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

Size: px
Start display at page:

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

Transcription

1 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 Joslin Diabetes Center Global Projections for the Diabetes Epidemic: World 211 = 366 M 23 = 552 M >51% NAC 37.7 M 51.2 M 36% SACA 25.1 M 39.9 M 59% EUR 52.8 M WP 64.2 M MENA SEA 22% M 32.6 M 59.7 M 83% AFR 14.7 M 28. M 9% 71.4 M 121 M 69% M 6% M = million, AFR = Africa, NAC = North America and Caribbean, EUR = Europe, SACA = South and Central America, MENA = Middle East and North Africa, SEA = South-East Asia, WP = Western Pacific Diabetes Atlas Committee. Diabetes Atlas 5th Edition: IDF 211. Obesity is the Primary Risk Factor for Type 2 Diabetes 5 4 Age-adjusted relative risk of type 2 diabetes 1 Men 1 Women < < BMI 1 Chan JM et al. Diabetes Care 1994;17: ; 2 Colditz G et al. Ann Intern Med 1995;122:

2 The Dual Epidemic: Obesity and Diabetes 65% of adult Americans are overweight (BMI >25) and 32% are obese (BMI >3). 34% have the Metabolic Syndrome (ATP III criteria). There are now an estimated 25.8 million people with DM in the USA (11.3% of adults) and 79 million with Pre-diabetes (IFG/IGT). The lifetime risk of developing DM for people born in 2 is 33% for men and 39% for women. In this population CVD is the major cause of mortality. Look AHEAD Clinical Trial AIM: To determine whether cardiovascular morbidity and mortality in persons with type 2 diabetes can be reduced through intensive lifestyle intervention aimed at producing and maintaining weight loss. 2

3 Primary Outcome The incidence rate of the first post-randomization occurrence of a composite outcome, including cardiovascular death (fatal myocardial infarction and stroke) non-fatal myocardial infarction non-fatal stroke hospitalization for angina over 13.5 yr. follow-up is reduced in the Lifestyle Intervention compared to Diabetes Support and Education. Secondary Outcomes Composite #1 CVD death Non fatal MI Non fatal stroke Composite #2 All cause death Non fatal MI Non fatal stroke Hospitalization for angina Composite #3 All cause death Non fatal MI Non fatal stroke Hospitalization for angina Hospitalization for CHF CABG Carotid endarterectomy Peripheral vascular disease Look AHEAD Interventions Intensive Lifestyle Intervention () Diabetes Support & Education () 3

4 Power Analysis With planned sample of 5, participants, Look AHEAD had greater than 8% probability of detecting an 18% difference in CVD events between the two arms, assuming two sided alpha of.5 primary outcome rate of 2% per year in planned maximum follow up of 13.5 years. Baseline Characteristics of Participants Lifestyle (N=257) (N=2575) Women 59% 6% Minority 37% 37% Age (years) Insulin Users 15% 16% Baseline BMI Baseline Weight (kg) Baseline Waist (cm) History of Prior CVD Event 15% 14% Lifestyle Intervention: Phase I Weight Loss Induction Months 1-6 Weekly contact 3 group sessions/month 1 individual session/month Personal weight loss goal = 1% Study weight loss goal > 7% 4

5 Recommendations Dietary Intake kcal/day < 25 lb kcal/day > 25 lb < 3% calories from fat meal replacements menu plans Physical Activity gradual increase 175 min/wk 1, steps/day (approx. 5 miles) Lifestyle Intervention: Phase II, Weight Loss Maintenance Months 7-12 Reduced contact 2 group sessions/month 1 individual session/month 2 face-to-face contacts/month required; 3 recommended Individual weight loss goal continue weight loss if < 1% weight maintenance if > 1% Diabetes Support and Education 3-4 meetings / year to promote retention health education topics diet exercise social support 5

6 % Weight Loss at 1-Year % Weight Change p <.1.7% % 1-Year Changes in Markers of Diabetes Control Markers of Diabetes Control P-value Hemoglobin A1c (%), BL Hemoglobin A1c (%), Y Fasting glucose (mg/dl), BL Fasting glucose (mg/dl), Y Diabetes medications, BL Diabetes medications, Y1 86.5% 78.6% -7.8% 86.5% 88.7% 2.2%.93 1-Year Changes in Markers of Blood Pressure Control Markers of Blood Pressure Control P-value Systolic BP (mmhg), BL Systolic BP (mmhg), Y Diastolic BP (mmhg), BL Diastolic BP (mmhg), Y Antihypertensive medications, BL Antihypertensive medications, Y1 75.3% 75.2% -.1% 73.7% 75.9% 2.2%

7 1-Year Changes in Markers of Lipid Control Markers of Lipid Control P-value LDL-cholesterol (mg/dl), BL LDL-cholesterol (mg/dl), Y HDL-cholesterol (mg/dl), BL HDL-cholesterol (mg/dl), Y1 Triglycerides (mg/dl), BL Triglycerides (mg/dl), Y1 Lipid lowering medications, BL Lipid lowering medications, Y % 53.% 3.7% % 57.8% 9.4% Four Year Results Percent Weight Change from Baseline Repeated Measures Adjusted for Clinic and Baseline Level P-value for average effect across all visits: p<.1 % Weight change from baseline P-value Baseline (kg) NS Y1 BL <.1 Y2 BL <.1 Y3 BL <.1 Y4 BL <.1 Year 7

8 Percent Fitness Change from Baseline Repeated Measures Adjusting for Clinic and Baseline Level P-value for average effect across all visits: p<.1 % Fitness change from baseline P-value (METS) (METS) Baseline NS Y1 BL <.1 Y4 BL < Year Diabetes Control HbA1c Change from Baseline P-value for average effect across all visits: p<.1 A1c change from baseline P-value Baseline NS Y1 BL <.1 Y2 BL <.1 Y3 BL <.1 Y4 BL Year Blood Pressure Control SBP (mmhg) Change from Baseline P-value for average effect across all visits: p<.1 SBP change from baseline (mmhg) Year P-value (mmhg) (mmhg) Baseline NS Y1 BL <.1 Y2 BL <.1 Y3 BL Y4 BL

9 Blood Pressure Control DBP (mmhg) Change from Baseline Repeated Measures Adjusting for Clinic and Baseline Level P-value for average effect across all visits: p=.1 DBP change from baseline (mmhg) Year P- value (mmhg) (mmhg) Baseline NS Y1 BL <.1 Y2 BL Y3 BL Y4 BL Lipid Control HDL Cholesterol (mg/dl) Change from Baseline P-value for average effect across all visits: p<.1 HDL change from baseline (mg/dl) Year P-value (mg/dl) (mg/dl) Baseline NS Y1 BL <.1 Y2 BL <.1 Y3 BL <.1 Y4 BL <.1 Lipid Control Triglyceride (mg/dl) Change from Baseline P-value for average effect across all visits =.1 Trig change from baseline (mg/dl) Year P-value (mg/dl) (mg/dl) Baseline NS Y1 BL <.1 Y2 BL Y3 BL Y4 BL

10 Lipid Control LDL Cholesterol (mg/dl) Change from Baseline Repeated Measures Adjusting for Clinic and Baseline Level P-value for average effect across all visits: p=.9 LDL change from baseline (mg/dl) Year P-value (mg/dl) (mg/dl) Baseline NS Y1 BL Y2 BL Y3 BL Y4 BL LDL levels fell substantially in both groups over time Ten Year Results had significantly greater weight loss than 1

11 A1c Blood Pressure HDL C and Triglycerides 11

12 had significantly greater reductions in LDL Cholesterol than participants had significantly greater use of medications than Antihypertensive HR=.88 (.78,.89) p=.26 Statins HR=.86 (.78,.94) p =.1 Insulin HR=.74 (.66,.82) p <.1 Differences between and had better weight losses throughout the trial had greater improvements in fitness reduced glycated hemoglobin and need for insulin led to sustained improvements in SBP and HDL C had less improvement in LDL C but also used fewer statins than 12

13 BUT Did reduce cardiovascular morbidity and mortality? Analysis of time to first post randomization occurrence of primary and secondary outcomes in the two groups. Cumulative Hazard for Primary Outcome Non Significant Interaction (p =.6) with CVD History HR =.86 (.72, 1.2) HR = 1.13 (.9, 1.42) 13

14 Subgroup Analyses NOTE: Race/ethnicity groups with smaller numbers of participants are omitted from this table. Primary Study Question Answered 1. No significant difference between and in number of heart disease events that is both groups had a similar number of cardiovascular events. Main study answer was negative. 2. Both groups had a very low number of heart disease events. Both groups had less than half of the expected events. Good news for all. Why did we have so few CVD events? Many participants are taking medication for their diabetes, high blood pressure and high cholesterol (more so in than in ). These medications combined with regular checkups with a health professional may have kept CVD rates low in both groups These results parallel the overall improvement in CVD in the US in recent years 14

15 Other Outcomes Currently Being Analyzed More participants in than in had improvements in Obstructive Sleep Apnea at year % of Participants Same 1 Improved 2 Worse 3 OSA Category Kuna et al, under review More participants in than in actually had remission in Obstructive Sleep Apnea at year % Remission Remission of OSA, AHI < 5 events/h Kuna et al, under review 15

16 Other Areas of Interest Include: Malignancies Cognitive Impairment, Alzheimer s Disease Mobility, falls, physical function Multiple other problems of aging: diabetic micro and macro vascular complications, depression, bone density and fractures, body composition and sarcopenia The Look AHEAD of Tomorrow (at least through 215) intervention has been discontinued. In its place, everyone is being offered group meetings during the year. 6 month phone interviews will continue. Annual Exams will continue. Further follow up beyond August 213 is being planned and funding applied for. Look AHEAD has Succeeded as a Clinical Trial Extremely high retention: 89% of original subjects Excellent adherence to the protocol Sustained weight loss in group Complete data set with numerous outcomes Together, these factors allowed us to answer many questions regarding diabetes and obesity CVD, sleep apnea, cancer, kidney disease, fractures, mental health, mobility, quality of life 16

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

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

Epidemiology of Diabetes Mellitus in Asia

Epidemiology of Diabetes Mellitus in Asia Epidemiology of Diabetes Mellitus in Asia Nam H. Cho Professor of Preventive Medicine Director of Clinical Epidemiology Ajou University School of Medicine and Hospital, Suwon Korea President-elect of International

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

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

Supplement materials:

Supplement materials: Supplement materials: Table S1: ICD-9 codes used to define prevalent comorbid conditions and incident conditions Comorbid condition ICD-9 code Hypertension 401-405 Diabetes mellitus 250.x Myocardial infarction

More information

COSTS OF DIABETES IN DEVELOPING COUNTRIES

COSTS OF DIABETES IN DEVELOPING COUNTRIES COSTS OF DIABETES IN DEVELOPING COUNTRIES Jonathan Betz Brown, MPP, PhD Chair, International Diabetes Federation Task Force on Diabetes Health Economics Senior Investigator, Kaiser Permanente Center for

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

No relevant financial relationships

No relevant financial relationships MANAGEMENT OF LIPID DISORDERS Balancing Benefits and harms Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial relationships baron@medicine.ucsf.edu

More information

ADVANCE post trial ObservatioNal Study

ADVANCE post trial ObservatioNal Study Hot Topics in Diabetes 50 th EASD, Vienna 2014 ADVANCE post trial ObservatioNal Study Sophia Zoungas The George Institute The University of Sydney Rationale and Study Design Sophia Zoungas The George Institute

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

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

No relevant financial relationships

No relevant financial relationships MANAGEMENT OF LIPID DISORDERS: WHERE DO WE STAND WITH THE NEW PRACTICE GUIDELINES? Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Disclosure No relevant financial relationships

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

Cedars Sinai Diabetes. Michael A. Weber

Cedars Sinai Diabetes. Michael A. Weber Cedars Sinai Diabetes Michael A. Weber Speaker Disclosures I disclose that I am a Consultant for: Ablative Solutions, Boston Scientific, Boehringer Ingelheim, Eli Lilly, Forest, Medtronics, Novartis, ReCor

More information

Objectives. Objectives. Alejandro J. de la Torre, MD Cook Children s Hospital May 30, 2015

Objectives. Objectives. Alejandro J. de la Torre, MD Cook Children s Hospital May 30, 2015 Alejandro J. de la Torre, MD Cook Children s Hospital May 30, 2015 Presentation downloaded from http://ce.unthsc.edu Objectives Understand that the obesity epidemic is also affecting children and adolescents

More information

DECLARATION OF CONFLICT OF INTEREST. None

DECLARATION OF CONFLICT OF INTEREST. None DECLARATION OF CONFLICT OF INTEREST None Dietary changes and its influence on cardiovascular diseases in Asian and European countries Problems of Eastern European countries for cardiovascular disease prevention

More information

Statin therapy in patients with Mild to Moderate Coronary Stenosis by 64-slice Multidetector Coronary Computed Tomography

Statin therapy in patients with Mild to Moderate Coronary Stenosis by 64-slice Multidetector Coronary Computed Tomography Statin therapy in patients with Mild to Moderate Coronary Stenosis by 64-slice Multidetector Coronary Computed Tomography Hyo Eun Park 1, Eun-Ju Chun 2, Sang-Il Choi 2, Soyeon Ahn 2, Hyung-Kwan Kim 3,

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

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

New Recommendations for the Treatment of Hypertension: From Population Salt Reduction to Personalized Treatment Targets

New Recommendations for the Treatment of Hypertension: From Population Salt Reduction to Personalized Treatment Targets New Recommendations for the Treatment of Hypertension: From Population Salt Reduction to Personalized Treatment Targets Sidney C. Smith, Jr. MD, FACC, FAHA Professor of Medicine/Cardiology University of

More information

OBESITY IN PRIMARY CARE

OBESITY IN PRIMARY CARE OBESITY IN PRIMARY CARE Obesity- definition Is a chronic disease In ICD 10 E66 Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. Obesity is a leading

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

Hypertension Management Controversies in the Elderly Patient

Hypertension Management Controversies in the Elderly Patient Hypertension Management Controversies in the Elderly Patient Juan Bowen, MD Geriatric Update for the Primary Care Provider November 17, 2016 2016 MFMER slide-1 Disclosure No financial relationships No

More information

High intensity exercise improves cardiac structure and function and reduces liver fat in adults with Type 2 diabetes

High intensity exercise improves cardiac structure and function and reduces liver fat in adults with Type 2 diabetes High intensity exercise improves cardiac structure and function and reduces liver fat in adults with Type 2 diabetes Sophie Cassidy, s.cassidy@ncl.ac.uk 1) Concentric remodelling 1.2 * Eccentricity ratio

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

Preventive Cardiology Scientific evidence

Preventive Cardiology Scientific evidence Preventive Cardiology Scientific evidence Professor David A Wood Garfield Weston Professor of Cardiovascular Medicine International Centre for Circulatory Health Imperial College London Primary prevention

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

Preventing Diabetes K A R O L E. W A T S O N, M D, P H D, F A C C P R O F E S S O R O F M E D I C I N E / C A R D I O L O G Y

Preventing Diabetes K A R O L E. W A T S O N, M D, P H D, F A C C P R O F E S S O R O F M E D I C I N E / C A R D I O L O G Y Preventing Diabetes 2018 K A R O L E. W A T S O N, M D, P H D, F A C C P R O F E S S O R O F M E D I C I N E / C A R D I O L O G Y D A V I D G E F F E N S C H O O L O F M E D I C I N E A T U C L A CO-DIRECTOR,

More information

Using the New Hypertension Guidelines

Using the New Hypertension Guidelines Using the New Hypertension Guidelines Kamal Henderson, MD Department of Cardiology, Preventive Medicine, University of North Carolina School of Medicine Kotchen TA. Historical trends and milestones in

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

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

7/6/2012. University Pharmacy 5254 Anthony Wayne Drive Detroit, MI (313)

7/6/2012. University Pharmacy 5254 Anthony Wayne Drive Detroit, MI (313) University Pharmacy 5254 Anthony Wayne Drive Detroit, MI 48202 (313) 831-2008 Be able to identify the signs of a heart attack or stoke Identify what puts you at a higher risk for cardiovascular disease,

More information

Your Name & Phone Number Here! Longevity Index

Your Name & Phone Number Here! Longevity Index Your Name & Phone Number Here! Longevity Index Your Health Risk Analysis is based on a variety of medical and scientific data from organizations such as the American Heart Association, American Dietetic

More information

A factorial randomized trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes

A factorial randomized trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes A factorial randomized trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes Hypotheses: Among individuals with type 2 diabetes, the risks of major microvascular

More information

New Lipid Guidelines. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids.

New Lipid Guidelines. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Disclosure No relevant

More information

The EMPA-REG OUTCOME trial: Design and results. David Fitchett, MD University of Toronto, Canada

The EMPA-REG OUTCOME trial: Design and results. David Fitchett, MD University of Toronto, Canada The EMPA-REG OUTCOME trial: Design and results David Fitchett, MD University of Toronto, Canada Asian Cardio Diabetes Forum April 23 24, 2016 Kuala Lumpur, Malaysia Life Expectancy Is Reduced by ~12 Years

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

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

Placebo-Controlled Statin Trials Prevention Of CVD in Women"

Placebo-Controlled Statin Trials Prevention Of CVD in Women MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest

More information

Disclosure. No relevant financial relationships. Placebo-Controlled Statin Trials

Disclosure. No relevant financial relationships. Placebo-Controlled Statin Trials PREVENTING CARDIOVASCULAR DISEASE IN WOMEN: Current Guidelines for Hypertension, Lipids and Aspirin Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial

More information

Hypertension and obesity. Dr Wilson Sugut Moi teaching and referral hospital

Hypertension and obesity. Dr Wilson Sugut Moi teaching and referral hospital Hypertension and obesity Dr Wilson Sugut Moi teaching and referral hospital No conflict of interests to declare Obesity Definition: excessive weight that may impair health BMI Categories Underweight BMI

More information

T. Suithichaiyakul Cardiomed Chula

T. Suithichaiyakul Cardiomed Chula T. Suithichaiyakul Cardiomed Chula The cardiovascular (CV) continuum: role of risk factors Endothelial Dysfunction Atherosclerosis and left ventricular hypertrophy Myocardial infarction & stroke Endothelial

More information

Primary and Secondary Prevention of Cardiovascular Disease. Frank J. Green, M.D., F.A.C.C. St. Vincent Medical Group

Primary and Secondary Prevention of Cardiovascular Disease. Frank J. Green, M.D., F.A.C.C. St. Vincent Medical Group Primary and Secondary Prevention of Cardiovascular Disease Frank J. Green, M.D., F.A.C.C. St. Vincent Medical Group AHA Diet and Lifestyle Recommendations Balance calorie intake and physical activity to

More information

Disclosures OBESITY. Overview. Obesity: Definition. Prevalence of Obesity is Rising. Obesity as a Risk Factor. None

Disclosures OBESITY. Overview. Obesity: Definition. Prevalence of Obesity is Rising. Obesity as a Risk Factor. None Disclosures None OBESITY Florencia Halperin, M.D. Medical Director, Program for Management Brigham and Women s Hospital Instructor in Medicine, Harvard Medical School Overview Obesity: Definition Definition

More information

Supplementary Appendix

Supplementary Appendix Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Wanner C, Inzucchi SE, Lachin JM, et al. Empagliflozin and

More information

Obesity in the pathogenesis of chronic disease

Obesity in the pathogenesis of chronic disease Portoroz October 16th 2013 Obesity in the pathogenesis of chronic disease Rocco Barazzoni University of Trieste Department of Medical, Surgical and Health Sciences Obesity Trends* Among U.S. Adults BRFSS,

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

What s New in Bariatric Surgery?

What s New in Bariatric Surgery? Bariatric Surgery: Update for the General Surgeon What s New in Bariatric Surgery? 2,000 B.C. 2,000 A.D. 1. America keeps getting fatter without an end in sight. 2. Bariatric surgery is not just about

More information

The prevalence of obesity in adults has doubled over the past 30 years

The prevalence of obesity in adults has doubled over the past 30 years Obesity in America: Facts and Fiction MICHAEL G. PERRI, PhD Professor, Clinical and Health Psychology Interim Dean, College of Public Health and Health Professions University of Florida Overview: Key Questions

More information

«Πατσζαρκία και Καρδιαγγειακή Νόζος»

«Πατσζαρκία και Καρδιαγγειακή Νόζος» «Πατσζαρκία και Καρδιαγγειακή Νόζος» Δημήτρης Π. Παπαδόπουλος-FESC Clinical Assist. Professor George Washington University USA Επιμελητής Καρδιολογικής Κλινικής Π.Γ.Ν.Α. «ΛΑΪΚΟ» Υπεύθυνος Αντιυπερτασικού

More information

ADVANCES IN MANAGEMENT OF HYPERTENSION

ADVANCES IN MANAGEMENT OF HYPERTENSION Prevalence 29%; Blacks 33.5% About 72.5% treated; 53.5% uncontrolled (>140/90) Risk for poor control: Latinos, Blacks, age 18-44 and 80,

More information

Placebo-Controlled Statin Trials MANAGEMENT OF HIGH BLOOD CHOLESTEROL MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES

Placebo-Controlled Statin Trials MANAGEMENT OF HIGH BLOOD CHOLESTEROL MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest

More information

Supplementary Online Content. Abed HS, Wittert GA, Leong DP, et al. Effect of weight reduction and

Supplementary Online Content. Abed HS, Wittert GA, Leong DP, et al. Effect of weight reduction and 1 Supplementary Online Content 2 3 4 5 6 Abed HS, Wittert GA, Leong DP, et al. Effect of weight reduction and cardiometabolic risk factor management on sympton burden and severity in patients with atrial

More information

Disclosure. No relevant financial relationships. Placebo-Controlled Statin Trials

Disclosure. No relevant financial relationships. Placebo-Controlled Statin Trials MANAGEMENT OF HYPERLIPIDEMIA AND CARDIOVASCULAR RISK IN WOMEN: Balancing Benefits and Harms Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial

More information

NOT-FED Study New Obesity Treatment- Fasting, Exercise, Diet

NOT-FED Study New Obesity Treatment- Fasting, Exercise, Diet NOT-FED Study New Obesity Treatment- Fasting, Exercise, Diet FASTING 16 hours a day EXCERCISE 150 min a week DIET Low carb NOSM Northern Research Conference, Kenora, 2018 R Minty, T O Driscoll, L Kelly,

More information

2014/10/20. Management of Lipid Disorders Eric Klug Sunninghill, Sunward Park and CM JHB Academic Hospitals

2014/10/20. Management of Lipid Disorders Eric Klug Sunninghill, Sunward Park and CM JHB Academic Hospitals Management of Lipid Disorders Eric Klug Sunninghill, Sunward Park and CM JHB Academic Hospitals Sudden and unexpected deaths in an adult population, Cape Town, South Africa, 2001-2005 1 Sudden and unexpected

More information

Hypertension Update Warwick Jaffe Interventional Cardiologist Ascot Hospital

Hypertension Update Warwick Jaffe Interventional Cardiologist Ascot Hospital Hypertension Update 2008 Warwick Jaffe Interventional Cardiologist Ascot Hospital Definition of Hypertension Continuous variable At some point the risk becomes high enough to justify treatment Treatment

More information

Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology

Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology Disclosures In compliance with the accrediting board policies, the American Diabetes Association requires the

More information

Effects of whole grain intake on weight changes, diabetes, and cardiovascular Disease

Effects of whole grain intake on weight changes, diabetes, and cardiovascular Disease Effects of whole grain intake on weight changes, diabetes, and cardiovascular Disease Simin Liu, MD, ScD Professor of Epidemiology and Medicine Director, Center for Global Cardiometabolic Health Brown

More information

Should we prescribe aspirin and statins to all subjects over 65? (Or even all over 55?) Terje R.Pedersen Oslo University Hospital Oslo, Norway

Should we prescribe aspirin and statins to all subjects over 65? (Or even all over 55?) Terje R.Pedersen Oslo University Hospital Oslo, Norway Should we prescribe aspirin and statins to all subjects over 65? (Or even all over 55?) Terje R.Pedersen Oslo University Hospital Oslo, Norway The Polypill A strategy to reduce cardiovascular disease by

More information

Effective Interventions in the Clinical Setting: Engaging and Empowering Patients. Michael J. Bloch, M.D. Doina Kulick, M.D.

Effective Interventions in the Clinical Setting: Engaging and Empowering Patients. Michael J. Bloch, M.D. Doina Kulick, M.D. Effective Interventions in the Clinical Setting: Engaging and Empowering Patients Michael J. Bloch, M.D. Doina Kulick, M.D. UNIVERSITY OF NEVADA SCHOOL of MEDICINE Sept. 8, 2011 Reality check: What could

More information

Antihypertensive Trial Design ALLHAT

Antihypertensive Trial Design ALLHAT 1 U.S. Department of Health and Human Services Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic National Institutes

More information

Results/ conclusion. Reference Duration Number subjects. Study description. Limitations of the data. Randomized controlled trial (RCT)

Results/ conclusion. Reference Duration Number subjects. Study description. Limitations of the data. Randomized controlled trial (RCT) (original) Appel, 1997 8 weeks 459 459 ; all received a control SAD for 3 weeks then randomized to (i) control (ii) a diet rich in fruits and veg (FV) or (iii) a combination diet (combo) rich in fruits,

More information

Sleep Apnea: Vascular and Metabolic Complications

Sleep Apnea: Vascular and Metabolic Complications Sleep Apnea: Vascular and Metabolic Complications Vahid Mohsenin, M.D. Professor of Medicine Yale University School of Medicine Director, Yale Center for Sleep Medicine Definitions Apnea: Cessation of

More information

Section 03: Pre Exercise Evaluations and Risk Factor Assessment

Section 03: Pre Exercise Evaluations and Risk Factor Assessment Section 03: Pre Exercise Evaluations and Risk Factor Assessment ACSM Guidelines: Chapter 3 Pre Exercise Evaluations ACSM Manual: Chapter 3 Risk Factor Assessments HPHE 4450 Dr. Cheatham Purpose The extent

More information

Lifestyle Medicine. This presentation will:

Lifestyle Medicine. This presentation will: Lifestyle Medicine This presentation will: Identify barriers to lifestyle therapy and develop strategies to promote behavioral changes in patients with obesity and/or T2D. AACE = American Association of

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

Statistical Fact Sheet Populations

Statistical Fact Sheet Populations Statistical Fact Sheet Populations At-a-Glance Summary Tables Men and Cardiovascular Diseases Mexican- American Males Diseases and Risk Factors Total Population Total Males White Males Black Males Total

More information

9/26/2018. Andy Weiler, M.Ed. September 26 th, 2018

9/26/2018. Andy Weiler, M.Ed. September 26 th, 2018 Andy Weiler, M.Ed. September 26 th, 2018 1 2 Stay tuned for the answer to our riddle Riddle #2 3 Riddle #2 Riddle #2 4 Riddle #2 The answer: 50%/50% chance to be right Fluids: blood volume, body water,

More information

American Academy of Insurance Medicine

American Academy of Insurance Medicine American Academy of Insurance Medicine October 2012 Dr. Alison Moy Liberty Mutual Dr. John Kirkpatrick Thrivent Financial for Lutherans 1 59 year old male, diagnosed with T2DM six months ago Nonsmoker

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

4. resisted training ** OR resistance training * OR resisted exercise ** OR resistance exercise ** OR strength training ** OR strength exercise **

4. resisted training ** OR resistance training * OR resisted exercise ** OR resistance exercise ** OR strength training ** OR strength exercise ** Supplementary Table 1. Search strategy (up to January 10 th 2015). MEDLINE Result: 253 studies 1. clinical trial ** OR controlled trial ** OR randomized controlled trial * OR randomised controlled trial

More information

ALLHAT. Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic

ALLHAT. Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic 1 U.S. Department of Health and Human Services National Institutes of Health Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker

More information

`~äçêáéëi=läéëáíó=~åç=aá~äéíéë= with Dr. T. Colin Campbell

`~äçêáéëi=läéëáíó=~åç=aá~äéíéë= with Dr. T. Colin Campbell `~äçêáéëi=läéëáíó=~åç=aá~äéíéë= with Dr. T. Colin Campbell This lecture will cover the following topics 1. Introduction 2. Overweight and Obesity in Children 3. Overweight and Obesity in Adults 4. Proposed

More information

Adult Diabetes Clinician Guide NOVEMBER 2017

Adult Diabetes Clinician Guide NOVEMBER 2017 Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Adult Diabetes Clinician Guide Introduction NOVEMBER 2017 This evidence-based guideline summary is based on the 2017 KP National Diabetes Guideline.

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

Individualized Treatment Goals for Optimal Long-Term Health Outcomes among Patients with Type 2 Diabetes Mellitus

Individualized Treatment Goals for Optimal Long-Term Health Outcomes among Patients with Type 2 Diabetes Mellitus 1 Dissertation Title Page: Individualized Treatment Goals for Optimal Long-Term Health Outcomes among Patients with Type 2 Diabetes Mellitus Qian Shi, MPH, PhD candidate Department of Global Health Management

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

Felix Vallotton Ball (1899) LDL-C management in Asian diabetes: moderate vs. high intensity statin --- a lesson from EMPATHY study

Felix Vallotton Ball (1899) LDL-C management in Asian diabetes: moderate vs. high intensity statin --- a lesson from EMPATHY study Felix Vallotton Ball (1899) LDL-C management in Asian diabetes: moderate vs. high intensity statin --- a lesson from EMPATHY study Conflict of interest disclosure None Committee of Scientific Affairs Committee

More information

Dietary recommendations in Obesity, Hypertension, Hyperlipidemia, and Diabetes. Stephen D. Sisson MD

Dietary recommendations in Obesity, Hypertension, Hyperlipidemia, and Diabetes. Stephen D. Sisson MD Dietary recommendations in Obesity, Hypertension, Hyperlipidemia, and Diabetes Stephen D. Sisson MD Objectives To review dietary recommendations in the following conditions: Obesity Hypertension Diabetes

More information

3/20/2011. Body Mass Index (kg/[m 2 ]) Age at Issue (*BMI > 30, or ~ 30 lbs overweight for 5 4 woman) Mokdad A.H.

3/20/2011. Body Mass Index (kg/[m 2 ]) Age at Issue (*BMI > 30, or ~ 30 lbs overweight for 5 4 woman) Mokdad A.H. U.S. Adults: 1988 Nineteen states with 10-14% 14% Prevalence of Obesity (*BMI > 30, or ~ 30 lbs overweight for 5 4 woman) Metabolic John P. Cello, MD Professor of Medicine and Surgery, University of California,

More information

ADVANCES IN MANAGEMENT OF HYPERTENSION

ADVANCES IN MANAGEMENT OF HYPERTENSION Advances in Management of Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Current Status of Prevalence 29%; Blacks 33.5%

More information

Soo LIM, MD, PHD Internal Medicine Seoul National University Bundang Hospital

Soo LIM, MD, PHD Internal Medicine Seoul National University Bundang Hospital Soo LIM, MD, PHD Internal Medicine Seoul National University Bundang Hospital 1. Importance of Lowering LDL-Cholesterol in Diabetes Patients & Lipid Guidelines Prevalence of dyslipidemia in Korea Prevalence

More information

GATEWAY Trial. Bariatric Surgery versus Conventional Medical Treatment in Obese Patients with Hypertension

GATEWAY Trial. Bariatric Surgery versus Conventional Medical Treatment in Obese Patients with Hypertension GATEWAY Trial Bariatric Surgery versus Conventional Medical Treatment in Obese Patients with Hypertension Carlos Aurelio Schiavon, MD, FACS On behalf of the GATEWAY Executive Committee and Investigators

More information

Part 1: Obesity. Dietary recommendations in Obesity, Hypertension, Hyperlipidemia, and Diabetes 10/15/2018. Objectives.

Part 1: Obesity. Dietary recommendations in Obesity, Hypertension, Hyperlipidemia, and Diabetes 10/15/2018. Objectives. Dietary recommendations in Obesity, Hypertension, Hyperlipidemia, and Diabetes Stephen D. Sisson MD Objectives To review dietary recommendations in the following conditions: Obesity Hypertension Diabetes

More information

Why Do We Treat Obesity? Epidemiology

Why Do We Treat Obesity? Epidemiology Why Do We Treat Obesity? Epidemiology Epidemiology of Obesity U.S. Epidemic 2 More than Two Thirds of US Adults Are Overweight or Obese 87.5 NHANES Data US Adults Age 2 Years (Crude Estimate) Population

More information

well-targeted primary prevention of cardiovascular disease: an underused high-value intervention?

well-targeted primary prevention of cardiovascular disease: an underused high-value intervention? well-targeted primary prevention of cardiovascular disease: an underused high-value intervention? Rod Jackson University of Auckland, New Zealand October 2015 Lancet 1999; 353: 1547-57 Findings: Contribution

More information

Management of Lipid Disorders and Hypertension: Implications of the New Guidelines

Management of Lipid Disorders and Hypertension: Implications of the New Guidelines Management of Lipid Disorders and Hypertension Management of Lipid Disorders and Hypertension: Implications of the New Guidelines Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine

More information

Environmental. Vascular / Tissue. Metabolics

Environmental. Vascular / Tissue. Metabolics Global Risk Reduction--WINS Picking Mom and Dad-2016 Environmental Vascular / Tissue Metabolics Stop smoking-1b Physical activity-1b Weight control-1b Chelation therapy-3c Influenza vaccination-1b Blood

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

Primary Outcome Results of DiRECT the Diabetes REmission Clinical Trial

Primary Outcome Results of DiRECT the Diabetes REmission Clinical Trial Finding a practical management solution for T2DM, in primary care Primary Outcome Results of DiRECT the Diabetes REmission Clinical Trial Mike Lean, Roy Taylor, and the DiRECT Team IDF Abu Dhabi, December

More information

Why Screen at 23? What can YOU do?

Why Screen at 23? What can YOU do? Why Screen at 23? Every 1 in 2 Asian American adults has diabetes or prediabetes. More than half of Asian Americans did not know they have type 2 diabetes or prediabetes. Asian Americans can develop diabetes

More information

Objectives. Describe results and implications of recent landmark hypertension trials

Objectives. Describe results and implications of recent landmark hypertension trials Hypertension Update Daniel Schwartz, MD Assistant Professor of Medicine Associate Medical Director of Heart Transplantation Temple University School of Medicine Disclosures I currently have no relationships

More information

What s In the New Hypertension Guidelines?

What s In the New Hypertension Guidelines? American College of Physicians Ohio/Air Force Chapters 2018 Scientific Meeting Columbus, OH October 5, 2018 What s In the New Hypertension Guidelines? Max C. Reif, MD, FACP Objectives: At the end of the

More information

Marshall Tulloch-Reid, MD, MPhil, DSc, FACE Epidemiology Research Unit Tropical Medicine Research Institute The University of the West Indies, Mona,

Marshall Tulloch-Reid, MD, MPhil, DSc, FACE Epidemiology Research Unit Tropical Medicine Research Institute The University of the West Indies, Mona, Marshall Tulloch-Reid, MD, MPhil, DSc, FACE Epidemiology Research Unit Tropical Medicine Research Institute The University of the West Indies, Mona, Jamaica At the end of this presentation the participant

More information

CARE PATHWAYS. Allyson Ashley

CARE PATHWAYS. Allyson Ashley CARE PATHWAYS Allyson Ashley WHAT IS A CARE PATHWAY? An explicit statement of the goals and key elements of care based on evidence, best practice, and patient s expectations and their characteristics The

More information

The Latest Generation of Clinical

The Latest Generation of Clinical The Latest Generation of Clinical Guidelines: HTN and HLD Dave Brackett Clinical Guideline Purpose Uniform approach Awareness of key details Diagnosis Treatment Monitoring Evidence based approach Inform

More information

Treadmill Workstations: A Worksite Physical Activity Intervention

Treadmill Workstations: A Worksite Physical Activity Intervention Treadmill Workstations: A Worksite Physical Activity Intervention Dinesh John, Ph.D. 1,2 Dixie L. Thompson, Ph.D., FACSM 1 Hollie Raynor 1, Ph.D. 1 Kenneth M. Bielak. M.D. 1 David R. Bassett, Ph.D., FACSM

More information

Targeted Nutrition Therapy Nutrition Masters Course

Targeted Nutrition Therapy Nutrition Masters Course Targeted Nutrition Therapy Nutrition Masters Course Nilima Desai, MPH, RD Learning Objectives Review clinical studies on innovative, targeted nutrition therapies for: o Blood glucose management o Dyslipidemia

More information