Impact of the metabolic syndrome and its individual components on risk and severity of coronary heart disease

Association Between Premorbid Metabolic Syndrome and Coronary Arterial Stenosis: Results from One Medical Center in Taiwan

Background: Although the relationship between metabolic syndrome (MetS) and cardiovascular disease is already well-established, there is limited evidence as to whether individuals are at risk for cardiovascular disease during the premorbid state of MetS. The aim of this study is to explore the relationship between coronary arterial stenosis and MetS in a nonhypertensive and nondiabetic population. Methods: In this cross-sectional study, we analyzed the data of participants who underwent annual health checkups in a medical center. These data were collected from physical examination, blood tests, cardiac computed tomography examinations, and medical charts. We excluded those with established hypertension or diabetes and age of <50 or >75 years. Results: This study recruited 700 participants with a mean age of 59.5 years. More than 31% had MetS, and the overall prevalence of coronary arterial stenosis was 48.0% (grade 1, 2, 3, 4: 16.3%, 20.9%, 8.4%, 2.4%, respectively). In univariate analysis, older age, male sex, smoking, body mass index, elevated fasting plasma glucose (FPG), elevated triglyceride, lower level of high-density lipoprotein cholesterol, and presence of MetS were all positively correlated with coronary arterial stenosis. After adjustment for confounding factors, MetS still showed strong association with high grades of coronary arterial stenosis [odds ratio (OR) 2.86, confidence interval (95% CI) 1.30-4.01]. Specific components of MetS, such as elevated triglyceride [OR 2.02, 95% CI 1.14-3.57] and elevated FPG [OR 2.25, 95% CI 1.31-3.88], were also associated with coronary arterial stenosis. Conclusion: Our study concluded that premorbid MetS was significantly associated with coronary arterial stenosis. As for the individual components, elevated triglyceride and elevated FPG were both correlated with coronary arterial stenosis. Early preventive measures would be suggested at this stage of MetS to prevent future cardiovascular events.

Visfatin is negatively associated with coronary artery lesions in subjects with impaired fasting glucose

It is not determined whether serum visfatin levels are related to the presence and severity of coronary artery disease (CAD) in non-diabetic subjects. In this study, a total of 65 consecutive non-diabetic participants who underwent coronary angiography were enrolled. Serum visfatin and fasting glucose, as well as the serum total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride, were measured in all participants before the procedure. The extent of coronary artery lesions was determined by Gensini score. Serum visfatin levels were significantly lower in patients with CAD compared to participants with normal coronary arteries. Inversely, the circulating levels of fasting glucose were found to be elevated in patients with CAD compared with the control subjects. Multivariable logistic regression analysis demonstrated that visfatin and impaired fasting glucose (IFG) were independently associated with the presence of CAD in non-diabetics. No significant relationship was found between serum visfatin and fasting glucose levels in IFG subjects. However, there was a negative association between visfatin concentrations and Gensini score in participants with IFG. Both circulating visfatin concentrations and IFG are independently associated with CAD in non-diabetics. Serum visfatin levels are negatively related to the angiographic severity of CAD in subjects with IFG.

Major dietary patterns and metabolic syndrome associated with severity of coronary artery disease: A structural equation modeling

BACKGROUND

The association of dietary patterns and metabolic syndrome with the severity of coronary artery disease (CAD) is little known.

AIM

This study aimed to explore the relationship between major dietary patterns and the severity of CAD among newly discovered patients by using structural equation modeling (SEM).

METHODS

In this cross-sectional study, we included 423 newly diagnosed patients with CAD, aged 35-65 years, who underwent coronary angiography. The severity of CAD was assessed by the Gensini score. All patients were tested by using a semi-quantitative food frequency questionnaire, international physical activity questionnaire, perceived stress scale, lipid profile, fasting blood glucose, and anthropometric and blood pressure measurements. Statistical analysis was performed using SPSS and AMOS version 24.

RESULTS

Two dietary patterns (DPs) were identified by principal components analysis and labeled as "unhealthy DP" and "healthy DP". The results of SEM analysis showed that the unhealthy DP has a significant positive direct association with the severity of CAD (β=0.304, p<0.001), which is indirectly mediated by the presence of metabolic syndrome (β=0.021, p=0.021), adjusted for age and perceived stress scale. However, healthy DP has a significant negative direct association with the Gensini score (β=-0.213, p<0.001), and an indirect association through negative metabolic syndrome (β=-0.019, p=0.022), controlled for gender, physical activity, and perceived stress scale.

CONCLUSIONS

The severity of CAD was directly associated with the unhealthy DP and indirectly mediated by the presence of the metabolic syndrome, while a healthy DP had a direct inverse association with CAD severity and indirectly mediated by the absence of metabolic syndrome.

Effect of metabolic syndrome on coronary heart disease in rural minorities of Xinjiang: a retrospective cohort study

Background

Metabolic syndrome is diagnosed by a cluster of risk factors that associated with an increased risk of coronary heart disease (CHD). We aimed to explore the impact of and interactions between individual metabolic syndrome components on the risk of CHD in Xinjiang.

Methods

The baseline population included 7635 participants. The degree to which the components increase the risk of CHD and the multiplicative interactions between them were assessed using hazard ratios (HRs) and 95% confidence intervals (CIs). Additive interactions were appraised by the relative excess risk due to interaction, synergy index (SI), and attributable proportion of interaction.

Results

A total of 304 CHD patients were enrolled from rural residents of Xinjiang. Elevated blood pressure (HR 1.81; 95% CI 1.35–2.44) and elevated fasting blood glucose (FBG) (HR 1.82; 95% CI 1.38–2.38) increased the risk of CHD after adjustment for confounding factors. We found a positive additive interaction (SI 1.14; 95% CI 0.51–2.51) between elevated blood pressure and elevated FBG, but none were significant. As the number of components increased, the risk of CHD increased. The combinations of [high triglycerides (TG) + low high-density lipoprotein cholesterol (HDL-C) + elevated FBG + large waistline] (HR 4.26; 95% CI 1.43–12.73) and [elevated blood pressure + elevated FBG + low HDL-C + large waistline] (HR 1.82; 95% CI 1.38–2.38) increased the risk of CHD.

Conclusions

We provide evidence that elevated blood pressure and elevated FBG are independent risk factors for CHD and it might be necessary to maintain the normal waistline for preventing CHD.

Anthropometric measures and the risk of coronary artery disease

BACKGROUND

Nowadays, obesity and overweight are projected to become main risk factors for coronary artery disease (CAD). We aimed to determine the association of anthropometric measures with presence of significant (sig.) CAD as evaluated by coronary angiography, among an adult Iranian population.

METHODS

The present study included 441 patients (men=275) aged > 30 years with suspected CAD, who had undergone coronary angiography between January 2019 and November 2019. All demographic data and patients' medical history as well as clinical examinations were recorded by a trained physician. Coronary angiography was performed using standard techniques to determine the presence of sig. coronary artery lesions. Logistic regression analyses were conducted to assess the odds ratio (OR) of each anthropometric measure for the presence of sig. CAD.

RESULTS

The mean age of participants was 51.2±8.7 years and sig. CAD was detected in 185 patients. Univariate analyses showed that body mass index (BMI), waist circumference (WC), and waist to hip ratio (WHR) were significantly associated with increased risk of CAD. On multivariable logistic regression model, BMI and WHR correlated independently with increased risk of CAD; while higher WC and wrist circumference (WrC) could not predict the CAD risk. The corresponding ORs (95% confidence interval) were 1.36 (1.04-1.74), 1.17 (0.95-1.63), 1.29 (1.12-1.41), and 1.24 (0.76-1.92) for BMI, WC, WHR, and WrC, respectively. Considering the receiver operating characteristic analysis, no superiority was observed for each of the measures for discriminating sig. CAD from non-sig. CAD status.

CONCLUSION

BMI and WHR are independently associated with the presence of CAD among Iranian population. These results emphasize the value of anthropometric assessment among those with suspected CAD.

Assessment of the Correlation between Severity of Coronary Artery Disease and Waist-Hip Ratio

AIM:

This study was conducted to investigate the correlation between waist/hip ratio (WHR) as a measurement of obesity and severity of coronary artery disease (CAD) assessed by angiography in Kosovo.

METHODS:

The study included 82 patients with suspected or known CAD who were referred for coronary angiography. All patients were subjected to full individual medical history, clinical examination including measurement of arterial blood pressure, body weight, height, body mass index (BMI), waist circumference, hip circumference, waist/hip ratio, and waist/height ratio. Coronary angiography was performed using standard techniques to determine the presence and severity of coronary artery lesions with the Gensini score.

RESULTS:

Among the 82 patients in the study, the mean age in the CAD group was 66.76 ± 9.12 years and the mean age in the non-CAD group was 64.80 ± 8.30 years. Patients in the CAD group had a mean BMI of 28.17 ± 3.32 kg/m² and those in the non-CAD group had a mean BMI of 28.76 ± 4.68 kg/m². Patients in the CAD group had a mean waist/height ratio of 1.76 ± 7.56 and those in the non-CAD group had a mean waist/height ratio of 0.57 ± 0.08. Patient in the CAD group had a mean waist/hip ratio of 0.93 ± 0.06 and those in the non-CAD group had a mean waist/hip ratio of 0.88 ± 0.07. Thirty-seven patients (45.1%) had no coronary artery disease (Gensini score = 0), 15 (18.3%) had mild disease (Gensini score = 1-32), 14 (17.1%) had moderate disease (Gensini score = 32-58), and 16 (19.5%) had severe disease (Gensini score ≥ 58).

CONCLUSION:

There was a significant positive correlation between waist/hip ratio and presence of CAD in Kosovar patients.

Serum triglyceride, high-density lipoprotein cholesterol, apolipoprotein B, and coronary heart disease in a Chinese population undergoing coronary angiography

BACKGROUND

Increased serum triglyceride and apolipoprotein B (apoB) levels and decreased high-density lipoprotein cholesterol (HDL-C) levels are risk factors for cardiovascular diseases. The major types of dyslipidemia in Chinese population are hypertriglyceridemia and low HDL-C.

OBJECTIVE

This study aimed to evaluate the effect of HDL-C, triglyceride, and apoB levels on the risk of coronary heart disease (CHD) in a Chinese population undergoing coronary angiography.

METHODS

This was a cross-sectional study. A total of 1941 consecutive patients who were referred to coronary angiography for the evaluation of suspected CHD were recruited. Lipid parameters were measured after an overnight fast. Patients were diagnosed with CHD and without CHD based on the findings of the coronary angiography.

RESULTS

There were 1363 angiography confirmed CHD patients and 578 non-CHD patients. In nonstatin users, the major types of dyslipidemia were hypertriglyceridemia combined with low HDL-C, isolated low HDL-C, and isolated hypertriglyceridemia, accounting for 21.60%, 19.70%, and 14.99%, respectively. In statin users, a low to moderate-intensity statin was effective in lowering low-density lipoprotein cholesterol (LDL-C). The proportion of reaching an LDL-C goal <2.6 mmol/L and <1.8 mmol/L in statin users was 83.20% and 55.19%, respectively. In nonstatin users, the triglyceride and apoB levels were higher and the HDL-C levels were lower in CHD patients compared with non-CHD patients after the adjustment of age, sex, body mass index, diabetes, smoking, and alcohol drinking (P = .002, .007, and .005, respectively). After adjusting for age, sex, body mass index, diabetes, hypertension, smoking and alcohol drinking, the quartiles of triglyceride, HDL-C, and apoB were associated with CHD (P for trend = .001, .005, and .003, respectively).

CONCLUSION

Serum triglyceride, HDL-C, and apoB levels were independently associated with CHD in a Chinese population undergoing coronary angiography with a relatively low level of LDL-C and a high prevalence of hypertriglyceridemia and low HDL-C.

Effect of Metabolic Syndrome Score, Metabolic Syndrome, and Its Individual Components on the Prevalence and Severity of Angiographic Coronary Artery Disease

Background:

The clinical significance of metabolic syndrome (MS) score, MS, and its individual components with respect to risk prediction of coronary artery disease (CAD) remains unclear. The objective of this study was to investigate whether and to what extent MS score, MS, and its individual components were related to the risk of CAD.

Methods:

Among 1191 participants who underwent coronary angiography for the confirmation of suspected myocardial ischemia, 858 were included in this study according to the inclusion criteria from September 2010 to June 2013. MS was diagnosed with the 2005 National Cholesterol Education Program Adult Treatment Panel III criteria. The severity of coronary atherosclerosis was assessed by Gensini score.

Results:

The results showed that the age- and sex-adjusted odds ratios (ORs) for CAD were as follows: MS score, 1.327; MS, 2.013; elevated waist circumference, 1.447; reduced high-density lipoprotein cholesterol, 1.654; and elevated fasting glucose, 1.782; all P < 0.05; whereas for elevated triglycerides, 1.324, and elevated blood pressure, 1.342, both P > 0.05. After multivariate adjustment, results showed that only MS and elevated fasting glucose were significantly associated with CAD (OR, 1.628, 95% confidence interval [CI], 1.151–2.305, P = 0.006 for elevated fasting glucose, and OR, 1.631, 95% CI, 1.208–2.203, P = 0.001 for MS). The study showed that only MS score and elevated fasting glucose were significantly associated with Gensini score (standardized coefficient, 0.101, P = 0.031 for elevated fasting glucose and standardized coefficient, 0.103, P = 0.009 for MS score).

Conclusions:

The present study demonstrated that MS score, MS, and its individual components might have different contributions to CAD prevalence and severity. MS and elevated fasting glucose were independent risk factors for the prevalence of angiographic CAD whereas MS score and elevated fasting glucose were significantly associated with the severity of CAD.

Relationship between dental caries and metabolic syndrome among 13 998 middle-aged urban Chinese

BACKGROUND

The association between dental caries and metabolic syndrome (MetS) is inconsistent. The aim of the present study was to assess the relationship between dental caries and MetS and its components in a middle-aged Chinese population.

METHODS

A cross-sectional analysis was performed of 13 998 participants aged 45-65 years undergoing a health check during 2013-14. An index variable of decayed, missing, and filled teeth (DMFT) was calculated. Logistic regression was used to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) after adjustment for sex, age, education level, dietary habits, alcohol use, smoking, physical activity, and periodontitis.

RESULTS

Of the 13 998 participants, 6164 had dental caries and 7834 did not; 3571 had MetS, whereas 10 427 did not. Participants with severe caries showed a higher prevalence of MetS, abdominal obesity, elevated blood pressure, dyslipidemia, and hyperglycemia than those with mild or no caries (all P < 0.01). Adjusted ORs for MetS for those with two or more dental caries and those with two or more DMFT were 1.12 (95 % CI 1.14-1.74) and 1.09 (95 % CI, 0.89-1.21), respectively (P _trend  < 0.001). Stratified analysis by individual MetS components showed that caries were associated with MetS among subjects with hyperglycemia (OR 1.14 [95%CI, 0.98-1.34]; P < 0.001). However, there was no significant relationship between caries and abdominal obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol, and elevated blood pressure (adjusted ORs [95 % CIs] 0.98 [0.82-1.16], 1.01 [0.85-1.19], 0.84 [0.70-1.00], and 0.96 [0.86-1.13], respectively; all P > 0.05).

CONCLUSIONS

Dental caries were associated with MetS among middle-aged Chinese in the present study.

The Prevalence of Metabolic Syndrome in Coronary Artery Disease Patients

BACKGROUND

Metabolic syndrome (MetS) is a worldwide health problem, which is growing in Iranian adults. MetS is associated with risk of type 2 diabetes and coronary artery disease (CAD). In this study, we aimed to investigate the prevalence of MetS and its individual components in CAD patients.

METHODS

This cross-sectional study was performed on 200 CAD patients who had undergone elective coronary angiography at the cardiology department. Anthropometric indices including waist circumference (WC) and body mass index were measured. Blood samples were obtained to determine glucose and lipid profile. MetS components were defined according to the modified Adult Treatment Panel III (ATP III) criteria.

RESULTS

The prevalence of MetS among patients was 49.5% (women: 55.9%; men: 40.2%; P < 0.05). The prevalence increased with age. The low high-density lipoprotein-cholesterol (low HDL-C) (84.8%), high fasting blood glucose (high FBG) (77.8%) and high WC (75.8%) were the most prevalent risk factors in CAD patients with MetS.

CONCLUSIONS

Recent data indicate that the dyslipidemia, hyperglycemia and abdominal obesity are crucial predictors of MetS in CAD patients. Further prospective studies are recommended for more clarification.

Associations between coronary heart disease and individual components of the metabolic syndrome according to glucose tolerance status

OBJECTIVE

To assess whether the contributions of individual metabolic syndrome components to coronary heart disease (CHD) risk vary in patients with different glucose tolerance.

METHODS

A total of 1619 patients were included in this cross-sectional study. CHD, metabolic syndrome and glucose tolerance were assessed using coronary angiography, anthropometric and biochemical parameters, and an oral glucose tolerance test, respectively. Associations between CHD and components of metabolic syndrome were determined using logistic regression analysis.

RESULTS

Low high-density lipoprotein-cholesterol (HDL-C) was the only CHD risk factor in patients with both CHD and metabolic syndrome who had normal glucose tolerance, after adjustments for age, smoking and low-density lipoprotein-cholesterol (LDL-C) concentration. In patients with CHD plus metabolic syndrome and prediabetes, the most important risk factor was hypertension; additional risk factors were high postprandial blood glucose (PBG) and low HDL-C. In patients with CHD plus metabolic syndrome and diabetes, high PBG was the strongest risk factor, followed by hypertension, high FBG and high waist circumference.

CONCLUSIONS

Individual components of metabolic syndrome contributed variously to CHD across different glucose tolerance statuses.

Association of inflammation and endothelial dysfunction with metabolic syndrome, prediabetes and diabetes in adults from Inner Mongolia, China

BACKGROUND

We examined the association of biomarkers of inflammation and endothelial dysfunction with diabetes and metabolic syndrome (MetS) in persons from Inner Mongolia.

METHODS

A cross-sectional study was conducted among 2,536 people aged 20 years and older from Inner Mongolia, China. Overnight fasting blood samples were obtained to measure plasma concentrations of high sensitivity C-reactive protein (hsCRP), soluble inter-cellular adhesion molecule-1 (sICAM-1), sE-selectin, angiotensin II, high density lipoprotein cholesterol, triglycerides, and blood glucose. Waist circumference and blood pressure were measured by trained staff. MetS was defined according to the modified ATP III definition for Asians. Elevated level of the biomarker was defined as values in the upper tertile of the distribution. Participants were categorized into one of four groups based on the presence or absence of metabolic and glycemic abnormalities: 1) free of prediabetes, diabetes and MetS (reference group), 2) prediabetes or diabetes only, 3) MetS without prediabetes or diabetes, and 4) MetS plus prediabetes or diabetes. The multivariable models are adjusted for age, gender, smoking, drinking, family history of hypertension, and body mass index.

RESULTS

Among study participants, 18.5% had prediabetes, 3.6% had diabetes, and 27.4% of the entire study population had 3 or more components of the MetS. Elevated hsCRP was associated with an increased odds of prediabetes or diabetes only, MetS without prediabetes or diabetes, and MetS plus prediabetes or diabetes with multivariable adjusted odds ratios (95% confidence intervals) of 2.3 (1.7-3.1), 3.0 (2.4-3.8), and 5.8 (4.5-7.5), respectively. Elevated sICAM-1 was associated with increased odds (95% CI) of prediabetes or diabetes only (2.1, 1.6-2.9) and MetS plus prediabetes or diabetes (4.2, 3.2-5.3) but was not associated with MetS alone. Elevated sE-selectin was associated with a modestly increased risk of MetS (OR 1.7, 95% CI 1.4-2.2). Elevated levels of Angiotensin II were not associated with the MetS plus prediabetes or diabetes in this study.

CONCLUSIONS

Diabetes and the MetS are common in the Inner Mongolia population. The biomarkers of inflammation and endothelial dysfunction are associated with increased risk for diabetes and MetS in this population. These results are consistent with results from other populations.