Diabetes, Diet and SMI: How can we make a difference?

Size: px
Start display at page:

Download "Diabetes, Diet and SMI: How can we make a difference?"

Transcription

1 Diabetes, Diet and SMI: How can we make a difference? Dr. Adrian Heald Consultant in Endocrinology and Diabetes Leighton Hospital, Crewe and Macclesfield Research Fellow, Manchester University

2 Relative risk Weight gain significantly increases diabetes risk Relative risk of type 2 diabetes according to BMI in women aged years < BMI (kg/m 2 ) Colditz GA, et al. Ann Intern Med. 1995;122(7):

3 Metabolic syndrome

4 The Inter-Relationship of Risk Factors and Consequences Raised fasting plasma glucose Obesity Raised triglyceride levels Reduced HDL cholesterol Raised blood pressure Metabolic syndrome Cardiovascular disease Mortality/morbidity HDL = High-density Lipoprotein; NECP = National Cholesterol Education Program Wilson et al. Circulation. 1998;97: ; NCEP Expert Panel. Circulation. 2002;106:

5 Metabolic Syndrome IDF definition 2005 Metabolic syndrome defined as criterion one plus any two of next four criteria: Central obesity Blood pressure Triglycerides Men 94 cm (37inches) Women 80 cm (31.5 inches) 130/85 mmhg* 150 mg/dl (1.7 mmol/l)* HDL cholesterol Men <40 mg/dl (1.03 mmol/l)* Women <50 mg/dl (1.29mmol/L)* Fasting blood glucose 100mg/dL ( 5.6 mmol/l) (recommend OGTT) *Or on treatment; or known type 2 diabetes IDF = International Diabetes Federation; HDL = High-density Lipoprotein; OGTT = Oral Glucose Tolerance Test Available at

6 Fasting blood sample Definitions Fasting venous glucose 6.0mM or less normal Fasting venous glucose impaired fasting glycaemia Fasting venous glucose 7.0mM or more type 2 diabetes if symptomatic (2 blood levels of 7.0mM or more required if patient is asymptomatic) 75 gram oral glucose tolerance test 2hour venous glucose 11.1mM or more type 2 diabetes 2hour venous glucose mm impaired glucose tolerance

7 Metabolic Health is a Major Controversy in Mental Health Care Life expectancy for individuals with schizophrenia is 20% lower than that of the general population Schizophrenia carries a 1.5 to 3 times greater mortality risk than is found in the general population Increased risk of morbidity Medical illnesses, Psychiatric comorbidities Decreased access to care Poverty Limited insight Harris & Barraclough. Br J Psychiatry. 1998;173:11 53; Brown et al. Br J Psychiatry. 2000;177: ; Baxter. Br J Psychiatry. 1996;168:

8

9 Osborn et al, Arch Gen Psychiatry Vol 64 Feb 2007 A total of people with Severe Enduring Mental illness (SMI) and without SMI were selected for the study Hazard ratios (HRs) in people with SMI compared with controls were: for CHD mortality 3.22 (95% [CI], ) for people years old 1.86 (95%CI, ) for those 50 through 75 years old 1.05(95% CI, ) for those older than 75 years

10 Osborn et al, Arch Gen Psychiatry Feb 2007 For stroke deaths, the HRs were: 2.53 (95% CI, ) for those younger than 50 years 1.89 (95% CI, ) for those 50 through 75 years old 1.34 (95% CI, ) for those older than 75 years Lung tumour related death rate of 1.32 (95% CI, ) for those 50 to 75 years old lost statistical significance after controlling for smoking and social deprivation

11 Increased HRs for CHD mortality occurred irrespective of sex, SMI diagnosis, or prescription of antipsychotic medication However, a higher prescribed dose of antipsychotics predicted greater risk of mortality from CHD and stroke

12 Antipsychotics and weight gain

13 Weight change (kg) Weight change (lb) Antipsychotics and associated weight gain Short-term mean weight change with some antipsychotics 6 Estimated weight change at 10 weeks on standard dose Aripiprazole Allison DB, et al. Am J Psychiatry 1999;156:1686

14 Metabolic syndrome prevalence (%) Metabolic syndrome prevalence over the disease course of schizophrenia (n=415) First episode <10 years years >20 years ATP III ATP IIIA IDF De Hert M, et al. Clin Pract Epidemol Ment Health 2006;2:14

15 Prevalence of Metabolic Syndrome by Age: ATP III and IDF criteria Metabolic syndrome prevalence (%) years (ATP III) years (IDF) General population years (ATP III) Patients with schizophrenia years (IDF) ATP III = Adult Treatment Panel III; IDF = International Diabetes Federation De Hert et al. Clin Pract Epidemol Ment Health. 2006;2:14

16 Mortality (%) Metabolic Syndrome Increases Total and Cardiovascular Mortality *** 18.0 Metabolic syndrome present Metabolic syndrome absent *** Total mortality CV mortality 2.2 ***p<0.001 vs. patients without metabolic syndrome CV = Cardiovascular Isomaa et al. Diabetes Care. 2001;24: Median follow-up: 6.9 years

17 Prevalence of Diabetes in Schizophrenia vs. General Population Prevalence (%) General population People with schizophrenia n=415 patients with schizophrenia De Hert et al. Clin Pract Epidemiol Mental Health. 2006;2:14 Age range (years)

18 Odds ratios CVD Risk Factors: More than Additive Effect of Multiple Risk Factors Multiple risk factors Single risk factors BMI >27 Smoking TC >220 DM HTN Smoking + BMI Smoking + BMI + TC >220 Smoking + BMI + TC >220 + DM Smoking + BMI + TC >220 + DM + HTN CVD = Cardiovascular Disease; BMI = Body Mass Index; TC = Total Cholesterol; DM = Diabetes Mellitus; HTN = Hypertension Based on data from Framingham Heart Survey Casey et al. J Clin Psychiatry. 2004;65(Suppl 7):4 18; Data from Wilson et al. Circulation. 1998;97:

19 Primary Care data

20 Cheshire SMI data (GP database) 453 patients (55.8% male 44.2% female) on the SMI Register in Cheshire, UK were screened for dysglycaemia (screening rate 57.3 %) and dyslipidaemia (screening rate 36.2%) Multivariate linear regression analysis revealed a direct relation between fasting glucose levels and BMI (Spearman s rho = 0.22, p<0.001) independent of age, sex, systolic blood pressure and fasting cholesterol and triglycerides.

21 Fasting glucose (mmol/l) Cheshire SMI data 2008 Relation between fasting glucose and BMI Body Mass Index (kg/m2)

22 Cheshire SMI 10 year follow-up data (GP database) 1511 diabetes patients BMI Phenotypic measurements taken yearly from 2002 to of 1511 patients had at least 1 weight measurement with calculation of BMI

23 246 patients had measurements at 1 time point 240 patients had measurements at 2 time points 225 patients had measurements at 3 time points 172 patients had measurements at 4 time points 140 patients had measurements at 5 time points 114 patients had measurements at 6 time points 76 patients had measurements at 7 time points 44 patients had measurements at 8 time points 29 patients had measurements at 9 time points 23 patients had measurements at 10 time points

24 P-value <0.001; r 2 = 0.82

25 Cheshire SMI 10 year follow-up data (GP database) 1511 diabetes patients Glucose 1111 patients had plasma glucose data on at least 1 time point Followed up

26 280 patients had measurements at 1 time point 259 patients had measurements at 2 time points 187 patients had measurements at 3 time points 159 patients had measurements at 4 time points 110 patients had measurements at 5 time points 71 patients had measurements at 6 time points 26 patients had measurements at 7 time points 14 patients had measurements at 8 time points 5 patients had measurements at 9 time points 0 patients had measurements at 10 time points

27 P-value 0.022; r 2 = 0.50 for glucose vs time P-value 0.10; r 2 = 0.29 for glucose vs BMI over all time points

28 Lifestyle Factors

29 Cromwell House Study 2007 (Salford UK) 25 men and 12 women with SMI Mean illness duration was 11.6 years Mean portions of fruit per day were (standard deviation) and of vegetables was ) Total fruit and vegetable portions were Vegetables were eaten on 3 days or more each week by 59.4% of individuals but fruit was only eaten on 3 days or more each week by 34.4% of the group with 37.5% reporting not eating fruit on any day of the week

30 Exercise (moderate activities) 10% 6% 3-5hours >5hours None 29% hours <1hour 39%

31 Insight Diet: Patient ratings on a visual scale of 1-10 for the Q. Would you describe your diet as healthy (average over last 3 months)? gave a mean of 5.7/10 Activity: Q. Would you consider yourself fairly physically active (average over last 3 months)? gave a mean of 5.0/10 Medication compliance: Q. Are you compliant with medication prescribed for you to take (over last 3 months)? gave a mean of 9.8/10

32 Conclusion 1 Within this sample there was a high prevalence of poor diet, smoking and inadequate exercise Many did not follow national recommendations for dietary intake of fruit and vegetables and daily exercise But many had insight into their unhealthy lifestyles Thus there is potential for interventions to improve lifestyle factors and reduce the risk of cardiometabolic disease

33 McCreadie et al. Br J Psych 2005; 187: people with schizophrenia in two areas of Scotland were randomly allocated: to receive free fruit and vegetables for 6 months alone to receive free fruit and vegetables for 6 months alone with instruction in meal planning and food preparation or to continue as before

34 Effects of any lifestyle intervention are not sustained McCreadie et al. Br J Psych 2005; 187:

35 Update on Lipids

36 Annual age-standardised CHD mortality (%) CHD mortality rises in line with total cholesterol Total cholesterol (mmol/l) Stamler J, Wentworth D, Neaton JD. JAMA 1986; 256:

37 Benefits of lowering cholesterol Nine large randomised trials (n=60,078) show that lowering cholesterol improves cardiovascular outcomes Reducing total cholesterol by 20% reduces CHD event rates by 20-30% Patients at highest risk of an event show most benefit

38 Survival free of event SIMVASTATIN: VASCULAR EVENT by FOLLOW-UP DURATION 100% 95% 90% 85% 80% 75% 55 ± 5.8 LESS per 1000 allocated SIMVASTATIN (logrank 2P< ) STATIN PLACEBO Years of follow-up

39 Annual CHD mortality rate Reducing cholesterol reduces CHD mortality 1.8% 1.6% 1.4% 1.2% LIPID CARE HPS 4S High risk study groups 1.0% POSCH 0.8% Low risk study groups 0.6% 0.4% WOSCOPS LRC 0.2% Helsinki AFCAPS/TexCAPS 0.0% Start of study End of study Total cholesterol (mmol/l)

40 Joint British Guidelines - Update 2006

41 Actions to make a difference Ensure that hyperlipidaemia and hypertension are identified and treated Screen for type 2 diabetes Weight reduction and healthy eating advice Encourage smoking cessation

42

43 Conclusion Obesity, metabolic syndrome and diabetes are highly prevalent in patients with SMI These health issues impact on life expectancy, quality of life and compliance with treatment Longitudinally monitor and target all risk factors: even one change can have a significant impact on risk (Framingham) link with Primary Care Lifestyle analysis with regular advice on diet and exercise is integral to improving cardiometabolic outcome in this group include in mental health reviews

44 Herophilus (Greek Physician, BC) When health is absent, wisdom cannot reveal itself, art cannot become manifest, strength cannot be exerted, wealth is useless and reason is powerless

Antipsychotic-Related Risk for Weight Gain and Metabolic Abnormalities During Development Christoph U. Correll, MD

Antipsychotic-Related Risk for Weight Gain and Metabolic Abnormalities During Development Christoph U. Correll, MD Antipsychotic-Related Risk for Weight Gain and Metabolic Abnormalities During Development Christoph U. Correll, MD Professor of Psychiatry and Molecular Medicine Hofstra North Shore - LIJ School of Medicine

More information

Know Your Number Aggregate Report Single Analysis Compared to National Averages

Know Your Number Aggregate Report Single Analysis Compared to National Averages Know Your Number Aggregate Report Single Analysis Compared to National s Client: Study Population: 2242 Population: 3,000 Date Range: 04/20/07-08/08/07 Version of Report: V6.2 Page 2 Study Population Demographics

More information

Lifestyle factors and the metabolic syndrome in Schizophrenia: a cross sectional study

Lifestyle factors and the metabolic syndrome in Schizophrenia: a cross sectional study DOI 10.1186/s12991-017-0134-6 Annals of General Psychiatry PRIMARY RESEARCH Lifestyle factors and the metabolic syndrome in Schizophrenia: a cross sectional study Adrian Heald 1,2, John Pendlebury 3, Simon

More information

The Metabolic Syndrome: Is It A Valid Concept? YES

The Metabolic Syndrome: Is It A Valid Concept? YES The Metabolic Syndrome: Is It A Valid Concept? YES Congress on Diabetes and Cardiometabolic Health Boston, MA April 23, 2013 Edward S Horton, MD Joslin Diabetes Center Harvard Medical School Boston, MA

More information

The Clinical Unmet need in the patient with Diabetes and ACS

The Clinical Unmet need in the patient with Diabetes and ACS The Clinical Unmet need in the patient with Diabetes and ACS Professor Kausik Ray (UK) BSc(hons), MBChB, MD, MPhil, FRCP (lon), FRCP (ed), FACC, FESC, FAHA Diabetes is a global public health challenge

More information

Is there a mechanism of interaction between hypertension and dyslipidaemia?

Is there a mechanism of interaction between hypertension and dyslipidaemia? Is there a mechanism of interaction between hypertension and dyslipidaemia? Neil R Poulter International Centre for Circulatory Health NHLI, Imperial College London Daegu, Korea April 2005 Observational

More information

Minimising the Impact of Medication on Physical Health in Schizophrenia

Minimising the Impact of Medication on Physical Health in Schizophrenia Minimising the Impact of Medication on Physical Health in Schizophrenia John Donoghue Liverpool Imagination is more important than knowledge Albert Einstein LIFESTYLE Making choices TREATMENT Worse Psychopathology,

More information

The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009

The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009 The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009 Learning Objectives 1. Understand the role of statin therapy in the primary and secondary prevention of stroke 2. Explain

More information

Diabetes Mellitus: A Cardiovascular Disease

Diabetes Mellitus: A Cardiovascular Disease Diabetes Mellitus: A Cardiovascular Disease Nestoras Mathioudakis, M.D. Assistant Professor of Medicine Division of Endocrinology, Diabetes, & Metabolism September 30, 2013 1 The ABCs of cardiovascular

More information

Introduction. Objectives. Psychotropic Medications & Cardiometabolic Risk

Introduction. Objectives. Psychotropic Medications & Cardiometabolic Risk Psychotropic Medications & Cardiometabolic Risk Sam Ellis, PharmD, BCPS, CDE Associate Professor University of Colorado School of Pharmacy Introduction Second GenerationAntipsychotics (SGA) first FDA approved

More information

Cardiovascular Risk Assessment and Management Making a Difference

Cardiovascular Risk Assessment and Management Making a Difference Cardiovascular Risk Assessment and Management Making a Difference Norman Sharpe March 2014 Numbers and age-standardised mortality rates from all causes, by sex, 1950 2010 Death rates halved Life expectancy

More information

Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden

Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden Cardiovascular Disease Prevention (CVD) Three Strategies for CVD

More information

CVD Risk Assessment. Michal Vrablík Charles University, Prague Czech Republic

CVD Risk Assessment. Michal Vrablík Charles University, Prague Czech Republic CVD Risk Assessment Michal Vrablík Charles University, Prague Czech Republic What is Risk? A cumulative probability of an event, usually expressed as percentage e.g.: 5 CV events in 00 pts = 5% risk This

More information

Know Your Number Aggregate Report Comparison Analysis Between Baseline & Follow-up

Know Your Number Aggregate Report Comparison Analysis Between Baseline & Follow-up Know Your Number Aggregate Report Comparison Analysis Between Baseline & Follow-up... Study Population: 340... Total Population: 500... Time Window of Baseline: 09/01/13 to 12/20/13... Time Window of Follow-up:

More information

LDL cholesterol and cardiovascular outcomes?

LDL cholesterol and cardiovascular outcomes? LDL cholesterol and cardiovascular outcomes? Prof Kausik Ray, BSc (hons), MBChB, FRCP, MD, MPhil (Cantab), FACC, FESC Professor of Cardiovascular Disease Prevention St Georges University of London Honorary

More information

Cardiovascular Complications of Diabetes

Cardiovascular Complications of Diabetes VBWG Cardiovascular Complications of Diabetes Nicola Abate, M.D., F.N.L.A. Professor and Chief Division of Endocrinology and Metabolism The University of Texas Medical Branch Galveston, Texas Coronary

More information

Metabolic Monitoring, Schizophrenia Spectrum Illnesses, & Second Generation Antipsychotics

Metabolic Monitoring, Schizophrenia Spectrum Illnesses, & Second Generation Antipsychotics Metabolic Monitoring, Schizophrenia Spectrum Illnesses, & Second Generation Antipsychotics National Council for Behavioral Health Montefiore Medical Center Northwell Health New York State Office of Mental

More information

programme. The DE-PLAN follow up.

programme. The DE-PLAN follow up. What are the long term results and determinants of outcomes in primary health care diabetes prevention programme. The DE-PLAN follow up. Aleksandra Gilis-Januszewska, Noël C Barengo, Jaana Lindström, Ewa

More information

Tailored Statin Treatment for Type 2 Diabetes. Han, Ki Hoon Asan Medical Center University of Ulsan

Tailored Statin Treatment for Type 2 Diabetes. Han, Ki Hoon Asan Medical Center University of Ulsan Tailored Statin Treatment for Type 2 Diabetes Han, Ki Hoon Asan Medical Center University of Ulsan 1 Cardiovascular disease ; No1. death (2001) respiratory tract infection Other NCD S HIV/AIDS deaths during

More information

Guidelines on cardiovascular risk assessment and management

Guidelines on cardiovascular risk assessment and management European Heart Journal Supplements (2005) 7 (Supplement L), L5 L10 doi:10.1093/eurheartj/sui079 Guidelines on cardiovascular risk assessment and management David A. Wood 1,2 * 1 Cardiovascular Medicine

More information

Trends In CVD, Related Risk Factors, Prevention and Control In China

Trends In CVD, Related Risk Factors, Prevention and Control In China Trends In CVD, Related Risk Factors, Prevention and Control In China Youfa Wang, MD, MS, PhD Associate Professor Center for Human Nutrition Department of International Health Department of Epidemiology

More information

Identification of subjects at high risk for cardiovascular disease

Identification of subjects at high risk for cardiovascular disease Master Class in Preventive Cardiology Focus on Diabetes and Cardiovascular Disease Geneva April 14 2011 Identification of subjects at high risk for cardiovascular disease Lars Rydén Karolinska Institutet

More information

Review of guidelines for management of dyslipidemia in diabetic patients

Review of guidelines for management of dyslipidemia in diabetic patients 2012 international Conference on Diabetes and metabolism (ICDM) Review of guidelines for management of dyslipidemia in diabetic patients Nan Hee Kim, MD, PhD Department of Internal Medicine, Korea University

More information

Metabolic Syndrome Update The Metabolic Syndrome: Overview. Global Cardiometabolic Risk

Metabolic Syndrome Update The Metabolic Syndrome: Overview. Global Cardiometabolic Risk Metabolic Syndrome Update 21 Marc Cornier, M.D. Associate Professor of Medicine Division of Endocrinology, Metabolism & Diabetes University of Colorado Denver Denver Health Medical Center The Metabolic

More information

Volume 2; Number 11 July 2008

Volume 2; Number 11 July 2008 Volume 2; Number 11 July 2008 CONTENTS Page 1 NICE Clinical Guideline 67: Lipid Modification (May 2008) Page 7 NICE Technology Appraisal 132: Ezetimibe for the treatment of primary (heterozygous familial

More information

How to Reduce CVD Complications in Diabetes?

How to Reduce CVD Complications in Diabetes? How to Reduce CVD Complications in Diabetes? Chaicharn Deerochanawong M.D. Diabetes and Endocrinology Unit Department of Medicine Rajavithi Hospital, Ministry of Public Health Framingham Heart Study 30-Year

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Clair C, Rigotti NA, Porneala B, et al. Association of smoking cessation and weight change with cardiovascular disease among people with and without diabetes. JAMA. doi:10.1001/jama.2013.1644.

More information

Qué factores de riesgo lipídicos debemos controlar? En qué medida?

Qué factores de riesgo lipídicos debemos controlar? En qué medida? Qué factores de riesgo lipídicos debemos controlar? En qué medida? Risk category High risk: CHD or CHD risk equivalents (10- year risk >20%) Moderately high risk: two or more risk factors (10-year risk

More information

More than We Bargained For: Metabolic Side Effects of Antipsychotic Medications

More than We Bargained For: Metabolic Side Effects of Antipsychotic Medications More than We Bargained For: Metabolic Side Effects of Antipsychotic Medications Michael D. Jibson, MD, PhD Professor of Psychiatry University of Michigan Disclosure In the past 12 months I have received

More information

LIST OF ABBREVIATIONS

LIST OF ABBREVIATIONS Diabetes & Endocrinology 2005 Royal College of Physicians of Edinburgh Diabetes and lipids 1 G Marshall, 2 M Fisher 1 Research Fellow, Department of Cardiology, Glasgow Royal Infirmary, Glasgow, Scotland,

More information

Screening Results. Juniata College. Juniata College. Screening Results. October 11, October 12, 2016

Screening Results. Juniata College. Juniata College. Screening Results. October 11, October 12, 2016 Juniata College Screening Results Juniata College Screening Results October 11, 2016 & October 12, 2016 JUNIATA COLLEGE The J.C. Blair Hospital CARES team screened 55 Juniata College employees on October

More information

Optimizing Postpartum Maternal Health to Prevent Chronic Diseases

Optimizing Postpartum Maternal Health to Prevent Chronic Diseases Optimizing Postpartum Maternal Health to Prevent Chronic Diseases Amy Loden, MD, FACP, NCMP Disclosures Research: None Financial: none applicable to this presentation PRIUM QEssentials Market Research

More information

Ischemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010

Ischemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Ischemic Heart and Cerebrovascular Disease Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Relationships Between Diabetes and Ischemic Heart Disease Risk of Cardiovascular Disease in Different Categories

More information

Epidemiologic Measure of Association

Epidemiologic Measure of Association Measures of Disease Occurrence: Epidemiologic Measure of Association Basic Concepts Confidence Interval for population characteristic: Disease Exposure Present Absent Total Yes A B N 1 = A+B No C D N 2

More information

Should we base treatment decisions on short-term or lifetime CVD risk? Rod Jackson University of Auckland New Zealand

Should we base treatment decisions on short-term or lifetime CVD risk? Rod Jackson University of Auckland New Zealand Should we base treatment decisions on short-term or lifetime CVD risk? Rod Jackson University of Auckland New Zealand Presentation outline Strengths & weaknesses of short-term risk approach Strengths &

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE QUALITY AND OUTCOMES FRAMEWORK (QOF) INDICATOR DEVELOPMENT PROGRAMME Briefing paper QOF indicator area: Primary prevention of CVD Potential output:

More information

How would you manage Ms. Gold

How would you manage Ms. Gold How would you manage Ms. Gold 32 yo Asian woman with dyslipidemia Current medications: Simvastatin 20mg QD Most recent lipid profile: TC = 246, TG = 100, LDL = 176, HDL = 50 What about Mr. Williams? 56

More information

Approach to Dyslipidemia among diabetic patients

Approach to Dyslipidemia among diabetic patients Approach to Dyslipidemia among diabetic patients Farzad Hadaegh, MD, Professor of Internal Medicine & Endocrinology Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences

More information

Dyslipidemia in women: Who should be treated and how?

Dyslipidemia in women: Who should be treated and how? Dyslipidemia in women: Who should be treated and how? Lale Tokgozoglu, MD, FACC, FESC Professor of Cardiology Hacettepe University Faculty of Medicine Ankara, Turkey. Cause of Death in Women: European

More information

BEST PRACTICE MANAGEMENT: CARDIOVASCULAR RISKS

BEST PRACTICE MANAGEMENT: CARDIOVASCULAR RISKS BEST PRACTICE MANAGEMENT: CARDIOVASCULAR RISKS Neil R Poulter ICCH, Imperial College London BHIVA: October 10th, 2008 Background CVD is the biggest single killer in the world CVD rates are increasing High

More information

4/7/ The stats on heart disease. + Deaths & Age-Adjusted Death Rates for

4/7/ The stats on heart disease. + Deaths & Age-Adjusted Death Rates for + Update on Lipid Management Stacey Gardiner, MD Assistant Professor Division of Cardiovascular Medicine Medical College of Wisconsin + The stats on heart disease Over the past 10 years for which statistics

More information

Established Risk Factors for Coronary Heart Disease (CHD)

Established Risk Factors for Coronary Heart Disease (CHD) Getting Patients to Make Small Lifestyle Changes That Result in SIGNIFICANT Improvements in Health - Prevention of Diabetes and Obesity for Better Health Maureen E. Mays, MD, MS, FACC Director ~ Portland

More information

10/8/2015. MN Nursing Conference October 7th, 2015 Michael Miedema, MD MPH. None

10/8/2015. MN Nursing Conference October 7th, 2015 Michael Miedema, MD MPH. None MN Nursing Conference October 7th, 2015 Michael Miedema, MD MPH None 1 Objectives Why the need for change in the guidelines? What is the potential impact of these guidelines? Where do we go from here?

More information

Young high risk patients the role of statins Dr. Mohamed Jeilan

Young high risk patients the role of statins Dr. Mohamed Jeilan Young high risk patients the role of statins Dr. Mohamed Jeilan KCS Congress: Impact through collaboration CONTACT: Tel. +254 735 833 803 Email: kcardiacs@gmail.com Web: www.kenyacardiacs.org Disclosures

More information

Implications of The LookAHEAD Trial: Is Weight Loss Beneficial for Patients with Diabetes?

Implications of The LookAHEAD Trial: Is Weight Loss Beneficial for Patients with Diabetes? Implications of The LookAHEAD Trial: Is Weight Loss Beneficial for Patients with Diabetes? Boston, MA November 7, 213 Edward S. Horton, MD Professor of Medicine Harvard Medical School Senior Investigator

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Larsen JR, Vedtofte L, Jakobsen MSL, et al. Effect of liraglutide treatment on prediabetes and overweight or obesity in clozapine- or olanzapine-treated patients with schizophrenia

More information

Eugene Barrett M.D., Ph.D. University of Virginia 6/18/2007. Diagnosis and what is it Glucose Tolerance Categories FPG

Eugene Barrett M.D., Ph.D. University of Virginia 6/18/2007. Diagnosis and what is it Glucose Tolerance Categories FPG Diabetes Mellitus: Update 7 What is the unifying basis of this vascular disease? Eugene J. Barrett, MD, PhD Professor of Internal Medicine and Pediatrics Director, Diabetes Center and GCRC Health System

More information

An example of a systematic review and meta-analysis

An example of a systematic review and meta-analysis An example of a systematic review and meta-analysis Sattar N et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet 2010; 375: 735-742. Search strategy

More information

Session 21: Heart Health

Session 21: Heart Health Session 21: Heart Health Heart disease and stroke are the leading causes of death in the world for both men and women. People with pre-diabetes, diabetes, and/or the metabolic syndrome are at higher risk

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Pedersen SB, Langsted A, Nordestgaard BG. Nonfasting mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis. JAMA Intern Med. Published online November 7, 2016.

More information

Reducing low-density lipoprotein cholesterol treating to target and meeting new European goals

Reducing low-density lipoprotein cholesterol treating to target and meeting new European goals European Heart Journal Supplements (2004) 6 (Supplement A), A12 A18 Reducing low-density lipoprotein cholesterol treating to target and meeting new European goals University of Sydney, Sydney, NSW, Australia

More information

Impact of Lifestyle Modification to Reduce Cardiovascular Disease Event Risk of High Risk Patients with Low Levels of HDL C

Impact of Lifestyle Modification to Reduce Cardiovascular Disease Event Risk of High Risk Patients with Low Levels of HDL C Impact of Lifestyle Modification to Reduce Cardiovascular Disease Event Risk of High Risk Patients with Low Levels of HDL C Thomas P. Bersot, M.D., Ph.D. Gladstone Institute of Cardiovascular Disease University

More information

Clinical Practice Guideline Key Points

Clinical Practice Guideline Key Points Clinical Practice Guideline Key Points Clinical Practice Guideline 2008 Key Points Diabetes Mellitus Provided by: Highmark Endocrinology Clinical Quality Improvement Committee In accordance with Highmark

More information

Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality: A Population-based Cohort Study and Pooling Prospective Studies

Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality: A Population-based Cohort Study and Pooling Prospective Studies Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality: A Population-based Cohort Study and Pooling Prospective Studies Mohsen Mazidi 1, Niki Katsiki 2, Dimitri P. Mikhailidis 3, Maciej Banach

More information

Fructose in diabetes: Friend or Foe. Kim Chong Hwa MD,PhD Sejong general hospital, Division of Endocrinology & Metabolism

Fructose in diabetes: Friend or Foe. Kim Chong Hwa MD,PhD Sejong general hospital, Division of Endocrinology & Metabolism Fructose in diabetes: Friend or Foe Kim Chong Hwa MD,PhD Sejong general hospital, Division of Endocrinology & Metabolism Contents What is Fructose? Why is Fructose of Concern? Effects of Fructose on glycemic

More information

Considerations and Controversies in the Management of Dyslipidemia for ASCVD Risk Reduction

Considerations and Controversies in the Management of Dyslipidemia for ASCVD Risk Reduction Considerations and Controversies in the Management of Dyslipidemia for ASCVD Risk Reduction Pamela B. Morris, MD, FACC, FAHA, FASCP, FNLA Chair, ACC Prevention of Cardiovascular Disease Council The Medical

More information

Your Guide to Managing and Understanding Your Cholesterol Levels

Your Guide to Managing and Understanding Your Cholesterol Levels Your Guide to Managing and Understanding Your Cholesterol Levels Our goal at Bon Secours is to help you be well. Our experienced Heart Team includes cardiologists, cardiovascular surgeons, electrophysiologists,

More information

Total risk management of Cardiovascular diseases Nobuhiro Yamada

Total risk management of Cardiovascular diseases Nobuhiro Yamada Nobuhiro Yamada The worldwide burden of cardiovascular diseases (WHO) To prevent cardiovascular diseases Beyond LDL Multiple risk factors With common molecular basis The Current Burden of CVD CVD is responsible

More information

The target blood pressure in patients with diabetes is <130 mm Hg

The target blood pressure in patients with diabetes is <130 mm Hg Controversies in hypertension, About Diabetes diabetes and and metabolic Cardiovascular syndrome Risk ESC annual congress August 29, 2011 The target blood pressure in patients with diabetes is

More information

2013 ACC AHA LIPID GUIDELINE JAY S. FONTE, MD

2013 ACC AHA LIPID GUIDELINE JAY S. FONTE, MD 2013 ACC AHA LIPID GUIDELINE JAY S. FONTE, MD How do you interpret my blood test results? What are our targets for these tests? Before the ACC/AHA Lipid Guidelines A1c:

More information

RISK FACTORS OR COMPLICATIONS AND RECOMMENDED TREATMENT GOALS AND FREQUENCY OF EVALUATION FOR ADULTS WITH DIABETES

RISK FACTORS OR COMPLICATIONS AND RECOMMENDED TREATMENT GOALS AND FREQUENCY OF EVALUATION FOR ADULTS WITH DIABETES RISK FACTORS OR COMPLICATIONS AND RECOMMENDED TREATMENT GOALS AND FREQUENCY OF EVALUATION FOR ADULTS WITH DIABETES Risk Factors or Complications Glycemic Control Fasting & Capillary Plasma Glucose Anti-platelet

More information

Disclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease

Disclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease Disclosures Diabetes and Cardiovascular Risk Management Tony Hampton, MD, MBA Medical Director Advocate Aurora Operating System Advocate Aurora Healthcare Downers Grove, IL No conflicts or disclosures

More information

The CARI Guidelines Caring for Australians with Renal Impairment. Cardiovascular Risk Factors

The CARI Guidelines Caring for Australians with Renal Impairment. Cardiovascular Risk Factors Cardiovascular Risk Factors ROB WALKER (Dunedin, New Zealand) Lipid-lowering therapy in patients with chronic kidney disease Date written: January 2005 Final submission: August 2005 Author: Rob Walker

More information

Hyperlipidemia: Lowering the Bar on the Lipid Limbo. Community Faculty Development Symposium March 13, 2004 Hugh Huizenga MD, MPH

Hyperlipidemia: Lowering the Bar on the Lipid Limbo. Community Faculty Development Symposium March 13, 2004 Hugh Huizenga MD, MPH Mark slides Hyperlipidemia: Lowering the Bar on the Lipid Limbo Community Faculty Development Symposium March 13, 2004 Hugh Huizenga MD, MPH Hyperlipidemia is a common problem Nearly 50% of men in the

More information

Evidence Briefing for NHS Bradford and Airedale. Physical health monitoring for people with schizophrenia or other serious mental illness

Evidence Briefing for NHS Bradford and Airedale. Physical health monitoring for people with schizophrenia or other serious mental illness Evidence Briefing for NHS Bradford and Airedale Physical health monitoring for people with schizophrenia or other serious mental illness The NICE clinical guideline on schizophrenia 1 recommends that GPs

More information

The Diabetes Link to Heart Disease

The Diabetes Link to Heart Disease The Diabetes Link to Heart Disease Anthony Abe DeSantis, MD September 18, 2015 University of WA Division of Metabolism, Endocrinology and Nutrition Oswald Toosweet Case #1 68 yo M with T2DM Diagnosed DM

More information

Metformin should be considered in all patients with type 2 diabetes unless contra-indicated

Metformin should be considered in all patients with type 2 diabetes unless contra-indicated November 2001 N P S National Prescribing Service Limited PPR fifteen Prescribing Practice Review PPR Managing type 2 diabetes For General Practice Key messages Metformin should be considered in all patients

More information

Andrejs Kalvelis 1, MD, PhD, Inga Stukena 2, MD, Guntis Bahs 3 MD, PhD & Aivars Lejnieks 4, MD, PhD ABSTRACT INTRODUCTION. Riga Stradins University

Andrejs Kalvelis 1, MD, PhD, Inga Stukena 2, MD, Guntis Bahs 3 MD, PhD & Aivars Lejnieks 4, MD, PhD ABSTRACT INTRODUCTION. Riga Stradins University CARDIOVASCULAR RISK FACTORS ORIGINAL ARTICLE Do We Correctly Assess the Risk of Cardiovascular Disease? Characteristics of Risk Factors for Cardiovascular Disease Depending on the Sex and Age of Patients

More information

Andrew Cohen, MD and Neil S. Skolnik, MD INTRODUCTION

Andrew Cohen, MD and Neil S. Skolnik, MD INTRODUCTION 2 Hyperlipidemia Andrew Cohen, MD and Neil S. Skolnik, MD CONTENTS INTRODUCTION RISK CATEGORIES AND TARGET LDL-CHOLESTEROL TREATMENT OF LDL-CHOLESTEROL SPECIAL CONSIDERATIONS OLDER AND YOUNGER ADULTS ADDITIONAL

More information

1/14/2013 Pediatric Cardiovascular Disease and the Future of our Children Linda Alwine FNP-BC Objectives Identify the prevalence and epidemiology of h

1/14/2013 Pediatric Cardiovascular Disease and the Future of our Children Linda Alwine FNP-BC Objectives Identify the prevalence and epidemiology of h Pediatric Cardiovascular Disease and the Future of our Children Linda Alwine FNP-BC Objectives Identify the prevalence and epidemiology of hyperlipidemia. Identify risk factors that lead to the development

More information

Metabolic Syndrome: Why Should We Look For It?

Metabolic Syndrome: Why Should We Look For It? 021-CardioCase 29/05/06 15:04 Page 21 Metabolic Syndrome: Why Should We Look For It? Dafna Rippel, MD, MHA and Andrew Ignaszewski, MD, FRCPC CardioCase presentation Andy s fatigue Andy, 47, comes to you

More information

Diabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable?

Diabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable? Diabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable? Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of

More information

Lifetime clinical and economic benefits of statin-based LDL lowering in the 20-year Followup of the West of Scotland Coronary Prevention Study

Lifetime clinical and economic benefits of statin-based LDL lowering in the 20-year Followup of the West of Scotland Coronary Prevention Study Lifetime clinical and economic benefits of statin-based LDL lowering in the 20-year Followup of the West of Scotland Coronary Prevention Study Harvey White Green Lane Cardiovascular Service and Cardiovascular

More information

University of Groningen. Metabolic risk in people with psychotic disorders Bruins, Jojanneke

University of Groningen. Metabolic risk in people with psychotic disorders Bruins, Jojanneke University of Groningen Metabolic risk in people with psychotic disorders Bruins, Jojanneke IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from

More information

2016 EUROPEAN GUIDELINES ON CVD PREVENTION IN CLINICAL PRACTICE

2016 EUROPEAN GUIDELINES ON CVD PREVENTION IN CLINICAL PRACTICE 2016 EUROPEAN GUIDELINES ON CVD PREVENTION IN CLINICAL PRACTICE Massimo F Piepoli, MD, PhD, FESC, Piacenza, Italy on behalf of the 6 th Joint Task Force 2 3 Guidelines still based upon the principles of

More information

Physical health assessment and monitoring in long-term mental health care

Physical health assessment and monitoring in long-term mental health care Physical health assessment and monitoring in long-term mental health care Dr Alan Farmer Consultant Psychiatrist Worcestershire Mental Health Partnership NHS Trust A brief questionnaire Current thoughts,

More information

Metabolic Syndrome. Shon Meek MD, PhD Mayo Clinic Florida Endocrinology

Metabolic Syndrome. Shon Meek MD, PhD Mayo Clinic Florida Endocrinology Metabolic Syndrome Shon Meek MD, PhD Mayo Clinic Florida Endocrinology Disclosure No conflict of interest No financial disclosure Does This Patient Have Metabolic Syndrome? 1. Yes 2. No Does This Patient

More information

Why are NICE guidelines and standards important and relevant to us?

Why are NICE guidelines and standards important and relevant to us? Why are NICE guidelines and standards important and relevant to us? Dr Liz England GP, Laurie Pike health centre RCGP Mental Health Clinical and Commissioning Lead SWB CCG Mental Health Lead NIHR Clinical

More information

ATP IV: Predicting Guideline Updates

ATP IV: Predicting Guideline Updates Disclosures ATP IV: Predicting Guideline Updates Daniel M. Riche, Pharm.D., BCPS, CDE Speaker s Bureau Merck Janssen Boehringer-Ingelheim Learning Objectives Describe at least two evidence-based recommendations

More information

CVD risk assessment using risk scores in primary and secondary prevention

CVD risk assessment using risk scores in primary and secondary prevention CVD risk assessment using risk scores in primary and secondary prevention Raul D. Santos MD, PhD Heart Institute-InCor University of Sao Paulo Brazil Disclosure Honoraria for consulting and speaker activities

More information

ASSeSSing the risk of fatal cardiovascular disease

ASSeSSing the risk of fatal cardiovascular disease ASSeSSing the risk of fatal cardiovascular disease «Systematic Cerebrovascular and coronary Risk Evaluation» think total vascular risk Assess the risk Set the targets Act to get to goal revised; aupril

More information

Serum levels of galectin-1, galectin-3, and galectin-9 are associated with large artery atherosclerotic

Serum levels of galectin-1, galectin-3, and galectin-9 are associated with large artery atherosclerotic Supplementary Information The title of the manuscript Serum levels of galectin-1, galectin-3, and galectin-9 are associated with large artery atherosclerotic stroke Xin-Wei He 1, Wei-Ling Li 1, Cai Li

More information

ESC/EAS GUIDELINES ON MANAGEMENT OF DYSLIPIDEMIAS IN CLINICAL PRACTICE

ESC/EAS GUIDELINES ON MANAGEMENT OF DYSLIPIDEMIAS IN CLINICAL PRACTICE ESC/EAS GUIDELINES ON MANAGEMENT OF DYSLIPIDEMIAS IN CLINICAL PRACTICE Professor Željko Reiner, MD, PhD,FRCP(Lond), FESC Director, University Hospital Center Zagreb School of Medicine, University of Zagreb,

More information

Hypertension with Comorbidities Treatment of Metabolic Risk Factors in Children and Adolescents

Hypertension with Comorbidities Treatment of Metabolic Risk Factors in Children and Adolescents Hypertension with Comorbidities Treatment of Metabolic Risk Factors in Children and Adolescents Stella Stabouli Ass. Professor Pediatrics 1 st Department of Pediatrics Hippocratio Hospital Evaluation of

More information

John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam

John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam Latest Insights from the JUPITER Study John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam Inflammation, hscrp, and Vascular Prevention

More information

What have We Learned in Dyslipidemia Management Since the Publication of the 2013 ACC/AHA Guideline?

What have We Learned in Dyslipidemia Management Since the Publication of the 2013 ACC/AHA Guideline? What have We Learned in Dyslipidemia Management Since the Publication of the 2013 ACC/AHA Guideline? Salim S. Virani, MD, PhD, FACC, FAHA Associate Professor, Section of Cardiovascular Research Baylor

More information

Risk Factors for Heart Disease

Risk Factors for Heart Disease Risk Factors for Heart Disease Risk Factors we cannot change (Age, Gender, Family History) Risk Factors we can change (modifiable) Smoking Blood pressure Cholesterol Diabetes Inactivity Overweight Stress

More information

American Osteopathic College of Occupational and Preventive Medicine 2012 Mid-Year Educational Conference St. Petersburg, Florida

American Osteopathic College of Occupational and Preventive Medicine 2012 Mid-Year Educational Conference St. Petersburg, Florida The 21 st Century Paradigm Shift: Prevention Rather Than Intervention for the Treatment of Stable CHD The Economic Burden of Cardiovascular Diseases Basil Margolis MD, FACC, FRCP Director, Preventive Cardiology

More information

Metabolic Syndrome: A Preventable & Treatable Cluster of Conditions

Metabolic Syndrome: A Preventable & Treatable Cluster of Conditions Metabolic Syndrome: A Preventable & Treatable Cluster of Conditions April D. McNeill MD Candidate 2016, Southern Illinois University, School of Medicine GE-NMF Primary Care Leadership Program, July 2013

More information

Overweight and Obesity in Older Persons: Impact Upon Health and Mortality Outcomes

Overweight and Obesity in Older Persons: Impact Upon Health and Mortality Outcomes Overweight and Obesity in Older Persons: Impact Upon Health and Mortality Outcomes Gordon L Jensen, MD, PhD Senior Associate Dean for Research Professor of Medicine and Nutrition Objectives Health outcomes

More information

Behind LDL: The Metabolism of ApoB, the Essential Apolipoprotein in LDL and VLDL

Behind LDL: The Metabolism of ApoB, the Essential Apolipoprotein in LDL and VLDL Behind LDL: The Metabolism of ApoB, the Essential Apolipoprotein in LDL and VLDL Sung-Joon Lee, PhD Division of Food Science Institute of Biomedical Science and Safety Korea University Composition of Lipoproteins:

More information

DIABETES. A growing problem

DIABETES. A growing problem DIABETES A growing problem Countries still grappling with infectious diseases such as tuberculosis, HIV/AIDS and malaria now face a double burden of disease Major social and economic change has brought

More information

Since 1980, obesity has more than doubled worldwide, and in 2008 over 1.5 billion adults aged 20 years were overweight.

Since 1980, obesity has more than doubled worldwide, and in 2008 over 1.5 billion adults aged 20 years were overweight. Impact of metabolic comorbidity on the association between body mass index and health-related quality of life: a Scotland-wide cross-sectional study of 5,608 participants Dr. Zia Ul Haq Doctoral Research

More information

Eyes on Korean Data: Lipid Management in Korean DM Patients

Eyes on Korean Data: Lipid Management in Korean DM Patients Eyes on Korean Data: Lipid Management in Korean DM Patients ICDM Luncheon Symposium Sung Rae Kim MD PhD Division of Endocrinology and Metabolism The Catholic University of Korea Causes of Death in People

More information

GUIDELINES FOR DYSLIPIDEMIA MANAGEMENT AND EDUCATION THROUGH NOVA SCOTIA DIABETES CENTRES

GUIDELINES FOR DYSLIPIDEMIA MANAGEMENT AND EDUCATION THROUGH NOVA SCOTIA DIABETES CENTRES GUIDELINES FOR DYSLIPIDEMIA MANAGEMENT AND EDUCATION THROUGH NOVA SCOTIA DIABETES CENTRES Prepared by DCPNS Action Committee Dr. Lynne Harrigan Brenda Cook Peggy Dunbar Bev Harpell with the assistance

More information

Early Intervention in Psychosis... Dec 7 th Wakefield

Early Intervention in Psychosis... Dec 7 th Wakefield Early Intervention in Psychosis... Dec 7 th Wakefield David.Shiers@doctors.org.uk Declaration of Interest: 1. Member of two Guideline Development Groups (GDG) for NICE: a) NICE guidance for children and

More information

Hearts and Minds An ECG Update. Tuesday 18 th November The Met Hotel, Leeds

Hearts and Minds An ECG Update. Tuesday 18 th November The Met Hotel, Leeds Hearts and Minds An ECG Update Tuesday 18 th November The Met Hotel, Leeds Ashleigh Bradley Specialist Clinical Pharmacist for Mental Health and Lithium Clinic Airedale NHS Foundation Trust Introduction

More information

1. Which one of the following patients does not need to be screened for hyperlipidemia:

1. Which one of the following patients does not need to be screened for hyperlipidemia: Questions: 1. Which one of the following patients does not need to be screened for hyperlipidemia: a) Diabetes mellitus b) Hypertension c) Family history of premature coronary disease (first degree relatives:

More information

Diabetes and Heart Disease. Sarah Alexander, MD, FACC Assistant Professor of Medicine Rush University Medical Center

Diabetes and Heart Disease. Sarah Alexander, MD, FACC Assistant Professor of Medicine Rush University Medical Center Diabetes and Heart Disease Sarah Alexander, MD, FACC Assistant Professor of Medicine Rush University Medical Center No conflicts of interest or financial relationships to disclose. 2 What s the problem??

More information

Implementing Type 2 Diabetes Prevention Programmes

Implementing Type 2 Diabetes Prevention Programmes Implementing Type 2 Diabetes Prevention Programmes Jaakko Tuomilehto Department of Public Health University of Helsinki Helsinki, Finland FIN-D2D Survey 2004 Prevalence of previously diagnosed and screen-detected

More information