Consensus Recommendations by the Asian Pacific Society of Cardiology: Optimising Cardiovascular Outcomes in Patients with Type 2 Diabetes

The Asian Pacific Society of Cardiology convened a consensus statement panel for optimising cardiovascular (CV) outcomes in type 2 diabetes, and reviewed the current literature. Relevant articles were appraised using the Grading of Recommendations, Assessment, Development and Evaluation system, and consensus statements were developed in two meetings and were confirmed through online voting. The consensus statements indicated that lifestyle interventions must be emphasised for patients with prediabetes, and optimal glucose control should be encouraged when possible. Sodium–glucose cotransporter 2 inhibitors (SGLT2i) are recommended for patients with chronic kidney disease with adequate renal function, and for patients with heart failure with reduced ejection fraction. In addition to SGLT2i, glucagon-like peptide-1 receptor agonists are recommended for patients at high risk of CV events. A blood pressure target below 140/90 mmHg is generally recommended for patients with type 2 diabetes. Antiplatelet therapy is recommended for secondary prevention in patients with atherosclerotic CV disease

Genetic Associations of Type 2 Diabetes with Islet Amyloid Polypeptide Processing and Degrading Pathways in Asian Populations

10.1371/journal.pone.0062378PLoS ONE86

Sleep and Obesity

Rising global prevalence and incidence of obesity lead to increased cardiovascular-renal complications and cancers. Epidemiological studies reported a worldwide trend towards suboptimal sleep duration and poor sleep quality in parallel with this obesity epidemic. From rodents and human models, it is highly plausible that abnormalities in sleep, both quantity and quality, impact negatively on energy metabolism. While excess dietary intake and physical inactivity are the known drivers of the obesity epidemic, promotion of healthy sleep habits has emerged as a new target to combat obesity. In this light, present review focuses on the existing literature examining the relationship between sleep physiology and energy homeostasis. Notably, sleep dysregulation perturbs the metabolic milieu via alterations in hormones such as leptin and ghrelin, eating behavior, neuroendocrine and autonomic nervous systems. In addition, shift work and trans-meridian air travel may exert a negative influence on the hypothalamic-pituitary-adrenal axis and trigger circadian misalignment, leading to impaired glucose tolerance and increased fat accumulation. Amassing evidence has also suggested that uncoupling of the circadian clock can increase the risk of adverse metabolic health. Given the importance of sleep in maintaining energy homeostasis and that it is potentially modifiable, promoting good sleep hygiene may create new avenues for obesity prevention and treatment

The effect of weekend and holiday sleep compensation on childhood overweight and obesity

OBJECTIVES: A growing trend in childhood sleep habits is to compensate for the weekday sleep deficit by longer weekend and holiday sleep duration. We aimed to investigate the effect of weekend/holiday sleep compensation in relation to childhood overweight and obesity. METHODS: This is a community-based cross-sectional study with 5159 children (49.6% boys), mean age of 9.25 years (SD: 1.78), from 13 primary schools in Hong Kong. Data on sleep patterns, lifestyle, body weight, and height of children were obtained from questionnaires. Sleep durations during weekdays, weekends, and holidays were predictor variables. BMI z scores and obesity/overweight status were the outcome measures. RESULTS: Children slept significantly longer during holidays (mean [SD]: 10.20 (0.92) hours) and weekends (school terms) (10.07 [0.93] hours) than during school weekdays (9.18 [0.95] hours). Children with shorter sleep duration had higher BMI z scores regardless of the sleep parameters used in the analysis. Among children who slept <8 hours during weekdays, those children who did not compensate for their sleep deficit during weekends or holidays had significantly increased risk of overweight/obesity compared with those children with sleep compensation (odds ratios: 2.59 [95% confidence interval: 1.22-5.48] and 2.32 [95% confidence interval: 1.00 -5.53], respectively). CONCLUSIONS: There was a prominent difference in sleep duration between weekdays and weekends/holidays among school children. Short sleep duration was associated with higher BMI, but compensation of sleep during weekends/holidays may partly ameliorate the risk of childhood overweight/obesity. Further prospective and interventional study is needed to delineate the risk-benefit effect of these increasingly common sleep habits among children and adolescents. Copyright © 2009 by the American Academy of Pediatrics.Link_to_subscribed_fulltex

Restless legs symptoms in adolescents: Epidemiology, heritability, and pubertal effects

Aims: We aimed to determine the prevalence, pubertal effect, familial aggregation, and heritability of restless legs (RLS) symptoms in Chinese adolescents. In addition, the correlates and consequences of RLS symptoms were examined. Methods: This was a population-based family study that involved 1549 adolescents (probands), their parents and siblings. RLS symptoms were assessed by a single question measuring the core features of RLS. Subjects with RLS symptoms for at least once per week were considered as abnormal. Impairment of daytime functions, behavioral problems, health status, and lifestyle practice were also documented. Results: The prevalence of RLS symptoms was 2.8% in adolescents and 7.4% in their parents with female preponderance. Gender difference of RLS symptoms emerged in mid-pubertal adolescents (Tanner stage 3 or above). RLS symptoms were closely associated with various sleep problems (range of ORs=2.24 to 32.5, p<0.05), except habitual snoring. They were also independently associated with impairment of daytime functions, poor general health and frequent temper outbursts but not caffeine or alcohol intake or cigarette smoking after adjustment for age, sex, and other comorbid sleep problems. RLS symptoms presented with a modest familial aggregation and heritability (h2±SE=0.17±0.04, p<0.001).Interpretation. RLS symptoms are common in Chinese adolescents with significant health repercussions. Puberty plays a critical role in the emergence of gender difference of RLS symptoms, which are accounted for by both genetic and environmental factors. © 2013 Elsevier Inc.Link_to_subscribed_fulltex

Erectile Dysfunction Predicts Coronary Heart Disease in Type 2 Diabetes

ObjectivesWe examined the predictive power of erectile dysfunction (ED) on coronary heart disease (CHD) events in Chinese men with type 2 diabetes.BackgroundSubjects with diabetes are prone to develop cardiovascular complications. Erectile dysfunction is strongly associated with CHD in cross-sectional studies, but prospective data are lacking.MethodsA consecutive cohort of men with no clinical evidence of cardiovascular disease underwent comprehensive assessments for diabetic complications. Erectile dysfunction was defined according to the definition of the National Institutes of Health Consensus Conference 1992. Coronary heart disease events were censored with centralized territory-wide hospital databases in 2005.ResultsOf 2,306 subjects (age: 54.2 ± 12.7 years; follow-up: 4.0 [range 1.7 to 7.1] years), 26.7% had ED at baseline. The incidence of CHD events was higher in men with ED than those without (19.7/1,000 person-years, 95% confidence interval [CI] 14.3 to 25.2 person-years vs. 9.5/1,000 person-years, 95% CI 7.4 to 11.7 person-years). Men who developed CHD events were older; had a higher frequency of ED and microvascular complications; had longer duration of diabetes; and had higher blood pressure, total cholesterol, low-density lipoprotein cholesterol, and urinary albumin/creatinine ratio but lower high-density lipoprotein cholesterol and estimated glomerular filtration rate than those without CHD events. Erectile dysfunction remained an independent predictor for CHD events (hazard ratio 1.58, 95% CI 1.08 to 2.30, p = 0.018) after adjustment for other covariates along with age, duration of disease, and use of antihypertensive agents and albuminuria.ConclusionsIn type 2 diabetic men without clinically overt cardiovascular disease, the presence of ED predicts a new onset of CHD events. Symptoms of ED should be independently sought to identify high-risk subjects for comprehensive cardiovascular assessments