The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study

Clustering of metabolic syndrome risk factors and arterial stiffness in young adults: the Northern Ireland Young Hearts Project

OBJECTIVES

This study aimed to investigate whether the clustering of the risk factors of the metabolic syndrome (MetS) is associated with stiffness of central and peripheral arterial segments; whether these associations are similar in men and women; and whether insulin resistance and low-grade inflammation mediate any such associations.

BACKGROUND

Increased arterial stiffness may explain, at least in part, the increased cardiovascular and diabetes risk associated with the MetS. However, the mechanisms linking the MetS to an increased arterial stiffness are incompletely understood, and gender differences may exist.

METHODS

Cross-sectional analyses of data on 313 young men and women (mean age 23 years) from the Northern Ireland Young Hearts Project. Subjects were categorized according to the number of traits of the MetS; in addition a continuous MetS score was calculated. Arterial stiffness was assessed by measuring pulse wave velocity (PWV) in three arterial segments using a non-invasive optical method.

RESULTS

The prevalence of the MetS was similar for men (10.6%) and women (10.5%). After adjustment for potential confounders and other cardiovascular risk factors, PWV of the three arterial segments investigated increased with increasing traits of the MetS in women only. Women with the MetS, as compared to those without risk factors of the syndrome, had greater PWV of the aorto-iliac (+14.0%, P = 0.016), the aorto-radial (+13.2%, P = 0.010) and aorto-dorsalis pedis (+11.8%, P = 0.011) segments. A great deal (up to 75%) of the association between the MetS and aortic-iliac PWV was mediated by heart rate, inflammation markers [C-reactive protein (CRP) and fibrinogen] and insulin resistance [homeostatic model assessment-insulin resistance (HOMA-IR)], whereas these variables did not explain much of the association between the MetS and PWV of the peripheral segments.

CONCLUSIONS

Young women with the MetS show increased stiffness of peripheral and central arteries, a mechanism that may explain their increased cardiovascular risk. Low-grade inflammation, insulin resistance and sympathetic activation explain much of the adverse impact of the MetS on central, but not peripheral, arterial stiffness.

The link between abdominal obesity, metabolic syndrome and cardiovascular disease

AIM

The prevalence of metabolic syndrome has increased dramatically in recent years, and the cluster of metabolic abnormalities it encompasses results in increased cardiovascular morbidity and mortality. The role of abdominal (visceral) obesity and the underlying molecular and cellular mechanisms central to this association have been the subject of intensive research in recent times. The aim of this review is to correlate data in this area, highlighting the central role of excess visceral fat and its secreted adipokines, and to review existing and emerging therapies.

DATA SYNTHESIS

Data were generated from a search of the PubMed database using the terms 'abdominal obesity', 'metabolic syndrome', 'insulin resistance', 'adipokines', 'interleukin-6 (IL-6)', 'adiponectin', 'tumour necrosis factor-alpha (TNF-alpha)' and 'cardiovascular disease'.

CONCLUSION

Metabolic syndrome is associated with a pro-inflammatory state, and the role of visceral obesity is thought to be central to this. Visceral obesity leads to alteration of the normal physiological balance of adipokines, insulin resistance, endothelial dysfunction and a pro-atherogenic state. In association with this, the presence of conventional cardiovascular risk factors such as hypertension, dyslipidaemia and smoking results in a significantly elevated cardiovascular and metabolic (cardiometabolic) risk. Better understanding of the molecular mechanisms central to this association has led to the development of potential therapeutic agents.

The metabolic syndrome and incidence of cardiovascular disease in non-diabetic subjects--a population-based study comparing three different definitions

AIMS

Between 1998 and 2005, a number of definitions of the metabolic syndrome (MetS) have been proposed. The aim of this population-based cohort study was to compare prevalence rates and the prediction of cardiovascular disease (CVD) using different definitions of MetS.

METHODS

A total of 5047 non-diabetic subjects (66% women), from the city of Malmö, Sweden, were followed. The incidence of fatal and non-fatal CVD (cardiac events, n = 176, and stroke, n = 171) was monitored over 11 years of follow-up. MetS was defined in three different ways [by International Diabetes Federation (IDF), National Cholesterol Education Program--Adult Treatment Panel III (NCEP-ATPIII), or European Group for the study of Insulin Resistance (EGIR) criteria] based on data on waist circumference, blood pressure, serum triglycerides, High-density lipoprotein cholesterol and fasting blood glucose. The IDF definition identified 21.9% of the subjects having the MetS. Corresponding figures for the NCEP-ATPIII and EGIR definitions were 20.7 and 18.8%, respectively.

RESULTS

After taking age, gender, low-density lipoprotein cholesterol and lifestyle factors into account, the hazard ratio (HR) for CVD event according to the IDF, NCEP-ATPIII and EGIR definitions were HR 1.11 (95% CI: 0.86-1.44), 1.59 (1.25-2.03) and 1.35 (1.05-1.74), respectively. The results were largely similar for cardiac and stroke events.

CONCLUSIONS

The prevalence of Mets according to the IDF definition was higher in comparison with NCEP-ATPIII and EGIR definitions, but the IDF definition was not superior to these definitions for prediction of CVD events. This was true for both genders and questions the usefulness of the current IDF criteria of MetS in a North-European, Caucasian population. In addition, single risk factors such as smoking had an equal prediction as the metabolic syndrome.

The usefulness of the International Diabetes Federation and the National Cholesterol Education Program's Adult Treatment Panel III definitions of the metabolic syndrome in predicting coronary heart disease in subjects with type 2 diabetes

OBJECTIVE

The purpose of this study was to compare the predictive value for coronary heart disease (CHD) of the International Diabetes Federation (IDF) definition (with Asian criteria for central obesity) of the metabolic syndrome with existing criteria of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) in Chinese subjects with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Subjects with type 2 diabetes and without macrovascular diseases or end-stage renal disease were categorized by the criteria of the IDF and the NCEP ATP III. CHD was defined as myocardial infarction, ischemic heart disease, coronary revascularization, heart failure, and death related to CHD.

RESULTS

Of 4,350 patients (aged 54.4 +/- 13.4 years; median follow-up period 7.1 [interquartile range 5.2-8.5] years), 65.9% had metabolic syndrome according to either IDF or NCEP ATP III criteria. The NCEP ATP III definition identified metabolic syndrome in 786 subjects (18.1%) who did not fulfill the criteria of the IDF. HDL cholesterol and systolic blood pressure were predictors of CHD after adjustment for other confounding factors. Compared with subjects without metabolic syndrome, the IDF criteria failed to predict CHD (hazard ratio 1.13 [95% CI 0.86-1.48], P = 0.374). In contrast, the NCEP ATP III definition (2.51 [1.80-3.50], P < 0.001) predicted an increased risk of CHD with the NCEP-only group having the highest risk (2.49 [1.66-3.73], P < 0.001).

CONCLUSIONS

With established type 2 diabetes, the IDF definition of the metabolic syndrome failed to identify a subgroup of patients who had the highest risk for CHD. Practitioners must recognize the appropriate setting for its application.

Obesity and atherogenic dyslipidemia

Obesity is associated with an increased risk of coronary heart disease, in part due to its strong association with atherogenic dyslipidemia, characterized by high triglycerides and low high-density lipoprotein (HDL) cholesterol. There has been substantial research effort focused on the mechanisms of the link between obesity and atherogenic dyslipidemia, both in the absence and presence of insulin resistance. After a brief overview of the epidemiology of atherogenic dyslipidemia, this article details the known molecular mechanisms of adipocyte function and its relationship to apoB-containing lipoprotein assembly and metabolism, both in the healthy as well as in the obese states. We also discuss the pathophysiology of low HDL cholesterol in obesity and the implications for cardiovascular disease risk.

Elevated Lp-PLA2 levels add prognostic information to the metabolic syndrome on incidence of cardiovascular events among middle-aged nondiabetic subjects

BACKGROUND

To explore potential interrelationships between lipoprotein-associated phospholipase A2 (Lp-PLA2), the metabolic syndrome (MetS), and incident cardiovascular disease (CVD).

METHODS AND RESULTS

MetS was defined by the National Cholesterol Education Program Adult treatment Panel III criteria in 4480 nondiabetic Malmö Diet and Cancer Study subjects without history of CVD. Incidence of first CVD event (stroke [130 cases] or myocardial infarction [131]) was monitored over 10 years of follow-up. Lp-PLA2 activity and mass were significantly higher in subjects with MetS. Lp-PLA2 activity compared with Lp-PLA2 mass was more strongly correlated to individual components and increased more linearly with number of MetS components. Elevated Lp-PLA2 activity (top compared with bottom tertile), but not elevated Lp-PLA2 mass, increased risk for incident CVD (relative risk, RR: 1.54, 95% CI 1.07 to 2.24), as did MetS (1.42, 1.06 to 1.90) after taking possible confounders into account. Relative to those without either elevated Lp-PLA2 activity or MetS, combination of MetS and elevated Lp-PLA2 activity increased risk for CVD (1.97, 1.34 to 2.90). Elevated Lp-PLA2 activity without MetS increased risk for CVD (1.40, 1.03 to 1.92) but not MetS without elevated Lp-PLA2 activity (1.46, 0.94 to 2.27).

CONCLUSION

Lp-PLA2 is associated to the MetS. Higher plasma levels of Lp-PLA2 increased risk for incident CVD regardless of MetS. The simultaneous presence of elevated Lp-PLA2 activity and MetS may identify an especially high risk individual.

Different definitions of the metabolic syndrome and risk of first-ever acute ischaemic non-embolic stroke in elderly subjects

To investigate which of the three recently proposed definitions of the metabolic syndrome (MetS) is related to the excessive risk of ischaemic non-embolic stroke in elderly individuals, and thus may be more appropriate to implement in clinical practice. In a population-based case-control study of subjects aged older than 70 years (163 patients vs. 166 controls), we evaluated the association of first-ever acute ischaemic non-embolic stroke with the MetS defined by using recent definitions as proposed by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), the International Diabetes Federation (IDF) and the National Heart, Lung and Blood Institute/American Heart Association (NHLBI/AHA). By applying the NCEP ATP III, NHLBI/AHA and IDF definitions, the prevalence of MetS in the patient group was 46%, 57.1% and 69.9%, respectively, compared with 15.7%, 18.1% and 30.7% in the control group (p < 0.001 for all comparisons). After adjusting for multiple risk factors, the odds ratio (OR) for ischaemic stroke was 2.59 [95% confidence interval (CI): 1.24-5.42, p = 0.012] for NCEP ATP III-defined MetS and 3.18 (95% CI: 1.58-6.39, p = 0.001) for NHLBI/AHA-defined MetS. However, the association of IDF-defined MetS with ischaemic stroke was not significant (OR 1.18, 95% CI: 0.50-2.78, p = 0.71). The implementation of the IDF (unlike NCEP ATP III and NHLBI/AHA) MetS definition substantially increases the number of elderly subjects labelled as having MetS without contributing to the identification of those at high risk of stroke.

Ten-year risk of cardiovascular incidence related to diabetes, prediabetes, and the metabolic syndrome

BACKGROUND

The relative contributions of the metabolic syndrome (MetS) and dysglycemia on the risk of cardiovascular disease (CVD) have not been dissected. We aimed to compare MetS with dysglycemia in their association with the 10-year incidence risk of CVD.

METHODS

A total of 30,378 subjects were recruited from 11 provinces in the CMCS and followed-up for new coronary heart disease (CHD) and stroke events (ischemic stroke and hemorrhagic stroke) for 10 years. Incidence rates and HRs were estimated by the presence or absence of MetS, impaired fasting glucose (IFG) and diabetes, and by the various traits of MetS.

RESULTS

Among the subjects, 18.2% were defined as having MetS; 21.1% had IFG, and 6.8% had diabetes. Metabolic syndrome prevalence in IFG and diabetes was 38.1% and 48.7%, respectively, and the prevalence of IFG and diabetes in MetS was 44.1% and 18.3%, respectively. After adjusting for nonmetabolic risk factors, HRs of total CVD, CHD, and ischemic stroke in MetS were significant and higher than those in non-MetS, regardless of glycemic status. In the absence of MetS, the impact of dysglycemia was found only in IFG to CHD and diabetes to ischemic stroke. Hyperglycemia without any concomitant disorders was not associated with significantly higher risk of CVD.

CONCLUSIONS

The increased CVD risk in individuals with IFG or diabetes was largely driven by the coexistence of multiple metabolic disorders rather than hyperglycemia per se. Identification of clustering of metabolic abnormalities should be given more consideration in CVD prevention.

Obesity and Lifestyle Management in Polycystic Ovary Syndrome

Polycystic ovary syndrome is frequently associated with obesity, with at least 50% of women with polycystic ovary syndrome demonstrating overweight or obesity defined by body mass index >25 or >30 kg/m. Overweight and obesity impact the clinical reproductive and metabolic features of the syndrome. Long-term complications of obesity such as cardiovascular risk and diabetes, as well as those over the short term in reproductive function, are significantly improved by lifestyle modification. Weight reduction is difficult to achieve over the long-term and programs designed for modest reduction in overall body weight (5% to 10%) with improvements in fitness are as effective as severe weight reduction in reducing metabolic disease and improving ovulatory potential. Further research is needed into the best approach for successful interventions that result in long-term sustained weight loss.

The Metabolic Syndrome and the Carotid Artery Structure in Noninstitutionalized Elderly Subjects

Background and Purpose— In contrast to the young adult population, limited data are presently available regarding the epidemiology of the metabolic syndrome (MetS) and its relationship with cardiovascular disease risk in the elderly. We have investigated the frequency of the MetS and its association with the carotid artery structure in an elderly free-living population.

Methods— The study population consists of 5585 French noninstitutionalized elderly men and women aged 65 to 85 years, free of diabetes, who participated in the multicenter Three City Study and who underwent ultrasound examination of the carotid arteries at baseline examination between March 1999 and March 2001. The MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria.

Results— The MetS was present in 12.1% of the study participants, with slightly higher rates in men. Subjects with the MetS had higher frequency of carotid plaques (odds ratio, 1.30; 95% CI, 1.09 to 1.55), higher intima-media thickness of the common carotid artery (odds ratio, 1.81; 95% CI, 1.37 to 2.41), and higher lumen diameter (odds ratio, 2.17; 95% CI, 1.61 to 2.94) (upper quintiles) after adjustment for other cardiovascular risk factors. This association was observed in both genders and in subjects without prevalent cardiovascular disease. Elevated blood pressure as defined in the MetS was the main determinant of the relations between the MetS and the carotid parameters, especially the lumen diameter.

Conclusions— The present data suggest that noninstitutionalized elderly subjects with the MetS have altered structure of the carotid arteries.

Consistently Stable or Decreased Body Mass Index in Young Adulthood and Longitudinal Changes in Metabolic Syndrome Components

Background— Data are sparse regarding the association of stable body mass index (BMI) over the long term with metabolic syndrome components in young adults.

Methods and Results— Participants in the Coronary Artery Risk Development in Young Adults Study, including white and black adults 18 to 30 years of age at the initial examination in 1985 to 1986, were stratified into groups by baseline BMI and change in BMI (stable/decreased, increased >2 kg/m 2 , or fluctuating) across all 6 examinations between years 0 and 15 of the study. Changes in metabolic syndrome components were compared between groups. Among 1358 men and 1321 women, 16.3% maintained a stable BMI, 73.9% had an increased BMI, and 9.8% had a fluctuating BMI. Over 15 years, participants with stable BMI had essentially unchanged levels of metabolic syndrome components, regardless of baseline BMI, whereas those with increased BMI had progressively worsening levels. For example, men with a baseline BMI of 20.0 to 24.9 kg/m 2 and stable BMI during follow-up had a mean increase of only 15 mg/dL in fasting triglycerides over 15 years compared with 65 mg/dL ( P <0.001) in those whose BMI increased. Incidence of metabolic syndrome at year 15 was lower in the stable BMI group (2.2%) compared with the increased BMI group (18.8%; P <0.001).

Conclusions— Adverse progression of metabolic syndrome components with advancing age may not be inevitable. Young adults who maintained stable BMI over time had minimal progression of risk factors and lower incidence of metabolic syndrome regardless of baseline BMI. Greater public health efforts should be aimed at long-term weight stabilization.

A cross-sectional study of socioeconomic status and the metabolic syndrome in Korean adults

PURPOSE

Socioeconomic status may influence the risk of the metabolic syndrome. We investigated the association between socioeconomic status and the metabolic syndrome in Korean adults.

METHODS

We analyzed a total of 8,541 subjects ages 20 to 79 years who participated in the Korean National Health and Nutrition Examination Survey, 2001. Socioeconomic status was measured by education and income level.

RESULTS

The prevalence of the metabolic syndrome among this population was 29%. Relative to women with educational level<7 years, those with educational levels of 7 to 9 years, 10 to 12 years, and >13 years had odds ratios for the metabolic syndrome of 0.92 (95% confidence interval [CI]: 0.73 to 1.16), 0.55 (95% CI: 0.44 to 0.70), and 0.31 (95% CI: 0.22 to 0.43), respectively (p for trend<0.05). Relative to women with lower income, those with middle and upper income had odds ratios for the metabolic syndrome of 0.90 (95% CI: 0.75 to 1.08) and 0.80 (95% CI: 0.66 to 0.97), respectively (p for trend<0.05). A significant association between the metabolic syndrome and socioeconomic status was not observed in men.

CONCLUSIONS

Lower socioeconomic status was associated with a higher risk of the metabolic syndrome in Korean women but not in Korean men.

Metabolic syndrome and NASH

Clinical and epidemiologic studies have associated non-alcoholic fatty liver with the metabolic syndrome, with insulin resistance as the pivotal pathogenic factor. Obesity, type 2 diabetes mellitus, dyslipidemia, and hypertension contribute to risk for liver disease and to disease progression. The presence of multiple metabolic abnormalities is associated with the severity of liver disease. Patients have a high risk for cardiovascular morbidity and mortality, mediated by early atherosclerosis. This evidence has precise therapeutic implications: only a behavioral approach to lifestyle correction will address all alterations characterizing the metabolic syndrome, including metabolic liver disease.

The metabolic syndrome: an introduction

It is my pleasure to introduce this special thematic issue of Applied Physiology, Nutrition, and Metabolism (APNM) on metabolic syndrome (MetS). This publication comes at an exciting time, in the midst of debates encompassing the most appropriate clinical definition of MetS, its potential etiological pathways, and questions about the very existence of MetS as an entity unto itself. This compilation of invited reviews and original research articles provides an overview and sampling of the latest research on MetS. It has been designed to meet the interests of the diverse readership of APNM and to stimulate further research in this important area of investigation.

Endocannabinoid Antagonism: Blocking the Excess in the Treatment of High-Risk Abdominal Obesity

Abdominal obesity is a prevalent, worldwide problem linked to cardiometabolic comorbidities and an increased risk of coronary heart disease. First-line therapy to reduce such risk revolves around diet and exercise; however, such changes are often difficult to implement and unsuccessful. Understanding the underlying pathophysiology of underlying metabolic derangements could provide new targets for pharmacologic therapy. One system that has gained recent attention is the endocannabinoid system. The endocannabinoid system has a significant role in central appetite control and peripheral lipogenesis and is up-regulated in diet-induced obesity. Rimonabant is a selective cannabinoid-1 receptor antagonist and is the first compound of its type to test the hypothesis that down-regulating an overactive endocannabinoid system could have therapeutic benefit not only for weight loss but also for the atherogenic dyslipidemia and insulin resistance that cluster with abdominal obesity in particular. Animal models have been critical for elucidating the role of the endocannabinoid system in obesity and in demonstrating that antagonism with rimonabant can induce loss of visceral fat and improve insulin sensitivity. Early human trials with rimonabant have confirmed significant reductions in weight, as well as favorable changes in atherogenic dyslipidemia, insulin resistance, and markers of inflammation. Interestingly, some of these beneficial metabolic effects are partially weight-loss-independent, confirming the importance of peripheral endocannabinoid system effects in addition to central effects.

Metabolic syndrome and cardiovascular risk in primary hypertension

The metabolic syndrome can be found in approximately one third of patients who do not have diabetes but have primary hypertension. Its presence has been associated with a wide range of traditional and nontraditional cardiovascular risk factors and early signs of cardiovascular and renal damage. Moreover, it was emphasized recently that the metabolic syndrome predicts an increased probability of sustaining a cardiovascular event or dying. In the clinical setting of insulin resistance, attention should be paid to the metabolic side effects of antihypertensive drugs; therefore, preference should be given to renin-angiotensin system inhibitors and calcium channel blockers rather than to beta blockers and diuretics.

Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies

OBJECTIVES

The purpose of this research was to assess the association between the metabolic syndrome (MetSyn) and cardiovascular events and mortality by meta-analyses of longitudinal studies.

BACKGROUND

Controversy exists regarding the cardiovascular risk associated with MetSyn.

METHODS

We searched electronic reference databases through March 2005, studies that referenced Reaven's seminal article, abstracts presented at meetings in 2003 to 2004, and queried experts. Two reviewers independently assessed eligibility. Longitudinal studies reporting associations between MetSyn and cardiovascular events or mortality were eligible. Two reviewers independently used a standardized form to collect data from published reports. Authors were contacted. Study quality was assessed by the control of selection, detection, and attrition biases.

RESULTS

We found 37 eligible studies that included 43 cohorts (inception 1971 to 1997) and 172,573 individuals. Random effects meta-analyses showed MetSyn had a relative risk (RR) of cardiovascular events and death of 1.78 (95% confidence interval [CI] 1.58 to 2.00). The association was stronger in women (RR 2.63 vs. 1.98, p = 0.09), in studies enrolling lower risk (<10%) individuals (RR 1.96 vs. 1.43, p = 0.04), and in studies using factor analysis or the World Health Organization definition (RR 2.68 and 2.06 vs. 1.67 for National Cholesterol Education Program definition and 1.35 for other definitions; p = 0.005). The association remained after adjusting for traditional cardiovascular risk factors (RR 1.54, 95% CI 1.32 to 1.79).

CONCLUSIONS

The best available evidence suggests that people with MetSyn are at increased risk of cardiovascular events. These results can help clinicians counsel patients to consider lifestyle interventions, and should fuel research of other preventive interventions.

The National Cholesterol Education Program - Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes

OBJECTIVE

The clinical value of metabolic syndrome is uncertain. Thus, we examined cardiovascular disease (CVD) and diabetes risk prediction by the National Cholesterol Education Program (NCEP)-Adult Treatment Panel III (ATPIII), International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome.

RESEARCH DESIGN AND METHODS

We analyzed the risks associated with metabolic syndrome, the NCEP multiple risk factor categories, and 2-h glucose values in the San Antonio Heart Study (n = 2,559; age range 25-64 years; 7.4 years of follow-up).

RESULTS

Both ATPIII metabolic syndrome plus age > or = 45 years (odds ratio 9.25 [95% CI 4.85-17.7]) and multiple (two or more) risk factors plus a 10-year coronary heart disease (CHD) risk of 10-20% (11.9 [6.00-23.6]) had similar CVD risk in men without CHD, as well as CHD risk equivalents. In women counterparts, multiple (two or more) risk factors plus a 10-year CHD risk of 10-20% was infrequent (10 of 1,254). However, either a 10-year CHD risk of 5-20% (7.72 [3.42-17.4]) or ATPIII metabolic syndrome plus age > or = 55 years (4.98 [2.08-12.0]) predicted CVD. ATPIII metabolic syndrome increased the area under the receiver operating characteristic curve of a model containing age, sex, ethnic origin, family history of diabetes, and 2-h and fasting glucose values (0.857 vs. 0.842, P = 0.013). All three metabolic syndrome definitions imparted similar CVD and diabetes risks.

CONCLUSIONS

Metabolic syndrome is associated with a significant CVD risk, particularly in men aged > or = 45 years and women aged > or = 55 years. The metabolic syndrome predicts diabetes beyond glucose intolerance alone.

Carotid atherosclerosis in normal-weight metabolic syndrome

OBJECTIVE

To examine whether or not individuals with a normal body mass index (BMI) (18.5 kg/m(2)-24.9 kg/m(2)), but who also fulfill the criteria for the metabolic syndrome (MetS) class, can be associated with carotid atherosclerosis.

METHODS

The subjects were consecutive in-patients with a normal BMI (18.5 kg/m(2)-24.9 kg/m(2)) in the Medical Department of Seiyo Municipal Nomura Hospital enrolled between September 1996 and February 2006. The subjects were 452 men aged 69+/-15 (mean+/-standard deviation) years and 542 women aged 74+/-13 years. Carotid atherosclerosis was assessed by carotid intima-media thickness (IMT) on B-mode ultrasonography.

RESULTS

Compared with men with BMI 18.5 kg/m(2) to 20.9 kg/m(2), the odds ratios of the MetS were 2.83 (95% confidence interval [CI], 1.69-4.76) for men with BMI 21 kg/m(2) to 22.9 kg/m(2) and 6.13 (95% CI, 3.57-10.5) for men with BMI 23.0 kg/m(2) to 24.9 kg/m(2) after controlling for age, smoking status, high low-density lipoprotein cholesterol, and uric acid. Using the same regression model and BMI categories in women, the odds ratios were 2.52 (95% CI, 1.42-2.83) and 4.38 (95% CI, 2.42-7.92), respectively. Multivariate-adjusted carotid IMT was significantly greater in men with than without MetS, especially in patients with BMI 23.0 kg/m(2) to 24.9 kg/m(2). Although in women, there were no inter-group differences in categories of normal BMI and MetS.

CONCLUSION

Individuals in the upper normal BMI range have a relatively high prevalence and are at increased risk of having metabolic syndrome. Therefore, screening of individuals with normal or slightly elevated BMI is important in preventing atherosclerosis.

Abdominal obesity, waist circumference and cardio-metabolic risk: awareness among primary care physicians, the general population and patients at risk--the Shape of the Nations survey

OBJECTIVE

Abdominal obesity, measured by waist circumference (WC), is a more accurate predictor of cardiometabolic risk than general obesity measured by body mass index (BMI). The 'Shape of the Nations' survey was performed to assess knowledge and understanding of the increased risk associated with abdominal obesity.

RESEARCH DESIGN AND METHODS

Approximately 100 primary care physicians (PCPs), 400 members of the general population and 100 patients at risk for cardiovascular disease (CVD) were interviewed in each of 27 countries using a structured questionnaire. Demographic characteristics were obtained and subjects were asked about their understanding of risk factors, assessment of body weight and shape, and use of WC to assess cardiometabolic risk.

RESULTS

On average, 39% of all people visiting a PCP worldwide were overweight or obese, according to PCP reports; in North America, this proportion was 49%. Abdominal obesity was recognised by 58% of PCPs worldwide as a significant risk factor for heart disease; an equal proportion considered high BMI to be a risk factor. Worldwide, 45% of all physicians reported never measuring WC and 52% overestimated the WC that puts their patients at risk. In the general population, 42% were aware of the association between abdominal obesity and risk, but a higher proportion (60%) considered high BMI an important risk factor. Very few of the general population measured their waist or knew the WC that is considered to confer significantly increased risk. More than half (59%) of at-risk patients had not been informed by their doctors about the link between abdominal obesity and heart disease.

CONCLUSIONS

The Shape of the Nations survey findings demonstrate the need for education and action to improve preventive health efforts worldwide by educating PCPs, the general population and patients at risk about the dangers of abdominal obesity and of WC as an easy, reliable way to assess cardiometabolic risk.

Metabolic Syndrome may be a Risk Factor for Early Carotid Atherosclerosis in Women but not in Men

AIM

Metabolic syndrome (MetS) is a cluster of metabolic abnormalities and a predictor of both type 2 diabetes mellitus and adverse cardiovascular events. Whether there are gender differences in the association between early atherosclerosis and MetS has not yet been thoroughly elucidated.

METHODS

The subjects consisted of 388 men aged 64+/-16 years and 480 women aged 70+/-13 years. Early atherosclerosis was assessed by carotid intima-media thickness (IMT) on B-mode ultrasonography.

RESULTS

Carotid IMT values were significantly greater in both male (p=0.007) and female (p=0.002) subjects with MetS. After adjusting for established risk factors, the difference persisted on a significant level in women (p=0.003), but was weak in men (p=0.013). Multiple regression analysis using IMT as an objective variable, with adjustment for various risk factors as explanatory variables, showed that MetS (p=0.016) was a significant independent contributing factor along with known risk factors only in women. Among the components of MetS, hypertension (p=0.036) and dyslipidemia (p=0.008) had a strong impact on carotid IMT in men, whereas hypertension (p=0.003) ranked first in women.

CONCLUSION

The effect of MetS in early carotid atherosclerosis is more pronounced in women than in men, and the impact of MetS components on carotid IMT differs between men and women.

Metabolic syndrome in HD patients: association with body composition, nutritional status, inflammation and serum iron

OBJECTIVE

Insulin resistance and metabolic syndrome (MeS) are common in end-stage renal disease (ESRD) patients on maintenance hemodialysis (HD). Such metabolic and clinical abnormalities may lead to an increased risk for cardiovascular disease.

METHODS

The study group included 22 well-nourished and 20 middle- to moderate-malnourished, stable ESRD patients, with median dialysis duration of 48 months (IQR 24.5-82.0). To determine nutritional status, body composition, inflammatory biomarkers and the presence of MeS subjective global assessment (SGA), anthropometrical measurements (BMI and waist circumference), bioelectrical impedance analysis (BIA), and biochemical parameters [the levels of serum albumin, cholesterol, HDL-cholesterol, triglyceride, hematocrit, hemoglobin, iron, TIBC, transferrin saturation (TSAT), ferritin, calcium, phosphorus, intact parathormone (i-PTH), TNF-alpha, IL-6 and high sensitivity C-reactive protein (hs-CRP)] were used. All parameters were evaluated by comparisons between two groups, with MeS (Group 2) and without it (Group 1). Logistical regression analysis was used to evaluate the correlation between measured variables and the presence of MeS in HD patients. Independent variables for MeS were identified by backward multivariate regression analysis. To identify the independent predictors for insulin resistance index (HOMA-IR) multivariate regression analysis was conducted, after linear regression analysis.

RESULTS

After adjustment for confounding variables, a model consisting of serum levels of iron, transferrin saturation (TSAT), and BMI which accounted for 62% of the variance in MeS, determined only BMI as an independent marker (according to ATP-III criteria). But, serum glucose level, iron, waist and total fat mass accounted for 68% of the variance in MeS, according to IDF criteria. Glucose level was an independent predictor. BMI and iron, as independent variables, contributed to 29% of the variance in IR HOMA, the sensitive marker of MeS.

CONCLUSION

The present study demonstrated that serum iron participated together with independent predictors, glucose and BMI, in the pathogenesis of IR and MeS of ESRD patients on maintenance HD.

Systemic oxidative alterations are associated with visceral adiposity and liver steatosis in patients with metabolic syndrome

Although evidence suggests the link between chronic inflammation and oxidative stress as the main mechanism responsible for endothelial dysfunction and cardiovascular complications in patients with metabolic syndrome, little is known about the determining role of each metabolic syndrome component in such alterations. This study investigated the relation between systemic oxidative alterations and metabolic syndrome features in 41 patients. Compared with control subjects, serum vitamin C and alpha-tocopherol concentrations were lower and those of lipid peroxides [thiobarbituric acid reactive substances (TBARs)] were higher in metabolic syndrome patients (P < 0.001). A linear relation was observed between visceral fat thickness and serum TBARs:cholesterol ratio (r = 0.541, P < 0.001), whereas negative correlations were found between alpha-tocopherol and BMI (r = -0.212, P < 0.05) and the grade of liver steatosis (r = -0.263, P < 0.02). Patients with metabolic syndrome and liver steatosis had higher serum hyaluronate (HA) concentrations (P < 0.001). Serum HA was positively correlated with serum alanine amino transferase (r = 0.715, P < 0.001) and the homeostasis monitoring assessment index (r = 0.248, P < 0.03). The presence of metabolic syndrome was predicted from a linear combination of visceral fat and all oxidative variables. In metabolic syndrome patients, serum nitrosothiols and vitamin C concentrations, which were lower (P < 0.001) than in control subjects, were inversely related to the grade of hypertension (r = -0.645, P < 0.001 and r = -0.415, P < 0.007, respectively). In conclusion, metabolic syndrome patients exhibited decreased antioxidant protection and increased lipid peroxidation. Our results indicate a strong association between increased abdominal fat storage, liver steatosis, and systemic oxidative alterations in metabolic syndrome patients and diminished nitrosothiols and vitamin C concentrations as important factors associated with hypertension in these patients.

Comparison of different definitions of the metabolic syndrome in relation to cardiovascular mortality in European men and women

AIMS/HYPOTHESIS

We estimated cardiovascular disease (CVD) mortality in individuals with the metabolic syndrome on the basis of different definitions.

METHODS

We collaboratively analysed data from 4,715 men and 5,554 women, who were aged 30 to 89 years, had a maximum follow-up of 7 to 16 years, and were drawn from nine European population-based cohorts. Cox regression analysis with age as time scale was performed to estimate hazard ratio (HR) for mortality, adjusting for cohort, serum total cholesterol and smoking.

RESULTS

The prevalence of the metabolic syndrome according to definitions of WHO, the National Cholesterol Education Program (NCEP), NCEP revised and the International Diabetes Federation (IDF) was 27.0%, 25.9%, 32.2% and 35.9% respectively in men and 19.7%, 23.4%, 28.5% and 34.1% respectively in women. The corresponding HRs (95% CIs) for CVD mortality were 2.09 (1.59-2.76), 1.74 (1.31-2.30), 1.72 (1.31-2.26) and 1.51 (1.15-1.99) in men, and 1.60 (1.01-2.51), 1.39 (0.89-2.18), 1.09 (0.70-1.69) and 1.53 (0.99-2.36) in women. The paired homogeneity test showed that in men the HR was higher with the WHO definition than with the IDF definition (p=0.03). In women the HR was lower with the revised NCEP definitions than with either the WHO (p=0.02) or the IDF (p=0.01) definitions. With a few exceptions, HRs for full definitions of the syndrome were not significantly different from those for their single components.

CONCLUSIONS/INTERPRETATION

Metabolic syndrome by the four definitions predicted CVD mortality in men, but the prediction was weak in women. Further research is required on the utility of definitions of the metabolic syndrome above and beyond that of its single components and in individual CVD risk stratification, particularly with regard to sex difference in the prediction.

Metabolic syndrome, low-density lipoprotein cholesterol, and risk of cardiovascular disease: A population-based study

We sought to examine the relative contribution to cardiovascular risk of the metabolic syndrome (MS) compared with that of a high LDL cholesterol level in a population-based study of 2493 men and women, age 41-72 years, without major cardiovascular diseases at baseline. MS was defined according to the National Cholesterol Education Program criteria. The study population was subdivided into four groups on the basis of presence (prevalence: 15%) or absence of MS (85%) and presence (15%) or absence of high LDL cholesterol (85%) defined as a level >5.02 mmol/L or </=5.02 mmol/L. After 9.5 years, 233 had a cardiovascular endpoint (cardiovascular death, ischemic heart disease, and stroke). In proportional-hazard models, adjusting for age, sex, and smoking, and with subjects without MS and LDL cholesterol </=5.02 mmol/L as reference (73%), the relative risk of an endpoint (95% CI) was 1.49 (1.04-2.13) in participants without MS and LDL cholesterol >5.02 mmol/L (12%), 1.80 (1.26-2.57) in subjects with MS and LDL cholesterol </=5.02 mmol/L (12%) and 3.21 (1.99-5.17) in participants with both MS and LDL cholesterol >5.02 mmol/L (3%). In a general population, MS was associated with a cardiovascular risk comparable with that of a high LDL cholesterol level.

Metabolic syndrome in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study: daily life blood pressure, cardiac damage, and prognosis

The prevalence of the metabolic syndrome (National Cholesterol Education Program Adult Treatment Panel III criteria) and its relationships with daily life blood pressures, cardiac damage, and prognosis were determined in 2013 subjects from a Northern Italian population aged 25 to 74 years. Home blood pressure, 24-hour blood pressure, and left ventricular mass index (echocardiography) were also measured. Cardiovascular and noncardiovascular deaths were registered over 148 months. Metabolic syndrome was found in 16.2% of the sample, an office blood pressure elevation being the most frequent (95.4%) and the blood glucose abnormality the least frequent (31.5%) component. There was in metabolic syndrome a frequent elevation in home and/or 24-hour average blood pressure, as well as a greater left ventricular mass index and prevalence of left ventricular hypertrophy, which was manifest even when data were adjusted for between-group differences, including blood pressure. The adjusted risk of cardiovascular and all-cause mortality was greater in metabolic syndrome subjects (+71.0% and +37.0%; P<0.05), a further marked increase being observed with left ventricular hypertrophy or "in-office" and "out-of-office" blood pressure elevations. The increased risk was related to the blood pressure and the blood glucose component of metabolic syndrome, with no contribution of the remaining components. Thus, metabolic syndrome is common in a Mediterranean population in which it significantly increases the long-term risk of death. Cardiac abnormalities and increases in home and 24-hour blood pressure are common in metabolic syndrome, and their occurrence further enhances the risk. The contribution of metabolic syndrome components to the risk, however, is unbalanced and mainly related to blood pressure and glucose abnormalities.

The metabolic syndrome in women

The metabolic syndrome, an increasingly prevalent disorder, is known to significantly enhance the risk of developing cardiovascular disease and diabetes. The syndrome is defined by a constellation of cardiac risk factors that include obesity, atherogenic dyslipidemia, hypertension, and insulin resistance. There are several unique features of the metabolic syndrome in women. An insulin-resistant state associated with both polycystic ovarian syndrome and increased abdominal fat may contribute to the development of the metabolic syndrome and increase cardiovascular risk when present. Menopause heralds a decline in circulating estrogen levels, which may increase cardiovascular risk through effects on adiposity, lipid metabolism, and prothrombotic state. The key elements involved in managing the metabolic syndrome are dietary and lifestyle modification. Appropriate treatment may also include managing individual cardiac risk factors with the use of antihypertensive and lipid-modifying agents among others.

apoB/apoA–I ratio is related to femoral artery plaques and is predictive for future cardiovascular events in healthy men

OBJECTIVES

The aim of the present study was to investigate the association between serum concentrations of apoB, apoA-I and the apoB/apoA-I ratio and future cardiovascular events in a group of healthy 58-year-old men during 6.6 years of follow-up. A further aim was to investigate the concentrations of apoB, apoA-I and the apoB/apoA-I ratio to the association of plaque occurrence in the carotid and femoral arteries.

BACKGROUND

Previous studies have shown that the apoB/apoA-I ratio is an important cardiovascular risk factor, whereas the association between apoB/apoA-I ratio and presence of atherosclerotic plaques in the carotid and femoral arteries has been less investigated.

METHODS

The carotid and femoral arteries were examined by high-resolution B-mode ultrasound in 391, 58-year-old men identified by screening in the city of Göteborg, Sweden. Assessment of plaque occurrence and measurement of apolipoproteins (apoA-I and apoB) was performed.

RESULTS

Subjects with an apoB/apoA-I ratio >/=0.9 had a significantly increased risk to suffer a cardiovascular event during 6.6 years of follow-up (OR 3.07, 95% CI 1.22-7.71), while no difference in risk for cardiovascular events was observed for subjects with LDL cholesterol >3.4 mmol/L compared to subjects <3.4 mmol/L (OR 1.04, 95% CI 0.37-2.46). A greater risk for plaques in the femoral artery was also observed in subjects with an apoB/apoA-I ratio >/=0.9 compared to subjects <0.9 (OR 3.06, 95% CI 1.22-7.70). In a multiple logistic regression model, both elevated apoB/apoA-I ratio and plaque occurrence in the femoral artery were of significant importance for cardiovascular events during follow-up.

CONCLUSIONS

The results showed that the apoB/apoA-I ratio was associated with arteriosclerosis in the femoral artery, and predicted future cardiovascular events. These observations, and the fact that apoB and apoA-I can be measured in the non-fasting state with high precision, in combination with the finding that LDL cholesterol did not predict cardiovascular disease, support results from other studies that the apoB/apoA-I ratio may be a superior risk marker for cardiovascular disease.

Metabolic syndrome and coronary heart disease risk in a population-based study of middle-aged men from France and Northern Ireland

Metabolic Syndrome (MetS) was found associated with an increased CHD risk in several studies but data about this relationship in Southern Europe are lacking. We studied the association of MetS according to three different indexes (the National Cholesterol Education Program's definition (NCEP), a modified World Health Organization's definition (WHO) and the recent International Diabetes Federation's definition (IDF)) with CHD risk in a case-control study nested within the PRIME cohort, composed of subjects from France (Southern Europe) and Belfast (Northern Europe). The PRIME prospective study is composed of 10 592 men, aged 50-59 at baseline and followed for 5 years. Subjects included in this nested case-control study were 296 cases of incident CHD and 540 controls, who remained free of CHD during the 5 years of follow-up of the PRIME cohort and matched for age, recruitment centre and recruitment date. All subjects had questionnaires and a medical examination at baseline, and a blood sample was taken. Using the IDF's, the WHO's and the NCEP's definitions respectively, the frequency of MetS was 38.9%, 35.5% and 29.7% in cases and 32.4%, 28.7% and 22.6% in controls. After adjustment for physical activity, smoking and drinking habits, MetS was associated with CHD risk whichever the definition used (ORIDF=1.41 [1.02-1.95], P<0.04, ORWHO=1.40 [1.01-1.94], P<0.05 and ORNCEP=1.46[1.04-2.04], P<0.04). These results were homogeneous in France (low risk of CHD) and Belfast (high risk of CHD). Our results add further evidence that MetS is predictive of CHD risk in middle-aged men from Northern and Southern Europe, and highlight differences between the three definitions studied.

Is the metabolic syndrome a real clinical entity and should it receive drug treatment?

Metabolic syndrome represents a cluster of risk factors commonly associated with obesity and diabetes that in turn are associated with an increased risk of cardiovascular disease. The worldwide prevalence of metabolic syndrome, obesity, and diabetes is on the rise, leading to serious public health concerns surrounding the downstream consequences in the form of premature cardiovascular disease. In this review, we examine the debate surrounding the characterization and diagnosis of metabolic syndrome and discuss potential treatment options.

Metabolic syndrome and early-onset coronary artery disease: is the whole greater than its parts?

OBJECTIVES

We sought to examine the association between the metabolic syndrome (MetS) (defined both by the 2001 National Cholesterol Educational Program Adult Treatment Panel III [ATP-III] definition and the American Heart Association/National Heart, Lung and Blood Institute [AHA/NHLBI] revision incorporating the lower threshold for impaired fasting glucose [IFG]) and early-onset coronary artery disease (CAD).

BACKGROUND

The impact of MetS on premature CAD has not been studied extensively. Lowering the threshold to define the IFG component (from 110 to 100 mg/dl) and the value of the syndrome as a whole versus its individual components are subjects of intense debate.

METHODS

We performed a case-control study with 393 early-onset CAD subjects (acute myocardial infarction, angina with > or =50% stenosis, or coronary revascularization) in men under age 46 years or women under age 56 years and 393 control subjects individually matched for gender, age, and race/ethnicity.

RESULTS

By conditional logistic regression, presence of ATP-III MetS without diabetes (adjusted odds ratio [adj-OR] 4.9; 95% confidence interval [CI] 3.4 to 8.0) and with diabetes (adj-OR 8.0, 95% CI 4.39 to 14.6) was a strong independent determinant of early-onset CAD. Using the AHA/NHLBI revision, these ORs became slightly stronger. However, neither definition of MetS remained significantly associated with early-onset CAD in multivariate models adjusting for individual components.

CONCLUSIONS

The presence of MetS imparts a high risk of early-onset clinical CAD, but the prognostic information associated with the syndrome is not greater than the sum of its parts.

Relationship between adipokines, inflammation, and vascular reactivity in lean controls and obese subjects with metabolic syndrome

PURPOSE

Metabolic syndrome is an important risk factor for cardiovascular disease. Adipokines interfere with insulin action and endothelial cell function. We investigated the relationship among adipokines, metabolic factors, inflammatory markers, and vascular reactivity in obese subjects with metabolic syndrome and lean controls.

METHODS

Cross-sectional study of 19 obese subjects with metabolic syndrome and 8 lean volunteers evaluated as controls. Vascular reactivity was assessed by venous occlusion pletysmography measuring braquial forearm blood flow (FBF) and vascular resistance (VR) responses to intra-arterial infusions of endothelium-dependent (acetylcholine-Ach) and independent (sodium nitroprusside-SNP) vasodilators. Blood samples were obtained to evaluate C reactive protein (CRP), plasminogen activator inhibitor 1 (PAI-1), fibrinogen, adiponectin, resistin, and lipid profile. Patients were classified with regard to insulin resistance through the HOMA-IR index.

RESULTS

PAI-1, CRP and fibrinogen were higher and adiponectin was lower in metabolic syndrome subjects compared to controls. Metabolic syndrome subjects had impaired vascular reactivity. Adiponectin and PAI-1 were associated with insulin, HOMA-IR, triglycerides, and HDLc; and resistin with CRP. Adiponectin was associated with VR after Ach in the pooled group and resistin with D FBF after Ach in the metabolic syndrome group.

CONCLUSION

Metabolic syndrome subjects exhibited low levels of adiponectin and high levels of CRP, fibrinogen, and PAI-1. Adiponectin and PAI-1 correlated with insulin resistance markers. Adiponectin and resistin correlated with vascular reactivity parameters. An adipocyte-endothelium interaction might be an important mechanism of inflammation and vascular dysfunction.

Metabolic syndrome and risk of cardiovascular disease: a meta-analysis

PURPOSE

The use of different definitions of the metabolic syndrome has led to inconsistent results on the association between the metabolic syndrome and risk of cardiovascular disease. We examined the association between the metabolic syndrome and risk of cardiovascular disease.

METHODS

A MEDLINE search (1966-April 2005) was conducted to identify prospective studies that examined the association between the metabolic syndrome and risk of cardiovascular disease. Information on sample size, participant characteristics, metabolic syndrome definition, follow-up duration, and endpoint assessment was abstracted.

RESULTS

Data from 21 studies met the inclusion criteria and were included. Individuals with the metabolic syndrome, compared to those without, had an increased mortality from all causes (relative risk [RR] 1.35; 95% confidence interval [CI], 1.17-1.56) and cardiovascular disease (RR 1.74; 95% CI, 1.29-2.35); as well as an increased incidence of cardiovascular disease (RR 1.53; 95% CI, 1.26-1.87), coronary heart disease (RR 1.52; 95% CI, 1.37-1.69) and stroke (RR 1.76; 95% CI, 1.37-2.25). The relative risk of cardiovascular disease associated with the metabolic syndrome was higher in women compared with men and higher in studies that used the World Health Organization definition compared with studies that used the Adult Treatment Panel III definition.

CONCLUSION

This analysis strongly suggests that the metabolic syndrome is an important risk factor for cardiovascular disease incidence and mortality, as well as all-cause mortality. The detection, prevention, and treatment of the underlying risk factors of the metabolic syndrome should become an important approach for the reduction of the cardiovascular disease burden in the general population.

Fatty liver, carotid disease and gallstones: A study of age-related associations

AIM: To evaluate carotid intima-media thickening (IMT) and plaques, gallstone disease (GD) and fatty liver (FL) as a function of age.

METHODS: In 449 subjects, FL and carotid disease were assessed ultrasonographically. In a subgroup of 65/449 patients with non-alcoholic fatty liver disease (NAFLD), carotid disease, GD and associated factors were determined.

RESULTS: FL of unspecified etiology was more common in younger and GD in older individuals. FL subjects had an increased prevalence of IMT and a decreased prevalence of plaques and manifested carotid disease earlier. Plaques were more common in subjects with GD. Age was an independent predictor of carotid disease outcome and FL was a protective factor for plaques. In NAFLD, there was an inverse correlation between body weight and age and the latter independently predicted carotid findings.

CONCLUSION: Cardiovascular risk in patients with FL and NAFLD needs to be assessed as a function of age and body weight.

Le syndrome métabolique

Metabolic syndrome is public health problem. The characteristic feature is an association between factors contributing to increased cardiovascular risk. Several definitions have been proposed from 1998 to 2005. All proposed definitions take into consideration insulin resistance and its corollary hyperglycemia, overweight, hypertriglyceridemia, and LDL-cholesterol lowering. The most widely used definitions are proposed by the World Health Organization (WHO) and the American "Cholesterol" program (NCEP-ATpIII). The prevalence of metabolic syndrome varies by geographic region as a function of the chosen definition, the study methodology, the selection criteria, the age and gender of the study population, and the period of the study. Prevalence is higher in the United States than Europe and increases with age. A growing number of adolescents appear to meet the criteria of metabolic syndrome. Irrespective of the definition retained, metabolic syndrome is associated with increased cardiovascular risk and increased risk of type II diabetes. Sound evidence is however lacking on whether the risk is greater than that of taking into account each individual factor. Several points remain to be clarified concerning the underlying mechanisms. Visceral adipose tissue appears to be a key element in the process via anomalous function related to obesity and insulin resistance. Management is based mainly on reduction of body weight and regular physical activity. Drugs may be necessary to correct for the dyslipidemia, normalize blood glucose and reduce blood pressure.

Haplotype combination of Calpain-10 gene polymorphism is associated with metabolic syndrome in type 2 diabetes

Patients with metabolic syndrome are at increased risk of developing cardiovascular disease. The combinations of the haplotype created by the alleles of three single nucleotide polymorphisms (SNPs): SNP-43, -19, and -63 of the Calpain-10 gene (CAPN10), have been reported to be associated with the risk of type 2 diabetes in many populations. The aim of this study was to examine the association of the CAPN10 polymorphism with metabolic syndrome in patients with type 2 diabetes in Korea. Overall, 382 patients with type 2 diabetes were enrolled in this study. All the subjects were genotyped according to CAPN10 SNP-43, -19, and -63. The restriction fragment length polymorphism method was used for the three SNPs. The baseline presence of components of metabolic syndrome was determined. Two hundred and sixty-five (69.4%) patients had metabolic syndrome. Patients with the 111/121 haplotype combination showed a higher risk of hypertension than the other haplotype combinations (odd ratio (OR)=2.334, P=0.010). Patients with the 111/121 haplotype combination had a significantly high risk of metabolic syndrome (OR=1.927, P=0.042). The results of this study suggest that a novel 111/121 haplotype combination created by the CAPN10 SNP-43, -19, and -63 increases the susceptibility to the metabolic syndrome in patients with type 2 diabetes.

Metabolic Syndrome and Cardiovascular Disease in Older People: The Cardiovascular Health Study

OBJECTIVES

To assess the prospective association between metabolic syndrome (MetS) and cardiovascular disease (CVD) in older people and to evaluate the effect of lowering the threshold for impaired fasting glucose (IFG) on the prevalence of IFG and MetS and the risk of CVD.

DESIGN

Prospective cohort study.

SETTING

Four field centers in U.S. communities.

PARTICIPANTS

Three thousand five hundred eighty-five subjects in the Cardiovascular Health Study free of diabetes mellitus and CVD at baseline (mean age 72, 62% female, 14% black).

MEASUREMENTS

Baseline measures of MetS components and adjudicated incident CVD events. MetS (2001) was defined first using the original criteria from the Third Adult Treatment Panel Report of the National Cholesterol Education Program (> or =3 of the following: large waist circumference (women >88 cm, men >102 cm), elevated triglycerides (> or =1.70 mmol/L), low high-density lipoprotein cholesterol (men <1.04 mmol/L, women <1.30 mmol/L), elevated fasting glucose (6.1-6.9 mmol/L), and high blood pressure (> or =130/85 mmHg or self-reported use of medications for hypertension). Subjects were also classified according to the revised definition of the MetS (2005) that applies the lower threshold for fasting glucose (5.6-6.9 mmol/L).

RESULTS

During follow-up (median 11 years), 818 coronary heart disease (CHD), 401 stroke, and 554 congestive heart failure (CHF) events occurred. Age- and race-adjusted hazard ratios (HRs) for CHD, stroke, and CHF were 1.30 (95% confidence interval (CI) = 1.07-1.57), 0.94 (95% CI = 0.73-1.21), and 1.40 (95% CI = 1.12-1.76) for women and 1.35 (95% CI = 1.10-1.66), 1.51 (95% CI = 1.08-2.12), and 1.47 (95% CI = 1.14-1.90) for men, respectively. Overall, women and men with MetS (2005) were 20% to 30% more likely to experience any CVD event than subjects without MetS (2005). Using the lower cut-point for IFG resulted in a near tripling in IFG prevalence (16% to 46%) and an additional 9% classified with MetS (2005) but HRs similar to those estimated from the original MetS (2001) criteria. High blood pressure was the component most strongly associated with incident CHD.

CONCLUSION

Results from this study of an elderly, population-based cohort provide support for earlier investigations in primarily middle-aged populations that link the presence of MetS with the development of CVD and further underscore the importance of recognizing and treating its individual components, particularly high blood pressure.

Two new criteria of the metabolic syndrome: prevalence and the association with brachial-ankle pulse wave velocity in Japanese male workers

In 1998 and 2001, The World Health Organization and the National Cholesterol Education Program Adult Treatment Panel III proposed working criteria for the metabolic syndrome (MS), but they are not perfect for use in diverse ethnicities. In 2005, the International Diabetes Federation (IDF) and eight societies in Japan respectively proposed new criteria. However, there has been no report regarding the application of these new criteria in Japanese workplaces. We conducted a cross-sectional study of 377 healthy Japanese men aged 20-64 yr who worked in a chemical factory in Kanagawa, Japan. Participants completed a self-reported questionnaire, underwent a physical examination including waist measurements and brachial-ankle pulse wave velocity (baPWV), and provided overnight fasting blood samples. The prevalence of MS in Japanese men was 17.0% and 13.5% according to the new IDF and Japanese criteria respectively. In both of the new criteria, baPWV was significantly higher in those with MS than those without MS (1,563 +/- 264.2 vs 1,362 +/- 204.6 cm/sec, p<0.001 in the new IDF criterion; 1,574 +/- 265.2 vs 1,368 +/- 209.1 cm/sec, p<0.001 in the Japanese criterion). In the analysis of the 5 or 6 subgroups stratified according to the number of MS components, baPWV increased significantly with increasing number of MS components (p for trend<0.01 in both criteria). The new IDF and Japanese criterion are both good for diagnosing MS among Japanese because a linear increase in baPWV occurred with increasing MS components after adjustment for potential confounding factors. Further studies are expected using these new criteria.

Inhibition of 11beta-HSD1 as a novel treatment for the metabolic syndrome: do glucocorticoids play a role?

The metabolic syndrome (syndrome X) is a cluster of risk factors and a common cause of cardiovascular disease in humans. Although the underlying mechanism for metabolic syndrome is still poorly understood, recent clinical data and studies with transgenic animals implicate elevated intracellular glucocorticoid tone in the etiology of metabolic syndrome. Development of selective inhibitors of 11beta-hydroxysteroid dehydrogenase (11beta-HSD)-1 and their use in rodent animal disease models encompassing several aspects of metabolic syndrome indicate the possibility of therapeutic intervention. This review will focus on recent advances in our understanding of the role of 11beta-HSD1 in metabolic disorders and other disease processes.

Metabolic syndrome, C-reactive protein, and prognosis in patients with established coronary artery disease

BACKGROUND

The prognosis associated with metabolic syndrome and high-sensitivity C-reactive protein (hs-CRP) in patients with stable coronary artery disease has not been well established.

METHODS

The WIZARD study was to determine the effects of 12 weeks of antibiotic therapy on coronary heart disease events in patients with stable coronary artery disease and known Chlamydia pneumoniae exposure. Baseline metabolic risk factors were available for 3319 patients enrolled from 1997 to 1998. The primary outcome was the first occurrence of death, recurrent myocardial infarction, coronary revascularization procedure, or hospitalization for angina.

RESULTS

Of the 3319 subjects, 825 patients experienced the primary outcome during the mean follow-up of 37 months. For the composite outcome, there was an increased hazard ratio (HR) for metabolic syndrome (HR 1.40, 95% CI 1.22-1.61) (unadjusted) and for hs-CRP (HR 1.60, 95% CI 1.38-1.85) (unadjusted). Both the metabolic syndrome and hs-CRP indicated, in a multivariable model including age and sex, an increased HR for the primary outcome (metabolic syndrome: HR 1.33, 95% CI 1.15-1.53; hs-CRP: HR 1.52, 95% CI 1.30-1.76).

CONCLUSIONS

Although related, the presence of the metabolic syndrome and increased levels of hs-CRP were associated with increased risk of adverse cardiovascular outcomes.

The metabolic syndrome: should current criteria influence clinical practice?

PURPOSE OF REVIEW

Many studies have recommended use of metabolic syndrome as an 'alternative' means to assess vascular disease risk, but few have been rigorous, leading to confusion amongst physicians regarding risk screening. This review critically appraises this evidence and also evaluates the data linking metabolic syndrome to type 2 diabetes.

RECENT FINDINGS

Although presence of metabolic syndrome predicts vascular events, such prediction is inferior and does not enhance simpler Framingham-based risk scores which can be determined using nonfasting blood samples. The dichotomous nature of metabolic syndrome criteria and lack of age, low-density lipoprotein cholesterol, and smoking in part account for their inferior predictive ability. Metabolic syndrome criteria better predict type 2 diabetes but diabetes screening, if adopted, will likely require a two-stage process, with the first stage not dependent on blood sampling. Nevertheless, recent interest in metabolic syndrome has contributed to greater interaction between diabetologists and cardiologists and highlighted more strongly the relevance of obesity to vascular risk.

SUMMARY

Best evidence suggests that current metabolic syndrome criteria should not be used as an alternative to established charts for risk prediction for vascular disease. Clinical focus should remain on established risk factors to determine and reduce risk of vascular events.