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Key studies Flashcards

1
Q

Intensive lifestyle changes for reversal of coronary heart disease:

n =?
follow up?

A

48 - 20 usual care, 28 in experimental group. Control group included ‘non-intensive’ lifestyle changes +- statin etc - i.e. usual care
Follow up was at 1 and 5 years

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2
Q

Intensive lifestyle changes for reversal of coronary heart disease:
Key 5 year findings:
- Absolute and relative reductions from baseline

A

Usual care group had increased stenosis of 11.1%, or relative of 27.7%
Experimental group had 3.1% decrease or 7.9%

The experimental group without statins had increase of 46.7% (from 40.7 to 51.9% absolute)

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3
Q

Intensive lifestyle changes for reversal of coronary heart disease:
Number of cardic events and RR comparison

A

45 vs 25, a risk ratio of 2.47

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4
Q

Intensive lifestyle changes for reversal of coronary heart disease:
How much of the experimental group showed regression?

A

82%, dose-dependent (i.e. adherence)

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5
Q

Intensive lifestyle changes for reversal of coronary heart disease:
Dates and journals

A

1 year study Lancet 1990, 5 year JAMA in 1998

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6
Q

Intensive lifestyle changes for reversal of coronary heart disease:
What was the relative difference in progression at 5 years?

A
  • 35.6% compared to all controls, and -54.6% compared to controls not taking lipid lowering meds
    (e. g. 27.7 + 7.9%)
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7
Q

Reduction in incidence of type 2 diabetes with lifestyle intervention or metformin:

n=?
follow up?

A

3234 people in 3 groups - placebo, metformin, intensive lifestyle
Follow up of 2.8 years - stopped early

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8
Q

Reduction in incidence of type 2 diabetes with lifestyle intervention or metformin:
Goals of intensive lifestyle changes?

A

7% weight loss and 150 minute PA

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9
Q

Reduction in incidence of type 2 diabetes with lifestyle intervention or metformin:

Rates of diabetes in follow up per 100 person years?
And percentage risk reduction?

A

11, 7.8 and 4.8

compared to placebo - 31% and 58%

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10
Q

Reduction in incidence of type 2 diabetes with lifestyle intervention or metformin:
NNT to prevent one case in three years?

A

6.9 for lifestyle and 13.9 for metformin

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11
Q

Reduction in incidence of type 2 diabetes with lifestyle intervention or metformin:
Remaining questions?

A

1) How sustainable?

2) Do they affect long-term micro and macro vascular complications? and mortality?

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12
Q

Reduction in incidence of type 2 diabetes with lifestyle intervention or metformin:
Key significance?

A

One of the first major RCT comparing lifestyle to medication in prevention of disease

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13
Q

Effects of a dietary portfolio of cholesterol-lowering foods versus lovastatin on serum lipids and C-reactive protein:
n=
Follow up?

A

n = 16 16 14 each group

Follow up - bloods at 0,2,4 weeks

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14
Q

Effects of a dietary portfolio of cholesterol-lowering foods versus lovastatin on serum lipids and C-reactive protein
Interventions?

A

1) Portolio diet
2) Very low sat fat, whole wheat and low-fat dietary foods diet
3) Same diet + low dose 20mg lovastatin

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15
Q

Effects of a dietary portfolio of cholesterol-lowering foods versus lovastatin on serum lipids and C-reactive protein:
Results at follow up (and how long?)?

A

Follow up at 4 weeks showed:
LDL - dropped 8%, 28.6 and 30.9%
CRP - 10%, 28.2%, 33.3%
CRP

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16
Q

Effects of a dietary portfolio of cholesterol-lowering foods versus lovastatin on serum lipids and C-reactive protein:
Key significance?

A

First study to investigate portfolio of cholesterol-lowering food against statins

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17
Q

Comparison of Atkins, Ornish, Weiht Watchers and Zone diets for weight loss and heart diseae risk reduction: a randomised trial:
Who?
n?
Follow up?

A

Dansinger
40 each diet - 22-72, obese and had HTN dyslipidaemia or fasting hyperglycaemia
1 year

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18
Q

Comparison of Atkins, Ornish, Weiht Watchers and Zone diets for weight loss and heart diseae risk reduction: a randomised trial:
Weight loss findings?

A

4.6 for Atkins, 7.1 for zone, 6.6 for WW and 3.3 for Ornish - no sig differences

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19
Q

Comparison of Atkins, Ornish, Weiht Watchers and Zone diets for weight loss and heart diseae risk reduction: a randomised trial:
LDL/HDL ratio changes?
BP?
Glucose?

A

ratio LDL/HDL dropped by 10% in all, whilst the other findings were unchanged

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20
Q

Comparison of Atkins, Ornish, Weiht Watchers and Zone diets for weight loss and heart diseae risk reduction: a randomised trial:

Key findings?
Weight loss?
Adherence?

A

Weight loss was the same, and associated with decreasing levels of total/HDL ratio, CRP and insulin
Adherence was low, <25%
Weight loss was assoc. with adherence

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21
Q 
Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention
Type of study?
n
follow up
Name of study?
A

This is a pilot study
30 men, low risk prostate ca who declined immediate surgery/hormonal/radiation
GEMINAL
30 day follow up

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22
Q

Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention
The intervention?

A 
low fat 10% of calories WFPB diet
Stress management 60 mintues a day
Modersate aerobic exercise
one hour group support a day
diet supplemented with soy, fish oil, vitamin E, selenium and vitamin C
23
Q

Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention
Significant secondary effects?

A

Lower abdominal circumference, weight, blood pressure and lipid profile

24
Q

Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention
Key findings?

A

48 up reg and 453 down regulated genes, protein metabolism and modification, intracellular protein traffic and protein phophoylation all effected

25
Q 
Percutaneous coronary angioplasty compared with exercise training in patietns with stable coronary artery disease
What kind of trial?
n =?
what patient group?
what intervention and control?
A

RCT
101 patients under 70 after routine angiography - randomised to 12 months exercise (>20 mintues at 70% of symptom-free heart rate) or to PCI with stent

26
Q 
Percutaneous coronary angioplasty compared with exercise training in patietns with stable coronary artery disease
Key findings (5)
A

3.5k vs 6.9k to boost one Canadian CF class
Increased VO2 max 22 to 26
Higher event-free survival (88% vs 70%) + Reduced re-hospitalisation + Fewer revascularisations
Improved exercise capacity - physical work capacity 133W to 159W (vs 130 to 130)
Resting heart rate improved (71 down to 66)

Increased VO2 max 22 to 26
Higher event-free survival (88% vs 70%)Reduced re-hospitalisation
Feewer revascularisations
Improved exercise capacity - physical work capacity 133W to 159W (vs 130 to 130)
Resting heart rate improved from 71 to 65

27
Q

Percutaneous coronary angioplasty compared with exercise training in patietns with stable coronary artery disease
What was the same in both groups?
What didn’t change?

A

Ischaemic threshold improved in both 98-127 and 99 to 119 (exercise vs PCI)
Maximal heart rate

28
Q

Effects of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer:

n=
follow up=

A

n=10 vs 25 controls

follow up 5 years

29
Q

Effects of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer:

Key findings:
telomere length
telomerase activity
what did pool data show about telomere length?

A

Telomere length increased 0.06 vs decreased 0.03 (2x number)

Telomerase activity decrease 0.25 vs 1.08 (4 x number)

pooled data showed adherence to lifestyle was significantly associated with telomere length but NOT telomerase activity

30
Q

Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreases and liver triacylglycerol:

n=
follow up=

what tests were done?

A

n = 11 with 8 matched controls

Follow up = bloods at baseline 1, 4 and 8 weeks

Tests included:

1) MRI measurements of TAG
2) Insulin suppression of hepatic glucose output
3) Fasting BM
4) Monitoring of first-phase and maximal insulin response AKA insulin sensitivity

31
Q

Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreases and liver triacylglycerol:

Key results

A

Fasting glucose normalised

Insulin suppression of hepatic glucose output normalised (from 43% to 74%, vs 68% in controls)

Hepatic TAG (12.8% to 2.9%) and pancreatic TAG decreased (8% to 6.2%)

First phase insulin response increased, and approached control values

Maximal insulin response became supernormal (1.37 vs 1.15)

32
Q

Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreases and liver triacylglycerol:

What was the intervention?

A

600kcal per day diet

33
Q

Association of an intensive lifestyle intervention with remission of type 2 diabetes

who did this study?
what’s the name of the study?

n=?

What was the intervention? (3 keys, and also intensity of contact)

A

Gregg et al, 2012
LookAHEAD

4503 - divided into two groups

Intervention was 1200-1800kcal a day, reduced SF and total fat, and 175min PA a week. There was weekly group and individual counselling for 6 months, then 3 sessions a month for 6 months, then twice monthly contact and group series/campaigns in years 2-4

Control was 3 group sessions a year on diet, physical activity and social support

34
Q

Association of an intensive lifestyle intervention with remission of type 2 diabetes

Outcomes at year 1 and 4?
Weight loss
Fitness
Remission

A

Weight loss was 7.9% greater at year 1, 3.9% at year 4

Fitness 15.4% and 6.4%

Remission of 11.4% and 7.3% vs 2% and 2%

35
Q

Association of an intensive lifestyle intervention with remission of type 2 diabetes

Sustained remission for 2-3-4 years?

What other outcomes were looked at?

A

For ILI 9.2%, 6.4%, 3.4% vs <2% for DSE

Outcomes included weight loss, fitness and remission

36
Q

Effect of a Lowfat vs Low-Carbohydrate Diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: the diet fits RCT:

Key findings:
Macro-nutrient distribution
Weight change
Diet interactions
Adverse events
A

48% vs 30% for carbs, 29% vs 45% for fats, 21% vs 23% for protein

-5.3kg and -6.0kg

No genotype or INS-30 interaction

18 adverse events, equal distribution

37
Q

Effect of a Lowfat vs Low-Carbohydrate Diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: the diet fits RCT:

n=

Intervention=

A

609 adults without DM, BMI 28-40

Either low-fat or low-carb diet, with 500-600 calorie deficit on average (not specifically instructed)

38
Q

Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label cluster-randomised tidal

n=

inclusion

Intervention?

A

49 practices, 149 each arm, intention-to-treat

inclusion - DM2 in past 6 years, BMI 27-45, no insulin, 20-65years

4 steps:
Withdrawal of DM2 and antihypertensive meds
Meal replacement - 800calories - for 3-5 months until target weight loss of 15kg
Stepped food re-introduction - 2-8 weeks
Structured support for long-term weight maintainence

39
Q

Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label cluster-randomised tidal

Primary outcomes:

A

Weight loss 15kg

Remission of DM - <6.5% after 2 months off al medication during 12 month study period

40
Q

Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label cluster-randomised tidal

Results:
Weight loss of 15kg
Remission
Mean weight loss
Quality of life scores
Adverse events
A

Weight loss 15kg in 36 (24%), none in control

Remission in 68 (46%)

Mean weight loss 10kg in intervention 1kg in control

Quality of life improved 7.2 in intervention, down 2.9 in control

9 adverse events - 7 intervention and 2 control (none led to withdrawal)

41
Q

Fasting-mimickig idet promotes Ngn3-driven B-cell rgeneration to reverse diabetes

In mice - what intervention?

In humans - what intervention?

A

MICE:
4 day fasting-mimicking diet, type 1 and 2 diabetes

HUMANS
Type 1 diabetic pancreatic cells - on 5 day fasting diet

42
Q

Fasting-mimickig idet promotes Ngn3-driven B-cell rgeneration to reverse diabetes:

In mice - what outcome?

In humans - what outcome?

A

Stepwise expression of Sox17, then pdx-1, then ngn3 theninsulin-producing beta cells produced - resembles pancreas development

In humans:
fasting reduces PKA/mTOR activity - this allows increased sox2 and ngn3 activity, and then insulin production.

Administration of IGF-1 cancels/reverses the effects of fasting diet.

43
Q

Fasting-mimickig idet promotes Ngn3-driven B-cell rgeneration to reverse diabetes

What is the human version of the fasting mimicking diet?

A

Belongs to L-Nutra

Plant based diet, attain fasting-like effects on IGF-1, IGFBP1, glucose and ketone bodies. Whilst providing macro and micronutrients to minimise fasting burden.

It is a 5 day programme with 4600kJ on day 1 and 3000 on 2-5

44
Q

From diabetes care to diabetes cure - the integration of systems biology, eHealth and Behavioural change

Which 3 conditions does this article discuss?

A

DM2, obesity, CVD

45
Q

From diabetes care to diabetes cure - the integration of systems biology, eHealth and Behavioural change

Major reasons lifestyle change don’t happen?

A
  • difficult for patient’s to sustain, lack of economic benefits in current healthcare system, failure to take a systems approach - instead making reductionist changes
46
Q

From diabetes care to diabetes cure - the integration of systems biology, eHealth and Behavioural change

What proposed changes?

A
  • flexibility of human physiology
  • 360 diagnosis
  • biopsychosocialeconomirc interventions
  • motivational tools
  • health literacy
  • personal health data
47
Q

From diabetes care to diabetes cure - the integration of systems biology, eHealth and Behavioural change

To overcome diabetes what 3 focuses do we need?

A
  • reversal as an aim, using lifestyle
    coping with environmental pressures
    reduction of environmental pressures
48
Q

From diabetes care to diabetes cure - the integration of systems biology, eHealth and Behavioural change

What level of change is necessary?

Give an example:

A

Regional level ecosystems allowing all components of the change system to interact. Community building and utilising local lifestyle-related economy and health centres.

Chicago-based South Side diabetes project - many early adopter activities already here, th challenge is to connect and integrate them, fund them until self-sustainable.

49
Q

Bonus:

Clinical events in prostate cancer trial:
Follow up?
n=
findings (2 key)

A

2 years
43 intervention, 13 control

cell growth suppressed 70% and 9% (blood test)
Ix had 2/43 undergo further treatment, control had 13/49

50
Q

Greater survival after breast cancer in physically active women with hgh v&F intake regardless of obesity

n=
type of trial
findings(2 key)

A

1490 women

5F&V and 180PA gave 50% reduction in mortality - almost the same if overweight/obese as normal weight

51
Q

Lifestyle heart trial - the absolute numbers at 1 and 5 years

A

Increase of2.3% then 11.1%

Decrease of 1.75% and 3.1%

52
Q

Stress management training and dietary changes in treating ischaemic heart disease

Type of trial
n=
Who did the trial
duration
2 key findings?
A

Ornish trial
24 intervention and 24 control
24 days
44% increase in exercise and 91% reduction in frequency of angina

53
Q 
Angina pectoris and atherosclerotic RFs in a multisite cardiac lifestyle intervention program:
Who
n=
intervention
duration
key findings (3)
A

Fratteroli
757 men and 395 women
1 hour stress management a day, PA 180, 10% fat plant based
12 weeks

74% angina free, 9% changed from limited to mild angina
similar to outcomes following ACBG or PCI

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