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Bolla E, Tentolouris N, Sfikakis PP, Tektonidou MG. Metabolic syndrome in antiphospholipid syndrome versus rheumatoid arthritis and diabetes mellitus: Association with arterial thrombosis, cardiovascular risk biomarkers, physical activity, and coronary atherosclerotic plaques. Front Immunol 2023; 13:1077166. [PMID: 36700208 PMCID: PMC9868803 DOI: 10.3389/fimmu.2022.1077166] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background Cardiovascular disease (CVD) is the foremost cause of morbidity and deaths in antiphospholipid syndrome (APS), driven by thrombo-inflammation and atherothrombosis mechanisms. Metabolic syndrome (MetS) is a proinflammatory and prothrombotic state characterized by increased CVD risk. We aimed to evaluate the prevalence of MetS in APS patients compared to rheumatoid arthritis (RA) and diabetes mellitus (DM) and its associations with clinical and laboratory patient characteristics and vascular ultrasound (US) markers of subclinical atherosclerosis. Methods We included 414 patients in our study: 138 patients with APS (median age: 44.9 years, females 70%) and matched 1:1 for age and sex RA and DM subjects. Three sets of criteria were used for MetS diagnosis: Joint Interim Statement (JIS), International Diabetes Federation (IDF) and modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII). The demographic, clinical and laboratory characteristics of all participants were recorded and carotid and femoral US was performed in patients with APS. Multivariate regression models were applied. Results Prevalence of MetS was 23.9%, 23.2%, 20.3% (based on JIS, IDF, modified NCEP-ATPIII criteria, respectively) in APS versus 17.4%, 17.4%, 13% in RA (p=0.181, p=0.231, p=0.106, respectively), and 44.2%, 44.2%, 40.6% in DM patients. In multivariate analysis, patients with systemic lupus erythematosus- related APS had an approximately 2.5-fold higher risk of MetS versus RA patients. MetS in APS was independently associated with arterial thrombosis (Odds ratio 3.5, p=0.030). Odds ratio for MetS was 1.16 for each one unit increase in C-reactive protein levels according to JIS and IDF criteria, and 1.49 and 1.47 for each one unit increase in uric acid levels using the IDF and modified NCEP-ATPIII models, respectively. APS patients with atherosclerotic carotid plaques had 4 to 6.5-fold increased risk of MetS. Odds for MetS were decreased by 26% with an increase in physical activity by one hour per week. Conclusions MetS is present in approximately one-fourth of APS patients at a comparable prevalence to that observed in patients with RA. MetS in APS is associated with arterial thrombosis, cardiovascular risk biomarkers, physical activity, and subclinical atherosclerosis, supporting its role in cardiovascular risk stratification and management in APS.
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Affiliation(s)
- Eleana Bolla
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Nikolaos Tentolouris
- Diabetes Center, First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Petros P. Sfikakis
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Maria G. Tektonidou
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece,*Correspondence: Maria G. Tektonidou, ;
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Huang SH, Chen SC, Geng JH, Wu DW, Li CH. Metabolic Syndrome and High-Obesity-Related Indices Are Associated with Poor Cognitive Function in a Large Taiwanese Population Study Older than 60 Years. Nutrients 2022; 14:nu14081535. [PMID: 35458097 PMCID: PMC9026510 DOI: 10.3390/nu14081535] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 12/17/2022] Open
Abstract
Metabolic syndrome (MetS) is prevalent in Taiwan; however, the association between MetS and cognitive function is unclear. The aim of this study was to explore the associations between MetS, its components, and obesity-related indices with cognitive function in a large Taiwanese cohort. We enrolled a total of 28,486 participants who completed the Mini-Mental State Examination (MMSE) questionnaire, which was used to evaluate cognitive function. MetS was defined according to the NCEP-ATP III guidelines and modified criteria for Asians. Ten obesity-related indices were also evaluated: body mass index (BMI), abdominal volume index (AVI), body adiposity index (BAI), waist−hip ratio (WHR), a body shape index (ABSI), lipid accumulation product, waist-to-height ratio (WHtR), conicity index (CI), body roundness index (BRI), and triglyceride glucose index. The prevalence of MetS and its components (except for hypertriglyceridemia) and the number of MetS components increased while the cognitive impairment worsened (from MMSE ≥ 24, 18−23 to 0−17). In addition, increases in all obesity-related index values were associated with a decline in cognitive function (from MMSE ≥ 24, 18−23 to 0−17, ANOVA p < 0.001). Multivariable analysis showed that MetS (p = 0.002), abdominal obesity (p < 0.001), low high-density lipoprotein cholesterol (p = 0.004), and hyperglycemia (p = 0.012) were significantly associated with a low MMSE score. Further, participants with high BMI (p = 0.001), WHR (p < 0.001), WHtR (p < 0.001), BRI (p < 0.001), CI (p < 0.001), BAI (p < 0.001), AVI (p < 0.001), and ABSI (p < 0.001) values were significantly associated with a low MMSE score. Our results show that MetS and its components (except for hypertriglyceridemia and high blood pressure) may lead to cognitive impairment, and that high values of obesity-related indices were associated with poor cognitive function.
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Affiliation(s)
- Szu-Han Huang
- Department of Post Baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Szu-Chia Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (S.-C.C.); (D.-W.W.)
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Jiun-Hung Geng
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan;
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Da-Wei Wu
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (S.-C.C.); (D.-W.W.)
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chien-Hsun Li
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Integrated Center of Healthy and Long-Term Care, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Correspondence: ; Tel.: +886–7-8036783 (ext. 3453); Fax: +886–7-8063346
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Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) and obesity are both related to increased risk of cardiovascular disease and mortality. Early atherosclerotic vascular changes can be detected by non-invasive tests like carotid artery intima-media thickness (cIMT) and pulse wave velocity (PWV). Both cIMT and PWV are significantly impaired in T2DM patients and in obese patients, but the additional effect of T2DM on these vascular measurements in obese subjects has not been evaluated. METHODS Two hundred morbidly obese patients with or without T2DM were enrolled in a prospective cohort study and underwent extensive laboratory testing, including cIMT and PWV measurements. The cohort was divided into a group with and a group without T2DM. RESULTS Within this cohort, 43 patients (21.5%) were diagnosed with T2DM. These patients were older and had more often (a history of) hypertension as compared to patients without T2DM. HbA1c levels were significantly increased, while LDL cholesterol was significantly lower and the use of statins higher than in non-diabetic participants. cIMT and PWV were significantly increased in subjects suffering from T2DM. The variability in cIMT and PWV was related to differences in age and systolic blood pressure, but not to the presence of T2DM. CONCLUSION While T2DM negatively affects the vasculature in morbid obesity, hypertension and age seem to be the major risk factors, independent from the presence of T2DM. CLINICAL TRIAL REGISTRATION Dutch Trial Register NTR5172 .
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Wang TT, Wang XM, Zhang XL. Circulating Vascular Cell Adhesion Molecule-1 (VCAM-1) and Intercellular Adhesion Molecule-1 (ICAM-1): Relationship with carotid artery elasticity in patients with impaired glucose regulation (IGR). ANNALES D'ENDOCRINOLOGIE 2019; 80:72-76. [PMID: 30825997 DOI: 10.1016/j.ando.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 04/17/2018] [Accepted: 01/11/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the relations of circulating adhesion molecule vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) with carotid artery elasticity in patients with impaired glucose regulation (IGR). METHODS A total of 208 subjects were enrolled from January 2013 to March 2014. One hundred forty-eight were IGR patients, and 60 had normal glucose tolerance (NGT). Carotid intima-media thickness (IMT), carotid artery pressure-strain elasticity coefficient (Eρ), stiffness (β), arterial compliance (AC), and pulse wave velocity (PWVβ), as well as blood pressure, body mass index, blood glucose, blood lipids, insulin resistance index, VCAM-1, and ICAM-1 were measured and compared between IGR and NGT patients. RESULTS Eρ, β and PWVβ were significantly higher in the IGR group than in the NGT group (P<0.05), but the IMT showed no significant difference (P>0.05). VCAM-1 and ICAM-1 were significantly higher in the IGR group than in the NGT group (P<0.05). VCAM-1 and ICAM-1 were positively correlated with Eρ, β, and PWVβ and negatively correlated with AC in IGR patients. CONCLUSIONS Changes in carotid artery elasticity and endothelial dysfunction are found in patients with IGR. Early comprehensive intervention should be performed in such IGR populations.
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Affiliation(s)
- Ting-Ting Wang
- Department of Endocrinology, Zaozhuang Municipal Hospital, 277100 Zaozhuang, Shandong, China
| | - Xiao-Mei Wang
- Department of Endocrinology, Zaozhuang Municipal Hospital, 277100 Zaozhuang, Shandong, China
| | - Xiao-Li Zhang
- Department of Blood Supply, Zaozhuang Central Blood Station, No. 44 Wenhuazhong Road Shizhong District, 277100 Zaozhuang, Shandong, China.
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Burggraaf B, van Breukelen – van der Stoep DF, de Vries MA, Klop B, van Zeben J, van de Geijn GJM, van der Meulen N, Birnie E, Prinzen L, Castro Cabezas M. Progression of subclinical atherosclerosis in subjects with rheumatoid arthritis and the metabolic syndrome. Atherosclerosis 2018; 271:84-91. [DOI: 10.1016/j.atherosclerosis.2018.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 02/02/2018] [Accepted: 02/13/2018] [Indexed: 10/18/2022]
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Visser L, Vries BMWD, Mulder DJ, Uyttenboogaart M, Veen SVD, Zeebregts CJ, Pol RA. The Influence of the Metabolic Syndrome on the Short- and Long-Term Outcome After Carotid Endarterectomy. Angiology 2016; 68:306-314. [DOI: 10.1177/0003319716664283] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease. The aim of this study is to determine the influence of MetS on short- and long-term outcome and survival after carotid endarterectomy (CEA). Between January 2005 and December 2014, data from all patients undergoing CEA were prospectively recorded. The metabolic syndrome was defined based on the presence of ≥3 of the following criteria: hypertension, high serum triglycerides, low levels of high-density lipoprotein cholesterol, high fasting serum glucose, and obesity. Primary end points were the occurrence of transient ischemic attack (TIA)/cerebrovascular accident (CVA), myocardial infarction, and mortality. A total of 564 interventions (in 525 patients) were performed, of which 244 (43.3%) were in patients who met the diagnosis of MetS. There were no differences in short- and long-term complications and overall survival between patients with and without MetS. Patients with diabetes mellitus (DM) had significantly more ipsilateral TIA/CVA after 30 days ( P = .001). The presence of MetS has no negative effect on the outcome after CEA. However, patients with DM have a significantly higher risk of ipsilateral TIA/CVA.
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Affiliation(s)
- Linda Visser
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bas M. Wallis de Vries
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Douwe J. Mulder
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten Uyttenboogaart
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sterre van der Veen
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clark J. Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert A. Pol
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Mellendijk L, Wiesmann M, Kiliaan AJ. Impact of Nutrition on Cerebral Circulation and Cognition in the Metabolic Syndrome. Nutrients 2015; 7:9416-39. [PMID: 26580647 PMCID: PMC4663605 DOI: 10.3390/nu7115477] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/12/2015] [Accepted: 11/03/2015] [Indexed: 12/12/2022] Open
Abstract
The increasing prevalence of Metabolic Syndrome (MetS), defined as the clustering of abdominal obesity, dyslipidemia, hypertension, and hyperglycemia, appears to be driving the global epidemics cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Nutrition has a major impact on MetS and plays an important role in the prevention, development, and treatment of its features. Structural and functional alterations in the vasculature, associated with MetS, might form the link between MetS and the increased risk of developing CVD and T2DM. Not only does the peripheral vasculature seem to be affected, but the syndrome has a profound impact on the cerebral circulation and thence brain structure as well. Furthermore, strong associations are shown with stroke, cognitive impairment, and dementia. In this review the impact of nutrition on the individual components of MetS, the effects of MetS on peripheral and cerebral vasculature, and its consequences for brain structure and function will be discussed.
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Affiliation(s)
- Laura Mellendijk
- Department of Anatomy, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen 6500 HB, The Netherlands.
| | - Maximilian Wiesmann
- Department of Anatomy & Geriatric Medicine, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen 6500 HB, The Netherlands.
| | - Amanda J Kiliaan
- Department of Anatomy, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen 6500 HB, The Netherlands.
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Qin G, Tu J, Zhang C, Tang X, Luo L, Wu J, Liu L, Lu W, Tao L, Shen S, Das UN, Pan W. The value of the apoB/apoAΙ ratio and the non-HDL-C/HDL-C ratio in predicting carotid atherosclerosis among Chinese individuals with metabolic syndrome: a cross-sectional study. Lipids Health Dis 2015; 14:24. [PMID: 25885111 PMCID: PMC4399243 DOI: 10.1186/s12944-015-0023-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 03/20/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is associated with carotid intima-media thickness (CIMT), which is a good predictor of cardiovascular disease (CVD). However, among individuals with MetS, direct comparative data regarding the utility of the apoB/apoAΙ ratio and the non-HDL-C/HDL-C ratio to diagnose carotid atherosclerosis are scarce, particularly in Chinese populations. We aimed to determine the relationship between the apoB/apoAΙ ratio and the non-HDL-C/HDL-C ratio and carotid atherosclerosis among Chinese individuals with MetS. METHODS We performed a retrospective study of 5822 Chinese participants who underwent a routine health screening examination. Lipid profiles, fasting glucose, fasting insulin, CRP, apoB, apoAΙ and CIMT were measured. RESULTS We observed that among Chinese individuals with MetS, men (53.95±0.58 ys) developed carotid atherosclerosis at a younger age than women (58.47±1.17 ys) (P<0.001). Both the apoB/apoAΙ ratio and the non-HDL-C/HDL-C ratio positively correlated with carotid atherosclerosis among Chinese individuals with MetS, particularly among women. Meanwhile, CIMT increased progressively across the quartiles of the non-HDL-C/HDL-C ratio (P for trend, <0.05). Receiver Operating Characteristic (ROC) analysis indicated that the AUC of the apoB/apoAΙ ratio (0.561) was higher than that of the non-HDL-C/HDL-C ratio (0.522) in men (P<0.05) and the AUC of the apoB/apoAΙ ratio (0.640) was lower than that of the non-HDL-C/HDL-C ratio (0.695) in women (P<0.05). Among Chinese individuals with MetS, the AUC of the non-HDL-C/HDL-C ratio was more prominent among women compared with men (P<0.05). CONCLUSION Our findings indicate that among individuals with MetS, Chinese men develop carotid atherosclerosis at a much younger age than women. There were no significant differences between the apoB/apoAΙ ratio and the non-HDL-C/HDL-C ratio for the prediction of carotid atherosclerosis among Chinese individuals with MetS. Among Chinese individuals with MetS, the utility of the non-HDL-C/HDL-C ratio was found to be greater among women than among men.
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Affiliation(s)
- Guangming Qin
- Department of Laboratory, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China.
| | - Jiangfeng Tu
- Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88# Jiefang Road, Hangzhou, 310009, China.
| | - Chenjing Zhang
- Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88# Jiefang Road, Hangzhou, 310009, China.
| | - Xiaoxiao Tang
- Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88# Jiefang Road, Hangzhou, 310009, China.
| | - Laisheng Luo
- Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88# Jiefang Road, Hangzhou, 310009, China.
| | - Jiaqi Wu
- Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88# Jiefang Road, Hangzhou, 310009, China.
| | - Lingang Liu
- Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88# Jiefang Road, Hangzhou, 310009, China.
| | - Wen Lu
- Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88# Jiefang Road, Hangzhou, 310009, China.
| | - Lisha Tao
- Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88# Jiefang Road, Hangzhou, 310009, China.
| | - Shengrong Shen
- School of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, 310029, China.
| | - Undurti N Das
- UND Life Sciences, 2020 S 360th St., Federal Way, WA, 98003, USA.
| | - Wensheng Pan
- Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88# Jiefang Road, Hangzhou, 310009, China.
- Department of Gastroenterology, The Second Affiliated Hospital Binjiang Campus, School of Medicine, Zhejiang University, Hangzhou, 310009, China.
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Metabolic syndrome showed significant relationship with carotid atherosclerosis. Heart Vessels 2015; 31:664-70. [PMID: 25810113 DOI: 10.1007/s00380-015-0668-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
Abstract
Metabolic syndrome (MetS) is associated with an increased risk of cardiovascular disease. We assessed the associations between MetS and the indicators of carotid atherosclerosis as assessed by ultrasonography taking into consideration of confounders in the general population. A total of 1281 subjects (856 males, 425 females) were included in the present study. The total plaque score and maximum intima-media thickness (IMT) of the carotid arteries were measured as indicators of atherosclerosis. Cardiovascular risk factors were several metabolic components, serum uric acid, serum C-reactive protein (CRP), and lifestyle factors. MetS was defined according to the criteria of the National Cholesterol Education Program. The prevalences of an elevated total plaque score (≥5) and elevated IMT (>1 mm) of the carotid arteries were significantly higher in subjects with MetS as compared to subjects without MetS. Furthermore, a trend was observed towards higher prevalences of these indicators of atherosclerosis as the number of components of MetS increased. Logistic regression analysis revealed a significant association between elevated plaque score and MetS even after adjustments for age, serum uric acid, serum CRP and lifestyle factors in the males. Among the indicators of atherosclerosis assessed by carotid ultrasonography, a significant independent association was observed between the total plaque score and MetS in males in the general population.
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Yau PL, Kim M, Tirsi A, Convit A. Retinal vessel alterations and cerebral white matter microstructural damage in obese adolescents with metabolic syndrome. JAMA Pediatr 2014; 168:e142815. [PMID: 25436854 PMCID: PMC4420159 DOI: 10.1001/jamapediatrics.2014.2815] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
IMPORTANCE Cerebral white matter (WM) damage has been reported in childhood obesity and in metabolic syndrome (MetS) but mechanisms remain unclear. OBJECTIVES To ascertain whether adolescents with MetS have retinal vessel alterations and if the anticipated reductions in retinal arteriolar diameter are associated with diminished cerebral WM microstructural integrity and to test a model for vascular etiology of the WM abnormalities. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of the brain correlates of obesity and related metabolic disease in youths. This study was conducted at the Brain, Obesity, and Diabetes Laboratory, New York University School of Medicine, New York. Thirty-nine obese adolescents with MetS and 51 matched adolescents without MetS received comprehensive endocrine, neuropsychological, retinal vessel, and diffusion tensor imaging-based cerebral WM evaluations. MAIN OUTCOMES AND MEASURES Retinal arteriolar diameter, cerebral WM microstructural integrity, waist circumference, and insulin resistance. RESULTS Obese adolescents with MetS had significant reductions in retinal arteriolar diameter relative to adolescents without MetS (mean [SD] central retinal arteriolar equivalent, 182.35 [16.10] vs. 198.62 [19.03] μm, respectively; P < .001). The greater the number of MetS criteria present, the greater the reduction was in retinal arteriolar diameter (β = -8.61; ∆r2 = 0.335; ∆F1,83 = 70.79; P < .001). We found that abdominal obesity (waist circumference) was the strongest MetS component related to reductions in retinal arteriolar diameter (rp[85] = -0.661; P < .001), and importantly, for the first time to our knowledge, we demonstrated that its effect was partially mediated by comorbid insulin resistance (indirect effect = -0.1355 [95% CI, -0.2471 to -0.0593]; Z = -2.56; P = .01). Consistent with our prior report of nondiabetic adolescents with MetS, we also uncovered cerebral WM microstructural damage. These subtle WM changes were associated with reductions in retinal arteriolar diameter, a proxy for cerebral microvascular health (3150 voxels or 3.15 cm3; P < .001). Importantly, some of the WM regions showing lower microstructural integrity also demonstrated associations with retinal arteriolar diameter, suggesting that the observed WM pathology is likely vascular in nature. CONCLUSIONS AND RELEVANCE We document, for the first time to our knowledge, the associations between retinal vessel alterations and subclinical WM pathology among obese adolescents with MetS. This suggests that the subtle WM pathology in adolescents with MetS may have a vascular origin. Future work should include direct assessments of cerebral microvascular health.
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Affiliation(s)
- Po Lai Yau
- Department of Psychiatry, New York University School of Medicine, New York, New York,Corresponding Author: Antonio Convit, M.D., Brain, Obesity, and Diabetes Laboratory (BODyLab), New York University School of Medicine, 145 East 32 Street, 8 Floor, New York, NY 10016, 212 263-7565 (phone), 212 263-4886 (fax),
| | - Minsung Kim
- Department of Psychiatry, New York University School of Medicine, New York, New York,Corresponding Author: Antonio Convit, M.D., Brain, Obesity, and Diabetes Laboratory (BODyLab), New York University School of Medicine, 145 East 32 Street, 8 Floor, New York, NY 10016, 212 263-7565 (phone), 212 263-4886 (fax),
| | - Aziz Tirsi
- Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Antonio Convit
- Department of Psychiatry, New York University School of Medicine, New York, New York,Department of Medicine, New York University School of Medicine, New York, New York,Department of Radiology, New York University School of Medicine, New York, New York,Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
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Jylhävä J, Lehtimäki T, Jula A, Moilanen L, Kesäniemi YA, Nieminen MS, Kähönen M, Hurme M. Circulating cell-free DNA is associated with cardiometabolic risk factors: the Health 2000 Survey. Atherosclerosis 2014; 233:268-71. [PMID: 24529155 DOI: 10.1016/j.atherosclerosis.2013.12.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 12/04/2013] [Accepted: 12/10/2013] [Indexed: 12/15/2022]
Abstract
Cell-free circulating DNA (cf-DNA) has recently arisen as a promising biomarker in acute cardiovascular pathologies and as a mortality predictor in myocardial infarction. We wanted to investigate whether the baseline cf-DNA concentration could serve as an indicator of increased cardiovascular risk and early atherosclerosis. The study population consisted of 1337 participants (aged 46-77 years) in the Health 2000 Survey. cf-DNA was quantified directly in plasma using the fluorescence-based Quant-iT™ high-sensitivity DNA assay kit. Increased cf-DNA levels paralleled a cluster of cardiometabolic risk factors, such as high blood pressure, unfavorable lipid metabolism profile and systemic inflammation in both sexes. In addition, higher cf-DNA levels indicated decreased arterial elasticity and glucose intolerance in women not using hormonal replacement therapy (HRT). The cf-DNA level was also observed to be an independent determinant for Young's elastic modulus but not for carotid artery compliance or beta stiffness index in the women not using HRT. Hence, we conclude that cf-DNA could serve as an auxiliary biomarker in cardiometabolic risk assessment and as an indicator of arterial stiffness in women not using HRT.
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Affiliation(s)
- Juulia Jylhävä
- Department of Microbiology and Immunology, School of Medicine, University of Tampere, FIN-33014 Tampere, Finland.
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and University of Tampere, School of Medicine, Tampere, Finland
| | - Antti Jula
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland
| | - Leena Moilanen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Y Antero Kesäniemi
- Institute of Clinical Medicine, Department of Medicine, University of Oulu, Oulu, Finland; Clinical Research Center, Oulu University Hospital, Oulu, Finland
| | - Markku S Nieminen
- Department of Medicine, Helsinki University Hospital, P.O. Box 340, FI-00029 HUS Helsinki, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland; University of Tampere, Tampere, Finland
| | - Mikko Hurme
- Department of Microbiology and Immunology, School of Medicine, University of Tampere, FIN-33014 Tampere, Finland; Fimlab Laboratories, Tampere, Finland
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Ijäs H, Morin-Papunen L, Keränen AK, Bloigu R, Ruokonen A, Puukka K, Ebeling T, Raudaskoski T, Vääräsmäki M. Pre-pregnancy overweight overtakes gestational diabetes as a risk factor for subsequent metabolic syndrome. Eur J Endocrinol 2013; 169:605-11. [PMID: 23959786 DOI: 10.1530/eje-13-0412] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is associated with an increased risk of subsequent diabetes and metabolic syndrome (MS). The independent significance of overweight, often associated with GDM, is controversial. This study was aimed to investigate the prevalence of MS and carotid intima-media thickness (CIMT) values in normal and overweight women with previous insulin-treated GDM and control without GDM 19 years after the index pregnancy. METHODS The study group consisted of 61 women with prior GDM and 55 controls who gave birth in Oulu University Hospital between 1988 and 1993. These women were further divided into subgroups according to pre-pregnancy BMI (<25 or ≥25 kg/m(2)). In 2008-2010, anthropometrics and blood pressure were measured, blood samples were taken, and an oral glucose tolerance test was performed to investigate the components of MS. CIMT was measured by Doppler ultrasound. RESULTS Total prevalence of MS was 62% in the GDM group and 31% in the control group (P=0.001); it was highest (86%) in GDM women with pre-pregnancy overweight. CIMT was significantly thicker (0.67 vs 0.56 mm, P=0.007) and more often abnormal (71.7 vs 45.3%, P=0.004) in the GDM group compared with the controls. In logistic regression analysis, the strongest factor predicting MS in the whole study population was pre-pregnancy overweight. CONCLUSIONS Pre-pregnancy overweight was the strongest predictive factor for later MS, whereas GDM indicated increased risk of subsequent diabetes and subclinical atherosclerosis. The risk of MS was highest when both of these factors were present.
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Affiliation(s)
- H Ijäs
- Departments of Obstetrics and Gynecology Radiology, Oulu University Hospital, PO Box 23, FIN-90029 OYS Oulu, Finland
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Novo S, Peritore A, Trovato RL, Guarneri FP, Di Lisi D, Muratori I, Novo G. Preclinical atherosclerosis and metabolic syndrome increase cardio- and cerebrovascular events rate: a 20-year follow up. Cardiovasc Diabetol 2013; 12:155. [PMID: 24152423 PMCID: PMC4016285 DOI: 10.1186/1475-2840-12-155] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 10/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intima-media thickness (IMT) is a validated marker of preclinical atherosclerosis and a predictor of cardiovascular events. PATIENTS We studied a population of 529 asymptomatic patients (age 62 ± 12.8 years), divided into two groups of subjects with and without Metabolic Syndrome (MetS). METHODS All patients, at baseline, have had a carotid ultrasound evaluation and classified in two subgroups: the first one without atherosclerotic lesions and the second one with preclinical atherosclerosis (increased IMT or asymptomatic carotid plaque). Cardiovascular endpoints were investigated in a 20-years follow-up. RESULTS There were 242 cardiovascular events: 144 among patients with MetS and 98 among in healthy controls (57.4% vs. 35.2%; P < 0.0001). 63 events occurred in patients with normal carotid arteries, while 179 events occurred in patients with preclinical atherosclerosis (31.8% vs. 54.1%; P < 0.0001). Of the 144 total events occurred in patients with MetS, 36 happened in the subgroup with normal carotid arteries and 108 in the subgroup with preclinical atherosclerosis (45% vs. 63.15%; P = 0.009). 98 events occurred in patients without MetS, of which 27 in the subgroup with normal carotid arteries and 71 in the subgroup with preclinical atherosclerosis (22.88% vs. 44.37%; P = 0.0003). In addition, considering the 63 total events occurred in patients without atherosclerotic lesions, 36 events were recorded in the subgroup with MetS and 27 events in the subgroup without MetS (45% vs. 22.88%; P = 0.0019). Finally, in 179 total events recorded in patients with preclinical carotid atherosclerosis, 108 happened in the subgroup with MetS and 71 happened in the subgroup without MetS (63.15% vs. 44.37%; P = 0.0009). The Kaplan-Meier function showed an improved survival in patients without atherosclerotic lesions compared with patients with carotid ultrasound alterations (P = 0.01, HR: 0.7366, CI: 0.5479 to 0.9904). CONCLUSIONS Preclinical atherosclerosis leads to an increased risk of cardiovascular events, especially if it is associated with MetS.
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Affiliation(s)
- Salvatore Novo
- Chair of Cardiovascular Disease and Centre for the Early Diagnosis of Preclinical and Multifocal Atherosclerosis and for Secondary Prevention, Department of Internal Medicine and Specialties (DIBIMIS), University of Palermo, Via del Vespro n, 139-90127, Palermo, Italy.
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14
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Ahbab S, Ataoğlu HE, Tuna M, Karasulu L, Cetin F, Temiz LU, Yenigün M. Neck circumference, metabolic syndrome and obstructive sleep apnea syndrome; evaluation of possible linkage. Med Sci Monit 2013; 19:111-7. [PMID: 23403781 PMCID: PMC3628860 DOI: 10.12659/msm.883776] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background This study was performed to evaluate neck circumference (NC) and metabolic syndrome (MS) parameters in severe and non-severe (mild-moderate) obstructive sleep apnea syndrome (OSAS) patients according to apnea-hypopnea index (AHI). Material/Method We enrolled 44 patients diagnosed with OSAS based on overnight polysomnography. The diagnosis of OSAS was based on AHI. Apnea is a pause of airflow for more than 10 seconds. and hypopnea is a decrease of airflow for more than 10 seconds and oxygen desaturation of 4% or greater. AHI score. per hour; below 5 normal. 5–29 mild-moderate. 30 and above were grouped as severe OSAS. Height. weight. neck circumference (NC). waist circumference (WC) and body mass index (BMI) of the patients were measured. MS was diagnosed by the Adult Treatment Panel (ATP) III criteria (≥3 of the following abnormalities): 1) WC ≥94 cm for males, ≥80 cm for females; 2) arterial blood pressure ≥130/85 mmHg; 3) fasting blood glucose ≥100 mg/dl; 4) high density lipoprotein (HDL) cholesterol <40 mg/dl in man, <50 mg/dl in women; 5) triglycerides ≥150 mg/dl. Results Mean BMI and NC were higher in severe OSAS patients compared to non-severe patients (p=0.021. p<0.001). According to ATP III criteria. 64% of severe and 61.1% of non-severe OSAS patients were MS (p=0.847). A logistic regression model displayed an association with NC as a risk factor for severe OSAS (p=0.01). but not with MS. Conclusions In this study. NC in severe OSAS patients was significantly higher than in non-severe OSAS patients. The prevalence of metabolic syndrome was not correlated with OSAS severity. NC is an independent risk factor for severe OSAS.
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Affiliation(s)
- Süleyman Ahbab
- Haseki Training and Research Hospital, Internal Medicine Clinic, Istanbul, Turkey.
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15
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Gender differences in association between metabolic syndrome and carotid intima media thickness. J Diabetes Metab Disord 2012; 11:13. [PMID: 23497686 PMCID: PMC3598192 DOI: 10.1186/2251-6581-11-13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 08/03/2012] [Indexed: 02/08/2023]
Abstract
Background Metabolic syndrome (Mets) is a cluster of cardiovascular risk factors which can predicts cardiovascular disease (CVD). Carotid intima-media thickness (CIMT) is known as a surrogate measure of subclinical atherosclerosis and predictor of CVD. Although, it has shown the association between Mets and CIMT, this relation regarding sex differences is limited. We aimed to find out whether gender differences in this association. Methods In this cross-sectional study, we recorded height, weight, waist circumference (WC), blood pressure, and lipid profiles. We used Mets; defined based on NCEP ATP III definition, and traditional cardiovascular risk factors; age, body mass index (BMI), WC, hyperlipidemia, and hypertension, in multivariate regression models which including;. The CIMT measurement < 0.73 or ≥0.73 mm was considered as low- or high risk to CVD. Results Overall, 150 subjects were enrolled to study that their ages were 36-75 years. The 47.3% of them (71 subjects) had Mets. CIMT was increased in Mets group compared non-Mets group (P = 0.001). In logistic regression analysis, a significant association was found between Mets and CIMT in women, but not in men (p = 0.002, and p = 0.364, respectively). After adjustment to age, WC, BMI, hypertension and hyperlipidemia, this association was significant just in women (p = 0.011) independent of WC, BMI, hyperlipidemia and hypertension. Conclusion Our data showed that MetS is a stronger risk factor for subclinical atherosclerosis in women than in men. So, we suggest the assessment of CIMT along with definition Mets in middle-aged women could be lead to earlier detection of at risk individuals to CVD.
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Yates KF, Sweat V, Yau PL, Turchiano MM, Convit A. Impact of metabolic syndrome on cognition and brain: a selected review of the literature. Arterioscler Thromb Vasc Biol 2012; 32:2060-7. [PMID: 22895667 PMCID: PMC3442257 DOI: 10.1161/atvbaha.112.252759] [Citation(s) in RCA: 293] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Metabolic syndrome (MetS), a clustering of risk factors for type 2 diabetes mellitus and cardiovascular disease, has been associated with cognitive dysfunction and brain abnormalities. This review describes the literature on the impact of MetS on brain and cognition and suggests directions for future research. A literature search for reports of MetS and cognition and brain imaging was conducted for both nonelderly adults and adolescents. No studies were found describing MetS and brain or cognition among adolescents; therefore, we also included studies investigating individual components of MetS in this age group. Most studies found associations between MetS and cognitive dysfunction. Multiple cognitive domains were affected by MetS in adults. In adolescents, the majority of findings were in executive functioning. Brain imaging literature in adults implicated MetS in ischemic stroke, white matter alterations, and altered brain metabolism. For adolescents, individual MetS factors were linked to volume losses in the hippocampus and frontal lobes. MetS negatively impacts cognitive performance and brain structure. Potential explanatory models include impaired vascular reactivity, neuroinflammation, oxidative stress, and abnormal brain lipid metabolism. We posit that insulin resistance-associated impairment in cerebrovascular reactivity is an important mechanism underlying brain deficits seen in MetS.
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Affiliation(s)
- Kathy F. Yates
- Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, NY 10016 USA
- Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd., Orangeburg, NY 10962 USA
| | - Victoria Sweat
- Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, NY 10016 USA
| | - Po Lai Yau
- Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, NY 10016 USA
| | - Michael M. Turchiano
- Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, NY 10016 USA
| | - Antonio Convit
- Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, NY 10016 USA
- Department of Medicine, New York University School of Medicine, 550 First Avenue, New York, NY 10016 USA
- Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd., Orangeburg, NY 10962 USA
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Würtz P, Tiainen M, Mäkinen VP, Kangas AJ, Soininen P, Saltevo J, Keinänen-Kiukaanniemi S, Mäntyselkä P, Lehtimäki T, Laakso M, Jula A, Kähönen M, Vanhala M, Ala-Korpela M. Circulating metabolite predictors of glycemia in middle-aged men and women. Diabetes Care 2012; 35:1749-56. [PMID: 22563043 PMCID: PMC3402262 DOI: 10.2337/dc11-1838] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Metabolite predictors of deteriorating glucose tolerance may elucidate the pathogenesis of type 2 diabetes. We investigated associations of circulating metabolites from high-throughput profiling with fasting and postload glycemia cross-sectionally and prospectively on the population level. RESEARCH DESIGN AND METHODS Oral glucose tolerance was assessed in two Finnish, population-based studies consisting of 1,873 individuals (mean age 52 years, 58% women) and reexamined after 6.5 years for 618 individuals in one of the cohorts. Metabolites were quantified by nuclear magnetic resonance spectroscopy from fasting serum samples. Associations were studied by linear regression models adjusted for established risk factors. RESULTS Nineteen circulating metabolites, including amino acids, gluconeogenic substrates, and fatty acid measures, were cross-sectionally associated with fasting and/or postload glucose (P < 0.001). Among these metabolic intermediates, branched-chain amino acids, phenylalanine, and α1-acid glycoprotein were predictors of both fasting and 2-h glucose at 6.5-year follow-up (P < 0.05), whereas alanine, lactate, pyruvate, and tyrosine were uniquely associated with 6.5-year postload glucose (P = 0.003-0.04). None of the fatty acid measures were prospectively associated with glycemia. Changes in fatty acid concentrations were associated with changes in fasting and postload glycemia during follow-up; however, changes in branched-chain amino acids did not follow glucose dynamics, and gluconeogenic substrates only paralleled changes in fasting glucose. CONCLUSIONS Alterations in branched-chain and aromatic amino acid metabolism precede hyperglycemia in the general population. Further, alanine, lactate, and pyruvate were predictive of postchallenge glucose exclusively. These gluconeogenic precursors are potential markers of long-term impaired insulin sensitivity that may relate to attenuated glucose tolerance later in life.
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Affiliation(s)
- Peter Würtz
- Computational Medicine, Institute of Clinical Medicine, University of Oulu, Oulu, Finland.
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Herder M, Arntzen KA, Johnsen SH, Mathiesen EB. The metabolic syndrome and progression of carotid atherosclerosis over 13 years. The Tromsø study. Cardiovasc Diabetol 2012; 11:77. [PMID: 22738646 PMCID: PMC3539868 DOI: 10.1186/1475-2840-11-77] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 06/19/2012] [Indexed: 11/17/2022] Open
Abstract
Background The metabolic syndrome (MetS) is associated with increased risk of cardiovascular disease. In this study, we examine if metabolic syndrome predicts progression of atherosclerosis over 13 years. Methods Participants were 1442 men and 1532 women in the population-based Tromsø Study who underwent carotid ultrasound examinations at baseline in the 4th (1994–5) and at follow-up in the 6th survey (2007–8). Of these, 278 men and 273 women fulfilled the criteria for the MetS, defined according to a modified version of the National Cholesterol Education Program Adult Treatment Panel III (NCEP, ATPIII). Carotid atherosclerosis was assessed as total plaque area (TPA) and mean intima-media thickness (IMT) at follow-up and as change in IMT and TPA from baseline to follow-up. Associations between MetS and its components and carotid atherosclerosis were assessed in linear regression models adjusted for age, total cholesterol and daily smoking, stratified by sex. Results IMT and TPA levels at follow-up (p < 0.0001) and progression of TPA (p = 0.02) were higher in the MetS group compared to the non-MetS group. In stepwise multivariable models, MetS was associated with TPA (β = 0.372 mm2, p = 0.009) and IMT (β = 0.051 mm, p < 0.0001) in men, and with IMT (β = 0.045 mm, p = 0.001) in women after 13 years of follow-up, but not with progression of IMT or TPA. In analyses stratified by age, MetS predicted progression of IMT (β = 0.043 mm, p = 0.046) and TPA (β = 1.02 mm2, p = 0.002) in men below 50 years of age. Hypertension was predictive of follow-up TPA and IMT in both genders and of progression of TPA in women. Impaired glucose tolerance was associated with follow up levels of IMT and TPA as well as progression in IMT in men. None of the other components of MetS were associated with progression of atherosclerosis. Conclusions Subjects with MetS had higher levels of IMT and TPA at follow up than those without MetS. Mets predicted progression of IMT and TPA in those below 50 years of age, but not in other age groups, indicating that MetS may be involved in the initiation of the atherosclerotic process.
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Affiliation(s)
- Marit Herder
- Department of Community Medicine, University of Tromsø, Tromsø, Norway.
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Novo S, Peritore A, Guarneri FP, Corrado E, Macaione F, Evola S, Novo G. Metabolic syndrome (MetS) predicts cardio and cerebrovascular events in a twenty years follow-up. A prospective study. Atherosclerosis 2012; 223:468-72. [PMID: 22704563 DOI: 10.1016/j.atherosclerosis.2012.05.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 05/04/2012] [Accepted: 05/16/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND PURPOSE Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors, considered as emerging and promoting atherosclerosis. This study aimed at the evaluation of the influence of MetS on the prediction of cerebro and cardiovascular events during a 20 years follow-up period in an asymptomatic population of middle-aged subjects. METHODS We evaluated 529 asymptomatic persons through a prospective study. Study population was divided into two subgroups: patients with and without MetS. Echo-color-Doppler was used in order to assess the presence of subclinical atherosclerosis. A 20 years follow-up study was carried out in order to estimate the incidence of cerebro and cardiovascular, fatal and non fatal, events (AMI, stroke, abdominal aortic aneurysm, TIA, angina pectoris). RESULTS 242 cerebro and cardiovascular events were registered, 43 fatal (24 in MetS and 19 in controls) and 199 non fatal (120 with MetS and 79 without it, p < 0.0001). Free-events survival was lower in patients suffering from MetS (p < 0.0012; HR 0.6847; C.I.95%: 0.5274-0.8889). Ultrasound showed a higher prevalence of subclinical atherosclerosis in patients with MetS than in the unaffected ones (68.12% vs. 57.5% p < 0.01; OR = 1.58 with C.I.95% = 1.10-2.28, p < 0.01). CONCLUSIONS Patients with MetS have a higher cardiovascular risk that can be explained by atherosclerotic changes: the components of MetS interact to affect vascular thickness synergistically and promote the development of subclinical atherosclerosis. So we recommend to prevent the development of MetS abnormalities and to investigate the presence of subclinical atherosclerosis by echo-color-Doppler in order to stratify more accurately the global CV risk.
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Affiliation(s)
- S Novo
- Center for the Early Diagnosis of Preclinical and Multifocal Atherosclerosis and for Secondary Prevention of Cardiovascular Diseases, Division of Cardiology, University Hospital Paolo Giaccone, 90127 Palermo, Italy.
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Abstract
OBJECTIVE To examine the association between metabolic syndrome (MetSyn) and carotid intima media thickness (IMT) separately in male and female police officers. METHODS MetSyn was defined using 2005 guidelines. B-mode ultrasound was used to measure mean and maximum (12 and 36 segments) carotid artery thickness. Analysis of covariance was used to compare mean IMT values across individuals categorized by number of MetSyn components. Adjustments were made for age, smoking status, and low-density lipoprotein cholesterol. RESULTS Among 106 women, the adjusted mean common and maximum36 carotid IMT were significantly and positively associated with number of MetSyn components. No associations were found in men (n = 304). Adjusted carotid IMT values were inversely associated with low high-density lipoprotein cholesterol and directly with hypertension in women. CONCLUSIONS Number of MetSyn components was significantly associated with carotid IMT in female but not in male officers.
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Koivistoinen T, Kööbi T, Moilanen L, Jula A, Lehtimäki T, Hyttinen J, Kähönen M. Arterial tension time reflects subclinical atherosclerosis, arterial stiffness and stroke volume. Clin Physiol Funct Imaging 2011; 31:464-71. [PMID: 21981458 DOI: 10.1111/j.1475-097x.2011.01042.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To introduce and evaluate a new haemodynamic parameter known as arterial tension time (ATT) and study whether ATT is associated with traditional cardiovascular risk factors as well as with indices of arterial stiffness, cardiac pump function and subclinical atherosclerosis. METHODS Arterial tension time was measured from the whole-body impedance cardiography (ICG) signal and defined as the time difference between the onset of arterial distension induced by stroke volume (SV) and maximal integrated arterial distension. As measures of subclinical atherosclerosis and arterial stiffness, carotid artery intima-media thickness (IMT), Young's elastic modulus (YEM), arterial stiffness index (ASI) and carotid artery compliance (CAC) were assessed with ultrasound in 336 Finnish adults (aged 46-76 years, 43·2% men) participating in the Health 2000 Survey. In addition, pulse wave velocity (PWV) and stroke volume index (SI), as indices of arterial stiffness and cardiac pump function, were assessed with ICG. RESULTS Arterial tension time was associated inversely with PWV, IMT, YEM and ASI (P<0·002 for all) and directly with SI and CAC (P<0·001 for both). Age, systolic blood pressure, diastolic blood pressure and fasting glucose were independent determinants of decreased ATT (P<0·04 for all). Moreover, accumulation of cardiovascular risk factors was associated with the decrease in ATT (P for trend <0·001). CONCLUSION Decreased ATT was associated with increased arterial stiffness, increased subclinical atherosclerosis and decreased SV. Current results suggest that ATT provides simultaneous information on several aspects of cardiovascular structure and function and could possibly serve as a new integrated parameter for cardiovascular risk stratification.
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Affiliation(s)
- Teemu Koivistoinen
- Departments of Clinical Physiology, University of Tampere, Tampere University Hospital, Finland.
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22
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Kettunen T, Eklund C, Kähönen M, Jula A, Päivä H, Lyytikäinen LP, Hurme M, Lehtimäki T. Polymorphism in the C-reactive protein (CRP) gene affects CRP levels in plasma and one early marker of atherosclerosis in men: The Health 2000 Survey. Scandinavian Journal of Clinical and Laboratory Investigation 2011; 71:353-61. [PMID: 21413847 DOI: 10.3109/00365513.2011.568123] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND C-reactive protein (CRP) is an inflammatory protein that may play a role in the pathogenesis of cardiovascular disease (CVD). However, its status as a causal risk factor is still controversial. CRP gene single nucleotide polymorphisms (SNPs) have been shown to associate with CRP concentration, but not convincingly with early atherosclerotic changes. OBJECTIVE We assessed whether CRP genotypes or their haplotypes associate with plasma CRP levels or carotid artery intima-media thickness (IMT) or carotid artery elasticity (CAE) in a Finnish middle-aged study population. METHODS We genotyped CRP gene polymorphisms -717A>G (rs2794521), -286C>T>A (rs3091244), +1059G>C (rs1800947), +1444C>T (rs1130864) and +1846G>A (rs1205) and measured CRP concentration in a sub-population (N=1332, mean age 58.2 ± 8.0, women n=727 and men n=605) of a large Finnish cross-sectional health examination survey, The Health 2000 Study, carried out in 2000-2001. Results. Significant association (both sexes p<0.0001, women p=0.015 and men p=0.029) was found between CRP rs1800947 genotype and CRP concentration. Multivariate analysis showed an independent effect of the genotype on CRP concentration after adjustment for risk factors (women p=0.036 and men p=0.009). Similar associations were seen at the haplotype level in haplotype ACCCA where +1059 C-carriers had lower median CRP values than non-carriers (p=0.008). One CRP genotype (rs1130864) was associated with one CAE parameter in men but no association was observed between CRP genotypes and carotid artery IMT. CONCLUSIONS CRP gene allelic variation is associated with CRP levels in both sexes and with one CAE parameter (SI) in men in a population-based Finnish cohort of middle-aged subjects.
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Affiliation(s)
- Terhi Kettunen
- Department of Clinical Chemistry, Centre for Laboratory Medicine Tampere University Hospital and University of Tampere, Finland.
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Jylhävä J, Haarala A, Kähönen M, Lehtimäki T, Jula A, Moilanen L, Kesäniemi YA, Nieminen MS, Hurme M. Pentraxin 3 (PTX3) is associated with cardiovascular risk factors: the Health 2000 Survey. Clin Exp Immunol 2011; 164:211-7. [PMID: 21391986 DOI: 10.1111/j.1365-2249.2011.04354.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Pentraxin 3 (PTX3) is a novel candidate immunoinflammatory marker that has been reported to be associated with cardiometabolic risk factors and to predict adverse outcomes in individuals with cardiovascular disease (CVD). Despite being a member of the same pentraxin protein family as C-reactive protein (CRP), PTX3 probably reflects different aspects of CVD pathogenesis. In this study, we assessed plasma PTX3 correlates and determinants in the Health 2000 Survey population, which comprised n = 403 insulin-resistant subjects, n = 845 hypercholesterolaemic subjects and n = 311 hypertensive subjects, all aged between 46 and 76 years. In insulin-resistant subjects the PTX3 concentration was found to correlate directly with age, pulse pressure and indoleamine 2,3-dioxygenase (IDO) enzyme activity and inversely with total and low-density lipoprotein (LDL) cholesterol. In hypercholesterolaemic subjects, the PTX3 concentration correlated directly with HDL cholesterol, systolic blood pressure and pulse pressure, whereas in hypertensive subjects, the PTX3 concentration correlated directly with systolic blood pressure, pulse pressure and IDO activity. No correlation was observed between the concentrations of PTX3 and CRP, adiposity indicators or indicators of subclinical atherosclerosis in any of the subject groups. PTX3 concentration variations were attributed to variations in LDL cholesterol and IDO activity in insulin-resistant subjects and to pulse pressure in hypercholesterolaemic and hypertensive subjects. These results indicate that, in individuals at high risk of CVD, the PTX3 concentration is associated with cardiovascular risk factors but not with subclinical atherosclerosis.
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Affiliation(s)
- J Jylhävä
- Department of Microbiology and Immunology, Medical School, University of Tampere, Finland.
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Rosolova H, Nussbaumerova B. Cardio-metabolic risk prediction should be superior to cardiovascular risk assessment in primary prevention of cardiovascular diseases. EPMA J 2011. [PMID: 23199124 PMCID: PMC3405365 DOI: 10.1007/s13167-011-0066-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cardiovascular atherosclerotic diseases represent the main cause of death in the developed and developing populations. Although major progress has been made in the management of the classical modifiable cardiovascular risk factors, unhealthy lifestyle conduces to an increasing prevalence of overweight, obesity, metabolic disorders, type 2 diabetes mellitus, premature atherosclerosis and cardiovascular diseases. That is why cardio-metabolic risk prediction should be superior in the primary prevention of atherosclerosis and cardiovascular diseases. Up-to-date primary preventive strategies according to the European Guidelines, especially the high risk strategy approach, are being implemented. Individual cardiovascular and better cardio-metabolic risk assessment represents the basic approach in the individualized primary prevention of cardiovascular diseases and type 2 diabetes mellitus. Cardio-metabolic biomarkers, especially high sensitivity C-reactive protein, albuminuria, N-terminal pro-brain natriuretic peptide, and imaging procedures (carotid intima-media thickness measured by ultrasound) could improve the prediction of cardiovascular diseases and type 2 diabetes beyond that using traditional risk factors.
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Affiliation(s)
- Hana Rosolova
- Centre of Preventive Cardiology of the 2nd Medical Department University Hospital, E. Benese 13, 305 99 Pilsen, Czech Republic
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van der Horst M, van Weissenbruch MM, de Vries JI. Thrombophilia mediates lowering cardiovascular risk factors in women with a history of preeclampsia. Hypertens Pregnancy 2010; 30:421-32. [PMID: 20860491 DOI: 10.3109/10641955.2010.506230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Preeclampsia is associated with increased risk of cardiovascular disease. The aim of this pilot study was to assess whether the presence of thrombophilia results in a greater tendency to develop endothelial dysfunction and cardiovascular diseases. METHODS Ten women with thrombophilia were matched with 10 women without thrombophilia for a history of hypertensive disorders during pregnancy. Laboratory measurements: blood pressure, insulin sensitivity, and micro- and macrovascular function were determined. RESULTS Women with thrombophilia had significant lower total- and low-density cholesterol, were more insulin sensitive, and had better microvascular function. CONCLUSION This study suggests that thrombophilia "mediates" in lowering of cardiovascular risk factors in women with a history of preeclampsia.
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Baldassarre D, Werba J, Castelnuovo S, Frigerio B, Amato M, Ravani A, Veglia F, Sirtori C, Tremoli E. The metabolic syndrome predicts carotid intima-media thickness no better than the sum of individual risk factors in a lipid clinic population. Atherosclerosis 2010; 210:214-9. [DOI: 10.1016/j.atherosclerosis.2010.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 02/04/2010] [Accepted: 02/05/2010] [Indexed: 10/19/2022]
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Antonini-Canterin F, La Carrubba S, Gullace G, Zito C, Di Bello V, Di Salvo G, Benedetto F, Novo S, Pezzano A, Perticone F, Balbarini A, Carerj S. Association between carotid atherosclerosis and metabolic syndrome: results from the ISMIR study. Angiology 2010; 61:443-8. [PMID: 20304865 DOI: 10.1177/0003319709360523] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The metabolic syndrome (MetS) has previously been associated with an early marker of atherosclerosis, the carotid intima-media thickness (IMT). From the ISMIR (Ispessimento Medio Intimale e Rischio cardiovascolare [media-intima thickness and cardiovascular risk]) study population of 479 asymptomatic participants, we identified 80 participants with MetS. Carotid IMT and plaques were evaluated by ultrasonography. Blood samples were obtained from all participants. Participants with MetS had a significantly higher prevalence of a carotid IMT > 0.80 mm (P = .004) and of carotid plaques (P < .001) as compared with participants without MetS. Carotid IMT was significantly correlated with fasting triglycerides and fibrinogen levels both in participants with MetS and in those without MetS (all P < .01). In contrast, IMT correlated with fasting plasma glucose, serum creatinine, and uric acid levels only in participants without MetS. Our study confirms the association between MetS and carotid atherosclerosis. In MetS, a significant correlation between carotid IMT and triglycerides and fibrinogen levels was found.
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Lee YH, Shin MH, Kweon SS, Rhee JA, Ryu SY, Ahn HR, Choi JS. Metabolic syndrome and carotid artery parameter in Koreans aged 50 years and older. Circ J 2010; 74:560-6. [PMID: 20103972 DOI: 10.1253/circj.cj-09-0477] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Few studies have reported on the relationship between metabolic syndrome (MetS) and carotid artery structure. The objective of this study was to examine the relationship between MetS and carotid artery parameters such as the common carotid artery intima-media thickness (CCA-IMT), plaques, and the diameter of the common carotid artery (CCAd). METHODS AND RESULTS The study population consisted of 1.730 community-dwelling Koreans aged 50 years and older without hypertension, diabetes mellitus or dyslipidemia. MetS was defined according to the modified National Cholesterol Education Program's Adult Treatment Panel III criteria. The risk for abnormal CCA-IMT (>or=1.00 mm) was significant in women with MetS (odds ratio (OR) 2.22; 95% confidence interval (CI) 1.14-4.31), but not in men with MetS (OR 1.06; 95%CI 0.39-2.91). No significant relationship between MetS and carotid plaques was observed in either sex. The relationship between MetS and high CCAd (highest quintile) was significant in both men (OR 2.19; 95%CI 1.38-3.49) and women (OR 2.02; 95%CI 1.39-2.94). CONCLUSIONS MetS independently correlates with carotid atherosclerosis and carotid enlargement. The effect of MetS on carotid atherosclerosis is more pronounced in women than in men.
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Affiliation(s)
- Young-Hoon Lee
- Department of Preventive Medicine, College of Medicine, Seonam University, Namwon city, South Korea
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Riikola A, Sipilä K, Kähönen M, Jula A, Nieminen MS, Moilanen L, Kesäniemi YA, Lehtimäki T, Hulkkonen J. Interleukin-6 promoter polymorphism and cardiovascular risk factors: The Health 2000 Survey. Atherosclerosis 2009; 207:466-70. [DOI: 10.1016/j.atherosclerosis.2009.06.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Revised: 06/01/2009] [Accepted: 06/02/2009] [Indexed: 10/20/2022]
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Drager LF, Bortolotto LA, Maki-Nunes C, Trombetta IC, Alves MJNN, Fraga RF, Negrão CE, Krieger EM, Lorenzi-Filho G. The incremental role of obstructive sleep apnoea on markers of atherosclerosis in patients with metabolic syndrome. Atherosclerosis 2009; 208:490-5. [PMID: 19762024 DOI: 10.1016/j.atherosclerosis.2009.08.016] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 07/23/2009] [Accepted: 08/11/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Metabolic syndrome (MS) is associated with subclinical atherosclerosis, but the relative role of obstructive sleep apnoea (OSA) is largely unknown. The main objective of this study is to determine the impact of OSA on markers of atherosclerosis in patients with MS. METHODS Eighty-one consecutive patients with MS according to the Adult Treatment Panel III underwent a clinical evaluation, polysomnography, laboratory and vascular measurements of carotid intima media thickness (IMT), carotid-femoral pulse wave velocity (PWV) and carotid diameter (CD) in a blind fashion. OSA was defined as an apnoea-hypopnoea index (AHI) > or =15 events/hour. Multiple linear regression was performed to determine the variables that were independently associated with the vascular parameters. RESULTS Fifty-one patients (63%) had OSA. No significant differences existed in age, sex, MS criteria, and cholesterol levels between patients with (MS+OSA) and without OSA (MS-OSA). Compared with MS-OSA patients, MS+OSA patients had higher levels of IMT (661+/-117 vs. 767+/-140 microm), PWV (9.6+/-1.0 vs. 10.6+/-1.6m/s), and CD (6705+/-744 vs. 7811+/-862 microm) (P<0.001 for each comparison). Among patients with MS+OSA, all vascular parameters were similar in patients with and without daytime sleepiness. The independent parameters associated with IMT, PWV, and CD were AHI, abdominal circumference, and systolic blood pressure (R(2)=0.42); AHI and systolic blood pressure (R(2)=0.38); and AHI, age, abdominal circumference and systolic blood pressure (R(2)=0.45), respectively. The R(2) of AHI for IMT, PWV and CD was 0.12, 0.10 and 0.20, respectively. CONCLUSIONS OSA is very common and has an incremental role in atherosclerotic burden in consecutive patients with MS.
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Affiliation(s)
- Luciano F Drager
- Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, Av Dr Enéas Carvalho de Aguiar, 44, CEP 05403-904, São Paulo, Brazil.
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Holewijn S, den Heijer M, Swinkels DW, Stalenhoef AFH, de Graaf J. The metabolic syndrome and its traits as risk factors for subclinical atherosclerosis. J Clin Endocrinol Metab 2009; 94:2893-9. [PMID: 19417041 DOI: 10.1210/jc.2009-0084] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
CONTEXT AND OBJECTIVE The metabolic syndrome (MetS) indicates an increased cardiovascular risk. The objective of the present study was to determine the impact of the MetS and its individual traits on subclinical atherosclerosis, as measured with six noninvasive measurements of atherosclerosis (NIMA) in a 50- to 70-yr-old Dutch population-based cohort. Furthermore, we determined the impact of three different definitions of the MetS. DESIGN We performed NIMA in 1517 participants of the Nijmegen Biomedical Study. The MetS was defined by definitions of the National Cholesterol Education Program, International Diabetes Federation, and the World Health Organization. RESULTS Participants with the MetS (National Cholesterol Education Program) were characterized by increased subclinical atherosclerosis compared with participants without any trait of the MetS, as reflected by lower ankle-brachial index at rest [percent change (95% confidence interval), M: -5.2% (-9; -1), F: -3.1% (-6; -1)] and after exercise [M: -7.7% (-17;+2), F: -6.6% (-11; -2)], higher augmentation index [M: +4.8% (+3; +7), F: +1.9% (+4; +18)], increased pulse wave velocity [M: +22.8% (+15;+32), F: +20.5% (+14; +28)], increased intima-media thickness [M: +9.3% (+5; +13), F: +6.9% (+3; +11)], and thicker plaques [M: +17.6% (-2; +41), F: +26.6% (+5; +53)]. Most intriguingly, the number of traits was strongly associated with the severity of subclinical atherosclerosis because all NIMA gradually deteriorated with increasing number of traits present; NIMA were already deteriorated when one or two traits were present and further deteriorated when four or five traits of the MetS were present. Similar result were found when International Diabetes Federation and World Health Organization definitions of the MetS were used. CONCLUSIONS For cardiovascular risk prediction, it is more important to take into account the presence of each individual trait and the number of traits of the MetS than to diagnose the presence of the MetS.
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Affiliation(s)
- Suzanne Holewijn
- Department of General Internal Medicine (463), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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