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

The Variant rs1784042 of the SIDT2 Gene is Associated with Metabolic Syndrome through Low HDL-c Levels in a Mexican Population

The Mexican population has one of the highest prevalences of metabolic syndrome (MetS) worldwide. The aim of this study was to investigate the association of single-nucleotide polymorphisms (SNPs) with MetS and its components. First, we performed a pilot Genome-wide association study (GWAS) scan on a sub-sample derived from the Health Workers Cohort Study (HWCS) (n = 411). Based on GWAS results, we selected the rs1784042 and rs17120425 SNPs in the SIDT1 transmembrane family member 2 (SIDT2) gene for replication in the entire cohort (n = 1963), using predesigned TaqMan assays. We observed a prevalence of MetS in the HWCS of 52.6%. The minor allele frequency for the variant rs17120425 was 10% and 29% for the rs1784042. The SNP rs1784042 showed an overall association with MetS (OR = 0.82, p = 0.01) and with low levels of high-density lipoprotein (HDL-c) (odds ratio (OR) = 0.77, p = 0.001). The SNP rs17120425 had a significant association with type 2 diabetes (T2D) risk in the overall population (OR = 1.39, p = 0.033). Our results suggest an association of the rs1784042 and rs17120425 variants with MetS, through different mechanisms in the Mexican population. Further studies in larger samples and other populations are required to validate these findings and the relevance of these SNPs in MetS.

The metabolic syndrome - What is it and how should it be managed?

A cluster of metabolic factors have been merged into an entity named the metabolic syndrome. Although the characteristics of this syndrome have varied over time the presently used definition was established in 2009. The presence of three abnormal findings out of five components qualifies a person for the metabolic syndrome: elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure and elevated fasting plasma glucose. Cut points have been defined for all components apart from waist circumference, for which national or regional values are used. The metabolic syndrome predicts cardiovascular disease and type 2 diabetes. This associated risk does not exceed its components whereof elevated blood pressure is the most frequent. A successful management should, however, address all factors involved. The management is always based on healthy lifestyle choices but has not infrequently to be supported by pharmacological treatment, especially blood pressure lowering drugs. The metabolic syndrome is a useful example of the importance of multiple targets for preventive interventions. To be successful management has to be individualized not the least when it comes to pharmacological therapy. Frail elderly people should not be over-treated. Knowledge transfer of how risk factors act should be accompanied by continuous trust building and motivation. In complex situations with a mix of biological risk factors, adverse social conditions and unhealthy lifestyle, everything cannot be changed at once. It is better to aim for small steps that are lasting than large, unsustainable steps with relapses to unhealthy behaviours. A person with the metabolic syndrome will always be afflicted by its components, which is the reason that management has to be sustained over a very long time. This review summarizes the knowledge on the metabolic syndrome and its management according to present state of the art.

The Association between Insulin Resistance and Cardiovascular Disease Risk: A Community-Based Cross-Sectional Study among Taiwanese People Aged over 50 Years

Background and Aims: Previous studies have implied that insulin resistance (IR) could represent a major underlying abnormality leading to cardiovascular disease (CVD). The aim of this study was to evaluate the relationships between IR (estimated by the homeostasis model assessment of IR (HOMA-IR) index) and CVD risk among middle-aged and elderly Taiwanese individuals. Methods: In this cross-sectional, community-based study, a total of 320 participants were interviewed to collect demographical parameters and blood samples. The recruited participants were divided into tertiles according to their levels of HOMA-IR. The Framingham risk score (FRS) was calculated according to the 2008 general CVD risk model from the Framingham Heart Study. Results: The HOMA-IR index was significantly correlated with the FRS, with a Pearson’s coefficient of 0.22. In the multiple logistic regression model, a higher HOMA-IR level was significantly associated with a high FRS (FRS ≥ 20%) (highest tertile vs. lowest tertile of HOMA-IR, crude OR = 3.69; 95% CI = 1.79–7.62), even after adjusting for smoking, fasting plasma glucose (FPG), and systolic blood pressure (SBP) (highest tertile vs. lowest tertile of HOMA-IR, adjusted OR = 11.51; 95% CI = 2.55–51.94). The area under the receiver operating characteristic curve for the HOMA-IR index as the predictor of high FRS was 0.627, and the optimal HOMA-IR cutoff value was 1.215 (sensitivity = 83.6%, specificity = 42.9%). Conclusions: We considered that HOMA-IR is an independent factor but that it cannot be used solely for evaluating the CVD risk due to the low AUC value. Further prospective cohort studies are warranted to better assess the relationship between CVD risk and insulin resistance.

Endothelial Dysfunction, a Marker of Atherosclerosis, Is Independent of Metabolic Syndrome in NAFLD Patients

BACKGROUND

The study was designed to assess cardiovascular risk factors flow-mediated dilatation % (FMD%) and carotid intima-media thickness (CIMT) in NAFLD.

METHODS

126 NAFLD subjects and 31 chronic hepatitis B (CHB) controls were studied. Measuring carotid intima-media thickness (CIMT) and the flow-mediated dilatation % (FMD%) by brachial artery Doppler ultrasound were used to assess atherosclerosis. The risk of cardiac events at 10 years (ROCE 10) was estimated by the Prospective Cardiovascular Munster Study (PROCAM) score.

RESULTS

58 of 126 NAFLD have coexistent metabolic syndrome. Mean CIMT was 0.73 ± 0.041 mm among NAFLD with MS, 0.66 ± 0.016 mm among NAFLD without MS, and 0.66 ± 0.037 in controls CHB patients. FMD% in NAFLD with MS was 10.43 ± 3.134%, but was 8.56 ± 3.581% in NAFLD without MS and 17.78 ± 6.051% in controls. PROCAM score of NAFLD with MS was 46.95 ± 6.509 while in NAFLD without MS was 38.2 ± 3.738. Controls had a PROCAM score of 38.13 ± 5.755. ROCE 10 in NAFLD with MS was 13.64 ± 8.568 while NAFLD without MS was 5.55 ± 1.949. Controls have a ROCE 10 of 5.95 ± 3.973. Post hoc analysis showed CIMT was dependent upon MS while FMD% was different between all subgroups hence independent of metabolic syndrome.

CONCLUSION

The markers of endothelial dysfunction are significantly higher in patients with NAFLD than controls.

Parasympathetic Response Patterns are Associated with Metabolic Syndrome Among Older Women but Not Men

Background

Little is known about the role of physiological stress responses in metabolic syndrome (MetS).

Purpose

To examine whether patterns of autonomic response to psychological stress are associated with MetS and whether this association is moderated by sex

Methods

1121 men and women (M_age = 65.3 ± 6.77 years) with and without coronary artery disease (CAD) underwent an anger recall stressor task. Heart rate and heart-rate variability (HRV; HF, LF/HF) were assessed. Clusters of participants showing similar patterns of response across baseline, stress, and recovery periods were created using ACECLUS and FASTCLUS in SAS. Logistic regressions included clusters and interaction between clusters and sex as independent variables, controlling for relevant covariates. ANCOVAs were conducted in secondary analyses utilizing a continuous composite representation of MetS.

Results

Men and women showing greater tonic and phasic HR elevations were more likely to meet MetS criteria (OR = 1.45, [95% CI = 1.02–2.07], p = .037). HF-HRV cluster interacted significantly with sex (p < .001) to predict MetS. In women, those with significant parasympathetic withdrawal to stress and poor recovery were more likely to have MetS than women with a more moderate response (OR = 2.56, [95% CI = 1.23–5.41], p = .013). Women who displayed stress-related parasympathetic activation were also at greater risk of MetS (OR = 2.30, [95% CI = 1.30–4.07], p = .004). Results using a continuous measure of MetS were generally consistent with these findings.

Conclusion

Among older participants with CAD or other noncardiovascular disease, hyperreactivity to stress was associated with greater prevalence of MetS, particularly in women. Consistent with emerging literature, women who showed blunting or activation of parasympathetic responses to stress were similarly at greater risk.

Current Data Regarding the Relationship between Type 2 Diabetes Mellitus and Cardiovascular Risk Factors

Reducing cardiovascular risk (CVR) is the main focus of diabetes mellitus (DM) management nowadays. Complex pathogenic mechanisms that are the subject of this review lead to early and severe atherosclerosis in DM patients. Although it is not a cardiovascular disease equivalent at the moment of diagnosis, DM subjects are affected by numerous cardiovascular complications, such as acute coronary syndrome, stroke, or peripheral artery disease, as the disease duration increases. Therefore, early therapeutic intervention is mandatory and recent guidelines focus on intensive CVR factor management: hyperglycaemia, hypertension, and dyslipidaemia. Most important, the appearance of oral or injectable antidiabetic medication such as SGLT-2 inhibitors or GLP-1 agonists has proven that an antidiabetic drug not only reduces glycaemia, but also reduces CVR by complex mechanisms. A profound understanding of intimate mechanisms that generate atherosclerosis in DM and ways to inhibit or delay them are of the utmost importance in a society where cardiovascular morbidity and mortality are predominant.

Severity of the metabolic syndrome as a predictor of prediabetes and type 2 diabetes in first degree relatives of type 2 diabetic patients: A 15-year prospective cohort study

BACKGROUND

Type 2 diabetes mellitus (T2DM) has high morbidity and mortality worldwide, therefore there is of paramount importance to identify the risk factors in the populations at risk early in the course of illness. A strong correlation between severity of metabolic syndrome (MetS) and HbA1c, fasting insulin and insulin resistance has been reported. Accordingly, the MetS severity score (or MestS Z-score) can potentially be used to predict the risk of T2DM progression over time.

AIM

To evaluate the association the of MestS Z-score in first degree relatives (FDRs) of T2DM with the risk of prediabetes and type 2 diabetes in future.

METHODS

A prospective open cohort study was conducted between 2003-2018. At baseline, the sample comprised of 1766 FDRs of patients with T2DM who had a normal glucose tolerance test. Relative risk (RR) and 95% confidence interval were calculated based on logistic regression. The receiver-operator characteristic analysis and area under the curve based on MetS Z-score were used to evaluate the risk of prediabetes and diabetes among the FDR population.

RESULTS

Baseline MetS Z-scores were associated with the its latest values (P < 0.0001). Compared with individuals who were T2DM free at the end of follow up, those who developed T2DM had higher MetS Z-score at baseline (P < 0.001). In multivariable logistic regression analyses for every unit elevation in MetS Z-score at the baseline, the RR for developing future T2DM and prediabetes was (RR = 1.94, RR = 3.84), (RR = 1.5, RR = 2.17) in total population and female group, respectively (P < 0.05). The associations remained significant after adjusting the potential confounding variables. A cut off value of 0.97 and 0.94 was defined in the receiver-operator characteristic curve based on the MetS Z-score for differentiating female patients with diabetes and prediabetes from the normal population, respectively.

CONCLUSION

The MetS Z-score was associated with an increased risk of future T2DM. Appropriate interventions at earlier stages for preventing and attenuating MetS effects may be considered as an effective strategy for FDR as at-risk population.

Metabolic Syndrome for Cardiovascular Disease Morbidity and Mortality Among General Japanese People: A Mini Review

Background

The importance of management of metabolic syndrome (MetS) for risk reduction of cardiovascular disease (CVD) has been recognized worldwide. Because of the comparatively unique characteristics of bodily figure/obesity and incident CVD in Japan, the relevance of MetS on CVD can be still discussed among Japanese people. The present study aimed to review briefly the relationship of MetS with CVD morbidity/mortality among general Japanese people.

Methods

Population-based prospective cohort studies evaluating the predictive value of MetS on CVD morbidity/mortality via a PubMed search up to 2019 were summarized.

Results

We identified two studies on morbidity that reported MetS to predict CVD morbidity. We identified three studies on mortality, and these studies showed an increased direction of hazard ratio (HR) of CVD mortality, while one study reported an insignificant prediction of MetS for CVD mortality. In the meta-analysis method, MetS significantly predicted CVD morbidity (HR=1.71 [95% confidence interval=1.34–2.18] in men and HR=1.89 [95% confidence interval=1.45–2.46] in women) as well as CVD mortality (HR=1.68 [95% confidence interval=1.37–2.06] in men and HR=1.73 [95% confidence interval=1.39–2.15] in women).

Conclusion

Among general Japanese people, MetS can be a positive predictor of CVD morbidity/mortality. Since the studies are limited, more research is needed to establish the findings.

High-Density Lipoprotein Cholesterol and Risk of Stroke Subtypes: Jichi Medical School Cohort Study

We aimed to investigate the relationship between high-density lipoprotein cholesterol (HDL-C) concentration and the incident stroke subtypes. We enrolled 11 027 participants between the ages of 18 and 90 years without a history of stroke in 12 Japanese communities. Cox's regression models were used for stroke subtypes, adjusted for traditional risk factors, according to the categories based on HDL-C concentrations: 1.04 to 1.55 mmol/L, ≥1.56 mmol/L, and <1.03 mmol/L (as the reference). During a mean follow-up of 10.7 years, 412 stroke events had occurred. However, HDL-C was not significantly associated with the incidence of cerebral infarction and subarachnoid hemorrhage. High HDL-C concentration was associated with a decreased incidence of intracerebral hemorrhage in women (hazard ratio = 0.23; 95% confidence interval = 0.06-0.89), but not in men (hazard ratio = 0.73; 95% confidence interval = 0.27-1.97). Therefore, high HDL-C concentration might have a protective effect on the incidence of intracerebral hemorrhage, particularly in women.

Associations of a metabolic syndrome severity score with coronary heart disease and diabetes in fasting vs. non-fasting individuals

BACKGROUND AND AIMS

Many traditional assessments of risk for coronary heart disease (CHD) and diabetes require laboratory studies performed after an 8-h fast. We assessed whether metabolic-syndrome (MetS) severity would remain linked to future CHD and diabetes even when assessed from non-fasting samples.

METHODS AND RESULTS

Participants in the Atherosclerosis Risk in Communities study were assessed at 4 visits and followed for 20-years of adjudicated CHD outcomes. We used Cox proportional-hazard models (for 20-year CHD outcomes) and logistic regression (for 9-year diabetes outcomes) to compare incident disease risk associated with a race/ethnicity-specific MetS-severity Z-score (MetS-Z) calculated in participants who were fasting (≥8 h) or non-fasting. All analyses were adjusted for sex, race, education, income and smoking. MetS Z-scores were overall similar between participants who were always fasting vs. those non-fasting at Visits 1-3 (all values -0.1 to 0.4), while MetS-Z for participants who were non-fasting at Visit-4 were higher at each visit. Baseline MetS-Z was linked to future CHD when calculated from both fasting and non-fasting measurements, with hazard ratio (HR) for fasting MetS-Z 1.53 (95% confidence interval [CI] 1.42, 1.66) and for non-fasting 1.28 (CI 1.08, 1.51). MetS-Z at Visit-1 also remained linked to future diabetes when measured from non-fasting samples, with odds ratio for fasting MetS-Z 3.10 (CI 2.88, 3.35) and for non-fasting 1.92 (CI 1.05, 3.51).

CONCLUSIONS

MetS-Z remained linked to future CHD and diabetes when assessed from non-fasting samples. A score such as this may allow for identification of at-risk individuals and serve as a motivation toward interventions to reduce risk.

Prevalence and Related Factors of Metabolic Syndrome in Beijing, China (Year 2017)

OBJECTIVE

Metabolic syndrome (MetS) is one of the major public health problems worldwide. The aim of this study was to investigate the prevalence and associated risk factors of MetS in Beijing to formulate targeted policies.

METHODS

Data from the 2017 Beijing Chronic Disease and Risk Factors Surveillance were used in this study, in which multistage stratified cluster sampling was adopted to collect a representative sample of 12,597 Beijing residents aged from 18 to 79 years. According to the definition of the International Diabetes Federation, the weighted prevalence of MetS and clustering of MetS components were estimated. The Rao-Scott adjusted χ2 test was used to test differences in MetS and components rates, and complex sampling unconditional logistic regression was used to explore influencing factors of MetS.

RESULTS

The prevalence of MetS was 25.59% (95% CI 23.77-27.41), and the proportion of men and women was 30.53% (95% CI 28.32-32.75) and 20.44% (95% CI 18.29-22.58), respectively. The proportion of central obesity, high fasting plasma glucose, high triglyceride, low high-density lipoprotein cholesterol, and high blood pressure (BP) was 42.02, 27.96, 32.87, 27.25, and 43.06%, respectively. A total of 29.60% (95% CI 27.55-31.74) participants presented at least three components of MetS. The results from complex sampling unconditional logistic regression revealed that the risk factors for having MetS included being 45-59 years old, being 60-79 years old, being male, living in a rural area, education with junior middle school level, education with primary school or below level, harmful use of alcohol, inappropriate sleep time, and having an unhealthy waist-to-height ratio (WHtR); the OR values were 1.55 (95% CI 1.32-1.81), 1.94 (95% CI 1.62-2.31), 1.51 (95% CI 1.34-1.70), 1.27 (95% CI 1.06-1.52), 1.38 (95% CI 1.13-1.68), 1.44 (95% CI 1.13-1.84), 1.50 (95% CI 1.14-1.99), 1.23 (95% CI 1.10-1.37), and 238.20 (95% CI 92.54-613.12), respectively.

CONCLUSIONS

The prevalence of MetS is still in a rising trend in Beijing. Strategies aimed at prevention and control of high BP should be prioritized to reduce the occurrence of MetS. WHtR is more important to evaluate MetS. Health education and personalized lifestyle intervention should be promoted to keep a healthy WHtR and waist circumference. An appropriate sleep time should be kept, and harmful alcohol drinkers should limit or abstain from alcohol.

Association Between Neighborhood Walkability and Predicted 10-Year Cardiovascular Disease Risk: The CANHEART (Cardiovascular Health in Ambulatory Care Research Team) Cohort

Background Individuals living in unwalkable neighborhoods appear to be less physically active and more likely to develop obesity, diabetes mellitus, and hypertension. It is unclear whether neighborhood walkability is a risk factor for future cardiovascular disease. Methods and Results We studied residents living in major urban centers in Ontario, Canada on January 1, 2008, using linked electronic medical record and administrative health data from the CANHEART (Cardiovascular Health in Ambulatory Care Research Team) cohort. Walkability was assessed using a validated index based on population and residential density, street connectivity, and the number of walkable destinations in each neighborhood, divided into quintiles (Q). The primary outcome was a predicted 10-year cardiovascular disease risk of ≥7.5% (recommended threshold for statin use) assessed by the American College of Cardiology/American Heart Association Pooled Cohort Equation. Adjusted associations were estimated using logistic regression models. Secondary outcomes included measured systolic blood pressure, total and high-density lipoprotein cholesterol levels, prior diabetes mellitus diagnosis, and current smoking status. In total, 44 448 individuals were included in our analyses. Fully adjusted analyses found a nonlinear relationship between walkability and predicted 10-year cardiovascular disease risk (least [Q1] versus most [Q5] walkable neighborhood: odds ratio =1.09, 95% CI: 0.98, 1.22), with the greatest difference between Q3 and Q5 (odds ratio=1.33, 95% CI: 1.23, 1.45). Dose-response associations were observed for systolic blood pressure, high-density lipoprotein cholesterol, and diabetes mellitus risk, while an inverse association was observed with smoking status. Conclusions In our setting, adults living in less walkable neighborhoods had a higher predicted 10-year cardiovascular disease risk than those living in highly walkable areas.

The effect of whey protein on the components of metabolic syndrome in overweight and obese individuals; a systematic review and meta-analysis

BACKGROUND

The risk of developing chronic diseases such as diabetes, cardiovascular disease, dyslipidemia, and stroke is increased following an outbreak of metabolic syndrome. Whey protein can play a major role in preventing metabolic syndrome.

OBJECTIVE

This study was conducted to systematically evaluate the effect of whey protein on the components of metabolic syndrome in overweight and obesity patients.

METHODS

This systematic review and meta-analysis was conducted on RCTs (PROSPERO registration number: CDR42019114794). Published articles of controlled trials between 1 January 2000 to 30 May 2019 indexed in PubMed, Scopus, Web of Science and Cochrane Library were reviewed. Keywords were Whey Protein, Metabolic Syndrome, HDL Lipoprotein, Blood Pressure, Triglyceride, Fasting Blood Glucose, Waist Circumference, Overweight and Obesity or a combination of them in the title/abstracts. The mean difference was extracted for each study. All analyses performed using STATA version 11.

RESULTS

There were 2344 individuals reviewed in this systematic review of 37 published articles.

CONCLUSION

According to the results, whey supplementation significantly reduced the SBP, DBP, HDL, waist circumference, TG and FBS in intervention groups in comparing to control groups.

Postpartum metabolic syndrome after gestational hypertension and preeclampsia, a prospective cohort study

OBJECTIVE

We evaluated the 6-month postpartum risk of metabolic syndrome (MetS), a marker of future cardiovascular disease (CVD) risk, comparing women whose most recent pregnancies were complicated with gestational hypertension (GH) or preeclampsia (PE) versus those who had normotensive pregnancies.

STUDY DESIGN

This was a prospective cohort study in which women with GH or PE and normotensive women were actively enrolled during the first 12 weeks after delivery in Nairobi, Kenya. Participants were interviewed, blood pressures and anthropometric measurements including waist circumference obtained at enrollment and 6 months postpartum. Fasting lipid profile and plasma glucose were measured at 6 months postpartum. A generalized linear regression model with Poisson distribution was used to estimate crude relative risk (RR) of 6-month postpartum MetS and adjusted RR (ARR) after adjusting for apriori potential confounders.

RESULTS

Among 194 postpartum women, 63 (32%) had experienced GH or PE. Prevalence of MetS at 6 months postpartum was higher among women whose pregnancies were complicated with GH or PE (34.9%) compared to those who were normotensive (11.5%). GH and PE were associated with a 3-fold or greater risk of MetS (ARR) 3.01; 95% Confidence interval [CI] 1.58, 5.71; p < 0.001) overall and three of the five components, namely hypertension (ARR 3.35 [2.04, 5.51], p < 0.001), hypertriglyceridemia (ARR 3.25 [1.16-9.10], p = 0.01), and fasting hyperglycemia (ARR 6.20 [1.07-35.76], p = 0.03), compared to having normal blood pressures during pregnancy.

CONCLUSION

At 6  months postpartum, GH and PE were associated with three-fold or higher risk of MetS and especially hypertension, fasting hypertriglyceridemia, and fasting hyperglycemia.

Metabolic Syndrome and Mortality in Continuous Ambulatory Peritoneal Dialysis Patients: A 5-Year Prospective Cohort Study

Background/Aims: Metabolic syndrome (MS) has been widely proved as a predictor of cardiovascular disease, all-cause, and cardiovascular mortality in general population. But its effects on mortality and technique failure have not been well illustrated in peritoneal dialysis (PD) patients. We aimed to investigate the association of MS and clinical outcomes in Chinese continuous ambulatory PD (CAPD) patients. Methods: A single-center, prospective, observational cohort study was conducted in CAPD patients enrolled from September 1 to December 31, 2011, and followed up until December 31, 2016. Demographic, clinical, biochemical and anthropological data were collected. The relationships between MS and mortality and technique failure were assessed using Kaplan-Meier and Cox Regression Survival Functions. Results: A total of 511 patients were enrolled. The baseline mean age was 48.4 ± 14.4 years, 282 patients (55.2%) were male, and 130 patients (25.4%) were diabetic. In total, 213 patients (41.7%) met the diagnostic criterion of MS. During a median of 4.4 years (interquartile range 2.3–5.3 years) follow-up period, 114 patients died, of whom, 65 patients (48%) died in MS group versus 49 patients (30%) in non-MS group. Patients who died tended to be older, higher in inflammation markers and with poorer nutritional state. Kaplan-Meier Survival Functions found patients with MS had a significant rising of all-cause mortality (log-rank test = 12.811, p < 0.001) and cardiovascular mortality (log-rank test = 14.529, p < 0.001) in all patients, and a significant rising of cardiovascular mortality (log-rank test = 4.486, p = 0.034) in non-diabetic patients. After adjusting for confounders, Cox Regression showed that MS was significantly associated with higher cardiovascular mortality in all patients (hazard ratio [HR] 2.21, 95% CI 1.12–4.36, p = 0.022) and in non-diabetic patients (HR 2.60, 95% CI 1.07–6.35, p = 0.036), but it has no significant effect on technique failure. Conclusion: In CAPD patients, MS predicted mortality, especially cardiovascular mortality. No relationship was found between MS and technique survival.

The Emerging Role of l-Glutamine in Cardiovascular Health and Disease

Emerging evidence indicates that l-glutamine (Gln) plays a fundamental role in cardiovascular physiology and pathology. By serving as a substrate for the synthesis of DNA, ATP, proteins, and lipids, Gln drives critical processes in vascular cells, including proliferation, migration, apoptosis, senescence, and extracellular matrix deposition. Furthermore, Gln exerts potent antioxidant and anti-inflammatory effects in the circulation by inducing the expression of heme oxygenase-1, heat shock proteins, and glutathione. Gln also promotes cardiovascular health by serving as an l-arginine precursor to optimize nitric oxide synthesis. Importantly, Gln mitigates numerous risk factors for cardiovascular disease, such as hypertension, hyperlipidemia, glucose intolerance, obesity, and diabetes. Many studies demonstrate that Gln supplementation protects against cardiometabolic disease, ischemia-reperfusion injury, sickle cell disease, cardiac injury by inimical stimuli, and may be beneficial in patients with heart failure. However, excessive shunting of Gln to the Krebs cycle can precipitate aberrant angiogenic responses and the development of pulmonary arterial hypertension. In these instances, therapeutic targeting of the enzymes involved in glutaminolysis such as glutaminase-1, Gln synthetase, glutamate dehydrogenase, and amino acid transaminase has shown promise in preclinical models. Future translation studies employing Gln delivery approaches and/or glutaminolysis inhibitors will determine the success of targeting Gln in cardiovascular disease.

Among young Sri Lankan patients with diabetes, how do lipid profiles differ between those with and without metabolic syndrome?

AIMS

Metabolic syndrome (MetS) is a risk factor for cardiovascular disease (CVD). Apolipoproteins are emerging as powerful predictors of CVD. We aimed to study associations of metabolic syndrome and apoB, apoAI, apoB/AI ratio in young Sri Lankans with type 2 diabetes.

MATERIALS & METHODS

Blood samples were available from 690 patients with type 2 diabetes in Sri Lanka Young Diabetes Study, and were analysed for apoB, apoAI, total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), triglycerides (TG) and glycated haemoglobin (HbA_1c). Their associations with MetS as perNCEP/ATPIII criteria were studied.

RESULTS

MetS was present in 60.9% of subjects. Of those with MetS, 76.0% were women. Those with MetS had higher apoB (1.27 V s 1.19 mmol/L; p = 0.001), apoB/AI (0.80 V s 0.75; p = 0.001), non-HDL cholesterol (NHDLC) (4.15 V s 3.98 mmol/L; p = 0.002),and triglycerides (1.51 V s 1.31 mmol/L; p < 0.001) and lower apoAI (1.58 V s 1.60 mmol/L; p = 0.03) and HDLC (1.02 V s 1.16 mmol/L, p < 0.001). ApoB and apoB/AIlevels increased significantly as the number of MetS components increased. ApoB and apoB:AI ratio were independently associated with MetS and components.

CONCLUSION

MetS showed a high prevalence among young Sri Lankans with diabetes. Elevated apoB is commonly clustered with other risk indicators in MetS.

Overweight, the major determinant of metabolic syndrome among industrial workers in Kerala, India: Results of a cross-sectional study

AIM

To determine the prevalence and associated risk factors of metabolic syndrome (MS) among industrial workers in Kerala, India.

MATERIALS AND METHODS

We measured fasting plasma glucose (FPG), triglycerides, high density lipoprotein cholesterol, waist circumference, systolic blood pressure and diastolic blood pressure among 2287 industrial workers (mean age 46 years, men 70%) from selected industries of two southern most Kerala districts using standard protocol in 2009. MS was defined according to international diabetes federation (IDF), Adult Treatment Panel (ATP-III) and American Heart Association(AHA)/National Heart Lung and Blood Institute (NHLBI) criteria (Harmonization). Age-standardized prevalence of MS was assessed for men and women. Multivariable logistic regression models were developed to find the associated factors of MS.

RESULTS

Age-standardized prevalence of MS was 14% (men 14%, women 15%), 19% (men 19%, women 21%) and 27% (men 30%, women 21%) as per IDF, ATP-III and Harmonization criteria respectively. Overweight adults were nine times (OR 9.41, 95% CI 7.34-12.06), twelve times (OR 11.80 CI 9.38-14.84), and four times (OR 3.56, CI 2.94-4.29) more likely to have MS compared to their counterparts according to IDF, ATP-III and Harmonization criteria respectively. Older adults and current alcohol users were more likely to have MS compared to their counterparts. Women were more likely to have MS as per IDF and ATP-III criteria.

CONCLUSIONS

MS prevalence was high among Industrial workers who generally have good access to health care. Overweight and other predictors of MS need to be addressed to reduce MS prevalence in this population.

Sex differences in the association of metabolic syndrome with low back pain among middle-aged Japanese adults: a large-scale cross-sectional study

BACKGROUND

Although some recent studies have indicated an association between metabolic syndrome (MetS) and musculoskeletal disease, little is known about the association of MetS with low back pain (LBP). The present study aimed to investigate sex differences in the association of MetS and the clustering of MetS components with LBP among middle-aged Japanese individuals.

METHODS

Study subjects were 45,192 adults (30,695 men, 14,497 women) aged 40-64 years who underwent annual health checkups conducted from April 2013 to March 2014. MetS was defined according to the criteria of the Examination Committee of Criteria for MetS in Japan as abdominal obesity plus at least two of dyslipidemia, high blood pressure, or high blood glucose. Information on LBP and health-related lifestyles were collected using a self-administered questionnaire. Logistic regression modeling was used to calculate the odds ratio (OR) and 95% confidence interval (CI) for LBP.

RESULTS

After adjusting for age and lifestyle factors, the OR of MetS for LBP was 1.15 (95% CI 0.95-1.40) in men and 2.16 (95% CI 1.32-3.53) in women. Compared to subjects without abdominal obesity, the presence of abdominal obesity significantly increased the OR for LBP among men (abdominal obesity only: OR 1.34, 95% CI 1.02-1.76; abdominal obesity plus one component: OR 1.24, 95% CI 1.01-1.52; abdominal obesity plus two or more components: OR 1.26, 95% CI 1.02-1.55). Among women, adding other components of MetS to abdominal obesity significantly increased ORs for LBP (abdominal obesity only: OR 1.70, 95% CI 0.94-3.08; abdominal obesity plus one component: OR 1.66, 95% CI 1.06-2.60; abdominal obesity plus two or more components: OR 2.30, 95% CI 1.41-3.78).

CONCLUSIONS

This large-scale cross-sectional study indicated that MetS was significantly associated with LBP among women only and that a sex-difference existed in the association between the clustering of MetS components and LBP. Clustering of MetS components by sex may need to be considered for the prevention of LBP, although further prospective studies are needed to clarify the causality.

Independent relationships of daily life activity and leisure-time exercise with metabolic syndrome and its traits in the general Japanese population

PURPOSE

This study aimed to investigate independent relationships of daily non-exercise life activity and leisure-time exercise volume and intensity with the prevalence of metabolic syndrome and its traits in Japanese adults.

METHODS

Data of 24,625 eligible subjects (12,709 men, 11,916 women) who participated in the baseline survey of the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study were analyzed. Information about lifestyle characteristics was obtained from a questionnaire. Logistic regression analyses were performed to evaluate the independent associations of daily life activity as well as leisure-time exercise volume and intensity with the prevalence of metabolic syndrome and its traits by sex.

RESULTS

Male subjects with higher daily life activity as well as with higher leisure-time exercise volume had a lower prevalence of metabolic syndrome, independently with each other. Female subjects with higher daily life activity also had a lower prevalence of metabolic syndrome. Particularly, male and female subjects with the highest daily life activity quartile showed considerably low odds ratios of 0.66 (95% CI, 0.53-0.81) and 0.64 (0.52-0.79), respectively, for low HDL-cholesterol even after the adjustment for BMI compared with the first quartile. Meanwhile, male subjects with the higher leisure-time exercise showed a quite lower prevalence of elevated triglycerides. Higher moderate-intensity exercise was more intensely associated with a lower prevalence of metabolic syndrome and some of its traits in both sexes.

CONCLUSIONS

Our results suggest that higher daily life activity and higher moderate-intensity exercise may be independently associated with a lower risk of metabolic syndrome in Japanese adults.

CETP genotype and concentrations of HDL and lipoprotein subclasses in African-American men

Aim: To assess the association between the CETP Taq1B and I405V polymorphisms with levels of lipoprotein subclasses in African-American (AA) men with and without Type 2 diabetes (T2DM). Patients & methods: AA men, over 30 years of age, with (n = 54) or without T2DM (n = 50), and not receiving lipid-lowering agents, underwent advanced lipid analysis and genotyping. Results & conclusion: In the total patient population Taq1B B2-allele carriers had significantly higher levels of large HDL subclasses (HDL-2b [p = 0.017] and HDL-L [p = 0.019]), lower levels of small-HDL subclasses (HDL-3a [p = 0.004] and HDL-3b [p = 0.031]), and lower levels of LDL subclasses (LDL-IVa [p = 0.012] and LDL-IIIb [p = 0.009]). The only significant genotype-diabetes interaction occurred with the HDL-2a subclass (p = 0.015). No statistically significant associations were seen with I405V genotype. Our observations of lower levels of small-HDL and higher levels of large-HDL suggest that a potentially important HDL subclass-CETP relationship exists.

Independent and joint association of obesity and metabolic syndrome with depression and inflammation

OBJECTIVE

To investigate the separate and combined associations of obesity and metabolic syndrome (MetS) with depression and the role of inflammation.

METHOD

Depression was assessed with the Patient Health Questionnaire-9 (PHQ-9) and was defined with a cutpoint of ≥10. Obesity was defined as body mass index (BMI) ≥30 kg/m2 from measured height and weight. MetS was defined based on the American Heart Association consensus definition. Participants were divided into four groups: healthy normal weight (MHN), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUN), and metabolic unhealthy obese (MUO). C-Reactive protein was assessed in a subsample.

RESULTS

A total of 18,025 subjects were included in the analysis. Participants with MUO had the highest prevalence of depression compared with the MHN group (14.8% vs. 6.8, p < .001). While both obesity and MetS were independently associated with depression, there was a significant interaction between the two (p < .001), indicating that the associations of obesity and MetS with depression were synergistic. After adjusting for baseline characteristics, compared with the MHN group, the MUO group had the highest odds of depression (odds ratio [OR] = 2.30, 95% CI [2.03, 2.61]), followed by MHO group (OR = 1.51, 95% CI [1.30, 1.74]) and the MUN group (OR = 1.39, 95% CI [1.18, 1.64]). The MUO group also showed the highest level of C-reactive protein, and the latter partially mediated the effect between MUO and depressive symptoms (20.5% of the total effect).

CONCLUSION

Both obesity and MetS are associated with depression independent of each other, but when present together, these conditions have a synergistic association with depression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Characteristics of metabolic factors related to arterial stiffness in young and old adults

It has not been adequately studied which biomarkers for cardiovascular risk indicate changes of atherosclerosis by aging process. The current study aimed to investigate the characteristics of metabolic factors related to arterial stiffness in young and old adults. Our cross-sectional study enrolled 851 healthy young adults and 719 old adults. Metabolic biomarkers included glucose, lipid profiles, and liver enzymes. In young adults, additional biomarkers such as C-reactive protein, apolipoproteins, lipoprotein(a), ferritin, and 25-hydroxycholecalciferol were measured. Arterial stiffness was evaluated by measuring brachial-ankle pulse wave velocity (baPWV). The mean age was 37.8 and 65.1 years old in the young and old groups, respectively. Without adjustment, most parameters were significantly correlated with baPWV in both young and old groups. Mean baPWV was significantly different according to metabolic syndrome (MetS) in both groups (13.1 and 12.1 m/s in the young subjects with and without MetS, respectively; 17.4 and 15.8 m/s, respectively, in the old group). After adjusting for age, sex, and hemodynamic factors, the difference in baPWV according to MetS was significant only in the old group. The relationship between most biomarkers and baPWV was influenced by metabolic disorders such as hypertension and diabetes in old adults. Total cholesterol (TC), low-density lipoprotein cholesterol (LDLC), and apolipoprotein B were significant in young group. In conclusion, the metabolic biomarkers related to arterial stiffness were different between young and old adults. Contrary to old adults, TC, LDLC, and apolipoprotein B were independent biomarkers for arterial stiffness in healthy young adults.

SGLT-2 Inhibitors and GLP-1 Agonists: First-Line Therapy for Diabetes With Established Cardiovascular Disease

There is a growing body of evidence that diabetes represents a significant and largely modifiable risk factor for cardiovascular disease (CVD). It is known to markedly increase the risk of CVD-with CVD accounting for 2 of every 3 deaths in patients with diabetes. It is suggested that once patients with diabetes develop clinical coronary disease, they have a grim prognosis. In 2008, the Food and Drug Association mandated the evidence of CV safety in any new diabetic therapy, leading to a multitude of large CV outcome trials to assess CV risk from these medications. However, several of these outcome trials with novel antidiabetic therapies have demonstrated not only safety but a clear and definite CV advantage in patients with type 2 diabetes. In this review, we discuss 2 relatively newer classes of diabetic drugs, sodium glucose cotransport 2 inhibitors and glucagon-like peptide 1 agonists, evaluate their efficacy in improving CV outcomes, and discuss the future of CV prevention with these agents.

The metabolic syndrome and its components are differentially associated with chronic diseases in a high-risk population of 350 000 adults: A cross-sectional study

AIMS

We compared strengths of associations conferred by the metabolic syndrome (MetS) and its components across four chronic disease categories (cancer, cardiovascular diseases [CVDs], chronic kidney disease [CKD], and chronic obstructive pulmonary disease [COPD]) in a community-dwelling high-risk population.

METHODS

This is a cross-sectional analysis of Israeli adults insured in a single health maintenance organization during 2010 to 2013 and having greater than or equal to two MetS components (hypertension, dysglycemia, low high-density lipoprotein level, high plasma triglyceride level, and obesity). Data regarding MetS components, chronic disease prevalence, and sociodemographic variables were retrieved from electronic health records and disease registries.

RESULTS

Among 347 244 eligible members, 54.2% had MetS. MetS was negatively associated with cancer, (prevalence ratio [PR] = 0.86; 95% confidence interval, 0.79-0.93) and positively associated with CKD (PR = 1.07, [1.01-1.13]). Some MetS components conferred different associations across the chronic diseases: a high triglyceride level was positively associated with cancer (PR = 1.15, 1.12-1.18) and CKD (PR = 1.37, 1.32-1.41) but negatively associated with CVD (PR = 0.88, 0.86-0.90) and COPD (PR = 0.93, 0.88-0.98). In the presence of MetS, those with dysglycemia had higher cancer prevalence than those with normoglycemia (PR-interaction MetS*dysglycemia on cancer = 1.14, 1.06-1.22). Likewise, in the presence of MetS, men were more likely than women to present with CVD (PR-interaction MetS*sex on CVD = 1.12, [1.05-1.20]).

CONCLUSIONS

Prevalences of the MetS and MetS components distribute unequally across four chronic diseases. MetS including dysglycemia may warrant screening for cancer, and MetS in males may indicate the presence of CVD. Longitudinal studies may reveal if MetS is associated with different risks or merely indicates better prognosis once having a chronic illness.

Neighborhood disadvantage across the transition from adolescence to adulthood and risk of metabolic syndrome

This study investigates the association between neighborhood disadvantage from adolescence to young adulthood and metabolic syndrome using a life course epidemiology framework. Data from the United States-based National Longitudinal Study of Adolescent to Adult Health (n = 9500) and a structural equation modeling approach were used to test neighborhood disadvantage across adolescence, emerging adulthood, and young adulthood in relation to metabolic syndrome. Adolescent neighborhood disadvantage was directly associated with metabolic syndrome in young adulthood. Evidence supporting an indirect association between adolescent neighborhood disadvantage and adult metabolic syndrome was not supported. Efforts to improve cardiometabolic health may benefit from strategies earlier in life.

Usefulness of waist-to-height ratio in screening incident metabolic syndrome among Japanese community-dwelling elderly individuals

This study examined a range of anthropometric indices and their relationships with metabolic syndrome (MetS). Despite recommendations that central obesity assessment should be employed as a marker of metabolic health, there is no consensus regarding the protocol for measurement. The present study included 720 men aged 71 ± 8 years and 919 women aged 71 ± 7 years from a rural village. We examined the relationship between anthropometric indices {e.g., body mass index (BMI), waist-to-height ratio (WHtR), waist-to-hip ratio (WHpR)}, and MetS based on the modified criteria of the National Cholesterol Education Program’s Adult Treatment Panel (NCEP-ATP) III report in a cross-sectional (N = 1,639) and cohort (N = 377) data. A receiver operating curve (ROC) analysis was performed to determine the optimal cut-off value and best discriminatory value of each of these anthropometric indices to predict MetS. In the cross-sectional study, WHtR as well as BMI and WHpR showed significantly predictive abilities for MetS in both genders; and WHtR showed the strongest predictive ability for the presence of MetS. Also in the cohort study, WHtR as well as BMI and WHpR showed significantly predictive abilities for incident MetS in both genders, and in men WHtR showed the strongest predictive ability for incident MetS, but in women BMI showed the strongest predictive ability. In the cross-sectional study, the optimal WHtR cutoff values were 0.52 (sensitivity, 71.0%; specificity, 77.9%) for men and 0.53 (sensitivity, 79.8%; specificity, 75.7%) for women. In the cohort study, the optimal WHtR values were 0.50 (sensitivity, 60.7%; specificity, 73.2%) for men and 0.50 (sensitivity, 75.0%; specificity, 56.1%) for women. Increased WHtR was significantly and independently associated with prevalence of MetS in both genders. These results suggest that WHtR is a useful screening tool for determining metabolic risk in Japanese elderly community dwelling individuals.

Elevated Triglycerides to High-Density Lipoprotein Cholesterol (TG/HDL-C) Ratio Predicts Long-Term Mortality in High-Risk Patients

BACKGROUND

Elevated triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio has been utilised as a predictor of outcomes in patients with adverse cardiometabolic risk profiles. In this study, we examined the prognostic value of elevated TG/HDL-C level in an Australian population of patients with high clinical suspicion of coronary artery disease (CAD) presenting for coronary angiography.

METHODS

Follow-up data was collected for 482 patients who underwent coronary angiography in a prospective cohort study. The primary endpoint was all-cause mortality and the secondary endpoint was a major adverse cardiac event (MACE). Patients were stratified into two groups according to their baseline TG/HDL-C ratio, using a TG/HDL-C ratio cut point of 2.5.

RESULTS

The mean follow-up period was 5.1 ± 1.2 years, with 49 all-cause deaths. Coronary artery disease on coronary angiography was more prevalent in patients with TG/HDL-C ratio ≥2.5 (83.6% vs. 69.4%, p = 0.03). On the Kaplan-Meier analysis, patients with TG/HDL-C ratio ≥2.5 had worse long-term prognosis (p = 0.04). On multivariate Cox regression adjusting for established cardiovascular risk factors and CAD on coronary angiography, TG/HDL-C ratio ≥2.5 was an independent predictor of long-term all-cause mortality (hazard ratio [HR] 2.10, 95% confidence interval [CI] 1.04-4.20, p = 0.04). On multivariate logistic regression adjusting for known cardiovascular risk factors and CAD on coronary angiography, TG/HDL-C ratio ≥2.5 was strongly associated with an increased risk of long-term MACE (odds ratio [OR] 2.72, 95% CI 1.42-5.20, p = 0.002).

CONCLUSIONS

Elevated TG/HDL-C ratio is an independent predictor of long-term all-cause mortality and is strongly associated with an increased risk of MACE.

Residual cardiovascular risk among people with diabetes

Type 2 diabetes (T2D) is a growing health concern across both developed and developing countries. Cardiovascular disease (CVD) remains the major cause of increased mortality in this patient population. In recent years, effective low density lipoprotein lowering treatments and other risk reduction strategies have substantially reduced the risk of atherosclerotic CVD, yet patients with T2D continue to remain at increased risk for atherosclerotic CVD. Here, we will briefly review various proposed underlying mechanisms for this residual risk with a more in-depth focus on the potential role of triglyceride-rich lipoproteins in residual risk and potential avenues to target this pharmacologically.

Visceral obesity, but not central obesity, is associated with cardiac remodeling in subjects with suspected metabolic syndrome

BACKGROUND AND AIMS

Metabolic syndrome (MetS) is a cluster of multiple risk factors including central obesity that may lead to cardiac damage and cardiovascular events. We investigated whether visceral obesity induces cardiac structural and functional remodeling independently from central obesity and other risk factors in subjects with suspected MetS.

METHODS AND RESULTS

We studied 229 participants with suspected MetS. Visceral fat area (VFA) was measured by bioelectrical impedance analysis. Left ventricular (LV) mass index, early diastolic velocity of mitral annulus (e'), and LV global longitudinal strain (GLS) were measured by echocardiography. Subjects were categorized into high and low VFA group (VFA_h and VFA_l). MetS was more prevalent in the VFA_h than in the VFA_l (p = 0.004). The VFA_h had a higher waist circumference (WC) than the VFA_l (p < 0.001). LV mass index was higher, but e' and GLS were lower in the VFA_h than in VFA_l (all p < 0.05). VFA was well correlated with blood pressure, fasting blood glucose, triglyceride, high-sensitivity C-reactive protein and adiponectin (all p < 0.05). VFA was correlated to LV mass index, e', and GLS (all p < 0.05) and was independently associated with GLS after adjustment for other risk factors, including WC (p = 0.005).

CONCLUSIONS

Visceral obesity assessed by VFA was well correlated with parameters of MetS. Visceral obesity, but not central obesity measured by WC, was independently associated with structural and functional cardiac remodeling in subjects with suspected MetS. It suggests that visceral obesity should be considered as an important risk factor for cardiac damage in dysmetabolic subjects.

TRIAL REGISTRATION

NCT02077530 (date of registration: November 1, 2013).

Cardiovascular Implications of Diabetes, Metabolic Syndrome, Thyroid Disease, and Cardio-Oncology in Women

Cardiovascular disease may be associated with several comorbidities, including diabetes mellitus, thyroid disorders, and the metabolic syndrome, which are predominantly observed in women and often starting at particular ages. In addition, common treatment options for carcinomas frequently seen in women may induce serious cardiotoxic effects. We review the scope of the problem, the pathophysiologic mechanisms involved, as well as the resulting abnormalities regarding cardiac structure and function as observed by using imaging techniques.

Vitamin D supplementation has no effect on matrix metalloproteinases-2, -9, and tissue inhibitor matrix metalloproteinase-1 in subjects with metabolic syndrome: A pilot study

The present randomized, double-blind, placebo controlled study aimed to evaluate the effect of vitamin D supplementation on matrix metalloproteinases-2, -9 (MMP-2 and MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in subjects with metabolic syndrome. Forty-six eligible subjects were randomly assigned to either vitamin D or placebo groups for 16 weeks. The participants were asked to take 50,000 IU vitamin D or matching placebo every week. Metabolic and anthropometric indices, serum MMP-2, MMP-9, TIMP-1 and high-sensitivity C-reactive protein (hsCRP) were assessed before and after intervention. Moreover, dietary intake, sun exposure and physical activity were also determined. The trial was registered at http://www.irct.ir (No. IRCT201409033140N14). Participants were 40.20 ± 4.60 y and 45.50% males. Compared to the baseline values, MMP-9 and TIMP-1 concentrations were decreased after 16 weeks in the intervention group (p = 0.03 and p = 0.04, respectively). However, the changes of MMP-2, MMP-9, TIMP-1 and hsCRP in the intervention group were not significant compared to the placebo group (p > 0.05). Furthermore, the metabolic or anthropometric indices between two study groups remained unchanged (p > 0.05). The findings of the present study demonstrated no effect of vitamin D supplementation on MMP-2, MMP-9 and TIMP-1 concentrations in subjects with metabolic syndrome. However, there is a need for more longitudinal trials to investigate the role of vitamin D on atherosclerosis and cardiovascular diseases in subjects with metabolic syndrome.

Total bilirubin independently predicts incident metabolic syndrome among community-dwelling women

BACKGROUND

Metabolic syndrome (MetS) is related to the increased risk of major cardiovascular diseases (CVD). The link between high serum total bilirubin (TBL) is cross-sectionally related to MetS and its components. However, whether serum TBL predicts incidence of MetS and its components remains inconclusive.

METHODS

The present study included 893 women aged 70 ± 9 years from a rural village. We examined the relationship between serum TBL and MetS based on the modified criteria of the National Cholesterol Education Program's Adult Treatment Panel (NCEP-ATP) III report in a cross-sectional (N = 893) and cohort (N = 288) data.

RESULTS

In the cross-sectional study, serum TBL (β = 0.536, p < 0.001) as well as age, alcohol consumption, exercise habits, history of CVD, SUA, GGT, and ALT was significantly and dependently associated with number of MetS components, but in the cohort study serum TBL was not associated with number of MetS components. Compared with the 1st tertile of serum TBL (0.20-0.55 mg/dL), multivariate-adjusted odds ratio (95% confidence interval) for the 2nd -3rd tertiles of serum TBL (0.54-2.00 mg/dL) was 0.70 (0.51-0.95) in the cross-sectional study and 0.41 (0.21-0.81) in the cohort study.

CONCLUSIONS

Our data demonstrated an independently negative association between serum TBL and MetS in Japanese community-dwelling women.

Metabolic Syndrome Severity Score in Korean Adults: Analysis of the 2010-2015 Korea National Health and Nutrition Examination Survey

BACKGROUND

Continuous metabolic syndrome (MS) severity scores that can track metabolic risk in individuals over time have been developed for Western populations. The present study aimed to develop gender- and age-specific equations for MS severity scores in Korean adults.

METHODS

Using data from the Korea National Health and Nutrition Examination Surveys (KNHANES) IV (2010-2012) and VI (2013-2015), we performed a confirmatory factor analysis of single MS factor that allowed for differential loadings across groups to generate gender- and age-specific, continuous MS severity scores. Then, we validated this equation in a different dataset of Korean adults.

RESULTS

In confirmatory analysis, waist circumference had the highest factor loading, indicating that waist circumference had the strongest correlation with MS among Korean adults. Lower factor loadings (< 0.4) among Korean adults aged 40-59 years were noted for systolic blood pressure and fasting glucose. MS severity score values were significantly correlated with metabolic parameters, including high-sensitivity C-reactive-protein, glycated hemoglobin, and homeostasis model assessment of insulin resistance. Furthermore, MS severity scores well predicted traditional MS according to receiver operating characteristic analysis in a validation dataset (KNHANES VII). In a longitudinal cohort dataset, participants diagnosed with Adult Treatment Program III (ATP-III) MS after an initial assessment had progressively higher baseline MS severity scores in relationship to their time until ATP-III MS diagnosis.

CONCLUSION

The new MS severity score equations for Korean adults proposed in this study provide a clinically-accessible continuous measure of MS for potential use in identifying adults at higher risk for MS-related diseases and following changes within individuals over time.

Small dense LDL cholesterol is associated with metabolic syndrome traits independently of obesity and inflammation

Background

Small dense LDL cholesterol (sdLDL-c) has been established to be highly associated with metabolic disorder. However, the relationship between circulating sdLDL-c and the presence of metabolic syndrome (MetS) has not been fully established.

Methods

A total of 1065 Chinese males (45.07 ± 11.08 years old) without diabetes and general obesity was recruited into a population-based, cross-sectional study. The MetS was defined based on the updated National Cholesterol Education Program/ Adult Treatment Panel III criteria for Asian Americans. Serum sdLDL-c concentration was measured by a homogeneous assay method and its relationship with MetS and its traits was investigated.

Results

Serum sdLDL-c concentrations increased gradually with increasing numbers of MetS components (p < 0.001) and the proportion of patients with MetS increased gradually with increasing sdLDL-c levels (p for trend< 0.001). For the second, third, and fourth sdLDL-c quartiles versus the first, the OR (95% CI) for MetS were 4.47(2.41,8.28), 5.47(2.97,10.07) and 8.39(4.58,15.38) (p < 0.001 for trend) after multivariate adjustment. The stratified analysis conducted according to LDL-c levels showed that the OR between serum sdLDL-c levels and MetS was greater in those LDL-c levels lower than 3.3 mmol/L (OR = 22.97; 95% CI, 7.64-69.09) than in those LDL-c levels higher than 3.3 mmol/L (OR = 17.49; 95% CI, 4.43-68.98). Mediation analysis showed sdLDL-c mediated 38.6% of the association of waist circumference with triglycerides, while the association between sdLDL-c and MetS components did not mediate by hsCRP.

Conclusions

This study found that high sdLDL-c concentrations were associated with the presence of MetS independently of central obesity and inflammation.

Serum Uric Acid to Creatinine Ratio Independently Predicts Incident Metabolic Syndrome Among Community-Dwelling Persons

BACKGROUND

Metabolic syndrome (MetS) is related to the increased risk of major cardiovascular disease. The link between high serum uric acid (SUA) and creatinine (Cr) levels is causally related to MetS and its components. However, whether renal function-normalized SUA [i.e., SUA to Cr ratio (SUA/Cr)] predicts incident MetS and its components remains inconclusive.

MATERIALS AND METHODS

We conducted a prospective cohort study designed as part of the Nomura study. The subjects comprised 447 men ages 68 ± 10 years and 625 women ages 68 ± 9 years from a rural village, and 155 (34.7%) men and 310 women (49.6%) had MetS at baseline. We found participants who underwent a similar examination 3 years later and analyzed the relationship between baseline SUA/Cr and incident MetS defined according to the modified criteria of the National Cholesterol Education Program-Adult Treatment Panel III (NCEP ATP III).

RESULTS

One hundred forty-nine (33.3%) men and 286 (45.8%) women had MetS after a 3-year follow-up. Multiple linear regression analysis was performed to evaluate the contribution of possible confounding factors for MetS. In women only, baseline SUA/Cr, as well as baseline number of MetS and age, was significantly and independently associated with the number of MetS components at follow-up. The multivariable-adjusted odds ratios (95% confidence interval) for incident MetS across three quartiles of baseline SUA/Cr (1st-2nd, 3rd, and 4th) were 1.00, 1.62 (0.97-2.69), and 2.07 (1.20-3.56), respectively. Furthermore, when subjects were stratified by age, estimated glomerular filtration rate (eGFR), and presence of baseline MetS, baseline SUA/Cr was also a significant and independent determinant for incident MetS in women with age ≥60 years, eGFR ≥70 mL/min/1.73 m², and presence of baseline MetS.

CONCLUSIONS

Baseline SUA/Cr was significantly associated with incident MetS among community-dwelling women.

Longitudinal assessment of coronary plaque volume change related to glycemic status using serial coronary computed tomography angiography: A PARADIGM (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging) substudy

BACKGROUND

Data on the impact of glycemic status on coronary plaque progression have been limited. This study evaluated the association between glycemic status and coronary plaque volume change (PVC) using coronary computed tomography angiography (CCTA).

METHODS

A total of 1296 subjects (61 ± 9, 56.9% male) who underwent serial CCTA with available glycemic status were enrolled and analyzed from the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry. The median inter-scan period was 3.2 (2.6-4.4) years. Quantitative assessment of coronary plaques was performed at both scans. All participants were categorized into the following groups according to glycemic status: normal, pre-diabetes (pre-DM), and diabetes mellitus (DM).

RESULTS

During the follow-up, significant differences in PVC (normal: 51.3 ± 83.3 mm³ vs. pre-DM: 51.0 ± 84.3 mm³ vs. DM: 72.6 ± 95.0 mm³; p < 0.001) and annualized PVC (normal: 14.9 ± 24.9 mm³ vs. pre-DM: 15.7 ± 23.8 mm³ vs. DM: 21.0 ± 27.7 mm³; p = 0.001) were observed among the 3 groups. Compared with normal individuals, individuals with pre-DM showed no significant differences in the adjusted odds ratio (OR) for plaque progression (PP) (1.338, 95% confidence interval [CI] 0.967-1.853; p = 0.079). However, the adjusted OR for PP was higher in DM individuals than in normal individuals (1.635, 95% CI 1.126-2.375; p = 0.010).

CONCLUSION

DM had an incremental impact on coronary PP, but pre-DM appeared to have no significant association with an increased risk of coronary PP after adjusting for confounding factors.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.govNCT02803411.

Menopause and metabolic syndrome in the Middle East countries; a systematic review and meta-analysis study

INTRODUCTION

Metabolic syndrome (MetS) prevalence that is associated with increasing risk of diabetes and cardiovascular diseases (CVD) has accelerated with age. Since, menopause is known as a partial cause of CVD accelartion with againg among women, determining the prevalence of MetS is important in this condition. We aimed to assess critically the prevalence rate of MetS among menopaused women in the Middle East Countries in this systematic review meta-analysis study.

METHODS & MATERIALS

International webdata bases including Scopus, ISI web of Science and PubMed were systematically searched using Medical Subject Headings terms from January 2000 to February 2017. We included all cross-sectional conducted in the Middle East that reported prevalence of MetS in menopause status regardless of MetS definition. Quality assessment was considered for each included study. The pooled prevalence of MetS based on the Adult Treatment Panel III (ATP III) was estimated using random effect method due to between-study heterogeneity by STATA software, version 11.0 (StataCorp, USA).

RESULTS

Within 60 studies, 21 and 17 studies were included in qualitative synthesis and meta-analysis respectively. The prevalence of MetS among menopaused women was estimated 54.87% (95% CI: 53.76-55.97) in the Middle East countries. In sub-group analysis based on country the prevalence rate of MetS in Iran and Turkey was estimated 58.78% (95% CI: 57.54-60.02), and 39.02% (95% CI: 36.57-41.47), respectively.

CONCLUSIONS

MetS was highly prevalent as an alarming sign among menopaused women in the Middle East countries. Thus, it is an emergency requirement to promote healthy lifestyle. Also, early detection and treatment of women who reach menopause and are at great risk of developing MetS is necessary for prevention of diabetes and CVD in the region.

Development of the Metabolic Syndrome: Study Design and Baseline Data of the Lufthansa Prevention Study (LUPS), A Prospective Observational Cohort Survey

The Lufthansa Prevention Study (LUPS) study is a prospective observation of a healthy worker cohort to identify early changes in metabolism leading to the Metabolic Syndrome (MetS) and to analyze their relation to behavioral factors like nutrition, physical activity, psychological status, and to underlying genetic conditions. The LUPS study recruited a sample of 1.962 non-diabetic healthy adults between 25-60 years, employed at a flight base of Lufthansa Technik GmbH in Hamburg, Germany. Baseline assessments included anthropometric measures, blood and urine samples and medical history. Psychosocial variables, dietary habits and life-style risk factors were assessed via self-reported questionnaires.In this report we describe the study design and present baseline parameters including the prevalence of the MetS using different classification criteria. The MetS was present in 20% of male and 12% of female subjects according to the 'Harmonizing the metabolic syndrome' definition. The prevalence varies between 2.6% in male and 2.3% in female subjects up to 48% in male and 41% in female subjects according to different classification criteria of MetS.In conclusion, this first cross-sectional view on the LUPS data confirms the expectation that this cohort is rather healthy and thus provides the opportunity to analyze early changes associated with the development of the MetS. The LUPS study is registered as a clinical trial NCT01313156.

Comparison Between Metabolic Syndrome and the Framingham Risk Score as Predictors of Cardiovascular Diseases Among Kazakhs in Xinjiang

Metabolic syndrome (MS) and Framingham risk score (FRS) can be used for predicting the risk of developing cardiovascular diseases (CVD). Previous studies that compared FRS and MS have focused on high-income urban areas. This study focused on the comparison between FRS and MS when used in nomadic minorities in mountain areas. Moreover, an applicable tool for predicting the risk of developing CVD was identified. 2,286 participants who were recruited from the far west of China were followed-up for a median of 5.49 years. MS and FRS were compared in terms of their ability in predicting development of CVD using Cox regression and receiver operating characteristic curve. After each component of MS was appraised, its area under the curve (AUC) was 0.647. When age was included, the AUC of MS risk score increased from 0.647 to 0.758 (P < 0.001). After adjusting for age, the AUC of FRS decreased from 0.732 to 0.582 (P < 0.001). The association between CVD and each quintile of MS risk score that included age was more significant than that between FRS and CVD under the same exposed condition. In conclusion, MS risk score that included age may be a better predictor of CVD among Kazakhs.