Lifestyle interventions for the prevention and treatment of hypertension

Nature Reviews Cardiology, Journal Year: 2020, Volume and Issue: 18(4), P. 251 - 275

Published: Oct. 9, 2020

Language: Английский

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Insulin: too much of a good thing is bad

BMC Medicine, Journal Year: 2020, Volume and Issue: 18(1)

Published: Aug. 21, 2020

Abstract Background Insulin shares a limited physiological concentration range with other endocrine hormones. Not only too low, but also high systemic insulin levels are detrimental for body functions. Main The function and clinical relevance of usually seen in association its role maintaining glucose homeostasis. However, is an anabolic hormone which stimulates large number cellular responses. excess concentrations to the balance. Although glucoregulatory activity mitigated during hyperinsulinemia by dampening efficiency signaling (“insulin resistance”), this not case most hormonal actions insulin, including promotion protein synthesis, de novo lipogenesis, cell proliferation; inhibition lipolysis, autophagy-dependent turnover, nuclear factor E2-related factor-2 (Nrf2)-dependent antioxidative; defense mechanisms. Hence, there no general resistance selective impairment causes less uptake from blood reduced activation endothelial NO synthase (eNOS). Because largely unrestricted signaling, increases risk obesity, type 2 diabetes, cardiovascular disease decreases health span life expectancy. In epidemiological studies, high-dose therapy associated increased disease. Randomized controlled trials treatment did observe any effect on risk, these studied low doses up 40 IU/day. Proof causal link between elevated comes Mendelian randomization studies comparing individuals genetically or production. Conclusions prolonged concentrations, culture, argue favor lifestyle that limits circadian levels. risks may have implications regimens used diabetes.

Language: Английский

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The triglyceride-glucose index is a predictor for cardiovascular and all-cause mortality in CVD patients with diabetes or pre-diabetes: evidence from NHANES 2001–2018

Cardiovascular Diabetology, Journal Year: 2023, Volume and Issue: 22(1)

Published: Oct. 17, 2023

The association between the triglyceride-glucose (TyG) index and mortality in cardiovascular disease (CVD) patients with diabetes or pre-diabetes remains unclear. This study aimed to investigate relationship baseline TyG all-cause (CV) CVD among American adults. .

Language: Английский

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Obesity, kidney dysfunction, and inflammation: interactions in hypertension

Cardiovascular Research, Journal Year: 2020, Volume and Issue: 117(8), P. 1859 - 1876

Published: Nov. 17, 2020

Abstract Obesity contributes 65–75% of the risk for human primary (essential) hypertension (HT) which is a major driver cardiovascular and kidney diseases. Kidney dysfunction, associated with increased renal sodium reabsorption compensatory glomerular hyperfiltration, plays key role in initiating obesity-HT target organ injury. Mediators dysfunction blood pressure include (i) elevated sympathetic nerve activity (RSNA); (ii) antinatriuretic hormones such as angiotensin II aldosterone; (iii) relative deficiency natriuretic hormones; (iv) compression by fat around kidneys; (v) activation innate adaptive immune cells that invade tissues throughout body, producing inflammatory cytokines/chemokines contribute to vascular injury, exacerbate HT. These neurohormonal, renal, mechanisms are interdependent. For example, excess adiposity increases adipocyte-derived cytokine leptin RSNA stimulating central nervous system proopiomelanocortin-melanocortin 4 receptor pathway. Excess visceral, perirenal sinus compress kidneys which, along RSNA, renin–angiotensin–aldosterone activation, although obesity may also activate mineralocorticoid receptors independent aldosterone. Prolonged obesity, HT, metabolic abnormalities, inflammation cause progressive making HT more resistant therapy often requiring multiple antihypertensive drugs concurrent treatment dyslipidaemia, insulin resistance, diabetes, inflammation. More effective anti-obesity needed prevent cascade cardiorenal, metabolic, disorders threaten overwhelm health care systems prevalence continues increase.

Language: Английский

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Weight-Loss Strategies for Prevention and Treatment of Hypertension: A Scientific Statement From the American Heart Association

Hypertension, Journal Year: 2021, Volume and Issue: 78(5)

Published: Sept. 20, 2021

Hypertension is a major risk factor for cardiovascular and renal diseases in the United States worldwide. Obesity accounts much of primary hypertension through several mechanisms, including neurohormonal activation, inflammation, kidney dysfunction. As prevalence obesity continues to increase, associated cardiorenal will also increase unless more effective strategies prevent treat are developed. Lifestyle modification, diet, reduced sedentariness, increased physical activity, usually recommended patients with obesity; however, long-term success these reducing adiposity, maintaining weight loss, blood pressure has been limited. Effective pharmacotherapeutic procedural strategies, metabolic surgeries, additional options or attenuate hypertension, target organ damage, subsequent disease. Medications can be useful short- treatment; prescription drugs Metabolic surgery producing sustained loss treating disorders many severe obesity. Unanswered questions remain related mechanisms obesity-related diseases, efficacy different treatment prevention timing interventions hypertension-mediated damage. Further investigation, randomized controlled trials, essential addressing questions, emphasis should placed on reduce burden hypertensive mortality.

Language: Английский

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Triglyceride-glucose index and coronary artery disease: a systematic review and meta-analysis of risk, severity, and prognosis

Cardiovascular Diabetology, Journal Year: 2023, Volume and Issue: 22(1)

Published: July 6, 2023

The TyG index is an indicator of insulin resistance (IR), which associated with the development and prognosis cardiovascular disease. This study aimed to summarize relationship between risk, severity, coronary artery disease (CAD) by performing a systematic review meta-analysis.The PubMed, EMBASE, Cochrane Library, Web Science databases were searched for articles published from inception until May 1, 2023. Cross-sectional studies, retrospective or prospective cohort studies recruiting patients CAD included. For analysis outcomes calcification, stenosis, plaque progression, multi-vessel CAD, in-stent re-stenosis. prognosis, primary outcome was major adverse events (MACE).Forty-one included in this study. Compared lowest index, those highest had higher risk [odds ratio (OR): 1.94, 95% confidence interval (CI) 1.20-3.14, I2 = 91%, P 0.007]. Additionally, these more likely have stenotic arteries (OR: 3.49, CI 1.71-7.12, 0%, 0.0006), progressed plaques 1.67, 1.28-2.19, 0.002), vessels involved 2.33, 1.59-3.42, < 0.0001). When calculated as categorized variable, it appears that acute syndrome (ACS) levels may incidence rate MACE [hazard (HR): 2.09, 1.68-2.62, 87%, 0.00001], whereas chronic (CCS) stable showed trend towards increased (HR: 1.24, 0.96-1.60, 85%, 0.09). continuous ACS HR 2.28 per 1-unit/1-standard deviation increment (95% 1.44-3.63, 95%, 0.0005). Similarly, CCS 1.49 1.21-1.83, 75%, Myocardial infarction non-obstructive 1.85 1-unit 1.17-2.93, 0.008).The simple new synthetic has been proven be valuable tool whole-course management patients. Patients are at severe lesions, worse compared lower levels.

Language: Английский

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Independent effects of the triglyceride-glucose index on all-cause mortality in critically ill patients with coronary heart disease: analysis of the MIMIC-III database

Cardiovascular Diabetology, Journal Year: 2023, Volume and Issue: 22(1)

Published: Jan. 13, 2023

Abstract Background The triglyceride-glucose (TyG) index is a reliable alternative biomarker of insulin resistance (IR). However, whether the TyG has prognostic value in critically ill patients with coronary heart disease (CHD) remains unclear. Methods Participants from Medical Information Mart for Intensive Care III (MIMIC-III) were grouped into quartiles according to index. primary outcome was in-hospital all-cause mortality. Cox proportional hazards models constructed examine association between and mortality CHD. A restricted cubic splines model used associations outcomes. Results total 1,618 (65.14% men) included. hospital intensive care unit (ICU) rate 9.64% 7.60%, respectively. Multivariable analyses indicated that independently associated an elevated risk (HR, 1.71 [95% CI 1.25–2.33] P = 0.001) ICU 1.50 1.07–2.10] 0.019). regression revealed increased linearly increasing (P non-linearity 0.467 0.764). Conclusions strong independent predictor greater Larger prospective studies are required confirm these findings.

Language: Английский

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Association between the triglyceride glucose (TyG) index and the risk of acute kidney injury in critically ill patients with heart failure: analysis of the MIMIC-IV database

Cardiovascular Diabetology, Journal Year: 2023, Volume and Issue: 22(1)

Published: Aug. 31, 2023

Abstract Background Insulin resistance (IR) can be effectively assessed using the dependable surrogate biomarker triglyceride-glucose (TyG) index. In various critical care contexts, like contrast-induced acute kidney injury (AKI), an elevated TyG index has demonstrated a robust correlation with incidence of AKI. Nonetheless, potential to predict AKI in critically ill patients heart failure (HF) remains uncertain. Methods A cohort participants was non-consecutively selected from Medical Information Mart for Intensive Care IV (MIMIC-IV) database and divided into quartiles based on their values. The primary outcome. secondary endpoint in-hospital mortality within both whole study population subset patients. use renal replacement therapy (RRT) which represented progression severity also included as representing restricted cubic splines model Cox proportional hazards models were utilized evaluate association risk HF condition. Kaplan-Meier survival analysis employed estimate disparities across groups differentiated by Results This total 1,393 patients, 59% being male. 82.8%. analyses revealed significant between HF. illustrated linear relationship higher increased this specific patient population. Furthermore, unveiled statistically differences RRT Conclusions results highlight independent predictor poor outcome However, further confirmation causality necessitates larger prospective studies.

Language: Английский

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Insulin resistance assessed by estimated glucose disposal rate and risk of incident cardiovascular diseases among individuals without diabetes: findings from a nationwide, population based, prospective cohort study

Cardiovascular Diabetology, Journal Year: 2024, Volume and Issue: 23(1)

Published: June 6, 2024

Abstract Background Recent studies have suggested that insulin resistance (IR) contributes to the development of cardiovascular diseases (CVD), and estimated glucose disposal rate (eGDR) is considered be a reliable surrogate marker IR. However, most existing evidence stems from involving diabetic patients, potentially overstating effects eGDR on CVD. Therefore, primary objective this study examine relationship with incidence CVD in non-diabetic participants. Method The current analysis included individuals China Health Retirement Longitudinal Study (CHARLS) who were free diabetes mellitus but had complete data at baseline. formula for calculating was as follows: (mg/kg/min) = 21.158 − (0.09 × WC) (3.407 hypertension) (0.551 HbA1c) [WC (cm), hypertension (yes 1/no 0), HbA1c (%)]. categorized into four subgroups according quartiles (Q) eGDR. Crude hazard ratios (HRs) 95% confidence intervals (CIs) computed investigate association between incident CVD, lowest quartile (indicating highest grade resistance) serving reference. Additionally, multivariate adjusted restricted cubic spine (RCS) employed dose–response relationship. Results We 5512 participants study, mean age 58.2 ± 8.8 years, 54.1% female. Over median follow-up duration 79.4 months, 1213 cases, including 927 heart disease 391 stroke, recorded. RCS curves demonstrated significant linear all outcomes (all P non-linearity > 0.05). After adjustment, lower levels founded significantly associated higher risk Compared Q1 eGDR, HRs (95% CIs) those Q2 4 0.88 (0.76 1.02), 0.69 (0.58 0.82), 0.66 (0.56 0.79). When assessed continuous variable, per 1.0-SD increase 17% (HR: 0.83, CI: 0.78 0.89) subgroup analyses indicating smoking status modified ( interaction 0.012). Moreover, mediation revealed obesity partly mediated association. incorporating basic model considerably improve predictive ability Conclusion A level found increased among This suggests may serve promising preferable predictor intervention target

Language: Английский

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Diagnostic and prognostic value of triglyceride glucose index: a comprehensive evaluation of meta-analysis

Cardiovascular Diabetology, Journal Year: 2024, Volume and Issue: 23(1)

Published: Aug. 23, 2024

The present umbrella review aims to collate and summarize the findings from previous meta-analyses on Triglyceride Glucose (TyG) Index, providing insights clinicians, researchers, policymakers regarding usefulness of this biomarker in various clinical settings. A comprehensive search was conducted PubMed, Scopus, Web Science up April 14, 2024, without language restrictions. AMSTAR2 checklist assessed methodological quality included meta-analyses. Statistical analyses were performed using Comprehensive Meta-Analysis (CMA) software. total 32 studies finally included. results revealed significant associations between TyG index health outcomes. For kidney outcomes, a high significantly associated with an increased risk contrast-induced nephropathy (CIN) (OR = 2.24, 95% CI: 1.82–2.77) chronic disease (CKD) (RR 1.46, 1.32–1.63). High type 2 diabetes mellitus (T2DM) 3.53, 2.74–4.54), gestational (GDM) 2.41, 1.48–3.91), diabetic retinopathy (DR) 2.34, 1.31–4.19). Regarding metabolic diseases, higher patients obstructive sleep apnea (OSA) (SMD 0.86, 0.57–1.15), syndrome (MD 0.83, 0.74–0.93), non-alcoholic fatty liver (NAFLD) 2.36, 1.88–2.97) compared those these conditions. In cerebrovascular dementia 1.14, 1.12–1.16), cognitive impairment 2.31, 1.38–3.86), ischemic stroke 1.37, 1.22–1.54). cardiovascular showed heart failure (HF) (HR 1.21, 1.12–1.30), atrial fibrillation (AF) 1.22, 0.57–1.87), hypertension (HTN) 1.52, 1.25–1.85). is promising for screening predicting medical conditions, particularly related insulin resistance disorders. However, heterogeneity suggest need further high-quality research confirm refine utility index.

Language: Английский

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