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CMHC PULSE

Cardio Metabolic Health Congress – Official Blog

Faculty Spotlight: Alan R. Saltiel, PhD

With nineteen issued patents, 290 published original papers, and thousands of citations in biochemistry literature, Alan R. Saltiel ranks among the most influential scientists in biology and biochemistry. After receiving a degree in Zoology from Duke University, and a Ph.D. in Biochemistry from the University of North Carolina, Saltiel conducted research surrounding thyroid-stimulating hormones, and the relationship to thyroid cancer. As a post-doctoral fellow, Saltiel began investigating insulin, and signaling pathways in insulin action. Saltiel’s research targeted drug discovery activities in diabetes, obesity, and cancer; he was responsible for pre-clinical studies on troglitazone: the first thiazolidinedione approved for the treatment of type 2 diabetes.

Saltiel has served as Director of the University of Michigan Life Sciences Institute since 2001, in addition to John Jacob Abel Professor of Life Sciences. In 2015, Saltiel created the Institute for Diabetes and Metabolic Health at the University of California, San Diego, while serving as a Professor of Medicine and Pharmacology.

Saltiel has received numerous awards throughout his career, including the Rosalyn Yalow Research and Development Award from the American Diabetes Association, Hirschl Award, and the John Jacob Abel Award from ASPET. He is a member of the Institute of Medicine, and a Fellow of the American Association for the Advancement of Science.

Saltiel will be the featured keynote speaker at CMHC’S Regional Conference Series in San Diego, delivering an address titled “Deep Dive Into Metabolic Health: Obesity, Inflammation, and Type 2 Diabetes.”

Link Between Alzheimer’s & Vascular Disease

The more risk factors for vascular disease one has in middle age, the higher the risk may be of developing Alzheimer’s disease in later life: the conclusion of a new study published in JAMA.

Vascular disease is defined as any condition that affects the circulatory system–the vessels that carry the blood to and from the heart. Types of vascular disease include atherosclerosis, the hardening or narrowing of the arteries due to plaque buildup, and peripheral artery disease, the narrowing of the arteries in the limbs. Obesity, high cholesterol, high blood pressure, diabetes, and smoking are some of the common risk factors for vascular disease.

Previous studies have suggested a link between vascular disease risk factors during midlife and increased risk of later-life dementia—particularly Alzheimer’s disease—the most common form of dementia.

However, Dr. Rebecca F. Gottesman – of the Department of Neurology at Johns Hopkins University School of Medicine in Baltimore, MD – and colleagues note that it has been unclear as to whether these risk factors are directly associated with the buildup of beta-amyloid in the brain.

Beta-amyloid is a protein associated with the development of Alzheimer’s disease. The protein can accumulate in the brain, forming “plaques” that disrupt communication between nerve cells. With the help of positron emission tomography (PET) brain imaging, Dr. Gottesman and team sought to gain a better understanding of how risk factors for vascular disease might affectbeta-amyloid accumulation in the brain.

The researchers analyzed the data of 346 dementia-free adults who had participated in the Atherosclerosis Risk in Communities (ARIC)-PET Amyloid Imaging Study for almost 25 years. Participants were a mean age of 52 years at the point of study enrollment between 1987 and 1989. At that time, subjects were assessed for the presence of vascular disease risk factors, including high cholesterol, smoking, high body mass index, high blood pressure, and diabetes.

Between 2011 and 2013 – at a mean age of 76 years – participants underwent PET imaging, which revealed the levels of beta-amyloid in their brains. “The availability of imaging biomarkers for brain amyloid allows the study of individuals before the development of dementia and thereby allows consideration of the relative contributions of vascular disease and amyloid to cognition, as well as the contribution of vascular disease to amyloid deposition,” note the researchers.

Compared with participants who had no risk factors for vascular disease at study baseline, those who had two or more risk factors were found to have significantly higher levels of beta-amyloid in their brains. The more vascular risk factors participants had, the higher were their levels of beta-amyloid.

Contrary to previous studies suggesting that the link between vascular disease risk factors and beta-amyloid levels varies by race, the researchers found that race did not influence their findings. Furthermore, the study results did not differ between people with and without the APOE e4 allele, which is a form of the APOE gene associated with an increased risk of Alzheimer’s disease.

Vitamin D: A Necessary Supplement!

A new study reports that in overweight and obese children and adolescents, a deficiency of vitamin D is associated with early markers of cardiovascular disease.

Lead author Marisa Censani, M.D., pediatric endocrinologist and director of the Pediatric Obesity Program in the Division of Pediatric Endocrinology at New York Presbyterian Hospital/Weill Cornell Medicine, states that “Pediatric obesity affects 17 percent of infants, children, and adolescents ages 2 to 19 in the United States, and obesity is a risk factor for vitamin D deficiency.”

The findings suggest that deficiency of the vitamin may have negative effects on specific lipid markers, with an increase in cardiovascular risk among children and adolescents. This is one of the first studies to assess the relationship of vitamin d deficiency to both lipoprotein ratios and non-high density lipoprotein cholesterol, specific lipid markers impacting cardiovascular risk during childhood, in children and adolescents who are obese or overweight.

Vitamin D was found to be significantly associated with an increase in atherogenic lipids and markers of early cardiovascular disease. Total cholesterol, triglycerides, LDL, non-HDL cholesterol, as well as total cholesterol/HDL and triglyceride/HDL ratios, were all higher in vitamin D-deficient patients—compared to patients without vitamin D deficiency.

The results support screening children and adolescents who are overweight or obese for vitamin D deficiency, and the potential benefits of improving vitamin d status to reduce cardiometabolic risk.

What to Eat…and What NOT to Eat

A recent report indicates that ten foods account for nearly half of all heart disease deaths in the United States. Researchers at Tufts Friedman School of Nutrition and Policy found that if people ate less salt and meat, and ate more nuts, fruits, and vegetables, they could greatly lower the risk of heart disease.

The researchers at Tufts developed their list of preferred foods from national surveys, which covered 16,000 people from 1999-2012. Volunteers filled out food diaries, and were tracked for several years subsequently, to see what had happened with their health. In 2012, the team wrote that over 700,000 Americans died of cardiovascular disease. Of these deaths, an estimated 45 percent were associated with ‘suboptimal intakes of the 10 dietary factors,’ states the report—published in the Journal of the American Medical Association.

The team used previously published studies surrounding the benefits or drawbacks of each of the 10 foods, in order to determine how much each one contributes to the risk of death from heart disease. Their calculations suggest that eating too much sodium accounted for 9.5 percent of the deaths; eating too few nuts accounted for 8.5 percent of the deaths; eating too much processed meat accounted for 8.2 percent of the deaths; and eating too little seafood was responsible for 7.8 percent of the deaths.

For decades, the American Heart Association has stressed that food is a critical factor in preventing the country’s primary cause of death. Many studies have previously demonstrated that Americans eat far too much meat, cheese, processed grains, sugar, and salt. Studies also confirm the health effects of the consumption of a daily handful of nuts, in addition to eating more vegetables, fruits, and whole grains; diets rich in these foods also lower the risk of cancer, diabetes, and Alzheimer’s disease. This study’s results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health.

Happy Hour: Good for the Heart?

A recent large-scale study indicates that alcohol, in moderation, is healthy for the heart. New research published in the British Medical Journal adds further evidence linking alcohol consumption with lower risks of heart attack, stroke, and cardiovascular disease. While the new study is consistent with earlier results that have shown potential heart health benefits from occasional drinking, it amplifies the message due to its large sample population.

Drinking about a glass of wine for women per day, and two glasses of wine for men, showed benefits for heart health in a large group of U.K. adults; of the near 2 million subjects, none had cardiovascular disease when the study began. People who did not drink showed increased risk for eight of the heart ailments, ranging from 12% to 56%, compared to those who drank in moderation; the eight conditions included the most common heart events—such as heart attack and stroke. Non-drinkers had a 33% higher risk of unstable angina, a condition in which the heart does not receive sufficient blood flow, and a 56% higher risk of dying unexpectedly from cardiovascular disease—compared to those people who drank a glass or two of alcohol each day.

There are several potential ways that casual drinking might benefit heart health, although none have been directly proven. Alcoholconsumption has been linked to increases in ‘good’ HDL cholesterol, and properties in the blood that reduce clotting. It is also possible that moderate drinking helps reduce stress levels.

Yet alcohol does not provide protection against four less common heart problems, including certain types of mild strokes. It is not clear from the current study why alcohol lowers the risk of some heart conditions and not others, but the results should reassure people who drink a few glasses of alcohol each week. Moreover, while casual drinking shows potential benefit, drinking to excess can increase risks for a variety of heart problems.

Faculty Spotlight: Anne L. Peters, MD

Currently a professor at the Keck School of Medicine of the University of Southern California and the Director of the USC Clinical Diabetes Programs, Dr. Anne L. Peters has worked in the field of diabetes prevention through extensive involvement with multiple clinical trials, NIH grants, over 100 articles in peer-reviewed medical journals, and speaking engagements across the globe.

While concurrently directing diabetes centers in Beverly Hills and in underserved East Los Angeles, Dr. Peters works with the LA County Department of Health Services on the institution of a county-wide diabetes program. Dr. Peters has previously served as director of the clinical diabetes programs at Cedars-Sinai Medical Center and UCLA before her tenure at USC, after receiving her medical degree from the Pritzker School of Medicine at the University of Chicago, performing an internal medicine residency at Stanford University and Harbor UCLA Medical Center, and a fellowship in endocrinology at Cedars-Sinai.

Dr. Peters has served as a principal investigator on multiple clinical trials focused on diabetes prevention, and is currently involved with three NIH grants aimed at curbing and reducing heart disease and diabetes. Dr. Peters has additionally established the Community Diabetes Initiatives Research Center in collaboration with Children’s Hospital Los Angeles. She has authored three books on diabetes, in addition to articles that have appeared in JAMA, The New England Journal of Medicine, Annals of Internal Medicine, and Diabetes Care.

Dr. Peters serves on the ABIM Endocrine Board, multiple ADA committees, and the EASD/ADA Diabetes Technology Committee. She was the recipient of the ADA Outstanding Physician Clinician Award in 2008, and the 2010 Bernardo Houssay Award from the National Minority Quality Forum for her work with underserved populations. Dr. Peters has of the ADA/EASD Position Statement on “Management of Hyperglycemia in Type 2 Diabetes,” and the ADA Position Statement on “Treatment of Type 1 Diabetes Across the Lifespan.”

Join us in San Diego on May 6th for the CMHC Regional Conference, and hear Dr. Peters and colleagues address “T2DM Updates in Treatment and Cardiovascular Outcomes and Trials” while providing updates on current and emerging therapies, treatment guidelines, and strategies to improve clinical outcomes.

Move — and Move Often!

While most physicians and nutritionists agree that low to moderate levels of weekly physical activity is often insufficient to significantly reduce body weight, studies indicate that those who transition from little to no daily physical activity to moderate levels have clinically meaningful reductions in cardiometabolic risk.

Scores of controlled trials over the last decade demonstrate that physical activity helps mitigate and reduce cardiometabolic risk via biologic mechanisms, which are not entirely dependent upon body weight or BMI reduction. Research increasingly supports that those who have prediabetes should consistently increase physical activity levels, despite little to no weight loss.

According to research published in the European Journal of Preventive Cardiology, the benefits of physical activity may outweigh the impact of being overweight and/or obese in middle-aged and elderly people. The observational study, conducted with a sample size of over 5,000 people aged 55 years and older, followed up with participants for 15 years. While overweightness and obesity is associated with a higher risk of cardiovascular disease, and weight loss is recommended, it is slightly different with the elderly population: weight loss, especially unintentional, is often associated with muscle loss and death.

Regardless of age, physical activity is associated with a lower risk of cardiovascular disease. Studies have further demonstrated that physical activity is protective for cardiovascular risk, playing a crucial role in the health of middle-aged and elderly people. Without adequate physical activity, those who are overweight and obese are at a significantly higher risk of developing cardiovascular disease.

The harmful effects of overweightness and obesity occur through adipose tissue, which accelerates the atherosclerotic process, thereby increasing cardiovascular risk. Exercise and physical activity lowers the harmful effects of atherosclerosis by reducing the stabilization of plagues on blood vessels, ultimately reducing the heart’s oxygen demand. Engaging in high levels of physical activity protects people from the harmful effects of adipose tissue on cardiovascular disease. The idea: move—and move often!

Announcing Dr. Paul Grundy for Boston’s Business of Medicine Pre-Conference

CMHC is excited to announce Paul Grundy, MD, MPH, FACOEM, FACPM as a speaker for the pre-conference Business of Medicine Day at the 12th Annual Cardiometabolic Health Congress in Boston. As Chief Medical Officer and Global Director of Health Transformation at IBM, Dr. Grundy is one of less than 100 IBM employees—and the only physician—selected into the company’s senior industry leadership forum: the IBM Industry Academy.

Dr. Grundy’s work focuses on shifting global healthcare delivery towards data-driven, consumer-focused, accountable systems, through the adoption of new information technologies and incentives systems. In his role, Dr. Grundy develops and executes strategies that support IBM’s healthcare-industry transformation initiatives, while acting as an active social entrepreneur, advocate, and speaker on global healthcare revolutions. His work has been published and reported widely in newspapers, radio, and television across the country, and he has been the recipient of the prestigious Barbara Starfield Primary Care Leadership Award, and the National Committee for Quality Assurance Award.

Dr. Grundy’s session, The Patient-Centered Medical Home: A Foundation for Patient Satisfaction, will begin at 11:00 AM on Wednesday, October 4th.  Visit www.cardiometabolichealth.org for more information and registration details.

Chronic Stress & Obesity: A New Perspective on “Comfort Food”

The biological connection between stress and obesity has long been suspected: during times of high anxiety and stress, people often crave ‘comfort foods,’ which are high in fat or sugar. Researchers have now found that specific hormones may play a significant role in this process: stress has been linked to biochemical changes that can trigger cravings, which lead to overeating, and ultimately result in obesity.

Specific biochemical reactions help explain this correlation: when we reach for fattening foods during stressful times, it is often an attempt to self-mediate—carbohydrates raise the body’s serotonin levels, the body’s ‘feel-good’ chemical. Researchers have also discovered that chronic stress can cause the body to release excess cortisol, a hormone critical in managing fat storage and energy use. Cortisol is known to increase appetite, and may encourage cravings for sugary and fatty foods.

More recent studies suggest that our bodies process food differently when under stress. One study found that lab mice, when fed a diet high in fat and sugar, gained significant amounts of body fat when placed under stressful conditions. Conversely, mice fed a normal diet did not gain as much weight—despite being placed under stressful conditions. Researchers linked this phenomenon to the molecule neuropeptide Y, which is released from nerve cells during stress and encourages fat accumulation. Diets high in fat and sugar appear to further accelerate the release of neuropeptide Y.

As physicians better understand the factors behind weight gain, they may be better equipped to help address the global obesity epidemic. Yet the most insidious aspect of the link between stress and obesity is that it is often self-reinforcing. When people are stressed and make unhealthy choices, they often gain weight, which only serves to further exacerbate stress.

While stress is an inevitable part of life, it does not necessarily need to lead to weight gain. By keeping portion size in mind, not allowing yourself to become too hungry, eating healthy snacks, and becoming more mindful about nutrition, we can avoid gaining weight when times are tough.

In order to gain more information surrounding nutrition, weight, and cardiometabolic disease, attend our CMHC Regional Conference Series. These one-day intensive workshops are designed to instruct participants in weight management, nutrition, and the prevention, management, and treatment of cardiovascular disease. Our upcoming agenda in Atlanta features a session titled Good Weight Management is Good Cardiometabolic Risk Management, delivered by Donna H. Ryan, MD.

Heart Failure in the South

A recent ethnographic study titled “Heart Failure Incidence and Mortality in the Southern Community Cohort Study (SCCS)” investigated heart failure incidence, and post-heart failure survival, by race and sex among low-income adults in the southern parts of the United States.

Heart failure risk factors in the study included hypertension, diabetes, myocardial infarction, and obesity. The participants—27,078 white and black men and women enrolled during 2002 to 2009 in the SCCS—had no history of heart failure. Over a median follow-up of almost 5 ½ years, 4,341 participants were diagnosed with heart failure. Among these cases, 952 deaths occurred over a median follow-up of 2.3 years. Researchers ultimately concluded that heart failure in this population was higher for all race-sex groups than previously reported in other studies.

While this segment of the population, geographically located in the South, had a significantly high instance of heart failure, a number of other studies have indicated that heart disease burden has shifted to the Southern United States. Study findings published in the American Heart Association journal Circulation reveal that the highest death tolls have shifted to the Deep South over the past few decades.

Researchers at the Centers for Disease Control and Prevention analyzed heart-related deaths across the United States and found that trends often vary by factors like gender, race, and location. In order to learn more about the geographic trends, researchers analyzed U.S. mortality statistics from 1973 to 2010, calculating mortality rates in two-year intervals and including heart-related deaths in adults 35 years or older.

By 2010, researchers found that the highest death rates were in Southern states like Alabama, Mississippi, and Arkansas. Researchers further noted that declines in heart disease mortality have been slowest in Southern states, compared to the rest of the country.

These findings highlight the need to address significant health disparities in the United States; the concentration of heart disease in the Southern United States is likely due to geographic and racial differences in heart disease prevention and treatment. In order to fully understand these geographic trends, it is critical to recognize the biological, behavioral, and environmental factors that influence them.

Learn more about the prevention, diagnosis, and treatment of cardiovascular disease at our upcoming CMHC Regional Conference in Atlanta, Georgia. The last session of the day will be “Getting to the Heart of the Matter: Diagnosis and Treatment of HTN and HF in Primary Care.”