Cardiometabolic risk assessment: An approach to the prevention of cardiovascular disease and diabetes mellitus

doi:10.1016/S1098-3597(05)80063-8

Clinical Cornerstone

Volume 7, Issues 2–3, 2005, Pages 7-16

https://doi.org/10.1016/S1098-3597(05)80063-8 Get rights and content

Abstract

An alarming increase in the development of cardiovascular disease (CVD) during the past 5 decades has led tointensive research on the epidemiology and pathogenesis of CVD, resulting in dramatic improvements in treatment. Today, there is an alarming increase in obesity and diabetes mellitus (DM), with a concomitant increase in diabetes-related complications, including CVD. Researchers have found that the risk of CVD becomes greater with increasing hyperglycemia and insulin resistance that occur in people long before the onset of clinical DM. Lifestyle modification with moderate weight loss has been shown to prevent or delay the onset of DM in patients who are at high risk for developing this disease. Unfortunately, the current guidelines for risk assessment provided by medical societies and national organizations are numerous, confusing, and inconsistent in their basic approach to identify specific risk factors for CVD and DM in patients. Extending routine systematic assessment from cardiovascular risk to cardiometabolic risk—that is, risk for developing CVD and/or DM— and increasing our understanding of the basic mechanisms that regulate energy balance and metabolic risk factors are needed to address this impending epidemic of DM.

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Citation Excerpt :
Cardiometabolic disease refers to obesity, diabetes, and cardiovascular disease (CVD), which are grouped together because they are related and share risk factors. For example, approximately 70% of total mortality in type 2 diabetes is due to CVD, and individuals with the metabolic syndrome, which is a clustering of risk factors including obesity, dyslipidemia, high blood pressure (BP), and insulin resistance, are at an increased risk of developing type 2 diabetes and CVD [1]. Unfortunately, the prevalence of these diseases is not distributed equally among the different racial/ethnic and socioeconomic groups in the USA.
Cardiometabolic diseases, which include obesity, diabetes, hypertension, and cardiovascular disease, are associated with reduced quality of life and reduced life expectancy. Unfortunately, there are racial/ethnic and socioeconomic disparities associated with these diseases such that minority populations, such as African Americans and Hispanics, and those of lower socioeconomic status, experience a greater burden. Several reports have indicated that there are differences in sleep duration and quality that mirror the disparities in cardiometabolic disease. The goal of this paper is to review the association between sleep and cardiometabolic disease risk because of the possibility that suboptimal sleep may partially mediate the cardiometabolic disease disparities.
We review both experimental studies that have restricted sleep duration or impaired sleep quality and examined biomarkers of cardiometabolic disease risk, including glucose metabolism and insulin sensitivity, appetite regulation and food intake, and immune function. We also review observational studies that have examined the association between habitual sleep duration and quality, and the prevalence or risk of obesity, diabetes, hypertension, and cardiovascular disease.
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Citation Excerpt :
Researchers have argued that relationships of sleep with blood pressure and serum lipid-lipoprotein concentrations become less evident with age (Chaput et al., 2007; Kim & Jo, 2010; Knutson, 2010; Lima-Costa, Peixoto, & Rocha, 2008; Van den Berg et al., 2007). Data on objectively measured sleep and metabolic risk factors in older adults are limited and somewhat conflicting (Eckel, Grundy, & Zimmet, 2005; Hasler et al., 2004; Vasudevan & Ballantyne, 2005; Wilson, D’Agostino, Parise, Sullivan, & Meigs, 2005). Research examining these associations in elderly dementia caregivers is even more limited, yet this group generally experiences frequent sleep difficulties, thereby potentially providing greater opportunity for poor sleep to impact health (Kring et al., 2010).
Research indicates that very short or long durations of sleep and inefficient sleep are associated with higher total cholesterol and risk of type 2 diabetes and hypertension. This study tested the hypothesis that inefficient sleep or short/long sleep durations are associated with an elevated prevalence of type 2 diabetes, dyslipidemia, and hypertension in a community-dwelling sample of elderly Alzheimer's caregivers. Participants were 126 caregivers for spouses with Alzheimer's disease who underwent in-home sleep assessment by wrist actigraphy for 72 consecutive hours. Sleep data were averaged across the 3 days/nights; nighttime sleep and daytime napping were computed. Morning fasting blood samples were collected to determine measures of blood lipids and glucose. The average of three resting blood pressure measurements was used to estimate mean resting blood pressure. Logistic regression models including covariates related to sleep and metabolic regulation indicated that nighttime sleep duration, percent sleep at night, and daytime naps were not significantly associated with odds of having diabetes (OR, 0.92; 95% CI, 0.56–1.53; OR, 0.93; 95% CI, 0.83–1.03; OR, 1.75; 95% CI, 0.74–4.11, respectively), dyslipidemia (OR, 0.83; 95% CI, 0.57–1.20; OR, 0.99; 95% CI, 0.92–1.07; OR, 0.64; 95% CI, 0.33–1.24, respectively), or hypertension (OR, 0.97; 95%CI, 0.62–1.52; OR, 1.02; 95% CI, 0.93–1.11; OR, 1.10; 95% CI, 0.44–2.74, respectively). When categorical and combined sleep parameters were examined, there were no significant associations with any of the metabolic conditions (all p > 0.05). The current study suggests that in an elderly sample of Alzheimer's caregivers, nighttime sleep duration, nighttime sleep efficiency and daytime naps are not significantly associated with prevalent type 2 diabetes, dyslipidemia, or hypertension. As several of the associations demonstrated clinically relevant magnitudes of the associations, larger studies to more fully test these hypotheses are warranted.
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CVD, type 2 diabetes and overweight/obesity are closely linked conditions. For example, approximately 70% of total mortality in type 2 diabetes is due to CVD, and individuals with the metabolic syndrome, which is a clustering of risk factors including obesity, dyslipidemia, high blood pressure and insulin resistance, are at increased risk of developing type 2 diabetes and CVD.3 The prevalence and impact of these cardiometabolic diseases is enormous.
Laboratory studies have found that short-term sleep restriction is associated with impairments in glucose metabolism, appetite regulation and blood pressure regulation. This chapter reviews the epidemiologic evidence for an association between habitual sleep duration and quality and risk of cardiometabolic diseases including obesity, diabetes and hypertension. Multiple studies observed a cross-sectional association between short sleep duration (generally <6 h per night) and increased body mass index or obesity, prevalent diabetes and prevalent hypertension. Many studies also reported an association between self-reported long sleep duration (generally >8 h per night) and cardiometabolic disease. There have been a few prospective studies and several, but not all, have found an association between short sleep and incident diabetes, hypertension and markers of cardiovascular disease. Future prospective epidemiologic studies need to include objective measures of sleep, and intervention studies are needed in order to establish a causal link between impaired or insufficient sleep and cardiometabolic disease risk.
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Insulin resistance (IR) is characterized by decreasing sensitivity of target tissues to the action of insulin, elevated blood glucose concentration, and increased hepatic production of atherogenic lipids. IR is associated with declining insulin production by the pancreas, the emergence of type 2 diabetes, and increasing risk of cardiovascular disease (CVD). Clinical markers of IR include elevated plasma glucose concentration under fasting conditions or following ingestion of an oral glucose challenge. IR and hyperinsulinemia produce a number of effects that promote CVD, including adverse effects on blood pressure, endothelial cell function, lipid profile, platelet function, and blood coagulation. Glucose dysregulation often occurs in combination with other cardiovascular risk factors, including hypertension, obesity, and dyslipidemia. Clinical trials have shown that lifestyle changes to promote weight loss and medical therapy with insulin-sensitizing agents can reduce the likelihood of progression from early stages of IR to type 2 diabetes. However, it is important to recognize that obesity is a chronic condition that needs strategies beyond a diet plan to maintain sufficient weight loss over time. Pharmacologic therapies that are currently in development may help not only to promote weight loss but also to improve the symptoms of cardiometabolic risk in patients with and without diabetes. (Clinical Cornerstone. 2007;8[Suppl 7]:S7-S18)
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Cardiometabolic risk assessment: An approach to the prevention of cardiovascular disease and diabetes mellitus

Abstract

Atherosclerosis

Diabetes Res Clin Pract

Lancet

Am J Cardiol

Am J Med.

Heart Disease and Stroke Statistics—2005 Update

Prevalence and trends im obesity among US adults, 1999–2000

JAMA

Diabetes and cardiovascular disease:The Framingham study

JAMA

Diabetes and atherosclerosis: Am epidemiologic view

Diabetes Metab Rev

Mortality from coronary heart disease im subjects with type 2 diabetes and im nondiabetic subjects with and without prior myocardial infarction

N Engl J Med

Cardiovascular risk factors im confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset ofclinical diabetes?

JAMA

Studien ber das Hypertonie-Hyperglykanie-yperurikaniesyndrom

Zentralblatt für Innere Medizin

Banting Lecture 1988. Role of insulin resistance im human disease

Diabetes

Zimmet PZ Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetesmellitus provisional report of a WHO consultation

Diabet Med

Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol im Adults. Executive summary of the third report of the NationalCholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol im Adults (Adult Treatment Panel III)

JAMA

Diagnosis and management of the metabolic syndrome: Am American Heart Association/National Heart, Lung, and Blood InstituteScientific Statement

Circulation

Impaired glucose tolerance and impaired fasting glycaemia: The current status on definition and intervention

Diabet Med.

Development of the multiple metabolic syndrome: Am epidemiologic perspective

Epidemiol Rev

Cardiovascular risk factors are really linked im the metabolic syndrome: This phenomenon suggests clustering rather than coincidence

Int J Cardiol

Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: A summary of the evidence

Diabetes Care