Intensive Lifestyle Intervention for Remission of Early Type 2 Diabetes in Primary Care in Australia: DiRECT-Aus.

OBJECTIVE: We aimed to assess whether remission of type 2 diabetes (T2D) could be achieved with a low-energy total diet replacement (TDR) in an Australian primary care setting. RESEARCH DESIGN AND METHODS: Individuals aged 20-65 years with T2D duration up to 6 years, BMI >27.0 kg/m2, and not treated with insulin were prescribed a 13-week low-energy TDR (Optifast; Nestlé Health Science) followed by 8-week structured food reintroduction and 31-week supported weight maintenance. The primary outcome was T2D remission at 12 months. RESULTS: A total of 155 participants comprised the intention-to-treat population. At 12 months, T2D remission was achieved in 86 (56%) participants, with a mean adjusted weight loss of 8.1% (95% CI 7.2-9.1). Two serious adverse events requiring hospitalization related to the study intervention were reported. CONCLUSIONS: At 12 months T2D remission was achieved for one in two Australian adults in a primary care setting.

Sex and age differences in the use of medications for diabetes and cardiovascular risk factors among 25,733 people with diabetes.

AIM: To determine sex and age differences in the use of medications for diabetes and cardiovascular risk factors in people with diabetes in Australia. METHODS: Pharmaceutical claims data of participants in the 45 and Up Study who self-reported having diabetes before 2013, were alive on 1st January 2013 and had at least one medication dispensing record between 1st January 2013 and 31st December 2019 were analysed. Annual sex and age-specific percentages of participants supplied specific medications were estimated for years 2013 to 2019. Percentages were reported for any glucose lowering medications and by drug class, any lipid modifying agents, and any blood pressure lowering medications. RESULTS: Altogether 25,733 participants (45.2% women) with diabetes were included. The percentage of participants who were supplied with glucose lowering medications was consistently lower in women compared to men. In both sexes, the percentage of participants who were supplied with glucose lowering medications was lowest among those aged ≥75 years and this decreased over time. Similar findings were observed for lipid modifying agents and blood pressure lowering medications. The use of sodium glucose co-transporter 2 inhibitors increased substantially in participants aged <75 years since it became available in 2013. However, no sex differences were observed in its use among people with hospital-recorded history of cardiovascular disease. CONCLUSIONS: Practitioners should be aware of possible sex disparities in the pharmacological treatment of diabetes and cardiovascular risk factors in people with diabetes in Australia. There is a possible time lag between reporting of research findings and uptake of sodium glucose co-transporter 2 inhibitors prescribing in individuals with diabetes and high cardiovascular risk in clinical practice, nevertheless, the result observed was consistent with the management guidelines at the time of the study.

Access route selection for percutaneous coronary intervention among Vietnamese patients: Implications for in-hospital costs and outcomes.

BACKGROUND: Little is known about rates of access site (transradial (TRI) or transfemoral (TFI)) preference for percutaneous coronary intervention (PCI) and in-hospital costs of patients undergoing these procedures in lower-and middle-countries. Here, we report on access site use, in-hospital costs and outcomes of patients undergoing PCI in Vietnam. METHODS: Information from 868 patients were included in the cohort of 1022 patients recruited into the first PCI registry in Vietnam. The total hospital costs and in-hospital outcomes of patients undergoing TRI and TFI were compared. Hospital costs were obtained from the hospital admission system, and major adverse cardiac events, major bleeding events and length of stay were identified through review of medical records. FINDINGS: TRI was the dominant access site for interventionists (694/868 patients). The TFI group reported more lesions of the left main artery, more previous coronary artery bypass grafts and previous PCI in comparison with the TRI group (all p < 0.05). The TRI group was associated with a lower overall cost of admission (the adjusted difference was -1526.3 USD, 95% confident interval CI (-1996.2; -1056.3), shorter length of hospital stay (-2 days, CI (-2.8; -1.2)) and lower rates of major bleeding post-procedure. Procedural factors such as radial access site, left main disease, PCI ≥2 stents, and PCI ≥ 2 lesions having the most impact on the in-hospital cost of patients undergoing PCI. INTERPRETATIONS: Among patients undergoing PCI, TRI was associated with lower costs and favourable clinical outcomes relative to TFI. FUNDING: This research received partial financial support from Curtin University, Australia.

Outcomes following the percutaneous coronary intervention in contemporary Vietnamese practice: Insight from a single centre prospective cohort.

BACKGROUND: Evidence regarding the outcomes of percutaneous coronary intervention (PCI) in low-and-middle incomes countries remains limited. OBJECTIVES: To report the outcomes post PCI at discharge, 30 days and 12 months in Vietnam and identify the key factors associated with adverse outcomes at 12 months. METHODS: We used data from a single centre prospective cohort in Vietnam. Data regarding demographics, clinical presentation, procedural information, and outcomes of patients were collected and analysed. Primary outcomes were mortality and major adverse cardiac and cerebrovascular events. RESULTS: In total, 926 patients were included. Poor outcomes were relatively low in those undergoing PCI. Predictors of mortality and major adverse cardiac and cerebrovascular events at 12 months post-PCI included being older than 75, being male, having acute myocardial infarction, left ventricular ejection fraction ≤ 40%, prior cerebral vascular disease and having an unsuccessful PCI. CONCLUSIONS: Adverse outcomes of patients undergoing PCI in Vietnam are relatively low in comparison with those reported in other countries across the Asia Pacific region. Identification of factors associated with poor outcomes is beneficial for improving the quality of cardiac care and developing the prediction model of outcomes post-PCI in Vietnam.

Novel insights into clinical characteristics and in-hospital outcomes of patients undergoing percutaneous coronary intervention in Vietnam.

BACKGROUND: Little is known about percutaneous coronary intervention (PCI) practices and outcomes in low-and middle-income nations, despite its rapid uptake across Asia. For the first time, we report on clinical characteristics and in-hospital outcomes for patients undergoing PCI at a leading cardiac centre in Vietnam. METHODS: Information on characteristics, treatments, and outcomes of patients undergoing PCI was collected into the first PCI registry through direct interviews using a standardised form, medical record abstraction, and reading PCI imaging data on secured disks. Subgroup analysis was also conducted to explore gender differences. RESULTS: Between September 2017 and May 2018, 1022 patients undergoing PCI were recruited from a total of 1041 procedures. The mean age was 68.3 years and two thirds were male. While 54.4% of patients presented with acute coronary syndromes, the rate of ST-elevation myocardial infarction was 14.5%. The majority of lesions were classified as type B2 and C and the radial artery was the most common access location for PCI (79.2%). The use of drug-eluting stents was universal and the angiographic success rate was 99.4%. Cardiac complications following PCI were rare with the exception of major bleeding (2.0%). Female patients were older with relatively more comorbidities and a higher incidence of major bleeding than males (p < 0.05). CONCLUSIONS: Findings of this study provide an opportunity to benchmark current PCI practices in Vietnam, identify possible care gaps and potentially inform the adoption of treatment guidelines as well as use of prevention strategies.

Establishment of a Percutaneous Coronary Intervention Registry in Vietnam: Rationale and Methodology.

Background: In lower- and middle-income countries across Asia there has been a rapid expansion and uptake of percutaneous coronary intervention (PCI). However, there has been limited routine collection of related data, particularly around quality, safety and cost. The aim of this study was to assess the viability of implementing routine collection of PCI data in a registry at a leading hospital in Hanoi, Vietnam. Method: A Vietnamese data collection form and collection strategy were developed in collaboration with the Vietnam National Heart Institute. Information on patient characteristics, treatments, and outcomes was collected through direct interviews using a standardised form and medical record abstraction, while PCI data was read and coded into paper forms by interventional cardiologists. Viability of the registry was determined by four main factors: 1) being able to collect a representative sample; 2) quality of data obtained; 3) costs and time taken for data collection by hospital staff; and 4) level of support from key stakeholders in the institute. Results: Between September 2017 and May 2018, 1,022 patients undergoing PCI were recruited from a total of 1,041 procedures conducted during that time frame. The estimated mean time to collect information from patients before discharge was 60 minutes. Of the collected data fields, 98% were successfully completed. Most hospital staff surveyed indicated support for the continuation of the activity following the implementation of the pilot study. Conclusions: The proposed methodology for establishing a PCI registry in a large hospital in Vietnam produced high quality data and was considered worthwhile by hospital staff. The model has the potential opportunity for replication in other cardiac catheterisation sites, leading to a national PCI registry in Vietnam.

Accuracy of hands v. household measures as portion size estimation aids.

Accurate estimation of food portion size is critical in dietary studies. Hands are potentially useful as portion size estimation aids; however, their accuracy has not been tested. The aim of the present study was to test the accuracy of a novel portion size estimation method using the width of the fingers as a 'ruler' to measure the dimensions of foods ('finger width method'), as well as fists and thumb or finger tips. These hand measures were also compared with household measures (cups and spoons). A total of sixty-seven participants (70 % female; age 32·7 (sd 13·7) years; BMI 23·2 (sd  3·5) kg/m(2)) attended a 1·5 h session in which they estimated the portion sizes of forty-two pre-weighed foods and liquids. Hand measurements were used in conjunction with geometric formulas to convert estimations to volumes. Volumes determined with hand and household methods were converted to estimated weights using density factors. Estimated weights were compared with true weights, and the percentage difference from the true weight was used to compare accuracy between the hand and household methods. Of geometrically shaped foods and liquids estimated with the finger width method, 80 % were within ±25 % of the true weight of the food, and 13 % were within ±10 %, in contrast to 29 % of those estimated with the household method being within ±25 % of the true weight of the food, and 8 % being within ±10 %. For foods that closely resemble a geometric shape, the finger width method provides a novel and acceptably accurate method of estimating portion size.

Predictors of weight loss 2 years after laparoscopic sleeve gastrectomy.

INTRODUCTION: Despite the rapidly increasing popularity of laparoscopic sleeve gastrectomy (LSG), there is limited data examining weight loss more than 1 year after the procedure. There have also been few studies examining baseline predictors of weight loss after LSG. We aimed to examine the percentage of excess weight loss (%EWL) in patients 2 years after LSG and identify baseline predictors of %EWL. METHODS: Electronic records from university hospitals were available for 292 patients who underwent LSG (205 women; mean age, 41.5 ± 11.1 years; mean weight, 126.5 ± 27.5 kg; mean BMI, 45.5 ± 7.5 kg/m(2) ). Variables assessed for predictive effect were baseline age, sex, BMI, presence of comorbidities (diabetes, hypertension, or obstructive sleep apnea), the amount of weight loss induced by a very low-calorie diet before surgery, and the number of clinic appointments attended over the 2 years. We performed linear regression and mixed model analyses between predictor variables and %EWL at 2 years. RESULTS: Adjusted %EWL was 31% at 2 weeks, 49% at 3 months, 64% at 6 months, 70% at 9 months, 76% at 12 months, 79% at 18 months, and 79% at 2 years. Multivariate analysis showed that lower baseline BMI, absence of hypertension, and greater clinic attendance predicted better %EWL (r(2) = 0.11). CONCLUSION: Longer-term follow-up studies of weight loss post LSG are required to assist with patient care and management.

Does Diet-Induced Weight Loss Lead to Bone Loss in Overweight or Obese Adults? A Systematic Review and Meta-Analysis of Clinical Trials.

Diet-induced weight loss has been suggested to be harmful to bone health. We conducted a systematic review and meta-analysis (using a random-effects model) to quantify the effect of diet-induced weight loss on bone. We included 41 publications involving overweight or obese but otherwise healthy adults who followed a dietary weight-loss intervention. The primary outcomes examined were changes from baseline in total hip, lumbar spine, and total body bone mineral density (BMD), as assessed by dual-energy X-ray absorptiometry (DXA). Secondary outcomes were markers of bone turnover. Diet-induced weight loss was associated with significant decreases of 0.010 to 0.015 g/cm(2) in total hip BMD for interventions of 6, 12, or 24 (but not 3) months' duration (95% confidence intervals [CIs], -0.014 to -0.005, -0.021 to -0.008, and -0.024 to -0.000 g/cm(2), at 6, 12, and 24 months, respectively). There was, however, no statistically significant effect of diet-induced weight loss on lumbar spine or whole-body BMD for interventions of 3 to 24 months' duration, except for a significant decrease in total body BMD (-0.011 g/cm(2); 95% CI, -0.018 to -0.003 g/cm(2)) after 6 months. Although no statistically significant changes occurred in serum concentrations of N-terminal propeptide of type I procollagen (P1NP), interventions of 2 or 3 months in duration (but not of 6, 12, or 24 months' duration) induced significant increases in serum concentrations of osteocalcin (0.26 nmol/L; 95% CI, 0.13 to 0.39 nmol/L), C-terminal telopeptide of type I collagen (CTX) (4.72 nmol/L; 95% CI, 2.12 to 7.30 nmol/L) or N-terminal telopeptide of type I collagen (NTX) (3.70 nmol/L; 95% CI, 0.90 to 6.50 nmol/L bone collagen equivalents [BCEs]), indicating an early effect of diet-induced weight loss to promote bone breakdown. These data show that in overweight and obese individuals, a single diet-induced weight-loss intervention induces a small decrease in total hip BMD, but not lumbar spine BMD. This decrease is small in comparison to known metabolic benefits of losing excess weight.

The efficacy of bariatric surgery performed in the public sector for obese patients with comorbid conditions.

OBJECTIVE: To determine the efficacy of bariatric surgery in the public sector for the treatment of complicated obesity. DESIGN, SETTING AND PARTICIPANTS: A longitudinal observational study of obese participants with comorbid conditions, aged 21-73 years, who underwent publicly funded bariatric surgery. Data were extracted from clinical databases (1 October 2009 to 1 September 2013) and recorded at seven time points. Participants are from an ongoing public obesity program. MAIN OUTCOME MEASURES: Postoperative weight loss and partial or full resolution of: type 2 diabetes mellitus (T2DM), hypertension (HTN), dyslipidaemia and obstructive sleep apnoea (OSA). RESULTS: The 65 participants in the cohort lost a mean weight of 22.6 kg (SD, 9.5 kg) by 3 months, 34.2.kg (SD, 20.1 kg) by 12 months and 39.9 kg (SD, 31.4 kg) by 24 months (P < 0.001). Body mass index (BMI) decreased from a preoperative mean of 48.2 kg/m(2) (SD, 9.5 kg/m(2)) to 35.7 kg/m(2) (SD, 7.7 kg/m(2)) by 24 months (P < 0.001). Full resolution of comorbid conditions by 18 months (P < 0.001) was achieved by almost half of those with baseline T2DM, nearly two-thirds with HTN and three-quarters of those with OSA, with continued improvements beyond 24 months. CONCLUSIONS: Bariatric surgery performed in the public sector is efficacious in the treatment of obese patients with comorbid conditions. Our findings parallel similar studies suggesting that there is equal benefit in publicly funded and privately performed procedures. This study highlights that obese patients reliant on public health care maintain sufficient intrinsic motivation in the absence of payment and supposed value-driven incentive. Improved access to bariatric surgery in the public sector can justifiably reduce the health inequities for those most in need.

HbA1c, fasting and 2 h plasma glucose in current, ex- and never-smokers: a meta-analysis.

AIMS/HYPOTHESIS: The relationships between smoking and glycaemic variables have not been well explored. We compared HbA1c, fasting plasma glucose (FPG) and 2 h plasma glucose (2H-PG) in current, ex- and never-smokers. METHODS: This meta-analysis used individual data from 16,886 men and 18,539 women without known diabetes in 12 DETECT-2 consortium studies and in the French Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR) and Telecom studies. Means of three glycaemic variables in current, ex- and never-smokers were modelled by linear regression, with study as a random factor. The I (2) statistic was used to evaluate heterogeneity among studies. RESULTS: HbA1c was 0.10% (95% CI 0.08, 0.12) (1.1 mmol/mol [0.9, 1.3]) higher in current smokers and 0.03% (0.01, 0.05) (0.3 mmol/mol [0.1, 0.5]) higher in ex-smokers, compared with never-smokers. For FPG, there was no significant difference between current and never-smokers (-0.004 mmol/l [-0.03, 0.02]) but FPG was higher in ex-smokers (0.12 mmol/l [0.09, 0.14]). In comparison with never-smokers, 2H-PG was lower (-0.44 mmol/l [-0.52, -0.37]) in current smokers, with no difference for ex-smokers (0.02 mmol/l [-0.06, 0.09]). There was a large and unexplained heterogeneity among studies, with I (2) always above 50%; I (2) was little changed after stratification by sex and adjustment for age and BMI. In this study population, current smokers had a prevalence of diabetes that was 1.30% higher as screened by HbA1c and 0.52% lower as screened by 2H-PG, in comparison with never-smokers. CONCLUSION/INTERPRETATION: Across this heterogeneous group of studies, current smokers had a higher HbA1c and lower 2H-PG than never-smokers. This will affect the chances of smokers being diagnosed with diabetes.

A globally applicable screening model for detecting individuals with undiagnosed diabetes.

AIMS: Current risk scores for undiagnosed diabetes are additive in structure. We sought to derive a globally applicable screening model based on established non-invasive risk factors for diabetes but with a more flexible structure. METHODS: Data from the DETECT-2 study were used, including 102,058 participants from 38 studies covering 8 geographical regions worldwide. A global screening model for undiagnosed diabetes was identified through tree-structured regression analysis. The performance of the global screening model was evaluated in each of the geographical regions by receiver operating characteristic (ROC) analysis. RESULTS: The global screening model included age, height, body mass index, waist circumference and systolic- and diastolic blood pressure. Area under the ROC curve ranged between 0.64 in North America and 0.76 in Australia and New Zealand. Overall, to identify 75% of the undiagnosed diabetes cases, 49% required further diagnostic testing. CONCLUSIONS: We identified a globally applicable screening model to detect individuals at high risk of undiagnosed diabetes. The model performed well in most geographical regions, is simple and requires no calculations. This global screening model may be particularly helpful in developing countries with no population based data with which to develop own screening models.

Higher-than-optimal body mass index and diabetes mortality in the Asia Pacific region.

AIMS: To estimate the population attributable fraction (PAF) of elevated body mass index (BMI) for diabetes mortality by country, sex and age group, for the Western Pacific and South-East Asia regions. METHODS: Published data on nationally representative mean BMI (since year 2000) and age-specific hazard ratios for death due to diabetes for a unit increase in BMI were used to calculate PAFs using the methodology of the WHO Global Burden of Disease project, taking a BMI of 21 kg/m(2) as the ideal. RESULTS: Data were available for 15 countries in the Western Pacific and South East Asia regions. This included data from 330,374 individuals. Age-standardized male PAFs ranged from 11% for India to 98% for American Samoa. Age-standardized female PAFs ranged from 9% in India to 95% in American Samoa. For males, several countries had PAFs at or below 30% - these were India, Indonesia and Japan; whereas, India and Indonesia were the only two countries with PAFs below approximately 30% for females. CONCLUSION: Although this study is not a trial and thus not able to definitively state the proportions of diabetes deaths that could be averted by reducing mean BMI, this paper demonstrates that theoretically between 9% and 98% of deaths from diabetes could be prevented by tackling obesity in the Asia Pacific region. Preventing these deaths is likely to have an enormous positive social and economic impact, particularly in this region consisting of many low and middle-income countries.

Glycemic thresholds for diabetes-specific retinopathy: implications for diagnostic criteria for diabetes.

OBJECTIVE: To re-evaluate the relationship between glycemia and diabetic retinopathy. RESEARCH DESIGN AND METHODS: We conducted a data-pooling analysis of nine studies from five countries with 44,623 participants aged 20-79 years with gradable retinal photographs. The relationship between diabetes-specific retinopathy (defined as moderate or more severe retinopathy) and three glycemic measures (fasting plasma glucose [FPG; n = 41,411], 2-h post oral glucose load plasma glucose [2-h PG; n = 21,334], and A1C [n = 28,010]) was examined. RESULTS: When diabetes-specific retinopathy was plotted against continuous glycemic measures, a curvilinear relationship was observed for FPG and A1C. Diabetes-specific retinopathy prevalence was low for FPG <6.0 mmol/l and A1C <6.0% but increased above these levels. Based on vigintile (20 groups with equal numbers) distributions, glycemic thresholds for diabetes-specific retinopathy were observed over the range of 6.4-6.8 mmol/l for FPG, 9.8-10.6 mmol/l for 2-h PG, and 6.3-6.7% for A1C. Thresholds for diabetes-specific retinopathy from receiver-operating characteristic curve analyses were 6.6 mmol/l for FPG, 13.0 mmol/l for 2-h PG, and 6.4% for A1C. CONCLUSIONS: This study broadens the evidence based on diabetes diagnostic criteria. A narrow threshold range for diabetes-specific retinopathy was identified for FPG and A1C but not for 2-h PG. The combined analyses suggest that the current diabetes diagnostic level for FPG could be lowered to 6.5 mmol/l and that an A1C of 6.5% is a suitable alternative diagnostic criterion.

Burden of lung cancer deaths due to smoking for men and women in the WHO Western Pacific and South East Asian regions.

INTRODUCTION: Eighty percent of all smokers live in low and middle-income countries of the Asia Pacific region but actual estimates of the burden of disease due to smoking in the region have yet to be quantified. METHODS: The burden of lung cancer due to smoking for all countries in the WHO Western Pacific and South East Asian regions was calculated from the population attributable fractions (PAFs). Nationally representative sex-specific prevalences of smoking were obtained from the World Health Organization, MEDLINE and/or national government documents and hazard ratios (HR) for lung cancer due to smoking in Asian and non-Asian populations were obtained from published data. The HR and prevalence were then used to calculate PAFs for lung cancer deaths due to smoking, by gender and by country. RESULTS: The national prevalence of smoking in the Asia Pacific region ranged from 18-65% in men and from 0-50% in women. The fraction of lung cancer deaths attributable to smoking ranged from 0-40% in Asian women and from 21-49% in Asian men. In ANZ, PAFs were as high as 80% for women and 68% for men. Future estimates of the burden of smoking-related lung cancer in Asia were obtained by assuming a continuation of current smoking habits in these populations. By extrapolating the higher HR from the ANZ region to Asia, resulted in an increase in the PAFs to 4-90% in women and from 62-85% in men. CONCLUSION: The current burden of lung-cancer due to smoking in the Asia-Pacific region is substantial accounting for up to 50% of deaths from the disease in men and up to 40% in women depending on the country. If current smoking habits in Asia remain unchanged then the number of people dying from smoking-related lung cancer over the next couple of decades is expected to double. It is known that the majority of lung cancer is due to smoking. This is the first paper to systematically compare current burdens of lung cancer deaths due to smoking in countries in the Western Pacific and South East Asia and by gender. Findings from this paper demonstrate the number of lung cancer deaths that could be prevented if the prevalence of smoking was eliminated.

The cost of overweight and obesity in Australia.

OBJECTIVE: To assess and compare health care costs for normal-weight, overweight and obese Australians. DESIGN, SETTING AND PARTICIPANTS: Analysis of 5-year follow-up data from the Australian Diabetes, Obesity and Lifestyle study, collected in 2004-2005. Data were available for 6140 participants aged >or= 25 years at baseline. MAIN OUTCOME MEASURES: Direct health care cost, direct non-health care cost and government subsidies associated with overweight and obesity, defined by both body mass index (BMI) and waist circumference (WC). RESULTS: The annual total direct cost (health care and non-health care) per person increased from $1472 (95% CI, $1204-$1740) for those of normal weight to $2788 (95% CI, $2542-$3035) for the obese, however defined (by BMI, WC or both). In 2005, the total direct cost for Australians aged >or= 30 years was $6.5 billion (95% CI, $5.8-$7.3 billion) for overweight and $14.5 billion (95% CI, $13.2-$15.7 billion) for obesity. The total excess annual direct cost due to overweight and obesity (above the cost for normal-weight individuals) was $10.7 billion. Overweight and obese individuals also received $35.6 billion (95% CI, $33.4-$38.0 billion) in government subsidies. Comparing costs by weight change since 1999-2000, those who remained obese in 2004-2005 had the highest annual total direct cost. Cost was lower in overweight or obese people who lost weight or reduced WC compared with those who progressed to becoming, or remained, obese. CONCLUSION: The total annual direct cost of overweight and obesity in Australia in 2005 was $21 billion, substantially higher than previous estimates. There is financial incentive at both individual and societal levels for overweight and obese people to lose weight and/or reduce WC.

Abdominal obesity and coronary heart disease in Thai men.

OBJECTIVE: To determine the association of four simple anthropometric indices with coronary heart disease (CHD) in Thai men, and to determine the optimal cut-off points for each index in the prediction of CHD. RESEARCH METHODS AND PROCEDURES: This is a cohort study with 17 years of follow-up. A total of 2536 male employees from the Electricity Generating Authority of Thailand 35 to 59 years of age at baseline were included in the study. Height, weight, waist circumference, and hip circumference were measured to generate BMI, waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). Cox regression models were used to estimate hazard ratios by thirds of each index. Receiver operating characteristic curves were used to assess discrimination of CHD. RESULTS: WHtR was most strongly associated with CHD events in Thai men. The age-adjusted hazard ratio for those in the highest, compared with the lowest, third was 2.89 (1.37, 6.11). Although WHtR had the largest area under the receiver operating characteristic curve (AUC) with the optimal cut-off estimated to be 0.51 (sensitivity, 55%; specificity, 61%), no statistically significant difference (p>0.10) was found between the AUC for WHtR and that for the other three indices. CONCLUSION: WHtR is, marginally, the best of the four indices considered to predict CHD events in Thai men.

Hypertension: its prevalence and population-attributable fraction for mortality from cardiovascular disease in the Asia-Pacific region.

OBJECTIVE: About half of the world's burden of cardiovascular disease is carried by countries in the Asia-Pacific region. This study aimed to quantify the contribution of hypertension to cardiovascular diseases (CVD) at the country level, by calculating the sex-specific, population-attributable fractions (PAFs) for fatal ischaemic heart disease (IHD) and stroke (haemorrhagic and ischaemic) for the World Health Organization Western Pacific and South-east Asian regions. METHODS: The most recent sex-specific prevalence data on hypertension were sought. Age-adjusted hazard ratio (HR) estimates for fatal IHD and stroke associated with hypertension were obtained using Cox analyses of individual participant cohort data from 600,000 adult participants in the Asia-Pacific Cohort Studies Collaboration. HR estimates and prevalence were then used to calculate sex-specific PAFs for fatal IHD and stroke, by country. RESULTS: In 15 countries with available data, the prevalence of hypertension ranged from 5-47% in men and from 7-38% in women. Overall, the fraction of IHD attributable to hypertension ranged from 4-28% in men and from 8-39% in women. Corresponding ranges for haemorrhagic stroke were 18-66% and 15-49%, and for ischaemic stroke were 8-44% and 12-45%. CONCLUSIONS: In the Asia-Pacific region, up to 66% of some subtypes of CVD can be attributed to hypertension, underscoring the immense impact that blood pressure- lowering strategies could have in this populous region.