Posts Tagged hypertension

Diabetes & Cardiovascular Disease Risk Factors among South Asians Compared to other Ethnic Groups


Dr. Alka Kanaya talked about Diabetes and cardiovascular disease risk factors in multi-ethnic groups comparison studies, at a joint event hosted by  www.eppicglobal.org and  www.bio2devicegroup.org .  Dr. Kanaya is Professor of Medicine, Epidemiology, and Biostatistics at UCSF and a principal investigator in Mediators of Atherosclerosis in South Asians Living in America or MASALA study, for short.  Primary objective of the study was to research and understand the high incidence of diabetes and CHD among people of South Asian origin.

Kanaya first shared information on South Asians (will be referred here as SA) and then discussed the study results in the context of multi ethnic comparison.  Currently there are 3.4 M people from South Asia living in the US.  It is the second fastest growing racial/ ethnic minority in the US.  They constitute 20% of all Asians and 75% of them are foreign born.  Although there is little organized medical data on SAs, overall they have relatively lower body weight (BMI), have more central abdominal obesity, and experience higher rates of diabetes and indicate high risk of early heart disease.

MASALA study began in March, 2010 and constitutes a total sample of 906 people, between the ages of 40 and 84.  People with prior history of any cardiovascular disease, those in active cancer treatments, those planning to move out of the area in the next 5 years, and nursing home residents, were excluded.  Data collected included weight, height, waist, seated BP, Ankle-brachial index (ABI predicts the sevearity of PAD, peripheral artery disease), 2 hour OGTT (oral glucose tolerance test), abdominal CT, and several blood tests and extremely detailed questionnaires regarding family history and information about personal habits like alcohol, smoking, sleep, diet and exercise.

Results from MASALA study were compared to results on almost all similar measures with Whites, Latinos, African-Americans and Chinese populations in ongoing MESA study.  See the websites of MESA (www.mesa.nhlbi.org) and MASALA (www.masalastudy.org) studies to see many interesting details on several patterns that emerged.  Kanaya specifically discussed some patterns among South Asians when compared with other ethnic groups.

When adjusted by sex and age, South Asians had significantly high rates of hypertension.  However, there weren’t major or alarming differences in cholesterol.  One of the reasons could be that South Asians were overall more educated, from higher socio-economic background, and were more likely to be using statins and other cholesterol lowering drugs

Most alarming differences were observed in diabetes and pre-diabetes levels.  Almost 30% of men and almost 15% of South Asian women had Diabetes Mellitus, versus 20% or lower among other groups of men, and 13% or lower among other groups of women.  Nearly 37% of SA men and 29% of SA women had IFG (impaired fasting glucose indicative of pre-diabetes), compared to 20% or less for men and 13% or less for women from other groups.  When adjusted for many indicators including age, sex, cholesterol, triglycerides, hypertension etc., South Asians were significantly more likely to have type 2 diabetes.

When adjusted for age, sex, BMI, and waist and excluding those on diabetes meds, this high incidence of Diabetes Mellitus among South Asians seemed to be associated with higher levels of insulin resistance, lower pancreatic B-cell function, and (as confirmed by abdominal CT data) high amount of body fat around abdominal regions and in the liver.

Mercat de la Boqueria, fruits & vegetables

Mercat de la Boqueria, fruits & vegetables (Photo credit: Wikipedia)

Among lifestyle factors, the high rates of DM (Diabetes Mellitus) among SA was attributed to poor diet with less fruits and vegetables and more Western diet (including pizza, pasta etc.), sweets, refined grains, and consumption of high animal based protein in the diet and low levels of exercise.  Considering that even on a relatively leaner body, South Asians carry more fat, the study concluded that guidelines for BMI should be lower for people of South Asian origin.

The study concluded that 75% of South Asians were overweight or obese using the recommended BMI cut-points in Asians.  Compared to other racial/ ethnic groups, South Asians were from higher socio economic status, had low smoking rates, and low to moderate alcohol use.  They also indicated very low physical activity, higher diabetes prevalence (specially among men), second highest prevalence of high blood pressure, and men have more coronary calcium than other groups.

A yoga class.

A yoga class. (Photo credit: Wikipedia)

Some of the recommendations for South Asians from the study were, to know the risk factors, work towards ideal BMI goal (less than 23 kg/m2 for SA), remember waist size matters more than BMI, walk at least 30 minutes a day 5 days a week, avoid a diet high in animal protein and refined carbs, and then something interesting – do Yoga!

Kanaya also shared results from her PRYSMS study that assigned subjects with metabolic syndrome into two groups, one practicing Restorative Yoga (included lot of lying down and relaxing poses) and other, Stretching Exercises.  In 6 months, both groups improved their PA and calorie intake.  Favorable changes in the stretching group included, lowered triglycerides and improved mental health.  Restorative yoga group reduced and sustained weight loss and weight girth loss but not visceral fat area.  Finally, only yoga group indicated reduction of fasting glucose and overall favorable metabolic changes in the yoga group included lowering of fasting insulin, glucose, HbA1c and HDL.

One wonders if very determined focus on material wealth goes with more stress.  In any case, it shows once again that stress relief is a key for improved health.  This was a fascinating talk and was followed by Q&A and animated discussion.

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How Technology Solutions can be Scaled to Improve Medical Adherence


 

 

Worldwide, medical adherence or patients prematurely stopping their medications, is a major obstacle to the effective delivery of health care.  David Parpart and Sunit Gala talked about the complexity of the problem, the enormous cost to the healthcare of non-compliance and the technology-based solutions they are offering (www.impactmeds.com) to improve adherence at a www.bio2devicegroup.org event.
To give a sense of the enormity of the problem, Parpart shared a typical scenario where out of 100% prescriptions, only 50-70% go to the pharmacy, and out of that only 48-66% come out of pharmacy, out which only 25-30% of the medications are taken as prescribed and finally a miniscule 15-20% are refilled as prescribed by the physician.  Among new prescriptions for medicines used to treat chronic conditions associated with increased cardiovascular risk, such as hypertension, diabetes, and dyslipidemia, according to some estimates, one-third of all new prescriptions go unfilled. About 350 daily deaths in the US are attributed to lack of medical adherence, said Parpart.

 

Non-adherence to prescribed medications not only costs huge amount of lost revenue to the pharmaceutical companies and lost sales to the drug stores, but also it also burdens hospitals with readmissions and burdens the payers, in addition to the impact on patients.  On account of non adherence, many patients suffer from bad health, and in many cases, particularly those suffering from chronic diseases, die early.   Chronic diseases account for 70% of all deaths and are the leading cause of mortality in the United States.  Patients who don’t take their medications as prescribed cost the U.S. health care system an estimated $290 billion.  Non-compliance costs pharmaceutical companies $300 billion in lost revenues.  Added cost to the society is $100 billion in preventable hospital visits and $350 billion in productivity losses.  There is a huge opportunity here to reduce costs and improve outcomes.  About 1 million unnecessary deaths can be prevented just within the United States this decade, with improved medical adherence, said Parpart.

 

So what are major barriers to medical adherence?  Some of the major barriers include the complexity of medication regimens, especially in case of chronic diseases when the patient is often taking 9 to 12 medications multiple times per day; the occurrence of side effects, which are sometimes unknown to the patients; the cost of prescription medications; and poor communication and lack of trust between the patient and their health care provider.  Just providing a planned opportunity for the patient to interact with the pharmacist regarding side effects and the necessity of sticking with the regimen greatly improves compliance according to numerous well-documented studies conducted by organizations such as the American Pharmacists Association.

 

Parpart and Gala shared the Impact Meds solution to this enormous challenge.   They leverage technology with a cloud-based software platform, RFID,  and offer an array of solutions that can be tailored and customized, starting with an opportunity for patients and pharmacists to register on their website with easy access for patients to get their questions answered and get pharmacist led counseling.  Their solution is a combination of availability of medical information, easy access points for patient-pharmacist interaction, tools for caregivers, medical tracking solutions, tracking biometrics and purchase refills, and scaling it to have maximum impact in terms of lowered medical costs to society and improved health for patients.  An important aspect of the solution is how it incentivizes pharmacists, physicians and patients through a combination of respect, regard and reward. Impact Meds is a recipient of 2012 Sanofi US Innovation Challenge Award, as well The Palo Alto Medical Foundation’s Developer Challenge.  The presentation was followed by Q&A from an enthusiastic audience, with the event running over-time.

 

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