Medical evaluation and treatment of the obese patient with cardiovascular disease
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, 30 October 1987, Pages G55-G58
A Symposium: New Approaches to Cardiovascular Therapy
Medical evaluation and treatment of the obese patient with cardiovascular disease
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, EdD MPH RD
From the Nutrition Coordinating Center, Cancer Research Institute, New England Deaconess Hospital and Harvard Medical School, Boston, Massachusetts USA
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The incidence of coronary artery disease only weakly correlates with the percent o however, obesity in humans is not a homogeneous condition. Classification of obesity based on anatomic distribution of body fat allows for identification of a group of patients at increased risk for cardiovascular disease. Abdominal (upper body) obesity, measured as the waist/hip ratio, is a strong independent risk factor of cardiovascular disease and should be used to assess a subgroup in need of medical weight loss treatment. A focus on dietary fat intake and the magnitude of overeating “caloric intake” are central to the pathogenesis of cardiovascular disease observed in the obese person. Identification of the process of overeating (magnitude of recent weight gain, episodes of weight cycling) is important in the design of successful medical nutrition treatment programs. A nutrition/medical history that includes age of obesity onset and duration of obesity provides additional criteria for assessment of risk of disease. Childhood-onset obesity and prolonged obesity (&15 years) has been associated with increased cardiovascular disease risk. Recently, grades of obesity based on body mass index have provided a valuable marker for treatment. Each reduction in obesity grade (equal to Δ5 body mass index or Δ11.6 kg) is associated with a decrease in risk of medical illness. The new focus of obesity treatment should be to decrease body weight in 10% to 15% increments (equal to 1 grade) with emphasis on reducing the risk of medical illness and treatment intensity (e.g., number of existing medical visits, hospitalization). Rather than focusing on achieving “ideal body weight,” the goal of any treatment should be to achieve and maintain medically significant weight loss using these criteria.
Remember meTolerance and efficacy of rituximab and changes in serum B cell biomarkers in patients with systemic complications of primary
Sj?gren’s syndrome -- Seror et al. 66 (3): 351 -- Annals of the Rheumatic Diseases
An international peer-reviewed journal for health professionals and researchers in the rheumatic diseases
Ann Rheum Dis
66:351-357
doi:10.1136/ard.
1Department of Rheumatology, H?pital Bicêtre, Assistance Publique–H?pitaux de Paris, Université paris-Sud 11, INSERM U802,
Le Kremlin Bicêtre, France
2Department of Rheumatology, H?pital Hautepierre, Strasbourg, France
3Department of Internal Medicine, H?pital Cochin, Université René-Descartes Paris 5, Assistance Publique–H?pitaux de Paris,
Paris, France
4Department of Internal Medicine, CHU de Lille, Lille, France
5Department of Rheumatology, CHU d’Angers, Angers, France
6Department of Immunology, H?pital Necker, Assistance Publique–H?pitaux de Paris, Paris, France
7Department of Hematology, H?pital Necker, Université René-Descartes Paris 5, Assistance Publique–H?pitaux de Paris, Paris,
Correspondence to: Professor X Mariette Service de Rhumatologie, H?pital de Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, F xavier.mariette{at}bct.ap-hop-paris.fr
Accepted 25 August 2006
Published Online First 1 September 2006
Objective: To investigate the safety and efficacy of rituximab (RTX) for systemic symptoms in patients with primary Sj?gren’s syndrome
(pSS), and changes in B cell biomarkers.
Patients and methods: The records of 16 patients with pSS according to the American European consensus group criteria were reviewed retrospectively.
Results: Patients, all women, had a median age of 58.5 (range 41–71) years and a disease duration of 9.5 (range 0–25) years. RTX was
prescribed for lymphoma (n = 5), refractory pulmonary disease with polysynovitis (n = 2), severe polysynovitis (n = 2), mixed
cryoglobulinaemia (n = 5), thrombocytopenia (n = 1) and mononeuritis multiplex (n = 1). The median follow-up duration was
14.5 (range 2–48) months. Three patients experienced adverse events, including one mild serum sickness-like reaction with
the presence of human antichimeric antibodies. Efficacy of treatment was observed in 4 of 5 patients with lymphomas and in
9 of 11 patients with systemic involvement. Dryness was improved in only a minority of patients. Corticosteroid dose was reduced
in 11 patients. RTX induced decreased rheumatoid factor, γ-globulin and β2-microglobulin levels, and the level of B cell activating
factor of the tumour necrosis factor family (BAFF) increased concomitantly with B cell depletion. Five patients were re-treated,
with good efficacy and tolerance, except for one with probable serum sickness-like reaction.
Conclusion: This study shows good efficacy and fair tolerance of RTX for systemic features. In addition, RTX allows for a marked reduction
in corticosteroid use. Except for BAFF, the level of which increases, serum B cell biomarker levels decrease after taking
RTX. Controlled trials should be performed to confirm the efficacy of RTX in pSS.
Published Online First 1 September 2006
* These authors contributed equally to this work.
Funding: This work was supported by grant Réseau de recherche clinique INSERM on Sj?gren’s syndrome.
Competing interests: None.
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