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VASCULAR DISEASES IN THE 21st CENTURY . How Technology Plays a Role. TOPIC OUTLINE. Description of the Evolution of Technology Effects of Technology on the Risk Factors for Vascular Disease Discussion of the Risk factors on Vascular Disease. Evolution of Technology.

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vascular diseases in the 21st century

VASCULAR DISEASES IN THE 21st CENTURY

How Technology Plays a Role

topic outline
TOPIC OUTLINE

Description of the Evolution of Technology

Effects of Technology on the Risk Factors for Vascular Disease

Discussion of the Risk factors on Vascular Disease

evolution of technology
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
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 boon1
High Tech Era : Bane or Boon?

Technological advancements lead to more sedentary lifestyle

sedentary behavior
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

slide7

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
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)

McGavockJM, Anderson TJ, LewanczukRZ. Am J Hypertens. 2006 Jul;19(7):701-7.

sedentary lifestyle and antecedents of vascular disease in young adults1
Sedentary lifestyle and antecedents of vascular disease in young adults
  •  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.
sedentary lifestyle and antecedents of vascular disease in young adults2
Sedentary lifestyle and antecedents of vascular disease in young adults

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).

s edentary b ehaviour and vigorous physical a ctivity on segment specific carotid wall thickness
Sedentary Behaviour and Vigorous Physical Activity on Segment-Specific Carotid Wall Thickness

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

slide12

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

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

slide13

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

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

slide14

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

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

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

slide15

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

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)

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

low recreational a ctivity as a r isk f actor for peripheral arterial disease
Low Recreational Activity as a Risk Factor for PeripheralArterialDisease

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 a ctivity as a r isk f actor for peripheral arterial disease1
Low Recreational Activity as a Risk Factor for PeripheralArterialDisease

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
Sedentary Hours and Slow Walking Speed Predicts Functional Decline in PAD

384 patients with an ABI <0.90

Slower 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 CollCardiol. 2011 Jun 7;57(23):2356-64.

fast food and cardiovascular disease
Fast Food and Cardiovascular Disease
  • In the United States, 37% of adults and 42% of childrenregularly 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– 8

2Pereira 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
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.
  • Univariateanalysis 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
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 and cvd risk markers the hamburg burger trial
Effects of fast-food meals on vascular function andCVD risk markers: the Hamburg Burger Trial

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 and cvd risk markers the hamburg burger trial1
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
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.

slide27

The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice A Rozanski et al. J Am CollCardiol, 2005; 45:637-651

Conceptual Models of Work Stress

slide28
Associations of occupation withintima-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

slide29

Associations of occupation with intima-media thickness: The Multi-Ethnic Study of Atherosclerosis (MESA)

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

slide30

Associations of occupation with intima-media thickness: The Multi-Ethnic Study of Atherosclerosis (MESA)

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

slide31

Associations of occupation with intima-media thickness: The Multi-Ethnic Study of Atherosclerosis (MESA)

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

slide32

Associations of occupation with intima-media thickness: The Multi-Ethnic Study of Atherosclerosis (MESA)

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.

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

health risk behaviors among business process outsourcing employees in the philippines luzon 2008
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
Health Risk Behaviors Among Business Process Outsourcing Employees in the Philippines

Cross sectional study

Qualitative: Focus Group Discussion(FGD)

Quantitative: Key Informant Interview(KII)

Primary Sampling Unit: BPO Companies

460 respondents, ≥ 18 yrs old

health risk behaviors among business process outsourcing employees in the philippines1
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 sex

52% consensual sex

67% never used condom

health risk behaviors among business process outsourcing employees in the philippines2
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
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)

slide38
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
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