1.
Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes.
Johnston, CA, Moreno, JP, Foreyt, JP
Current atherosclerosis reports. 2014;16(12):457
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Plain language summary
Obesity is a metabolic risk factor for Type 2 diabetes (T2D) and cardiovascular diseases(CVD). This study was carried out to measure the effectiveness of lifestyle interventions on cardiovascular morbidity and mortality. 5145 overweight and obese patients with T2D were randomised assigned in groups with lifestyle interventions of weight loss through exercise and reduced calorie intake. The control group were given diabetes support and education. The data from this study suggest that lifestyle interventions were effective in weight loss and management of the CVD. However reducing the risk of CVD in comparison to the control group was not determined.
Abstract
Look AHEAD (Action for Health in Diabetes) was a randomized controlled trial that examined the impact of long-term participation in an intensive weight loss intervention on cardiovascular disease (CVD) morbidity and mortality in people with type 2 diabetes (T2D). The results from this trial suggest that intensive lifestyle interventions are effective in helping patients to achieve management of cardiovascular risk factors and reducing the need to initiate medication usage to manage these conditions, though the benefits in terms of the prevention of CVD morbidity and mortality beyond those achieved through aggressive medical management of hypertension and dyslipidemia is not clear. Additional benefits of participation in an intensive lifestyle intervention such as lowered chronic kidney disease risk, blood pressure, medication usage, improved sleep apnea, and partial remission of diabetes are discussed.
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Effects of dehydroepiandrosterone (DHEA) on cardiovascular risk factors in older women with frailty characteristics.
Boxer, RS, Kleppinger, A, Brindisi, J, Feinn, R, Burleson, JA, Kenny, AM
Age and ageing. 2010;39(4):451-8
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Older women have the highest incidence of cardiovascular disease. This is thought to be partly due to declining hormone levels and changes in body composition with age. Dehydroepiandrosterone (DHEA) is a hormone that is associated with improved body composition and sense of wellbeing, and naturally declines with age. The aim of this double-blind, randomised, placebo-controlled trial was to examine the effects of DHEA supplementation on cardiovascular risk factors in older frail women. 88 women with low DHEA levels and an average age of 76 completed the 6-month study. Participants received either 50mg/day DHEA or a placebo for 6 months, along with exercise in the form of either yoga or chair aerobics. All participants also received calcium and vitamin D3 supplementation. Whilst DHEA supplementation increased the levels of sex hormones studied, cardiovascular risk factors such as abdominal fat, blood pressure, cholesterol levels and fasting glucose levels did not change. The authors concluded that short-term DHEA supplementation in older women increases levels of oestrogen and testosterone, but these changes may not have any impact on cardiovascular disease risk.
Abstract
OBJECTIVE this analysis was to investigate the effects of dehydroepiandrosterone (DHEA) on cardiovascular risk factors in older women with frailty characteristics. DESIGN, SETTING AND PARTICIPANTS the study was a double-blind, randomised, placebo-controlled trial of 99 women (mean 76.6 +/- 6.0 year) with the low DHEA-S level and frailty. INTERVENTION participants received 50 mg/day DHEA or placebo for 6 months; all received calcium (1,000-1,200 mg/day diet) and supplement (combined) and cholecalciferol (1,000 IU/day). Women participated in 90-min twice weekly exercise regimens, either chair aerobics or yoga. MAIN OUTCOME MEASURES assessment of outcome variables included hormone levels (DHEA-S, oestradiol, oestrone, testosterone and sex hormone-binding globulin (SHBG)), lipid profiles (total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and triglycerides), body composition measured by dual energy absorptiometry, glucose levels and blood pressure (BP). RESULTS eighty-seven women (88%) completed 6 months of study; 88% were pre-frail demonstrating 1-2 frailty characteristics and 12% were frail with > or =3 characteristics. There were significant changes in all hormone levels including DHEA-S, oestradiol, oestrone and testosterone and a decline in SHBG levels in those taking DHEA supplements. In spite of changes in hormone levels, there were no significant changes in cardiovascular risk factors including lipid profiles, body or abdominal fat, fasting glucose or BP. CONCLUSION research to date has not shown consistent effects of DHEA on cardiovascular risk, and this study adds to the literature that short-term therapy with DHEA is safe for older women in relation to cardiovascular risk factors. This study is novel in that we recruited women with evidence of physical frailty.