Global prevalence of cardiometabolic risk factors in the military population: a systematic review and meta-analysis

Association and biological pathways between metabolic syndrome and incident Parkinson's disease: A prospective cohort study of 289,150 participants

The relationship between metabolic syndrome (MetS) and Parkinson's disease (PD) remains uncertain due to inconsistent findings in previous studies. This prospective cohort study investigated the association between MetS and PD risk, along with potential biological mechanisms, using data from 289,150 PD-free participants in the UK Biobank. MetS was defined by the presence of at least three of the following components, while preMetS included one or two: increased waist circumference, elevated triglycerides (TG), high blood pressure (BP), elevated HbA1c, or reduced high-density lipoprotein cholesterol (HDL-C). Cox proportional hazards models were utilized to assess the risk of PD, and mediation analyses explored the role of blood biomarkers. Over a median follow-up of 13.1 years, 1682 participants developed PD. PreMetS (HR: 1.24, 95 % CI: 1.02-1.51, P = 0.028) and MetS (HR: 1.32, 95 % CI: 1.08-1.61, P = 0.008) were associated with an increased PD risk, with Kaplan-Meier analysis showing risk escalation with more MetS components. Among individual MetS components, increased waist circumference, elevated HbA1c, and reduced HDL-C were significantly associated with higher PD risk, while elevated TG and BP showed no significant association. Mediation analysis indicated that biomarkers of liver function (alkaline phosphatase) and kidney function (cystatin C) partially mediated the MetS-PD relationship. These findings highlight a significant link between MetS and higher PD risk, with possible mediation through specific blood biomarkers, though temporal ambiguity warrants cautious interpretation.

Noncommunicable disease risk factors and predictors of hypertension among Gurkha veterans in Nepal: a community-based cross-sectional study

BACKGROUND

Nepal faces a rising burden of noncommunicable diseases (NCDs), yet Gurkha veterans-a population with distinct sociocultural backgrounds, occupational exposures, and post-service lifestyle transitions;remain largely overlooked in NCD research. Their increased susceptibility to sedentary behavior and unhealthy dietary habits may contribute to heightened NCD risks. This study assesses key behavioral (smoking, alcohol use, diet, and physical inactivity) and metabolic (obesity, elevated blood pressure) risk factors and identifies predictors of hypertension among Gurkha veterans.

METHODS

A community-based cross-sectional study was conducted in Palpa district, Lumbini Province, Nepal, in 2019. A multistage sampling technique was employed to determine the sample size, and a total of 189 Gurkha veterans were interviewed for data collection. Data were analyzed using SAS software (Version 9.4). A Bivariate analysis was conducted to assess the statistical associations among NCD risk factors, followed by multivariable logistic regression to identify independent predictors of hypertension while controlling for potential confounders.

RESULTS

The study revealed a high prevalence of daily alcohol consumption (41.80%), and inadequate fruit intake (89.95%. Likewise, 28.57% of the Gurkha veterans had lower intake of vegetables and 26.98% of them were performing low physical activity of vigorous level. Moreover, 35.98% had overweight and obesity and, nearly half of the participants (47.62%) were hypertensive. Multivariable logistic regression showed that daily alcohol drinkers (AOR: 3.13, 95% CI: 1.56-6.25, p=0.001), those engaging in less than 75 minutes per week of vigorous physical activity (AOR: 4.82, 95% CI: 1.89-12.30, p=0.001), and those with overweight or obese status (AOR: 3.50, 95% CI: 1.70-7.22, p<0.001) had significantly higher odds of having hypertension.

CONCLUSION

Alcohol consumption, physical inactivity, and obesity were the strongest predictors of hypertension among ex-Gurkha soldiers. Given the distinct lifestyle transitions and health challenges faced by this population, targeted early screening, at the community level with a continuum of care and health promotion strategies are essential to mitigate the NCD burden among retired Gurkha soldiers.

2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2025 AHA Statistical Update is the product of a full year's worth of effort in 2024 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. This year's edition includes a continued focus on health equity across several key domains and enhanced global data that reflect improved methods and incorporation of ≈3000 new data sources since last year's Statistical Update.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Correlation between Obesity and Risk Factors of Cardiovascular Diseases in Military Personnel

Background

It is critical to precisely assess the presence of cardiovascular (CV) risk in military personnel, in order to avoid potentially CV-events. In Iran limited number of studies have been performed on military personnel and their CV-risk. We aimed to investigate correlation between obesity and cardiovascular disease (CVD) risk factors in military personnel.

Methods

The present cross-sectional analytical study, analyzed the data of 559 military personnel in Tehran, Iran in 2023. The dataset sourced from the registry system. The biochemical analysis of blood samples was performed by a biomedical analysis company. The univariate regression analyses were conducted through separate univariate linear regression within the obesity group.

Results

The mean age of personnel was 36.58 years. Among obese personel, there was an inverse relationship between age and cholesterol β=-0.11. Moreover, hemoglobin β=-0.68 and MCH β=-0.33 were significantly related to high cholesterol, MCH is associated with risk of metabolic syndrome (β=-0.57). Moreover among obese personnel, lower uric acid levels and higher ALT levels are correlated with an increased risk of Diabetes.

Conclusion

The prevalence of obesity in military personnel was the same as in the general population. Diabetes, hyperlipidemia, high blood pressure, obesity, and metabolic syndrome were all linked to CVD risk factors among military personnel. Although the prevalence of metabolic syndrome in military personnel was lower than their peers in other countries, other risk factors of CVD were prevalent among military personnel.

Dietary Nutrient Adequacy in Aeronautical Military Personnel in Spain: Strengths and Weaknesses

BACKGROUND/OBJECTIVES

Aeronautical military personnel operate under intense physical and mental stress, requiring high psychophysical aptitude. Adequate nutrition is essential to sustain operational readiness and mitigate the risk of chronic diseases and other health issues. This study aims to evaluate the nutritional status of aeronautical military personnel group in Spain through dietary parameters.

METHODS

A total of 390 male aeronautical military personnel, who attended the Centro de Instrucción de Medicina Aeroespacial (Madrid, Spain), were evaluated. Energy and nutrient intakes were estimated by three non-consecutive 24-h dietary recalls (DIAL® program).

RESULTS

The median energy intake was 2134 kcal/day, with significant variations across professional groups, highest in parachutists (2347 kcal/day). Protein intake was 18.2% TE, while carbohydrate intake was 37.6% TE, below standards, with 83.8% of participants not meeting the EFSA guidelines. However, a high intake of added sugars was observed (10% TE). Fat intake (38.3% TE) and saturated fats (11.7% TE) exceeded recommendations. Micronutrient deficiencies were notable for vitamin D (98% below recommendations), folate (56.4%), vitamin C (40.2%), calcium (50.3%), iodine (76.6%), and zinc (59%). Elevated cholesterol intake (352 mg/day) and inadequate fiber intake (18.5 g/day) were also observed.

CONCLUSIONS

This study highlights imbalanced dietary patterns among Spanish aeronautical military personnel, with high protein, fat, cholesterol and added sugar consumption, low carbohydrate, and inadequate intake of critical micronutrients and fiber. These findings emphasize the need for targeted dietary interventions, nutritional monitoring protocols, and specific guidelines to enhance health and performance in this specialized group.

Risk factors for adverse health in military and law enforcement personnel; an umbrella review

BACKGROUND

A better understanding of adverse health and underlying risk factors in the context of military and law enforcement is essential to developing future preventative strategies. We conducted an umbrella review to provide an overview of the current literature regarding risk factors for adverse health in military and law enforcement populations.

METHODS

We systematically searched the literature for systematic reviews and meta-analyses regarding risk factors for adverse health in military or law enforcement populations. We critically appraised the studies that matched our inclusion criteria, extracted the adverse health outcomes and underlying risk factors, and narratively synthesised the findings.

RESULTS

This umbrella review included 34 systematic reviews that covered data from 43 countries. We identified twenty-six adverse health outcomes and 220 underlying risk factors. The adverse health outcomes covered in the included systematic reviews were one infectious disease (Heliobacter pylori infection); two endocrine, nutritional, or metabolic diseases (metabolic syndrome and obesity); seven mental, behavioural, or neurodevelopmental disorders (adjustment disorder, alcohol misuse, anxiety, depression, poor mental health, PTSD, and stress); two diseases of the nervous system (insomnia and sleep-disordered breathing); one disease of the ear or mastoid process (noise-induced hearing loss); eight diseases of the musculoskeletal system and connective tissue (cervical spine injuries, injuries, lower extremity injuries, musculoskeletal injuries, neck pain, rhabdomyolysis, and stress fractures); one symptom, signs and abnormal clinical and laboratory findings, not elsewhere classified (suicidal ideation); three injuries, poisonings, or other consequences of external causes (concussion, heat illness, and suicide); and one factor influencing health status and contact with health services (burnout). Of the 220 identified risk factors, 136 were modifiable, and the most frequently reported were female sex, older age, lower functional movement screen scores, maladaptive coping, lack of social support, and neuroticism.

CONCLUSION

This umbrella review identified twenty-six adverse health outcomes and their underlying risk factors in military and law enforcement populations. Hereby, this study provides potential starting points for preventing adverse health in these populations. It also identifies a broad lack of systematic reviews investigating mental, behavioural, or neurodevelopmental disorders in military populations and diseases of the musculoskeletal system and connective tissue in law enforcement populations.

PROSPERO REGISTRATION NUMBER

CRD42022378123.

Physicians' Perceived Barriers and Willingness to Initiate Advance Care Planning with Young Adults Living with Cardiometabolic Diseases

Objectives

The current global practice is to plan for the end-of-life period of persons already terminally ill with chronic diseases. However, affected persons should not have to wait till the stage of terminal illness to begin making plans for future healthcare preferences. This pilot study explored perceived barriers to and willingness of physicians to initiate discussions on advance care planning (ACP) with young adults living with cardiometabolic diseases.

Materials and Methods

The study was the pilot phase of descriptive cross-sectional research conducted among primary care physicians practising in Kuwait. Pilot data was collected with an electronic version of the modified DECIDE questionnaire (adapted from the "DECIsion-making about goals of care for hospitalized ElDErly patients" study) from February to April 2023. Data were analysed with Google Sheets.

Results

Nine out of 22 participants exited the study early on grounds of non-familiarity with the concept of ACP. Thirteen responses were analysed and reported herein. The mean age of the participants was 44.2 (±7.9) years; eight were male and five were female; five were Hindu, 7 Muslim, and 2 Christian. Perceived barriers to initiating ACP discussions included lack of knowledge about ACP and its relationship to ACP and goals of care discussions (8), lack of knowledge about the legal status of ACP documents in Kuwait (11), religious disapproval (12), lack of knowledge about how to elicit values, beliefs, preferences related to end-of-life care (13) and fear that these conversations will diminish hope in patients with serious illness (12), among others. Twelve participants were willing to initiate discussions and exchange information with young adult patients. Twelve participants indicated that they were confident about initiating discussions and exchanging ACP information, had all not taken any extra training or certification in ACP, but, respectively, described their current level of skill in having ACP discussions and supporting patients in the finalisation of their advance care plans as limited (2), fair (3), average (4), very good (3) and expert (1).

Conclusion

Despite the low level of awareness and other factors perceived as barriers, the primary care physicians who participated in the study were confident and willing to initiate ACP discussions with young adults living with cardiometabolic diseases. With the generally reported lack of previous training in ACP, there might be a need for coordinated efforts in training or up-skilling on knowledge and practice of ACP among primary care physicians.

Digital health intervention in patients undergoing cardiac rehabilitation: systematic review and meta-analysis

Background

Cardiovascular disease (CVD) continues to be the foremost mortality internationally. Cardiac rehabilitation has proven as an effective program in reducing CVD burden. Participation in cardiac rehabilitation programs is very low. Digital health intervention emerged as an alternative method to deliver Cardiac rehabilitation. This review aimed to investigate the impact of digital health intervention on the outcomes of interest.

Methods

the following databases: PubMed, CINAHL, Scopus, and Cochrane Library have been searched to retrieve randomized controlled trials that examine the impact of digital health intervention on blood pressure, body mass index, lipid profile, blood glucose, Six-Minute Walk Test, and peak oxygen consumption. filters were set to include studies published in English between 2000-2023.

Results

Nineteen studies were included in this review. Six-Minute Walk Test (MD = 16.70; 95% CI: 6.00 to 27.39, p = 0.000) and maximal oxygen consumption (SMD = 0.27; 95% CI: 0.08 to 0.45, p = 0.004) significantly improved following digital health intervention, after employing the sensitivity analysis significant improvement was observed in systolic (MD = -2.54; 95% CI: -4.98 to -0.11, p = 0.04) and diastolic blood pressure (SMD = -2.0182; 95% CI: -3.9436 to -0.0928, p = 0.04) favoring experimental groups. Subgroup analysis revealed significant improvement in quality of life after three months of follow-up (SMD = 0.18; 95% CI: 0.05 to 0.31, p = 0.00), no significant differences have been observed in body mass index, lipid profile, and blood glucose.

Conclusion

The findings emphasize the significant impact of digital vs CBCR or usual care on physical capacity, blood pressure, and quality of life. Despite the non-statistically significant differences in body mass index and lipid profile, the comparable effect between the two methods suggests the superiority of digital over CBCR or usual care due to its convenient nature, accessibility, and cost-effectiveness.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Sugar-Sweetened Beverage Consumption and Implications for Aviation Preflight Indoctrination Students

BACKGROUND: Research has shown that excessive sugar-sweetened beverage (SSB) consumption has been associated with being overweight and obese and the military is not immune to this disorder. Being overweight/obese is one of the characteristics that comprise a condition known as Metabolic Syndrome (MetS). The global prevalence of MetS in the military population is estimated to be 21%, which varies depending upon the armed forces type and specialty. The purpose of this study is to identify the subset of the aviation population that may develop MetS at some future point and to put forth suggestions on how best to combat this and maintain operational readiness.METHODS: Data were collected by means of an anonymous 44-item survey administered and completed by 302 students enrolled in Aviation Preflight Indoctrination at the Naval Air Station Base in Pensacola, FL.RESULTS: Results indicated that 70.86% of students reported SSB consumption, with 95.3% preferring caffeinated to decaffeinated SSBs. 11.7% of personnel met the "at risk criteria" of consuming SSBs four times per week or greater (four 12-oz cans or more per week).DISCUSSION: Findings from this study indicate that approximately 11.7% of aviation pilots or flight officers are "at risk" of developing MetS. Given that it takes up to 4 yr to train a new fighter pilot, this could become a significant readiness issue on par with the impact seen with pilots leaving the services through natural attrition.Sather TE. Sugar-sweetened beverage consumption and implications for aviation preflight indoctrination students. Aerosp Med Hum Perform. 2024; 95(1):25-28.

Association between perceived stress and cardio-metabolic risk factors: preliminary results of NURSE (Nursing Unacquainted Related Stress Etiologies) study

Objective

Stress is known as a conventional risk factor of cardiovascular disease. Nurses work in stressful environment and could be one of the target populations to be assessed for cardio metabolic risk factor. This study aimed to identify the association between perceived stress and cardio-metabolic risk factors in nurses who are prone for various metabolic diseases.

Method

In this cross-sectional study, nurses from five different educational hospitals of Tehran University of Medical Science attended the study. A self-administered questionnaire as well as Perceived Stress scale were completed. All anthropometric indices and blood pressure were measured. After 10-12 hours of fasting, venous blood samples were taken and level of total cholesterol, triglyceride, high-density and low-density lipoprotein cholesterol, fasting blood sugar and insulin level were determined. Data were analyzed using SPSS version 16 and a p value less than 0.05 was considered statistically significant.

Results

In total 273 nurses were recruited in this study. The mean age of participants was 35.01 ± 0.399 years old. The mean of perceived stress was 15.55 ± 5.04 with the minimum of 3 and maximum of 30. There was no significant association between perceived stress and cardio-metabolic risk factors. Results showed that there was a negative association between perceived stress and insulin level only in nurses who worked rotationally (β = - 0.195, p = 0.048). This association remained significant after adjustment for age and sex (β = - 0.181, P = 0.041).

Conclusion

Finding of the current study showed that negative association between perceived stress and insulin level and there is no significant association between stress and cardio-metabolic risk factors in nurses.

Overview of oral health status and associated risk factors in maritime settings: An updated systematic review

OBJECTIVES

The aim of this study is to provide an updated overview of the oral health status and associated risk factors in maritime settings.

METHODS

We systematically searched PubMed, Ovid Embase, Web of Science, CINAHL and SCOPUS from January 2010 to April 2023. Two independent reviewers extracted the data. The quality of included studies was assessed using relevant assessment tools.

RESULTS

A total of 260 records were found in the initial search; 24 articles met the inclusion criteria. Most studies had descriptive design, and only two randomized controlled trials were found. The main oral health issues noted are oral cancer, dental caries, periodontal diseases, oral mucosal lesions, and dental emergency. Male seafarers have higher risk of oral cancers in the tongue, lips, and oral cavity while oral mucosal lesions are more prevalent among fishermen.

CONCLUSIONS

Dental caries and periodontal diseases are prevalent in both seafarers and fishermen. The consumption of tobacco, alcohol, fermentable carbohydrate, and poor oral hygiene are risk factors that affect the oral health status at sea. The occurrence of oral diseases in maritime setting requires more attention of researchers and authorities to develop strategies to tackle these issues.

TRIAL REGISTRATION

Systematic review registration number in PROSPERO: CRD42020168692.

Long-term risk of cardiovascular disease after traumatic brain injury: screening and prevention

Traumatic brain injury (TBI) is highly prevalent among individuals participating in contact sports, military personnel, and in the general population. Although it is well known that brain injury can cause neurological and psychiatric complications, evidence from studies on individuals exposed to a single or repetitive brain injuries suggests an understudied association between TBI and the risk of developing chronic cardiovascular diseases and risk factors for cardiovascular disease. Several studies have shown that people without pre-existing comorbidities who sustain a TBI have a significantly higher risk of developing chronic cardiovascular disease, than people without TBI. Similar observations made in military and professional American-style football cohorts suggest causal pathways through which modifiable cardiovascular risk factors might mediate the relationship between brain injury and chronic neurological diseases. A better understanding of cardiovascular disease risk after TBI combined with a proactive, targeted screening programme might mitigate long-term morbidity and mortality in individuals with TBI, and improve their quality of life.

Dietary Antioxidant Quality Score (DAQS), serum lipids, markers of glucose homeostasis, blood pressure and anthropometric features among apparently metabolically healthy obese adults in two metropolises of Iran (Tabriz and Tehran): a cross-sectional study

BACKGROUND

Oxidative stress (OS) is associated with a variety of non-communicable diseases, including MetS, diabetes mellitus, metabolic syndrome, and cardiovascular disease through increased production of reactive oxygen species (ROS) and impairment of antioxidant defense mechanisms. Antioxidants can protect cells against free radical damage, so it seems important to determine the relationship between the quality of dietary antioxidants intake and chronic diseases. The Dietary Antioxidant Quality Score (DAQS) is obtained by adding the daily intake of known dietary vitamins and minerals, including selenium, zinc, vitamin A, vitamin C, and vitamin E, compared to the recommended daily intake (RDI). Therefore, this study aims to determine the relationship between DAQS, serum lipids, markers of glucose homeostasis, blood pressure and anthropometric features among obese adults.

METHODS

In the present cross-sectional study, 338 individuals who were obese (BMI ≥ 30 kg/m²) aged 20-50 years were recruited from Tabriz and Tehran, Iran. A validated semi-quantitative Food Frequency Questionnaire (FFQ) with 168 food items was used to quantify dietary consumption; accordingly, DAQS was computed. Blood biomarkers were measured using enzyme-linked immunosorbent assay (ELISA) kits. A standard mercury sphygmomanometer was used to assess blood pressure, and bioelectrical impedance analysis (BIA) was performed to determine body composition. The association between the DAQS tertiles and biochemical variables was investigated using multinomial logistic regression.

RESULTS

Participants in the highest tertile of DAQS have a lower diastolic blood pressure (DBP) values in all of the adjusted models [odds ratio (OR) = 0.920; confidence interval (CI)= 0.852-0.993, P-value = 0.03] in the analysis of co-variance (ANCOVA) model. Similarly, subjects at the second tertile of DAQS had lower DBP compared with the first tertile in age and sex-adjusted model [OR= 0.937; CI= 0.882-0.997]. There was no statistically significant difference for other metabolic parameters in different DAQS tertiles.

CONCLUSION

According to our findings, higher DAQS was associated with lower DBP among obese adults with obesity in two major cities of Iran (Tehran and Tabriz). Other studies with interventional design are needed to better elucidate these associations and underlying mechanisms.

Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Pre-morbid cardiometabolic risks among South Africans living in informal settlements

AIM

Numerous studies have been conducted on cardiometabolic risk factors in South Africa. However, not much has been done in informal settlement populations faced with their own set of health risks. This study screened for pre-morbid cardiometabolic risks and associated factors among adults living in informal settlements in South Africa.

METHODS

A cross-sectional study used the WHO STEPwise questionnaire to collect data on demography, anthropometry, blood pressure, and glucose and cholesterol levels (n = 329). Cardiometabolic risks were based on the criteria considered by the International Diabetes Federation and the National Cholesterol Education Program Adult Treatment Panel III. Data were analysed using STATA 14.

RESULTS

The median age of the participants was 35 (25-42) years. Cardiometabolic risk factors among the participants were hypertension (66%), overweight/obesity (45%), abdominal obesity (46%), and elevated cholesterol (15%) and glucose levels (7%). The metabolic syndrome was found in 17% of the participants, with a high prevalence observed among participants aged 35-59 years (28%) and ≥ 60 years (40%). The metabolic syndrome was significantly associated with gender [males, adjusted odds ratio (AOR) = 0.4, 95% CI: 0.20-0.90] and age, 35-59 years (AOR = 5.07, 95% CI: 2.24-11.23) and ≥ 60 years (AOR = 6.57, 95% CI; 1.57-27.54).

CONCLUSIONS

Prevalent cardiometabolic risk factors in informal settlements indicate the need for routine screening for all the components of the metabolic syndrome at the primary healthcare level.

Association between pre-existing cardiometabolic comorbidities and the pathological profiles of breast cancer at initial diagnosis: a cross sectional study

The presence of comorbidities has been associated with later stages of breast cancer diagnosis. It is unclear whether biological mechanisms are partly responsible. We examined the association between the presence of pre-existing comorbidities and tumour profile at initial diagnosis with breast cancer. Data for the present analysis were derived from a prior inception cohort study comprising 2,501 multiethnic women, newly diagnosed with breast cancer between 2015 and 2017 in four hospitals across Klang Valley. At the inception of the cohort, medical and drug histories, height, weight and blood pressure were recorded. Blood samples were taken to measure serum lipid and glucose. Modified Charlson Comorbidity Index (CCI) was calculated using data extracted from medical records. The association of CCI as well as specific comorbidities, with pathological breast cancer profile was analysed. Higher comorbidity burden, namely cardiometabolic conditions were associated with unfavourable pathological features including larger tumours, involvement of >9 axillary lymph nodes, distant metastasis and human epidermal growth factor receptor 2 overexpression. These associations remained largely significant following multivariable analyses. Specifically, diabetes mellitus was independently associated with high nodal metastasis burden. Low level of high-density lipoprotein was associated with larger tumours (>5 cm), and distant metastasis. Evidence from this study seems to support the hypothesis that the later stages of breast cancer diagnosis in women with (cardiometabolic) comorbidities may be partially explained by underlying pathophysiological events.

Health Effects of Pesticide Exposure in Latin American and the Caribbean Populations: A Scoping Review

BACKGROUND

Multiple epidemiological studies have shown that exposure to pesticides is associated with adverse health outcomes. However, the literature on pesticide-related health effects in the Latin American and the Caribbean (LAC) region, an area of intensive agricultural and residential pesticide use, is sparse. We conducted a scoping review to describe the current state of research on the health effects of pesticide exposure in LAC populations with the goal of identifying knowledge gaps and research capacity building needs.

METHODS

We searched PubMed and SciELO for epidemiological studies on pesticide exposure and human health in LAC populations published between January 2007 and December 2021. We identified 233 publications from 16 countries that met our inclusion criteria and grouped them by health outcome (genotoxicity, neurobehavioral outcomes, placental outcomes and teratogenicity, cancer, thyroid function, reproductive outcomes, birth outcomes and child growth, and others).

RESULTS

Most published studies were conducted in Brazil (37%, n = 88 ) and Mexico (20%, n = 46 ), were cross-sectional in design (72%, n = 167 ), and focused on farmworkers (45%, n = 105 ) or children (21%, n = 48 ). The most frequently studied health effects included genotoxicity (24%, n = 62 ) and neurobehavioral outcomes (21%, n = 54 ), and organophosphate (OP) pesticides were the most frequently examined (26%, n = 81 ). Forty-seven percent (n = 112 ) of the studies relied only on indirect pesticide exposure assessment methods. Exposure to OP pesticides, carbamates, or to multiple pesticide classes was consistently associated with markers of genotoxicity and adverse neurobehavioral outcomes, particularly among children and farmworkers.

DISCUSSION

Our scoping review provides some evidence that exposure to pesticides may adversely impact the health of LAC populations, but methodological limitations and inconsistencies undermine the strength of the conclusions. It is critical to increase capacity building, integrate research initiatives, and conduct more rigorous epidemiological studies in the region to address these limitations, better inform public health surveillance systems, and maximize the impact of research on public policies. https://doi.org/10.1289/EHP9934.

Cardio-metabolic risk modeling and assessment through sensor-based measurements

OBJECTIVE

Cardio-metabolic risk assessment in the general population is of paramount importance to reduce diseases burdened by high morbility and mortality. The present paper defines a strategy for out-of-hospital cardio-metabolic risk assessment, based on data acquired from contact-less sensors.

METHODS

We employ Structural Equation Modeling to identify latent clinical variables of cardio-metabolic risk, related to anthropometric, glycolipidic and vascular function factors. Then, we define a set of sensor-based measurements that correlate with the clinical latent variables.

RESULTS

Our measurements identify subjects with one or more risk factors in a population of 68 healthy volunteers from the EU-funded SEMEOTICONS project with accuracy 82.4%, sensitivity 82.5%, and specificity 82.1%.

CONCLUSIONS

Our preliminary results strengthen the role of self-monitoring systems for cardio-metabolic risk prevention.

Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Knowledge, Attitudes, and Screening for Obstructive Sleep Apnea and Diabetes Mellitus among War Veterans Seeking Treatment of Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is one of the most common psychiatric disorders. However, we should not neglect the somatic aspects of PTSD. Associations with cardiovascular diseases (CVD) are particularly concerning because PTSD was associated with an even 53% higher risk for CVD. This study aimed to analyze the prevalence of several CVD risk factors, especially diabetes mellitus among PTSD patients divided into three groups according to obstructive sleep apnea (OSA) risk stratification (low, intermediate, and high). This cross-sectional study included one hundred male PTSD veterans. The mean age was 53 (40-67) years. The estimated OSA risk was 95% for the whole cohort, and 53% were in the high-risk group. Median HbA1c was 5.6 (4.6-10)%. The hemoglobin A1c (HbA1c) levels showed that 34 patients were in the prediabetes group, and 20 of them fulfilled the criteria for diabetes. However, only 13 of them were aware of their previous diagnosis of diabetes mellitus. In testing knowledge about diabetes, 62% and only 23% of patients knew the correct definition of HbA1c and level of fasting plasma glucose, respectively. Diabetic patients had insufficient knowledge about diabetic complications and treatment. A higher level of PTSD symptoms in veterans was associated with a higher prevalence of OSA. The results strongly support further research and education into early detection of CVD risk factors associated with PTSD.

Recent Trends of Metabolic Syndrome and Its Components in Military Recruits from Saudi Arabia

Metabolic syndrome (Met-S) constitutes the risk factors and abnormalities that markedly increase the probability of developing diabetes and coronary heart disease. An early detection of Met-S, its components and risk factors can be of great help in preventing or controlling its adverse consequences. The aim of the study was to determine the prevalence of cardio-metabolic risk factors in young army recruits from Saudi Arabia. A total of 2010 Saudis aged 18-30 years were randomly selected from groups who had applied to military colleges. In addition to designed questionnaire, anthropometric measurements and blood samples were collected to measure Met-S components according to the International Diabetes Federation (IDF) criteria. Met-S prevalence was 24.3% and it was higher in older subjects than the younger ones. There were significant associations between Met-S and age, education level and marital status. The most common Met-S components were high fasting blood sugar (63.6%) followed by high blood pressure (systolic and diastolic, 63.3% and 37.3% respectively) and high body mass index (57.5%). The prevalence of pre-diabetes and diabetes were found to be 55.2% and 8.4%, respectively. Hypertriglyceridemia was found in 19.3% and low levels of high-density lipoproteins (HDL) in 11.7% of subjects. In conclusion, there is a high prevalence of Met-S in young adults of Saudi Arabia. There is a need for regular monitoring of Met-S in young populations to keep them healthy and fit for nation building. It is also important to design and launch community-based programs for educating people about the importance of physical activity, cessation of smoking and eating healthy diet in prevention of chronic diseases.

Predicting the 10-year risk of cardiovascular diseases and its relation to healthy diet indicator in Iranian military personnel

Background

Epidemiological studies indicate increased prevalence of cardiovascular disease (CVD) among military personnel. Accordingly, identification of at-risk individuals and lifestyle modification such as improving diet quality can potentially inhibits the increasing trend of CVD mortality. The aim of this study was predicting the 10-year risk of CVD and its association with healthy diet indicator (HDI) among military personnel.

Methods

In this cross-sectional study, 400 male military personnel within the age range of 30–75 years were included. HDI score was calculated based on food frequency questionnaire, and the 10-year risk of CVD was evaluated using Framingham risk score (FRS). The FRS items include age, gender, total cholesterol, high density lipoprotein cholesterol (HDL-C), systolic blood pressure, status of diabetes and smoking. Partial correlation test was employed to investigate the relationship between Framingham risk score and HDI score.

Results

The mean age and body mass index (BMI) of participants were 38.67 ± 5.3 year and 25.28 ± 3.22 kg/m², respectively. Prediction of FRS was as follows: 96.5% were low risk, 2% were moderate risk, and 1.5% were high risk. The mean HDI score of participants in this study was 5.98 ± 1.36. While HDI score did not show a significant correlation with FRS (r: − 0.009, p:0.860), increased dietary sodium intake had a significant positive correlation with FRS (r: 0.114, p:0.026).

Conclusion

The most of participants (96.5%) had in low risk of CVD development in the next 10 years. Meanwhile, the FRS showed no significant relationship with HDI score. Further researches are required to confirm the results of the present study.

The Effectiveness of Telenursing for Self-Management Education on Cardiometabolic Conditions: A Pilot Project on a Remote Island of Ōsakikamijima, Japan

Introduction:

Providing self-management education for residents with cardiometabolic conditions in remote islands is a challenge due to the shortage of primary care practitioners (PCPs), specialist physicians, and nurses. Therefore, we applied telenursing with lifestyle-related chronic diseases in remote island residents in Japan. This project aimed to improve the self-management behavior, cardiometabolic indicators, self-efficacy, and quality of life (QoL) of residents with cardiometabolic risks.

Methods:

We chose Ōsakikamijima Island, Hiroshima Prefecture, Japan, which is designated under the Remote Islands Development Act. The project was conducted from 2013 to 2014. The residents aged over 40 and under 75 years old, selected from the annual specific health check-up examination and from PCPs for screening cardiometabolic risks (urinary protein, glycohemoglobin A1c, systolic and diastolic blood pressure (BP), Low-density lipoprotein cholesterol, High-density lipoprotein cholesterol, and triglyceride) were included. The effectiveness of telenursing for self-management education was 6-month-long with a 6-month follow-up and evaluated by a single-group pre-and post-test design. Face-to-face health education was applied at the initial interview followed by telenursing (biweekly telephone calls till third-month, and a monthly telephone call during the fourth and fifth-month) by the trained nurses outside the island. To enhance participants’ self-monitoring health behavior changes, the nurses used motivational interviewing and behavior change techniques based on the transtheoretical model.

Results:

A total of 130 residents, 42 agreed to participate, 41 finished the 6-month program, and 33 completed the 12-month follow-up. Most of their behavior changes like self-management behaviors, cardiometabolic indicators, and self-efficacy at 6-month were improved significantly except QoL. Among the 12-month study periods, self-management behaviors, body mass index, systolic BP, diastolic BP, and self-efficacy (sense of control), (all P < .05) showed significant improvement.

Conclusion:

This study results indicated that telenursing might be effective to improve the lifestyles-related behaviors in chronic diseases on the remote island of Ōsakikamijima, Japan.

Determinants of metabolic syndrome: a population survey at Bizerte military garrison in 2015-2017

Introduction:

Metabolic syndrome (MetS) is a worldwide major public health problem. In Tunisia, few studies have focused on MetS in general population and in military setting in particular.

Aim: To determine the prevalence of the MetS in a military population at Bizerte garrison (Tunisia) and to identify its associated factors.

Methods:

An analytical cross sectional study was conducted in Bizerte military garrison during the period 2015-2017. The study population was the active military persons who were presents during the time of the survey and assigned at the three main navy, air force and army units of Bizerte garrison. The adopted definition for the diagnosis of MetS was the International Diabetes Federation 2005 (IDF 2005). Multivariate analysis using a binary logistic regression model to identify independent factors to MetS (variable of interest) was performed. Data entry and analysis were performed using SPSS 20.0 Software.

Results:

During the study period, 2500 active military were enrolled among them 2418 men. The mean age was 36.6 ± 9.1 years [20.0 – 59.0]. The prevalence of MetS was 17.7%. MetS was significantly higher among participants aged 40 and above, (23.8% vs 13.1%), single (21.6% vs 13.7%), diabetic (38.5% vs 15.5%), and assigned in the air force (23.1% vs 14.6%) compared to the rest of the study population. The independent factors identified in multivariate analysis were age, armed forces' affiliation and marital status.

Conclusion:

The prevalence of MetS in our military population was relatively high despite of the medical criteria imposed before incorporation. Population and targeted approach are needed to prevent this scourge and to protect from the complications.

Effects of physical fitness training on metabolic syndrome among military personnel in Taiwan

INTRODUCTION

Metabolic syndrome (MS) is strongly associated with cardiovascular diseases and diabetes but can be prevented with regular physical activity. This study aimed to assess the impact of a physical fitness training programme on MS among military personnel.

METHODS

This retrospective observational study included volunteer army soldiers who underwent annual health examinations between 2011 and 2014. In 2011, the reformed physical fitness training programme and physical fitness test were introduced to the participants. MS evaluation and physical fitness performances were evaluated before and after implementing the training programme using a mixed-effects model and generalised estimating equation, adjusted for sex, age and smoking.

RESULTS

From 2011 to 2014, 1720 soldiers underwent the annual health examination. In 2011, before the fitness programme, 246 soldiers (14.3%) had MS. After implementation, decreases in blood pressure and fasting glucose levels were observed and maintained for 3 years. Running performance was negatively correlated to triglycerides (ß=-11.37; p<0.001) and waist circumference (ß=-0.42; p<0.001) and positively correlated to high-density lipoprotein cholesterol levels (ß=2.14; p<0.001). The severity of MS was reduced following introduction of the physical fitness programme.

CONCLUSIONS

MS and its components improved after introducing the reformed fitness programme, with running performance proving to be most relevant to MS. Clinicians should encourage increased physical activity to prevent MS among military personnel.

Oral health status and cardiovascular risk profile in Cameroonian military population

Background

Periodontal diseases (PD) seem to appear today as predictors of some cardiovascular diseases (CVD). There is a lack of data on the oral health among Cameroonian military population, and its relationship with CVD.

Purpose

Investigate on the link between oral health of Cameroonian military from the Ngaoundéré garrison and their cardiovascular risk profile.

Participants and methods

A cross-sectional study at the Fifth Military Sector Health Center in Ngaoundéré was conducted. General health parameters assessment was done according to the World Health Organization STEPS manual for surveillance of risk factors for non-communicable chronic diseases and the Alcohol Use Disorders Identification Test. The periodontal status was assessed using Dutch Periodontal Screening Index.

Results

Two hundred and five participants who were officers and non-commissioned officers (aged 47 ± 08 and 32 ± 08 years respectively), with 86.4% of men were included. Smoking was associated to periodontitis (OR = 4.44 [1.73–11.43], p = 0.0031). Quality of oral hygiene was associated to high cardiovascular risk profile, poor/good (OR = 3.96 [1.07–14.57], p = 0.0386) and medium/good (OR = 3.44 [1.11–10.66], p = 0.0322).

Conclusion

Lifestyle as tobacco consumption and poor oral hygiene were associated to CVD among military, and this call for change.