Cardiovascular Disease Risk Reduction and Body Mass Index

Interventions implemented through sporting organisations for promoting healthy behaviour or improving health outcomes

BACKGROUND

Chronic diseases are the leading cause of mortality and morbidity worldwide. Much of this burden can be prevented by adopting healthy behaviours and reducing chronic disease risk factors. Settings-based approaches to address chronic disease risk factors are recommended globally. Sporting organisations are highly prevalent, and engage many people in many countries. As such, they represent an ideal setting for public health interventions to promote health. However, there is currently limited evidence of their impact on healthy behaviour and health outcomes as previous systematic reviews are either limited in their scope (e.g. restricted to professional sporting organisations), or are out of date.

OBJECTIVES

Primary: to assess the benefits and harms of interventions implemented through sporting organisations to promote healthy behaviours (including physical activity, healthy diet) or reduce health risk behaviours (including alcohol consumption, tobacco use). Secondary: to assess the benefits and harms of these interventions to promote health outcomes (e.g. weight), other health-related behaviours (e.g. help-seeking behaviour) or health-related knowledge; to determine whether benefits and harms differ based on the characteristics of the interventions, including target population and intervention duration; to assess unintended adverse consequences of sporting organisation interventions; and to describe their cost or cost-effectiveness.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, one other database and two clinical trial registries, from inception to May 2024, to identify eligible trials. We searched Google Scholar in May 2024. We did not impose language or publication status restrictions. We also searched reference lists of included trials for other potentially eligible trials.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), including cluster-RCTs, of any intervention conducted within or using a sporting organisation for access to a target group, that aimed to improve a health behaviour primary outcome or a secondary review outcome, and had a parallel control group (no intervention, alternative intervention). Eligible participants were any individual exposed to an intervention involving a sporting organisation, including players, members, coaches, and supporters.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. We conducted random-effects meta-analyses to synthesise results where we could pool data from at least two trials. Where we could not conduct meta-analysis, we followed Cochrane guidance for synthesis using other methods and reported results according to the Synthesis Without Meta-analysis (SWiM) guidance.

MAIN RESULTS

We included 20 trials (42 trial arms, 8179 participants) conducted in high-income countries, and identified four ongoing trials and four trials awaiting classification. There was considerable heterogeneity in the type of participants, interventions and outcomes assessed across trials. Included trials primarily targeted sporting organisation members (eight trials) or supporters (eight trials), males only (11 trials) and adults (14 trials). Football clubs (e.g. soccer, American football, Australian football league) were the most common intervention setting (15 trials), and interventions targeted various combinations of health behaviours, knowledge and health outcomes. Fourteen trials (10 RCTs and four cluster-RCTs) assessed the impact of a sporting organisation intervention on a primary outcome: physical activity (nine trials); diet (six trials); alcohol consumption (11 trials); and tobacco use (two trials). For RCTs, we assessed the risk of bias for primary outcomes (physical activity, diet, alcohol consumption) and unintended adverse consequences as being at low risk of bias (four outcomes), some concerns (one outcome) or high risk of bias (32 outcomes), due to outcomes being self-reported. For cluster-RCTs, we assessed the risk of bias for all primary outcomes (alcohol consumption, tobacco use) as high risk (eight outcomes), due to outcomes being self-reported. Sporting organisation interventions versus control probably have a small positive effect on the amount of physical activity per day, equivalent to approximately 7.4 minutes of moderate-to-vigorous physical activity (MVPA) per day (standardised mean difference (SMD) 0.36, 95% confidence interval (CI) 0.22 to 0.49; I2 = 3%; 4 trials, 1213 participants; moderate-certainty evidence) and may not reduce sedentary behaviour (mean difference (MD) -15.18, 95% CI -30.82 to 0.47; I2 = 0%; 2 trials, 1047 participants; low-certainty evidence). Sporting organisation interventions versus control may have a moderate positive effect on fruit and vegetable consumption, equivalent to a score increase of 1.25 points on a 12-point scale for frequency of fruit and vegetable consumption (SMD 0.50, 95% CI 0.35 to 0.65; I2 = 0%; 5 trials, 1402 participants; low-certainty evidence). Sporting organisation interventions versus control may reduce sugary drink consumption (equivalent to a reduction of sugary drink consumption by 0.8 times per day), but the evidence is very uncertain (SMD -0.37, 95% CI -0.64 to -0.10; I2 = 0%; 2 trials, 225 participants; very low-certainty evidence). Sporting organisation interventions versus control may have little to no effect on alcohol consumption (equivalent to a reduction of 0.38 units of alcohol consumed per week), but the evidence is very uncertain (MD -0.38, 95% CI -1.00 to 0.24; I2 = 78%; 7 trials, 2313 participants; very low-certainty evidence). Two trials that could not be synthesised reported equivocal findings on tobacco use (low-certainty evidence). The evidence is very uncertain about the effect of sporting club interventions on unintended adverse consequences. Five trials assessed this outcome, with two reporting that there were no adverse consequences, one reporting only non-serious adverse consequences, and two reporting that there were serious unintended adverse consequences in less than 1% of participants.

AUTHORS' CONCLUSIONS

Overall, sporting organisation interventions probably increase MVPA by 7.4 minutes per day, may result in little to no difference in sedentary behaviour, and may increase fruit and vegetable consumption. The evidence is very uncertain about whether sporting organisation interventions decrease sugary drink and alcohol consumption. Findings for tobacco use and unintended adverse consequences were equivocal in the few trials reporting these; thus, the evidence was very uncertain. These findings should be interpreted in the context of the heterogeneity of the interventions, participants and sporting organisations for some outcomes.

Influence of multiple risk factor control level on cardiovascular outcomes in hypertensive patients

AIMS

The relationship between the level of baseline risk factor control and cardiovascular outcomes in hypertensive patients with blood pressure interventions is not well understood. It is also unclear whether the level of baseline risk factor control is persuasively associated with cardiovascular outcomes in hypertensive patients with a blood pressure lowering strategy.

METHOD AND RESULTS

We performed an analysis of the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial. Participants without complete baseline risk factor data were excluded. The primary outcome was a composite of cardiovascular events and all-cause mortality. Cox proportional hazard models were used to calculate the hazard ratio (HR) and estimate the association between risk factor control levels (≥6, 5, 4, and ≤3) and cardiovascular outcomes. A total of 8337 participants were involved in the analysis, and the median follow-up period was 3.19 years. Each additional risk factor uncontrolled was associated with a 24% higher cardiovascular risk (HR 1.24, 95% CI 1.11-1.37). Compared with participants with optimal risk factor control, those with ≤3 factors control exhibited 95% higher cardiovascular risk (HR 1.95, 95% CI 1.37-2.77). The corresponding protective effects of multiple risk factor modification were not influenced by intensive or standard antihypertensive treatment (P for interaction = 0.71).

CONCLUSION

A stepwise association was observed between cardiovascular risk and the number of risk factor control in hypertensive patients. The more risk factors were modified, the less cardiovascular risk was observed, irrespective of different blood pressure lowering strategies. Comprehensive risk factor control strategies are warranted to reduce cardiovascular disease risk in hypertensive patients.

Self-reported sleep duration and quality and cardiovascular diseases among middle-aged and older Chinese: A 7-year longitudinal cohort study

Cardiovascular disease (CVD) is a leading cause of death worldwide, and several studies have attempted to identify its risk factors. This study aimed to investigate the association between sleep duration and sleep quality, and the 7-year incidence of CVD among middle-aged and older Chinese individuals. A total of 6682 participants aged 45-90 years from the China Health and Retirement Longitudinal Study database were included in this study. The authors estimated sleep duration and quality based on self-reported data of night sleep hours and disturbance symptoms, and examined the associations between them and the composite outcome of CVD using logistic regression models. A total of 1692 participants (25.32%) reported new CVD events during follow-up. Short sleep duration (< 6 h/night) was significantly associated with a higher risk of CVD in all three models (p < .05). However, this was not observed for long sleep duration (> 8 h/night). Additionally, participants with mild sleep disturbance in all three models, and severe sleep disturbance in Models 2 and 3 had a significantly higher risk of CVD (p < .05). After stratification by age and daytime napping, we still found a significant association between short sleep duration and CVD in individuals aged 45-59 years, and between sleep disturbance and CVD in non-nappers (p < .05). However, these associations were not significant in individuals aged ≥60 years or in nappers (p > .05). In conclusion, short sleep duration and sleep disturbance are both associated with an increased risk of CVD in middle-aged and older Chinese individuals.

Age-specific heterogeneity of genetic susceptibility to cardiovascular disease might have opposite outcomes depending on the presence of prediabetes

Examining age-specific heterogeneity of susceptibility to cardiovascular disease is also essential in individuals without prediabetes to determine its relative size and direction compared to those with prediabetes. Of particular interest, age-specific heterogeneity in genetic susceptibility may exhibit opposite directions depending on the presence or absence of prediabetes.

Genetic associations of childhood and adult BMI on chronic heart failure and ischemic stroke: A Mendelian randomization

Background

Obesity has been confirmed to be associated with cardiovascular disease, but previous studies have focused on adults, and whether childhood obesity is associated with cardiovascular disease in adulthood needs further research.

Objective

This Mendelian randomization (MR) study aimed to investigate the associations of childhood and adult body mass index (BMI) with the risk of chronic heart failure (CHF) and ischemic stroke (IS).

Methods

Independent genetic instruments, demonstrating a strong association with exposure at the genome-wide significance level (P < 5 × 10-8), were carefully selected from comprehensive genome-wide association studies conducted within relevant European populations. Summary-level data for CHF and IS were obtained from the EBI database and large consortia of European population. To enhance robustness and generalizability, the analysis was replicated in an East Asian population cohort.

Results

According to a MR analysis based on a European population, a higher adult BMI was associated with an increased risk of CHF [(odds ratio (OR) 1.594, 95% confidence interval (CI) 1.483-1.713)] and IS (OR 1.163, 95%CI 1.096-1.233). In addition, higher childhood BMI level was associated with a higher risk of CHF (OR 1.323, 95%CI 1.153-1.524).and the effect was mainly driven by adult BMI. Replication analyses of adult BMI in East Asian populations showed consistent findings that adult BMI was associated with the risk of CHF (OR 2.167, 95%CI 1.786-2.630) and IS (OR 1.259, 95%CI 1.128-1.406).

Conclusions

Our study findings provide compelling evidence for the significant influence of adult BMI on the occurrence of CHF and IS. Furthermore, our observations suggest that the positive association between childhood BMI and the risk of CHF in adulthood can largely be attributed to individuals who maintain obesity into later life.

Lipid-Lowering Therapy in PURE Poland Cohort Study

The aim of this study is to present data on the use of lipid-lowering therapy (LLT) in relation to calculated cardiovascular risk (CVR) and an additionally defined target LDL-C concentration. The cohort consisted of 1287 participants in the Polish edition of the Prospective Urban and Rural Epidemiological Study (PURE). CVR was calculated for each participant using the SCORE2 or SCORE2-OP scale, and for patients with diabetes mellitus (DM), chronic kidney disease (CKD) or atherosclerotic cardiovascular disease (ASCVD) according to the respective criteria. In the cohort analysed, 107 of 212 people (50.5%) in the low cardiovascular risk (CVR) group, 284 of 414 people (68.6%) in the moderate CVR group, 562 of 612 people (91.8%) in the high CVR group and 48 of 49 people (98%) in the very high CVR group did not meet the target LDL-c criterion. Of those in the low CVR group, 86% of participants were not receiving lipid-lowering therapy (LLT); in the moderate CVR group, the proportion was 77.8%; in the high CVR group, 68.1% and in the very high CVR group, 75%. In each cardiovascular risk group, participants who did not meet the target LDL-c concentration criterion and did not take LLT made up the larger group.

Transcriptome-wide association studies: recent advances in methods, applications and available databases

Genome-wide association study has identified fruitful variants impacting heritable traits. Nevertheless, identifying critical genes underlying those significant variants has been a great task. Transcriptome-wide association study (TWAS) is an instrumental post-analysis to detect significant gene-trait associations focusing on modeling transcription-level regulations, which has made numerous progresses in recent years. Leveraging from expression quantitative loci (eQTL) regulation information, TWAS has advantages in detecting functioning genes regulated by disease-associated variants, thus providing insight into mechanisms of diseases and other phenotypes. Considering its vast potential, this review article comprehensively summarizes TWAS, including the methodology, applications and available resources.

Reduction of NADPH oxidase 4 in adipocytes contributes to the anti-obesity effect of dihydroartemisinin

Artemisinin derivatives have been found to have anti-obesity effects recently, but the mechanism is still controversial. Herein, long-term DHA treatment in obese mice significantly reduced the body weight and improved glucose metabolism. However, short-term DHA treatment did not affect glucose metabolism in obese mice, suggesting that the improved glucose metabolism in mice with DHA treatment could be secondary to body weight reduction. Consistent with previous reports, we observed that DHA inhibited the differentiation of adipocytes. Mechanistically, DHA significantly reduced the expression of NADPH oxidase 4 (NOX4) in white adipose tissue (WAT) of mice and differentiated adipocytes, and using NOX4 siRNA or the NOX4 inhibitor GKT137831 significantly attenuated adipocyte differentiation. Over-expression of NOX4 partially reversed the inhibition effect of DHA on adipogenic differentiation of preadipocytes. In addition, targeted proteomics analysis showed that DHA improved the abnormality of metabolic pathways. In conclusion, DHA significantly reduced fat mass and improved glucose metabolism in obese mice, possibly by inhibiting NOX4 expression to suppress adipocyte differentiation and lipid accumulation in adipocytes.

The Related Metabolic Diseases and Treatments of Obesity

Obesity is a chronic disease characterized by the abnormal or excessive accumulation of body fat, affecting more than 1 billion people worldwide. Obesity is commonly associated with other metabolic disorders, such as type 2 diabetes, non-alcoholic fatty liver disease, cardiovascular diseases, chronic kidney disease, and cancers. Factors such as a sedentary lifestyle, overnutrition, socioeconomic status, and other environmental and genetic conditions can cause obesity. Many molecules and signaling pathways are involved in the pathogenesis of obesity, such as nuclear factor (NF)-κB, Toll-like receptors (TLRs), adhesion molecules, G protein-coupled receptors (GPCRs), programmed cell death 1 (PD-1)/programmed death-ligand 1 (PD-L1), and sirtuin 1 (SIRT1). Commonly used strategies of obesity management and treatment include exercise and dietary change or restriction for the early stage of obesity, bariatric surgery for server obesity, and Food and Drug Administration (FDA)-approved medicines such as semaglutide and liraglutide that can be used as monotherapy or as a synergistic treatment. In addition, psychological management, especially for patients with obesity and distress, is a good option. Gut microbiota plays an important role in obesity and its comorbidities, and gut microbial reprogramming by fecal microbiota transplantation (FMT), probiotics, prebiotics, or synbiotics shows promising potential in obesity and metabolic syndrome. Many clinical trials are ongoing to evaluate the therapeutic effects of different treatments. Currently, prevention and early treatment of obesity are the best options to prevent its progression to many comorbidities.