{"id":3021,"date":"2006-10-09T08:02:45","date_gmt":"2006-10-09T08:02:45","guid":{"rendered":"http:\/\/moomango.co.uk\/htb\/?p=3021"},"modified":"2013-12-06T15:38:33","modified_gmt":"2013-12-06T15:38:33","slug":"effect-of-lifestyle-modification-on-risk-factors-for-cardiovascular-disease-and-metabolic-syndrome","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/3021","title":{"rendered":"Effect of lifestyle modification on risk factors for cardiovascular disease and metabolic syndrome"},"content":{"rendered":"

Simon Collins, HIV i-Base<\/strong><\/p>\n

Steven Grinspoon from Massachusetts General Hospital presented results from a study of lifestyle modifications on metabolic syndrome criteria and cardiovascular parameters in HIV-positive patients with the metabolic syndrome.<\/strong> [1]<\/p>\n

Previous studies have indicated that 17-45% HIV-positive patients have metabolic syndrome and that the relative risk for developing cardiovascular disease of type-2 diabetes mellitus (T2DM) are also higher in HIV-positive compared to HIV-negative men diagnosed with metabolic syndrome.<\/p>\n

The study randomised 34 patients to an intensive 6-month lifestyle modification intervention, modeled on the Diabetes Prevention Programme, or to standard health advice. The intervention included 1-2-1 weekly counseling with a dietician, as part of a diet and exercise programme.<\/p>\n

The dietary aims included reducing daily calories intake from fat to <35%, with <7% calories from saturated fat and at least 25-35 grams of soluble or insoluble fibre. Up to 10% and 20% calories could come from polyunsaturated and monusaturated fats respectively. The exercise component included 3 hours of physical activity each week, and 10,000 steps daily measured with a podometer.<\/p>\n

Baseline characteristics of the study group included mean age of 45 (+\/-2), 50% were smokers (39% in the control group), 50% were African-American, and over 60% were women, and are detailed in Table 1. Over 90% of patients were using RTIs, 50% were using PIs and 44% were using NNRTIs in their ARV regimen. While half the patients were using blood pressure medication, only 5-11% were using lipid lowering drugs (LLD). Waist circumference was the only statistically significant difference between the two groups at baseline.<\/p>\n

Table 1: Baseline characteristics<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
<\/th>\nIntervention<\/th>\nControl<\/th>\np-value<\/th>\n<\/tr>\n
Age<\/th>\n45 \u00b12<\/td>\n46 \u00b12<\/td>\nNS<\/td>\n<\/tr>\n
African American<\/th>\n69%<\/td>\n56%<\/td>\nNS<\/td>\n<\/tr>\n
Male\/female<\/th>\n37\/63%<\/td>\n33\/67%<\/td>\nNS<\/td>\n<\/tr>\n
Smoker<\/th>\n50%<\/td>\n39%<\/td>\nNS<\/td>\n<\/tr>\n
Duration HIV<\/th>\n128 mo<\/td>\n124 mo<\/td>\nnS<\/td>\n<\/tr>\n
Current blood pressure Rx<\/th>\n56%<\/td>\n50%<\/td>\nNS<\/td>\n<\/tr>\n
Lipids Rx<\/th>\n6%<\/td>\n11%<\/td>\nNS<\/td>\n<\/tr>\n
Waist (cms)<\/th>\n113<\/td>\n101<\/td>\n0.001<\/td>\n<\/tr>\n
TG (mg\/dL)<\/th>\n176 \u00b123<\/td>\n263 \u00b150<\/td>\nNS<\/td>\n<\/tr>\n
HDL (mg\/dL)<\/th>\n48 \u00b13<\/td>\n41 \u00b12<\/td>\nNS<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

NS: non significant<\/p>\n

Six patients discontinued the study early: 4 in the intervention arm (2 LTFU, 1 pregnancy, 1 family death) and 2 in the control arm (1 LTFU, 1 anemia).<\/p>\n

Table 2: Results at 6 months<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
<\/th>\nIntervention<\/th>\nStandard advice<\/th>\np-value<\/th>\n<\/tr>\n
Waist circumference (cms)<\/th>\n-2.6 \u00b11.1<\/td>\n1.2 \u00b11<\/td>\n0.022<\/td>\n<\/tr>\n
Blood pressure (mmHg)<\/th>\n-13 \u00b14<\/td>\n4 \u00b14<\/td>\n0.008<\/td>\n<\/tr>\n
Triglycerides<\/th>\n-1 \u00b122<\/td>\n-25 \u00b134<\/td>\n0.550<\/td>\n<\/tr>\n
HDL cholesterol<\/th>\n3 \u00b122<\/td>\n0 \u00b12<\/td>\n0.396<\/td>\n<\/tr>\n
Fasting glucose mmol\/L<\/th>\n0.17 \u00b10.17<\/td>\n0.06 \u00b10.11<\/td>\n0.716<\/td>\n<\/tr>\n
Systolic BP<\/th>\n-13 \u00b1-4<\/td>\n4 \u00b1-4<\/td>\n0.008<\/td>\n<\/tr>\n
Diastolic BP<\/th>\n-2 \u00b1-3<\/td>\n1 \u00b1-3<\/td>\n0.498<\/td>\n<\/tr>\n
HgbA1C<\/th>\n-0.1%<\/td>\n+0.25<\/td>\n0.017<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

In the intervention arm, caloric intake reduced by approximately -350 kcal\/day (p=0.068), with the percentage of calories from saturated fatty acids dropping by 2% (p=0.040) and fibre intake increasing by 4g\/day (p=0.057), with no changes in the control group. Exercise increased by approximately +16 hours\/week (p=0.014 compared to control). At month 6, significant improvements in some parameters included in the metabolic syndrome were reported in the intervention group and are detailed in Table 2.<\/p>\n

COMMENT<\/strong><\/p>\n

Although this was a small study and lipid markers (TC, LDL and HDL) were not helped, lifestyle modification significantly improved some of the markers associated with metabolic syndrome. The study only had short-term follow-up for some benefits that would be expected to accumulate further over time if the programme was maintained.<\/strong><\/p>\n

For example, previous research with the Dietary Prevention Programme intervention with 3 year follow-up showed that lifestyle changes reduced cumulative incidence of diabetes by 58% compared to control patients. In this placebo controlled randomised study in older patients with impaired glucose tolerance, the reduction in risk from use of metformin was only 31%.<\/strong> [2]<\/p>\n

Given current ARV choices, supporting lifestyle changes is currently one of the most optimistic interventions to reduce risk of CVD and T2DM in high-risk patients. It is disappointing that so few studies have focused on this area, as similar to smoking cessation programmes, these are also likely to have long-term cost benefit advantages. <\/strong><\/p>\n

References:<\/p>\n

    \n
  1. Fitch KV, Anderson EG, Grinspoon S et al. Effects of a lifestyle modification programme inHIV-infected patients with the metabolic syndrome. 8th IWADRLH, September 2006, San Francisco. Abstract 24.<\/li>\n
  2. Knowler WC, Barrett-Connor E, Fowler SE et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. NEJM 2002 Feb 7;346(6):393-403. PubMed ID: 11832527.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Simon Collins, HIV i-Base Steven Grinspoon from Massachusetts General Hospital presented results from a study of lifestyle modifications on metabolic syndrome criteria and cardiovascular parameters in HIV-positive patients with the metabolic syndrome. [1] Previous studies have indicated that 17-45% HIV-positive …<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,8,27],"tags":[129],"class_list":["post-3021","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-side-effects","category-weight-diabetes-metabolic-complications","tag-lipo-8th-2006"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/3021","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=3021"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/3021\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=3021"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=3021"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=3021"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}