The role of abdominal obesity and weight gain since adolescence in early atherosclerosis

Evaluation of Echocardiographic Epicardial Fat Thickness as a Sign of Cardiovascular Risk in Positive Exercise Test Patients

BACKGROUND

The association between epicardial fat thickness (EFT) and positive exercise test results for the diagnosis of coronary artery diseases (CAD) has yet to be evaluated. This study assessed the predictive value of EFT for CAD on the angiographs of patients with positive exercise tests.

METHODS

A total of 91 subjects were chosen consecutively from stable angina pectoris patients who were referred for coronary angiography due to a positive exercise test result. The EFT measures were obtained by echocardiographic parasternal long-axis views on the free wall of the right ventricle at end-systole of three cardiac cycles. Gensini scores were calculated by a conventional coronary angiography technique using a calculation method previously defined.

RESULTS

Receiver operator characteristic (ROC) curve analysis revealed a 0.65 cm (95% confidence interval: 0.628, 0.832, p < 0.001) area under the curve with 74.3% sensitivity and 62.3% specificity at the cut-off value of EFT for the prediction of critical coronary artery stenosis. Following ROC curve analysis, two groups were defined according to EFT cut-off value (groups 1 and 2). The severe coronary stenosis ratio was significantly higher in group 2 compared to group 1 (31.9 % vs. 11%, p < 0.001) and Gensini scores were significantly higher in group 2 (6.3 ± 13.3 vs. 16.5 ± 17.9; p < 0.001). There was no significant correlation between Gensini scores and EFT in group 1 (r = 0.093, p = 0.549), but there was a strong significant correlation in group 2 (r = 0.730, p < 0.001). Linear multivariate regression analysis revealed that EFT (> 0.65 cm) was the only independent risk factor for critical coronary artery stenosis (β = 0.451, p < 0.001).

CONCLUSIONS

EFT was significantly correlated with the severity and prevalence of coronary artery disease in positive exercise test patients.

Influence of obesity and cardiometabolic makers on lipoprotein-associated phospholipase A2 (Lp-PLA2) activity in adolescents: the healthy young cross-sectional study

BACKGROUND

Lipoprotein-associated phospholipase A2 activity (Lp-PLA2) is a good marker of cardiovascular risk in adults. It is strongly associated with stroke and many others cardiovascular events. Despite this, the impact of obesity on this enzyme activity and its relation to biomarkers of cardiovascular disease in adolescents is not very well investigated. The purpose of this article is to evaluate the influence of obesity and cardiometabolic markers on Lp-PLA2 activity in adolescents.

RESULTS

This cross-sectional study included 242 adolescents (10-19 years) of both gender. These subjects were classified in Healthy Weight (n = 77), Overweight (n = 82) and Obese (n = 83) groups. Lipid profile, glucose, insulin, HDL size, LDL(-) and anti-LDL(-) antibodies were analyzed. The Lp-PLA2 activity was determined by a colorimetric commercial kit. Body mass index (BMI), waist circumference and body composition were monitored. Food intake was evaluated using three 24-hour diet recalls. The Lp-PLA2 activity changed in function to high BMI, waist circumference and fat mass percentage. It was also positively associated with HOMA-IR, glucose, insulin and almost all variables of lipid profile. Furthermore, it was negatively related to Apo AI (β = -0.137; P = 0.038) and strongly positively associated with Apo B (β = 0.293; P < 0.001) and with Apo B/Apo AI ratio (β = 0.343; P < 0.001). The better predictor model for enzyme activity, on multivariate analysis, included Apo B/Apo AI (β = 0.327; P < 0.001), HDL size (β = -0.326; P < 0.001), WC (β = 0.171; P = 0.006) and glucose (β = 0.119; P = 0.038). Logistic regression analysis demonstrated that changes in Apo B/Apo AI ratio were associated with a 73.5 times higher risk to elevated Lp-PLA2 activity.

CONCLUSIONS

Lp-PLA2 changes in function of obesity, and that it shows important associations with markers of cardiovascular risk, in particular with waist circumference, glucose, HDL size and Apo B/Apo AI ratio. These results suggest that Lp-PLA2 activity can be a cardiovascular biomarker in adolescence.

Waist-to-height ratio, an optimal predictor for obesity and metabolic syndrome in Chinese adults

OBJECTIVE

Anthropometric indices to obesity were evaluated as predictors of metabolic syndrome risk factors. Our purpose was to explore an optimal or more reliable anthropometric indicator and optimal cut-off points for obesity on metabolic syndrome in Chinese adults.

PARTICIPANTS AND METHODS

The survey was conducted involving 2947 participants, aged 20 or above with cross-sectional study of population. The predictive validity and optimal cut-off values were analyzed by receiver operating characteristic (ROC) curves, area under curve (AUC) and the largest Youden's index (sensitivity + specificity - 1) by gender group, respectively. Kappa value showed diagnostic consistency.

RESULTS

According to the criteria of CDS 2004, IDF 2005 and AHA/NHLBI 2005, the prevalence of metabolic syndrome was 10.32%, 9.64% and 16.12% respectively, which indicated that the prevalence was higher in men than in women and increased with age (P < 0.05). The BMI, WC, WHR and WHtR in metabolic syndrome patients were greater than those in healthy volunteers and the indices in men were higher than those in women. With adjusted age and gender, the partial correlation coefficient for BMI-WC, BMI-WHR and BMI-WHtR was 0.7991, 0.5278 and 0.8196, respectively (P < 0.05). The area under curves (AUCs) of receiver operating characteristic (ROC) curves for WHtR was larger (P < 0.05) than that for WC and WHR. The cut-point of WHtR was approximately 0.5 in both genders with a satisfactory balance between sensitivity and specificity, where the Kappa (k) value for WHtR-BMI was higher than that for WHtR-WHR, and WHtR-WC.

CONCLUSIONS

The results indicated that WHtR might be an optimal anthropometric predictor of metabolic syndrome risk factors and the cut-point of WHtR was approximately 0.50 in both genders of Chinese adults.