CME INDIA Presentation by Dr. N. K. Singh, Director – Diabetes and Heart Research Centre, Dhanbad, Editor-CME INDIA.

The search for elixir of immortality has yielded mixed results (1)

• While interventions such as percutaneous coronary interventions and CABG have shown limited success in extending life expectancy, their absolute benefit remains modest, particularly in very ill patients.
• Cardiac-specific medications like statins and aspirin have demonstrated slightly better outcomes, especially in patients with established coronary artery disease, though their effectiveness in primary prevention is relatively low.
• The only strategies with proven benefit in primary or primordial prevention involve adopting and maintaining a healthy lifestyle. This includes smoking cessation, weight reduction, increased physical activity, a nutritious diet, and controlling blood pressure, cholesterol, and blood glucose levels.

After a decade new insight for Metabolic Syndrome (2)

• Since Metabolic Syndrome (MetS) was first identified, various global organizations and associations have defined it under different names, often expanding the list of risk factors and variables—what could now be called “MetS reloaded.” 
• At its core, MetS involves a cluster of clinically significant risk factors and associated variables that converge, increasing the risk for atherosclerotic cardiovascular disease (CCVD) and type 2 diabetes mellitus (T2DM).

Courtsey: Hayden, Melvin. (2023). Overview and New Insights into the Metabolic Syndrome: Risk Factors and Emerging Variables in the Development of Type 2 Diabetes and Cerebrocardiovascular Disease.

Ten-year cumulative exposure to SBP is a risk factor to CVD and all-cause mortality, above and beyond current SBP

Courtsey: Reges O, Ning H, Wilkins JT, Wu CO, Tian X, Domanski MJ, Lloyd-Jones DM, Allen NB. Association of Cumulative Systolic Blood Pressure With Long-Term Risk of Cardiovascular Disease and Healthy Longevity: Findings From the Lifetime Risk Pooling Project Cohorts. Hypertension. 2021 Feb;77(2):347-356.

Message from Secondary Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT)

Ensure blood pressure control early in life.

Increase mitochondrial function in order to prevent or treat Hypertension and keep them young

• One of the most extensively proven methods is restricting calories. 
• Calorie restriction is well known to reverse and prevent insulin resistance. 
• SIRT, which are a family of NAD+-dependent deacetylases, play a central role in mediating the effect of calorie restriction on mitochondrial function.
• In pancreatic b-cells, SIRT1 stimulates insulin secretion and provides defense from oxidative stress.
• SIRT1 activates PGC-1a in muscle and liver to increase mitochondrial biogenesis.
• It has also been reported that small molecules activating SIRT were able to increase insulin sensitivity and mitochondrial function, mimicking the effects of calorie.

Unique Longevity Message

If your grandmother exercised during pregnancy-you are protected

Exercise more than Viagra:Countering Anti-Hypertensive drugs causing ED?(6)

• A new meta-analysis finds that aerobic exercise is nearly as effective as medication in treating erectile dysfunction (ED), offering a safe and more affordable alternative.
• The most significant improvements in sexual performance were observed in men with severe ED. Since erectile dysfunction is linked to cardiovascular health, the same exercises that benefit heart health can also improve ED.
• As a meta-analysis of randomized controlled trials, the study’s conclusions are highly credible.

Yoga: The Science of Longevity

• Surya Namaskar, a positive impact also noted on autonomic function of the body. 
• Its regular practice of significantly decreases the oxidative stress of the body which plays a key role in insulin resistance.

Recent studies have suggested that intensive blood pressure lowering can improve left ventricular systolic and diastolic function

• Hypertension, when treated and without other cardiovascular diagnosis or diabetes, is associated with significant changes in left ventricular structure, function and energetics in addition to normal aging effects. These are, at least in part, related to the level of systolic blood pressure, and so are potentially modifiable.
• It is important that younger hypertensive patients are targeted before the age-related changes in left ventricular function compound the effects of hypertension.

Mystery Unfolding in 2024

Human longevity by modulating the telomere system and in slowing down the effects of many chronic disorders

Respect Your Circadian Rhythm

Chrono nutrition-A super Concept

Improve Your Gut Microbiota

• Gut microbiota is closely linked to hypertension. Exploring the relationship between gut microbiota and hypertension could provide new insights into the pathogenesis of hypertension, offering valuable perspectives for its prevention and treatment.
  Source: Clin Exp Hypertens. 2023 Dec 31;45(1):2195135.

Taking vacations could prolong life. 

Final Points

Hypertension – an important cause of premature death and disability.

The Crosstalk – Oxidative Stress and Inflammation is the Secret. We know the ways to halt it.

Mitochondria-Induced Endothelial Cell Dysfunction in Hypertension Progression can be tackled.

Lifestyle Interventions – MOST PROMISING INTERVENTIONS.

Altering Telomerase: Know it to do it.

Respecting Circadian Rhythm is centuries old Indian WISDOM.

Treat to Target of desirable BP goal – Right Time/Right Drug/Right Perspective.

References:

1. Sundeep Mishra,Does modern medicine increase life-expectancy: Quest for the Moon Rabbit?,Indian Heart Journal,Volume 68, Issue 1,2016,Pages 19-27,https://doi.org/10.1016/j.ihj.2016.01.003. 
2. Hayden, Melvin. (2023). Overview and New Insights into the Metabolic Syndrome: Risk Factors and Emerging Variables in the Development of Type 2 Diabetes and Cerebrocardiovascular Disease. 10.20944/preprints202302.0115.v1.
3. Reges O, Ning H, Wilkins JT, Wu CO, Tian X, Domanski MJ, Lloyd-Jones DM, Allen NB. Association of Cumulative Systolic Blood Pressure With Long-Term Risk of Cardiovascular Disease and Healthy Longevity: Findings From the Lifetime Risk Pooling Project Cohorts. Hypertension. 2021 Feb;77(2):347-356. doi: 10.1161/HYPERTENSIONAHA.120.15650. Epub 2020 Dec 21. PMID: 33342241; PMCID: PMC7864675
4. Muthiah Vaduganathan, MD, MPH; Brian L. Claggett, PhD; Stephen P. Juraschek, MD, PhD; et al Scott D. Solomon, MD¹ Secondary Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT).JAMA Cardiol. 2020;5(5):576-581. doi:10.1001/jamacardio.2019.6192
5. Kwak SH, Park KS, Lee KU, Lee HK. Mitochondrial metabolism and diabetes. J Diabetes Investig. 2010 Oct 19;1(5):161-9. doi: 10.1111/j.2040-1124.2010.00047.x. PMID: 24843427; PMCID: PMC4020716.
6. Mohit Khera, Samir Bhattacharyya, Larry E Miller, Effect of aerobic exercise on erectile function: systematic review and meta-analysis of randomized controlled trials, The Journal of Sexual Medicine, Volume 20, Issue 12, December 2023, Pages 1369–1375, https://doi.org/10.1093/jsxmed/qdad130
7. Chaya MS, et alAV. Insulin sensitivity and cardiac autonomic function in young male practitioners of yoga. The National Medicalournal of India. 2008; 21(5):217–21. 
8. Herzig S, Shaw RJ. AMPK: guardian of metabolism and mitochondrial homeostasis. Nat Rev Mol Cell Biol. 2018;19(2):121-135. doi:10.1038/nrm.2017.95
9. Henry, C.J., Kaur, B. & Quek, R.Y.C. Chrononutrition in the management of diabetes. Nutr. Diabetes 10, 6 (2020). https://doi.org/10.1038/s41387-020-0109-6
10. https://www.cell.com/trends/immunology/fulltext/S1471-4906(20)30070-3. April 28, 2020

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