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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIn a survey of the 50 US states in 1985, the highest rates of obesity reported were 10\u201314% per capita in 8 states. This number changed drastically in the last 30 years, with 4 of the 50 states reporting \u0026gt;25% obesity in 2003, and the vast majority of the remaining states reporting 20\u201324% obesity. This article gives an overview of obesity, its relationship to diabetes, and what this means to cardiologists.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eobesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ediabetes mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Elipid disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EIn a survey of the 50 US states in 1985, the highest rates of obesity reported were 10\u201314% per capita in 8 states. This number changed drastically in the last 30 years, with 4 of the 50 states reporting \u0026gt;25% obesity in 2003, and the vast majority of the remaining states reporting 20\u201324% obesity. Barbara V. Howard, PhD, Medstar Research Institute, Hyattsville, MD, gave an overview of obesity, its relationship to diabetes, and what this means to cardiologists. \u201cThis is an extraordinary change over a very short period of time,\u201d said Dr. Howard. This problem is not isolated to the United States, as obesity rates are climbing worldwide. Why is this happening? Although a great deal of attention has been given to the Western diet, inactivity is also a huge culprit. Current lifestyles involve much less physical activity than in previous times.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EIt is critical that glucose levels in cardiac patients be managed appropriately. Data from the CARDINAL (Complement and ReDuction of INfarct size after Angioplasty or Lytics) highlights the importance of glucose levels in coronary disease. This study found that nondiabetic patients with acute myocardial infarction (MI) who had high glucose levels at baseline and whose levels remained elevated had higher mortality (Goyal et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2006). Because of the escalation of diabetes prevalence, it is projected that contribution of diabetes to cardiovascular death will rise from 21% in 1999 to 29% in 2025 (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). \u201cThis is not just an epidemiologic problem, it\u0027s translated into the patients you\u0027re seeing,\u201d noted Dr. Howard.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/7\/23\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Obesity Trends Among US Adults.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-971722041\u0022 data-figure-caption=\u0022Obesity Trends Among US Adults.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/7\/23\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/7\/23\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/7\/23\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10886\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EObesity Trends Among US Adults.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EDaniel Kelly, MD, Washington University, St. Louis, MO, presented the basic metabolic mechanisms of the diabetic heart. \u201cOf the four major disease killers in the US today [heart disease, diabetes, cancer, stroke] diabetes is the only one that has increasing age-adjusted death rates\u201d said Dr. Kelly in his introductory remarks. Indeed, cardiovascular disease (CVD) remains the leading cause of death in people with diabetes. In addition to atherosclerosis and hypertension that often accompany diabetes, there is myocardial disease as well. This is illustrated by the fact that diabetic patients have a much graver prognosis following an acute MI than nondiabetic patients. \u201cTraditional secondary cardiac therapies we are giving patients following myocardial infarction are not as effective in the diabetic population,\u201d said Dr. Kelly.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EOne thought is that the accumulation of fat in the heart affects CVD in diabetic patients. \u201cThis really is a problem of accounting, that there are more calories coming in than can be expended,\u201d said Dr. Kelly. Once storage in the adipose tissue is exceeded, other organs (including the heart) begin storing fat. It is possible that this storage of fat in the heart muscle impacts the function of the heart in diabetic patients. The peroxisome proliferator activated receptor alpha (PPAR-\u03b1) promotes the transport and oxidation of fatty acids in the heart. This has led researchers to hypothesize that chronic activation of PPAR-\u03b1 may be to blame in the problems of the diabetic heart. This idea has been explored using a transgenic mouse model (MHC PPAR-\u03b1), whereby the mice have chronic expression of PPAR-\u03b1. \u201cMany of the signatures of the diabetic heart were recapitulated in this animal model\u2026the hearts ran on fat,\u201d said Dr. Kelly. When more fat was added to the mouse diet, additional cardiac dysfunction was observed (Finck et al. \u003Cem\u003EJ Clin Invest\u003C\/em\u003E 2002; Finck et al. \u003Cem\u003EProc Natl Acad Sci USA\u003C\/em\u003E 2003). These mice were subsequently bred with mice that had reduced cellular fat transport, the hypothesis being the inability to transport fat would \u201crescue\u201d the heart from lipotoxicity. The results demonstrated that this was the case (Yang et al. \u003Cem\u003ECirc Res\u003C\/em\u003E 2007). \u201cThese types of studies have demonstrated to us that 1) the importance chronically programming that is involved in metabolism of the diabetic heart, and 2) the increase of fatty acid delivery that occurs in the diabetic state. It raises the question of whether we should be thinking of modulating fatty acid and lipid delivery to the heart in the individual who has a combination of heart disease and diabetes,\u201d summarized Dr. Kelly.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EDarren McGuire, MD, University of Texas Southwestern Medical Center, Dallas, TX, discussed the treatment goals of diabetic patients in 2007. The rising increase in diabetes is a \u201cdramatic public health catastrophe and we are at the forefront of that,\u201d said Dr. McGuire. \u201cWe have completely engineered physical activity out of our daily lives,\u201d he noted. One therefore has to make a conscious choice to take the stairs instead of the elevator, and walk more during the day. He suggested that attendees use the pedometers given to them at the meeting, and encourage their patients to do so as well.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EThe number one treatment goal is diabetes prevention, and lifestyle interventions have demonstrated that they work. In the Diabetes Prevention Project trial, diabetes risk reduction was nearly 60% by lifestyle changes and significantly better than metformin or placebo (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E; Knowler et al. \u003Cem\u003ENEJM\u003C\/em\u003E 2002). The second treatment goal is better surveillance of diabetes. Cardiologists should be aware that because of the rising prevalence of diabetes, some heart patients may be undiagnosed. \u201cBefore you check the coronary arteries you need to know if that patient has diabetes or not,\u201d said Dr. McGuire. The third treatment goal is to aggressively address the cardiovascular risk that diabetic patients face. The American Diabetes Association recommends the following in order to reduce CVD risk in these patients:\u003C\/p\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n               \u003Cp id=\u0022p-9\u0022\u003ELifestyle counseling including smoking cessation, body weight control, increasing exercise, and improvement in diet\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n               \u003Cp id=\u0022p-10\u0022\u003EAspirin for those \u0026gt; 40 years of age or those with another cardiac risk factor\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n               \u003Cp id=\u0022p-11\u0022\u003EUse of statins for those \u0026gt; 40 years of age regardless of baseline LDL\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n               \u003Cp id=\u0022p-12\u0022\u003EBlood pressure less than 130\/80 mm Hg\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n               \u003Cp id=\u0022p-13\u0022\u003EAce inhibitors for patients \u0026gt;55 of age with another cardiac risk factor, independent of blood pressure (ADA, 2007)\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/7\/23\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Treatment Goal #1: Preventing Diabetes.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-971722041\u0022 data-figure-caption=\u0022Treatment Goal #1: Preventing Diabetes.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/7\/23\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/7\/23\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/7\/23\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10889\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-14\u0022 class=\u0022first-child\u0022\u003ETreatment Goal #1: Preventing Diabetes.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EIn the face of the epidemics of obesity and diabetes, clinicians should be aware of the problems inherent in these conditions to counsel and treat patients appropriately.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2007 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/7\/7\/23.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzm782\u0022\u003E\u003C\/script\u003E\n\u003Cscript 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