The CardioMetabolic Health Alliance

In the paper

“Factor analysis in epidemiological studies in different populations, including adolescents and ethnic minorities, demonstrates clustering of risk in the domains of adiposity and/or dyslipidemia, hyperglycemia or insulin resistance, and hypertension that explain 37% to 70% of variation and vary by sex and race (4-7).”

What the sources say

• Not checked yetcites [4] Goodman, 2005, Factor analysis of clustered cardiovascular risks in adolescence: obesity is the predominant correlate of risk among youth, Circulation source
• Not checked yetcites [5] Hanley, 2002, Factor analysis of metabolic syndrome using directly measured insulin sensitivity: The Insulin Resistance Atherosclerosis Study, Diabetes source
• Not checked yetcites [6] Hodge, 2001, Leptin and other components of the Metabolic Syndrome in Mauritius—a factor analysis, Int J Obes Relat Metab Disord source
• Not checked yetcites [7] Ang, 2005, The metabolic syndrome in Chinese, Malays, and Asian Indians. Factor analysis of data from the 1998 Singapore National Health Survey, Diabetes Res Clin Pract

In the paper

“The Think Tank consensus was that the metabolic syndrome (MetS) is a complex pathophysiological state comprised of a cluster of clinically measured and typically unmeasured risk factors”

In the paper

“AC.3.Risk for adverse health outcomes increases substantially with accumulation of component MetS risk factors, in addition to unmeasured (”

In the paper

“Another concept essential to the MetS definition is that people with MetS have or are at risk for multi-end-organ damage.”

In the paper

“However, there is a growing appreciation that obesity per se, as defined by simple anthropometric measures, such as BMI or waist circumference, is neither a necessary nor a sufficient descriptor of MetS and its consequences.”

In the paper

“MetS is present in w50% of patients with diagnosed vascular disease and may be even more prevalent among women with ASCVD (10,11).”

What the sources say

• Not checked yetcites [10] Gorter, 2004, Prevalence of the metabolic syndrome in patients with coronary heart disease, cerebrovascular disease, peripheral arterial disease or abdominal aortic aneurysm, Atherosclerosis source
• Not checked yetcites [11] Brevetti, 2006, Metabolic syndrome in peripheral arterial disease: relationship with severity of peripheral circulatory insufficiency, inflammatory status, and cardiovascular comorbidity, J Vasc Surg source

In the paper

“The latest prevalence estimates of MetS in men and women are 35% and 33%, respectively (42).”

What the sources say

• Not checked yetcites [42] Go, 2014, Heart disease and stroke statistics—2014 update: a report from the American Heart Association, Circulation

In the paper

“Excess ectopic and/or visceral adiposity is fundamental to the pathophysiology of MetS.”

In the paper

“In the Framingham Offspring Study, both MetS and T2D increased the risk of stroke by approximately 2-fold, and those patients with both had an even higher risk (12).”

What the sources say

• Not checked yetcites [12] Najarian, 2006, Metabolic syndrome compared with type 2 diabetes mellitus as a risk factor for stroke: the Framingham Offspring study, Arch Intern Med source

In the paper

“Similarly, Filipina women may have higher waist circumference and truncal fat and 3-to 4-fold higher rates of type 2 diabetes (T2D) and MetS compared with Caucasian women, controlling for other factors (17).”

What the sources say

• Not checked yetcites [17] Araneta, 2002, Type 2 diabetes and metabolic syndrome in Filipina-American women, Diabetes Care source

In the paper

“Because forecasts suggest that over one-half of the U.S. population will be obese by the year 2030, rates of MetS will almost certainly increase over the next decade.”

In the paper

“is associated with serious and extensive comorbidity”

In the paper

“AC.4.Obesity is a MetS risk factor that is imperfectly gauged by body mass index and/or waist circumference, and is modulated by adipocyte distribution, size, and function, as well as race, behavior, and lifestyle.”

In the paper

“AC.1.Metabolic syndrome (MetS) is a progressive pathophysiological state associated with substantially increased risk for development of type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD).”

In the paper

“AC.2.MetS is clinically manifested by a cluster of risk factors that are causally inter-related (not aggregating by chance alone).”

In the paper

“First, the current definition of MetS identifies a population at increased ASCVD risk”

In the paper

“is progressive in its course”

In the paper

“For example, South Asians have higher body fat content, waist to hip ratio, visceral fat to subcutaneous fat ratio, and adipocyte area than Caucasians matched for age, sex, and body mass index (BMI) (15,16).”

What the sources say

• Not checked yetcites [15] Anand, 2011, Adipocyte hypertrophy, fatty liver, and metabolic risk factors in South Asians: The Molecular Study of Health and Risk in Ethnic Groups (mol-SHARE), PLOS One source
• Not checked yetcites [16] Chandalia, 2007, Insulin resistance and body fat distribution in South Asian men compared to Caucasian men, PLOS One source

In the paper

“The TT identified disparity in care of patients with MetS to be a critical area for improvement.”

In the paper

“The Healthy Living Partnerships to Prevent Diabetes Study implemented a DPP-like lifestyle weight-loss program over 2 years by using a local diabetes education program with community health workers, involving weekly visits over the first 6 months and twice monthly visits over the next 18 months (83).Among 301 randomized patients, the intervention group achieved significant reductions in weight, B”

What the sources say

• Not checked yetcites [83] Katula, 2013, The Healthy Living Partnerships to Prevent Diabetes study: 2-year outcomes of a randomized controlled trial, Am J Prev Med source

In the paper

“Medicare beneficiaries in the same market as a commercial ACO realized decreases in total health care spending over 2 years, primarily due to reduced outpatient office visits, minor procedures, imaging, and laboratories.”

What the sources say

• Not checked yetcites [103] McWilliams, 2013, Changes in health care spending and quality for Medicare beneficiaries associated with a commercial ACO contract, JAMA source

In the paper

“Although larger provider groups attenuated racial disparities in some areas, they did not change disparities on other metrics, such as hospitalization rates (107).”

What the sources say

• Not checked yetcites [107] Anderson, 2014, Quality of care and racial disparities in Medicare among potential ACOs, J Gen Intern Med source

In the paper

“An extension study in which both the control and intervention arms were offered an 8-month lifestyle maintenance program found that both groups maintained weight changes compared with baseline, and those in the initial intervention group lost a further 1.5% of body weight, with significant decreases in total cholesterol and systolic blood pressure (79).”

What the sources say

• Not checked yetcites [79] Ackermann, 2011, Long-term effects of a community-based lifestyle intervention to prevent type 2 diabetes: the DEPLOY extension pilot study, Chronic Illn source

In the paper

“A randomized controlled trial in 2 community health centers enrolled 525 patients with uncontrolled ASCVD, T2D, hypertension, or hyperlipidemia; results showed that pairing nurse practitioners and community health workers demonstrated significant reductions in blood pressure, cholesterol, and HbA 1c over 1 year of follow-up compared with usual care (86).”

What the sources say

• Not checked yetcites [86] Allen, 2011, Community Outreach and Cardiovascular Health (COACH) trial: a randomized, controlled trial of nurse practitioner/community health worker cardiovascular disease risk reduction in urban community health centers, Circ Cardiovasc Qual Outcomes source

In the paper

“In addition to this and other race-specific issues, however, TT participants recognized that wellintentioned alteration of existing diagnostic criteria around racial differences could stigmatize minority populations and lead to undesirable consequences.”

In the paper

“The TT acknowledges that the concepts of staging and subtyping are works in progress and require further modification, testing, and validation before they can be used routinely in clinical care.”

In the paper

“The Look AHEAD (Action for Health in Diabetes) trial provides the longest-term evidence of the effect of an intensive lifestyle intervention in overweight and obese adults with T2D.The curriculum was modified from the DPP and included structured meal plans and moderate exercise up to 200 min/week.At 8 years, 50.3% in the intervention group versus 35.7% in the usual care group lost $5% of body”

What the sources say

• Not checked yetcites [84] 2014, Eight-year weight losses with an intensive lifestyle intervention: the Look AHEAD Study, Obesity (Silver Spring) source

In the paper

“Several dietary patterns, such as the DASH (Dietary Approaches to Stop Hypertension) and Mediterranean diets, may reduce blood pressure, improve lipids, reduce inflammation, and reduce risk for ASCVD (28,70).”

What the sources say

• Not checked yetcites [28] Eckel, 2014, 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, J Am Coll Cardiol source
• Not checked yetcites [70] Estruch, 2013, Primary prevention of cardiovascular disease with a Mediterranean diet, N Engl J Med source

In the paper

“On average, African-Americans have higher HDL-C and lower triglyceride levels(72).”

What the sources say

• Not checked yetcites [72] Frank, 2014, Racial/ethnic differences in dyslipidemia patterns, Circulation source

In the paper

“The Group Health Cooperative reduced physician panel sizes, increased ancillary staff, lengthened visit times, and provided time for team care planning, in addition to expanding technology to better engage patients.Comparison with control clinics in the area demonstrated better patient satisfaction scores, reduced provider burnout, improved performance on quality of care metrics, and reduced”

What the sources say

• Not checked yetcites [97] Reid, 2010, The Group Health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers, Health Aff (Millwood) source

In the paper

“For example, the Geisinger ProvenHealth Navigator demonstrated a reduction in the incidence of end-stage renal disease and amputation among patients with T2D over 4 years, although without a change in myocardial infarction or stroke (98).”

What the sources say

• Not checked yetcites [98] Maeng, 2012, Can a patient-centered medical home lead to better patient outcomes? The quality implications of Geisinger's ProvenHealth Navigator, Am J Med Qual source

In the paper

“Many observational studies show an association between higher levels of physical activity and lower rates of chronic diseases and increased longevity (67).”

What the sources say

• Not checked yetcites [67] Warburton, 2010, A systematic review of the evidence for Canada's Physical Activity Guidelines for Adults, Int J Behav Nutr Phys Act source

In the paper

“Second, participants felt that better metrics are needed to define abdominal obesity, as current definitions are imprecise and not well suited for many populations.”

In the paper

“KF.2.The presence of ectopic fat and/or visceral adipose tissue is critical to the pathogenesis of MetS and may explain some of the variability in phenotypic presentation across racial groups.”

In the paper

“Evaluation of another such model in West Virginia found that an EHR-based screening tool identified 11% of over 94,000 patients as being at risk for T2D (99), enabling the facility to better screen and connect patients to local lifestyle intervention programs.”

What the sources say

• Not checked yetcites [99] Baus, 2013, Registry-based diabetes risk detection schema for the systematic identification of patients at risk for diabetes in West Virginia primary care centers, Perspect Health Inf Manag

In the paper

“This paradox may translate to underdiagnosis of MetS in African-Americans using current diagnostic criteria, which would likely result in lack of treatment of MetS in this population.”

In the paper

“A program targeting a predominantly low-income non-Caucasian urban population delivered a lifestyle intervention in 12 weeks using group sessions and found significant reductions in the proportion of subjects meeting the MetS waist circumference (90% to 68%; p ¼ 0.009) and hypertension (68% to 48%; p ¼ 0.04) criteria over 6 months.At 3 months, 46.4% lost $5% of body weight and 26% lost $7% of body”

What the sources say

• Not checked yetcites [91] Seidel, 2008, Translating the Diabetes Prevention Program into an urban medically underserved community: a non-randomized prospective intervention study, Diabetes Care source

In the paper

“In another study of 36 family practices implementing PCMH components over 26 months, improvement was seen in prevention and chronic care quality metrics, but not in patient-assessed outcomes (96).”

What the sources say

• Not checked yetcites [96] Jaén, 2010, Patient outcomes at 26 months in the patient-centered medical home National Demonstration Project, Ann Fam Med source

In the paper

“KF.1.MetS is a cluster of risk factors, both formally defined and less well recognized, that increase the risk of certain diseases.”

In the paper

“The DEPLOY (Diabetes Education & Prevention with a Lifestyle Intervention Offered at the YMCA) study was a pilot clusterrandomized trial comparing group-based DPP lifestyle intervention through a Young Men's Christian Association (16 group sessions with goals of 5% to 7% reduction in baseline body weight and 150 min/ week of moderate exercise) with brief counseling.Among 92 randomized participants”

What the sources say

• Not checked yetcites [78] Ackermann, 2008, Translating the Diabetes Prevention Program in the community. The Deploy Pilot Study, Am J Prev Med source

In the paper

“Although different financial models have been proposed and are incorporated in some PCMH models, evaluations do not specifically address the effectiveness of these strategies, nor have most studies demonstrated overall short-term cost savings (100).”

What the sources say

• Not checked yetcites [100] Edwards, 2014, Structuring payment to medical homes after the Affordable Care Act, J Gen Intern Med source

In the paper

“African-American beneficiaries with T2D were less likely to receive LDL testing and retinal examinations and were more likely to be hospitalized than Caucasian beneficiaries.”

What the sources say

• Not checked yetcites [107] Anderson, 2014, Quality of care and racial disparities in Medicare among potential ACOs, J Gen Intern Med source

In the paper

“In 2005, the NCEP-ATP III criteria were modified to suggest lower waist circumference cutpoints for Asian Americans ($90 cm [35 inches] in men and $80 cm [31 inches] in women) (2).”

What the sources say

• Not checked yetcites [2] Grundy, 2005, Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement, Circulation source

In the paper

“In men in the NHANES (National Health and Nutrition Examination Survey) from 2003 to 2006, MetS was present in 6.8% of normal weight, 29.8 % of overweight, and 65% of obese individuals (14).Similarly, among women, 9.3% of normal weight, 33.1% of overweight, and 56.1% of obese individuals had MetS (14).”

What the sources say

• Not checked yetcites [14] Ervin, 2009, Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003–2006, Natl Stat Health Report

In the paper

“Finally, peer leaders can effectively provide education and support for lifestyle.This was demonstrated in a study where 116 Latino adults with T2D were randomized to receive diabetes self-management education and either 12 months of weekly group sessions with peer leaders or 12 months of telephone outreach with health workers (87).Both groups achieved significant HbA 1c , blood pressure, and”

What the sources say

• Not checked yetcites [87] Tang, 2014, Comparative effectiveness of peer leaders and community health workers in diabetes self-management support: results of a randomized controlled trial, Diabetes Care source

In the paper

“In Colorado Heart Healthy Solutions, community health workers conducted screenings, assessed readiness for change, and provided education and medical referrals to patients with an uncontrolled risk factor for coronary heart disease or a Framingham Risk Score $10%.They provided further phone follow-up, and found significant reductions in Framingham Risk score, blood pressure, and cholesterol at ret”

What the sources say

• Not checked yetcites [85] Krantz, 2013, Effectiveness of a community health worker cardiovascular risk reduction program in public health and health care settings, Am J Public Health source

In the paper

“A systematic review of 31 studies found a positive effect of components of the PCMH model on patient and staff experiences, as well as positive effects on preventive services, with reduction in emergency department visits in older adults, but no effect on hospital admissions or total costs (95).”

What the sources say

• Not checked yetcites [95] Jackson, 2013, Improving patient care. The patient centered medical home. A systematic review, Ann Intern Med source

In the paper

“Recently, the AACE and the American College of Endocrinology developed an advanced framework for defining obesity as a chronic disease characterized by pathophysiological processes that result in increased adipose tissue mass and can result in increased morbidity and mortality (40), with MetS as 1 such important consequence.”

What the sources say

• Not checked yetcites [40] Garvey, 2014, American Association of Clinical Endocrinologists and American College of Endocrinology Position Statement on the 2014 advanced framework for a new diagnosis of obesity as a chronic disease, Endocr Pract source

In the paper

“MetS consists of elements that do not aggregate by chance alone and are causally inter-related, and each element contributes independently to an increased risk for ASCVD (3).”

What the sources say

• Not checked yetcites [3] Yudkin, 2004, Low-grade inflammation may play a role in the etiology of the metabolic syndrome in patients with coronary heart disease: the HIFMECH Study, Metabolism source

In the paper

“Another cultural adaptation of the DPP in African-American churches involved 37 participants and compared an abbreviated 6-week program to a longer 16-week program; it found that fasting glucose and BMI decreased significantly in both groups at 12 months (90).”

What the sources say

• Not checked yetcites [90] Boltri, 2011, Translation of the National Institutes of Health Diabetes Prevention Program in African American churches, J Natl Med Assoc

In the paper

“To emphasize the importance of addressing disparities, the TT discussed key studies such as the Lawrence Latino Diabetes Prevention project (89), which recruited 312 participants at high risk for T2D for a lifestyle intervention involving 3 individual and 13 group sessions over 12 months versus usual care.The curriculum was adapted to address knowledge gaps and language barriers, customize dietary”

What the sources say

• Not checked yetcites [89] Ockene, 2012, Outcomes of a Latino community-based intervention for the prevention of diabetes: the Lawrence Latino Diabetes Prevention Project, Am J Public Health source

In the paper

“There were some improvements in LDL testing for patients with T2D and ASCVD but not on other quality metrics (103).”

What the sources say

• Not checked yetcites [103] McWilliams, 2013, Changes in health care spending and quality for Medicare beneficiaries associated with a commercial ACO contract, JAMA source

In the paper

“An evaluation of Medicare enrollees in the Medicare Physician Group Practice Demonstration compared with control subjects found that the savings were highest for acute care and dually-eligible beneficiaries, with an overall reduction in 30-day medical readmissions (104).”

What the sources say

• Not checked yetcites [104] Colla, 2012, Spending differences associated with the Medicare Physician Group Practice Demonstration, JAMA source