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CMHC PULSE

Cardio Metabolic Health Congress – Official Blog

A “Vaccine” for Cholesterol Clearance?

AT04A, a peptide-based formulation that induces an immune response against a protein that interferes with cholesterol clearance, has been effective in lowering cholesterol in studies with mice. AT04A qualifies as an immunotherapy, as it targets one of the body’s own proteins–not a protein associated with a pathogen.

The study is the first to demonstrate that the AT04A vaccine induced high and persistent’ antibody levels against PCSK9 (an enzyme that prevents the clearance of low-density lipoprotein cholesterol–‘bad’ cholesterol–from the blood).

When the AT04A formulation was injected under the skin of mice that had been fed diets of fatty food, it reduced the total amount of cholesterol by 53%, shrank atherosclerotic damage to blood vessels by 64%, and reduced biological markers of blood vessel inflammation by 21% to 28%, in comparison to the unvaccinated mice. Moreover, the induced antibodies remained functional over the entire study period, and concentrations were still high at the study’s conclusion.

“The way that AT04A is administered is comparable to a vaccine,” explained Gunther Staffler, PhD, the chief technology officer at the company that initially developed AT04A. “However, the difference between a conventional vaccine and our approach is that a vaccine induces antibodies that are specific to bacterial or viral proteins that are foreign to the body—pathogens—whereas AT04A induces antibodies against a target protein that is produced by the body—endogenous proteins. This it is really an immunotherapeutic approach rather than a vaccine approach.”

Coconut Oil: Not So Healthy?

 A recent new advisory report from the American Heart Association advises against the use of coconut oil, a popular trend in the health and wellness industry.

The Dietary Fats and Cardiovascular Disease, after viewing existing data on saturated fats, has demonstrated that coconut oil specifically increased LDL—known as ‘bad’ cholesterol—in seven out of seven controlled oils. 82% of the fat in coconut oil is saturated, according to data: exceeding butter, beef fat, and pork lard.

The advisory stated: “Because coconut oil increases LDL cholesterol, a cause of cardiovascular disease, and has no known offsetting favorable effects, we advise against the use of coconut oil.” Marie-Pierre St-Onge, associate professor of nutritional medicine at Cornell University Medical School, believes that coconut oil is so popular for weight loss due to her research on medium-chain triglycerides. Because coconut oil has a higher proportion of medium-chain triglycerides than most other fats or oils, and her research indicated that medium-chain triglycerides may increase the rate of metabolism, many now believe that coconut oil can be responsible for weight loss.

However, St-Onge’s research used a ‘designer oil’ that was full of 100% medium-chain triglycerides; traditional coconut oil only contains about 13-15%. Moreover, another study published by St-Onge reveals that smaller doses of medium-chain triglycerides does not help with weight loss in overweight adolescents.

“You can put it on your body, but don’t put it in your body,” said Frank Sacks, lead author on the report.

1/3 of World = Overweight

A new study reports that more than two billion adults and children across the globe are overweight or obese, and suffer from related health problems. Spurred by poor nutrition and low levels of physical activity, this number equates to one-third of the world’s population.

While 2.2 billion people can be classified as overweight or obese, more than 710 million are obese: 5% of all children, and 12% of all adults, can be categorized in this segment. The United States has the greatest percentage of obese or overweight children and young adults, at 13%.

The study, published in the New England Journal of Medicine, states that a growing number of people across the globe are dying from poor health, and problems linked to being overweight. “People who shrug off weight gain do so at their own risk–risk of cardiovascular disease, diabetes, cancer, and other life-threatening conditions,” said Dr. Christopher Murray, director of the Institute for Health Metrics and evaluation at the University of Washington, who worked on the study.

Researchers analyzed data collected between 1980 and 2015 from 68.5 billion people, and revealed that the number of people affected by obesity has doubled since 1980 in 73 countries, and continued to rise across most other countries in the analysis. Although the percentages of obese children were lower than adults, that rate at which their numbers have increased was greater–indicating greater future risk if nothing is done to alleviate and curb the growing problem.

“This raises the alarm that we may be facing a wave of obesity in the coming years across high and low income countries,” states Goodarz Danaei, assistant professor of global health at the Harvard T.H. Chan School of Public Health. Because obesity levels have risen in all countries, irrespective of income levels, the issue does not simply boil down to wealth. The paper reads: “Changes in the food environment and food systems are probably major drivers.”

Most Cardiologists Lack Nutrition Education

A recent study has found that the majority of cardiologists lack current, up-to-date education surrounding nutrition and diet. A report published by the American Journal of Medicine, authored by a dozen healthcare professionals in the United States and Spain, titled “A Deficiency of Nutrition Education and Practice in Cardiology” details that less than a third of cardiologists describe their nutrition knowledge as “mostly up to date” or better.

Although the leading cause of premature death and disability in the United States is heart disease, most cardiologists report inadequate training in nutrition. “Using nutrition as medicine is probably one of the most cost effective ways to treat disease but is incredibly underutilized by healthcare providers,” explained Andrew Freeman, M.D., a cardiologist at National Jewish Health in Denver, and one of the study’s co-authors. “If we could empower healthcare providers with information on how to implement this in daily practice, we could transform healthcare rapidly, prevent healthcare cost explosions, and reduce morbidity and mortality.”

Ninety percent of cardiologists surveyed reported receiving no or minimal nutrition education during cardiovascular fellowship training; 59 percent reported no nutrition education during international medicine training; 31 percent reported no nutrition education throughout medical school. Almost two-thirds of all surveyed cardiologists reported spending three minutes or less per visit discussing nutrition with their patients.

The report further noted that the total annual cost related to heart and vascular diseases in the United States is $315 billion, much of which could be lessened with proper nutritional training and implementation.

Heart Disease Among Chinese Americans: Frequently Overlooked

A new study published by the Centers for Disease Control and Prevention indicates that risk factors for heart disease among Chinese Americans are often overlooked, as the standard generally utilized to determine a healthy weight is commonly not adjusted for Asian populations.

The study, “Obesity and Modifiable Cardiovascular Disease Risk Factors Among Chinese Americans in New York City, 2009—2012” examined the relationship between body mass index (BMI) and risk factors for cardiovascular disease among New York City’s Chinese Americans.

Simona Kwon, lead investigator of the study and director of New York University’s Center for the Study of Asian Health, reported that Asian Americans are often left out of health research analysis, “Because it looks like we’re not experiencing health disparities in cardiovascular disease.”

Kwan reports that there is a well established link between high rates of diabetes and South Asian communities, yet there is a ‘model minority’ of East Asians having less risk of cardiovascular disease. While the World Health Organization defines a ‘normal’ BMI as between 18.5 to 24.9, ‘overweight’ as 25 to 29.9, and ‘obese’ as 30 or higher, people of Asian descent tend to have higher body fat percentages—so BMI measurements must be adjusted.

Measured against standard BMI values, the authors found a low prevalence of Chinese Americans who were overweight and obese, yet when they used the BMI cut points adjusted or the Asian population, the numbers went up. Researchers state that Chinese Americans are disproportionately affected by cardiovascular disease risk factors that are preventable and treatable, like diabetes and high blood pressure.

Because physicians decide whether or not to screen patients for diabetes based on BMI, authors of the article suggest that patients of Asian descent should use lower BMI cut points; traditional cutoffs would miss Chinese Americans at risk of diabetes.

“There’s a need to disaggregate data on Asian Americans and focus on subgroups because when you look at Asian Americans as a whole, a lot of differences get masked,” says Kwan.

Sleep Hygiene & Heart Disease

A recent study indicates that getting sufficient sleep is especially critical for those at risk for heart disease and diabetes, as less than six hours per night may increase their risk of premature death.

Participants in the study who had a high body mass index (BMI) and elevated cholesterol, in conjunction with several other risk factors for cardiovascular disease and diabetes—a combination termed metabolic syndrome—and slept less than six hours per night were twice as likely to die of heart disease or stroke over a nearly 17-year period, as people without the syndrome.

Lead study author Julio Fernandez-Mendoza, an assist professor of psychiatry and Penn State College of Medicine, stated: “If you have several heart disease risk factors, taking care of your sleep and consulting with a clinician if you have insufficient sleep is important if you want to lower your risk of death from heart disease or stroke.”

The study involved 1,344 adult participants, 39.2 percent of which had metabolic syndrome. After following the people for almost 17 years, the researchers analyzed the relationship between metabolic syndrome, the length of time the participants slept at the outset of the study, and risk of death throughout the next almost two decades. The data signified that people with metabolic syndrome who slept at least 6 hours at the beginning of the study were 1.5 times more likely to die of cardiovascular disease than those without metabolic syndrome; however, people with metabolic syndrome who slept less than 6 hours were 2.1 times more likely to die.

Moreover, the people who slept less—and also had metabolic syndrome—were twice as likely to die from any given cause during the study period as the people who did not have the syndrome. Comparatively, the people with metabolic syndrome who slept 6 or more hours were 1.3 times more likely to die from any cause. The results demonstrate a strong link between shorter sleep duration and mortality among people with metabolic syndrome, indicating the need for proper and consistent sleep hygiene.

Obesity Crisis Will Double Number of Stroke Victims

Fueled by the consistently worsening obesity crisis, cases of stroke victims are expected to almost double in the next two decades.

Experts note that the number of new strokes in the United Kingdom alone could jump by 44% by 2035; currently, more than one in four adults qualifies as obese or overweight—compared to one in thirty-five, a statistic from the 70s.

The Stroke Association has noted that poor lifestyles habits put people at a much greater risk of attacks, further commenting that the additional costs of skyrocketing cases could cripple public health service organizations.

While obesity significantly boosts the risk of stroke, some elementary lifestyle changes can be implemented in order to prevent cardiovascular disease: including eating healthier meals, and committing to an exercise routine. Statistics indicate that almost nine in ten strokes are due to long-term conditions like diet, lack of movement, and obesity.

Recent studies have also demonstrated that the risks for stroke also exist for younger people, not solely older adults. According to the Centers for Disease Control and Prevention, obesity has more than doubled in younger children and teens throughout the past three decades.

The findings highlight the need to recognize obesity as a risk factor for stroke in younger adults, and take steps to control related conditions like high blood pressure and hypertension.

Obesity Causes Heart Changes—Even Among Youth

A high BMI is known to cause heart disease in mid-to-late life, but new research has revealed it can worsen cardiovascular health even in those as young as 17.

Obesity can cause poor cardiovascular health, even in the young, according to a new study.

European researchers say they’ve detected the development of cardiovascular changes known to be precursors of heart disease in those aged as young as 17 as a result of high body mass index (BMI).

The research was presented at the European Society of Human Genetics 2017 conference in Copenhagen, Denmark.

Higher than normal BMI is known to lead to cardiovascular ill-health in mid-to-late life, but there has been limited investigation of its effect in young, healthy adults.

Genomic analysis of thousands of 17-to-21-year-olds involved in the UK’s Avon Longitudinal Study of Parents and Children found a high BMI caused significant burden on the heart’s left ventricle.

A thickening of the left ventricle in the heart, known as hypertrophy, means it has to work harder to pump blood and is a common marker for heart disease.

Dr Kaitlin Wade from the Medical Research Council Integrative Epidemiology Unit at the University of Bristol led the study and says the results support efforts to tackle the obesity epidemic from an early age in order to prevent cardiovascular disease.

“Our results showed that the causal impact of higher BMI on cardiac output was solely driven by the volume of blood pumped by the left ventricle,” Dr Wade said.

This, she says, can partly explain the causal effect of higher BMI on cardiac hypertrophy, a thickening of the heart muscle, and higher blood pressure that was observed among the participants.

“It is the first time that the nature of this relationship has been shown in a group of young adults where it has been possible to draw improved conclusions about its causation,” Dr Wade said.

“We believe that there are clear messages for cardiovascular health in our findings and we hope that they may lead to increased efforts to tackle obesity from early life.”

NCQA Patient-Centered Medical Home: Updated & Upgraded

 The National Committee for Quality Assurance (NCQA), an independent non-profit organization that works to improve health care quality, has recently given its patient-centered medical home ‘a makeover’ in order to “reduce documentation burdens, lower costs, and facilitate quality improvements.”

The NCQA’s move marks a growing effort spearheaded by the healthcare industry’s leadership organizations in response to new technologies, uncertainty surrounding reimbursements, and heightened reporting requirements. The organization’s recent announcement of a comprehensive overhaul will enact changes that aim to create “a much more user-friendly version of the popular practice transformation framework that avoids the pain points of previous iterations of the program,” said Michael S. Barr, MD, Executive Vice President of the Quality Measurement and Research Group at NCQA.

Due to a host of complaints from physicians and providers regarding the ‘unduly onerous’ recognition process, the NCQA wishes to reduce or eliminate costs, lower documentation burdens, and streamline some of the aspects of the recognition process that were devaluing patient care. A marked change is the abolition of distinctions between Level 1, 2, and 3; providers are now recognized or working towards recognition. The NCQA and healthcare industry realizes that ‘all-or-nothing measurements’ are not the optimal, most effective way to encourage innovation and improvement.

Moreover, the NCQA has replaced the three-year recertification cycle with annual check-ins, so that providers are not required to go through the entire recognition process again. Yearly meetings are designed to ensure that recognized practices are primarily focused on a high level of patient-centered care, and continuously improving. Each practice will also be assigned an NCQA representative, who can assist them in moving throughout the process, and also confirm and certify that the practice has met the necessary requirements.

Barr hopes that the revamped PCMH recognition process will help providers move towards a more efficient, effective way to deliver care, but admits that they will need more than yearly check-ins to succeed in an increasingly data-driven world. He urged stakeholders that it is time to “optimize electronic health records (EHRs), so that we can really align them with what we need to do to improve patient care.” Barr further clarifies that EHRs should be redesigned in order to effectively communicate the patients’ stories, and simultaneously equip providers with the necessary data to make informed, personalized, and effective choices with the patient and caregivers.

Heart Disease: #1 Killer Worldwide

New research published in the May 17 issue of the Journal of the American College of Cardiology indicates that roughly a third of all global deaths are the result of heart disease and stroke: cardiovascular disease is currently the number one killer around the world.

Gregory Roth, the study’s lead author and assistant professor of cardiology at the University of Washington School of Medicine, notes that the statistics present “an alarming threat to global health…trends in cardiovascular disease mortality are no longer declining for high-income regions, and low- and middle-income countries are also seeing more cardiovascular disease related deaths.”

The accumulation of research assessed current international rates of a variety of types of heart disease, including stroke, coronary heart disease, atrial fibrillation, and peripheral arterial disease. The highest rates of disease were in countries across sub-Saharan Africa, Centrla Asia, and eastern and central Europe. The lowest incidence of heart disease was found in wealthy Asian nations, including Singapore, Japan, and South Korea.

Nevertheless, approximately 18 million people across the globe died from heart disease in 2015; researchers stated that over 400 million men and women have a kind of cardiovascular illness. High levels of cardiovascular disease are seen both in high-income countries, and in regions with more limited access to effective, inexpensive treatments.

Dr. Roth notes that the risk factors for heart disease—high blood pressure, poor diet and high cholesterol, excessive smoking and drinking, and obesity—are common throughout the world. “Now we need to find innovative ways to deliver our low-cost, effective treatments to the hundreds of millions of people who can’t access them.”

These findings should present opportunities for public health officials across local, national, and international levels to collaborate and share strategies on how to address the aforementioned risk factors.