This online calculator can predict your stroke risk

August 14, 2020

Science Daily/University of Virginia Health System

Doctors can predict patients' risk for ischemic stroke based on the severity of their metabolic syndrome, a conglomeration of conditions that includes high blood pressure, abnormal cholesterol levels and excess body fat around the abdomen and waist, a new study finds.

The study found that stroke risk increased consistently with metabolic syndrome severity even in patients without diabetes. Doctors can use this information -- and a scoring tool developed by a UVA Children's pediatrician and his collaborator at the University of Florida -- to identify patients at risk and help them reduce that risk.

"We had previously shown that the severity of metabolic syndrome was linked to future coronary heart disease and type 2 diabetes," said UVA's Mark DeBoer, MD. "This study showed further links to future ischemic strokes."

Ischemic Stroke Risk

DeBoer developed the scoring tool, an online calculator to assess the severity of metabolic syndrome, with Matthew J. Gurka, PhD, of the Department of Health Outcomes and Biomedical Informatics at the University of Florida, Gainesville. The tool is available for free at https://metscalc.org/.

To evaluate the association between ischemic stroke and metabolic syndrome, DeBoer and Gurka reviewed more than 13,000 participants in prior studies and their stroke outcomes. Among that group, there were 709 ischemic strokes over a mean period of 18.6 years assessed in the studies. (Ischemic strokes are caused when blood flow to the brain is obstructed by blood clots or clogged arteries. Hemorrhagic strokes, on the other hand, are caused when blood vessels rupture.)

The researchers used their tool to calculate "Z scores" measuring the severity of metabolic syndrome among the study participants. They could then analyze the association between metabolic syndrome and ischemic stroke risk.

The subgroup with the highest association between metabolic syndrome and risk for ischemic stroke was white women, the researchers found. In this group, the research team was able to identify relationships between the individual contributors to metabolic syndrome, such as high blood pressure, and stroke risk.

The researchers note that race and sex did not seem to make a major difference in stroke risk overall, and they caution that the increased risk seen in white women could be the results of chance alone. "Nevertheless," they write in a new scientific article outlining their findings, "these results are notable enough that they may warrant further study into race and sex differences."

The overall relationship between metabolic syndrome severity and stroke risk was clear, however. And this suggests people with metabolic syndrome can make lifestyle changes to reduce that risk. Losing weight, exercising more, choosing healthy foods -- all can help address metabolic syndrome and its harmful effects.

DeBoer hopes that the tool he and Gurka developed will help doctors guide patients as they seek to reduce their stroke risk and improve their health and well-being.

"In case there are still individuals out there debating whether to start exercising or eating a healthier diet," DeBoer said, "this study provides another wake-up call to motivate us all toward lifestyle changes."

https://www.sciencedaily.com/releases/2020/08/200814101659.htm

Obesity and metabolic syndrome are risk factors for severe influenza, COVID-19

July 15, 2020

Science Daily/American Society for Microbiology

Metabolic syndrome increases the risk of severe disease from viral infection, according to a review of the literature performed by a team of researchers from St. Jude Graduate School of Biomedical Sciences and the University of Tennessee Health Science Center, both in Memphis. The research appears this week in the Journal of Virology, a publication of the American Society for Microbiology.

Metabolic syndrome is a cluster of at least 3 co-occurring conditions that raise the risk of heart disease, stroke and type 2 diabetes mellitus (T2DM). These conditions include excess abdominal fat, high blood pressure, excess blood sugar, abnormalities of lipids (including excess triglycerides and cholesterol), insulin resistance and a proinflammatory state.

Multiple studies have shown that obesity is associated with increased severity of influenza A, higher viral titers in exhaled breath and prolonged transmission of the virus, according to the report. Changes in the viral population may abet the emergence of more pathogenic influenza variants, according to the report. Despite the fact that influenza vaccines generate robust antibody titers in obese subjects, obesity doubles the likelihood of developing influenza.

As with influenza virus, the Centers for Disease Control and Prevention recently recognized obesity as a risk factor for severe illness caused by SARS-CoV-2. "This is not surprising because excess body weight and fat deposition apply pressure to the diaphragm, which further increases the difficulty of breathing during a viral infection," the researchers write.

But the risk goes beyond the burden of excess weight. A recent study highlighted in the literature review looked at 174 diabetes patients with confirmed cases of COVID-19. The study found that these patients were at significantly higher risk for severe pneumonia compared to non-diabetic COVID-19 patients. CT scans revealed a greater severity of lung abnormalities in these patients.

There was also a profound increase in serum IL-6 levels, a predictive biomarker for disease severity, the investigators write. These data imply that SARS-CoV-2 causes severe disease in obese patients and in those with T2DM by inducing bilateral pneumonia and a cytokine storm that damages the lung epithelial-endothelial barrier. (The epithelium lines surfaces exposed to the outer environment, such as the respiratory tract, the endothelium lines inner pathways such as those of the vasculature.)

However, one hypothetical risk for patients with T2DM who have hypertension or heart disease appears not to be a problem, after all, according to the report. These patients are commonly treated with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). These increase expression of ACE2, the receptor that SARS-CoV-2 uses to gain entry into cells.

Clinicians and researchers were initially concerned that ACE inhibitors and ARBs could promote adhesion and entry of SARS-CoV-2 into host cells, thereby increasing the risk of severe COVID-19. Contrary to concerns, multiple studies now suggest that ACE inhibitors and ARBs do not lead to poorer outcomes in COVID-19 infection.

"Future research should seek to [determine] how metabolic abnormalities increase viral pathogenesis, as this information will play an essential role in global preparedness against emerging seasonal and pandemic virus strains," the investigators conclude.

https://www.sciencedaily.com/releases/2020/07/200715131234.htm

Weightlifting is good for your heart and it doesn't take much

November 13, 2018

Science Daily/Iowa State University

Lifting weights for less than an hour a week may reduce your risk for a heart attack or stroke by 40 to 70 percent, according to a new study. Spending more than an hour in the weight room did not yield any additional benefit, the researchers found. The results show benefits of strength training are independent of running, walking or other aerobic activity.

"People may think they need to spend a lot of time lifting weights, but just two sets of bench presses that take less than 5 minutes could be effective," said DC (Duck-chul) Lee, associate professor of kinesiology.

The results -- some of the first to look at resistance exercise and cardiovascular disease -- show benefits of strength training are independent of running, walking or other aerobic activity. In other words, you do not have to meet the recommended guidelines for aerobic physical activity to lower your risk; weight training alone is enough. The study is published in Medicine and Science in Sports and Exercise.

Lee and his colleagues analyzed data of nearly 13,000 adults in the Aerobics Center Longitudinal Study. They measured three health outcomes: cardiovascular events such as heart attack and stroke that did not result in death, all cardiovascular events including death and any type of death. Lee says resistance exercise reduced the risk for all three.

"The results are encouraging, but will people make weightlifting part of their lifestyle? Will they do it and stick with it? That's the million-dollar question," Lee said.

Barriers to resistance training

The researchers recognize that unlike aerobic activity, resistance exercise is not as easy to incorporate into our daily routine. Lee says people can move more by walking or biking to the office or taking the steps, but there are few natural activities associated with lifting. And while people may have a treadmill or stationary bike at home, they likely do not have access to a variety of weight machines.

For these reasons, Lee says a gym membership may be beneficial. Not only does it offer more options for resistance exercise, but in a previous study Lee found people with a gym membership exercised more. While this latest study looked specifically at use of free weights and weight machines, Lee says people will still benefit from other resistance exercises or any muscle-strengthening activities.

"Lifting any weight that increases resistance on your muscles is the key," Lee said. "My muscle doesn't know the difference if I'm digging in the yard, carrying heavy shopping bags or lifting a dumbbell."

Other benefits of strength training

Much of the research on strength training has focused on bone health, physical function and quality of life in older adults. When it comes to reducing the risk for cardiovascular disease, most people think of running or other cardio activity. Lee says weight lifting is just as good for your heart, and there are other benefits.

Using the same dataset, Lee and his colleagues looked at the relationship between resistance exercise and diabetes as well as hypercholesterolemia, or high cholesterol. The two studies, published in Mayo Clinic Proceedings, found resistance exercise lowered the risk for both.

Less than an hour of weekly resistance exercise (compared with no resistance exercise) was associated with a 29 percent lower risk of developing metabolic syndrome, which increases risk of heart disease, stroke and diabetes. The risk of hypercholesterolemia was 32 percent lower. The results for both studies also were independent of aerobic exercise.

"Muscle is the power plant to burn calories. Building muscle helps move your joints and bones, but also there are metabolic benefits. I don't think this is well appreciated," Lee said. "If you build muscle, even if you're not aerobically active, you burn more energy because you have more muscle. This also helps prevent obesity and provide long-term benefits on various health outcomes."

https://www.sciencedaily.com/releases/2018/11/181113115430.htm