Somers, V K

Abstract Background Normal weight obesity (NWO) has been linked to metabolic syndrome (MetS), cardiovascular disease (CVD) and mortality, but has not been comprehensively studied in the Hispanic population. Purpose Our study aims to examine the CVD risk factors associated with NWO and to compare the development of CVD risk factors between NWO and normal weight non-obese (NWNO) Hispanic adults over 6 years. Methods This is a prospective study using data from the Hispanic Community Health Study (HCHS). Interviews and clinical assessments were collected from 2008–2011 (visit 1) to 2014–2017 (visit 2). NWO was defined as a body mass index (BMI) between 18.5–24.9 kg/m2 and a body fat percentage of ≥25 % in men and ≥35% in women, estimated using the Tanita scale. We identified 1,000 HCHS participants as having a normal weight at visit 1 and not missing data on covariates of interest including hypertension (HTN), hyperlipidemia (HLD), MetS, and insulin resistance (Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) ≥2.5). Participants were categorized into NWO (n=104) or NWNO (n=896) groups. Univariate logistic regression models were used to estimate the odds ratio (OR) and 95% confidence intervals (CI) of the association between health risk factors and NWO. Multivariate logistic regression models were used to estimate the odds of developing CVD risk factors over 6 years, using propensity score matching. Results The prevalence of NWO among our sample of Hispanic adults was 10.4% and the 6-year incidence of NWO at visit 2 was 3.5% (n=31) from NWNO participants at visit 1. Higher BMI (OR=5.19; 95% CI=3.15–9.27, p<0.001) and a higher mean overnight heart rate (OR=1.34; 95% CI=1.01–1.79, p=0.043) were statistically significantly associated with NWO at visit 1. Furthermore, HTN (OR=2.88; 95% CI=1.31–6.71, p=0.011), HLD (OR=2.12; 95% CI=1.21–3.77, p=0.009), and MetS (OR=3.48; 95% CI=1.62–8.09, p=0.002) were statistically significantly associated with NWO at visit 1. Participants with NWO at visit 1 had higher odds of developing insulin resistance (OR=1.79; 95% CI=1.07–3.04, p=0.029) and MetS (OR=2.03; 95% CI=1.15–3.66, p=0.016) at visit 2 compared to NWNO participants at visit 1, after age and sex matching. Conclusion Among Hispanic adults, the prevalence of NWO was associated with a higher BMI, higher mean overnight heart rate, treated HTN, HLD, and MetS. Hispanic adults with NWO were more likely to develop insulin resistance and MetS over 6 years compared to NWNO Hispanic adults. Overall, NWO among Hispanic adults was associated with CVD risk factors which places this population at a higher risk for CVD morbidity and mortality.

Abstract Background Cardiovascular disease (CVD) is the leading cause of death in patients with type 2 diabetes mellitus (T2DM). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated cardiovascular (CV) benefits and are recommended for T2DM patients with atherosclerotic CVD (ASCVD). However, real-world data on their adoption in high-risk populations, particularly myocardial infarction (MI) and stroke survivors, remain limited. Purpose To assess real-world utilization of GLP-1RAs and SGLT2i among T2DM patients with ASCVD focusing on trends, disparities by age, sex, and region from 2015 to 2023. Methods A nationwide cohort study using data from the National Registry of Reimbursed Health Services (2015–2023), covering all reimbursed health services in the Czech Republic. Patients with nonfatal MI (ICD-10: I21, I22) or stroke (I63, I64) and confirmed T2DM were included. Prescriptions were identified at the event or within 12 months post-event. Utilization trends were analyzed, and logistic regression was used to determine predictors of medication use. Results Among 116,218 MI patients (median age:68 years, 33.5% women), 53,128 (46%) had T2DM (median age:71 years, 37% women). Within 12 months post-MI, 2.1% received GLP-1RAs and 10.6% received SGLT2i, with increasing trends from 0.3% (2015) to 4.8% (2023) (GLP-1RAs) and 0.4% (2015) to 34.8% (2023) (SGLT2i). Women were less likely to receive SGLT2i (aOR: 0.70 [95%CI:0.65–0.74]), while no significant difference was observed for GLP-1RAs (aOR:0.98 [95%CI:0.86–1.12]). Older patients (>70 years) had lower odds of receiving GLP-1RAs (aOR:0.31 [95%CI:0.27–0.36]) and SGLT2i (aOR:0.53 [95%CI:0.50–0.56]). Prescription rates were highest in Prague (3.1% GLP-1RAs; 13.5% SGLT2i) and lowest in the Moravian-Silesian Region (1.4% GLP-1RAs; 8.8% SGLT2i). Among 164,729 stroke patients (median age:73 years, 49% women), 78,562 (48%) had T2DM (median age:75 years, 50% women). Within 12 months post-stroke, 1.2% received GLP-1RAs and 3.7% received SGLT2i, with increasing trends from 0.2% (2015) to 2.8% (2023) (GLP-1RAs) and 0.1% (2015) to 10.4% (2023) (SGLT2i). Women were less likely to receive GLP-1RAs (aOR:0.82 [95%CI:0.72–0.95]) and SGLT2i (aOR:0.57 [95%CI:0.52–0.62]). Older patients (>70 years) had lower odds of receiving GLP-1RAs (aOR:0.31 [95%CI:0.27–0.36]) and SGLT2i (aOR:0.40 [95%CI:0.37–0.44]). Regional disparities were notable, with prescription rates varying from 0.8–2.1% (GLP-1RAs) and 2.4–5.2% (SGLT2i). Conclusions Prescribing rates for GLP-1RAs and SGLT2i have increased over the past eight years but remain low, even among MI and stroke survivors. Women, older patients, and those in lower-income regions are significantly less likely to receive these therapies. Targeted interventions are needed to improve secondary prevention in high-risk diabetic populations and to address these disparities.Myocardial infarction patients Stroke patients