vascular diseases in the 21st century how technology plays a role

VASCULAR DISEASES IN THE 21st CENTURY

How Technology Plays a Role

TOPIC OUTLINE

Description of the Evolution of TechnologyEffects of Technology on the Risk Factors for

Vascular DiseaseDiscussion of the Risk factors on Vascular

Disease

Evolution of Technology

The mid-twentieth century defined technology as the activity by which man seeks to manipulate his environment

The twentieth century has seen manipulations being made and lifestyles being constantly improved as technology advanced.

High Tech Era: Bane or Boon?

With technology advancement,the life style of man kept on changing = became more and more easy and comfortable

Technology earlier was meant to provide comfortable life to man but later science and technology merged into one

The technological advancement in science has to a great extent reduced death due to communicable diseases and epidemics = increased life-span of human beings

High Tech Era : Bane or Boon?

Technological advancements lead to more sedentary lifestyle

Sedentary Behavior

Human endeavors resulting in energy expenditure of no more than 1.5 times resting energy expenditure

Time spent sitting, reclining, or lying down during waking hours

Independently associated with lower levels energy expenditure increased risk of weight gain increased risk of metabolic syndrome Diabetes heart disease

Charles E. Matthews, et al. Amount of Time Spent in Sedentary Behaviors in the United States, 2003–2004. Am J Epidemiol 2008;167:875–881

Older adolescents (ages 16–19 years) spent nearly 60% of their time, or >8

hours/day in sedentary behaviors

Charles E. Matthews, et al. Amount of Time Spent in Sedentary Behaviors in the United States, 2003–2004. Am J Epidemiol 2008;167:875–881

Sedentary lifestyle and antecedents of vascular disease in young adults

A total of 135 otherwise healthy young men (n = 68) and women (n = 67) <40 years of age

Stratified into three groups based on physical activity status: 1) sedentary (n = 73); 2) physically active (n = 24); and 3) endurance-trained (n = 38)

McGavock JM, Anderson TJ, Lewanczuk RZ. Am J Hypertens. 2006 Jul;19(7):701-7.

http://www.ncbi.nlm.nih.gov/pubmed?term=McGavock%20JM%5BAuthor%5D&cauthor=true&cauthor_uid=16814124



http://www.ncbi.nlm.nih.gov/pubmed?term=Anderson%20TJ%5BAuthor%5D&cauthor=true&cauthor_uid=16814124

http://www.ncbi.nlm.nih.gov/pubmed?term=Lewanczuk%20RZ%5BAuthor%5D&cauthor=true&cauthor_uid=16814124



http://www.ncbi.nlm.nih.gov/pubmed/16814124





Arterial compliance and flow-mediated dilation were determined by diastolic pulse contour wave analysis and echocardiographic imaging of the brachial artery respectively.

Insulin sensitivity was estimated from the homeostasis model for insulin resistance and the 13C-glucose breath test.


RESULTS:Both conduit (16.4 +/- 0.5 v 19.5 +/- 0.7

mL/mmHg x 10; P < .01) and resistant (8.5 +/- 0.3 v 10.7 +/- 0.5 mL/mmHg x 100; P < .01) artery compliance were significantly lower in sedentary subjects than in physically active or endurance-trained subjects

The HOMA(IR) was 2.5-fold higher in the sedentary group than in the endurance-trained group (P < .05).

Sedentary Behaviour and Vigorous Physical Activity on Segment-Specific Carotid Wall Thickness

POPULATION 495 Healthy Caucasians (age 30–60 yrs) fulfilling criteria:(i) accelerometer monitoring for at least 3 days and 10

h/day(ii) far-wall IMT well defined in at least CCA and

carotid bulb(iii) absence of carotid plaque (iv) low, below average or average 10-year CHD risk

INTERVENTION

Monitoring of habitual physical activity through an accelerometerCarotid ultrasound at baseline and after 3 yearsMeasurement of atherosclerotic risk factors

OUTCOME Effect of sedentary time and PA levels on carotid wall thicknessin different carotid segmentsPattern of daily free-living activity in a healthy, young-to-middle age population

METHODS Cross-sectional studyMichaela Koza`kova, et al. Effect of sedentary behaviour and vigorous physical activity on segment-specific carotid wall thickness and its progression in a healthy population. European Heart Journal (2010) 31, 1511–1519

Michaela Koza`kova, et al. Effect of sedentary behaviour and vigorous physical activity on segment-specific carotid wall thickness and its progression in a healthy population. European Heart Journal (2010) 31, 1511–1519


In a population without increased CHD risk, the proportion of time spent in sedentary activity is directly associated with increase in IMT in the CCA, independent of age, and established atherosclerotic risk factors

In the longitudinal analysis, subjects with short periods of vigorous PA at baseline had a lower CCA IMT progression over the following 3 years when compared with those with light-to-moderate activity



Higher luminal diameter and arterial pressure increase wall tensile stress compensatory increase in wall thickness to normalize wall tensile stress

‘Physiological’ arterial remodelling is further supported by the observation that an independent effect of sedentary time on carotid wall thickness was seen only at the CCA level (segment with simple ‘linear’ geometry and laminar pulsatile flow pattern, where flow- and pressure-induced changes in vascular morphology can be more easily identified)



Low Recreational Activity as a Risk Factor for Peripheral Arterial Disease

1381 patients with PAD (ankle-brachial index <0.9) at the time of elective angiography or a history of revascularization of the lower extremities regardless of ABI

Validated physical activity questionnaire to retrospectively measure lifetime recreational activity (LRA).

PAD was present in 19% (n = 258) of all subjects.

Wilsom, AM et al. Abstract. Low lifetime recreational activity is a risk factor for peripheral arterial disease. J Vasc Surg. 2011 Aug;54(2):427-32, 432.e1-4. Epub 2011 Jun 12.




Low Recreational Activity as a Risk Factor for Peripheral Arterial Disease

Subjects with no regular LRA had greater diastolic BP and more likely to be female. They had lower average ABI, and a higher proportion had PAD (25.6%)

Multivariate analysis showed that age (P < .001), female gender (P < .001), systolic blood pressure (P = .014), fasting glucose (P < .001), serum triglycerides (P = .02), and cumulative pack years (P < .001) were independent negative predictors of ABI, and LRA was a positive predictor of ABI (P < .001)

History of sedentary lifestyle independently increased the odds ratio for PAD (odds ratio, 0.46; 95% confidence interval, 1.01-2.10)

Wilsom, AM et al. Abstract. Low lifetime recreational activity is a risk factor for peripheral arterial disease. J Vasc Surg. 2011 Aug;54(2):427-32, 432.e1-4. Epub 2011 Jun 12.




Sedentary Hours and Slow Walking Speed Predicts Functional Decline in PAD

384 patients with an ABI <0.90Slower walking speed outside the home was

associated with faster annual decline in calf muscle density

Greater hours sitting per day were associated with faster decline in 6-min walk (<4 h: -35.8 feet/year; 4 to <7 h: -41.1 feet/year; 8 to <11 h: -68.7 feet; ≥12 h: -78.0 feet; p = 0.008).

Similar associations were observed for greater hours sitting per day and faster declines in fast-paced (p = 0.018) and usual-paced (p < 0.001) 4-m walking velocity McDermott, MM et al. Abstract. Greater sedentary hours and slower walking speed outside the home predict faster declines in functioning and adverse calf muscle changes in peripheral arterial disease. J Am Coll Cardiol. 2011 Jun 7;57(23):2356-64.







Technology= Fast Pace of Life= Fast Food

Fast Food and Cardiovascular Disease

In the United States, 37% of adults and 42% of children regularly consume fast food1

higher intakes of energy, fat, saturated fat, sodium, and carbonated soft drinks

lower intakes of vitamins A and C, milk, fruit, and vegetables

Fast food consumption has been shown to promote weight gain and insulin resistance2

1Paeratakul S, et al. Fast-food consumption among US adults and children: dietary and nutrient intake profile. J Am Diet Assoc 2003;103(10):1332– 82Pereira MA, et al. Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis. Lancet 2005;365:36–42.

Impact of Nutrition on PAD

Cross-sectional study of NHANES (1999-2004) to determine specific nutrients associated with prevalent PAD in the US

422 individuals had prevalent PAD (5.9%). significantly higher rates of hypertension, coronary artery disease, diabetes,

and smoking than those without PAD. Univariate analysis revealed that consumption of all nutrients

considered were associated with lower odds of PAD, including antioxidants (vitamins A, C, and E), folate, other B vitamins (B(6), B(12)), fiber, and polyunsaturated and saturated fatty acids.

Nutrients associated with reduced prevalence of PAD were vitamin A (odds ratio [OR], 0.79; P = .036), vitamin C (OR, 0.84; P < .001), vitamin E (OR, 0.78; P = .011), vitamin B(6) (OR, 0.71; P = .023), fiber (OR, 0.65; P < .001), folate (OR, 0.67; P = .006), and omega-3 (alpha-linolenic) fatty acid (OR, 0.79; P = .028).

Lane, JS et al. Abstract. Nutrition impacts the prevalence of peripheral arterial disease in the United States. J Vasc Surg. 2008 Oct;48(4):897-904. Epub 2008 Jun 30.




Dietary Intake of Patients with PAD

Comparison of dietary intake of participants with PAD and claudication with recommendations of the National Cholesterol Education Program (NCEP) and dietary reference intake values recommended by the Institute of Medicine (IOM) of the National Academy of Sciences

Forty-six participants consumed a mean macronutrient composition of 17% protein, 51% carbohydrate, and 30% fat. Few met recommended daily intake for sodium (0%), vitamin E

(0%), folate (13%), saturated fat (20%), fiber (26%), and cholesterol (39%).

Participants with PAD and claudication have poor nutrition, with diets particularly high in saturated fat, sodium, and cholesterol, and low in fiber, vitamin E, and folate intakes. Gardner, AW et al. Abstract. Dietary intake of participants with peripheral artery

disease and claudication. Angiology. 2011 Apr;62(3):270-5.


Effects of fast-food meals on vascular function andCVD risk markers: the Hamburg Burger Trial

HAMBURG BURGER TRIAL

POPULATION Twenty-four healthy volunteers aged 18–65 yMajor exclusion criteria were CVD, diabetes, dysfunctionof coagulation, acute infection, anemia, and intolerance of anycomponents of the different meals

INTERVENTION

Most frequently consumed fast food meals versus vegetarian alternatives

OUTCOME Flow-Mediated Endothelium Dependent Dilatation (FMD), Oxidative Stress and Vascular Markers

METHODS observer-blinded, randomized, 3-way crossovertrial

Tanja, KR, et al. Acute effects of various fast-food meals on vascular function and cardiovascular disease risk markers: the Hamburg Burger Trial. Am J Clin Nutr 2007;86:334–40.

Effects of fast-food meals on vascular function andCVD risk markers: the Hamburg Burger Trial

*Results unexpected, given previous reports that various dietary components or vitamin supplements could prevent acute diet induced changes in vascular function

*Changes in FMD can most likely be attributed to diet effects

Work-Related Stress

"Problems at work are more strongly associated with health complaints than are any other life stressor--more so than even financial problems or family problems." --St. Paul Fire and Marine Insurance Co.

The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice

A Rozanski et al. J Am Coll Cardiol, 2005; 45:637-651

Conceptual Models of Work Stress

Associations of occupation with intima-media thickness:

The Multi-Ethnic Study of Atherosclerosis (MESA)

Various studies have linked occupational exposures to cardiovascular disease (CVD) incidence and mortality.

Previous studies on occupation and IMT focussed on job characteristics (strain and stress caused by job demands) The Atherosclerosis Risk in Communities Study and the Kuopio

Ischaemic Heart Disease Risk Factor Study both reported significant associations between job stress and increased IMT: attenuated to non-significance after traditional CVD risk factors were included in the analysis

The Cardiovascular Risk in Young Finns Study reported that among men, job strain was associated with increased IMT even after adjustments were made for other CVD risk factors

Kaori Fujishiro, et al. Associations of occupation, job control and job demands with intima-media thickness: The Multi-Ethnic Study of Atherosclerosis (MESA). Occup Environ Med. 2011 May ; 68(5): 319–326

Blue-collar workers had greater internal carotid artery (ICA)-IMT than managers/professionals after adjustments were made for traditional cardiovascular disease risk factors and SES, suggesting that blue-collar jobs carry additional risk.

Occupational category was more strongly associated with ICA-IMT, whereas job control was more strongly associated with common carotid artery (CCA)-IMT.

Low job control was associated with greater CCA-IMT, with the association being stronger for those in high-demand jobs than in low-demand jobs.




Health Risk Behaviors Among Business Process Outsourcing Employees in the Philippines (Luzon

2008)

FELICIANO, ET AL . DEPARTMENT OF HEALTH NATIONAL EPIDEMIOLOGY CENTER, APPLIED

PUBLIC HEALTH DIVISION 2008

Health Risk Behaviors Among Business Process Outsourcing Employees in the

Philippines

Cross sectional studyQualitative: Focus Group Discussion(FGD)Quantitative: Key Informant Interview(KII)Primary Sampling Unit: BPO Companies460 respondents, ≥ 18 yrs old

Health Risk Behaviors Among Business Process Outsourcing Employees in the

Philippines

Prevalence:Smoking = 42% (Filipino general pop = 33% )Alcohol Drinking = 48% (Filipino general pop = 39%)Drug use = 1% (Marijuana, Shabu)>1 sexual partner last 6 mos = 14%

8% commercial sex

12% group sex52% consensual sex67% never used condom

Health Risk Behaviors Among Business Process Outsourcing Employees in the Philippines

Increased weight from baseline – 67%No exercise – 61% (Rather sleep!)Almost all of them are not satisfied with their

existing health benefits

Prevalence of Vascular Diseases and Risk Factors in BPO Company (year 2010)

Yr 2010: N = 1,994 (30 to 45 years old)Primary Hypertension = 37 (1.8%)Obesity = 9 (0.45%)Deep venous insufficiency = 1 (0.05%)Hypercholesterolemia = 11 (0.55%)Diabetes Mellitus type 2 = 5 (0.25%)

*YR 2012: N = 505 (30 to 50 years old)Primary Hypertension = 115 (23%)

Maleza,Francisco JR (Presented at 2011 PSVM Annual Convention)

Call centre employees and tobacco dependence: making a differenceMishra GA, Indian J Cancer 2010 Jul;47 Suppl 1:43-52

646 BPO employees: 4-arm cluster randomized trial, 18 months (control, health education, focus group discussion, behavioral therapy, pharmacotherapy)

Prevalence of tobacco dependence = 41% Quit rate is similar to 3 intervention arms (20%)Higher Quit rate with pharmacotherapy (45%)

SUMMARY

With the evolution of technology, previously identified risk factors are becoming more prevalent and their association with vascular disease are becoming more evident.

Low level physical activity is associated with impaired vascular function, development and progression of vascular diseases

Technology is helpful in identifying modifiable risk factors

Prevention, control and treatment of peripheral vascular disease should be the key focus

vascular diseases in the 21st century how technology plays a role

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