The effectiveness of yoga to prevent diabetes mellitus type 2 Cardiorespiratory Fitness in Childhood and Adolescence Affects Future Cardiovascular Risk Factors: A Systematic Review of Longitudinal Studies Cost-effectiveness of interventions to control cardiovascular diseases and type 2 diabetes mellitus in South Asia: protocol for a systematic review The Influence of Yoga-Based Programs on Risk Profiles in Adults with Type 2 Diabetes Mellitus: A Systematic Review Lipoprotein(a) as a risk factor for cardiovascular mortality in type 2 diabetic patients: a 10-year follow-up study. Gestational diabetes risk factors and long-term consequences for both mother and offspring: a literature review Effects of adjunctive exercise on physiological and psychological parameters in depression: a randomized pilot trial. Sources of evidence for systematic reviews of interventions in diabetes. Impact of dietary fiber intake on glycemic control, cardiovascular risk factors and chronic kidney disease in Japanese patients with type 2 diabetes mellitus: the Fukuoka Diabetes Registry Office and ambulatory pulse pressure—association with clinical characteristics and cardiovascular risk factors in normoalbuminuric patients with type 2 diabetes (ROADMAP study) Clinical and biochemical characterization of women with polycystic ovary syndrome in North Rhine-Westphalia. Short-term and long-term sequelae in intrauterine growth retardation (IUGR) Statin therapy worsens insulin sensitivity in women with polycystic ovary syndrome (PCOS): a prospective, randomized, double-blind, placebo-controlled study. Madurai Area Physicians Cardiovascular Health Evaluation Survey (MAPCHES)--an alarming status. Associations Between Marijuana Use and Cardiovascular Risk Factors and Outcomes Uric acid level as a risk factor for cardiovascular and all-cause mortality in middle-aged men: a prospective cohort study. Hemostatic risk factors in patients with coronary artery disease and type 2 diabetes - a two year follow-up of 243 patients Independent Associations of Fasting Insulin, Glucose, and Glycated Haemoglobin with Stroke and Coronary Heart Disease in Older Women Do sugar-sweetened beverages cause adverse health outcomes in children? A systematic review protocol Rosiglitazone for type 2 diabetes mellitus. Dietary fiber and the glycemic index: a background paper for the Nordic Nutrition Recommendations 2012 Translating the Diabetes Prevention Program: a comprehensive model for prevention training and program delivery. Overview of Systematic Reviews: Yoga as a Therapeutic Intervention for Adults with Acute and Chronic Health Conditions
Background : Type 2 diabetes mellitus ( T2DM ) is becoming a leading problem worldwide . Emerging reports reveal alarming evidence of increasing prevalence of T2DM that has reached p and emic levels . Despite the significant incidence , there are limited reliable data re sources and comprehensive systematic review and meta- analysis on the effects of yoga on people who are a prediabetic or high risk for developing T2DM . Objective : The objective of this protocol is to conduct a full-scale systematic review and meta-analyses on the effects of yoga on people who are prediabetes or high risk of developing T2DM . Methods : The articles enrolled in the study will be retrieved from the online data bases between 2002 and the date the search es are executed . The search es will be repeated just before the final analyses and further relevant studies for inclusion . We will conduct a bibliographic search in data bases : Medline / PubMed , Scopus , Cochrane Library , EBSCO , and IndMED using keywords including prediabetes state , high risk for diabetes , metabolic syndrome , and yoga . A defined search strategy will be implemented along with selection criteria to obtain full-text articles of relevant studies . This study protocol was prepared according to the Preferred Reporting Items for Systematic Review s and Meta- Analysis for Protocol s 2015 guidelines . There will be no language restrictions . Ethics and dissemination : The proposed study will be based on published studies and publicly available anonymized data without directly involving human participants and therefore requires neither formal human ethical review nor approval by a human research ethics committee . We published an outline of the protocol in the International Prospect i ve Register of Systematic Review s ( PROSPERO ) in 2018 . We plan to disseminate the findings of this systematic review and meta- analysis through publication in a peer- review ed journal and presentation at relevant conference proceedings . In addition , we believe the results of the systematic review will have implication s for policy and practice . We will prepare policymaker summary using a vali date d format , disseminate through social media and email discussion groups . Review registration number : PROSPERO registration number CRD Background Although cardiorespiratory fitness ( CRF ) in childhood and adolescence may be linked to future cardiovascular health , there is currently limited evidence for a longitudinal association . Objectives To provide a systematic review on the prospect i ve association between CRF in childhood and adolescence and cardiovascular disease ( CVD ) risk factors at least 2 years later . Methods Using a systematic search of Medline , Embase , and SPORTD iscus , relevant articles were identified by the following criteria : generally healthy children and adolescents between 3 and 18 years of age with CRF assessed at baseline , and a follow-up period of ≥ 2 years . The outcome measures were CVD risk factors . We appraised quality of the included articles with STROBE and QUIPS checklists . Results After screening 7524 titles and abstract s , we included 38 articles , assessing 44,169 children and adolescents followed up for a median of 6 years . Eleven articles were of high quality . There was considerable heterogeneity in methodology , measurement of CRF , and outcomes , which hampered meta- analysis . In approximately half of the included articles higher CRF in childhood and adolescence was associated with lower body mass index ( BMI ) , waist circumference , body fatness and lower prevalence of metabolic syndrome in later life . No associations between CRF in childhood and adolescence and future waist-to-hip ratio , blood pressure , lipid profile , and glucose homeostasis were observed . Conclusion Although about half of the included articles reported inverse associations between CRF in childhood and adolescence and future BMI , body fatness , and metabolic syndrome , evidence for other CVD risk factors was unconvincing . Many articles did not account for important confounding factors such as adiposity . Recommendations for future research include st and ardizing the measurement of CRF , i.e. by reporting VO2max , using st and ardized outcome assessment s , and performing individual patient data meta-analyses Introduction While a number of strategies are being implemented to control cardiovascular diseases ( CVDs ) and type 2 diabetes mellitus ( T2DM ) , the cost-effectiveness of these in the South Asian context has not been systematic ally evaluated . We aim to systematic ally review the economic ( cost-effectiveness ) evidence available on the individual- , group- and population -level interventions for control of CVD and T2DM in South Asia . Methods and analysis This review will consider all relevant economic evaluations , either conducted alongside r and omised controlled trials or based on decision modelling estimates . These studies must include participants at risk of developing CVD/T2DM or with established disease in one or more of the South Asian countries ( India , Bangladesh , Pakistan , Sri Lanka , Nepal , Maldives , Bhutan and Afghanistan ) . We will identify relevant papers by systematic ally search ing all major data bases and registries . Selected articles will be screened by two independent research ers . Method ological quality of the studies will be assessed using a modified Drummond and a Phillips checklist . Cochrane guidelines will be followed for bias assessment in the effectiveness studies . Results Results will be presented in line with the PRISMA ( Preferred Reporting Items for Systematic review and Meta- analysis ) checklist , and overall quality of evidence will be presented as per the GRADE ( Grade s of Recommendation , Assessment , Development and Evaluation ) approach . Ethics and dissemination The study has received ethics approval from the All India Institute of Medical Sciences , New Delhi , India . The results of this review will provide policy-relevant recommendations for the uptake of cost-effectiveness evidence in prioritising decisions on essential chronic disease care packages for South Asia . Study registration number PROSPERO CRD42013006479 There is growing evidence that yoga may offer a safe and cost-effective intervention for Type 2 Diabetes mellitus ( DM 2 ) . However , systematic review s are lacking . This article critically review s the published literature regarding the effects of yoga-based programs on physiologic and anthropometric risk profiles and related clinical outcomes in adults with DM 2 . We performed a comprehensive literature search using four computerized English and Indian scientific data bases . The search was restricted to original studies ( 1970–2006 ) that evaluated the metabolic and clinical effects of  yoga in adults with DM 2 . Studies targeting clinical population s with cardiovascular disorders that included adults with comorbid DM were also evaluated . Data were extracted regarding study design , setting , target population , intervention , comparison group or condition , outcome assessment , data analysis and presentation , follow-up , and key results , and the quality of each study was evaluated according to specific predetermined criteria . We identified 25 eligible studies , including 15 uncontrolled trials , 6 non-r and omized controlled trials and 4 r and omized controlled trials ( RCTs ) . Overall , these studies suggest beneficial changes in several risk indices , including glucose tolerance and insulin sensitivity , lipid profiles , anthropometric characteristics , blood pressure , oxidative stress , coagulation profiles , sympathetic activation and pulmonary function , as well as improvement in specific clinical outcomes .  Yoga may improve risk profiles in adults with DM 2 , and may have promise for the prevention and management of cardiovascular complications in this population . However , the limitations characterizing most studies preclude drawing firm conclusions . Additional high- quality RCTs are needed to confirm and further eluci date the effects of st and ardized yoga programs in population s with DM 2 Although patients with type 2 diabetes have a high risk of death from cardiovascular disease ( CVD ) , the traditional risk factors do not fully explain this excess of mortality . In this regard , it would be of great interest to assess the role of nontraditional risk factors such as lipoprotein(a ) in cardiovascular mortality in diabetic patients . Danesh et al. ( 1 ) , in a meta- analysis including the prospect i ve studies published before 2000 , concluded that there was a clear association between lipoprotein(a ) and CVD in the general population . Further prospect i ve reports have demonstrated that lipoprotein(a ) is an independent predictor of the development of CVD ( 2–5 ) . However , little data exist on the clinical importance of lipoprotein(a ) in the diabetic population . We herein report a prospect i ve study to evaluate the relationship between lipoprotein(a ) levels and cardiovascular mortality in type 2 diabetic patients of Caucasian origin . One hundred twenty-two consecutive type 2 diabetic out patients of Caucasian origin attending the outpatient diabetic unit of a university hospital between April and May of 1993 were enrolled for a 10-year prospect i ve study . To avoid the possible transient increase of lipoprotein(a ) after starting insulin treatment ( 6 ) , all patients in whom insulin treatment was initiated in the months before the study were excluded . Patients with renal failure were also excluded . To assess evidence of macroangiopathy , we used the World Health Organization ( WHO ) protocol , which includes a detailed question naire and a 12-lead electrocardiogram ( 7,8 ) . By the end of the study , data were available from 100 patients . Of these , 29 had died ( 23 from CVD ) . Metabolic parameters ABSTRACT Introduction : Established risk factors for gestational diabetes mellitus ( GDM ) include ethnicity , obesity , and family history of diabetes . Untreated GDM patients have higher rates of maternal and perinatal morbidity . GDM is an independent risk factor for future longer-term risk of type 2 diabetes mellitus ( T2DM ) , metabolic syndrome , cardiovascular morbidity , malignancies , ophthalmic , psychiatric , and renal disease in the mother . Offspring risk long-term adverse health outcomes , including T2DM , subsequent obesity , impacted neurodevelopmental outcome , increased neuropsychiatric morbidity , and ophthalmic disease . Areas covered : We critically review data from retrospective , prospect i ve , and meta- analysis studies pertaining to established GDM risk factors , complications during pregnancy and birth ( both mother and offspring ) , and long-term consequences ( both mother and offspring ) . Expert commentary : Many of the adverse consequences of GDM might be avoided with proper management and treatment . Patients belonging to high-risk ethnic groups , and /or with body mass index ≥ 25 kg/m2 , and /or known history of diabetes in first-degree relatives may benefit from universal screening and diagnostic criteria proposed by the International Association of Diabetes and Pregnancy Study Group ( IADPSG ) . The IADPSG one-step method has several advantages , including simplicity of execution , greater patient-friendliness , and higher diagnostic accuracy . Additionally , evidence suggests that the recent increased popularity of bariatric surgery will help to decrease GDM rates over next 5 years . Similarly , metformin may be useful for treating and preventing obstetrical complications in confirmed GDM patients OBJECTIVE Major depressive disorder ( MDD ) is associated with decreased physical activity and increased rates of the metabolic syndrome ( MetS ) , a risk factor for the development of type 2 diabetes and cardiovascular disorders . Exercise training has been shown to improve cardiorespiratory fitness and metabolic syndrome factors . Therefore , our study aim ed at examining whether patients receiving an exercise program as an adjunct to inpatient treatment will benefit in terms of physiological and psychological factors . METHOD Fourty-two in patients with moderate to severe depression were included . Twenty-two patients were r and omized to additional 3x weekly exercise training ( EXERCISE ) and compared to treatment as usual ( TAU ) . Exercise capacity was assessed as peak oxygen uptake ( VO2peak ) , ventilatory anaerobic threshold ( VAT ) and workload expressed as Watts ( W ) . Metabolic syndrome was defined according to NCEP ATPIII panel criteria . RESULTS After 6 weeks of treatment , cardiorespiratory fitness ( VO2peak , VAT , Watt ) , waist circumference and HDL cholesterol were significantly improved in EXERCISE participants . Treatment response expressed as ≥50 % MADRS reduction was more frequent in the EXERCISE group . CONCLUSIONS Adjunctive exercise training in depressed in patients  improves physical fitness , MetS factors , and psychological outcome . Given the association of depression with cardiometablic disorders , exercise training is recommended as an adjunct to st and ard antidepressant treatment AIMS To analyse the effect on systematic review s in diabetes interventions of including only trials that are indexed in medline , and to assess the impact of adding trials from other data bases and the grey literature . METHODS All systematic review s of diabetes interventions which included a meta- analysis of r and omized controlled trials , and were published since 1996 , were selected . The impact on the meta- analysis of including only those trials indexed in medline , and the effect of then adding trials from other sources , was assessed . Where possible this was measured quantitatively , by redoing the meta- analysis , otherwise a qualitative estimate was made . RESULTS Forty-four systematic review s met our inclusion criteria . There were 120 articles reporting trial data which were not indexed in medline . These came from 52 % of the review s. In 34 % of the review s , basing a meta- analysis on a search of only medline would miss trials that could affect the result . Sources of non- medline data which had the biggest effect on the meta-analyses were journal articles from central and embase ( mainly in Diabetes , Nutrition and Metabolism ) and unpublished data ( mainly from industry ) . The exceptions were journal articles on herbal medicine , mostly indexed in Chinese language data bases . CONCLUSIONS A search of only the medline data base is insufficient for systematic review s of diabetes , because in about 34 % of review s the missed trials could affect the results of the meta- analysis . It is recommended that central ( on the Cochrane Library ) also be search ed . Scanning meeting abstract s , and seeking unpublished data are also recommended if the intervention has only recently been introduced Background Dietary fiber is beneficial for the treatment of type 2 diabetes mellitus , although it is consumed differently in ethnic foods around the world . We investigated the association between  dietary fiber intake and obesity , glycemic control , cardiovascular risk factors and chronic kidney disease in Japanese type 2 diabetic patients . Methods A total of 4,399 patients were assessed for  dietary fiber intake  using a brief self-administered diet history question naire . The associations between dietary fiber intake and various cardiovascular risk factors were investigated cross-sectionally . Results Body mass index , fasting plasma glucose , HbA1c , triglyceride and high-sensitivity C-reactive protein negatively associated with dietary fiber intake after adjusting for age , sex , duration of diabetes , current smoking , current drinking , total energy intake , fat intake , saturated fatty acid intake , leisure-time physical activity and use of oral hypoglycemic agents or insulin . The homeostasis model assessment insulin sensitivity and HDL cholesterol positively associated with dietary fiber intake . Dietary fiber intake was associated with reduced prevalence of abdominal obesity , hypertension and metabolic syndrome after multivariate adjustments including obesity . Furthermore ,  dietary fiber  intake was associated with lower prevalence of albuminuria , low estimated glomerular filtration rate and chronic kidney disease after multivariate adjustments including protein intake . Additional adjustments for obesity , hypertension or metabolic syndrome did not change these associations . Conclusion We demonstrated that increased dietary fiber intake was associated with better glycemic control and more favorable cardiovascular disease risk factors including chronic kidney disease in Japanese type 2 diabetic patients . Diabetic patients should be encouraged to consume more dietary fiber in daily life To investigate the association of office and ambulatory 24-h pulse pressure ( PP ) with clinical characteristics and cardiovascular risk factors in normoalbuminuric type 2 diabetic patients enrolled to the R and omised Olmesartan and Diabetes Microalbuminuria Prevention study , 4449 patients ( 2054 male and 2395 female ; mean age 57.7±8.7 years ) with type 2 diabetes , normoalbuminuria and at least one additional cardiovascular risk factor were included into the analysis . After adjustment by age , there were significant correlations between office PP and presence of hypertension ( r=0.24 ; P<0.001 ) , presence of cardiac and vascular disorders ( r=0.17 ; P<0.001 ) , metabolic syndrome ( r=0.10 ; P<0.001 ) , duration of diabetes ( r=0.09 ; P<0.001 ) , fasting blood glucose ( r=0.08 ; P<0.001 ) , albumin/creatinine ratio ( r=0.07 ; P<0.001 ) , insulin treatment , glycosylated haemoglobin ( HbA1c ) , male gender and current smoking . In the subgroup of 1234 patients with  ambulatory blood pressure measurement  performed , ambulatory PP adjusted for office PP correlated with fasting blood glucose ( r=0.16 ; P<0.001 ) , metabolic syndrome ( r=0.14 ; P<0.001 ) , albumin/creatinine ratio ( r=0.11 ; P<0.001 ) and indices of glycemic control ( HbA1c : r=0.11 ; P<0.001 ) . In this group of normoalbuminuric type 2 diabetic patients , office and ambulatory PP were associated with duration of diabetes , indices of glycemic control and cardiovascular risk factors . There was relationship between office and ambulatory PP and albuminuria even within normal albuminuria range Polycystic ovary syndrome ( PCOS ) , defined as the combination of oligoanovulation and hyper and rogenism , affects more than 5 % of women of reproductive age . Insulin resistance and hyperinsulinemia appear to play an important role in its pathogenesis . Here , we will present a characterization of a PCOS cohort from North Rhine-Westphalia in Germany . Clinical features , family history as well as endocrine and metabolic parameters were prospect ively recorded from 200 successive patients . All patients were evaluated for insulin resistance and beta-cell-function by oral glucose tolerance test .  Patient data were compared with those of 98 age-matched control women . PCOS patients showed significantly higher BMI , body fat mass and and rogen levels as well as impaired glucose and insulin metabolism . A positive family history of PCOS and diabetes was more frequent in PCOS patients . Insulin resistance ( 71 % ) was the most common metabolic abnormality in PCOS patients followed by obesity ( 52 % ) and dyslipidemia ( 46.3 % ) , with an incidence of 31.5 % for the metabolic syndrome . C-reactive protein and other cardiovascular risk factors were frequently elevated even in young PCOS patients . While the clinical characteristics and endocrine parameters of this German PCOS cohort were heterogeneous , they were comparable to those from other Caucasian population Intrauterine Growth Retardation ( IUGR ) is defined as a rate of growth of a fetus that is less than normal for the growth potential of the fetus ( for that particular gestational age ) . Small for Gestational Age ( SGA ) is defined infant born following IUGR , with a weight at birth below the 10th percentile . Suboptimal fetal growth occurring in IUGR fetuses is an important cause of perinatal mortality and morbidity . The acute neonatal consequences of IUGR include metabolic and hematological disturbances , and disrupted thermoregulation ; in addition , respiratory distress ( RDS ) , necrotizing enterocolitis ( NEC ) , and retinopathy of prematurity ( ROP ) may contribute to perinatal morbidity . Metabolic disturbances are related to glucose and fatty acid metabolism . It is well-known that individuals who display poor growth in utero are at significantly increased risk for type 2 diabetes mellitus ( T2DM ) , obesity , hypertension , dyslipidemia , and insulin resistance ( the so-called metabolic syndrome , MS ) . MS ultimately leads to the premature development of cardiovascular diseases . In addition , short stature in children and adults , premature adrenarche , and the polycystic ovarian syndrome ( PCOS ) are endocrinological sequelae of IUGR . ( 8) Early onset growth delay and prematurity significantly increase the risk for neurological sequelae and motor and cognitive delay . Future prospect i ve studies need to investigate risk factors for infants who are SGA . If reliable prediction can be achieved , there is potential to reduce future perinatal morbidity and mortality , and long term consequences among SGA babies CONTEXT Statins have been shown to improve hyper and rogenism in women with polycystic ovary syndrome ( PCOS ) . However , their use has also been associated with impairment of glucose metabolism and an increased risk of type 2 diabetes mellitus . Because women with PCOS are prone to disturbances in glucose metabolism , statin therapy could also have negative effects . OBJECTIVE Our objective was to explore the effects of atorvastatin therapy on hormonal and metabolic parameters in women with PCOS . DESIGN AND SETTING We conducted a r and omized , double-blind , placebo-controlled 6-month follow-up study conducted at Oulu University Hospital , Finl and . PATIENTS Women with PCOS ( Rotterdam criteria ) were treated with atorvastatin ( 20 mg/d , n = 15 ) or placebo  ( n = 13 ) for 6 months . INTERVENTIONS Fasting serum sample s were collected at baseline and at 3 and 6 months . Oral and iv glucose tolerance tests were performed at 0 and 6 months . MAIN OUTCOME MEASURES And rogen secretion and glucose metabolism were measured . RESULTS Fasting levels and area under the curve of insulin increased significantly and insulin sensitivity ( insulinogenic and Matsuda indexes ) decreased during 6 months of atorvastatin therapy . Serum levels of dehydroepi and rosterone sulfate decreased in the atorvastatin group , whereas no change was observed in serum testosterone levels . Levels of C-reactive protein , total and low-density lipoprotein-cholesterol , and triglycerides decreased significantly during statin therapy . CONCLUSIONS Atorvastatin therapy improves chronic inflammation and lipid profile , but it impairs insulin sensitivity in women with PCOS . Because women with PCOS have an increased risk of developing type 2 diabetes mellitus , the results suggest that statin therapy should be initiated on the basis of generally accepted criteria and individual risk assessment of cardiovascular disease , and not only because of PCOS BACKGROUND Studies have shown that South Asians are highly susceptible to cardiovascular diseases ( CVDs ) . There is very little information available about the prevalence of risk factors for CVD in the physician population , a group that might be expected to be more aware of cardiovascular risk and health status . AIM To evaluate the prevalence of cardiovascular risk factors - including metabolic , dietary and behavioural - among the physician population in southern India . METHODS Approximately 4000 physicians of differing specialties from eight southern districts in Tamilnadu , India , in and around the city of Madurai were listed . Of these , 1600 were r and omly selected to participate in a cross-sectional survey  , of which 1514 physicians agreed to participate . The survey included demographic question naires , objective measurements of blood pressure , fasting blood sugar , fasting lipids and waist circumference , and question naires about their dietary and behavioural habits .  RESULTS Complete data were available for 1433 physicians . Using a blood pressure cut-off value of 130/85 mmHg or higher , the study recorded a prevalence of 41 % among men and 23 % among women . On applying the International Diabetes Federation criteria for the metabolic syndrome for the South Asian population , the present study identified 49 % of female physicians and 41 % of male physicians as having the metabolic syndrome . Only 17 % were physically active . Less than one-half of them consumed vegetables . Nearly 31 % of male physicians were smokers . CONCLUSION Analysis of these data suggests that the risk for CVD and stroke is at epidemic proportions in a cohort of well-educated physicians who are in the highest quintile of income As more states legalize the sale and consumption of marijuana , the number of Americans using it continues to rise ( 1 , 2 ) . This increase in the use of marijuana highlights the need for a better underst and ing of its risks and benefits . One area of importance is its effect on cardiovascular disease , the number one cause of morbidity and mortality worldwide ( 3 ) . Marijuana may affect cardiovascular health in several ways . Like other psychoactive drugs , it may have hemodynamic effects that can precipitate events ( 4 ) . The active ingredient in marijuana is 9-tetrahydrocannabinol ( THC ) ( 5 ) , which is responsible for the psychoactive effects of marijuana through its interaction with cannabinoid receptors . These receptors are ubiquitous in the brain and its vasculature and present throughout the body , including the myocardium , coronary endothelium , and smooth muscle cells ( 6 , 7 ) . In vitro and animal studies have reported that THC can modulate cannabinoid receptors on human cardiomyocytes and vascular smooth muscles , result ing in ischemia ( 7 , 8) . In vitro studies also have demonstrated that THC influences the regulation of glucose and lipid metabolism , suggesting a possible effect on vascular risk factors ( 9 , 10 ) . At the cellular level , THC may cause inflammatory cytokine release , alteration in lipid metabolism ( 11 , 12 ) , and reactive oxygen species formation ( 13 ) . These effects may potentiate the progression of vascular disease .  Marijuana smoking , the predominant method of use , causes a 5-fold increase in the blood carboxyhemoglobin level and a 3-fold increment in the quantity of tar inhaled compared with tobacco ( 14 ) . Studies on secondh and marijuana smoke have found endothelial dysfunction in rats after exposure ( 15 ) . Given the myriad ways in which marijuana might potentiate vascular disease , we conducted a systematic review to assess the effect of regular marijuana use on cardiovascular outcomes and their associated risk factors . Methods The protocol was registered at PROSPERO ( CRD42016051297 ) ( 16 ) at the start of our investigation . This review focuses on studies examining marijuana use and cardiovascular risk factors and outcomes ; our protocol also includes search es and a review of hemodynamic changes associated with marijuana use that are not reported here . Data Sources and Search es We search ed several online data bases ( PubMed , MEDLINE , EMBASE , PsycINFO , and the Cochrane Library ) for titles and abstract s between 1 January 1975 and 30 September 2017 . We chose a 1975 start date because that was the year the Alaska Supreme Court ruled that the Alaska constitution 's right to privacy protects an adult 's ability to use and possess a small amount of marijuana in the home for personal use ( 17 ) . We also conducted reference and author tracking to identify additional articles and search ed Clinical Trials.gov and the National Institutes of Health Research Portfolio ( NIH RePORTER ) for ongoing or completed studies not reported in the literature . For search terms and details , see Supplement 1 . Supplement . Supplementary Material Study Selection All titles and abstract s were independently screened by 2 review ers ( M.G. and D.R. ) . We included observational studies ( cohort , casecontrol , cross-sectional ) and interventional studies ( r and omized controlled trials , experimental studies ) that enrolled participants older than 12 years and were published in English . The exposure criterion was any form of marijuana ( plant or pharmaceutical ) . The main outcomes of interest were cardiovascular risk factors and outcomes . We excluded case reports , case series , review articles , editorials , and in vitro and animal studies . The same 2 investigators independently review ed the full texts of selected articles to identify those that met our inclusion criteria . Disagreements regarding inclusion were resolved by a third review er ( S.K. ) . Interrater reliability for the abstract selection process and the concurrent decision to include the article in the review was excellent ( Cohen , 0.87 ) . For the selection process , see Supplement 2 . Data Extraction and Quality Assessment For each included study , the review ers collected information on study design ( observational or experimental ) , the study population ( for example , healthy volunteers , regular users , or hospitalized patients ) , age distribution , cannabis make-up ( plant based or pharmaceutical ) , route of exposure ( smoking , vaporizing , eating , or injecting ) , exposure duration , and funding source . Four investigators ( D.R. , M.G. , S.K. , and D.K. ) independently rated study quality as low , moderate , or high risk of bias ( ROB ) . We assessed ROB for outcomes in trials with the Cochrane Risk of Bias Tool ( 18 ) , and for outcomes in observational studies with the Newcastle-Ottawa scale ( 19 ) . Disagreements were resolved by consensus . Risk-of-bias tools and scoring are available in Supplement 3 . Data Synthesis and Analysis We performed a qualitative assessment and synthesis of evidence . Because of the heterogeneity of outcomes and lack of reporting of effect sizes , we did not pool any data . Through group discussion , we grade d the overall strength of the evidence for each outcome as insufficient , low , moderate , or high on the basis of methods outlined by the Agency for Healthcare Research and Quality ( 20 ) . Role of the Funding Source The NIH had no role in the design , analysis , interpretation of data , preparation or approval of the manuscript , or decision to su bmi t the manuscript for publication . Results Literature Search Our search yielded 3006 abstract s , 1669 of which were selected for further evaluation . Among these , 140 were selected for full-text review . Another 7 articles were added via author and reference tracking . Of these 147 papers , 24 met our inclusion criteria ( Figure ) . Figure . Evidence search and selection . Study Characteristics The evidence included 9 prospect i ve cohort studies , 3 retrospective cohort studies , 2 casecontrol studies , 2 interventional studies ( 1 experimental study and 1 r and omized trial ) , 7 cross-sectional studies , and 1 case-crossover study . Thirteen studies assessed  cardiovascular risk factors  , and 11 examined  cardiovascular diseases .  Most studies ( n= 16 ; 66.7 % ) did not report the chemical constitution ( for example , THC vs. cannabidiol ) of the marijuana used in the study . Among articles that specified the form of marijuana used , the plant-based form was predominant ( n= 7 ) . Among those that specified the route of exposure , smoking was predominant ( n= 11 ) , followed by oral use ( n= 2 ) . Eleven papers did not report the specific route or form of marijuana administration ( such as edible or smoked ) . Tables 1 to 4 of Supplement 3 detail the quality assessment s for individual studies . Cardiovascular Risk Factors Metabolic Parameters : Lipid and Glucose Levels and Diabetes Eleven studies provided data on 1 or more metabolic parameter outcomes , including hyperglycemia , dyslipidemia , and diabetes ( Appendix Table 1 ) . Appendix Table 1 . Studies That Examined Exposure to MJ and CVD Five cross-sectional studies ( 3 low and 2 high ROB ) examined the association between marijuana use and hyperglycemia , dyslipidemia , metabolic syndrome , or diabetes ( 2125 ) . Marijuana use was measured by self-report in all studies . Four studies were based on 3 different waves of the NHANES ( National Health and Nutrition Examination Survey ; 1988 to 1994 , 2005 to 2010 , and 2005 to 2012 ) ( 2123 , 25 ) . Three of the 4 used multivariable analysis to examine the association between marijuana use and metabolic parameters after adjustment for baseline characteristics . All 3 studies reported that marijuana use had different favorable associations , including a lower prevalence of diabetes ( 22 ) , lower glucose levels ( 25 ) , or higher high-density lipoprotein cholesterol concentrations ( 21 , 22 , 25 ) . The fourth NHANES study ( 2005 to 2012 ) used both regression models and an instrumental variable analysis to examine associations ( 23 ) . Marijuana use was associated with a beneficial metabolic effect in the regression model evaluation ; no such effect was seen in the instrumental variable analysis . The final cross-sectional study was an exploratory analysis based on a small sample of 30 persons who were heavy marijuana users and 30 control participants matched for age , sex , ethnicity , and body mass index ( BMI ) ( 24 ) . The authors identified no differences between groups in glucose tolerance or fasting glucose , total cholesterol , or triglyceride levels . Three prospect i ve studies ( 1 low , 1 moderate , and 1 high ROB ) examined the association of marijuana use with risk factors ( 2628 ) . Two were based on the CARDIA ( Coronary Artery Risk Development in Young Adults ) cohort study , which examined the development and determinants of clinical and sub clinical cardiovascular disease and its risk factors ( 26 , 28 ) . The CARDIA study began in 1985 to 1986 with 5113 black and white men and women aged 18 to 30 years . It included comprehensive in-person baseline and outcome data ( sociodemographic characteristics ; fasting glucose levels ; BMI ; diet and physical activity ; and use of tobacco , alcohol , and other substances ) and several exposure assessment s during a long follow-up . Questions pertaining to marijuana use lacked detail on the form used , and exposure was quantified differently in each study . The low-ROB CARDIA-based study reported no associations between marijuana use and changes in glucose , high-density lipoprotein cholesterol , or triglyceride levels among heavy users ( > 1800 days of use ) compared with nonusers during 15 years of follow-up ( 26 ) . The moderate-ROB CARDIA-based study examined the association between marijuana use and diabetes and prediabetes ( 28 ) . Marijuana use was ascertained in year 7 of the prospect i ve cohort , and exposure was very limited : The highest category of use was a lifetime frequency of more than 100 times . Incidence of diabetes and prediabetes assessed at 4 subsequent follow-up examinations over 18 years was based on laboratory assessment ( oral glucose BACKGROUND Despite abundant epidemiologic evidence , the role of elevated serum uric acid level as a cardiovascular risk factor is controversial . We assessed the predictive value of serum uric acid levels for cardiovascular and overall mortality . METHODS A population -based prospect i ve cohort study was performed of 1423 middle-aged Finnish men initially without cardiovascular disease , cancer , or diabetes . The main outcome measure was death from cardiovascular disease and any cause . RESULTS The mean follow-up was 11.9 years . There were 157 deaths during follow-up , of which 55 were cardiovascular . In age-adjusted analyses , serum uric acid levels in the upper third were associated with a greater than 2.5-fold higher risk of death from cardiovascular disease than levels in the lower third . Taking into account cardiovascular risk factors and variables commonly associated with gout increased the relative risk to 3.73 . Further adjustment for factors related to the metabolic syndrome strengthened the risk to 4.77 . Excluding the 53 men using diuretics did not alter the results . In age-adjusted analyses , men with serum uric acid levels in the upper third were 1.7-fold more likely to die of any cause than men with levels in the lower third . Adjustment for further risk factors strengthened the association somewhat . CONCLUSIONS Serum uric acid levels are a strong predictor of cardiovascular disease mortality in healthy middle-aged men , independent of variables commonly associated with gout or the metabolic syndrome . Serum uric acid measurement is an easily available and inexpensive risk marker , but whether its relationship to cardiovascular events is circumstantial or causal remains to be answered BackgoundThrombosis is regarded to be a key factor in the development of acute coronary syndromes in patients with coronary artery disease ( CAD ) . We hypothesize , that hemostatic and rheological risk factors may be of major relevance for the incidence and the risk stratification of these patients . Methods In 243 patients with coronary artery disease and stable angina pectoris parameters of metabolism , hemostasis , blood rheology and endogenous fibrinolysis were assessed . Patients were prospect ively followed for 2 years in respect to elective revascularizations and acute coronary syndromes . Results During follow-up 88 patients presented with cardiac events , 22 of those were admitted to the hospital because of acute events , 5 Patients were excluded due to non- cardiac death . Patients with clinical events were found to be more frequently diabetic and presented with a more progressed coronary atherosclerosis . Even though patients with diabetes mellitus demonstrated a comparable level of multivessel disease ( 71 % vs. 70 % ) the rate of elective revascularization  was higher ( 41 % vs. 28 % , p < 0.05 ) . The results were also unfavorable for the incidence of acute cardiovascular events ( 18 % vs. 8 % , p < 0.01 ) . In comparison to non-diabetic patients diabetics demonstrated significantly elevated levels of fibrinogen ( 352 ± 76 vs. 312 ± 64 mg/dl , p < 0.01 ) , plasma viscosity ( 1.38 ± 0.23 vs. 1.31 ± 0.16 mPas , p < 0.01 ) , red blood cell aggregation ( 13.2 ± 2.5 vs. 12.1 ± 3.1 E , p < 0.05 ) and plasmin-activator-inhibitor ( 6.11 ± 3.4 vs. 4.7 ± 2.7 U/l , p < 0.05 ) . Conclusion Pathological alterations of fibrinogen , blood rheology and plasminogen-activator-inhibtor as indicators of a procoagulant state are of major relevance for the short-term incidence of cardiac events , especially in patients with diabetes mellitus type 2 , and may be used to stratify patients to specific therapies Background Evidence suggests that variations in fasting glucose and insulin amongst those without frank type 2 diabetes mellitus are important determinants of cardiovascular disease . However , the relative importance of variations in fasting insulin , glucose , and glycated haemoglobin as risk factors for cardiovascular disease in women without diabetes is unclear . Our aim was to determine the independent associations of fasting insulin , glucose , and glycated haemoglobin with coronary heart disease and stroke in older women . Methods and Findings We undertook a prospect i ve cohort study of 3,246 British women aged 60–79 y , all of whom were free of baseline coronary heart disease , stroke , and diabetes , and all of whom had fasting glucose levels below 7 mmol/l .  Fasting insulin and homeostasis model assessment for insulin sensitivity ( HOMA-S )  were linearly associated with a combined outcome of coronary heart disease or stroke ( n = 219 events ) , but there was no association of fasting glucose or glycated haemoglobin with these outcomes . Results were similar for coronary heart disease and stroke as separate outcomes . The age , life-course socioeconomic position , smoking , and physical activity adjusted hazard ratio for a combined outcome of incident coronary heart disease or stroke per one st and ard deviation of fasting insulin was 1.14 ( 95 % CI 1.02–1.33 ) . Additional adjustment for other components of metabolic syndrome , low-density lipoprotein cholesterol , fasting glucose , and glycated haemoglobin had little effect on this result . Conclusions Our findings suggest that in women in the 60–79 y age range , insulin resistance , rather than insulin secretion or chronic hyperglycaemia , is a more important risk factor for coronary heart disease and stroke . Below currently used thresholds of fasting glucose for defining diabetes , neither fasting glucose nor glycated haemoglobin are associated with cardiovascular disease Background Cardiovascular disease and type 2 diabetes are examples of chronic diseases that impose significant morbidity and mortality in the general population worldwide . Most chronic diseases are associated with underlying preventable risk factors , such as elevated blood pressure , high blood glucose or glucose intolerance , high lipid levels , physical inactivity , excessive sedentary behaviours , and overweight/obesity . The occurrence of intermediate outcomes during childhood increases the risk of disease in adulthood . Sugar-sweetened beverages are known to be significant sources of additional caloric intake , and given recent attention to their contribution in the development of chronic diseases , a systematic review is warranted . We will assess whether the consumption of sugar-sweetened beverages in children is associated with adverse health outcomes and what the potential moderating factors are . Methods / Design Of interest are studies addressing sugar-sweetened beverage consumption , taking a broad perspective . Both direct consumption studies as well as those evaluating interventions that influence consumption ( e.g. school policy , educational ) will be relevant . Non-specific or multi-faceted behavioural , educational , or policy interventions may also be included subject to the level of evidence that exists for the other interventions /exposures . Comparisons of interest and endpoints of interest are pre-specified . We will include r and omized controlled trials , controlled clinical trials , interrupted time series studies , controlled before-after studies , prospect i ve and retrospective comparative cohort studies , case – control studies , and nested case – control design s. The MEDLINE ® , Embase , The Cochrane Library , CINAHL , ERIC , and PsycINFO ® data bases and grey literature sources will be search ed . The processes for selecting studies , abstract ing data , and resolving conflicts are described . We will assess risk of bias using design -specific tools . To determine sets of confounding variables that should be adjusted for , we have developed causal directed acyclic graphs and will use those to inform our risk of bias assessment s. Meta- analysis will be conducted where appropriate ; parameters for exploring statistical heterogeneity and effect modifiers are pre-specified . The Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach will be used to determine the quality of evidence for outcomes . Systematic review registration PROSPERO CRD42014009641 Background Diabetes has long been recognised as a strong , independent risk factor for cardiovascular disease , a problem which accounts for approximately 70 % of all mortality in people with diabetes . Prospect i ve studies show that compared to their non-diabetic counterparts , the relative risk of cardiovascular mortality for men with diabetes is two to three and for women with diabetes is three to four . The two biggest trials in type 2 diabetes , the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) and the University Group Diabetes Program ( UGDP ) study did not reveal a reduction of cardiovascular endpoints through improved metabolic control . Theoretical benefits of the peroxisome proliferator activated receptor gamma ( PPAR-gamma ) activator rosiglitazone on endothelial function and cardiovascular risk factors might result in fewer macrovascular disease events in people with type 2 diabetes mellitus . Objectives To assess the effects of rosiglitazone in the treatment of type 2 diabetes . Search methods Studies were obtained from computerised search es of MEDLINE , EMBASE and The Cochrane Library . Selection criteria Studies were included if they were r and omised controlled trials in adult people with type 2 diabetes mellitus and had a trial duration of at least 24 weeks . Data collection and analysis Two authors independently assessed trial quality and extracted data . Pooling of studies by means of fixed-effects meta- analysis could be performed for adverse events only . Main results Eighteen trials which r and omised 3888 people to rosiglitazone treatment were identified . Longest duration of therapy was four years with a median of 26 weeks . Published studies of at least 24 weeks rosiglitazone treatment in people with type 2 diabetes mellitus did not provide evidence that patient-oriented outcomes like mortality , morbidity , adverse effects , costs and health-related quality of life are positively influenced by this compound . Metabolic control measured by glycosylated haemoglobin A1c ( HbA1c ) as a surrogate endpoint did not demonstrate clinical ly relevant differences to other oral antidiabetic drugs . Occurrence of oedema was significantly raised ( OR 2.27 , 95 % confidence interval ( CI ) 1.83 to 2.81 ) . The single large RCT ( ADOPT - A Diabetes Outcomes Progression Trial ) indicated increased cardiovascular risk . New data on raised fracture rates in women reveal extensive action of rosiglitazone in various body tissues . Authors ' conclusions New studies should focus on patient-oriented outcomes to clarify the benefit-risk ratio of rosiglitazone therapy . Safety data and adverse events of all investigations ( published and unpublished ) should be made available to the public The aim of this study is to review recent data on dietary fiber ( DF ) and the glycemic index ( GI ) , with special focus on studies from the Nordic countries regarding cardiometabolic risk factors , type 2 diabetes , cardiovascular disease , cancer , and total mortality . In this study , recent guidelines and scientific background papers or up date s on older reports on DF and GI published between 2000 and 2011 from the US , EU , WHO , and the World Cancer Research Fund were review ed , as well as prospect i ve cohort and intervention studies carried out in the Nordic countries . All of the reports support the role for fiber-rich foods and DF as an important part of a healthy diet . All of the five identified Nordic papers found protective associations between high intake of DF and health outcomes ; lower risk of cardiovascular disease , type 2 diabetes , colorectal and breast cancer . None of the reports and few of the Nordic papers found clear evidence for the GI in prevention of risk factors or diseases in healthy population s , although association was found in sub-groups , e.g. overweight and obese individuals and suggestive for prevention of type 2 diabetes . It was concluded that DF is associated with decreased risk of different chronic diseases and metabolic conditions . There is not enough evidence that choosing foods with low GI will decrease the risk of chronic diseases in the population overall . However , there is suggestive evidence that ranking food based on their GI might be of use for overweight and obese individuals . Issues regarding methodology , validity and practicality of the GI remain to be clarified BACKGROUND The Diabetes Prevention Program ( DPP ) demonstrated that lifestyle intervention reduces risk for type 2 diabetes and the metabolic syndrome . A universal framework for translation of multiple aspects of the DPP intervention , including training , support , and evaluation is needed to enhance treatment fidelity in a variety of setting s. PURPOSE This study aims to develop a comprehensive model for diabetes prevention translation using a modified DPP lifestyle intervention . METHODS The DPP lifestyle intervention was adapted to a 12-session group-based program called Group Lifestyle Balance for implementation in the community setting . A model for training and support mirroring that of the DPP was developed for prevention professionals administering the program . The process of training/support and program implementation was evaluated for feasibility and effectiveness using a nonr and omized prospect i ve design in two phases ( N=51 , Phase 1 : 2005 - 2006 ; N=42 , Phase 2 : 2007 - 2009 ; data analysis completed 2008 - 2009 ) . A total of 93 nondiabetic individuals with BMI > or=25 kg/m(2 ) and the metabolic syndrome or prediabetes participated . Measures were collected at baseline and post-intervention for all and 6 and 12 months post-intervention for Phase 2 . RESULTS Significant decreases in weight , waist circumference , and BMI were noted in both phases from baseline . Participants in Phase 2 also demonstrated decreases in total cholesterol , non-HDL cholesterol , and systolic and diastolic blood pressure that were maintained at 12 months . Average combined weight loss for both groups over the course of the 3-month intervention was 7.4 pounds ( 3.5 % relative loss , p<0.001 ) ; 23.8 % and 52.2 % of those who completed the program reached 7 % and 5 % weight loss , respectively . More than 80 % of those achieving 7 % weight loss in the Phase-2 group maintained their weight loss at 6 months . CONCLUSIONS A comprehensive diabetes prevention model for training , intervention delivery , and support was shown to be successful and was effective in reducing diabetes and cardiovascular disease risk factors in this group of high-risk individuals Objectives . Overview the quality , direction , and characteristics of yoga interventions for treatment of acute and chronic health conditions in adult population s. Methods . We search ed for systematic review s in 10 online data bases , bibliographic references , and h and - search es in  yoga-related  journals . Included review s satisfy Oxman criteria and specify yoga as a primary intervention in one or more r and omized controlled trials for treatment in adults . The AMSTAR tool and GRADE approach evaluated the method ological quality of review s and quality of evidence . Results . We identified 2202 titles , of which 41 full-text articles were assessed for eligibility and 26 systematic review s satisfied inclusion criteria . Thirteen systematic review s include quantitative data and six papers include meta- analysis . The quality of evidence is generally low . Sixteen different types of health conditions are included . Eleven review s show tendency towards positive effects of yoga intervention , 15 review s report unclear results , and no , review s report adverse effects of yoga . Yoga appears most effective for reducing symptoms in anxiety , depression , and pain . Conclusion . Although the quality of systematic review s is high , the quality of supporting evidence is low . Significant heterogeneity and variability in reporting interventions by type of yoga , setting s , and population characteristics limit the generalizability of results
However , these effects were not robust against selection bias .
Conclusion Based on the results of this meta- analysis , no recommendation can be made for or against yoga in order to influence the parameters of metabolic syndrome .
Despite method ological drawbacks , and until further research is undertaken , yoga can be preliminarily considered as a safe and effective intervention for reducing waist circumference and systolic blood pressure in individuals with metabolic syndrome who are not adhering to conventional forms of exercise
Background Metabolic syndrome is the most important risk factor for developing cardiovascular disease and type 2 diabetes .
The aim of this review was to systematic ally assess and perform a meta- analysis of the effects of yoga on the parameters of metabolic syndrome .