Journal: The Journal of Clinical Endocrinology & Metabolism Authors: Hertzel C Gerstein, Eric E Smith, Chinthanie Ramasundarahettige, Dipika Desai, Philip Awadalla, Philippe Broet, Sandra Black, Trevor J B Dummer, Jason Hicks, Alan Moody, Jean-Claude Tardif, Koon K Teo, Jennifer Vena, Salim Yusuf, Douglas S Lee, Matthias G Friedrich, Sonia S Anand Abstract: Background Diabetes is a risk factor for cerebrovascular disease and cognitive impairment. The anatomical basis for this is uncertain. Methods The Canadian Alliance for Healthy Hearts and Minds collected brain and carotid magnetic resonance imaging (MRI) and 2 cognitive tests (the Digit Symbol Substitution Test and the Montreal Cognitive Assessment test) in a cross-sectional sample of men and women. Brain MRIs identified brain infarcts (BI), lacunar BI, high white matter hyperintensity (WMH), vascular brain injury (VBI; BI or high WMH), and small vessel VBI (lacunar BI or high WMH). Carotid MRIs estimated carotid wall volume, a measure of subclinical atherosclerosis. Cognitive scores were standardized to each site’s mean score, and cognitive impairment was identified by 1 or both test scores ≤1 standard deviation below the site’s mean score on that test. Results The 7733 participants included 495 participants (6.4%) with diabetes, of whom 388 were taking diabetes drugs. After age and sex adjustment, diabetes was independently associated with BI (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.05, 2.24), VBI (OR 1.64, 95% CI 1.26, 2.13), small vessel VBI (OR 1.67, 95% CI 1.28, 2.19), and cognitive impairment (OR 1.47, 95% CI 1.20, 1.80). The association between diabetes and small vessel VBI persisted after adjustment for cerebrovascular disease risk factors and nonlacunar infarcts (OR 1.52, 95% CI 1.15, 2.01), and the association with cognitive impairment persisted after adjustment for small vessel VBI (OR 1.27, 95% CI 1.03, 1.56). Conclusion Small vessel disease characterizes much of the relationship between diabetes and VBI. However, additional factors are required to disentangle the relationship between diabetes and cognitive impairment. Link: https://doi.org/10.1210/clinem/dgaa815

Journal: Canadian Journal of Cardiology Authors: Bartosz Orzel, Melanie Keats, Yunsong Cui, Scott Grandy Abstract: Background Physical inactivity is an important risk factor for cardiovascular disease (CVD). Atlantic Canada is a region with lower physical activity (PA) levels and poorer CVD outcomes than the rest of Canada. Yet, within-region variation is expected. This study aimed to assess the association between PA and CVD and how this relationship varied on a regional level. Methods: This cross-sectional study used data from the Atlantic Partnership for Tomorrow’s Health (PATH) Study. The cohort included 823 CVD cases and 2469 age, sex, and province of residence matched controls between the ages 35-69. Data collected included self-reported CVD and PA levels, as well as information on sociodemographic characteristics, health status, and lifestyle behaviours. Simple and multiple logistic regression were used to assess the association between PA and CVD. Results High PA levels were associated with a 26% reduction in the mean probability of CVD compared to low PA levels across the total population. Compared to high PA levels, moderate and low PA levels were associated with increased odds of CVD across all four provinces. However, regional variation was observed, with higher odds of CVD for low-to-moderate PA levels in Newfoundland and Labrador (NL) and New Brunswick (NB) compared to Nova Scotia (NS) and Prince Edward Island (PEI). Conclusions Atlantic Canadians experience regional inequalities in the association between PA and CVD. Future work needs to explore underlying pathways driving these regional differences, which may be the impetus for interventions that mitigate risk and CVD burden in populations of greatest need. https://doi.org/10.1016/j.cjco.2021.01.007