News Release 

Recovering from metabolic syndrome significantly reduces risk for cardiovascular disease

Embargoed News from Annals of Internal Medicine

American College of Physicians

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information.

1. Recovering from metabolic syndrome significantly reduces risk for cardiovascular disease

Abstract: http://annals.org/aim/article/doi/10.7326/M19-0563 URLs go live when the embargo lifts

It is known that metabolic syndrome (high blood pressure, high blood sugar, excess abdominal fat, high triglyceride level, and/or unhealthy cholesterol levels) is associated with an increased risk of cardiovascular disease. When patients with metabolic syndrome reverse the syndrome, this risk decreases. Findings from a nationwide population-based cohort study are published in Annals of Internal Medicine.

Metabolic syndrome is a group of five risk factors that increase the likelihood of developing heart disease and stroke. There is a lack of population-scale evidence showing whether there is an association between dynamic changes in metabolic syndrome status and alterations in the risk for cardiovascular disease.

Researchers from Seoul National University College of Medicine analyzed data from the National Health Insurance Database of Korea to investigate whether recovery from or development of metabolic syndrome in a population is associated with an altered risk for cardiovascular disease. A total of 9,553,042 persons who received national health screenings from 2009 to 2014 were studied. Study participants were divided into four groups depending on their metabolic syndrome status during three consecutive general health examinations: 1) those who chronically remained in metabolic syndrome state; 2) those with newly developed metabolic syndrome; 3) those who recovered from metabolic syndrome; 4) and those who remained free of metabolic syndrome. The researchers compared the risks for developing cardiovascular diseases or strokes among these four groups and found that those who recovered from metabolic syndrome had a lower risk for cardiovascular disease compared with those who remained in the metabolic syndrome state. On the other hand, participants with newly developed metabolic syndrome had significantly higher risk for cardiovascular disease than those who remained free of the condition According to the authors, these findings suggest that efforts to prevent the development of or seek recovery from metabolic syndrome will help to reduce risk for cardiovascular disease.

Notes and media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To reach the lead author, Dong Ki Kim, MD, PhD, please contact Jeongseok Choi at cjs5402@gmail.com.

2. The Apple Watch ECG app could be used to generate a standard ECG

Proposed ECG method could potentially be used to diagnose a heart attack

Abstract: http://annals.org/aim/article/doi/10.7326/M19-2018

URLs go live when the embargo lifts

An electrocardiogram (ECG) generated by the Apple Watch series 4 or 5 could potentially be used to diagnose a heart attack when a specific method of obtaining the ECG is used and the results are reviewed by a specialist. The method used to obtain a multilead ECG reading is described in a brief research report published in Annals of Internal Medicine.

The Apple Watch series 4 and 5 are the first wearable health devices that allow consumers to generate ECGs using the ECG app. The app is proven to be able to detect sinus rhythm, bradycardia, tachycardia, or atrial fibrillation, but is limited by the number of leads (a standard ECG has 12). The Apple Watch monitors the electrical activity of the heart only in the direction, ignoring the superoinferior axis captured by standard leads and the horizontal plane captured by precordial leads.

A researcher from the Hospital Clinico San Carlos in Madrid, Spain proposed a simple method to record a quasi-standard ECG using the Apple Watch. After obtaining lead I in the standard position on the wrist, leads II and III can be obtained by moving the watch to the ankle or any place on the leg and touching the digital crown with a finger on the right hand for lead II and left hand for lead III. To record the precordial leads, the watched can be moved across the thorax. The watch can also be used to do an ECG in another person. [The process is illustrated here https://bcove.video/2QdTM1i for media information only]. The results are shown to be similar to those obtained using a standard ECG, meaning they could feasibly be used to detect a heart attack.

According to the study author, the report should be interpreted with caution. A broad range of clinical studies is needed to determine the role of such devices in the diagnosis and follow-up of patients with known or suspected heart disease.

Media contacts: For embargoed PDFs please contact Lauren Evans at Laevans@acponline.org. To speak with the lead author, Miguel Ángel Cobos Gil, MD, PhD, please contact prensa.hcsc@dalud.madrid.org.

3. European breast cancer screening guidelines highlight stark differences between U.S. and European programs

Abstract: http://annals.org/aim/article/doi/10.7326/M19-2125

Editorial: http://annals.org/aim/article/doi/10.7326/M19-3104

URLs go live when the embargo lifts

The European Commission Initiative for Breast Cancer Screening and Diagnosis guidelines highlight the stark differences between U.S. and European screening programs. While the European Beast Guidelines generally agree with recommendations from other major groups, such as the American College of Physicians and the American Cancer Society, they differ in some major ways. Most importantly, the European guidelines call for less frequent screening, but they also make recommendations for what to do if an abnormality is found. A synopsis of the European Breast Guidelines is published in Annals of Internal Medicine.

An international panel of 28 multidisciplinary members, including patients, developed questions and corresponding recommendations that were informed by systematic reviews of the evidence conducted between March 2016 and December 2018. Using GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework, the group developed guidelines that focused on outcomes that matter to women and provided a rating of certainty of the evidence.

In summary, the European Breast Guidelines recommend against annual mammography screening given that the risks may outweigh the benefits. They do not suggest screening for women aged 40 to 44 years, but suggest screening every 2 to 3 years for women aged 45 to 74 years. The European guideline group also does not suggest tailored screening with automated or hand-held breast ultrasonography or magnetic resonance imaging for women with high breast density, nor does it recommend digital breast tomosynthesis (DBT) or 3-dimensional (3D) mammography for screening in the context of population-based organized screening programs. However, the group does suggest DBT as a follow up for women recalled because of a suspicious lesion or mammography screening.

According to the author of an accompanying editorial from the David Geffen School of Medicine, the European Guidelines highlight the differences between European and U.S. screening programs in two key ways. First, less frequent screening is recommended in Europe, which could be due to the fact that European screening includes readings from two radiologists, not just one as in the U.S. The other key difference is that U.S. guidelines stop their recommendations at screening, while the European recommendations offer guidance on what to do if an abnormality is found during screening.

Media contacts: For embargoed PDFs please contact Lauren Evans at Laevans@acponline.org. To speak with the lead author, Holger J. Schunemann, MD, PhD, MSc, please contact Veronica McGuire at vmcguir@mcmaster.ca.

Also new in this issue:

Patients With Opioid Use Disorder Deserve Trained Providers

Melissa B. Weimer, DO, MCR; Jeanette M. Tetrault, MD; and David A. Fiellin, MD

Ideas & Opinions

Abstract: http://annals.org/aim/article/doi/10.7326/M19-2303

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