1/10. The clinical implications of insulin resistance.insulin resistance is a prime risk factor associated with atherosclerosis and thrombosis. Other risk factors include dyslipidemia, obesity, and hypertension. The constellation of those factors, which is known as the cardiovascular dysmetabolic syndrome, increases the risk of macrovascular disease. insulin resistance may contribute directly to cardiovascular disease and may also act as a precursor of diabetes, which is also associated with an increased risk of macrovascular disease. insulin resistance can be difficult to assess clinically, but it is invariably present in patients with type 2 diabetes, impaired fasting glucose, or impaired glucose tolerance. Treatment of insulin resistance includes diet, exercise, smoking cessation, strict control of hypertension, aggressive treatment of lipid abnormalities, and keeping the hemoglobin A1c level below 7%. New oral agents improve glycemic control for those with diabetes or insulin resistance, but their role in reducing the risk of macrovascular disease is undetermined.- - - - - - - - - - ranking = 1keywords = obesity (Clic here for more details about this article) |
2/10. Ethnic disparities in cardiovascular health.Disparities in the cardiovascular outcomes of African-American patients is evident from national, regional, and local statistical data, as well as from the daily practice of medicine. This discussion highlights the complexity of ethnic disparities using a case-based approach with two typical cases from a cardiology practice. These cases underscore the complex interplay of the following factors in ethnic disparities. 1. Excess burden of cardiovascular risk factors in african americans, with particular emphasis on high blood pressure, diabetes, obesity, physical inactivity, and psychosocial stress. 2. Inadequate knowledge of how personal risk factors are directly linked to atherosclerosis and heart disease. 3. Cultural factors in symptom recognition and health-care seeking behavior. 4. Economic factors influencing access to health care including prevention, diagnosis, and treatment. 5. A combination of psychosocial stress, racism, and frustration leading to sub-optimal interactions with the health care system. 6. genetics of disease and predisposition to vascular disease and atherosclerosis. We must come to terms with these fundamental factors in the causation and, therefore, the resolution of ethnic disparities in cardiovascular health. Successful strategies must include: 1) partnerships for long-term, sustainable, population-wide strategies on risk factor modification; 2) models of culturally competent health care delivery; and 3) research on the gene-environment interactions, which cause the susceptibility of ethnic minorities to cardiovascular disease.- - - - - - - - - - ranking = 1keywords = obesity (Clic here for more details about this article) |
3/10. Dysmetabolic syndrome: multiple risk factors for premature adult disease in an adolescent girl.The clinical diagnosis of dysmetabolic syndrome in an adult defines a patient with abnormal glucose metabolism (or diabetes), hypertension, hyperlipidemia, and obesity. This disorder accelerates atherosclerosis and significantly raises the risk for cardiovascular events. With the marked rise in the prevalence of obesity in childhood, obesity-linked risk factors are being expressed at young ages. The case of a 12-year-old girl with dysmetabolic syndrome is described and discussed. Emerging clinical data now indicate that the presence of 1 risk factor for cardiovascular disease in an overweight child should prompt screening for additional clinical abnormalities, with the aim of finding treatable disorders.- - - - - - - - - - ranking = 3keywords = obesity (Clic here for more details about this article) |
4/10. obesity and the metabolic syndrome.The prevalence of marked obesity is increasing rapidly among adults and has more than doubled in 10 years. Sixty-one percent of the adult population of the united states is overweight or obese. Americans are the fattest people on earth. Paradoxically these increases in the numbers of persons who are obese or overweight have occurred during recent years when Americans have been preoccupied with numerous dietary programs, diet products, weight control, health clubs, home exercise equipment, and physical fitness videos, each "guaranteed" to bring rapid results. overweight and obesity are also world problems. The world health organization estimates that 1 billion people around the world are now overweight or obese. Westernization of diets has been part of the problem. Fruits, vegetables, and whole grains are being replaced by readily accessible foods high in saturated fat, sugar, and refined carbohydrates. Since class 3 obesity (morbid or extreme obesity) is associated with the most severe health complications, the incidence of hypertension, stroke, heart disease, diabetes, and peripheral vascular disease will increase substantially in the future. Recently, obesity alone has been implicated in the development of cardiac hypertrophy and CHF. The metabolic syndrome associated with abdominal obesity, which includes insulin resistance, dyslipidemia, and elevated CRP levels, identifies subjects who have an increase in cardiovascular morbidity and mortality. Twenty to 25% of the adult population in the united states have the metabolic syndrome, and in some older groups this prevalence approaches 50%. The prevalence of overweight children in the united states has also been increasing dramatically, especially among non-Hispanic blacks and Mexican-American adolescents. overweight children usually become overweight adults. atherosclerosis begins in childhood. The degree of atherosclerotic changes in children and young adults can be correlated with the presence of the same risk factors seen in adults. As health providers, our direction is obvious!- - - - - - - - - - ranking = 6keywords = obesity (Clic here for more details about this article) |
5/10. The type 2 tablet. Evidence based medication for type 2 diabetes.BACKGROUND: Diabesity--the association of type 2 diabetes and obesity--is a major public health problem worldwide and is increasing dramatically in australia. The abnormalities associated with diabetes, the 'type 2 diabetes syndrome' are cardiovascular risk factors and increased cardiovascular events. The full implications of type 2 diabetes syndrome may not be fully appreciated and opportunities for effective interventions may be being missed. OBJECTIVE: This article aims to review the cardiovascular risk associated with type 2 diabetes syndrome and to summarise the evidence supporting wider use of medications that target the different components of type 2 diabetes syndrome. DISCUSSION: The cardiovascular benefits of metformin, the ACE inhibitors, aspirin and the statins have been shown in prospective controlled trials and the beneficial effects of these medications are additive. There is a case for these medications to be considered for those with type 2 diabetes (and an opportunity for the pharmaceutical industry to provide the 'type 2 tablet' containing all four medications).- - - - - - - - - - ranking = 1keywords = obesity (Clic here for more details about this article) |
6/10. Polycystic ovary (Stein-Leventhal) syndrome: etiology, complications, and treatment.polycystic ovary syndrome (PCOS) occurs in approximately 3% to 5% of the female population and may be the leading cause of infertility in those of reproductive age. PCOS presents clinically with a variety of signs and symptoms; the most common being menstrual irregularities, hyperandrogenism, infertility, and obesity. The true pathophysiology has not been clearly elucidated; however, there is growing agreement that gonadotropin dynamic dysfunction, hyperandrogenism, and insulin resistance are key features. The diagnosing of PCOS involves radiologic and laboratory studies. Radiologic studies typically include pelvic ultrasound; laboratory data should be obtained regarding pertinent gonadotropins and other hormone levels. PCOS is not a benign condition. It may lead to complications involving glucose metabolism, dyslipidemias, cardiovascular disease, and cancer. The goals of treatment should focus on restoring menstrual regularity, decreasing androgen excesses, and decreasing insulin resistance.- - - - - - - - - - ranking = 1keywords = obesity (Clic here for more details about this article) |
7/10. Heart disease, schizophrenia, and affective psychoses: epidemiology of risk in primary care.A retrospective cohort design was used to study risk factors and cardiovascular end points among adults, with and without psychoses, receiving primary care. Earlier onset of risk factors and heart disease was noted among individuals with schizophrenia compared to those with affective psychoses and no disabilities. patients with schizophrenia had increased relative risk for obesity, congestive heart failure, dementia, depression and death, while patients with affective psychoses had increased risk for dementia and diabetes.- - - - - - - - - - ranking = 1keywords = obesity (Clic here for more details about this article) |
8/10. family history of heart attack as an independent predictor of death due to cardiovascular disease.Although a family history of ischemic heart disease is a well-accepted risk factor for cardiovascular disease, only three prospective studies--all in men--have examined the predictive strength of a positive family history after adjusting for other heart disease risk factors. The present analysis is based on a 9 year follow-up of 4014 men and women from 40 to 79 years old who resided in Rancho Bernardo, CA, and who reported no known cardiovascular disease in response to a standardized interview. At baseline 38% of this group reported a family history of a heart attack in a parent, sibling, or child; 15% of those with a positive family history in a first-degree relative indicated that the heart attack had occurred before the relative was 50 years old. Younger men (less than 60 years) with a positive family history at any age had significantly higher mean blood pressures and total plasma cholesterol levels; older men were more likely to have diabetes mellitus. Younger women with a positive family heart attack to subsequent cardiovascular death was determined by the Cox model after adjusting for age, systolic blood pressure, total plasma cholesterol level, obesity, cigarette smoking, personal history of diabetes, and estrogen use (in women). In men, but not in women, a positive family history of heart attack was independently predictive of death from all causes and from cardiovascular and ischemic heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = obesity (Clic here for more details about this article) |
9/10. The reactions of patients and doctors in the united arab emirates towards smoking.One hundred male U.A.E. nationals (50 smokers and 50 non-smokers) rated their own risk for developing heart disease, developing arthritis and having an automobile accident; and the risks facing the average smoker and average non-smoker. Smokers in the U.A.E., like smokers in the U.K., exhibited "constrained optimism." Non-smokers, unlike non-smokers in the U.K., were "pessimistic" about their chances of developing heart disease and having an accident. Eighty-two male doctors, 41 smokers and 41 non-smokers, were asked to respond to two hypothetical patients (one with long-term obesity newly diagnosed as being hypertensive, the other a long-term smoker newly diagnosed as having lung cancer). Compared with smoker doctors, doctors who themselves did not smoke expected to feel more uncomfortable when managing the smoker patient, and perceived him as more responsible for his condition. Possible reasons for these results, their implications and ways of pursuing the issues raised are discussed.- - - - - - - - - - ranking = 1keywords = obesity (Clic here for more details about this article) |
10/10. Non-insulin-dependent diabetes mellitus (NIDDM) in Asians in the UK.South Asian subjects in the United Kingdom have a substantially increased risk of both diabetes and cardiovascular disease. The excess risk of cardiovascular disease is not explained by risk factors such as smoking, blood pressure or dyslipidaemia. It has been proposed that the insulin resistance syndrome, perhaps consequent upon central obesity, may underlie the risk of both glucose intolerance and cardiovascular disease. In non-diabetic south Asian subjects we have found higher concentrations of insulin and of proinsulin-like molecules, higher blood pressure, and lower concentrations of high density lipoprotein cholesterol, but no elevation of activity of plasminogen activator inhibitor. Newly diagnosed diabetic subjects from the south Asian population are younger and thinner than newly diagnosed europid subjects, but are more centrally obese and hyperinsulinaemic. It is possible that the coexistence of diabetes and cardiovascular disease represents the consequence of a common antecedent.- - - - - - - - - - ranking = 1keywords = obesity (Clic here for more details about this article) |
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