Relationship Between Body Adiposity and Arterial Stiffness in Young Indian Adults

ABSTRACT Background: Obesity is one of the major cardiovascular risk factors and is linked with arterial stiffness. This study was undertaken to establish the relationship between regional adiposity and arterial stiffness using simple noninvasive techniques. Methods: In total, 181 young Asian Indian adults aged 18–28 years (mean age 21.9 ± 2.2) were measured for adiposity and arterial stiffness. Total body fat percentage was derived from skinfold thickness of various body sites. Body mass index and waist‑hip‑ratio were also measured. Arterial stiffness was measured using a SphygmoCor with a carotid‑radial pulse wave analysis technique. Results: Significant gender differences were observed on anthropometric variables including skinfold thickness (P < 0.05) and all the arterial stiffness variables (P < 0.05) except pulse wave velocity. Systolic pressure, augmentation pressure, augmentation index (AIx), AIx at 75% heart rate, and aortic systolic pressure had statistically significant correlations with all three adiposity variables (P < 0.05). Significant correlations were found in a higher number of variables in the females. Physical activity had negative correlations with arterial stiffness and adiposity variables (P < 0.05). Conclusion: Arterial stiffness measured by carotid‑radial pulse wave analysis is strongly related to adiposity measured from skinfold thickness in females. Females had higher arterial stiffness and adiposity compared with men. These findings could be helpful in future research using noninvasive arterial stiffness measurements

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Reproducibility of 24-h ambulatory blood pressure and measures of autonomic function.

Determining the number of familiarization sessions required for accurate recordings of ambulatory blood pressure monitoring and autonomic function is a prerequisite for the appropriate design of intervention studies. The benefit of familiarization trials remains largely unexplored. The objective of the current investigation was to assess the reproducibility of 24-h ambulatory blood pressure, 24-h heart rate variability (HRV) and resting measurements of HRV and blood pressure variability (BPV). Eleven prehypertensive and hypertensive adults participated. Ambulatory blood pressure and HRV were measured across 24 h on four occasions. In addition, 5-min resting measures of HRV and BPV were recorded and analysed. Variability between consecutive pairs of trials was calculated. The typical error induced by ambulatory recordings of systolic blood pressure reduced over time (3.8-2.8 mmHg). The greatest effect of familiarization was observed at night. Ambulatory HRV was more reproducible than resting measures. The most reproducible markers were root mean square of successive differences [coefficient of variation (CV): 13.2-10%] and high frequency normalized units (CV: 15.2-6.4%), with the percentage of adjacent NN intervals differing by more than 50 ms showing the poorest reproducibility (CV: 23.9-20.7%). Overall BPV (SD) was more reproducible than the frequency domain low frequency component. Familiarization trials are required for the most accurate recordings of both 24-h ambulatory blood pressure monitoring and HRV. Ambulatory HRV provide superior reproducibility to resting measurements

Nurses' and midwives' experiences and views about responding to out of work emergencies: A constructivist grounded theory study

Aim To explore nurses' and midwives' experiences, views, perceptions and impact on their responses to out of work emergencies where first aid may be required. Design A constructivist grounded theory study was conducted between 2012 and 2019. Methodology In-depth, semi-structured interviews were undertaken with 16 nurses and midwives. Participants were recruited via a participant referral process with registered nurses and midwives being accessed from three NHS organizations. Data were analysed and coded using constant comparative analysis with the support of Nvivo 10 software leading to the construction of a substantive grounded theory. Results A core enduring in vivo theme, ‘The Right Thing to Do’, emerged as a central conceptual reality constructed via three key in vivo themes; ‘Something I've Heard’, ‘Am I Covered?’ and ‘Just Who I Am’, each with several sub-themes. A pervading anxiety about responding at off-duty situations requiring first aid was persistently evident across these themes. Conclusion The study showed a strong sense of moral agency among nurses and midwives, despite a powerful underlying feeling of anxiety surrounding broader issues of urban myth, protection and personal and professional identity. The substantive theory emerged as ‘doing "The Right Thing" in a climate of anxiety’

Acute changes in arterial stiffness following exercise in healthy Caucasians and South Asians

Background Arterial stiffness and exercise capacity are independent predictors of cardiovascular diseases. This study aims to establish the acute changes in arterial stiffness using applanation tonometry following sub-maximal exercise in Caucasians and South Asians. This study also aims to establish the relationship between exercise capacity and arterial stiffness. Methods In total, 69 participants including 37 Caucasians and 32 South Asians were assessed for arterial stiffness non-invasively using SpygmoCor (SCOR-PVx, Version 8.0, AtCor Medical Inc North America, USA) before and after an exercise test using the Bruce protocol on a treadmill and by measuring aerobic capacity using a metabolic analyser (Medical Graphics, Cardio Control, Minnesota, USA). Results Significant increases in arterial stiffness variables were observed including augmentation pressure, subendocardial viability ratio, ejection duration, pulse pressure, augmentation index and mean arterial pressure following exercise in both ethnic groups (P 0.05). There was no change in pulse wave velocity (p > 0.05). Exercise capacity was inversely related to arterial stiffness (P < 0.05). Conclusion There are no differences in arterial stiffness at the baseline and following acute exercise between Caucasians and South Asians. There was significant increase in arterial stiffness following exercise in both groups. Exercise capacity is inversely related to arterial stiffness. The results suggest that non invasive arterial stiffness could be used as a tool to measure acute changes following exercise

Acute changes in arterial stiffness following exercise in people with metabolic syndrome.

Background: This study aims to examine the changes in arterial stiffness immediately following submaximal exercise in people with metabolic syndrome. Methods: Ninety-four adult participants (19–80 years) with metabolic syndrome gave written consent and were measured for arterial stiffness using a SphygmoCor (SCOR-PVx, Version 8.0, Atcor Medical Private Ltd, USA) immediately before and within 5–10 min after an incremental shuttle walk test. The arterial stiffness measures used were pulse wave velocity (PWV), aortic pulse pressure (PP), augmentation pressure, augmentation index (AI), subendocardial viability ratio (SEVR) and ejection duration (ED). Results: There was a significant increase (p < 0.05) in most of the arterial stiffness variables following exercise. Exercise capacity had a strong inverse correlation with arterial stiffness and age (p < 0.01). Conclusion: Age influences arterial stiffness. Exercise capacity is inversely related to arterial stiffness and age in people with metabolic syndrome. Exercise induced changes in arterial stiffness measured using pulse wave analysis is an important tool that provides further evidence in studying cardiovascular risk in metabolic syndrome

Effect of an IT-supported home-based exercise programme on metabolic syndrome in India

We studied the effectiveness of a home-based exercise programme with information technology (IT) support in people with metabolic syndrome in India. Ninety-four participants with metabolic syndrome (mean age 50 years) were randomized into two groups. Both groups received a 12-week home exercise programme and Group 2 received additional IT support for health education. Before and after the exercise programme, participants were measured for arterial stiffness using applanation tonometry, exercise capacity using an incremental shuttle walk test and quality of life (QoL) using the SF-36 questionnaire. Sixty-one participants completed the post intervention tests. There was a significant reduction in systolic blood pressure, mean pressure and aortic systolic pressure in both groups. Pulse wave velocity, aortic pulse pressure and aortic diastolic pressure showed significant reductions only in Group 2. There were no significant changes in QoL measures, except vitality in Group 2. There was significant improvement in fasting blood glucose in Group 2, cholesterol in Group 1 and triglycerides in both groups. The participants’ exercise capacity did not change significantly, although the mean duration of regular exercise was 7.2 weeks for Group 1 and 10.0 weeks for Group 2 (P = 0.019). Metabolic syndrome was reversed in 16% of the participants in both groups. IT support, through mobile text messages and phone calls, may be helpful in metabolic syndrome. Longer-term studies are now required

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially