RESUMO
At the beginning of the 20th century, there was a shift in disease patterns from that of communicable disease to noncommunicable disease (NCD). As a result, cardiovascular disease (CVD) has emerged as a leading cause of morbidity and mortality worldwide. Its incidence and effect on various populations at a molecular level as well as clinical implications have been heavily studied; however, its role in morbidity and mortality in the Indo-Caribbean population is often overlooked. The Caribbean diaspora is a vibrant and heterogeneous culture, encompassing individuals with ancestries from across the world including the Indian subcontinent and Africa. Abundant research is consistently conducted on these populations, but limited research exists on how the interplay between genetics and environment translates to the manifestation of various diseases in the Indo-Caribbean population. This scoping review aims to identify and assess the current literature within the past 10 years conducted on CVD in Indo-Caribbeans in order to gain a thorough understanding of disease and management to improve health outcomes. Additionally, this review aimed to identify gaps in research that require further study to gain a better understanding of relevant variables affecting disease outcomes in the Indo-Caribbean population. Multiple health databases were queried, and the initial search yielded over 3,000 results. However, after screening with the inclusion and exclusion criteria established, the final search included less than 1% of the papers initially searched. This search yielded data that included treatment and management of myocardial infarction, hypertension, and atherosclerosis, but notably did not yield papers that discussed the relationship between social determinants of health and CVD in Indo-Caribbeans. Florida and New York are prominent states that have robust Indo-Caribbean populations; the lack of research renders these states vulnerable to improving health outcomes in these patients. The authors call for increased focus on this population in research studies and efforts to improve the quality of the data collected through stratification by ethnicity. Robust data may allow for improvement in the treatment and management of CVD in Indo-Caribbeans, which offers a more proactive rather than reactive approach to decreasing morbidity and mortality.
RESUMO
AIMS: GLP-1 analogs have recently risen to the forefront as effective medications for lowering weight through actions in the central nervous system (CNS). However, their actions in the CNS have not yet been studied in the human brain after longer-term administration at the highest dose approved for obesity (liraglutide 3.0 mg). MATERIALS AND METHODS: A total of 20 participants with obesity were treated with placebo and liraglutide (3.0 mg) in the context of a randomized, placebo-controlled, double-blind, cross-over trial after 5 weeks of dose escalation. Neurocognitive and neuroimaging (fMRI) responses to food cues were examined at the clinical research center of Beth Israel Deaconess Medical Center. RESULTS: While using liraglutide, patients lost more weight (placebo-subtracted -2.7%; P < .001), had decreased fasting glucose (P < .001) and showed improved cholesterol levels. In an uncontrolled analysis, brain activation in response to food images was not altered by liraglutide vs placebo. When controlled for BMI/weight, liraglutide increased activation of the right orbitofrontal cortex (OFC) in response to food cues (P < .016, corrected for multiple comparisons). CONCLUSIONS: In contrast to prior studies, we demonstrate for the first time that liraglutide treatment, administered over a longer period at the highest doses approved for obesity, does not alter brain activation in response to food cues. A counter-regulatory increase in reward-related OFC activation in response to food cues can be observed when neuroimaging data are controlled for BMI changes, indicating changes in CNS that could lead to later plateaus of weight loss. These data point to a promising focus for additional interventions which, by contributing to the CNS reward system, could provide tangible benefits in reversing the plateauing phenomenon and promoting further weight loss.
