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The ticking time bomb in lifestyle-related diseases among women in the Gulf Cooperation Council countries; review of systematic reviews.
Alshaikh, MK, Filippidis, FT, Al-Omar, HA, Rawaf, S, Majeed, A, Salmasi, AM
BMC public health. 2017;(1):536
Abstract
BACKGROUND This study aims to review all published systematic reviews on the prevalence of modifiable cardiovascular disease risk factors among women from the Gulf Cooperation Council countries (GCC). This is the first review of other systematic reviews that concentrates on lifestyle related diseases among women in GCC countries only. METHOD Literature searches were carried out in three electronic databases for all published systematic reviews on the prevalence of cardiovascular disease risk factors in the GCC countries between January 2000 and February 2016. RESULTS Eleven systematic reviews were identified and selected for our review. Common reported risk factors for cardiovascular disease were obesity, physical inactivity, diabetes, metabolic syndrome and hypertension. In GCC countries, obesity among the female population ranges from 29 to 45.7%, which is one of the highest rates globally, and it is linked with physical inactivity, ranging from 45 to 98.7%. The prevalence of diabetes is listed as one of the top ten factors globally, and was reported with an average of 21%. Hypertension ranged from 20.9 to 53%. CONCLUSIONS The high prevalence of lifestyle-related diseases among women population in GCC is a ticking time bomb and is reaching alarming levels, and require a fundamental social and political changes. These findings highlight the need for comprehensive work among the GCC to strengthen the regulatory framework to decrease and control the prevalence of these factors.
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The role of PPARgamma in cardiovascular diseases.
Kvandová, M, Majzúnová, M, Dovinová, I
Physiological research. 2016;(Suppl 3):S343-S363
Abstract
The peroxisome proliferator-activated receptors (PPAR) belong to the nuclear superfamily of ligand-activated transcription factors. PPARgamma acts as a nutrient sensor that regulates several homeostatic functions. Its disruption can lead to vascular pathologies, disorders of fatty acid/lipid metabolism and insulin resistance. PPARgamma can modulate several signaling pathways connected with blood pressure regulation. Firstly, it affects the insulin signaling pathway and endothelial dysfunction by modulation of expression and/or phosphorylation of signaling molecules through the PI3K/Akt/eNOS or MAPK/ET-1 pathways. Secondly, it can modulate gene expression of the renin- angiotensin system - cascade proteins, which potentially slow down the progression of atherosclerosis and hypertension. Thirdly, it can modulate oxidative stress response either directly through PPAR or indirectly through Nrf2 activation. In this context, activation and functioning of PPARgamma is very important in the regulation of several disorders such as diabetes mellitus, hypertension and/or metabolic syndrome.
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Assessment of the environmental and genetic factors influencing prevalence of metabolic syndrome in Saudi Arabia.
Gosadi, IM
Saudi medical journal. 2016;(1):12-20
Abstract
Metabolic syndrome (MS) is a combination of factors that increases the risk of cardiovascular atherosclerotic diseases including diabetes, obesity, dyslipidemia, and high blood pressure. Cardiovascular diseases are one of the leading causes of death in the adult Saudi population where the increase in cardiovascular-related mortality is augmented by the rise in the prevalence of MS. Metabolic syndrome is a multi-factorial disorder influenced by interactions between genetic and environmental components. This review aims to provide a comprehensive assessment of studied environmental and genetic factors explaining the prevalence of MS in the Kingdom of Saudi Arabia. Additionally, this review aims to illustrate factors related to the population genetics of Saudi Arabia, which might explain a proportion of the prevalence of MS.
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Prognostic interactions between cardiovascular risk factors.
Vishram, JK
Danish medical journal. 2014;(7):B4892
Abstract
BACKGROUND Cardiovascular disease (CVD) still remains the leading cause of death worldwide, especially in Europe where the prevalence of hypertension is 60% higher compared with the United States and Canada and the clustering of hypertension and the metabolic disorders central adiposity, dyslipidemia and dysglycemia, known as the metabolic syndrome (MetS), affects 25% of the population. Despite the great initiatives of many primary prevention strategies, risk factor control is still poor. In an attempt to optimize risk factor control, two issues among others have been of great debate in the past decade: (1) the superiority of systolic blood pressure (SBP) as a risk factor in the elderly; and (2) the clinical relevance of MetS. However, in order to further elucidate these issues, we need to get a deeper understanding of how the cardiovascular risk factors interact with one another. Thus, prognostic interactions were used in the present PhD thesis to test the following hypotheses: Primary hypotheses: (1) The superiority of SBP over diastolic blood pressure (DBP) as a risk factor occurs at an earlier age if an individual presents with other cardiovascular risk factors. (2) The prevalence and prognostic significance of MetS differ according to age and gender. The first hypothesis is explored in paper 1 (for the endpoint fatal and nonfatal (total) stroke) and paper II (for mortality from coronary heart disease (CHD), stroke, and all-causes), while the second hypothesis is explored in paper III (for total CHD, total stroke, and CVD mortality). METHODS Using 34-42 cohorts from the MORGAM Project with baseline between 1982-1997, approximately 68 000-86 000 apparently healthy men and women aged 19-78 years, without CVD (papers I-III) and not receiving antihypertensive treatment (papers I-II) were included. During 12-13 years of follow-up, the incident events of total stroke were up to 1957, of total CHD were 4368, and of all-cause mortality were 7903. In papers I-II, event risk was analyzed by multivariate-adjusted Cox regressions including SBP and DBP simultaneously, as well as other cardiovascular risk factors and any significant interactions between variables. In paper III, MetS prevalence and prognostic significance was considered according to modified definitions of the International Diabetes Federation (IDF) and the revised National Cholesterol Education Program - Adult Treatment Panel (NCEP-ATP III), and the influence of possible interactions between age and gender on MetS prevalence and prognostic significance was explored using logistic as well as multivariate-adjusted Cox regressions. MetS was analyzed separately for men and women in various age-groups. RESULTS Taking into account the significant interactions between cardiovascular risk factors, the results were as follows: Papers I-II: Age-related shifts were shown for the independent relative importance of SBP and DBP as risk factors for stroke (both total and fatal) and all-cause mortality, but not for CHD mortality where SBP remained significant in all ages. The prognostic shift to the superiority of SBP was significantly established in the 6th decade, and only for stroke mortality was this shift influenced by other cardiovascular risk factors, such that it occurred at an earlier age in men from high-risk countries and with a higher cholesterol level. However, from mid-age and onwards, a potential harmful effect of low DBP for the risk of total stroke and all-cause mortality was present. Paper III: The prevalence and prognostic significance of MetS showed great variations among countries and were influenced by both age and gender. With older age, the prevalence of MetS increased 5-fold in women from ages 19-39 years to 60-78 years and 2-fold in men. The CVD risk associated with MetS was (1) higher in women than in men especially when using the NCEP-ATP III criteria, and (2) independently of age in men whereas in women total CHD risk decreased significantly and the total stroke risk tended to increase (although not significant) with older age. CONCLUSION The present thesis elucidates through prognostic interactions the complex interplay between cardiovascular risk factors. Our results indicate the independent prognostic superiority of SBP in elderly Europeans, and only for stroke mortality risk this prognostic superiority of SBP was influenced by other cardiovascular risk factors such that it was established at an earlier age. The prevalence and prognostic significance of MetS differed according to both age and gender. In women, MetS was associated with higher relative event risks and the MetS associated relative CHD risk decreased with advancing age.
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Genes for blood pressure: an opportunity to understand hypertension.
Ehret, GB, Caulfield, MJ
European heart journal. 2013;(13):951-61
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Abstract
Hypertension (HTN) is quantitatively the major cardiovascular risk factor and responsible for ∼50% of cardiovascular morbidity and mortality. Blood pressure (BP) is also a classical complex genetic trait with heritability estimates of 30-50%. Although much is known about BP regulation, the intrinsic origin of essential HTN remains obscure although many environmental factors are known. Analyses of rare monogenic syndromes of HTN have focused attention on pathways that involve renal sodium handling, and steroid hormone metabolism including the mineralocorticoid receptor activity. The genetic basis of common essential HTN on the other hand is only just becoming accessible through high-throughput approaches. Unbiased genome-wide analyses of BP genomics have identified 43 genetic variants associated with systolic, diastolic BP, and HTN. It is highly likely based on current findings that there are hundreds of such loci with small effects on BP, opening a perspective on the genetic architecture of BP that was unknown before. It is our hope that the knowledge of these and further loci will lead to improved understanding of BP pathophysiology and to the identification of new targets for drug therapy.
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Aldosterone, hypertension, and beyond.
Samavat, S, Ahmadpoor, P, Samadian, F
Iranian journal of kidney diseases. 2011;(2):71-6
Abstract
Aldosterone, a mineralocorticoid hormone, has a well-known function on water balance and blood pressure homeostasis. Recently, its role in metabolic syndrome, insulin resistance, and obesity has come into a spotlight. Aldosterone induces inflammation and oxidative stress that are attenuated by mineralocorticoid receptor blockers such as spironolactone. Aldosterone exerts its effects via the epithelial sodium channel by non-genomic pathways, including serum and glucocorticoid kinase 1, neural precursor cell-expressed developmentally downregulated (gene 4) protein, and K-Ras, and genomic pathways via epigenetic mechanisms. Beyond regulating epithelial sodium channel, aldosterone induces cardiac hypertrophy, endothelial dysfunction, podocyte injury, and fibrosis. This opens new horizons for mineralocorticoid receptor antagonists and novel therapeutic targets such as serum-glucocorticoid regulated kinase 1.
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Thiazide and loop diuretics.
Sica, DA, Carter, B, Cushman, W, Hamm, L
Journal of clinical hypertension (Greenwich, Conn.). 2011;(9):639-43
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Abstract
KEY POINTS AND PRACTICAL RECOMMENDATIONS • Although chlorthalidone and hydrochlorothiazide are structurally similar, they are very different pharmacokinetically, with chlorthalidone having both an extremely long half-life (approximately 40 to 60 hours) and a large volume of distribution, with gradual elimination from the plasma compartment by tubular secretion. • Furosemide usage, the most widely used diuretic in the loop diuretic class, can be complicated by extremely erratic absorption, with a bioavailability range of 12% to 112%. • Chlorthalidone, at a dose of 25 mg, is comparatively more potent than 50 mg of hydrochlorothiazide, particularly as related to overnight blood pressure reduction. • In ALLHAT, there was no difference among chlorthalidone, amlodipine, lisinopril, and doxazosin for the primary outcome or mortality. • Secondary outcomes were similar except for a 38% higher rate of heart failure with amlodipine; a 10% higher rate of combined cardiovascular disease, a 15% higher rate of stroke, and a 19% higher rate of heart failure with lisinopril; and a 20% higher rate of cardiovascular disease, a 20% higher rate of stroke (40% higher rate in blacks), and an 80% higher rate of heart failure with doxazosin, compared with chlorthalidone. • The ACCOMPLISH study may affect future practice guidelines as a result of its findings favoring the amlodipine/benazepril combination; however, the generalizability to patient populations with a lesser cardiovascular risk profile remains in question and the dose of hydrochlorothiazide was only 12.5 mg to 25 mg daily, which was a dose lower than that used in placebo-controlled trials using hydrochlorothiazide. • Certain low-renin patient groups (eg, blacks, the elderly, and diabetics) as well as those who manifest the metabolic syndrome are commonly more responsive to thiazide-type diuretic therapy. • Diuretics can be successfully combined with β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, centrally acting agents, and even calcium channel blockers. • Although thiazide-type diuretics are among the best-tolerated antihypertensive agents in terms of symptomatic adverse effects, diuretic-related adverse side effects include those with established mechanisms (eg, such as electrolyte changes and/or metabolic abnormalities) and other side effects, which are less well understood mechanistically (eg, impotence), although the latter is not universally accepted as a diuretic-related side effect. • Thiazide-induced hypokalemia is associated with increased blood glucose, and treatment of thiazide-induced hypokalemia may reverse glucose intolerance and possibly prevent diabetes. • Thiazide-induced hyperuricemia occurs as a result of volume contraction and competition with uric acid for renal tubular secretion, but does not necessarily contraindicate using a thiazide, especially if a uric acid-lowering drug such as allopurinol is being used. • Adverse interactions include the blunting of thiazide effects by nonsteroidal anti-inflammatory drugs and the potential to increase fatigue, lethargy, and increase in glucose when combined with β-blockers. • Thiazide-type diuretics are useful first-line agents in the treatment of hypertension because they have been proven to reduce cardiovascular mortality and morbidity in systolic and diastolic forms of hypertension and do so at low cost. • Loop diuretics should not be used as first-line therapy in hypertension since there are no outcome data with them. They should be reserved for conditions of clinically significant fluid overload (eg, heart failure and significant fluid retention with vasodilator drugs, such as minoxidil) or with advanced renal failure and can be combined with thiazide-type diuretics.
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Epidemiology of hypertension and chronic kidney disease in China.
Chen, J
Current opinion in nephrology and hypertension. 2010;(3):278-82
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PURPOSE OF REVIEW Hypertension and chronic kidney disease have become major public health challenges in China. RECENT FINDINGS It is estimated that approximately 153 million Chinese adults had hypertension in 2002. It is also estimated that 2.33 million total cardiovascular deaths and 1.27 million premature cardiovascular deaths were attributable to increased blood pressure in 2005 in China. Approximately 39% of Chinese adult populations are highly sensitive to dietary sodium intake, a risk factor for hypertension and cardiovascular disease. The prevalence of chronic kidney disease varied greatly among studies due to differences in study populations and definitions of chronic kidney disease. A large prospective cohort study estimates that incidence and mortality of end-stage renal disease was 30.7 and 20.9 per 100,000 person-years among Chinese adults aged 40 years and older. Hypertension and the metabolic syndrome have been documented as risk factors for chronic kidney disease. In addition, a J-shaped association between body weight and incidence of end-stage renal disease and an inverse association between alcohol consumption and risk of end-stage renal disease were documented. SUMMARY These results underscore the urgent need to develop national strategies for the prevention, detection, and treatment of hypertension and chronic kidney disease.
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Relative risk of diabetes, dyslipidaemia, hypertension and the metabolic syndrome in people with severe mental illnesses: systematic review and metaanalysis.
Osborn, DP, Wright, CA, Levy, G, King, MB, Deo, R, Nazareth, I
BMC psychiatry. 2008;:84
Abstract
BACKGROUND Severe mental illnesses (SMI) may be independently associated with cardiovascular risk factors and the metabolic syndrome. We aimed to systematically assess studies that compared diabetes, dyslipidaemia, hypertension and metabolic syndrome in people with and without SMI. METHODS We systematically searched MEDLINE, EMBASE, CINAHL & PsycINFO. We hand searched reference lists of key articles. We employed three search main themes: SMI, cardiovascular disease, and each cardiovascular risk factor. We selected cross-sectional, case control, cohort or intervention studies comparing one or more risk factor in both SMI and a reference group. We excluded studies without any reference group. We extracted data on: study design, cardiovascular risk factor(s) and their measurement, diagnosis of SMI, study setting, sampling method, nature of comparison group and data on key risk factors. RESULTS Of 14592 citations, 134 papers met criteria and 36 were finally included. 26 reported on diabetes, 12 hypertension, 11 dyslipidaemia, and 4 metabolic syndrome. Most studies were cross sectional, small and several lacked comparison data suitable for extraction. Meta-analysis was possible for diabetes, cholesterol and hypertension; revealing a pooled risk ratio of 1.70 (1.21 to 2.37) for diabetes and 1.11 (0.91 to 1.35) of hypertension. Restricting SMI to schizophreniform illnesses yielded a pooled risk ratio for diabetes of 1.87 (1.68 to 2.09). Total cholesterol was not higher in people with SMI (Standardized Mean Difference -0.10 (-0.55 to 0.36)) and there were inconsistent data on HDL, LDL and triglycerides with some, but not all, reporting lower levels of HDL cholesterol and raised triglyceride levels. Metabolic syndrome appeared more common in SMI. CONCLUSION Diabetes (but not hypertension) is more common in SMI. Data on other risk factors were limited by poor quality or inconsistent research findings, but a small number of studies show greater prevalence of the metabolic syndrome in SMI.
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Spotlight on renin. The renin system, salt-sensitivity and metabolic syndrome.
Fujita, T
Journal of the renin-angiotensin-aldosterone system : JRAAS. 2006;(3):181-3