Teresa Caulin-Glaser

Effect of a Community-Based Weight Management Program on Weight Loss and Cardiovascular Disease Risk Factors

Objective: The purpose of our retrospective database analysis was to describe and evaluate the outcomes of a weight loss intervention in a community medical wellness center.

Cardiac rehabilitation is associated with an improvement in C-reactive protein levels in both men and women with cardiovascular disease.

PURPOSEnInflammation is involved in the development of atherosclerotic plaque. The most studied indicator of inflammation in coronary heart diseases (CHD) is C-reactive protein (CRP) which has prognostic significance in those with CHD. The purpose of this study is to evaluate the effect of participation in cardiac rehabilitation (CR) on this marker of vascular inflammation, CRP.nnnMETHODSnWe analyzed CRP levels in 172 patients with CHD who participated in a CR program.nnnRESULTSnMen and women in CR demonstrated significant improvement in body mass index (-0.35, P = .002), exercise capacity (METs 1.8, P < .0001), HDL-C (1.8, P = .003), and CRP (-3.1, P = .003). The improvement in CRP was not significantly different based on age or the presence of metabolic syndrome.nnnCONCLUSIONnParticipation in CR was associated with a marked improvement of cardiac risk factors and appears to independently decrease the level of CRP regardless of gender, age, or presence of metabolic syndrome.

Cardiovascular Disease Risk of Type 2 Diabetes Mellitus and Metabolic Syndrome: Focus on Aggressive Management of Dyslipidemia

Type 2 diabetes mellitus and the closely related metabolic syndrome markedly increase the risk of cardiovascular disease a major contributor is the dyslipidemia. Recent studies and new national guidelines suggest these very high risk patients with cardiovascular disease achieve optional low density lipoprotein cholesterol (LDL-C) level of less than 70 mg/dl. In addition there may be no threshold to begin therapeutic lifestyle change and pharmacologic therapy to reduce LDL-C by 30-40%. Although randomized controlled trials with statins indicate that LDL reduction clearly reduces cardiovascular risk in these patients, the typical dyslipidemia of type 2 diabetes mellitus is also characterized by low high density lipoprotein cholesterol (HDL-C) levels, increased triglyceride-rich lipoproteins and small dense LDL, as well as increased postprandial lipemia. The later lipoproteins increase non-HDL-C levels. In order to address these abnormalities it may be necessary to utilize combined approaches with a fibrate or nicotinic acid, or other agents with statins to help reduce risk beyond statins. In addition, supervised, therapeutic life-style change is often underutilized therapy in patients with established coronary artery disease. This review will focus on maximizing the treatment of dyslipidemia in type 2 diabetes and the metabolic syndrome and discuss the evidence based studies and new developments in the management in these very high risk patients.

Effect of a Weight Management Program on the Determinants and Prevalence of Metabolic Syndrome

Objective: As prevalence of obesity and metabolic syndrome (met synd) rises, establishing effective, community‐based treatments is imperative. Our investigation sought to evaluate and report the effect of a weight management program on the prevalence and determinants of met synd, and the effect of participation level.

A systematic approach to improve lipids in coronary artery disease patients participating in a cardiac rehabilitation program.

PURPOSEnTo determine the effectiveness of an intervention, directed toward the primary care physician (PCP), to improve the number of patients treated to low-density lipoprotein cholesterol (LDL-C) goal in a cardiac rehabilitation (CR) population.nnnMETHODSnA pre-post intervention cohort comparison using data collected from participants in a CR program with LDL-C > or =100 mg/dL at entry. The control cohort participated in CR between 1/00 and 10/02, 41.5% (n = 178) had an entry LDL-C > or =100 mg/dL. The intervention cohort participated in CR between 10/03 and 1/05, 26.4% (n = 67) had an entry LDL-C > or =100 mg/dL. The intervention group had identical treatment as the control group as well as the following: each participant with an LDL-C > or =100 mg/dL in the intervention cohort had an entry letter sent to his or her cardiologist and PCP from the programs Cardiology Medical Director, detailing the lipid goals and therapeutic options. In addition, monthly faxes on progress toward lipid goals were sent to the PCP.nnnRESULTSnThe control cohort was less likely to achieve LDL-C goal compared with the intervention cohort (43% vs 67%, respectively; P = .001). A patient was also less likely to have a lipid medication change during CR in the control group compared with the intervention group (29% vs 42%, respectively; P = .05).nnnCONCLUSIONnUse of systematic reminders directed at the PCP during CR can substantially increase the percentage of patients achieving nationally recognized LDL-C goals.

Independent effect of cardiac rehabilitation on lipids in coronary artery disease.

PURPOSEnWe evaluate the effects cardiac rehabilitation (CR) participation independent of using lipid-altering agents (LAAs) on low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, total cholesterol, and triglyceride. Measurements included absolute and relative change in lipids and increases in percent of patients achieving goals.nnnMETHODSnAnalysis of 766 patients who participated in CR between 2000 and 2003 was performed. On enrollment to CR, all were being treated with an LAA defined as HIviG-CoA reductase inhibitors, bile acid sequestrant, fibrate, and niacin, hormone replacement therapy. Preenrollment and postenrollment lipids were obtained. Analysis was performed on 2 cohorts, participants enrolled on an LAA with no change in medication (n = 13) and participants enrolled on an LAA with a change in medications (n = 153).nnnRESULTSnAt completion of CR, 74.9% of patients on LAA at enrollment with no medication adjustments during the program were at Adult Treatment Panel III goal for low-density lipoprotein cholesterol compared with 68.5% at entry (P = .01), all other lipid parameters also significantly improved. Sixty-three percent who started CR on an LAA and had dose adjustment or an additional LAA added achieved low-density lipoprotein cholesterol goal compared with 43.1% at entry (P < .0001).nnnCONCLUSIONnParticipation in CR significantly potentiates the lipid-improving effects of pharmacological therapy and independently contributed to the percent of patients achieving all lipid levels at Adult Treatment Panel III goal.

Effects of cardiac rehabilitation on lipoprotein abnormalities in patients with Type 2 diabetes mellitus and metabolic syndrome

Type 2 diabetes mellitus (DM) and the related metabolic syndrome are highly prevalent clinical entities. The Adult Treatment Panel III guidelines have called specific attention to the importance of targeting cardiovascular risk factors in metabolic syndrome and Type 2 DM as a method of risk-reduction therapy. One of the cornerstones of treatment and prevention for both of these conditions is individualized, systematic and intensive lifestyle interventions in addition to traditional pharmacological therapy. The goals of cardiac rehabilitation and secondary prevention programs are to prevent disability resulting from cardiovascular disease, improve cardiac risk profile, and prevent subsequent cardiovascular events, hospitalizations and death from cardiac causes. The benefit seen with cardiac rehabilitation in patients with Type 2 DM and metabolic syndrome is likely related to the impact these programs have on the common pathophysiological background of atherosclerosis shared in Type 2 DM and metabolic syndr...