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Cardio Metabolic Health Congress – Official Blog

Sitting at Work? Exercise to Reduce Cardiometabolic Risk

Regular exercise outside of work can reduce the risk of metabolic syndrome in people whose jobs have them sitting most of the time, according to a small study from Brazil.

“If you have a sedentary occupation, especially in a sitting position for hours, you should move yourself out of work at least 150 minutes per week in a moderate intensity to mitigate the detrimental effects of sedentary behavior at work,” Eduardo Caldas Costa from Federal University of Rio Grande do Norte in Natal reported.

Sedentary behavior has been associated with an increased risk for metabolic syndrome – a cluster of unfavorable markers including abdominal obesity, high blood pressure and low HDL “good” cholesterol – which, in turn, is associated with an increased risk of developing heart disease and type 2 diabetes.

The researchers investigated whether Navy workers who spent about eight hours daily seated, mostly in administrative duties, had different risks for metabolic syndrome based on their activity levels outside of work.

All the workers were men, ranging in age from 26 to 42. Out of 502 workers included in the final analysis, 201, or 40 percent, did not achieve at least 150 minutes per week of moderate-vigorous activity. Nearly half, 48 percent, were overweight and almost 19 percent were obese.

After adjusting for age, time in the job, body mass index (BMI) and tobacco use, researchers found the sedentary workers who met the physical activity recommendations were only about half as likely to have metabolic syndrome, compared to those with lower activity levels.

Workers with higher activity levels were also less likely to have abdominal obesity, high blood pressure and low HDL.

Even those who increased their activity slightly (the “insufficiently active” group) had lower blood pressure than workers who remained sedentary off the job, researchers reported in the Journal of Occupational and Environmental Medicine.

“Sedentary occupation workers should break up prolonged sitting time at work as much as they can in order to reduce the risk for cardiovascular and metabolic diseases,” Caldas Costa said by email. “Be involved in regular physical activity out of work, including leisure time, domestic activities, and active transportation (i.e., walking and/or cycling).”

Only the physically active group, he added, and not the insufficiently active group, had a reduced risk for metabolic syndrome compared to the sedentary group. “Therefore,” he said, “it seems that probably there is a minimum quantity of physical activity that can mitigate the detrimental effects of sedentary behavior at work.”

Salt Consumption: Enough to Damage Heart?

The amount of salt a typical American adult consumes each day may be enough to damage the heart muscle and make it harder to pump blood, a U.S. study suggests.

A high-salt diet has long been linked to higher odds of developing high blood pressure and heart disease as well as an increased risk of heart attack, stroke and heart failure. But determining the ideal amount of dietary salt is controversial because some research has also found an elevated risk of heart disease, high blood pressure and heart attacks in otherwise healthy people who consume too little salt.

In the current study, published in the Journal of the American College of Cardiology, half of the people consumed at least 3.73 grams a day of sodium, the equivalent of about two teaspoons of table salt.

Compared with adults who ate less sodium, people who consumed more than 3.7 grams of sodium a day were more likely to have enlargement in the left chambers of the heart that are responsible for pumping oxygen-rich blood into the body. They were also more likely to have signs of muscle strain in the heart that can precede structural damage.

“This study enhances our understanding of the adverse effects of salt intake on heart function,” said lead study author Dr. Senthil Selvaraj, a researcher at the Hospital of the University of Pennsylvania in Philadelphia.

While the results don’t settle the debate over the optimal amount of salt, the findings should still encourage people who eat a lot of salt to cut back, Selvaraj said by email. That’s because reducing sodium intake can help reverse high blood pressure, a major risk factor for heart failure, stroke and heart attacks.

“There is still a healthy debate ongoing,” Selvaraj added. “It is still worth the effort to reduce your sodium intake.”

Cardiovascular diseases are the leading cause of death worldwide, killing almost one in every three people. Sodium is found not only in table salt, but also in a variety of foods such as bread, milk, eggs, meat, and shellfish as well as processed items like soup, pretzels, popcorn, soy sauce and bouillon or stock cubes.

To lower the risk of heart disease, adults should reduce sodium intake to less than 2 grams a day, or the equivalent of about one teaspoon of salt, according to the World Health Organization (WHO).

For the current study, researchers examined data from lab tests of sodium intake, heart structure and heart function for almost 3,000 adults. Participants were 49 years old on average, 54 percent had high blood pressure and half were African-American. They were typically overweight or obese. To assess how sodium intake influenced the heart, researchers accounted for age, sex, smoking status, alcohol use, activity levels, and certain medications.

The study wasn’t a controlled experiment designed to prove how or if salt damages the heart or impairs heart function.
One limitation of the study is that researchers tested sodium intake using overnight urine samples, which may not be as accurate as the gold standard, 24-hour urine collection, the authors note.

Researchers also didn’t have enough data on people who consumed very little sodium to assess how low salt intake influences the heart. “We know less than we should about salt,” said Thomas Marwick, author of an accompanying editorial and director of the Baker Heart and Diabetes Institute in Melbourne, Australia.

“In general, most of the population take far more salt than is good for them and this is a reminder to reduce intake,” Marwick said by email. “It’s ubiquitous and hard to reduce to very low levels,” Marwick added. “While some zealots want to reduce intake to zero, I’m not sure that drastic reduction is necessarily beneficial.”

New ADA/AADE Standards Combine Diabetes Education & Support

New recommendations from the American Diabetes Association (ADA) and American Association of Diabetes Educators (AADE) combine the concepts of diabetes self-management education and support for the first time.


The document, published in both Diabetes Care and the Diabetes Educator, is an update from 2014, when guidelines for diabetes self-management support and diabetes self-management education had been outlined separately.

Today, the view is that “diabetes self-management education and support (DSMES) is a critical element of care for all people with diabetes and those at risk for developing the condition,” write task force co-chairs and certified diabetes educators Joni Beck, PharmD, and Deborah A Greenwood, PhD, RN, and colleagues.

“DSMES is the ongoing process of facilitating the knowledge, skills, and ability necessary for prediabetes and diabetes self-care, as well as activities that assist a person in implementing and sustaining the behaviors needed to manage his or her condition on an ongoing basis, beyond or outside of formal self-management training,” they explain.

While the standards define evidence-based DSMES services that meet or exceed Medicare’s diabetes self-management training (DSMT) regulations, they don’t actually guarantee reimbursement. “The hope is that payers will view these standards as a tool for reviewing DSMES reimbursement requirements and consider change to align with the way their beneficiaries’ engagement preferences have evolved,” the authors say.

Currently, less than 5% of Medicare beneficiaries use the DSMES benefits that are covered.

The standards apply to diabetes educators in a variety of settings and within new and emerging models of care, such as virtual visits, accountable care organizations, patient-centered medical homes, and value-based payment models.

These same DSMES standards are used both for ADA recognition and AADE accreditation and also can serve as a guide for non-accredited and non-recognized diabetes education providers.

Although there is overlap between DSMES services and those of the National Diabetes Prevention Program (National DPP) lifestyle-change program, the two are tailored to different audiences (diabetes vs prediabetes) and have different goals (diabetes management vs prevention). Recognition of DPP programs is handled by the US Centers for Disease Control and Prevention. Centers providing both types of services have been shown successful, but they need to meet both sets of standards.

The new document details 10 specific standards for DSMES programs: internal structure, stakeholder input, evaluation of population served, quality coordinator overseeing DSMES services, the DSMES team, curriculum, individualization, ongoing support, participant progress, and quality improvement.

While previous standards have used the term “program,” the current terminology is “services,” which “more clearly delineates the need to individualize and identify the elements of DSMES appropriate for an individual. This revision encourages providers of DSMES to embrace a contemporary view of the new complexities of the evolving healthcare landscape,” the authors write.

Expect the next revision sooner than 3 years from now, they say. “Given the rapidly changing healthcare environment and the ever-growing field of technology, the 2017 Standards Revision Task Force recognizes the potential need to review the literature for evidence-driven updates more frequently in the future as advances in healthcare delivery are evolving.”

Why Are Different Countries Obese?

Recently published studies dictate different causes and factors behind the public health epidemic of obesity, focusing on several different countries–many of which have varying reasons for their respective obesity epidemics.

The Pacific Islands, Middle East and Americas lead the way in terms of regions with the greatest obesity rates. In 2014, more than 48% of the population of the Cook Islands was classified as obese. Qatar led the way in the Middle East with 34%, followed closely by the United States at 33%, according to the World Health Organization.

Obesity is defined using a person’s body mass index, the ratio between weight and height, with a BMI of 25 to 29.9 considered overweight and over 30 obese. The number of overweight or obese infants and children under the age of 5 increased from 32 million in 1990 to 42 million in 2013, according to the World Health Organization, with numbers increasing from 4 million to 9 million in the African region alone over that period.

While physical inactivity is said to be aiding the growing rate of obesity worldwide, for example as urbanization leads to more sedentary lives, experts point out that in some populations, exercise simply isn’t a priority.

This is evident in the Middle East and China, they say, namely through perceptions of exercise and its place on residents’ list of priorities. In Kuwait, focus groups from the World Health Organization found that locals consider exercise as sport rather than something done with a group of friends or at home, according to Temo Waqanivalu, team leader of population-based prevention of noncommunicable diseases at the WHO. “There’s a whole cultural barrier,” he said.

In addition, in the Middle East overall, it’s not considered the norm for women to take part in outdoor exercise or physical activity for leisure. “Having women exercise openly is a cultural issue,” he said. Across Asia and the Middle East, Hu thinks there is a great deal of misunderstanding. “Most people are not aware of the benefits of being physically active on their health,” he said.

CHCP Credentials & Continuing Education

The Alliance for Continuing Education in the Health Professions has recently published an interview profiling the General Manager of the Cardiometabolic Health Congress, Amanda Jamrogiewicz, who recently achieved her CHCP—delivering enhanced credibility to CMHC as a provider of continuing medical education.

The CHCP credential is one of the primary ways to enhance professional development: recognition from the industry that one is both knowledgeable and experienced in CME accreditation. Because there is no formal education or degree in terms of CME, the CHCP credential adds significant value to professional and educational development.

Moreover, the CHCP designation provides CMHC with a valuable CME/CE resource, credible not only to internal organizational activities, but also to outside stakeholders. Through the CHCP accreditation, leaders in healthcare education and training develop the necessary information, tools, and skillsets in order to navigate today’s healthcare industry. CHCP programs are dedicated to providing training in the allied healthcare fields, and students become both highly proficient and knowledgeable in the sphere of healthcare.

The CHCP credential furthers CMHC’s commitment to valuable clinical education, rooted in the most recent scientific discoveries, research, and findings.

Visit the CMHC Education Resource Center for further information. 

Moderate Drinking May Help Prevent Diabetes

A study published in Diabetologia, conducted by researchers from the National Institute of Public Health of the University of Southern Denmark, suggests that people who drink three to four times a week are less likely to develop type 2 diabetes than those who never drink.

The study, which surveyed over 70,000 people on alcohol intake, found that wine was particularly beneficial—as it likely plays a role in helping manage blood sugar. The study does note, however, that drinking frequency has an independent effect from the amount of alcohol taken: the effects are more beneficial when drinking the alcohol in four portions, rather than all at once.

The researchers concluded that moderate drinking three to four times a week reduced a woman’s risk of diabetes by 32%, while it lowered a man’s risk by 27%, compared with people drinking less than one day a week.

The findings further suggest that not all types of alcohol yielded the same effect: while men who drank 1-6 peers per week lowered their diabetes risk by 21%, there was little to no impact on women’s risk. Conversely, a high intake of spirits among women significantly increased their risk of diabetes—yet there was no effect on men.

The team have used a similar survey to research the effect of alcohol on other conditions, finding that drinking moderately a few times a week was linked to a lower risk of cardiovascular disorders including heart attack and stroke.

Stopping Cholesterol-Lowering Drugs Could be Deadly

A new study confirms that stopping a cholesterol-lowering drug can be critically dangerous. Researchers found that people who stopped taking statins, after reporting a side effect, were 13% more likely to die, or have a hear attack or stroke over the next four years.


Statins work by inhibiting the liver’s ability to produce cholesterol, while simultaneously helping the organ remove existing fats in the blood. These drugs are ‘almost universally prescribed’ to people with cardiovascular disease; moreover, the U.S. Preventive Services Task Force recommends the drugs to people ages 40-75, who have no history of heart disease, if they have one or more risk factors.

While there is extensive literature and clinical studies surrounding the efficacy of statins, a quarter to a half of patients stop taking the drugs within six months to a year, according to Dr. Alexander Turchin of Brigham and Women’s Hospital in Boston. In order to determine whether people who continue taking statins fare better than those who do not, researchers analyzed data from two Boston hospitals between 2000 and 2011.

During that period, over 200,000 adults were prescribed and treated with statins; almost 45,000 of those people reported a side effect that they thought might be from the medication: generally muscle or stomach aches. The researchers focused on 28,266 people from those 45,000 with possible side effects: most of them, 19,989 individuals, continued to take the statins.

Approximately four years after the side effects were reported, 3,677 patients had died, or suffered a heart attack or stroke. Overall, researchers found that people who stopped taking statins were 13 percent more likely to die or have a heart attack, or stroke. According to Dr. Robert Rosenson, a professor of cardiology at the Icahn School of Medicine at Mount Sinai in New York City, these new findings further confirm and expand on previous studies that demonstrated the benefits of continuing to take statins.

Ozone Exposure Tied to Higher Cardiovascular Risk

Research findings recently published in the journal JAMA Internal Medicine, conducted by researchers from Duke University with colleagues from several educational institutions in China, indicate that exposure to high and harmful ozone levels can increase blood pressure: a primary risk factor for cardiovascular disease.

Senior author Junfeng Zhang, a professor in global and environmental health at Duke University, stated: “We know that ozone can damage the respiratory system, reduce lung function, and cause asthma attacks.” While exposure to ozone has been correlated with reductions in lung function, this new study of adults in China reveals that it is also strongly correlated with increased risks of heart attack and stroke. The study monitored 89 health adults in China from December 2014 to January 2015, measuring indoor and outdoor ozone levels, in addition to other pollutants. Other measured markers included levels of inflammation, oxidative stress, stiffness in arteries, blood clotting, blood pressure, and lung function.

After analyzing the data, the researchers confirmed that ozone exposure was “linked to markers of blood platelet activation and raised blood pressure;” the former is a high risk factor for blood clotting. The ozone exposure levels during the study were lower than levels that have been associated with impaired lung function: “The main basic for the current air quality standard set by the Environmental Protection Agency.”

Professor Zhang has said that in 2015, a third of the entire U.S. population (approximately 108 million people) lived in geographic regions in which ozone levels were higher than the set EPA standard. Moreover, as global ozone levels will increase due to climate change and the increasing warmth of the atmosphere, there will likely be an increased trend in these findings.

Link Between Childhood Cardiovascular Risk Factors & Future Lower Cognition

A recent study published by the Journal of the American College of Cardiology includes data that indicates an association between the presence of cardiovascular risk factors in adolescence, and a lower cognition later in life–“regardless of the exposure experienced during adulthood.”


The data investigated a sample of 3,596 individuals from childhood to adulthood, including follow-up cognitive testing, in addition to measurements of cardiovascular risk factors like cholesterol levels, blood pressure, body mass index, exposure to smoking, etc.

The study was able to specifically pinpoint the worsening of midlife cognitive performance among those individuals with high blood pressure and cholesterol in childhood, adolescence, and young adulthood. The data further demonstrated that smoking in adolescence and young adulthood is linked to a decrease in cognition: specifically, memory and learning.

Study participants between the ages of 6 and 24 who had all risk factors within the recommended levels performed better on cognitive testing than their counterparts who exceeded all risk factors guidelines at least twice; the difference corresponded to the effect of 6 years of aging. Researchers further found that those participants with the highest blood pressure had a difference in cognitive age of 8.4 years, compared to those with the lowest blood pressure.

Suvi Rovio, PhD, lead author of the study and a senior scientist at the Research Centre of Applied and Preventative Cardiovascular Medicine at the University of Turku in Finland, stated: “These findings support the need for active monitoring and treatment strategies against cardiovascular risk factors from childhood…this shouldn’t just be a matter of cognitive deficits prevention, but one of primordial prevention.”

The Benefits of a Vegan Diet

While there are a multitude of promises available regarding specific diets that will help individuals lose weight and/or mitigate cardiovascular risks factors, clinical research indicates that within a few weeks of eating a whole-food, plant-based diet, many people will have improved insulin sensitivity and lowered levels of cholesterol.


Dr. Thomas M. Campbell, Medical Director of the T. Colin Campbell Center for Nutrition Studies and clinical director of the University of Rochester Program for Nutrition Medicine, also refers to the high probability of improved bowel movements, enhanced sleep hygiene and increased energy, and improved skin quality.

Extensive scientific literature and research demonstrates that dietary cholesterol and saturated fat are linked to a heightened risk of cardiovascular disease. Meat and fish have saturated fat, while a vegan diet is devoid of any cholesterol, and low in terms of saturated fat. When people begin to eat a plant-based diet, therefore, their cholesterol levels decline; and ultimately, their risk of cardiovascular disease decreases. This all happens within a few weeks, as blood vessel walls become healthier due to the increase of nitric oxide in arterial walls, which reduces the risk for heart attacks and strokes. Moreover, without heavy saturated fats from animal products, blood is less viscous and begins to pump more easily at lower pressures.

The American Diabetes association confirms that among individuals with type 2 diabetes, those who eat a vegan diet have considerably improved glycemic control, in addition to lessened cardiovascular risk factors. The diet can even reverse the disease altogether, in some patients. According to Dr. Michael Klaper, an internationally-recognized authority on the link between diet and health, “A person with uncontrolled diabetes, on insulin, can see demonstrable improvements in medication usage and efficacy in 24 hours.” Conversely, another study also published by the American Diabetes Association indicates that those who eat high amounts of animal protein are 22 percent more likely to develop diabetes.