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Take a look at a selection of our recent media coverage:

Cardiometabolic and social factors combined better for prediction of adverse COVID-19 outcomes

15th July 2022

Combining both cardiometabolic and social determinants of health improves the predictive power of models assessing outcomes in COVID-19

The combination of clinical markers of cardiometabolic disease and social determinants of health provides a better predictive model for adverse outcomes in patients with COVID-19 according to a retrospective analysis by researchers from Alabama, US.

Cardiometabolic diseases such as diabetes have become recognised as a risk factor for both infection and more severe disease in COVID-19. Moreover, it has also become clear that there increased risks of infection and more severe disease based on race, ethnicity and various socioeconomic determinants. Therefore, combined analyses that incorporate both cardiometabolic and social factors might enable a better understanding of how health disparities impact upon COVID-19 outcomes, yet such analyses are rarely undertaken. As a result, for the present study, the US team made use of electronic health records incorporating both clinical and social factors and sought to determine the ability of models based on parameters extracted from both factors, were able to predict the subsequent need for hospitalisation, intensive care unit (ICU) admission and mortality after infection with COVID-19.

Using these records, the researchers obtained clinical patient data (e.g., glucose levels, body mass index, blood pressure etc) and to calculate a cardiometabolic disease staging (CMDS) value, used to assign risk levels for diabetes, and all-cause and cardiovascular disease mortality. CMDS values range from 0 to 0.99 with higher values indicating a greater risk of developing diabetes. Individual-level social determinants of health (SDoH) included factors such as martial, employment and insurance status. A neighbourhood SDoH considered factors such as social vulnerability (an index of poverty) rurality and health care access. Using regression analysis, the researchers modelled the risk of being hospitalised, admitted to ICU and death, using a CMDS model only and then after addition of both individual and neighbourhood SDoH values to determine whether the predictive power of the model changed and which was assessed by measuring the area under the curve.

Cardiometabolic health and COVID-19-related outcomes

A total of 2,873 patients with a mean age of 58.3 years (40.9% male) were included in the analysis, of whom 13.9% were hospitalised, 13.7% admitted to an ICU and 14.8% who died.

Using the CMDS model, each one standard deviation increase in CMDS score was associated with hospitalisation (odds ratio, OR = 2.0, 95% CI 1.83 – 2.20), ICU admission (OR = 1.88) and death (OR = 1.69).

Based on individual level SDoH, patients with no insurance had a higher odds of being hospitalised (OR = 3.35), an ICU admission (OR = 2.99) and death (OR = 7.27). In addition, the analysis also showed that patients with high social vulnerability were more likely to be hospitalised or admitted to an ICU.

Interestingly, when the CMDS model alone was used to predict hospitalisation, it had an area under the curve (AUC) of 0.776. But when individual level SDoH was added to the model, the predictive power improved and the AUC increased to 0.815. However, when both individual and neighbourhood SDoH were added, the AUC increased slightly more (0.819) and in both instances, these differences were significant (p < 0.05). Similar improvements to the predictive power were seen when individual and neighbourhood SDoH were added for both ICU admission and mortality models.

The authors concluded that using both clinical and social factor data improved the predictability of models for determination of the risk of severe outcomes after infection with COVID-19. They added that incorporation of both clinical and social measures could help guide treatment, intervention and prevention efforts to improve both health and inequality.

Citation
Howell CR et al. Associations between cardiometabolic disease severity, social determinants of health (SDoH), and poor COVID-19 outcomes Obesity (Silver Spring) 2022

Omega-3 supplements appear ineffective for depressed patients with cardiometabolic disease

9th June 2022

A meta-analysis has found that, compared with placebo, omega-3 supplements did not improve depression scores in those with cardiometabolic disease

Omega-3 supplements given to patients with cardiometabolic disease and who experience depression do not produce a meaningful improvement in depression scores compared to placebo. This was the conclusion from a systematic review and meta-analysis by researchers from Leicester, UK.

The term cardiometabolic disease encompasses cardiovascular disease, diabetes and chronic renal failure, and which are the top causes of death across the world. Among individuals with cardiometabolic disease, the presence of co-morbid mental health conditions, such as depression, have been found to increase the risk of cardiovascular mortality. Moreover, cardiometabolic diseases can give rise to depression, as evidenced by the fact that 28% of patients attending a cardiac rehabilitation clinic were found to be suffering from depression. Patients with depression can be easily treated with antidepressants although there is tentative evidence that the use of antidepressants can increase the risk of both cerebrovascular and cardiovascular disease. One dietary alternative to medical therapy is the use of omega-3 supplements with some data showing that the use of these supplements improved depression symptoms among patients with HIV. Furthermore and more widely, a 2019 meta-analysis of the use of omega-3 supplements concluded that these supplements have a beneficial effect on depression.

Nevertheless, whether the use of omega-3 supplements in patients with cardiometabolic diseases, and who are depressed, is an effective treatment has not been examined and was the subject of the present analysis. The UK team undertook a systematic review and meta-analysis of double-blind, randomised trials, in which the supplements were used, to determine the impact on depression scores in this population. The primary outcome was the mean change in depression scores at the point of follow-up.

Omega-3 supplements and depression scores

Only 7 trials were eligible for inclusion in the final analysis which reported on the outcome for 2,574 participants (74% male) with diabetes, coronary heart disease, cardiovascular disease, heart failure and a recent acute myocardial infarction.

All of the trials used omega-3 supplements with doses ranging from 1000 to 3000mg and for 10, 12 or 48 weeks.

Overall, 6 of the 7 trials recorded no statistically significant improvement compared to placebo (p > 0.05) at the end of the intervention. In the one trial where an improvement did occur, there was a 34% reduction in Beck Depression Inventory scale score (p < 0.05).

Commenting on the trials the authors described how they had focused on randomised trials to reduce the risk of bias but despite this restriction, several of the trials were ranked as either ‘moderate’ or ‘high’ for risks of bias.

They concluded that while omega-3 supplements appeared to be safe, the available data did not suggest that such supplements would reduce depression scores in patients with cardiometabolic diseases.

Citation
Arsenyadis F et al. The Effects of Omega-3 Supplementation on Depression in Adults with Cardiometabolic Disease: A Systematic Review of Randomised Control Trials Nutrients 2022

Sustained weight loss reduces risk of adverse cardiometabolic outcomes

3rd November 2021

Sustained weight loss over 6 years delays the onset of the adverse cardiometabolic outcomes type 2 diabetes, hypertension and hyperlipidaemia.

A sustained weight loss over several years, not only delays but reduces the overall incidence of adverse cardiometabolic outcomes including type 2 diabetes, hypertension and hyperlipidaemia. This was the conclusion of a retrospective analysis of nearly 50,0000 patients by researchers from Geisinger Health, Pennsylvania, US. According to the world Health Organisation (WHO), worldwide levels of obesity have tripled since 1975 and in 2016, more than 1.9 billion adults, 18 years and older, were overweight and of these over 650 million were obese. However, obesity is not limited to adults and WHO data also suggests that in 2020, 39 million children under the age of 5 were overweight or obese. In a 2017 article, the World Obesity Federation issued a position statement, arguing that obesity should be perceived as a chronic relapsing disease process in which an abundance of food, coupled with low levels of physical activity, various environmental factors and genetic susceptibilities, all interact to create a positive energy balance. Increased weight and obesity are linked to a higher incidence of cardiovascular diseases, musculoskeletal disorders and some cancers. Nevertheless, even a 5% sustained weight loss improves metabolic function in multiple organs although longer term maintenance of weight loss is challenging, with one meta-analysis of 29 weight loss studies concluding that “weight-loss maintenance 4 or 5 y after a structured weight-loss program averages 3.0 kg or 23% of initial weight loss.”

However, what remains unclear is the impact of sustained weight loss on the development of cardiometabolic diseases and for the present study, researchers turned to in data held the Geisinger Health System, which represents one of the largest healthcare organisations in the US. The team looked at adult patients for whom there were 3 or more electronic health record entries for weight measurements within a 2-year period. Individuals were then categorised as obesity maintainers (OM), i.e., those with a history of obesity and who maintained their weight within 3% of their baseline levels; weight loss rebounders (WLRs) who had lost > 5% body weight but had regained > 20% of their 1-year loss and finally weight loss maintainers (WLMs), who again loss > 5% of their body weight but maintained > 80% of their 1-year weight loss. The outcomes of interest were the development of type 2 diabetes, hypertension and hyperlipidaemia, all of which were extracted from the electronic health records. In their analysis, researchers adjusted for several factors such as age, gender and various co-morbidities.

Findings

The sample contained 49,327 individuals with a mean age of 50.4 years (60.2% female) with the majority classed as OM (the reference group) and the whole sample were followed-up for a mean period of 6.6 years. After 5 years, 11.1% of the OM, 9.1% of the WLR and 6.5% of the WLM had developed type 2 diabetes and those in the sustained weight loss group (WLM) had a 33% lower risk of developing incident type 2 diabetes (adjusted hazard ratio, aHR = 0.68, 95% CI 0.62 – 0.74, p < 0.0001). Similarly, the WLM had a reduced risk of developing hypertension (aHR = 0.72) and hyperlipidaemia (aHR = 0.86).

Based on these findings, the authors concluded that sustained weight loss was associated with a delayed onset of cardiometabolic diseases and that these associations are enhanced in those with the greatest weight loss.

Citation

Bailey-Davis L et al. Impact of Sustained Weight Loss on Cardiometabolic Outcomes. Am J Cardiol 2021