Mahesh J. Patel

Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: A scientific statement from the American Heart Association and the American Diabetes Association

Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus.

The Importance of Cardiorespiratory Fitness in the United States: The Need for a National Registry A Policy Statement From the American Heart Association

The recent 2012 update of the Heart Disease and Stroke Statistics from the American Heart Association (AHA) emphasizes the continuing burden of cardiovascular disease (CVD) in the United States, with a prevalence of CVD nearing 40% in those approaching 60 years of age and exceeding 70% in older ages.1 Direct and indirect costs of CVD in the United States exceeded

Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association

300 billion in 2008, and the projected total costs of CVD in 2015 and 2030 are more than

Branched chain amino acids are novel biomarkers for discrimination of metabolic wellness

500 billion and nearly

Secondary Prevention After Coronary Artery Bypass Graft Surgery A Scientific Statement From the American Heart Association

1200 billion, respectively.2 Recently, the AHA developed year 2020 impact goals to achieve ideal cardiovascular health, which is influenced greatly by key health behaviors of being physically active, maintaining appropriate dietary habits, and not smoking.3 The obesity epidemic in the United States has been a substantial contributor to the CVD burden, with current estimates of obesity prevalence being ≈20% in US children and adolescents and >33% in adults 20 to 74 years of age. It is well accepted that for most people, obesity is a direct outcome of an energy-rich diet, lack of sufficient physical activity (PA), or both. Another consequence of both obesity and insufficient PA is a reduction in cardiorespiratory (or aerobic) fitness (CRF) levels. Collectively, this evidence emphasizes that an individual’s health behaviors have a major role in the prevention of CVD, which is of critical importance in the United States and worldwide from a medical and economic perspective. Increasing attention is being given to the importance of PA and physical fitness (PF), both muscular fitness and especially CRF, for decreasing chronic diseases, promoting overall cardiovascular and general health, improving quality of life, and delaying CVD and mortality in the US population.4,5 Clearly, PF and CRF in particular are an underpinning for academic achievement, job productivity, and overall maintenance …

Sedentary Behavior and Mortality in Older Women: The Women’s Health Initiative

Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus.

Added Sugars and Cardiovascular Disease Risk in Children: A Scientific Statement From the American Heart Association.

OBJECTIVE To identify novel biomarkers through metabolomic profiles that distinguish metabolically well (MW) from metabolically unwell (MUW) individuals, independent of body mass index (BMI). MATERIALS/METHODS This study was conducted as part of the Measurement to Understand the Reclassification of Disease of Cabarrus/Kannapolis (MURDOCK) project. Individuals from 3 cohorts were classified as lean (BMI<25kg/m²), overweight (BMI≥25kg/m², BMI<30kg/m²) or obese (BMI≥30kg/m²). Cardiometabolic abnormalities were defined as: (1) impaired fasting glucose (≥100mg/dL and ≤126mg/dL); (2) hypertension; (3) triglycerides ≥150mg/dL; (4) HDL-C <40mg/dL in men, <50mg/dL in women; and (5) insulin resistance (calculated Homeostatic Model Assessment (HOMA-IR) index of >5.13). MW individuals were defined as having <2 cardiometabolic abnormalities and MUW individuals had≥two cardiometabolic abnormalities. Targeted profiling of 55 metabolites used mass-spectroscopy-based methods. Principal components analysis (PCA) was used to reduce the large number of correlated metabolites into clusters of fewer uncorrelated factors. RESULTS Of 1872 individuals, 410 were lean, 610 were overweight, and 852 were obese. Of lean individuals, 67% were categorized as MUW, whereas 80% of overweight and 87% of obese individuals were MUW. PCA-derived factors with levels that differed the most between MW and MUW groups were factors 4 (branched chain amino acids [BCAA]) [p<.0001], 8 (various metabolites) [p<.0001], 9 (C4/Ci4, C3, C5 acylcarnitines) [p<.0001] and 10 (amino acids) [p<.0002]. Further, Factor 4, distinguishes MW from MUW individuals independent of BMI. CONCLUSION BCAA and related metabolites are promising biomarkers that may aid in understanding cardiometabolic health independent of BMI category.

Diabetes Mellitus and Trends in Hospital Survival After Myocardial Infarction, 1994 to 2006 Data From the National Registry of Myocardial Infarction

Background—Despite evidence supporting the use of aspirin, β-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering therapies in eligible patients, adoption of these secondary prevention measures after coronary artery bypass grafting has been inconsistent. We sought to rigorously test on a national scale whether low-intensity continuous quality improvement interventions can be used to speed secondary prevention adherence after coronary artery bypass grafting. Methods and Results—A total of 458 hospitals participating in the Society of Thoracic Surgeons National Cardiac Database and treating 361 328 patients undergoing isolated coronary artery bypass grafting were randomized to either a control or an intervention group. The intervention group received continuous quality improvement materials designed to influence the prescription of the secondary prevention medications at discharge. The primary outcome measure was discharge prescription rates of the targeted secondary prevention medications...

Current trends in reducing cardiovascular risk factors in the United States: focus on worksite health and wellness.

BACKGROUND Although epidemiologic studies have shown associations between sedentary behavior and mortality, few have focused on older women with adequate minority representation and few have controlled for both physical activity and functional status. PURPOSE The objective of this study was to determine the relationship between sedentary time and total; cardiovascular disease (CVD); coronary heart disease (CHD); and cancer mortality in a prospective, multiethnic cohort of postmenopausal women. METHODS The study population included 92,234 women aged 50-79 years at baseline (1993-1998) who participated in the Womens Health Initiative Observational Study through September 2010. Self-reported sedentary time was assessed by questionnaire and examined in 4 categories (≤4, >4-8, ≥8-11, >11 hours). Mortality risks were examined using Cox proportional hazard models adjusting for confounders. Models were also stratified by age, race/ethnicity, body mass index, physical activity, physical function, and chronic disease to examine possible effect modification. Analyses were conducted in 2012-2013. RESULTS The mean follow-up period was 12 years. Compared with women who reported the least sedentary time, women reporting the highest sedentary time had increased risk of all-cause mortality in the multivariate model (HR=1.12, 95% CI=1.05, 1.21). Results comparing the highest versus lowest categories for CVD, CHD, and cancer mortality were as follows: HR=1.13, 95% CI=0.99, 1.29; HR=1.27, 95% CI=1.04, 1.55; and HR=1.21, 95% CI=1.07, 1.37, respectively. For all mortality outcomes, there were significant linear tests for trend. CONCLUSIONS There was a linear relationship between greater amounts of sedentary time and mortality risk after controlling for multiple potential confounders.

Race and Sex Differences in Small-Molecule Metabolites and Metabolic Hormones in Overweight and Obese Adults

Background: Poor lifestyle behaviors are leading causes of preventable diseases globally. Added sugars contribute to a diet that is energy dense but nutrient poor and increase risk of developing obesity, cardiovascular disease, hypertension, obesity-related cancers, and dental caries. Methods and Results: For this American Heart Association scientific statement, the writing group reviewed and graded the current scientific evidence for studies examining the cardiovascular health effects of added sugars on children. The available literature was subdivided into 5 broad subareas: effects on blood pressure, lipids, insulin resistance and diabetes mellitus, nonalcoholic fatty liver disease, and obesity. Conclusions: Associations between added sugars and increased cardiovascular disease risk factors among US children are present at levels far below current consumption levels. Strong evidence supports the association of added sugars with increased cardiovascular disease risk in children through increased energy intake, increased adiposity, and dyslipidemia. The committee found that it is reasonable to recommend that children consume ⩽25 g (100 cal or ≈6 teaspoons) of added sugars per day and to avoid added sugars for children <2 years of age. Although added sugars most likely can be safely consumed in low amounts as part of a healthy diet, few children achieve such levels, making this an important public health target.