CI: 0.41, 0.87). The covariates/predictors that relate to the behaviors differed between the groups. We conclude that interventions to increase physical activity and healthy eating for Asian American and white adults with prediabetes should address the different covariates/predictors for each group.     

Circulating 25-hydroxyvitamin D concentrations are correlated with cardiometabolic risk among American black and white adolescents living in a year-round sunny climate

OBJECTIVE

Low vitamin D status is common among healthy black and white adolescents residing at southern U.S. latitudes with a year-round sunny climate. Thus we aimed to study the relationships between circulating 25-hydroxyvitamin D [25(OH)D] and cardiometabolic risk factors in this population.

RESEARCH DESIGN AND METHODS

25(OH)D concentrations were measured with liquid chromatography tandem mass spectroscopy in 701 girls and boys (14–18 years old, 54% blacks, 49% females). Cardiometabolic risk was indexed by adipokines, inflammatory markers, fasting glucose, homeostatic model assessment-insulin resistance (HOMA-IR), lipid profile, and blood pressure (BP).

RESULTS

Controlling for age, sex, race, sexual maturation, season, physical activity, and percent body fat, 25(OH)D concentrations were significantly correlated with adiponectin (r = 0.06, P = 0.05), leptin (r = −0.32, P < 0.01), fibrinogen (r = −0.05, P = 0.03), glucose (r = −0.16, P = 0.02), HOMA-IR (r = −0.17, P < 0.01), HDL cholesterol (r = 0.14, P = 0.02), systolic BP (r = −0.10, P = 0.02), and diastolic BP (r = −0.21, P < 0.01). When 25(OH)D concentrations were stratified into increasing tertiles, there were significant linear upward trends for adiponectin (P = 0.01) and HDL cholesterol (P = 0.04), but significant linear down trends for glucose (P < 0.01), HOMA-IR (P < 0.01), and systolic BP (P < 0.01), after adjusting for the above covariates.

CONCLUSIONS

Circulating 25(OH)D concentrations are associated with various adverse cardiometabolic risk factors, independent of adiposity. Clinical trials addressing the effects of vitamin D supplementation on cardiometabolic risk are warranted in adolescents irrespective of their geographical regions.Low vitamin D status as indicated by circulating 25-hydroxyvitamin D [25(OH)D] is linked to cardiometabolic risk factors such as inflammation, insulin resistance, abnormal lipid profile, and high blood pressure (BP) in adults (1–4). However, few studies have evaluated the relationship between 25(OH)D concentrations and these cardiometabolic risk factors in children and adolescents. In this regard, there are at least three studies using the nationally representative sample of children and adolescents from the National Health and Nutrition Examination Survey (NHANES) (5–7). First, in 2009, Reis et al. (5) conducted a cross-sectional analysis of 3,577 fasting nondiabetic youth aged 12 to 19 years (65% whites, 14% blacks, and 11% Mexicans) who participated in the 2001–2004 NHANES. After adjustment for age, sex, race, BMI, and physical activity by self-report, 25(OH)D concentrations were found to be inversely associated with systolic BP and plasma glucose concentrations. Second, Kumar et al. (6) demonstrated that in 6,257 children and adolescents aged 1 to 21 years from the 2001–2004 NHANES sample, vitamin D deficiency (<15 ng/mL) compared with 25(OH)D sufficiency (>30 ng/mL) was associated with increased systolic BP, and lower HDL cholesterol, after multivariable adjustment. Third, in 2011, using the newly updated serum 25(OH)D data released by the National Center for Health Statistics, Ganji et al. (7) studied 5,867 adolescents aged 12–19 years from three cycles of NHANES (2001 to 2002, 2003 to 2004, and 2005 to 2006). They found that serum 25(OH)D was related to homeostatic model assessment–insulin resistance index (HOMA-IR), systolic BP, and HDL cholesterol, but not to C-reactive protein (CRP).Although the aforementioned NHANES studies in children and adolescents have been valuable, there are still questions unaddressed. First, data collection from the south U.S. regions by the study design were limited to the winter season (5–7). Second, most of the data were collected in the geographical regions with relatively high latitudes, such that it is unclear whether low vitamin D status affects cardiometabolic factors in adolescents residing in low latitudes (5–7). Finally, CRP has been the only inflammatory factor used in the analyses in relation to 25(OH)D (7). Other inflammatory factors and, perhaps more noteworthy, adipokines are not yet included.The southeastern region of the U.S. has a sunny climate and relative proximity to the equator, which should favor plentiful cutaneous production of vitamin D. However, we have recently reported that low vitamin D status is common in black and white adolescents (14–18 years of age) residing in Augusta, GA (33° North latitude) (8). Furthermore, plasma 25(OH)D concentrations were consistently and inversely related to the degree of adiposity. Thus the current study aimed to evaluate whether 25(OH)D concentrations were correlated with cardiometabolic risk factors including adipokines, inflammatory markers, fasting glucose, HOMA-IR, lipid profile, and BP independent of adiposity in this adolescent population.     

Adipocytes and cardiometabolic risk

To describe the link between adipocytes and cardiometabolic risk and present mechanisms by which obesity contributes to dysglycemia, dyslipidemia, hypertension, and a prothrombotic, inflammatory state favoring atherogenesis. Review of relevant literature compiled via a literature search (PUBMED) of English-language literature publications between 1994 and 2010. Cardiometabolic risk is a term that includes a series of conditions and factors, which contribute to increased risk of developing atherosclerosis. Cardiometabolic risk encompasses traditional coronary risks factors such as smoking, arterial hypertension, diabetes, obesity, elevated cholesterol, old age, male gender, and a positive family history of early coronary events plus additional contributing factors such as insulin resistance, atherogenic dyslipidemia, physical inactivity, unhealthy eating, inflammation, and hypercoagulable state. Adipocyte accumulation and dysfunction contribute to most, if not all, of the cardiometabolic risk factors. A number of different pathologic mechanisms through which adipocytes contribute to cardiometabolic risk and promote atherosclerosis are reviewed. Dysfunctional adipocytes are associated with the development of insulin resistance, hyperglycemia, atherogenic dyslipidemia and arterial hypertension, and favor a prothrombotic and proinflammatory state. Adipocytes dysfunction increases cardiometabolic risk through a variety of mechanisms.     

Epidemiology and risk factors of the cardiometabolic syndrome in the Middle East

The metabolic syndrome (MetS), a constellation of cardiovascular risk factors, is a growing health challenge worldwide. Most studies on MetS epidemiology are from developed countries. The Middle East is lagging behind in understanding the epidemiology of MetS and its risk factors in the region. This is partly owing to a scarcity of high-quality, nationally representative studies. In a series of recent national surveys, we have studied the epidemiology of MetS and its risk factors in Iran. We review the current situation in the region and highlight current gaps of knowledge and epidemiological concepts that need to be taken into account when doing population-level health programming. We explore the results of our national surveys as successful examples along this path.     

The association of low birth weight and physiological risk factors of hypertension in African American adolescents

Low birth weight (LBW) has been associated with increased blood pressure and the development of cardiovascular disease including hypertension. Elevated blood pressure, cortisol, and hyperresponsiveness during physiologic stress may function as hypertension biological markers. We examined the association of blood pressure and cortisol levels during induced physiologic stress with LBW in an African American adolescent population (n = 106). METHODS AND RESULTS: Birth weight was obtained from parents. Blood pressure and cortisol levels were measured at rest and in response to an induced physiological stressor. Compared with normal birth weight group (n = 73), the LBW group (n = 33) demonstrated elevated (+4 mm Hg) diastolic pressure (P = .002) and cortisol hyperresponsiveness (P = .05). Seventy-nine percent of LBW adolescents had elevated blood pressure and/or cardiovascular reactivity (P = .04), and 39% had elevated blood pressures. CONCLUSIONS: Low birth weight African American adolescents demonstrated physiological risk factors for hypertension, and these findings add support to the association between LBW and the development of hypertension.     

HIV risk behaviors in African American males.

Human immunodeficiency virus/acquired immune syndrome (HIV/AIDS) infection is the fifth leading cause of death for people who are 25-44 years in the United States, and is the leading cause of death for African American men ages 35-44. The incidence rates for HIV among African Americans are steadily increasing, despite wide-spread campaigns to educate the public about the disease. The purpose of this article is to review the epidemiology and statistics related to HIV/AIDS, as well as changes in the epidemic among African American males. A review of the literature was conducted which specifically focused on HIV risk behaviors, changing patterns of behavior, and risk modification among African American males. Opportunities for future research are also detailed.     

Pubertal timing and growth influences cardiometabolic risk factors in adult males and females

OBJECTIVE

Early pubertal onset in females is associated with increased risk for adult obesity and cardiovascular disease, but whether this relationship is independent of preceding childhood growth events is unclear. Furthermore, the association between male puberty and adult disease remains unknown. To clarify the link between puberty and adult health, we evaluated the relationship between pubertal timing and risk factors for type 2 diabetes and cardiovascular disease in both males and females from a large, prospective, and randomly ascertained birth cohort from Northern Finland.

RESEARCH DESIGN AND METHODS

Pubertal timing was estimated based on pubertal height growth in 5,058 subjects (2,417 males and 2,641 females), and the relationship between puberty and body weight, glucose and lipid homeostasis, and blood pressure at age 31 years was evaluated with linear regression modeling.

RESULTS

Earlier pubertal timing associated with higher adult BMI, fasting insulin, diastolic blood pressure, and decreased HDL cholesterol in both sexes (P < 0.002) and with higher total serum cholesterol, LDL cholesterol, and triglycerides in males. The association with BMI and diastolic blood pressure remained statistically significant in both sexes, as did the association with insulin levels and HDL cholesterol concentrations in males after adjusting for covariates reflecting both fetal and childhood growth including childhood BMI.

CONCLUSIONS

We demonstrate independent association between earlier pubertal timing and adult metabolic syndrome-related derangements both in males and females. The connection emphasizes that the mechanisms advancing puberty may also contribute to adult metabolic disorders.Accumulating evidence suggests an association between early timing of puberty and adverse health outcomes later in life. Typically evaluating females only, these studies show that early menarche is correlated with increased risk for several metabolic syndrome-associated disorders in adulthood [e.g., obesity, type 2 diabetes (1,2), and cardiovascular disease (3)]. The relationship between pubertal timing and BMI is particularly well-documented. Declining ages of pubertal onset associate with increased BMI in childhood (4–7). Likewise, studies addressing the link between pubertal timing and later risk for obesity show that pubertal onset is a negative predictor of adult BMI. Some studies claim that the link between puberty and adult BMI is a secondary consequence of a correlation between prepubertal BMI and puberty (6–8), but there are studies suggesting that the association between pubertal timing and adult BMI is independent of the degree of childhood obesity (9–12).Data on the relationship between male pubertal timing and adult metabolic traits are scarce. Although abnormal levels of metabolic syndrome related-traits are more common in males than females, most studies exploring the relationship between pubertal timing and risk of adult disease have used age of menarche as the marker of puberty. One study showed that early pubertal timing may predict central adiposity in adult males (9). In addition, early puberty has been associated with elevated blood pressure in two reports, although the sample size was limited to only 135 males and 148 females in one of the studies (13,14). In contrast, early puberty was not associated with increased serum triglyceride levels in adult males, even if early puberty correlated with elevated triglycerides in adult females (12). Studies on the relationship between pubertal timing and adult glucose homeostasis in males appear to be lacking.Because the risk for adult metabolic disease is shaped over the life course, detailed knowledge of the link with critical developmental events may highlight important pathogenic mechanisms. Therefore, to disentangle the relationship between puberty and cardiometabolic risk in both sexes, we studied 2,417 males and 2,641 females of a large, unique, and genetically homogenous birth cohort with data on longitudinal childhood growth and a wide spectrum of adult of cardiometabolic risk factors. Our study had the following specific aims: 1) to assess the relationship between pubertal timing and adult body size, glucose, lipids, and blood pressure, both by evaluating the effect of pubertal timing alone and adjusting for patterns of prepubertal growth, and 2) to quantify the size of the pubertal timing effect on adult metabolic risk. Pubertal timing was assessed based on height growth during adolescence using a previously validated measurement, which allowed us to estimate the timing of puberty similarly in both sexes.     

Endocannabinoid system and cardiometabolic risk

The increasing prevalence of overweight and obesity counteracts the favorable advances of risk factor management achieved for cardiovascular disease (CVD) prevention. Obese and overweight individuals are at increased risk for CVDs and diabetes mellitus, a risk pattern called "cardiometabolic risk." There is a growing interest concerning the role of the endocannabinoid system in energy metabolism and how blockade of cannabinoid receptors (CB(1)) may optimize fat distribution, insulin sensitivity, and blood lipids to improve cardiovascular risk profile.