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Ciardullo S. The MAFLD-MASLD debate: Does cardiovascular risk prediction define the winner? Liver Int 2024; 44:1564-1566. [PMID: 38886912 DOI: 10.1111/liv.15950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Stefano Ciardullo
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
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Shang Y, Grip ET, Modica A, Skröder H, Ström O, Ntanios F, Gudbjörnsdottir S, Hagström H. Metabolic Syndrome Traits Increase the Risk of Major Adverse Liver Outcomes in Type 2 Diabetes. Diabetes Care 2024; 47:978-985. [PMID: 38498331 PMCID: PMC11116921 DOI: 10.2337/dc23-1937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/20/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE Type 2 diabetes (T2D) increases the risk for major adverse liver outcomes (MALOs), including cirrhosis and its complications. Patients with T2D frequently have other traits of the metabolic syndrome (MetS). It remains uncertain whether there is a synergistic effect of accumulating MetS traits on future MALO risk. RESEARCH DESIGN AND METHODS Patients with T2D without a history of liver disease were identified from national registers in Sweden from 1998 to 2021. MetS traits included hypertension, low HDL level, hypertriglyceridemia, obesity, and albuminuria, in addition to T2D. MALO events were identified based on administrative coding from national registers until 31 October 2022. Data were analyzed using Cox regression models. RESULTS In total, 230,992 patients were identified (median age 64 years; 58% male), of whom 3,215 (1.39%) developed MALOs over a median follow-up of 9.9 years. Compared with patients with one MetS trait (only T2D) at baseline, those with more than one MetS trait had a higher rate of MALOs (adjusted hazard ratio [aHR] 2.33, 95% CI 1.53-3.54). The rate of MALOs increased progressively with increasing numbers of MetS traits at baseline (aHR 1.28 per added trait, 95% CI 1.23-1.33). During follow-up, patients who acquired additional MetS traits had a progressively higher rate of MALOs. The MetS trait with the largest association with incident MALOs was hypertension (aHR 2.06, 95% CI 1.57-2.71). CONCLUSIONS Having or acquiring additional traits of MetS increase the rate of progression to MALOs in patients with T2D. These results could be used to inform screening initiatives for liver disease.
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Affiliation(s)
- Ying Shang
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Emilie Toresson Grip
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Quantify Research, Stockholm, Sweden
| | | | | | - Oskar Ström
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Quantify Research, Stockholm, Sweden
| | | | - Soffia Gudbjörnsdottir
- Swedish National Diabetes Register
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Hannes Hagström
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Division of Hepatology, Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden
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Ahmad A, Lim LL, Morieri ML, Tam CHT, Cheng F, Chikowore T, Dudenhöffer-Pfeifer M, Fitipaldi H, Huang C, Kanbour S, Sarkar S, Koivula RW, Motala AA, Tye SC, Yu G, Zhang Y, Provenzano M, Sherifali D, de Souza RJ, Tobias DK, Gomez MF, Ma RCW, Mathioudakis N. Precision prognostics for cardiovascular disease in Type 2 diabetes: a systematic review and meta-analysis. COMMUNICATIONS MEDICINE 2024; 4:11. [PMID: 38253823 PMCID: PMC10803333 DOI: 10.1038/s43856-023-00429-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Precision medicine has the potential to improve cardiovascular disease (CVD) risk prediction in individuals with Type 2 diabetes (T2D). METHODS We conducted a systematic review and meta-analysis of longitudinal studies to identify potentially novel prognostic factors that may improve CVD risk prediction in T2D. Out of 9380 studies identified, 416 studies met inclusion criteria. Outcomes were reported for 321 biomarker studies, 48 genetic marker studies, and 47 risk score/model studies. RESULTS Out of all evaluated biomarkers, only 13 showed improvement in prediction performance. Results of pooled meta-analyses, non-pooled analyses, and assessments of improvement in prediction performance and risk of bias, yielded the highest predictive utility for N-terminal pro b-type natriuretic peptide (NT-proBNP) (high-evidence), troponin-T (TnT) (moderate-evidence), triglyceride-glucose (TyG) index (moderate-evidence), Genetic Risk Score for Coronary Heart Disease (GRS-CHD) (moderate-evidence); moderate predictive utility for coronary computed tomography angiography (low-evidence), single-photon emission computed tomography (low-evidence), pulse wave velocity (moderate-evidence); and low predictive utility for C-reactive protein (moderate-evidence), coronary artery calcium score (low-evidence), galectin-3 (low-evidence), troponin-I (low-evidence), carotid plaque (low-evidence), and growth differentiation factor-15 (low-evidence). Risk scores showed modest discrimination, with lower performance in populations different from the original development cohort. CONCLUSIONS Despite high interest in this topic, very few studies conducted rigorous analyses to demonstrate incremental predictive utility beyond established CVD risk factors for T2D. The most promising markers identified were NT-proBNP, TnT, TyG and GRS-CHD, with the highest strength of evidence for NT-proBNP. Further research is needed to determine their clinical utility in risk stratification and management of CVD in T2D.
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Affiliation(s)
- Abrar Ahmad
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Asia Diabetes Foundation, Hong Kong SAR, China
| | - Mario Luca Morieri
- Metabolic Disease Unit, University Hospital of Padova, Padova, Italy
- Department of Medicine, University of Padova, Padova, Italy
| | - Claudia Ha-Ting Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Feifei Cheng
- Health Management Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Tinashe Chikowore
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Hugo Fitipaldi
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Chuiguo Huang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Sudipa Sarkar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert Wilhelm Koivula
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom
| | - Ayesha A Motala
- Department of Diabetes and Endocrinology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sok Cin Tye
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
- Sections on Genetics and Epidemiology, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gechang Yu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yingchai Zhang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Michele Provenzano
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Diana Sherifali
- Heather M. Arthur Population Health Research Institute, McMaster University, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | | | - Maria F Gomez
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden.
- Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Nestoras Mathioudakis
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Ahmad A, Lim LL, Morieri ML, Tam CHT, Cheng F, Chikowore T, Dudenhöffer-Pfeifer M, Fitipaldi H, Huang C, Kanbour S, Sarkar S, Koivula RW, Motala AA, Tye SC, Yu G, Zhang Y, Provenzano M, Sherifali D, de Souza R, Tobias DK, Gomez MF, Ma RCW, Mathioudakis NN. Precision Prognostics for Cardiovascular Disease in Type 2 Diabetes: A Systematic Review and Meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.26.23289177. [PMID: 37162891 PMCID: PMC10168509 DOI: 10.1101/2023.04.26.23289177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Precision medicine has the potential to improve cardiovascular disease (CVD) risk prediction in individuals with type 2 diabetes (T2D). Methods We conducted a systematic review and meta-analysis of longitudinal studies to identify potentially novel prognostic factors that may improve CVD risk prediction in T2D. Out of 9380 studies identified, 416 studies met inclusion criteria. Outcomes were reported for 321 biomarker studies, 48 genetic marker studies, and 47 risk score/model studies. Results Out of all evaluated biomarkers, only 13 showed improvement in prediction performance. Results of pooled meta-analyses, non-pooled analyses, and assessments of improvement in prediction performance and risk of bias, yielded the highest predictive utility for N-terminal pro b-type natriuretic peptide (NT-proBNP) (high-evidence), troponin-T (TnT) (moderate-evidence), triglyceride-glucose (TyG) index (moderate-evidence), Genetic Risk Score for Coronary Heart Disease (GRS-CHD) (moderate-evidence); moderate predictive utility for coronary computed tomography angiography (low-evidence), single-photon emission computed tomography (low-evidence), pulse wave velocity (moderate-evidence); and low predictive utility for C-reactive protein (moderate-evidence), coronary artery calcium score (low-evidence), galectin-3 (low-evidence), troponin-I (low-evidence), carotid plaque (low-evidence), and growth differentiation factor-15 (low-evidence). Risk scores showed modest discrimination, with lower performance in populations different from the original development cohort. Conclusions Despite high interest in this topic, very few studies conducted rigorous analyses to demonstrate incremental predictive utility beyond established CVD risk factors for T2D. The most promising markers identified were NT-proBNP, TnT, TyG and GRS-CHD, with the highest strength of evidence for NT-proBNP. Further research is needed to determine their clinical utility in risk stratification and management of CVD in T2D.
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5
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Alcohol consumption and metabolic syndrome: Clinical and epidemiological impact on liver disease. J Hepatol 2023; 78:191-206. [PMID: 36063967 DOI: 10.1016/j.jhep.2022.08.030] [Citation(s) in RCA: 76] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/04/2022] [Accepted: 08/19/2022] [Indexed: 02/01/2023]
Abstract
Alcohol use and metabolic syndrome are highly prevalent in the population and frequently co-exist. Both are implicated in a large range of health problems, including chronic liver disease, hepatocellular carcinoma, and liver-related outcomes (i.e. decompensation or liver transplantation). Studies have yielded mixed results regarding the effects of mild-moderate alcohol consumption on the risk of metabolic syndrome and fatty liver disease, possibly due to methodological differences. The few available prospective studies have indicated that mild-moderate alcohol use is associated with an increase in liver-related outcomes. This conclusion was substantiated by systems biology analyses suggesting that alcohol and metabolic syndrome may play a similar role in fatty liver disease, potentiating an already existing dysregulation of common vital homeostatic pathways. Alcohol and metabolic factors are independently and jointly associated with liver-related outcomes. Indeed, metabolic syndrome increases the risk of liver-related outcomes, regardless of alcohol intake. Moreover, the components of metabolic syndrome appear to have additive effects when it comes to the risk of liver-related outcomes. A number of population studies have implied that measures of central/abdominal obesity, such as the waist-to-hip ratio, can predict liver-related outcomes more accurately than BMI, including in individuals who consume harmful quantities of alcohol. Many studies even point to synergistic interactions between harmful alcohol use and many metabolic components. This accumulating evidence showing independent, combined, and modifying effects of alcohol and metabolic factors on the onset and progression of chronic liver disease highlights the multifactorial background of liver disease in the population. The available evidence suggests that more holistic approaches could be useful for risk prediction, diagnostics and treatment planning.
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Wooten JS, Breden M, Hoeg T, Smith BK. Effects of weight-loss on adipokines, total and regional body composition and markers of metabolic syndrome in women who are overweight and obese. ENDOCRINE AND METABOLIC SCIENCE 2022. [DOI: 10.1016/j.endmts.2022.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Teixeira JE, Bragada JA, Bragada JP, Coelho JP, Pinto IG, Reis LP, Fernandes PO, Morais JE, Magalhães PM. Structural Equation Modelling for Predicting the Relative Contribution of Each Component in the Metabolic Syndrome Status Change. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063384. [PMID: 35329071 PMCID: PMC8992136 DOI: 10.3390/ijerph19063384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023]
Abstract
Understanding the factor weighting in the development of metabolic syndrome (MetS) may help to predict the progression for cardiovascular and metabolic diseases. Thus, the aim of this study was to develop a confirmatory model to describe and explain the direct and indirect effect of each component in MetS status change. A total of 3581 individuals diagnosed with MetS, aged 18−102 years, were selected between January 2019 and December 2020 from a community-representative sample of Portuguese adults in a north-eastern Portuguese region to test the model’s goodness of fit. A structural equation modelling (SEM) approach and a two-way ANOVA (age × body composition) were performed to compare the relative contribution of each MetS component using joint interim statement (JIS). Waist circumference (β = 0.189−0.373, p < 0.001), fasting glucose (β = 0.168−0.199, p < 0.001) and systolic blood pressure (β = 0.140−0.162, p < 0.001) had the highest direct effect on the change in MetS status in the overall population and concerning both sexes. Moreover, diastolic blood pressure (DBP), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-c) had a low or non-significant effect. Additionally, an indirect effect was reported for age and body composition involving the change in MetS status. The findings may suggest that other components with higher specificity and sensitivity should be considered to empirically validate the harmonised definition of MetS. Current research provides the first multivariate model for predicting the relative contribution of each component in the MetS status change, specifically in Portuguese adults.
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Affiliation(s)
- José E. Teixeira
- Research Centre in Sports Sciences, Health and Human Development (CIDESD), 5001-801 Vila Real, Portugal; (J.A.B.); (J.E.M.)
- Department of Sport Sciences, Instituto Politécnico de Bragança (IPB), 5300-253 Bragança, Portugal;
- Correspondence:
| | - José A. Bragada
- Research Centre in Sports Sciences, Health and Human Development (CIDESD), 5001-801 Vila Real, Portugal; (J.A.B.); (J.E.M.)
- Department of Sport Sciences, Instituto Politécnico de Bragança (IPB), 5300-253 Bragança, Portugal;
| | - João P. Bragada
- North East Local Health Unit (ULSNE)—Health Care Unit of Santa Maria, 5301-852 Bragança, Portugal; (J.P.B.); (J.P.C.); (I.G.P.); (L.P.R.)
| | - Joana P. Coelho
- North East Local Health Unit (ULSNE)—Health Care Unit of Santa Maria, 5301-852 Bragança, Portugal; (J.P.B.); (J.P.C.); (I.G.P.); (L.P.R.)
| | - Isabel G. Pinto
- North East Local Health Unit (ULSNE)—Health Care Unit of Santa Maria, 5301-852 Bragança, Portugal; (J.P.B.); (J.P.C.); (I.G.P.); (L.P.R.)
| | - Luís P. Reis
- North East Local Health Unit (ULSNE)—Health Care Unit of Santa Maria, 5301-852 Bragança, Portugal; (J.P.B.); (J.P.C.); (I.G.P.); (L.P.R.)
| | - Paula O. Fernandes
- Applied Management Research Unit (UNIAG), Instituto Politécnico de Bragança (IPB), 5300-253 Bragança, Portugal;
| | - Jorge E. Morais
- Research Centre in Sports Sciences, Health and Human Development (CIDESD), 5001-801 Vila Real, Portugal; (J.A.B.); (J.E.M.)
- Department of Sport Sciences, Instituto Politécnico de Bragança (IPB), 5300-253 Bragança, Portugal;
| | - Pedro M. Magalhães
- Department of Sport Sciences, Instituto Politécnico de Bragança (IPB), 5300-253 Bragança, Portugal;
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Byrne CD, Targher G. Non-alcoholic fatty liver disease-related risk of cardiovascular disease and other cardiac complications. Diabetes Obes Metab 2022; 24 Suppl 2:28-43. [PMID: 34324263 DOI: 10.1111/dom.14484] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/15/2021] [Accepted: 06/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIM Non-alcoholic fatty liver disease (NAFLD) affects approximately 25% of the global adult population. The aim of this narrative review is to describe the associations between NAFLD and cardiovascular disease (CVD), arrhythmias, cardiac conduction defects, myocardial remodelling and heart failure. We also discuss the potential mechanisms that mediate or attenuate the strength of these associations, and briefly summarize the effect of treatments that both ameliorate NAFLD and decrease risk of CVD. METHODS Searches of PubMed were performed by the two authors using the terms listed in Appendix. We limited the timeframe to the last decade due to the vast amount of research in the field (up to April 2021) for meta-analyses, reviews and original papers. Only articles published in English were considered. RESULTS NAFLD is associated with an increased risk of fatal/non-fatal CVD events and other cardiac and arrhythmic complications (left ventricular hypertrophy, aortic-valve sclerosis and certain arrhythmias), independently of common CVD risk factors. There are probably several underlying mechanisms, including hepatic/systemic insulin resistance, atherogenic dyslipidaemia, hypertension and pro-atherogenic, pro-coagulant and pro-inflammatory mediators released from the steatotic/inflamed liver that may be involved. Some genetic polymorphisms, such as PNPLA3 (rs738409 C>G) and TM6SF2 (rs58542926 C>T), may worsen the liver disease, but also attenuate the strength of the association between NAFLD and CVD, possibly via their effects on lipoprotein metabolism. Of the currently tested drugs for treating NAFLD that also benefit the vasculature, pioglitazone and GLP-1 receptor agonists are the most promising. CONCLUSIONS The complex interplay between the liver and cardiometabolic risk factors contributes to CVD, arrhythmias and cardiac disease in NAFLD. There is an urgent need for a multidisciplinary approach to manage both liver disease and cardiometabolic risk, and to test the cardiovascular and cardiac effects of new drugs for NAFLD.
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Affiliation(s)
- Christopher D Byrne
- Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, Southampton General Hospital, Southampton, UK
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Miñambres I, Sánchez-Hernandez J, Cuixart G, Sánchez-Pinto A, Sarroca J, Pérez A. Characterization of the hypertriglyceridemic waist phenotype in patients with type 2 diabetes mellitus in Spain: an epidemiological study. Rev Clin Esp 2021; 221:576-581. [PMID: 34839890 DOI: 10.1016/j.rceng.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 06/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES In patients with type 2 diabetes mellitus (DM2), the presence of increased waist circumference and triglycerides is a reflection of increased visceral fat and insulin resistance. However, information about the prevalence and clinical characteristics of the hypertriglyceridemic waist (HTGW) phenotype in patients with DM2 is scarce. The aim of the present study was to analyze the prevalence and characteristics of DM2 patients with HTGW. METHODS We analyzed 4214 patients with DM2 in this epidemiological, cross-sectional study conducted in primary care centers across Spain between 2011 and 2012. The HTGW phenotype was defined as increased waist circumference according to the International Diabetes Federation criteria for Europids (≥ 94 cm for men and ≥ 80 cm for women) with the presence of triglyceride levels ≥ 150 mg/dL. We compared the demographic, clinical and analytical variables according to the presence or absence of the HTGW phenotype. RESULTS Thirty-five percent of patients presented the HTGW phenotype. Patients with the HTGW phenotype had a higher body mass index (31.14 ± 4.88 vs. 29.2 ± 4.82 kg/m2; p < .001) and glycated hemoglobin levels (7.38 ± 1.2% vs. 7 ± 1.07%; p < .001). The presence of hypertension, peripheral arterial disease, cardiac insufficiency and microvascular complications were higher when compared with patients without the HTGW phenotype. Patients with the HTGW phenotype were less adherent to prescribed diet (69.8 vs. 81%; p < .001), exercise (44.6 vs. 58.2%; p < .001) and presented greater weight increase within the year prior to the study visit (29.4 vs. 22.5%; p < .001). CONCLUSIONS The HTGW phenotype is prevalent in the Spanish DM2 population and identifies a subgroup of patients with higher cardiometabolic risk and prevalence of diabetic complications.
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Affiliation(s)
- I Miñambres
- Departamento de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Diabetes y Enfermedades Metabólicas Asociadas CIBER (CIBERDEM), Barcelona, Spain
| | - J Sánchez-Hernandez
- Departamento de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - G Cuixart
- Departamento de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Sánchez-Pinto
- Unidad de Enfermería, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - A Pérez
- Departamento de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Diabetes y Enfermedades Metabólicas Asociadas CIBER (CIBERDEM), Barcelona, Spain.
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Targher G, Tilg H, Byrne CD. Non-alcoholic fatty liver disease: a multisystem disease requiring a multidisciplinary and holistic approach. Lancet Gastroenterol Hepatol 2021; 6:578-588. [PMID: 33961787 DOI: 10.1016/s2468-1253(21)00020-0] [Citation(s) in RCA: 215] [Impact Index Per Article: 71.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/13/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a public health problem worldwide. This narrative Review provides an overview of the current literature to support the notion that NAFLD is a multisystem disease. Convincing evidence shows a strong association between NAFLD and the risk of developing multiple extrahepatic complications such as type 2 diabetes, cardiovascular disease (ie, the predominant cause of mortality in people with NAFLD), chronic kidney disease, and some types of extrahepatic malignancies. The magnitude of this risk parallels the severity of NAFLD (especially the stage of liver fibrosis). There are probably multiple underlying mechanisms by which NAFLD might increase the risk of cardiovascular disease, type 2 diabetes, and extrahepatic complications. Addressing the growing burden of NAFLD will require setting up a multidisciplinary working group and framework to progress and embrace novel collaborative ways of working to deliver holistic, person-centred care and management of people with NAFLD.
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Affiliation(s)
- Giovanni Targher
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, and Metabolism, Innsbruck Medical University, Innsbruck, Austria
| | - Christopher D Byrne
- Department of Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
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Association between Atrial Fibrillation Incidence and Temperatures, Wind Scale and Air Quality: An Exploratory Study for Shanghai and Kunming. SUSTAINABILITY 2021. [DOI: 10.3390/su13095247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
As a common cardiovascular disease, atrial fibrillation has the characteristics of high morbidity, high disability, and high fatality rates, seriously endangering human health and sustainability. Some research has confirmed that environmental factors are related to the risk of illness and death from cardiovascular diseases (including atrial fibrillation), while there is still little comparison on the situation of the two cities in China. This research uses medical data in Shanghai and Kunming establishing, through two-step research, logistic models to compare the impacts on atrial fibrillation incidence to figure out the association between environmental factors (including air pollution, weather, temperature, and wind scales) and atrial fibrillation. Finally, this research shows that environmental impacts on atrial fibrillation prevalence have generality, regionality, and lagging characteristics. The result is significant for atrial fibrillation patients and provides a reliable medical theory basis for nursing measures. Besides, this research provides a prospective method of offering early warning for potential atrial fibrillation patients, helping to maintain human beings’ sustainable development.
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Guo X, Ding Q, Liang M. Evaluation of Eight Anthropometric Indices for Identification of Metabolic Syndrome in Adults with Diabetes. Diabetes Metab Syndr Obes 2021; 14:1431-1443. [PMID: 33833536 PMCID: PMC8019619 DOI: 10.2147/dmso.s294244] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/03/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Several previous reports have highlighted the association between adiposity and risk of metabolic syndrome (MetS). Although it is necessary to identify which adiposity indices are best suited to identify MetS, no such study has been completed in diabetic patients. The aim of this study was to evaluate the ability of eight anthropometric indices to identify MetS in diabetic, middle-aged and elderly Chinese patients. PATIENTS AND METHODS A cross-sectional study was conducted in 906 type 2 diabetic patients in Guangxi. RESULTS The highest odds ratios for the identification of MetS were identified with CUN-BAE (OR = 28.306). The largest areas under the curve (AUCs) were observed for WHtR and BRI in men aged 40-59; CUN-BAE in men aged 60 and over; WHtR, BRI, and TyG in women aged 40-59; and BMI for women aged 60 and over. The weakest indicator for the screening of MetS in type 2 diabetes was the ABSI. CONCLUSION The most effective anthropometric indicator for the identification of MetS varied across sex and age subgroups.
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Affiliation(s)
- Xintong Guo
- Guangxi Medical University, Nanning, Guangxi Province, People’s Republic of China
| | - Qinpei Ding
- Guangxi Medical University, Nanning, Guangxi Province, People’s Republic of China
| | - Min Liang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, People’s Republic of China
- Correspondence: Min Liang Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of ChinaTel +138-7883-8907 Email
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Banitalebi E, Mardaniyan Ghahfarrokhi M, Faramarzi M, Earnest CP. Sprint interval training vs. combined aerobic + resistance training in overweight women with type 2 diabetes. J Sports Med Phys Fitness 2020; 61:712-724. [PMID: 33269876 DOI: 10.23736/s0022-4707.20.11105-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Aerobic and resistance training have known efficacy for treating type2 diabetes (T2D). Less is known about interval training in this population. We examined the effects of sprint interval (SIT) and combined aerobic + resistance (COMB) training on HbA1C and (Primary Outcome) in participants with T2D. Secondary outcomes included HOMA-IR and standard clinical chemistries. Exploratory/Tertiary included immerging cardiovascular disease risk indices. METHODS Participants (N.=52; 45-60y, BMI>30kg/m2, HbA1c, ≥6.5%) were randomly assigned to either SIT (N.=17), COMB (N.=17) or usual care control (Control, N.=18) for 10-weeks. Data were analyzed by ANOVA and effect sizes estimated using Cohen's D (CD). RESULTS We observed significant reductions in HbA1c for SIT (-1.82%, 95% CI, -2.50, -1.14) and COMB (-1.24%, 95% CI, -2.19, -0.29), but not Control (0.02%, 95% CI, -0.67, 0.71). Secondary outcome analysis demonstrated significant reductions in HOMA-IR for SIT (-4.89, 95% CI, -6.94, -2.83) and COMB training (-2.90, 95% CI, -5.00, -0.79), but not Control (-0.44, 95% CI, -3.44, 2.46). Effect size estimates and accompanying confidence interval bound were deemed "large" for HBA1c and moderate-to-large for HOMA-IR. Non-significant changes for the Control group were deemed "trivial." Both analyses were significant vs. Control. Similar patterns were observed for most standard laboratory measures and tertiary outcomes. CONCLUSIONS Our results demonstrated that SIT and COMBO training are effective exercise training regimens in overweight women with T2D independently of changes in body mass.
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Affiliation(s)
- Ebrahim Banitalebi
- Department of Sport Sciences, University of Shahrekord, Shahrekord, Iran
| | | | - Mohammad Faramarzi
- Department of Sport Sciences, University of Shahrekord, Shahrekord, Iran
| | - Conrad P Earnest
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
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Miñambres I, Sánchez-Hernández J, Cuixart G, Sánchez-Pinto A, Sarroca J, Pérez A. Characterization of the hypertriglyceridemic waist phenotype in patients with type2 diabetes mellitus in Spain: An epidemiological study. Rev Clin Esp 2020; 221:S0014-2565(20)30207-1. [PMID: 32921435 DOI: 10.1016/j.rce.2020.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/25/2020] [Accepted: 06/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES In patients with type2 diabetes mellitus (DM2), the presence of increased waist circumference and triglycerides is a reflection of increased visceral fat and insulin resistance. However, information about the prevalence and clinical characteristics of the hypertriglyceridemic waist (HTGW) phenotype in patients with DM2 is scarce. The aim of the present study was to analyze the prevalence and characteristics of DM2 patients with HTGW. METHODS We analyzed 4214 patients with DM2 in this epidemiological, cross-sectional study conducted in primary care centers across Spain between 2011 and 2012. The HTGW phenotype was defined as increased waist circumference according to the International Diabetes Federation criteria for Europids (≥94cm for men and ≥80cm for women) with the presence of triglyceride levels ≥150mg/dl. We compared demographic, clinical and analytical variables according to the presence or absence of the HTGW phenotype. RESULTS Thirty-five percent of patients presented the HTGW phenotype. Patients with the HTGW phenotype had a higher body mass index (31.14±4.88 vs. 29.2±4.82kg/m2; P<.001) and glycated hemoglobin levels (7.38±1.2% vs. 7±1.07%; P<.001). The presence of hypertension, peripheral arterial disease, cardiac insufficiency and microvascular complications were higher when compared with patients without the HTGW phenotype. Patients with the HTGW phenotype were less adherent to prescribed diet (69.8 vs. 81%; P<.001), exercise (44.6 vs. 58.2%; P<.001) and presented greater weight increase within the year prior to the study visit (29.4 vs. 22.5%; P<.001). CONCLUSIONS The HTGW phenotype is prevalent in the Spanish DM2 population and identifies a subgroup of patients with higher cardiometabolic risk and prevalence of diabetic complications.
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Affiliation(s)
- I Miñambres
- Departamento de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, España; CIBER de Diabetes y enfermedades metabólicas asociadas (CIBERDEM), Barcelona, España
| | - J Sánchez-Hernández
- Departamento de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - G Cuixart
- Departamento de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - A Sánchez-Pinto
- Unidad de Enfermería, Hospital Vall d'Hebron, Barcelona, España
| | | | - A Pérez
- Departamento de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, España; CIBER de Diabetes y enfermedades metabólicas asociadas (CIBERDEM), Barcelona, España.
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Retrospective Examination of Class Attendance on Corporately Sponsored Weight Loss Programming: The Naturally Slim Experience. J Occup Environ Med 2019; 62:e102-e110. [PMID: 31880737 DOI: 10.1097/jom.0000000000001807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To examine the effect of class participation in participants enrolled in a corporate sponsored commercial weight loss program. METHODS We examined 111,262 participants for percent weight loss (primary outcome) using general linear models and weight loss relative to class participation (secondary outcome). RESULTS We observed a significant trend (P < 0.001) for achieving significant weight loss for the entire cohort who lost 3.65% (99% CI, 3.62, 3.69) body weight. Individuals taking ≥4 classes (n = 87,346) lost 4.97% (99% CI, 4.53, 4.61). Those taking ≥9 classes (n = 74,525) achieved 4.95% (99% CI, 4.93, 5.01) weight loss. Similar patterns for men and women were observed within each analysis. CONCLUSION Overall, participants lost a clinically beneficial (≥3%) amount of weight following class participation and greater class attendance produced a greater weight loss percentage approaching clinical significance (≥5%).
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Liu B, Liu B, Wu G, Yin F. Relationship between body-roundness index and metabolic syndrome in type 2 diabetes. Diabetes Metab Syndr Obes 2019; 12:931-935. [PMID: 31354325 PMCID: PMC6590402 DOI: 10.2147/dmso.s209964] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/06/2019] [Indexed: 01/09/2023] Open
Abstract
Background: The present study evaluated the relationship between body-roundness index (BRI) and metabolic syndrome (MetS) in type 2 diabetes. Methods: A cross-sectional study was conducted on 585 type 2 diabetes in Qinhuangdao. MetS was defined as per the Chinese Diabetes Society. Results: The BRI was strongly associated with the odds of having MetS in both males and females after adjustment for age, history of diabetes, and body-mass index (P<0.05). AUC of the BRI were 0.824 for males and 0.775 for females (P<0.001). The optimal cutoff points for the BRI were 3.85 in males (sensitivity 76.5%, specificity 82.1%) and 4.05 in females (sensitivity 76.4%, specificity 70.3%). Conclusion: The BRI was correlated with MetS and was an effective indicator for the screening of MetS in type 2 diabetes.
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Affiliation(s)
- Bowei Liu
- Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao 066000, Hebei Province, China
| | - Bo Liu
- Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao 066000, Hebei Province, China
| | - Guangfei Wu
- Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao 066000, Hebei Province, China
| | - Fuzai Yin
- Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao 066000, Hebei Province, China
- Correspondence: Fuzai Yin Department of Endocrinology, First Hospital of Qinhuangdao, 258 Wenhua Road, Qinhuangdao, Hebei 066000, ChinaTel +86 335 590 8603Fax +86 335 303 2042Email
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Gurka MJ, Guo Y, Filipp SL, DeBoer MD. Metabolic syndrome severity is significantly associated with future coronary heart disease in Type 2 diabetes. Cardiovasc Diabetol 2018; 17:17. [PMID: 29351794 PMCID: PMC5775549 DOI: 10.1186/s12933-017-0647-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/23/2017] [Indexed: 02/06/2023] Open
Abstract
Background The severity of the metabolic syndrome (MetS) is significantly associated with future coronary heart disease (CHD) among individuals without baseline Type 2 diabetes. However, the validity of assessing MetS severity among individuals with diabetes is unknown. Objective To assess for differences in MetS severity by timing of Type 2 diabetes diagnosis and to assess for associations between MetS severity and future CHD among individuals with diabetes. Methods We analyzed data from participants of the Atherosclerosis Risk in Communities study, including 1419 with- and 7241 without diabetes, followed during 4 visits and adjudicated CHD diagnoses over a 20-year period. We used Cox-regression techniques to assess hazard ratios (HR) of CHD based on a sex- and race/ethnicity-specific MetS-severity Z-score (standard MetS score) and a similar MetS-severity score formulated without incorporating glucose as a component of MetS (no-glucose MetS score). Results For both the standard- and no-glucose MetS-severity scores, scores were highest in the baseline-diabetes group, lowest in the never-diabetes group and intermediate in the incident-diabetes groups. Among participants with diabetes, increasing MetS-severity score at baseline was associated with incident CHD, using both the standard MetS score (HR 1.29, 95% confidence interval [CI] 1.21, 1.39) and the no-glucose score (HR 1.42, CI 1.24, 1.62) (both p < 0.001). For the baseline-diabetes group, this relationship remained significant when Visit 2 Hemoglobin-A1c was included in the model, both for the standard MetS score (HR 1.21, CI 1.09, 1.34; p < 0.001) and the no-glucose score (HR 1.25, CI 1.04, 1.51; p = 0.02). Conclusions MetS severity appears to provide an estimate of metabolic disarray in the setting of diabetes and is predictive of future CHD events beyond HbA1c. Identifying MetS severity among individuals with diabetes may help in identifying those at higher risk, who could then receive further preventative treatment. Electronic supplementary material The online version of this article (10.1186/s12933-017-0647-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthew J Gurka
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, 32608, USA
| | - Yi Guo
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, 32608, USA
| | - Stephanie L Filipp
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, 32608, USA
| | - Mark D DeBoer
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Virginia, 409 Lane Rd, Room 2017, P.O. Box 800386, Charlottesville, VA, 22908, USA.
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18
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Three novel obese indicators perform better in monitoring management of metabolic syndrome in type 2 diabetes. Sci Rep 2017; 7:9843. [PMID: 28852155 PMCID: PMC5574991 DOI: 10.1038/s41598-017-10446-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 08/09/2017] [Indexed: 12/13/2022] Open
Abstract
The present study evaluated the performance of three novel obese indicators, visceral adiposity index (VAI), lipid accumulation product (LAP) and waist circumference-triglyceride index (WTI), for identifying metabolic syndrome(MetS) in type 2 diabetes. A cross-sectional study was conducted on 711 type 2 diabetes in Qinhuangdao. The MetS was defined as the definition of Chinese Diabetes Society. Receiver operating characteristic curve analyses were performed to assess the accuracy of three obese indicators as diagnostic tests for MetS. The prevalence of MetS was 71.3%. In men, among all three obese indicators, the LAP had the highest area under curve (AUC) value (AUC = 0.894), followed by VAI (AUC = 0.860) and WTI (AUC = 0.855). In women, among all three obese indicators, the LAP had the highest AUC value (AUC = 0.906), followed by WTI (AUC = 0.887) and VAI (AUC = 0.881). However. there was no significant difference between the three obese indicators(P > 0.05). Three obese indicators were effective indicators for the screening of MetS, LAP and WTI are more simple.
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Retrospective Analysis of Annual Worksite Preventive Health Checkups on Hypertension and Metabolic Syndrome. J Occup Environ Med 2017; 59:e74-e83. [PMID: 28394778 DOI: 10.1097/jom.0000000000000994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To examine worksite preventive care checkups on the prevalence of hypertension and metabolic syndrome (MetS). METHODS Participants (N = 9269) participated in four annual checkups, counseled, and referred for physician follow-up. Hypertension and MetS prevalence were examined using general linear models or chi-squared analyses. RESULTS Significant reductions in the prevalence of hypertension in men (20 to 39 years [20% vs. Y2 9%], 40 to 65 years [38% vs. 20%], 65+ years [38% vs. 24%]) and women (20 to 39 years [8% vs. 4%], 40 to 65 years [23% vs. 11%], 65+ years [29% vs. 15%]), continuing through Y4. MetS followed a similar, yet attenuated pattern, with significance noted in men: (40 to 65 years; Y1 [48%] vs. Y2 [38%]; 65+ years [Y1 [42%] vs. Y3 [40%]]), and women (40 to 65 years group [Y1 [36%] vs. Y3 [32%]]; 65+ years [Y1 [41%] vs. Y3 [38%]]). CONCLUSION Preventive care checkups concurrent with physician referral may significantly help reduce hypertension and MetS in the workplace.
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Bae JC, Cho NH, Suh S, Kim JH, Hur KY, Jin SM, Lee MK. Cardiovascular disease incidence, mortality and case fatality related to diabetes and metabolic syndrome: A community-based prospective study (Ansung-Ansan cohort 2001-12). J Diabetes 2015; 7:791-9. [PMID: 25407754 DOI: 10.1111/1753-0407.12248] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 10/16/2014] [Accepted: 11/02/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND We evaluated the separate and combined effect of metabolic syndrome (MS) and diabetes on incident cardiovascular disease (CVD), CVD mortality and case fatality risk (CFR). METHODS 8898 subjects were categorized into four groups on the basis of the presence of MS and diabetes (with MS, with diabetes, with both or without either). We compared the development of CVD events, mortality and CFR. RESULTS Over a mean follow-up of 8.0 years, 690 subjects developed CVD. There were 434 deaths, of which 101 were from CVD. The presence of diabetes alone, MS alone, or both was associated with an increased risk for incident CVD and CVD mortality. Compared with the MS only group, the adjusted hazard ratio (HR) for CVD events and CVD mortality in the diabetes only group was 1.07 (95% confidence interval [CI] 0.77-1.48) and 2.02 (95% CI 0.99-1.72), respectively. Among individuals with diabetes, the presence of MS did not significantly increase CVD risk and CVD mortality. The adjusted odds ratio for CVD CFR, including adjustment for the presence of MS, in subjects with diabetes versus without diabetes was 2.11 (95% CI 1.34-3.31). CONCLUSIONS There was no difference in the risk of incident CVD between individuals with diabetes alone and MS alone, whereas CVD mortality was much higher in individuals with diabetes only. The presence of MS did not exhibit an additive effect on CVD risk and mortality in individuals with diabetes. Individuals with diabetes had a higher CVD case fatality regardless of the presence of MS.
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Affiliation(s)
- Ji Cheol Bae
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Changwon Hospital, Seoul, Republic of Korea
| | - Nam H Cho
- Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sunghwan Suh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dong-A University Medical Center, Busan, Republic of Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Moon-Kyu Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Earnest CP, Church TS. Evaluation of a Voluntary Worksite Weight Loss Program on Metabolic Syndrome. Metab Syndr Relat Disord 2015; 13:406-14. [DOI: 10.1089/met.2015.0075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Conrad P. Earnest
- Exercise and Sport Nutrition Lab, Department of Health and Kinesiology, Texas A&M University, College Station, Texas
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Chen JJ, Wendel LJ, Birkholz ES, Vallone JG, Coleman AL, Yu F, Mahajan VB. The metabolic syndrome and severity of diabetic retinopathy. Clin Ophthalmol 2015; 9:757-64. [PMID: 25995613 PMCID: PMC4425343 DOI: 10.2147/opth.s80355] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND While metabolic syndrome has been strongly implicated as a risk factor for macrovascular diseases, such as stroke and cardiovascular disease, its relationship with microvascular diseases, including diabetic retinopathy, has been less defined. The purpose of this pilot study was to investigate the association between metabolic syndrome and the presence and severity of diabetic retinopathy. METHODS A retrospective case-control chart review at the University of Iowa ophthalmology and primary care clinics included 100 patients with proliferative diabetic retinopathy (PDR), 100 patients with nonproliferative diabetic retinopathy (NPDR), 100 diabetic patients without diabetic retinopathy, and 100 nondiabetic patients who were randomly selected. Using the International Diabetes Foundation definition, the prevalence of metabolic syndrome and the number of components of metabolic syndrome were compared among these groups. RESULTS The prevalence of metabolic syndrome in patients with diabetes was 69.3%, which was significantly higher than that in patients without diabetes (27%; P<0.0001) (odds ratio [OR] =6.28; 95% confidence interval [CI]: 3.76-10.49; P=0.0004). However, there was no significant difference in the prevalence of metabolic syndrome between diabetics with and without diabetic retinopathy, with rates of 67.5% and 73%, respectively (P=0.36) (OR =0.77; 95% CI: 0.45-1.32; P=0.34). In addition, there was no significant difference between the PDR and NPDR groups, with rates of 63% and 72%, respectively (P=0.23) (OR =0.70; 95% CI: 0.38-1.30; P=0.26). CONCLUSION The metabolic syndrome was highly prevalent in patients with diabetes, but it was not associated with the presence or severity of retinopathy.
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Affiliation(s)
- John J Chen
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA ; Mayo Clinic, Rochester, MN, USA
| | - Lucas J Wendel
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA ; Vitreoretinal Service, University of Iowa, Iowa City, IA, USA
| | - Emily S Birkholz
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - John G Vallone
- Department of Pathology, University of Southern California, USA
| | - Anne L Coleman
- Department of Ophthalmology, School of Public Health, University of California, Los Angeles, CA, USA ; Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA
| | - Fei Yu
- Department of Biostatistics, University of California, Los Angeles, CA, USA
| | - Vinit B Mahajan
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA ; Vitreoretinal Service, University of Iowa, Iowa City, IA, USA ; Omics Laboratory, University of Iowa, Iowa City, IA, USA
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Earnest CP, Johannsen NM, Swift DL, Gillison FB, Mikus CR, Lucia A, Kramer K, Lavie CJ, Church TS. Aerobic and strength training in concomitant metabolic syndrome and type 2 diabetes. Med Sci Sports Exerc 2015; 46:1293-301. [PMID: 24389523 DOI: 10.1249/mss.0000000000000242] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Concomitant type 2 diabetes (T2D) and metabolic syndrome exacerbates mortality risk; yet, few studies have examined the effect of combining (AER + RES) aerobic (AER) and resistance (RES) training for individuals with T2D and metabolic syndrome. METHODS We examined AER, RES, and AER + RES training (9 months) commensurate with physical activity guidelines in individuals with T2D (n = 262; 63% female, 44% black). Primary outcomes were change in, and prevalence of, metabolic syndrome score at follow-up (mean and 95% confidence interval [CI]). Secondary outcomes included maximal cardiorespiratory fitness (VO2peak) and estimated METs from time-to-exhaustion (TTE) and exercise efficiency calculated as the slope of the line between ventilatory threshold, respiratory compensation, and maximal fitness. General linear models and bootstrapped Spearman correlations were used to examine changes in metabolic syndrome associated with training primary and secondary outcome variables. RESULTS We observed a significant decrease in metabolic syndrome scores (P for trend = 0.003) for AER (-0.59, 95% CI = -1.00 to -0.21) and AER + RES (-0.79, 95% CI = -1.40 to -0.35), both being significant (P ≤ 0.02) versus control (0.26, 95% CI = -0.58 to 0.40) and RES (-0.13, 95% CI = -1.00 to 0.24). This led to a reduction in metabolic syndrome prevalence for the AER (56% vs 43%) and AER + RES (55% vs 46%) groups between baseline and follow-up. The observed decrease in metabolic syndrome was mediated by significant improvements in exercise efficiency for the AER and AER + RES training groups (P < 0.05), which was more strongly related to TTE (25%-30%; r = -0.38, 95% CI = -0.55 to -0.19) than VO2peak (5%-6%; r = -0.24, 95% CI = -0.45 to -0.01). CONCLUSIONS AER and AER + RES training significantly improved metabolic syndrome scores and prevalence in patients with T2D. These improvements appear to be associated with improved exercise efficiency and are more strongly related to improved TTE versus VO2peak.
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Affiliation(s)
- Conrad P Earnest
- 1Department for Health, University of Bath, Bath, UNITED KINGDOM; 2School of Kinesiology, Louisiana State University, Baton Rouge, LA; 3Department of Kinesiology, East Carolina University, Greenville, NC; 4Division of Cardiology, Duke University Medical Center, Durham, NC; 5Universidad Europea and Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, SPAIN; 6Division of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, LA; and 7Cardiac Rehabilitation and Prevention, Ochsner Clinical School, University of Queensland School of Medicine, John Ochsner Heart and Vascular Institute, New Orleans, LA
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Ogedengbe OS, Ezeani IU, Chukwuonye II, Anyabolu EN, Ozor II, Eregie A. Evaluating the impact of type 2 diabetes mellitus on cardiovascular risk in persons with metabolic syndrome using the UKPDS risk engine. Diabetes Metab Syndr Obes 2015; 8:437-45. [PMID: 26396537 PMCID: PMC4577267 DOI: 10.2147/dmso.s69199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of this study is to evaluate the impact of coexistence of metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM) on the estimated cardiovascular risk as calculated using the United Kingdom Prospective Diabetic Study risk engine (UKPDS-RE) and also to determine the impact of the coexistence of MS and T2DM on the 10-year risk of developing coronary heart disease and stroke. METHODOLOGY This is a cross-sectional study in which convenience sampling technique was used to recruit 124 consecutive persons with T2DM and 96 controls using a questionnaire administered technique. The World Health Organization (WHO) criterion was used to define MS and the UKPDS-RE was used to identify persons with increased risk for stroke and those with increased risk for coronary heart disease. The data obtained were analyzed using SPSS version 16. Statistical comparisons were made with chi-square for comparison of proportions. A P-value of less than 0.05 was taken as statistically significant. RESULTS Fifteen subjects were identified as having an increased 10-year risk for stroke and ten as having an increased risk for a coronary event. The odds of a T2DM subject with MS having an increased risk for stroke compared with a T2DM subject without MS was 0.9579≈1 while the odds of a T2DM subject with MS developing an increased risk for a coronary event compared with a T2DM subject without MS was =3.451≈3. CONCLUSION MS was more common in subjects with T2DM compared with controls (irrespective of the diagnostic criteria used) and MS appears to increase the risk of a coronary event in subjects with T2DM by threefold. Also from this study, MS did not appear to cause an additional increase in the risk of stroke in subjects with T2DM.
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Affiliation(s)
- O Stephen Ogedengbe
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Ignatius U Ezeani
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Federal Medical Center, Umuahia, Nigeria
- Correspondence: Ignatius U Ezeani, Department of Medicine, Federal Medical Center, PMB 7001, Umuahia, Abia State, Nigeria, Tel +234 80 6069 2131, Email
| | - Ijezie I Chukwuonye
- Division of Nephrology, Department of Internal Medicine, Federal Medical Center, Umuahia, Nigeria
| | - Ernest N Anyabolu
- Division of Nephrology, Department of Internal Medicine, Imo State University Teaching Hospital, Orlu, Nigeria
- Division of Nephrology, Department of Internal Medicine, Federal Medical Centre, Owerri, Nigeria
| | - Ikemefuna I Ozor
- Division of Neurosurgery, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Aihanuwa Eregie
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Nigeria
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López-Suárez A, Bascuñana-Quirell A, Beltrán-Robles M, Elvira-González J, Fernández-Palacín F, Barroso-Casamitjana E, Solino-Ocaña I. Metabolic syndrome does not improve the prediction of 5-year cardiovascular disease and total mortality over standard risk markers. Prospective population based study. Medicine (Baltimore) 2014; 93:e212. [PMID: 25501079 PMCID: PMC4602819 DOI: 10.1097/md.0000000000000212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Metabolic syndrome (MS) is widely believed to be an important risk factor for cardiovascular disease (CVD). We assessed whether a model based on MS improved prediction of CVD and total mortality over the Framingham's general CVD system (FRS) and whether MS was better than its individual components. Prospective cohort study of 855 participants randomly selected from the general population. Cox proportional hazards models were used to estimate the hazard ratios selecting a composite endpoint of CVD and total mortality. The performance of the FRS was compared with that of 4 MS-based models that differed in their use of individual components of MS as well as in the use of optimized cut-points of MS. The assessment included metrics of discrimination, calibration, and risk reclassification. Of all the models, only the model containing the 5 optimized components of MS improved model fit (deviance 10.7, P = 0.005), discrimination (difference of areas under the receiving operating curves 0.018), and risk reclassification in participants without events (net reclassification index 5.97, P = 0.01). The addition of optimized waist circumference to the FRS model improved the performance more than any other MS-based model. Every model containing the dichotomous definition of MS failed to improve model fit, discrimination, and risk reclassification. MS did not contribute predictive information over the FRS for the 5-year risk of CVD and total mortality. Some individual components of MS, in particular waist circumference, might play a role as part of the FRS provided their cut-off points are optimized.
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Affiliation(s)
- Alejandro López-Suárez
- From the Internal Medicine Department, Virgen del Camino Hospital, Carretera de Chipiona, Sanlúcar de Barrameda, Cádiz, Spain (ALS, ABQ, MBR, JEG, EBC, ISO); and Statistic and Operative Research, Faculty of Sciences, University of Cdiz, Avda. República Saharaui s/n, Puerto Real, Cádiz, Spain (FFP)
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The gene-diet interaction, LPL PvuII and HindIII and carbohydrate, on the criteria of metabolic syndrome: KMSRI-Seoul Study. Nutrition 2014; 29:1115-21. [PMID: 23927945 DOI: 10.1016/j.nut.2013.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 02/11/2013] [Accepted: 02/27/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the effects of the interaction between lipoprotein lipase (LPL) PvuII and HindIII haplotypes and carbohydrate intakes on the components of metabolic syndrome (MetSyn) in Koreans. METHODS LPL PvuII and HindIII genotype, LPL mass, triglyceride, high-density lipoprotein cholesterol, blood pressure (BP), waist circumference (WC), insulin, and Homeostasis Model of Assessment - Insulin Resistance were determined using a cross-sectional design in 269 controls and 280 MetSyn patients. RESULTS LPL mass was significantly lower in patients with PvuII and HindIII mutant alleles (P2 and H2) and decreased as the number of MetSyn components increased in all PvuII and HindIII haplotypes. Both LPL mass-adjusted WC and systolic BP (SBP) were positively associated with a ratio of percent energy from carbohydrate to percent energy from fat in individuals with P2H2 haplotype. After adjustment for age, sex, and LPL mass, the odds ratio (OR) for excessive WC was higher in carriers of P2H2 in the highest carbohydrate intake tertile compared with carriers of P1H1 in the lowest carbohydrate intake tertile (OR, 6.94; 95% confidence interval [CI], 1.39-34.62). Moreover, the OR for high SBP were higher in carriers of P1H2/P2H1 in the highest carbohydrate intake tertile (OR, 7.84; 95% CI, 1.79-34.46) and in carriers of P2H2 in the highest carbohydrate intake tertile (OR, 4.24; 95% CI, 1.16-15.48) than P1H1 carriers. CONCLUSION This study suggests that P2H2 carriers in the highest carbohydrate intake tertile may be at risk for MetSyn because they had increased odds of excessive WC and high SBP.
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Tan MC, Ng OC, Wong TW, Joseph A, Chan YM, Hejar AR. Prevalence of metabolic syndrome in type 2 diabetic patients: A comparative study using WHO, NCEP ATP III, IDF and Harmonized definitions. Health (London) 2013. [DOI: 10.4236/health.2013.510227] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Emerging Type 2 Diabetes in Young Adults. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 771:51-61. [DOI: 10.1007/978-1-4614-5441-0_7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Lee SR, Han Y, Kim JW, Park JY, Kim JM, Suh S, Park MK, Lee HJ, Kim DK. Cardio-metabolic features of type 2 diabetes subjects discordant in the diagnosis of metabolic syndrome. Diabetes Metab J 2012; 36:357-63. [PMID: 23130320 PMCID: PMC3486982 DOI: 10.4093/dmj.2012.36.5.357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 07/10/2012] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The aim of this study is to investigate the cardio-metabolic parameters and surrogate markers of insulin resistance in a discordant group of type 2 diabetes (T2DM) subjects who satisfy the Adults Treatment Panel (ATP) III criteria, but not the International Diabetes Federation (IDF) criteria, for metabolic syndrome (MetS). METHODS We assessed the prevalence of MetS in T2DM subjects (n=167) who were selected from subjects registered at the diabetes center of Dong-A University Medical Center. We used the ATP III criteria and the IDF criteria for the diagnosis of MetS and sorted the subjects into 2 MetS groups: one group diagnosed per ATP III criteria (MetSa) and one diagnosed per IDF criteria (MetSi). We then compared the clinical characteristics, metabolic parameters (homeostasis model assessment of insulin resistance, aspartate aminotransferase, alanine aminotransferase, and uric acid values) and co-morbidities (prevalence of microalbuminuria, fatty liver, and cardiovascular disease) between the MetSa, MetSi, and discordant MetS groups. RESULTS The prevalence of MetS in the MetSa group (73.6%) was higher than in the MetSi group (62.2%). The MetS prevalence in the discordant group was 11.4%. The discordant group showed no significant differences in clinical characteristics (except waist circumference and body mass index), metabolic parameters, or prevalence of co-morbidities, as compared with subjects with MetS by both criteria. CONCLUSION In this study, cardio-metabolic features of the subjects diagnosed with MetS using ATP III criteria, but not IDF criteria, are not significantly different from those of subjects diagnosed with MetS using both criteria.
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Affiliation(s)
- Sa Rah Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sevrance-Uva Surgical Hospital, Busan, Korea
| | - Ying Han
- Department of Medicine, Dong-A University Graduate School, Busan, Korea
| | - Ja Won Kim
- Department of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Ja Young Park
- Department of Medicine, Busan St. Mary's Medical Center, Busan, Korea
| | - Ji Min Kim
- Department of Medicine, Hanseo Hospital, Busan, Korea
| | - Sunghwan Suh
- Division of Endocrinology & Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi-Kyoung Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Hye-Jeong Lee
- Department of Pharmacology, Dong-A University College of Medicine, Busan, Korea
| | - Duk Kyu Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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Xiang Y, Huang G, Zhou W, Che Z, Zhou P, Zhou Z. Prevalence of metabolic syndrome (MetS) in Chinese subjects gradually increased with impaired glucose homeostasis: a multicenter, clinical based, cross-sectional study. BMC Public Health 2012; 12:675. [PMID: 22905725 PMCID: PMC3549788 DOI: 10.1186/1471-2458-12-675] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 08/10/2012] [Indexed: 01/21/2023] Open
Abstract
Background Metabolic Syndrome (MetS) is a high risk factor for Cardiovascular Diseases (CVD). We estimated to investigate how MetS prevalence by glucose homeostasis varies across different age and gender groups. Methods We studied 9257 Chinese subjects over the age of 15 years in two cross-sectional surveys in 2006. With oral glucose tolerance test (OGTT) test, 2341 subjects were normal glucose tolerance (NGT), and 5448 were diagnosed as having type 2 diabetes (T2D). All other 1468 subjects were considered to be impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) subjects. Diabetes was diagnosis by WHO99 criteria. We used modified NCEP-III criteria for the diagnosis of MetS. Results The prevalences of MetS in the male NGT, IFG/IGT and T2D groups were 25.9% (404/1559), 65.6% (769/1172), and 73.5% (2483/3376), respectively. The prevalences of MetS in the female NGT, IFG/IGT and T2D groups were 13.4% (105/782), 51.0% (151/296), and 75.4% (1563/2072), respectively. The prevalence of MetS in the male IFG/IGT group gradually decreased from 73.26% to 41.08% in subjects over the age of 30 years. The prevalence of MetS in the female IFG/IGT group gradually increased from 30% to 75% with aging. Conclusions The prevalence of MetS in subjects with different glucose tolerances in China was high and gradually increased with impaired glucose homeostasis both in males and females.
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Affiliation(s)
- Yufei Xiang
- Diabetes Center, 2nd Xiangya Hospital, and Institute of Metabolism and Endocrinology, Key Laboratory of Diabetes Immunology, Ministry of Education, Central South University, Changsha, Hunan 410011, China
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Novelletto BF, Guzzinati S, Avogaro A. Prevalence of Metabolic Syndrome and Its Relationship with Clinically Prevalent Cardiovascular Disease in the Veneto Region, Northeastern Italy. Metab Syndr Relat Disord 2012; 10:56-62. [DOI: 10.1089/met.2011.0065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Affiliation(s)
| | | | - Angelo Avogaro
- Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy
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Song SH, Gray TA. Early intensive cardiovascular risk management in young people with type 2 diabetes. Diabetes Res Clin Pract 2011; 92:e70-2. [PMID: 21420751 DOI: 10.1016/j.diabres.2011.02.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 02/21/2011] [Indexed: 10/18/2022]
Abstract
This study assessed the adequacy of cardiovascular risk management among recently diagnosed early-onset T2D. Despite the presence of adverse cardiovascular risk profile, intensive treatment to prevent cardiovascular disease remained suboptimal in these young subjects.
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Affiliation(s)
- Soon H Song
- Diabetes Centre, Northern General Hospital, Sheffield, UK.
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Mata-Cases M, De Prado-Lacueva C, Salido-Valencia V, Fernández-Bertolín E, Casermeiro-Cortés J, García-Durán M, Jabalera-López S, Fernández-Sanmartín MI. Incidence of complications and mortality in a type 2 diabetes patient cohort study followed up from diagnosis in a primary healthcare centre. Int J Clin Pract 2011; 65:299-307. [PMID: 21314867 DOI: 10.1111/j.1742-1241.2010.02503.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AIMS To determine the microvascular and macrovascular complications and mortality incidence rates and to identify the related factors in patients recently diagnosed with type 2 diabetes between 1991 and 2000 and followed until 2006. METHODS Retrospective longitudinal study in a primary healthcare center. Patients without any measure of glycaemia in the 3 years previous to diabetes diagnosis were excluded. Annual incidence rates for microvascular and macrovascular complications and mortality were estimated. Analysis of KaplanMeier survival curves and Cox proportional risk models by gender were done. RESULTS Of 469 patients [mean age: 60.4 (SD 10.7) years, 53.9% women], 80 died principally of tumoral (38.7%) and cardiovascular (30%) causes. The mean follow-up period was 8.81 years. (SD 3.21). The complication rates per 1000 patients/year (95% CI) were: microvascular complications 29.11 (22.97-36.38), macrovascular complications 24.10 (19.05-30.08) and mortality 19.23 (15.25-23.93), all of those being significantly greater in males except for cerebrovascular disease. Complications and mortality were associated with age, HbA1c, HDL-cholesterol, blood pressure and smoking with a different significance for each gender. HbA1c was related to microvascular complications in both sexes and to macrovascular complications only in women. CONCLUSION The annual rates for death and complications in a Mediterranean type 2 diabetic patient cohort followed from diagnosis were lower than those published in Anglo-Saxon countries. Males showed higher death and complication rates except in terms of cerebrovascular disease. Predictors of complication and death were different depending on gender. In terms of mortality, unlike in other studies, only one-third of the deaths were for cardiovascular causes.
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Affiliation(s)
- M Mata-Cases
- Primary Healthcare Center La Mina, SAP Litoral, Barcelona Family and Community Medicine Teaching Unit, Institut Català de la Salut, Sant Adrià de Besòs (Barcelona), Spain.
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Aversa A, Bruzziches R, Francomano D, Rosano G, Isidori AM, Lenzi A, Spera G. Effects of testosterone undecanoate on cardiovascular risk factors and atherosclerosis in middle-aged men with late-onset hypogonadism and metabolic syndrome: results from a 24-month, randomized, double-blind, placebo-controlled study. J Sex Med 2011; 7:3495-503. [PMID: 20646185 DOI: 10.1111/j.1743-6109.2010.01931.x] [Citation(s) in RCA: 169] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Longitudinal studies have demonstrated that male hypogonadism could be considered a surrogate marker of incident cardiovascular disease. AIM To evaluate the effects of parenteral testosterone undecanoate (TU) in outclinic patients with metabolic syndrome (MS) and late-onset hypogonadism (total testosterone (T) at or below 11nmol/L or free T at or below 250pmol/L). METHODS This is a randomized, double-blind, double-dummy, placebo-controlled, parallel group, single-center study. Fifty patients (mean age 57±8) were randomized (4:1) to receive TU 1,000mg (every 12 weeks) or placebo (PLB) gel (3-6 g/daily) for 24 months. MAIN OUTCOME MEASURES Homeostasis model assessment index of insulin resistance (HOMA-IR), carotid intima media thickness (CIMT), and high-sensitivity C-reactive protein (hsCRP). RESULTS At baseline, all patients fulfilled the National Cholesterol Education Program-Third Adult Treatment Panel (NCEP-ATPIII) and International Diabetes Federation (IDF) criteria for the definition of MS. An interim analysis conducted at 12 months showed that TU markedly improved HOMA-IR (P < 0.001), CIMT (P < 0.0001), and hsCRP (P<0.001) compared with PLB; thus, all patients were shifted to TU treatment. After 24 months, 35% (P < 0.0001) and 58% (P < 0.001) of patients still presented MS as defined by NCEP-ATPIII and IDF criteria, respectively. Main determinants of changes were reduction in waist circumference (P<0.0001), visceral fat mass (P<0.0001), and improvement in HOMA-IR without changes in body mass index (BMI). CONCLUSIONS TU reduced fasting glucose, waist circumference, and improved surrogate markers of atherosclerosis in hypogonadal men with MS. Resumption and maintenance of T levels in the normal range of young adults determines a remarkable reduction in cardiovascular risk factors clustered in MS without significant hematological and prostate adverse events.
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Affiliation(s)
- Antonio Aversa
- Department of Medical Pathophysiology, Sapienza University of Rome, Italy.
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Tenenbaum A, Fisman EZ. "The metabolic syndrome... is dead": these reports are an exaggeration. Cardiovasc Diabetol 2011; 10:11. [PMID: 21269524 PMCID: PMC3036609 DOI: 10.1186/1475-2840-10-11] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 01/27/2011] [Indexed: 02/06/2023] Open
Abstract
The debates continue over the validity of the metabolic syndrome concept. The continuous increment of the obesity pandemic is almost worldwide paralleled by rising rates of metabolic syndrome prevalence. Then, it seems obvious that these debates drove the need for further investigations as well as a deeper cooperation between relevant national and international organizations regarding the issue. Instead, part of the scientific community elected to totally "dismiss" the concept of the metabolic syndrome. Meanwhile, the best available evidence from three consecutive large meta-analyses has systematically shown that people with metabolic syndrome are at increased risk of cardiovascular events. The most recent and largest of them included near one million patients (total n = 951,083). The investigators concluded that the metabolic syndrome is associated with a 2-fold increase in cardiovascular outcomes and a 1.5-fold increase in all-cause mortality rates. One of the ways to hit the metabolic syndrome is an utterly simplistic view on this concept as a predictive tool only. Of course, the presence of the metabolic syndrome possesses a definite predictive value, but first of all it is a widely accepted concept regarding a biological condition based on the complex and interrelated pathophysiological mechanisms starting from excess central adiposity and insulin resistance. Therefore, it is completely unfair to compare it with statistically constructed predictive tools, including stronger prognostic variables even unrelated to each other from the biological point of view. For example, in the criteria for metabolic syndrome (in contrast to Framingham score) age and cholesterol--presumably low density lipoprotein-cholesterol (LDL-C)--levels are not included, as well as a variety of strong predictors used in other risk-stratification scores: previous myocardial infarction, heart failure, smoking, family history, etc. However, the metabolic syndrome identifies additional important residual vascular risk mainly associated with insulin resistance and atherogenic dyslipidemia (low high density lipoprotein-cholesterol (HDL-C), high triglycerides, small, dense LDL-C). Therefore, the metabolic syndrome could be a useful additional contributor in estimation of global cardiovascular risk beyond age, high LDL-C or other standard risk factors. The components of the metabolic syndrome have partially overlapping mechanisms of pathogenic actions mediated through common metabolic pathways. Therefore their total combined effect could be less than the summed of the individual effects. The concept that the metabolic syndrome is a consequence of obesity and insulin resistance, provides a useful "life-style changes" approach for prevention and treatment: caloric restriction, weight-loss and increased physical activity. The next step could theoretically be pharmacological interventions such as metformin, acarbose, fibrates, weight-loss drugs (currently only orlistat is practically available) and perhaps glucagon-like peptide-1 agonists. A third step should probably be kept for bariatric surgery.
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Dentali F, Squizzato A, Caprioli M, Fiore V, Bernasconi M, Paganini E, Ageno W, Venco A, Grandi AM. Prevalence of arterial and venous thromboembolic events in diabetic patients with and without the metabolic syndrome: a cross sectional study. Thromb Res 2011; 127:299-302. [PMID: 21216446 DOI: 10.1016/j.thromres.2010.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Revised: 12/14/2010] [Accepted: 12/15/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND Metabolic syndrome (MS) is associated with an increased risk of cardiovascular events. Recent studies have found a higher prevalence of the MS in patients with idiopathic venous thromboembolic events (VTE) compared to controls suggesting a role of the MS in the pathogenesis of VTE. The presence of MS was shown to further increase the risk of arterial cardiovascular diseases (CVD) in diabetic patients. Conversely, there are no studies that have compared the risk of VTE in diabetic patients with and without the MS. METHODS A cross sectional study comparing the prevalence of arterial cardiovascular events and VTE in diabetic patients with and without the MS was conducted. RESULTS Nine hundred and fifty three patients were included in the study; 85.7% of patients had MS. Patients with the MS had an increased prevalence of CVD as compared with those without (23.4% vs. 11.8%) and the MS was an independent predictor of CVD in diabetic patients (OR 3.16, 95%CI 1.78, 5.59) after multiple logistic regression analysis. The prevalence of VTE was higher in patients with the MS in comparison to patients without the MS, but this association was not statistically significant (3,43% vs 1.47%; OR 2.38, 95% CI 0.56, 10.10%). CONCLUSION Our study confirms the role of MS as an adjunctive cardiovascular risk factor in patients with diabetes. There is insufficient evidence to evaluate the role of the as an adjunctive risk factor for VTE in these patients. Further studies are necessary to confirm or refute these preliminary findings.
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Affiliation(s)
- F Dentali
- Department of Clinical Medicine, University of Insubria, Varese, Italy.
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Gunathilake W, Song S, Sridharan S, Fernando DJ, Idris I. Cardiovascular and metabolic risk profiles in young and old patients with type 2 diabetes. QJM 2010; 103:881-4. [PMID: 20675397 DOI: 10.1093/qjmed/hcq135] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Young patients (aged < 40 years) with type 2 diabetes (T2D) have a high lifetime risk of developing cardiovascular disease (CVD). However, little is known about the CVD risk profile of this cohort in the UK primary care setting. AIM To determine CVD risk profile of young patients with T2D without CVD compared to older (aged >40 years) subjects. DESIGN A cross-sectional study using The Health Improvement Network (THIN) database, which contains anonymized patient information from more than 300 general practices throughout England and Wales. METHODS T2D subjects above the age of 18 years without previous CVD and not on lipid or blood pressure lowering therapy were randomly selected. Data on glycaemic control and CVD risk factors [weight, body mass index (BMI), lipid profile] were collected. RESULTS A total of 49,919 patients with T2D were identified, of whom 2756 (0.5%) and 47,163 (99.5%) were aged below and above 40 years, respectively. Despite being at least 30 years younger (mean age: early vs. later onset; 33.8 vs. 66.9 years, P < 0.001), the proportions of adverse CVD risk profiles for young patients were similar to the older cohort with T2D. For young vs. old patients: the prevalence of BMI >25: 84.4% vs. 85.3%, P = 0.77; total cholesterol >4 mmol/l: 53.4% vs. 53.8%, P = 0.76; systolic hypertension: 58.2 vs. 58.4%, P = 0.36 and diastolic hypertension: 28.1 vs. 28.5%, P = 0.73). Glycaemic controls were similarly suboptimal between the two groups (mean HbA1c: young vs. old; 7.6% vs. 7.5%, P = 0.49). The prevalence of risk factor clustering were also similar between young vs. old patients with T2D. DISCUSSION Young T2D subjects possess risk factors that confer high lifetime risk for macrovascular complications, and therefore merits aggressive cardioprotective treatment.
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Affiliation(s)
- W Gunathilake
- Sherwood Forest Hospitals Foundation Trust, Nottinghamshire, UK
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Ahmed MH, Abu EO, Byrne CD. Non-Alcoholic Fatty Liver Disease (NAFLD): new challenge for general practitioners and important burden for health authorities? Prim Care Diabetes 2010; 4:129-137. [PMID: 20299294 DOI: 10.1016/j.pcd.2010.02.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 02/18/2010] [Accepted: 02/19/2010] [Indexed: 02/06/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of hepatic dysfunction encountered in general practice. A large proportion of individuals with type 2 diabetes and the metabolic syndrome develop NAFLD. NAFLD is associated with severe insulin resistance and increased risk of cardiovascular disease and can progress to non-alcoholic steato-hepatitis, liver cirrhosis and cancer. Currently the only known effective treatments for NAFLD are lifestyle changes including stable weight loss and a diet low in calories. General practitioners will increasingly play a key role in dealing with this evolving but serious epidemic of NAFLD and associated metabolic complications. However, success will depend on the appropriate systems and mechanisms being in place in primary care and the proper motivation, support and education of the patient. This review provides the primary care physician with: (a) a step-by step guide of how to identify NAFLD, (b) information to exclude common other causes of liver fat accumulation and (c) additional insight into relationships between NAFLD and other conditions such as obesity, cardiovascular disease and type 2 diabetes.
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Affiliation(s)
- Mohamed H Ahmed
- Chemical Pathology Department, Southampton University Hospital NHS Trust, Southampton, UK
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Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, Rinfret S, Schiffrin EL, Eisenberg MJ. The Metabolic Syndrome and Cardiovascular Risk. J Am Coll Cardiol 2010; 56:1113-32. [PMID: 20863953 DOI: 10.1016/j.jacc.2010.05.034] [Citation(s) in RCA: 1808] [Impact Index Per Article: 129.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 05/10/2010] [Accepted: 05/13/2010] [Indexed: 11/16/2022]
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Findeisen HM, Weckbach S, Stark RG, Reiser MF, Schoenberg SO, Parhofer KG. Metabolic syndrome predicts vascular changes in whole body magnetic resonance imaging in patients with long standing diabetes mellitus. Cardiovasc Diabetol 2010; 9:44. [PMID: 20804545 PMCID: PMC2936364 DOI: 10.1186/1475-2840-9-44] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 08/30/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although diabetic patients have an increased rate of cardio-vascular events, there is considerable heterogeneity with respect to cardiovascular risk, requiring new approaches to individual cardiovascular risk factor assessment. In this study we used whole body-MR-angiography (WB-MRA) to assess the degree of atherosclerosis in patients with long-standing diabetes and to determine the association between metabolic syndrome (MetS) and atherosclerotic burden. METHODS Long standing (> or = 10 years) type 1 and type 2 diabetic patients (n = 59; 31 males; 63.3 +/- 1.7 years) were examined by WB-MRA. Based on the findings in each vessel, we developed an overall score representing the patient's vascular atherosclerotic burden (MRI-score). The score's association with components of the MetS was assessed. RESULTS The median MRI-score was 1.18 [range: 1.00-2.41] and MetS was present in 58% of the cohort (type 2 diabetics: 73%; type 1 diabetics: 26%). Age (p = 0.0002), HDL-cholesterol (p = 0.016), hypertension (p = 0.0008), nephropathy (p = 0.0093), CHD (p = 0.001) and MetS (p = 0.0011) were significantly associated with the score. Adjusted for age and sex, the score was significantly (p = 0.02) higher in diabetics with MetS (1.450 [1.328-1.572]) compared to those without MetS (1.108 [0.966-1.50]). The number of MetS components was associated with a linear increase in the MRI-score (increase in score: 0.09/MetS component; r2 = 0.24, p = 0.038). Finally, using an established risk algorithm, we found a significant association between MRI-score and 10-year risk for CHD, fatal CHD and stroke. CONCLUSION In this high-risk diabetic population, WB-MRA revealed large heterogeneity in the degree of systemic atherosclerosis. Presence and number of traits of the MetS are associated with the extent of atherosclerotic burden. These results support the perspective that diabetic patients are a heterogeneous population with increased but varying prevalence of atherosclerosis and risk.
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Affiliation(s)
- Hannes M Findeisen
- Department of Internal Medicine II, University Hospitals - Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
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Sone H, Tanaka S, Iimuro S, Oida K, Yamasaki Y, Oikawa S, Ishibashi S, Katayama S, Ito H, Ohashi Y, Akanuma Y, Yamada N. Components of metabolic syndrome and their combinations as predictors of cardiovascular disease in Japanese patients with type 2 diabetes. Implications for improved definition. Analysis from Japan Diabetes Complications Study (JDCS). J Atheroscler Thromb 2009; 16:380-7. [PMID: 19672033 DOI: 10.5551/jat.no117] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM The prognostic power of metabolic syndrome (MetS) in patients with diabetes has been studied with inconsistent results depending on the definition of MetS. To clarify the best combination of MetS components to predict future cardiovascular disease (CVD) events, we estimated CVD risk in Japanese patients with type 2 diabetes according to MetS components. METHODS Patients were categorized according to the presence three MetS components in addition to hyperglycemia. hypertension, dyslipidemia and excess waist circumference (WC) (according to either Japanese or Asian cut-off values). Hazard ratios for CVD events were compared in patients with various categories of MetS components. RESULTS At least two components of MetS were required for a significantly elevated risk for CVD; however, component combinations with significantly increased risk differed depending on gender or the WC cut-off value. Any two among 1) excess WC (men > or =90 cm, women > or =80 cm); 2) hypertension (systolic blood pressure > or =130 mmHg or diastolic blood pressure > or =85 mmHg or use of an antihypertensive agent); and 3) dyslipidemia (triglycerides > or =150 mg/dL or HDL-cholesterol <40 mg/dL or use of drug treatment) could be used to identify significantly higher risk (approximately twice) for CVD regardless of gender. CONCLUSIONS The results suggest that the current MetS criteria should be modified when applied to patients with type 2 diabetes.
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Affiliation(s)
- Hirohito Sone
- Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, Tsukuba, Japan
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Madarász E, Tamás G, Tabák AG, Kerényi Z. Carbohydrate metabolism and cardiovascular risk factors 4 years after a pregnancy complicated by gestational diabetes. Diabetes Res Clin Pract 2009; 85:197-202. [PMID: 19481830 DOI: 10.1016/j.diabres.2009.05.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 04/30/2009] [Accepted: 05/01/2009] [Indexed: 11/23/2022]
Abstract
AIMS The aim of the present study was to determine the prevalence of abnormal glucose tolerance and the metabolic syndrome in a cohort of previously gestational diabetic (GDM) women 4 years after delivery. METHODS Sixty-eight prior GDM and a control group of 39 women with normal glucose tolerance during pregnancy were invited to participate in a follow-up study. RESULTS The prevalence of diabetes, impaired glucose tolerance and impaired fasting glucose (IFG) was 21%, 16%, and 6% among prior GDM women and 0%, 15%, and 0% among controls respectively (P=0.0039). Independently of the metabolic syndrome criteria used this status was found more frequently among women with prior GDM (all P<0.05). The prevalence of the metabolic syndrome showed a dose-response relationship with the level of weight categories (P<0.005) as well as with the level of glucose intolerance (P=0.024). CONCLUSION According to our results a disturbed carbohydrate metabolism and a clustering of cardiovascular risk factors might be observed in previous GDM women 4 years after delivery.
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Abstract
NAFLD (non-alcoholic fatty liver disease) refers to a wide spectrum of liver damage, ranging from simple steatosis to NASH (non-alcoholic steatohepatitis), advanced fibrosis and cirrhosis. NAFLD is strongly associated with insulin resistance and is defined by accumulation of liver fat >5% per liver weight in the presence of <10 g of daily alcohol consumption. The exact prevalence of NAFLD is uncertain because of the absence of simple non-invasive diagnostic tests to facilitate an estimate of prevalence. In certain subgroups of patients, such as those with Type 2 diabetes, the prevalence of NAFLD, defined by ultrasound, may be as high as 70%. NASH is an important subgroup within the spectrum of NAFLD that progresses over time with worsening fibrosis and cirrhosis, and is associated with increased risk for cardiovascular disease. It is, therefore, important to understand the pathogenesis of NASH and, in particular, to develop strategies for interventions to treat this condition. Currently, the 'gold standard' for the diagnosis of NASH is liver biopsy, and the need to undertake a biopsy has impeded research in subjects in this field. Limited results suggest that the prevalence of NASH could be as high as 11% in the general population, suggesting there is a worsening future public health problem in this field of medicine. With a burgeoning epidemic of diabetes in an aging population, it is likely that the prevalence of NASH will continue to increase over time as both factors are important risk factors for liver fibrosis. The purpose of this review is to: (i) briefly discuss the epidemiology of NAFLD to describe the magnitude of the future potential public health problem; and (ii) to discuss extra- and intra-hepatic mechanisms contributing to the pathogenesis of NAFLD, a better understanding of which may help in the development of novel treatments for this condition.
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Mata-Cases M, Fernández-Bertolín E, García-Durán M, Cos-Claramunt X, Pareja-Rossell C, Pujol-Ribera E. Prevalencia de enfermedad cardiovascular en personas recién diagnosticadas de diabetes mellitus tipo 2. GACETA SANITARIA 2009; 23:133-8. [DOI: 10.1016/j.gaceta.2008.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 05/05/2008] [Indexed: 11/16/2022]
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Scott R, O'Brien R, Fulcher G, Pardy C, D'Emden M, Tse D, Taskinen MR, Ehnholm C, Keech A. Effects of fenofibrate treatment on cardiovascular disease risk in 9,795 individuals with type 2 diabetes and various components of the metabolic syndrome: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Diabetes Care 2009; 32:493-8. [PMID: 18984774 PMCID: PMC2646035 DOI: 10.2337/dc08-1543] [Citation(s) in RCA: 388] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We explored whether cardiovascular disease (CVD) risk and the effects of fenofibrate differed in subjects with and without metabolic syndrome and according to various features of metabolic syndrome defined by the Adult Treatment Panel III (ATP III) in subjects with type 2 diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. RESEARCH DESIGN AND METHODS The prevalence of metabolic syndrome and its features was calculated. Cox proportional models adjusted for age, sex, CVD status, and baseline A1C levels were used to determine the independent contributions of metabolic syndrome features to total CVD event rates and the effects of fenofibrate. RESULTS More than 80% of FIELD participants met the ATP III criteria for metabolic syndrome. Each ATP III feature of metabolic syndrome, apart from increased waist circumference, increased the absolute risk of CVD events over 5 years by at least 3%. Those with marked dyslipidemia (elevated triglycerides >or=2.3 mmol/l and low HDL cholesterol) were at the highest risk of CVD (17.8% over 5 years). Fenofibrate significantly reduced CVD events in those with low HDL cholesterol or hypertension. The largest effect of fenofibrate to reduce CVD risk was observed in subjects with marked dyslipidemia in whom a 27% relative risk reduction (95% CI 9-42, P = 0.005; number needed to treat = 23) was observed. Subjects with no prior CVD had greater risk reductions than the entire group. CONCLUSIONS Metabolic syndrome components identify higher CVD risk in individuals with type 2 diabetes, so the absolute benefits of fenofibrate are likely to be greater when metabolic syndrome features are present. The highest risk and greatest benefits of fenofibrate are seen among those with marked hypertriglyceridemia.
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Affiliation(s)
- Russell Scott
- Lipid and Diabetes Research Group, Christchurch Hospital, Christchurch, New Zealand.
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Yun JE, Sull JW, Lee HY, Park E, Kim S, Jo J, Lee SJ, Kim SY, Choi YJ, Jee SH, Huh KB. Serum adiponectin as a useful marker for metabolic syndrome in type 2 diabetic patients. Diabetes Metab Res Rev 2009; 25:259-65. [PMID: 19214966 DOI: 10.1002/dmrr.946] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although adiponectin is generally known as a predictor of metabolic syndrome, potential of adiponectin as a predictor for metabolic syndrome in type 2 diabetes is debated. The purpose of this study is to determine the association between adiponectin and metabolic syndrome in patients with type 2 diabetes. METHODS Adiponectin and the risk of metabolic syndrome were examined among 1013 type 2 diabetes patients who visited Huh's Diabetes Center from January 2003 to June 2006. Adiponectin levels were classified into quartile groups, and metabolic syndrome was defined according to the standard of National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III. Insulin sensitivity was directly assessed using the short insulin tolerance test (SITT) (Kitt: %/ min). RESULTS Adiponectin was significantly correlated with metabolic syndrome components. The age-adjusted correlations between adiponectin and clinical parameters including metabolic components were significant; adiponectin was negatively correlated with waist circumference, diastolic blood pressure and triglyceride, and positively correlated with high-density lipoprotein (HDL) cholesterol. Subjects with metabolic syndrome showed lower adiponectin levels than those without metabolic syndrome. After multivariate adjustment, participants with lower adiponectin levels also had a higher risk for metabolic syndrome (OR for lowest quartiles 2.21; 95% CI, 1.51-3.24). Metabolic syndrome risk was stronger among those with low adiponectin and severe insulin resistance simultaneously. This study has shown additive effects of adiponectin and insulin resistance on metabolic syndrome. CONCLUSIONS In type 2 diabetic patients, the adiponectin was a useful predictor of metabolic syndrome independent of potential confounding variables.
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Affiliation(s)
- Ji Eun Yun
- Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
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Chei CL, Yamagishi K, Tanigawa T, Kitamura A, Imano H, Kiyama M, Sato S, Iso H. Metabolic Syndrome and the Risk of Ischemic Heart Disease and Stroke among Middle-Aged Japanese. Hypertens Res 2009; 31:1887-94. [PMID: 19015596 DOI: 10.1291/hypres.31.1887] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Limited information is available regarding risk of cardiovascular disease and trends for the metabolic syndrome in Asia. We examined the impact of the metabolic syndrome and its components on risk of cardiovascular disease among middle-aged Japanese according to four criteria. We followed 2,613 subjects from a rural Japanese community who participated in cardiovascular health examinations between 1990 and 1993. After 27,477 person-years of follow-up through 2003, there were 42 incidents of ischemic heart disease, 73 total strokes (54 ischemic and 18 hemorrhagic), and 115 total cases of cardiovascular disease. The metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII), American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI), International Diabetes Federation (IDF), and Japanese criteria. The multivariable hazard ratios (95%CI) associated with the metabolic syndrome based on NCEP-ATPIII criteria were 2.1 (1.1-4.0) for ischemic heart disease, 1.7 (1.0-2.7) for total stroke, 2.0 (1.2-3.5) for ischemic stroke, 1.1 (0.4-2.8) for hemorrhagic stroke, 2.0 (1.3-3.1) for ischemic cardiovascular disease, and 1.7 (1.2-2.5) for total cardiovascular disease. The population-attributable fractions of the metabolic syndrome based on NCEP-ATPIII criteria were 26-27% for ischemic heart disease and ischemic stroke and 20% for total cardiovascular disease. The metabolic syndrome based on AHA/NHLBI, IDF and Japanese criteria had weaker associations with risk of cardiovascular disease, and the association with risk of ischemic heart disease was not statistically significant. The metabolic syndrome based on NCEP-ATP III criteria predicted risks of ischemic heart disease, ischemic stroke and total cardiovascular disease, whereas that based on three other criteria predicted them less effectively.
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Affiliation(s)
- Choy-Lye Chei
- Department of Public Health Medicine, Graduate School of Comprehensive Human Sciences, and Institute of Community Medicine, University of Tsukuba, Tsukuba, Japan
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Chung HS, Seo JA, Kim SG, Kim NH, Kim DM, Chung CH, Choi DS. Relationship Between Metabolic Syndrome and Risk of Chronic Complications in Koreans with Type 2 Diabetes. KOREAN DIABETES JOURNAL 2009. [DOI: 10.4093/kdj.2009.33.5.392] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Hye Soo Chung
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ji A Seo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sin Gon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nan Hee Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Doo Man Kim
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Choon Hee Chung
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dong seop Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Bulugahapitiya U, Siyambalapitiya S, Sithole J, Fernando DJ, Idris I. The clinical impact of identifying metabolic syndrome in patients with diabetes: a cross-sectional study. Diab Vasc Dis Res 2009; 6:21-4. [PMID: 19156624 DOI: 10.3132/dvdr.2009.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The objectives of the study were to determine whether identifying patients with metabolic syndrome (MetS) (as defined by International Diabetes Federation [IDF] criteria) among patients with diabetes would affect the decision to prescribe statin for primary prevention of cardiovascular disease (CVD), based on currently available public health guidelines. We analysed the most recent recorded CVD risk profiles obtained from electronic patient files from 304 general practices in England and Wales. Of 60,258 patients with diabetes, 11,005 men and women aged 30-74 years fulfilled criteria for primary CVD prevention and were not on lipid-lowering drugs. Outcome data were extrapolated to an estimated national diabetes prevalence of 3.6%. Identifying MetS in this group of patients would produce an additional 29,536 (8.4%; 95% CI: 7.7, 9.0), 104,288 (29.6%; 95% CI: 28.5, 30.7) and 147, 328 (41.9%; 95% CI: 40.8, 43.0) patients nationally who would not have been eligible otherwise for primary CVD prevention strategies with statins, based on the Joint British Societies', the National Institute for Health and Clinical Excellence and the General Medical Services contract guidelines, respectively. The sensitivity and positive predictive value of these different strategies to detect metabolic syndrome were 87.5% and 69.1%; 57.3% and 76.8%; and 37.8% and 70.2%, respectively. In conclusion, among individuals with diabetes, identifying patients with MetS may further increase the use of statin therapy for primary CVD prevention.
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