Epidemiology

Blood pressure and cardiovascular disease

This major observational study affirms the notion that the lower the blood pressure the lower the cardiovascular outcomes. A group of 1.3 million outpatient adults was observed and analyzed over 8 years. The study finds that both systolic and diastolic blood pressure are independent contributors to increased CVD. In addition to guideline-driven blood pressure targets, the BP goal should be individualized based on the patient’s comorbidities, medication burden, and side effects.

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BMI vs. CVD contradiction

The study observes that higher BMI is associated with higher cardiovascular mortality and morbidity. On the contrary, it is intriguing to see that CVD longevity is prolonged in adults with elevated BMI (>25) compare to those with normal BMI (19-25). A speculative explanation could be that once cardiovascular illness has been established, the high BMI-induced damage is irreversible and subsequently somewhat protective. Future research will clarify the molecular mechanisms of these observations.

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Undiagnosed diabetes is declining in the US

National Health and Nutrition Examination Survey (NHANES) data show that undiagnosed diabetes has declined from 16% of total diabetes cases in the early 1990s to about 10% in 2013. Unrecognized diabetes was confirmed by either fasting glucose ≥ 126 mg/dL or A1c ≥ 6.5%. 

Authors found that undiagnosed diabetes was more prevalent in older, overweight and obese patients, as well as in ethnic minorities and those without health insurance.

Although DM prevalence has steadily increased in the United States this is still good news, as proper diagnosis can lead to early intervention and control.

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Carbohydrates, not fats, increase total mortality

PURE is a major epidemiological study that followed 140,000 individuals in 18 countries for 7 years. Perhaps not a surprise that high carbohydrate intake was associated with 28% increased risk of total mortality, while total fats (saturated, monounsaturated and polyunsaturated) with 23% reduction.

Evidence is mounting that between the two excesses, fats are favored over carbohydrates, thus guiding the national and international movement toward taxation of sugary drinks.

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Thyroid Cancer: Incidence & Mortality Are UP

Among patients in the United States diagnosed with thyroid cancer from 1974-2013, the overall incidence of thyroid cancer increased 3% annually, with increases in the incidence rate and thyroid cancer mortality rate for advanced-stage papillary thyroid cancer. These findings are consistent with a true increase in the occurrence of thyroid cancer in the United States.

JAMA