Contrasting cardiovascular mortality trends in Eastern Mediterranean populations: Contributions from risk factor changes and treatments.

BACKGROUND: Middle income countries are facing an epidemic of non-communicable diseases, especially coronary heart disease (CHD). We used a validated CHD mortality model (IMPACT) to explain recent trends in Tunisia, Syria, the occupied Palestinian territory (oPt) and Turkey. METHODS: Data on populations, mortality, patient numbers, treatments and risk factor trends from national and local surveys in each country were collated over two time points (1995-97; 2006-09); integrated and analysed using the IMPACT model. RESULTS: Risk factor trends: Smoking prevalence was high in men, persisting in Syria but decreasing in Tunisia, oPt and Turkey. BMI rose by 1-2 kg/m(2) and diabetes prevalence increased by 40%-50%. Mean systolic blood pressure and cholesterol levels increased in Tunisia and Syria. Mortality trends: Age-standardised CHD mortality rates rose by 20% in Tunisia and 62% in Syria. Much of this increase (79% and 72% respectively) was attributed to adverse trends in major risk factors, occurring despite some improvements in treatment uptake. CHD mortality rates fell by 17% in oPt and by 25% in Turkey, with risk factor changes accounting for around 46% and 30% of this reduction respectively. Increased uptake of community treatments (drug treatments for chronic angina, heart failure, hypertension and secondary prevention after a cardiac event) accounted for most of the remainder. DISCUSSION: CHD death rates are rising in Tunisia and Syria, whilst oPt and Turkey demonstrate clear falls, reflecting improvements in major risk factors with contributions from medical treatments. However, smoking prevalence remains very high in men; obesity and diabetes levels are rising dramatically.

Walk-run transition speed training as an efficient exercise adjunct to dietary restriction in the management of obesity: a prospective intervention pilot study.

OBJECTIVE: The aim of this study was to test the utility of preferred walk-run transition speed (WRTS) in exercise training adjunct to dietary restriction for obesity management in healthy obese women. MATERIALS AND METHODS: 37 obese women (age: 35 ± 9 years, body mass index (BMI): 34.9 ± 4.6 kg/m(2)) were assigned to an intervention pilot study during 6 months of restricted diet alone (RD) followed by 6 months of RD combined with WRTS (RD and WRTS) as a training exercise. Body mass, waist circumference (WC), fat mass (FM), fat free mass (FFM), active cell mass (ACM), fasting glucose, serum lipids (triacylglycerol (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), apo-lipoproteins A1 (ApoA1) and B (ApoB)], leptin and insulin concentrations, and HOMA-IR were assessed at baseline (T0), at the end of the RD alone (T1), and at the end of the RD and WRTS programme (T2). RESULTS: Mean weight loss was 8.6 ± 4.9 kg and 2.2 ± 2.9 kg for (T0-T1) and (T1-T2), respectively. Significant BMI and WC reductions were reported at T1 and T2. FM decreased significantly both with RD and with RD and WRTS training whereas FFM and ACM increased with RD and WRTS training only. TG decreased significantly with the two phases of the programme. A significant increase in HDL-C, and a decrease in LDL-C and TC/HDL-C ratio were noticed with RD and WRTS training. Heart rate monitored in training improved significantly after RD and WRTS training. A significant relationship (r = 0.542, p < 0.02) was demonstrated between reductions in serum leptin and insulin concentrations observed with both RD and WRTS training. CONCLUSION: The addition of WRTS training to RD promoted a greater reduction in body mass, WC, FM, leptin and insulin concentrations, improved metabolic and cardiovascular risk factors, and enhanced cardiovascular fitness.