Association of baseline risk factors with cardiovascular (CV) events during long-term degarelix therapy in men with prostate cancer. Is a targeted and planned GP intervention effective in cardiovascular disease prevention? A randomized controlled trial Relation of plasma total homocysteine to cardiovascular mortality in a French population. Cardiovascular risk in relation to body mass index and use of evidence-based preventive medications in patients with or at risk of atherothrombosis. The effect of pharmacological therapy on the cardiovascular system of patients with systemic rheumatic diseases. Lifestyle changes followed by bariatric surgery lower inflammatory markers and the cardiovascular risk factors C3 and C4. Abdominal obesity and all-cause and cardiovascular mortality in end-stage renal disease. One-year cardiovascular event rates in outpatients with atherothrombosis. The International Polycap Study-3 (TIPS-3): Design, baseline characteristics and challenges in conduct Hepatic histology in obese patients undergoing bariatric surgery. Cardiovascular risk profile and outcome of patients with abdominal aortic aneurysm in out-patients with atherothrombosis: data from the Reduction of Atherothrombosis for Continued Health (REACH) Registry. Saxagliptin Efficacy and Safety in Patients With Type 2 Diabetes Mellitus and Cardiovascular Disease History or Cardiovascular Risk Factors: Results of a Pooled Analysis of Phase 3 Clinical Trials A Systematic Assessment of Cardiovascular Outcomes in the Saxagliptin Drug Development Program for Type 2 Diabetes Ankle-brachial blood pressure index predicts cardiovascular events and mortality in Japanese patients with chronic kidney disease not on dialysis The role of bariatric surgery in morbidly obese patients with inflammatory bowel disease. Young obese women with polycystic ovary syndrome have evidence of early coronary atherosclerosis. Comparision of the risk of cardiovascular events and death in patients treated with degarelix compared with LHRH agonists. Effects of bariatric surgery on mortality in Swedish obese subjects. Effects of individual risk factors on the incidence of cardiovascular events in the treated hypertensive patients of the Hypertension Optimal Treatment Study. HOT Study Group. Bariatric Surgery May Improve Employment Status in Unemployed, Underserved, Severely Obese Patients Effects of intentional weight loss in patients with obesity and heart failure: a systematic review. Preventing cardiovascular disease in women: an intervention-control randomized study. Changes in Testosterone Levels and Sex Hormone-Binding Globulin Levels in Extremely Obese Men after Bariatric Surgery Bariatric surgery and long-term cardiovascular events.
190 Background : GnRH agonists have been associated with a greater incidence of  CV events  in men with prostate cancer . Less is known about GnRH antagonists and CVD . We used prospect i ve data to evaluate the relationships of baseline CV risk , dosing regimen and duration of degarelix therapy , and CV events . METHODS Data from 16 phase II/III and one extended phase III trial was pooled ( n=1,704 ) . Maintenance doses and exposure time varied between 20 - 480 mg and 1 - 66 months , respectively . Baseline CV risk was assessed based on established CVD , BMI ( > 30 kg/m2 ) , smoking , hypertension , type 2 diabetes , and hyperlipidemia . Patients were stratified into 3 groups : 1 ) no CV risk factors ( n=337 ) , 2 ) ≥1 CV risk factors without CVD ( n=803 ) , 3 ) established CVD ( n=564 ) . Acute CV events were collected prospect ively . RESULTS The incidence of CV events in patients with established CVD , ≥1 CV risk factors , and no CV risk factors was 20 % ( n=112 ) , 8 % ( n=57 ) and 7 % ( n=28 ) , respectively . Established CVD was associated with a 3.1-fold increased risk for CV events ( p<0.0001 ) , whereas presence of ≥1 CV risk factors with 1.3-fold ( p=0.28 ) . The cumulative hazard curve indicated no increases in hazards with increasing duration of treatment . Hazards of primary CV events  during degarelix treatment ( 0.049 ) were not statistically different from that during the 2 years prior treatment ( 0.48 , p=0.85 ) . In multivariate models , age , established CV disease , high BMI and no alcohol consumption were independently associated with greater risk for CV events ( Table ) ; type 2 diabetes ( p=0.13 ) and smoking ( p=0.08 ) were of borderline significance . Degarelix dose and schedule were not associated with CV risk ( p=0.78 ) in the model . CONCLUSIONS CV events during degarelix treatment were largely confined to those with established CVD and further modulated by aging and modifiable risk factors . Rates of CV events were similar before and after degarelix treatment . [ Table : see text ] [ Table : see text ] Background The optimal intensity and duration of the intervention to achieve sustained risk reduction in patients at high and very high cardiovascular ( CV ) risk still need to be established . The aim of this study was to evaluate the impact of general practitioner ’s ( GP ’s ) systematic and planned intervention on total CV risk reduction and a change in individual CV risk factors . Material / Methods This was a cluster-r and omized trial ( IS RCT N31857696 ) including 64 practice s and 3245 patients aged ≥40 . The participating GPs and their examinees were r and omized into an intervention or to a control group ( st and ard care ) . Intervention group practitioners followed up their examinees during 1 , 3 , 6 , 12 , and 18 months . The main outcome measures were change in proportion of patients with low , moderate , high , and very high CV risk , and change in individual CV risk factors from the first to the second registration . Results The proportion of patients with very high CV risk was lower in the intervention group , the same as of patients with high blood pressure , total and LDL cholesterol , and increased intake of alcohol . The mean systolic ( −1.49 mmHg ) and diastolic ( −1.57 mmHg ) blood pressure , triglycerides ( −0.18 mmol/L ) , body mass index ( −0.22 ) , and waist ( −0.4 cm ) and hip circumference ( −1.08 cm ) was reduced significantly in the intervention group . There was no additional impact in the intervention group of other tested CV risk factors . Conclusions Systematic and planned GP ’s intervention in CVD prevention reduces the number of patients with very high total CV risk and influences a change in lifestyle habits Although there is considerable epidemiologic evidence for a relation between plasma homocysteine ( HCY ) and cardiovascular ( CV ) disease , the role of HCY as a causal CV risk factor remains controversial , mainly because of the intercorrelation between HCY and other CV risk factors . The goal of the present nested case-control prospect i ve study is to determine the multiadjusted relation between HCY and CV mortality in a large and low CV risk population after a mean follow-up of 14 years . In 1980 and 1981 , plasma was saved from 5,000 patients who underwent a systematic health checkup , including clinical and biologic examinations .  In 1999 ,  HCY concentration was measured in 110 subjects who died of CV disease ( cases ) and in 154 r and omly matched survivors ( control subjects ) . Statistical analysis was adjusted for CV risk factors . Based on Cox analyses , 3 factors emerged as independent predictors of CV mortality : C-reactive protein , systolic blood pressure , and HCY . The adjusted hazard ratio for CV mortality was 1.22 ( 95 % confidence interval 1.04 to 1.41 ) per 1 SD ( 3.9 micromol/L ) increment of HCY . Thus , HCY is an independent risk predictor for CV mortality . Because of extensive adjustment procedures , the present study provides additional epidemiologic evidence for a causal relation between HCY and CV disease AIM Explore the relation between body mass index ( BMI ) and cardiovascular disease , and the influence of optimal medical therapy ( OMT ) on this relationship . METHODS AND RESULTS Patients from the REACH cohort , an international , prospect i ve cohort of patients with or at high risk of atherosclerosis with documentation of potential confounders , including treatments and risk factors , were followed up to 4 years ( n = 54 285 ) . Patients were categorized according to baseline BMI ( ranging from underweight to Grade III obesity ) . Optimal medical therapy was defined as the use of the four cardioprotective medication classes ( statins , ACE inhibitors/angiotensin II receptor blockers , β-blockers , and antiplatelet agents ) . The main outcomes were all-cause mortality , cardiovascular ( CV ) mortality , and CV events . In primary and secondary prevention , a reverse J-shaped curve best described the relationship between BMI categories and the incidence of the various outcomes . In secondary prevention , the highest adjusted risks were observed for underweight patients ( 1.97 , P < 0.01 , and 1.29 , P = 0.03 , for CV mortality and CV events ) and the lowest HRs were observed , respectively , in Grade II and Grade III obese patients ( 0.73 , P < 0.01 and 0.80 , P < 0.01 ) . The proportion of patients on OMT increased with BMI from 10.1 to 36 % ( P < 0.001 ) . The apparent CV protection conferred by obesity persisted in patients receiving OMT . CONCLUSION An obesity paradox was observed in both primary and secondary CV prevention patients . The intensity of use of evidence -based preventive medications does not account for the paradoxical CV protection associated with obesity . At extremes of BMI , further interventions beyond OMT may be needed to reduce CV risk The higher mortality rate among rheumatoid arthritis ( RA ) patients in comparison with the general population is largely attributable to cardiovascular ( CV ) disease , particularly coronary atherosclerosis , but also non-fatal myocardial infa rct ion and heart failure . It may be due to RA-specific risk factors such as hyperhomocysteinemia , disease-related dyslipidemia or vascular inflammation , or morbidity related to high levels of cytokines such as tumour necrosis factor ( TNF ) and RA medications . Non-steroidal anti-inflammatory drugs ( NSAIDs ) are among the most important in rheumatology , but many are associated with CV disease . A number of r and omised control trials have shown that , although exposure to low doses of corticosteroids for 1 - 3years does not significantly increase CV risk , longer exposure can increase CV events . The use of disease-modifying antirheumatic drugs ( DMARDs ) , particularly methotrexate , increases homocysteinemia , reduces inflammation and improves lipid profiles , thus reducing the development of atherosclerosis and clinical ly overt CVD . Although contraindicated in RA patients with severe heart failure , biological agents such as anti-TNF agents delay and even reverse the progression of endothelial dysfunction and atherosclerosis .  Tocilizumab leads to changes in lipid profiles without increasing adverse vascular events . The effects on the CV system depend on the drug itself , the dose and the period of exposure , and so CV risk should be evaluated before starting treatment with any drug BACKGROUND Morbidly obese patients are at risk of developing insulin resistance and cardiovascular disease . Low- grade systemic inflammation is an important factor for this development . We evaluated the effect of bariatric surgery on markers of inflammation , coagulation and glucose metabolism . METHODS Ninety-seven morbidly obese patients and 17 lean subjects ( control group ) participated .  Anthropometric measurements  as well as  fasting blood sample s  were obtained at first admission , prior to surgery , and 1 year after surgery . RESULTS At admission , the morbidly obese group had significantly elevated levels of the complement components C3 and C4 compared to the lean control group ( P<0.0001 ) . Levels of C3 and C4 dropped significantly in the morbidly obese group over time ( P<0.0001 ) , and , 1 year after the operation , levels were comparable to those of the control group . The same changes were seen for markers of inflammation ( high-sensitivity C-reactive protein , tumor necrosis factor-α , interferon-γ , interleukin-1 receptor antagonist , IL-6 , and IL-13 ) , coagulation ( fibrinogen and plasminogen activator inhibitor-1 ) , and glucose metabolism ( leptin and insulin ) . There was a positive correlation between changes in C3 and body mass index , weight , coagulation parameters , inflammatory parameters , and leptin , respectively . CONCLUSIONS Bariatric surgery in morbidly obese patients  reduced weight effectively . Even more importantly , the increased levels of several risk factors associated with diabetes and cardiovascular co-morbidity normalized 1 year after surgery OBJECTIVE The aim of this study was to investigate the predictive value for all-cause and cardiovascular ( CV ) death of anthropometric measurements of abdominal obesity in patients with end-stage renal disease ( ESRD ) . BACKGROUND Surrogate measures of abdominal obesity and segmental fat distribution ( waist circumference and waist/hip ratio [ WHR ] ) are stronger predictors of all-cause and CV death than body mass index ( BMI ) in the general population , but the issue has never been investigated in patients with ESRD . METHODS We performed a prospect i ve cohort study in 537 patients with ESRD ( age 63 + /- 15 years ) . RESULTS In BMI -adjusted Cox models , waist circumference was a direct predictor of all-cause and CV mortality ( p < 0.001 ) , whereas BMI showed an inverse relationship ( p < 0.001 ) with these outcomes . The incidence rates of overall and CV death were maximal in patients with relatively lower BMI scores ( below the median ) and higher waist circumferences ( at least the median ) and minimal in patients with higher BMI scores ( at least the median ) and small waist circumferences ( below the median ) . The prognostic power of waist circumference for all-cause ( hazard ratio [ HR ] [ 10-cm increase ] : 1.23 ; 95 % confidence interval [ CI ] : 1.02 to 1.47 ; p = 0.03 ) and CV mortality ( HR : 1.37 ; 95 % CI : 1.09 to 1.73 ; p = 0.006 ) remained significant after adjustment for CV comorbidities and traditional and emerging risk factors . WHR was found to be related to all-cause ( p = 0.009 ) and CV mortality ( p = 0.07 ) . CONCLUSIONS Abdominal obesity underlies a high risk of all-cause and CV mortality in patients with ESRD . Redefinition of nutritional status by combining the metrics of abdominal obesity and BMI may refine prognosis in the ESRD population CONTEXT Few data document current cardiovascular ( CV ) event rates in stable patients with atherothrombosis in a community setting . Differential event rates for patients with documented coronary artery disease ( CAD ) , cerebrovascular disease ( CVD ) , or peripheral arterial disease ( PAD ) or those at risk of these diseases have not been previously evaluated in a single international cohort . OBJECTIVE To establish contemporary , international , 1-year CV event rates in out patients with established arterial disease or with multiple risk factors for atherothrombosis . DESIGN , SETTING , AND PARTICIPANTS The Reduction of Atherothrombosis for Continued Health ( REACH ) Registry is an international , prospect i ve cohort of 68 236 patients with either established atherosclerotic arterial disease ( CAD , PAD , CVD ; n = 55 814 ) or at least 3 risk factors for atherothrombosis ( n = 12 422 ) , who were enrolled from 5587 physician practice s in 44 countries in 2003 - 2004 . MAIN OUTCOME MEASURES Rates of CV death , myocardial infa rct ion ( MI ) , and stroke . RESULTS As of July 2006 , 1-year outcomes were available for 95.22 % ( n = 64 977 ) of participants . Cardiovascular death , MI , or stroke rates were 4.24 % overall : 4.69 % for those with established atherosclerotic arterial disease vs 2.15 % for patients with multiple risk factors only . Among patients with established disease , CV death , MI , or stroke rates were 4.52 % for patients with CAD , 6.47 % for patients with CVD , and 5.35 % for patients with PAD . The incidences of the end point of CV death , MI , or stroke or of hospitalization for atherothrombotic event(s ) were 15.20 % for CAD , 14.53 % for CVD , and 21.14 % for PAD patients with established disease . These event rates increased with the number of symptomatic arterial disease locations , ranging from 5.31 % for patients with risk factors only to 12.58 % for patients with 1 , 21.14 % for patients with 2 , and 26.27 % for patients with 3 symptomatic arterial disease locations ( P<.001 for trend ) . CONCLUSIONS In this large , contemporary , international study , out patients with established atherosclerotic arterial disease , or at risk of atherothrombosis , experienced relatively high annual CV event rates . Multiple disease locations increased the 1-year risk of CV events Background It is hypothesized that in individuals without clinical cardiovascular disease ( CVD ) , but at increased CVD risk , a 50 % to 60 % reduction in CVD risk could be achieved using fixed dose combination ( FDC ) therapy ( usually comprised of multiple blood‐pressure agents and a statin [ with or without aspirin ] ) in a single “ polypill ” . However , the impact of a polypill in preventing clinical CV events has not been evaluated in a large r and omized controlled trial . Methods TIPS‐3 is a 2x2x2 factorial r and omized controlled trial that will examine the effect of a FDC polypill on major CV outcomes in a primary prevention population . This study aims to determine whether the Polycap ( comprised of atenolol , ramipril , hydrochlorothiazide , and a statin )  reduces CV events in persons without a history of CVD , but who are at least at intermediate CVD risk . Additional interventions in the factorial design of the study will compare the effect of ( 1 ) aspirin versus placebo on CV events ( and cancer ) , ( 2 ) vitamin D versus placebo on the risk of fractures , and ( 3 ) the combined effect of aspirin and the Polycap on CV events . Results The study has r and omized 5713 participants across 9 countries . Mean age of the study population is 63.9 years , and 53 % are female . Mean INTERHEART risk score is 16.8 , which is consistent with a study population at intermediate CVD risk . Conclusion Results of the TIP‐3 study will be key to determining the appropriateness of FDC therapy as a strategy in the global prevention of CVD BACKGROUND / AIMS Obesity is one of the most important clinical associations with non-alcoholic steatohepatitis ( NASH ) . Our aim was to assess the prevalence of non-alcoholic fatty liver disease (NAFLD)/NASH in morbidly obese patients and the risk factors to more aggressive liver disease in this population . METHODS Review of available studies on prevalence of NAFLD/NASH in severely obese patients su bmi tted to bariatric surgery .  RESULTS Twelve observational and transversal studies were included , with consecutive recruitment , and prospect i ve evaluation of data , summing 1620 patients with severe obesity .  Prevalence of steatosis and NASH was 91 % ( range : 85 - 98 % ) and 37 % ( 24 - 98 % ) , respectively , with unexpected cirrhosis in 1.7 % ( 1 - 7 % ) . NASH was not related with age or body mass index , but there was an association between male sex and NASH/hepatic fibrosis . Diabetes mellitus and insulin resistance were the conditions most frequently associated with NASH , and hypertension with advanced hepatic fibrosis . CONCLUSIONS There is a very high prevalence of NAFLD in asymptomatic morbidly obese patients , more than one-third presenting histological criteria for NASH . This review underscores the large variations in prevalence of NASH between studies , calling for the need for a better agreement in the use of the histological criteria OBJECTIVE Data sets regarding patients with abdominal aortic aneurysm ( AAA ) have almost universally been restricted to single geographic regions . We aim ed to obtain data on the risk factor profile and cardiovascular ( CV ) co-morbidity among multi-ethnic patients with known AAA in the global REACH ( REduction of Atherothrombosis for Continued Health ) Registry . METHODS The REACH Registry is an international , prospect i ve , observational out-patient registry enrolling out- patients > /=45 years of age with established coronary artery disease ( CAD ) , cerebrovascular disease ( CVD ) or peripheral arterial disease ( PAD ) or with at least three atherothrombotic risk factors . This report includes observations pertaining to 68,236 out- patients enrolled in 44 countries . MAIN OUTCOME MEASURES Gender , ethnic origin , CV risk factors , established atherosclerotic disease ( CAD , CVD and PAD ) at baseline , and CV outcome events at 1-year were compared in patients with and without AAA . RESULTS An AAA was reported in 1722 ( 2.5 % ) of 68,236 out- patients enrolled in the REACH Registry . Older age ( 73 + /- 8 vs 68 + /- 10 , P < .0001 ) , male gender ( 81 % vs 63 % , P < .0001 ) , White ethnicity ( 79 % vs 67 % , P < .0001 ) and a history of smoking ( 81 % vs 55 % , P < .0001 ) were independently related to the diagnosis of AAA . There was a weaker association with hypertension or hypercholesterolemia , and an inverse relation with diabetes . Fatal and non-fatal coronary and cerebrovascular event rates were not different between the AAA and non-AAA cohorts , but individuals with AAA suffered increased rates of other cardiovascular deaths ( 1.39 % vs 0.94 % , P = .0135 ) , hospitalizations for atherothrombotic events ( 14.1 % vs 9.3 % , P < .0001 ) due to increased rates of revascularization procedures , and new or worsening PAD ( 3.7 % vs 1.3 % , P < .0001 ) at 1-year follow-up . CONCLUSION This study , the largest published to date , presents the CV risk profile and outcome of patients with an established diagnosis of AAA from a cohort of patients with either overt manifestations of CV disease or multiple risk factors , and further defines these patients in a multi-ethnic , global context Abstract Objective : This post hoc analysis sought to assess the efficacy , safety , and tolerability of saxagliptin in patients with type 2 diabetes mellitus and cardiovascular ( CV ) risk factors or disease ( CVD ) . Methods : Data from 5 r and omized controlled trials were pooled to compare saxagliptin 5 mg with placebo : 2 studies of saxagliptin as monotherapy in drug-naïve patients and 1 each of saxagliptin as add-on therapy to metformin , glyburide , or a thiazolidinedione . Analysis was performed according to the following baseline/trial entry criteria : 1 ) history /no history of CVD ; 2 ) ≥ 2 versus 0 to 1 CV risk factors ; 3 ) statin use versus no statin use ; and 4 ) hypertension versus no hypertension . Change from baseline glycated hemoglobin ( HbA1c ) , fasting plasma glucose , and postpr and ial glucose levels ; and the proportion of patients achieving an HbA1c level < 7 % were analyzed ( week 24 ) . Safety was assessed by adverse events , hypoglycemia , and body weight . Results : In total , 882 patients received saxagliptin 5 mg and 799 received placebo . Differences in adjusted mean change from baseline HbA1c ( 95 % CI ) were greater with saxagliptin compared with placebo in patients with a history of CVD ( −0.64 % [ −0.90 to −0.38 ] ) and no history of CVD ( −0.68 % [ −0.78 to −0.58 ] ) ; with ≥ 2 CV risk factors ( −0.73 % [ −0.85 to −0.60 ] ) and 0 to 1 CV risk factor ( −0.62 % [ −0.75 to −0.48 ] ) ; with statin use ( −0.70 % [ −0.89 to −0.52 ] ) and no statin use ( −0.66 % [ −0.77 to −0.56 ] ) ; and with hypertension ( −0.69 % [ −0.82 to −0.57 ] ) and no hypertension ( −0.66 % [ −0.80 to −0.52 ] ) . Saxagliptin was well tolerated , with similar adverse event rates and types compared with placebo . There was a < 1 % rate of confirmed hypoglycemia in all groups except in patients with CV history who received placebo ( 2.1 % ) . Conclusion : Saxagliptin improved glycemic measures , result ed in low rates of confirmed hypoglycemia , and was well tolerated in patients with or without CVD and CV risk factors Abstract Objective : The objective was to assess the relative risk ( RR ) for cardiovascular ( CV ) events across all 8 r and omized phase 2/3 trials evaluating saxagliptin in patients with type 2 diabetes mellitus . Methods : Cardiovascular events ( death , myocardial infa rct ion [ MI ] , stroke , revascularization procedures , and cardiac ischemia ) were reported by investigators through st and ard adverse event reporting procedures and were systematic ally identified . Post hoc blinded adjudication of all deaths , MIs , and strokes was performed using prespecified endpoint definitions by an independent clinical events committee ( CEC ) . Results : A total of 4607 r and omized and treated patients ( n = 3356 treated with saxagliptin [ 2.5–100 mg/d ] ; n = 1251 , comparator [ n = 656 , placebo ; n = 328 , metformin ; n = 267 , uptitrated glyburide ] ) were included . The median ages were 54 years ( saxagliptin ) and 55 years ( comparator ) ( interquartile range , 47–61 each ) ; 51 % were female , 73 % were white , 52 % were hypertensive , 44 % had hypercholesterolemia , 39 % had a smoking history , 20 % had a first-degree family member with premature coronary heart disease , and 12 % had prior CV disease . Cardiovascular events were experienced by 61 patients ( 38 [ 1.1 % ] , saxagliptin ; 23 [ 1.8 % ] , comparator ) , and CV death/MI/stroke events were reported by investigators in 41 patients : 23 ( 0.7 % ) , saxagliptin ; 18 ( 1.4 % ) , comparator ( relative risk , 95 % confidence interval [ CI ] , 0.44 [ 0.24–0.82 ] ) . The CEC review ed 147 patients with potential CV events and identified a total of 40 patients with CV death/MI/stroke : 22 ( 0.7 % ) , saxagliptin ; 18 ( 1.4 % ) , comparator ( RR , 0.43 [ 0.23–0.80 ] ) . Component proportions for CV death , MI , and stroke were ( saxagliptin vs comparator ) : 7 ( 0.2 % ) vs 10 ( 0.8 % ) , 8 ( 0.2 % ) vs 8 ( 0.6 % ) , and 11 ( 0.3 % ) vs 5 ( 0.4 % ) , respectively . Conclusion : No increased risk of CV death/MI/stroke was observed in patients r and omly assigned saxagliptin across a broad drug development program . Although this systematic overview has inherent and important limitations , the data support a potential reduction in CV events with saxagliptin . The hypothesis of CV protection with saxagliptin will be tested prospect ively in a large r and omized clinical outcome trial evaluating saxagliptin compared with st and ard of care in patients with type 2 diabetes at increased risk for CV events The ankle-brachial blood pressure index  ( ABPI ) has been recognized to have a predictive value for cardiovascular ( CV ) events and mortality in general or dialysis population s. However , the associations between ABPI and those outcomes have not been fully investigated in predialysis patients . The present study aim ed to clarify the relationships between ABPI and both CV events and mortality in Japanese chronic kidney disease ( CKD ) patients not on dialysis . In this prospect i ve observational study , we enrolled 320 patients with CKD stages 3–5 who were not on dialysis .  At baseline , ABPI was examined and a low ABPI was defined as < 0.9 . CV events and all-cause deaths were examined in each patient . A Cox proportional hazards model was applied to determine the risk factors for CV events , as well as for mortality from CV and all causes . The median follow-up period was 30 months . CV events occurred in 56 patients and all-cause deaths occurred in 48 , including 20 CV deaths . Multivariate analysis showed that age and low ABPI were risk factors for CV events . It was demonstrated that age , a history of cerebrovascular disease and low ABPI were determined as independent risk factors for CV mortality . In addition , age , body mass index and low ABPI were independently associated with all-cause mortality .  In patients with CKD , low ABPI during the predialysis period is independently associated with poor survival and CV events , suggesting the usefulness of measuring ABPI for predicting CV events and patient survival in CKD BACKGROUND Bariatric surgery is considered as being contraindicated for morbidly obese patients who also have inflammatory bowel disease ( IBD ) . The aim of our study was to report the outcomes of bariatric surgery in morbidly obese IBD patients . METHODS The prospect ively collected data of all the patients diagnosed as having IBD who underwent bariatric operations in 2 medical centers between October 2006 and January 2014 were retrieved and analyzed . RESULTS One male and 9 female morbidly obese IBD patients ( 8 with Crohn 's disease and 2 with ulcerative colitis ) underwent bariatric surgery .  Their mean age was 40 years , and their mean body mass index was 42.6 kg/m2 . Nine of them underwent a laparoscopic sleeve gastrectomy and 1 underwent a laparoscopic adjustable gastric b and .  Eight patients had obesity-related co-morbidities , including type 2 diabetes , hypertension , sleep apnea , osteoarthropathy , etc  . After a median follow-up of 46 months ( range 9 - 67 ) , all of the patients lost weight , with an excess weight loss of 71 % , and 10 out of 16 obesity-related co-morbidities were resolved . There was 1 complication not related to IBD , and no IBD exacerbation . CONCLUSION Bariatric surgery was safe and effective in our morbidly obese IBD patients . The surgical outcome in this selected patient group was similar to that of comparable non-IBD patients CONTEXT Polycystic ovary syndrome ( PCOS ) is associated with comorbidities that may contribute to increased risk of cardiovascular disease . PCOS is associated with increased risk of metabolic syndrome , dyslipidemia , and diabetes , but it remains unclear whether traditional cardiovascular ( CV ) risk factors can help predict coronary artery disease in this population . OBJECTIVE The objectives of the study were to detect early-onset sub clinical coronary atherosclerosis ( using coronary artery calcium as a marker ) in young women with PCOS , compared with age- and body mass index-matched controls , and to compare traditional CV risk factors and inflammatory markers in the two groups . DESIGN This was a prospect i ve case-control study . SETTING The study was conducted at a university hospital . SUBJECTS Twenty-four obese ( body mass index > or= 30 kg/m2 ) PCOS subjects and 24 obese controls participated . OUTCOME MEASURES Coronary artery calcium , inflammatory markers ( high-sensitivity C-reactive protein , IL-6 , TNFalpha , adiponectin , leptin ) , fasting blood tests ( glucose , lipids , insulin ) , and dual-energy x-ray absorptiometry scan for body fat distribution were measured . RESULTS Coronary artery calcium was detected in eight of 24 PCOS subjects ( 33 % ) and two of 24 controls ( 8 % ) ( odds ratio 5.5 , 95 % confidence interval 1.03 , 29.45 , P < 0.03 ) . Traditional CV risk factors did not differ significantly between the two groups , nor did markers of inflammation or adiposity , body fat distribution , or metabolic parameters with the exception of significantly lower quantitative insulin sensitivity check index ( marker for insulin resistance ) in the PCOS group ( P < 0.05 ) . CONCLUSIONS Young , obese women with PCOS have a high prevalence of early asymptomatic coronary atherosclerosis , compared with obese controls . This increased risk is independent of traditional CV risk factors and novel markers of inflammation . These findings underscore the need to screen and aggressively counsel and treat these women to prevent symptomatic CV disease 42 Background : LHRH agonists are used to treat patients ( pts ) with advanced prostate cancer and have been associated with an increased risk of cardiovascular ( CV ) events and related deaths .  Degarelix is a GnRH antagonist that appears to mitigate this risk . METHODS Results were pooled from 2328 pts participating in 6 prospect i ve r and omised trials . Most pts ( n=1,686 ) received 1 year of GnRH antagonist or LHRH agonist treatment ; the remainder ( n=642 ) had 3 - 7 months ' treatment . Data were classified based on the MedDRA system and analysed using Kaplan Meier plots and a Cox proportional hazard model . Event analysis was based on death from any cause or CV event defined as arterial embolic/thrombotic ; haemorrhagic or ischemic cerebrovascular ; myocardial infa rct ion or other ischemic heart disease .  High risk pts were defined as men with a baseline CV disease ( CVD ) history . RESULTS Treatment groups ( GnRH antagonist , n=1,491 [ degarelix ] ; LHRH agonist , n=837 [ goserelin , n=458 ; leuprolide , n=379 ] ) were balanced for baseline characteristics and CVD history ( 31 % vs. 29 % ) . Characteristics associated with CVD ( e.g. statin medication , elevated blood pressure , diabetes , cholesterol > 6.2 mmol/L ) were similar between groups . The risk of a CV event or death was significantly lower in pts receiving degarelix during the first year of treatment ( see Table ) . In pts with baseline CVD the findings remained significant . In pts with no baseline CVD , there was no difference in subsequent CVD events or death in either group . In analysis by time to CV event only in all pts and pts with baseline CVD ( see Table ) , men receiving GnRH antagonist had a significantly lower risk of CV events . CONCLUSIONS In all pts treated with a GnRH antagonist ( degarelix ) risk of a CV event or death was significantly lower than in pts receiving an LHRH agonist over a treatment period of up to 1 year . In pts with baseline CVD , risk reduction remained significant at ~50 % . [ Table : see text ] BACKGROUND Obesity is associated with increased mortality . Weight loss improves cardiovascular risk factors , but no prospect i ve interventional studies have reported whether weight loss decreases overall mortality . In fact , many observational studies suggest that weight reduction is associated with increased mortality . METHODS The prospect i ve , controlled Swedish Obese Subjects study involved 4047 obese subjects . Of these subjects , 2010 underwent bariatric surgery ( surgery group ) and 2037 received conventional treatment ( matched control group ) .  We report on overall mortality during an average of 10.9 years of follow-up . At the time of the analysis ( November 1 , 2005 ) , vital status was known for all but three subjects ( follow-up rate , 99.9 % ) . RESULTS The average weight change in control subjects was less than + /-2 % during the period of up to 15 years during which weights were recorded . Maximum weight losses in the surgical subgroups were observed after 1 to 2 years : gastric bypass , 32 % ; vertical-b and ed gastroplasty , 25 % ; and b and ing , 20 % . After 10 years , the weight losses from baseline were stabilized at 25 % , 16 % , and 14 % , respectively . There were 129 deaths in the control group and 101 deaths in the surgery group . The unadjusted overall hazard ratio was 0.76 in the surgery group ( P=0.04 ) , as compared with the control group , and the hazard ratio adjusted for sex , age , and risk factors was 0.71 ( P=0.01 ) . The most common causes of death were myocardial infa rct ion ( control group , 25 subjects ; surgery group , 13 subjects ) and cancer ( control group , 47 ; surgery group , 29 ) . CONCLUSIONS Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality BACKGROUND The Hypertension Optimal Treatment ( HOT ) Study has provided information about cardiovascular events in 18790 hypertensives , subjected to pronounced blood pressure ( BP ) lowering for a mean of 3.8 years . The HOT study data have subsequently been analysed after stratification of the patients according to global cardiovascular risk , and it has been found that , despite intensive blood pressure lowering in all risk strata , morbid event rates increased with increasing risk stratum . OBJECTIVES Previously analysed global risk strata were based on combinations of risk factors . The analyses presented here were intended to provide information on the relative role that the presence of each individual factor may have in increasing cardiovascular risk , despite good BP control . METHODS Risk ratios ( RR ) for patients with and those without a risk factor were calculated with 95 % confidence intervals ( CI ) using a Cox proportional hazard model , and adjusted for all variables except the one under examination . RESULTS For all risk factors considered and for all types of event , RR were always greater than 1 , indicating a greater risk in the presence , compared with that in the absence of each factor . The male gender was a statistically significant risk for cardiovascular ( CV ) events , CV and total mortality and particularly for myocardial infa rct ion ( MI ) ; age > or = 65 years for CV events , stroke , CV and particularly total mortality ; smoking for all events analysed , but particularly for total mortality ( twice higher in smokers than in non-smokers ) ; high serum cholesterol ( > 6.8 mmol/l ) for CV events , MI and CV mortality ; high serum creatinine ( > 155 micromol/l ) for CV events , stroke , CV and total mortality ; diabetes for CV events , stroke , total mortality and particularly CV mortality ; and ischaemic heart disease for all events analysed . Adjusted RR were often close to or greater than 2 . CONCLUSIONS Each of the risk factors considered was found to be an important cause of residual risk , despite good BP control . These findings emphasize the importance of addressing other correctable risk factors , e.g. smoking , hypercholesterolaemia and diabetes , as well as rigorous control of blood pressure , and of initiating antihypertensive therapy before cardiovascular and renal damage becomes manifest Background The purpose of this study was to determine the impact of bariatric surgery on employment status in underserved , unemployed patients with severe obesity . Methods A retrospective review of all unemployed severely obese patients seen in our urban safety-net bariatric surgery program was performed . Preoperative patient question naires and medical records were review ed to evaluate patient employment status at the time of initial evaluation by the multidisciplinary bariatric surgery team . Follow-up data was obtained on all available patients ( including those who did not undergo surgery ) , including weight and employment status . A st and ardized telephone question naire was administered to supplement details regarding employment . Changes in employment status and body weight were determined in both groups . Results Here , 193 unemployed severely obese patients were evaluated by the multidisciplinary obesity team . The vast majority of patients ( > 80 % ) were minorities ( primarily Hispanic ) and publicly insured . Seventy-two underwent bariatric surgery and 121 did not . Twenty-four percent of the surgical patients and 9 % of the non-surgical patients had acquired full-time employment at least one year postoperatively ( p = 0.043 ) . There was a 10-point body mass index reduction in the surgical group , compared to 1-point reduction in the non-surgical group after one year . Conclusions Bariatric surgery may improve employment status in an unemployed severely obese patient cohort . Future research in this area should collect detailed prospect i ve data on employment prior to surgery and assess changes longitudinally to provide a more complete picture of the impact of bariatric surgery on employment OBJECTIVE Obesity is an independent risk factor for the development of heart failure , and the two commonly co-exist . The European Society of Cardiology does not provide guidance regarding weight loss strategies in heart failure . The aim of this study was to systematic ally review the evidence for outcomes following intentional weight loss in patients with heart failure and obesity . METHOD A systematic review of English articles was undertaken using data bases PubMed , Embase and CENTRAL . R and omized controlled trials and observational studies reporting outcomes following intentional weight loss by lifestyle , surgical or pharmacotherapy intervention in patients with obesity and heart failure were included . RESULTS Four r and omized controlled trials and seven observational studies were identified . Two r and omized controlled trials used  diet and exercise  as an intervention , one used diet alone and one used a pharmacological intervention ( orlistat ) . All but one reported significant weight loss . Two reported improvement in exercise capacity and quality of life . One reported improvement in New York Heart Association functional class in heart failure with preserved ejection fraction . The observational studies , five of which reported on outcomes following bariatric surgery , despite being small , heterogeneous and high risk of bias , suggested a trend in improvement of left ventricular function , quality of life and exercise capacity following weight loss . CONCLUSION Weight loss is achievable with lifestyle intervention in those with heart failure and obesity and may result in improvements in New York Heart Association classification , quality of life and exercise capacity This 1-year , group-r and omized , intervention-control study looked at the effectiveness of a primary prevention , community-based program for reducing  cardiovascular ( CV ) risk factors in women . Women between the ages of 20 and 50 were recruited through community contacts , including religious and academic institutions , health clinics , and large local employers in the Duluth , Minnesota , and Superior , Wisconsin , area . All study activities took place in neighborhood places of worship . Screenings at baseline and 12 months included physical and laboratory measurements  addressing  CV risk factors  and assessment of the women 's knowledge about CV disease in women . All participants received an individualized review of their CV risk factors and recommendations for modifying them , along with educational literature about CV disease in women . The control group had limited follow-up compared with the intervention group , who participated in general CV health classes and received a follow-up phone call and information about health re sources . The study showed that education and one-on-one follow-up significantly change behavior . Comprehensive community-based screening and individualized review decrease women 's risk for CV disease Objective . Obesity is a risk factor for hypogonadotropic hypogonadism in men . Weight loss has been shown to improve hypogonadism in obese men . This study evaluated the early changes in sex hormones profile after bariatric surgery . Methods . This is a prospect i ve study including 29 morbidly obese men . Main outcomes were changes in serum levels of total testosterone ( TT ) , free testosterone ( cFT ) , SHBG , estradiol , adiponectin , and leptin at 1 and 6 months after surgery . Results . The mean age of patients was 31 ± 8 years and the mean BMI was 56.8 ± 11.7 kg/m2 . Fifteen patients underwent Roux-en-Y gastric bypass and 14 patients underwent sleeve gastrectomy .  At baseline , 22 patients ( 75.9 % ) had either low TT levels ( < 10.4 nmol/L ) or low cFT levels ( < 225 pmol/L ) . Total testosterone and SHBG levels increased significantly at 1 month after surgery ( p ≤ 0.001 ) . At 6 months after surgery , TT and cFT increased significantly ( p ≤ 0.001 ) and 22 patients ( 75.9 % ) had normalized TT and cFT levels . There were no changes in estradiol levels at either 1 month or 6 months after surgery . Conclusions . Increases in TT and SHBG levels occurred early at 1 month after bariatric surgery while improvements in cFT levels were observed at 6 months after bariatric surgery CONTEXT Obesity is a risk factor for cardiovascular events . Weight loss might protect against cardiovascular events , but solid evidence is lacking . OBJECTIVE To study the association between bariatric surgery , weight loss , and cardiovascular events . DESIGN , SETTING , AND PARTICIPANTS The Swedish Obese Subjects ( SOS ) study is an ongoing , nonr and omized , prospect i ve , controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden of 2010 obese participants who underwent bariatric surgery and 2037 contemporaneously matched obese controls who received usual care . Patients were recruited between September 1 , 1987 , and January 31 , 2001 . Date of analysis was December 31 , 2009 , with median follow-up of 14.7 years ( range , 0 - 20 years ) . Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women . Exclusion criteria were identical in surgery and control patients . Surgery patients underwent gastric bypass ( 13.2 % ) , b and ing ( 18.7 % ) , or vertical b and ed gastroplasty ( 68.1 % ) , and controls received usual care in the Swedish primary health care system . Physical and biochemical examinations and data base cross-checks were undertaken at preplanned intervals . MAIN OUTCOME MEASURES The primary end point of the SOS study ( total mortality ) was published in 2007 . Myocardial infa rct ion and stroke were predefined secondary end points , considered separately and combined . RESULTS Bariatric surgery was associated with a reduced number of cardiovascular deaths ( 28 events among 2010 patients in the surgery group vs 49 events among 2037 patients in the control group ; adjusted hazard ratio [ HR ] , 0.47 ; 95 % CI , 0.29 - 0.76 ; P = .002 ) . The number of total first time ( fatal or nonfatal ) cardiovascular events ( myocardial infa rct ion or stroke , whichever came first ) was lower in the surgery group ( 199 events among 2010 patients ) than in the control group ( 234 events among 2037 patients ; adjusted HR , 0.67 ; 95 % CI , 0.54 - 0.83 ; P < .001 ) . CONCLUSION Compared with usual care , bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults
In conclusion , this review highlights the benefits of bariatric surgery in reducing or eliminating risk factors for CVD .
It provides further evidence to support surgical treatment of obesity to achieve CVD risk reduction
Obesity is associated with increased risk for cardiovascular ( CV ) disease ( CVD ) and CV mortality .
Bariatric surgery has been shown to resolve or improve CVD risk factors , to varying degrees .
The objective of this systematic review was to determine the impact of bariatric surgery on CV risk factors and mortality .
A systematic review of the published research was performed to evaluate evidence regarding CV outcomes in morbidly obese bariatric patients .