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Lou Y, Zhang Y, Zhao P, Qin P, Wang C, Ma J, Peng X, Chen H, Zhao D, Xu S, Wang L, Zhang M, Hu D, Hu F. Association of fasting plasma glucose change trajectory and risk of hypertension: a cohort study in China. Endocr Connect 2022; 11:EC-21-0464.R1. [PMID: 34860174 PMCID: PMC8789013 DOI: 10.1530/ec-21-0464] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022]
Abstract
We aimed to assess the association between fasting plasma glucose (FPG) change trajectory and incident hypertension among Chinese population. This cohort study included 11,791 adults aged 18-80 years without hypertension at first entry and who completed at least four follow-ups between 2009 and 2016. Logistic regression was used to estimate odds ratios (ORs) and 95% CIs for the association between FPG change trajectory and probability of hypertension. During a median follow-up of 5.10 years (total person-years 61,887.76), hypertension developed in 2177 participants. After adjusting for baseline potential confounders, the probability of hypertension increased with the increasing FPG change trajectory (adjusted OR (aOR) 1.22, 95% CI 1.07-1.40), bell-shape trajectory (aOR 1.15, 95% CI 1.02-1.30) and other-shape trajectory (aOR 1.13, 95% CI 1.02-1.25) which showed a higher variability of FPG compared to the decreasing group. In addition, the increasing FPG change trajectory was associated with a higher probability of hypertension compared with the decreasing group regardless of age and BMI but was only significant in males and in those with normal FPG at baseline. Our study indicates that the increasing FPG change trajectory determines the highest risk of hypertension, demonstrating the importance of maintaining low and stable levels of FPG, especially in males and in those with normal FPG.
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Affiliation(s)
- Yanmei Lou
- Department of Health Management, Beijing Xiaotangshan Hospital, Beijing, People’s Republic of China
| | - Yanyan Zhang
- Department of Epidemiology and Health Statistics, Shenzhen University Health Science Center, Shenzhen, Guangdong, People’s Republic of China
| | - Ping Zhao
- Department of Health Management, Beijing Xiaotangshan Hospital, Beijing, People’s Republic of China
| | - Pei Qin
- Department of Epidemiology and Health Statistics, Shenzhen University Health Science Center, Shenzhen, Guangdong, People’s Republic of China
| | - Changyi Wang
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease, Shenzhen, Guangdong, People’s Republic of China
| | - Jianping Ma
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease, Shenzhen, Guangdong, People’s Republic of China
| | - Xiaolin Peng
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease, Shenzhen, Guangdong, People’s Republic of China
| | - Hongen Chen
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease, Shenzhen, Guangdong, People’s Republic of China
| | - Dan Zhao
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease, Shenzhen, Guangdong, People’s Republic of China
| | - Shan Xu
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease, Shenzhen, Guangdong, People’s Republic of China
| | - Li Wang
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease, Shenzhen, Guangdong, People’s Republic of China
| | - Ming Zhang
- Department of Epidemiology and Health Statistics, Shenzhen University Health Science Center, Shenzhen, Guangdong, People’s Republic of China
| | - Dongsheng Hu
- Department of Epidemiology and Health Statistics, Shenzhen University Health Science Center, Shenzhen, Guangdong, People’s Republic of China
| | - Fulan Hu
- Department of Epidemiology and Health Statistics, Shenzhen University Health Science Center, Shenzhen, Guangdong, People’s Republic of China
- Correspondence should be addressed to F Hu:
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Zhao Y, Sun H, Wang B, Zhang M, Luo X, Ren Y, Zhou J, Han C, Wang C, Li L, Zhang L, Pang C, Yin L, Feng T, Zhao J, Hu D. Impaired fasting glucose predicts the development of hypertension over 6years in female adults: Results from the rural Chinese cohort study. J Diabetes Complications 2017; 31:1090-1095. [PMID: 28433447 DOI: 10.1016/j.jdiacomp.2017.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/17/2017] [Accepted: 04/06/2017] [Indexed: 12/28/2022]
Abstract
AIMS To investigate whether impaired fasting glucose (IFG) is an independent risk factor for incident hypertension in a rural Chinese population. METHODS We selected 9583 eligible participants 18 to 75years old, who were without hypertension and diabetes at baseline (from 2007 to 2008) and were from a rural area in the middle of China. Concentration of fasting glucose at baseline was assessed in quartiles to predict hypertension risk by gender. Odds ratios (ORs) and 95% confidence intervals (CIs) for IFG (fasting glucose of 100 to 125mg/dl) associated with hypertension were estimated by logistic regression models. RESULTS Risk of hypertension was increased for females with glucose levels in quartile 2 (90-96mg/dl), quartile 3 (96-102mg/dl), and quartile 4 (102-125mg/dl) versus quartile 1 (<90mg/dl): OR=1.27 (95% CI=1.01-1.60), 1.30 (1.04-1.63), and 1.55 (1.24-1.93), respectively. During the 6-year follow-up, the cumulative incidence of hypertension was greater for people with IFG than normal fasting glucose (NFG) at baseline (23.9% vs 18.4%, p<0.001 for males and 23.8% vs 16.4%, p<0.001 for females). Risk of incident hypertension was significantly increased for females with IFG versus NFG (OR=1.23 95% CI=1.05-1.45). CONCLUSIONS IFG may be an independent risk factor for hypertension in normotensive nondiabetic Chinese females.
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Affiliation(s)
- Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| | - Haohang Sun
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| | - Bingyuan Wang
- The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China; Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China.
| | - Ming Zhang
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China.
| | - Xinping Luo
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China.
| | - Yongcheng Ren
- The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China; Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China.
| | - Junmei Zhou
- The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China; Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China.
| | - Chengyi Han
- The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China; Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China.
| | - Chongjian Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| | - Linlin Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| | - Lu Zhang
- The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China; Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, People's Republic of China.
| | - Chao Pang
- Department of Prevention and Health Care, Military Hospital of Henan Province, Zhengzhou, Henan, People's Republic of China.
| | - Lei Yin
- Department of Prevention and Health Care, Military Hospital of Henan Province, Zhengzhou, Henan, People's Republic of China.
| | - Tianping Feng
- Department of Prevention and Health Care, Military Hospital of Henan Province, Zhengzhou, Henan, People's Republic of China.
| | - Jingzhi Zhao
- Department of Prevention and Health Care, Military Hospital of Henan Province, Zhengzhou, Henan, People's Republic of China.
| | - Dongsheng Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
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Huang CL, Chang HW, Chang JB, Chen JH, Lin JD, Wu CZ, Pei D, Hung YJ, Lee CH, Chen YL, Hsieh CH. Normal fasting plasma glucose predicts type 2 diabetes and cardiovascular disease in elderly population in Taiwan. QJM 2016; 109:515-22. [PMID: 26576838 PMCID: PMC4986423 DOI: 10.1093/qjmed/hcv204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/20/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hyperglycemia increases prevalence of metabolic syndrome (MetS), type 2 diabetes (T2D) and cardiovascular disease (CVD). But the role of normoglycemia on the development of T2D and CVD in elderly population remains unclear. AIM To determine an optimal cut-off for fasting plasma glucose (FPG) to predict MetS and subsequent risk of T2D and CVD in an elderly Taiwanese population with normal FPG levels. DESIGN Two stages included cross-sectional (Stage 1) and prospective (Stage 2) cohort study. METHODS In Stage 1 18 287 subjects aged ≥60 years were enrolled; of these, 5039 without T2D and CVD advanced to Stage 2 and a mean follow-up of 3.8 years. MetS components were analysed, and in Stage 1, FPG cut-offs for MetS risk were calculated using receiver operating characteristic (ROC) curve analyses. In Stage 2, subjects without T2D and CVD in Stage 1 were classified into high-FPG and low-FPG groups based on cut-offs, and sex specific differences in incidence for T2D and CVD were calculated. RESULTS ROC curve analysis gave an optimal FPG cut-off for MetS of 93 mg/dl and 92 mg/dl for males and females, respectively. The high-FPG group had a 1.599- and 1.353-fold higher chance of developing T2D compared with the low-FPG group for males and females, respectively (95% CI: 1.606-2.721 and 1.000-1.831, P = 0.015 and 0.05). The high-FPG group had a 1.24-fold higher chance of developing CVD for females (95% CI: 1.015-1.515, P = 0.035); however, there was no difference for males. CONCLUSIONS Our results suggest that FPG within the normal range was associated with MetS, and elderly subjects with high normal levels have a higher incidence of developing T2D for both sexes, and CVD for females, over the short-term.
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Affiliation(s)
- C-L Huang
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - H-W Chang
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - J-B Chang
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - J-H Chen
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - J-D Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Shuang-Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - C-Z Wu
- Division of Endocrinology and Metabolism, Cardinal Tien Hospital, New Taipei City, Taiwan and
| | - D Pei
- Division of Endocrinology and Metabolism, Cardinal Tien Hospital, New Taipei City, Taiwan and
| | - Y-J Hung
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - C-H Lee
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Y-L Chen
- Department of Pathology, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - C-H Hsieh
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Wei SH, Lin JD, Hsu CH, Wu CZ, Hsieh CH, Pei D, Chang JB, Liang YJ, Hsia TL, Chen YL. Higher normal range of fasting plasma glucose still has a higher risk for metabolic syndrome: a combined cross-sectional and longitudinal study in elderly. Int J Clin Pract 2015; 69:863-70. [PMID: 25757152 DOI: 10.1111/ijcp.12633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION It is well known that higher fasting plasma glucose (FPG) is associated with metabolic syndrome (MetS). This relationship still exists even the FPG is within the normal range. However, most of these studies did not exclude subjects who were on medications which would affect the results of the studies. At the same time, there is no longitudinal study done to validate this correlation, especially in elderly. In this study, the relationships between normal FPG and MetS were evaluated. METHOD We randomly selected 57,517 subjects who were ≥ 60-years old from health screening centre. In the first part of study, subjects were enrolled in the cross-sectional study to find out the optimal cut-off value of FPG with higher chances to have MetS. In the second part of current study, subjects with MetS at baseline were excluded from the same study group, and performed a median 5.3-year longitudinal study. RESULTS There were 18,287 subjects enrolled in this study. In the first part of study, the cross-sectional study, optimal cut-off values of FPG were determined by the ROC curve and the sensitivity for these cut-off values were 56.6% in men and 60.9% in women, respectively. The result showed that lower FPG is healthier than the higher (log-rank test, p < 0.001). During the follow-up period, 5039 subjects showed hazard ratios of 2.09 for men and 1.884 for women developing future MetS. CONCLUSION Our study is the first longitudinal design in elderly and showed that older subjects with higher FPG proved to have higher risk of Mets even the FPG is still within its normal range.
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Affiliation(s)
- S-H Wei
- Department of Family Medicine, School of Medicine, Cardinal Tien Hospital, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - J-D Lin
- Division of Endocrinology and Metabolism, Department of Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - C-H Hsu
- Department of Family Medicine, School of Medicine, Cardinal Tien Hospital, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - C-Z Wu
- Division of Endocrinology and Metabolism, Department of Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - C-H Hsieh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - D Pei
- Department of Internal Medicine, School of Medicine, Cardinal Tien Hospital, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - J-B Chang
- Division of Clinical Pathology, Department of Pathology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Y-J Liang
- Department of Life-Science, Fu-Jen Catholic University, Taipei, Taiwan
| | - T-L Hsia
- Department of Internal Medicine, School of Medicine, Cardinal Tien Hospital, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Y-L Chen
- Department of Pathology, School of Medicine, Cardinal Tien Hospital, Fu-Jen Catholic University, New Taipei City, Taiwan
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Ren L, Gu B, Du Y, Wu X, Liu X, Wang H, Jiang L, Guo Y, Wang J. Hemoglobin in normal range, the lower the better?-Evidence from a study from Chinese community-dwelling participants. J Thorac Dis 2014; 6:477-82. [PMID: 24822106 DOI: 10.3978/j.issn.2072-1439.2014.02.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 02/26/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To examine the association between hemoglobin (Hb) levels and cardiovascular risk factors in a large community-dwelling cohort. METHODS A total of 4,186 women and 4,851 men were enrolled in the study. Data on personal history, physical examination and biochemical parameters were collected. Subjects were categorized by gender and divided into different group according to the level of Hb or blood pressure, and the association between Hb levels and cardiovascular risk factors was examined using Pearson's correlation analysis. RESULTS In both men and women even with normal Hb level, tertiles of Hb levels were positively associated with body mass index (BMI), total-cholesterol (TC), triglyceride (TG), uric acid (UA), diastolic blood pressures (DBP) and fasting plasma glucose (FPG) (all P=0.000 in men and women). Furthermore, significantly increased incidence of hyperuricemia (P=0.000 both in men and women) and obesity (P=0.000 both in men and women) were observed with the gradually increased Hb level. In addition, Pearson's correlation analysis revealed obvious correlation between Hb level and various cardiovascular risk factors including blood pressure and UA. Binary logistic regression analysis further demonstrated that the level of Hb was an important risk factor for elevated blood pressure (OR =1.216; 95% CI: 1.138-1.293, P=0.000 in men; OR =1.287; 95% CI: 1.229-1.363, P=0.000 in women). CONCLUSIONS Increasing Hb levels, even in subjects with normal level were associated with increasing prevalence of cardiovascular risk factors, suggesting that a slightly low Hb level might be beneficial to Chinese community-dwelling individuals.
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Affiliation(s)
- Lianxiang Ren
- 1 Department of Medical Examination Center, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 211100, China ; 2 Department of Laboratory Medicine, 3 Department of Neurology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Clinical Laboratory Medicine, BenQ Medical Center, Nanjing 210019, China ; 5 Department of Pathogen Biology, Nanjing Medical University, Nanjing 210029, China ; 6 Department of Gerontology, 7 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 8 Department of Laboratory Medicine, Jiangsu Shengze Hospital, Wujiang 215228, China
| | - Bing Gu
- 1 Department of Medical Examination Center, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 211100, China ; 2 Department of Laboratory Medicine, 3 Department of Neurology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Clinical Laboratory Medicine, BenQ Medical Center, Nanjing 210019, China ; 5 Department of Pathogen Biology, Nanjing Medical University, Nanjing 210029, China ; 6 Department of Gerontology, 7 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 8 Department of Laboratory Medicine, Jiangsu Shengze Hospital, Wujiang 215228, China
| | - Yixing Du
- 1 Department of Medical Examination Center, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 211100, China ; 2 Department of Laboratory Medicine, 3 Department of Neurology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Clinical Laboratory Medicine, BenQ Medical Center, Nanjing 210019, China ; 5 Department of Pathogen Biology, Nanjing Medical University, Nanjing 210029, China ; 6 Department of Gerontology, 7 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 8 Department of Laboratory Medicine, Jiangsu Shengze Hospital, Wujiang 215228, China
| | - Xin Wu
- 1 Department of Medical Examination Center, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 211100, China ; 2 Department of Laboratory Medicine, 3 Department of Neurology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Clinical Laboratory Medicine, BenQ Medical Center, Nanjing 210019, China ; 5 Department of Pathogen Biology, Nanjing Medical University, Nanjing 210029, China ; 6 Department of Gerontology, 7 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 8 Department of Laboratory Medicine, Jiangsu Shengze Hospital, Wujiang 215228, China
| | - Xinjian Liu
- 1 Department of Medical Examination Center, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 211100, China ; 2 Department of Laboratory Medicine, 3 Department of Neurology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Clinical Laboratory Medicine, BenQ Medical Center, Nanjing 210019, China ; 5 Department of Pathogen Biology, Nanjing Medical University, Nanjing 210029, China ; 6 Department of Gerontology, 7 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 8 Department of Laboratory Medicine, Jiangsu Shengze Hospital, Wujiang 215228, China
| | - Hui Wang
- 1 Department of Medical Examination Center, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 211100, China ; 2 Department of Laboratory Medicine, 3 Department of Neurology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Clinical Laboratory Medicine, BenQ Medical Center, Nanjing 210019, China ; 5 Department of Pathogen Biology, Nanjing Medical University, Nanjing 210029, China ; 6 Department of Gerontology, 7 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 8 Department of Laboratory Medicine, Jiangsu Shengze Hospital, Wujiang 215228, China
| | - Li Jiang
- 1 Department of Medical Examination Center, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 211100, China ; 2 Department of Laboratory Medicine, 3 Department of Neurology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Clinical Laboratory Medicine, BenQ Medical Center, Nanjing 210019, China ; 5 Department of Pathogen Biology, Nanjing Medical University, Nanjing 210029, China ; 6 Department of Gerontology, 7 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 8 Department of Laboratory Medicine, Jiangsu Shengze Hospital, Wujiang 215228, China
| | - Yan Guo
- 1 Department of Medical Examination Center, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 211100, China ; 2 Department of Laboratory Medicine, 3 Department of Neurology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Clinical Laboratory Medicine, BenQ Medical Center, Nanjing 210019, China ; 5 Department of Pathogen Biology, Nanjing Medical University, Nanjing 210029, China ; 6 Department of Gerontology, 7 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 8 Department of Laboratory Medicine, Jiangsu Shengze Hospital, Wujiang 215228, China
| | - Junhong Wang
- 1 Department of Medical Examination Center, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 211100, China ; 2 Department of Laboratory Medicine, 3 Department of Neurology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Clinical Laboratory Medicine, BenQ Medical Center, Nanjing 210019, China ; 5 Department of Pathogen Biology, Nanjing Medical University, Nanjing 210029, China ; 6 Department of Gerontology, 7 Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 8 Department of Laboratory Medicine, Jiangsu Shengze Hospital, Wujiang 215228, China
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Lian WC, Lin JD, Hsia TL, Hsu CH, Wu CZ, Hsieh CH, Pei D, Chen YL. Metabolic syndrome in normoglycaemic elderly men. Int J Clin Pract 2013; 67:964-70. [PMID: 24073972 DOI: 10.1111/ijcp.12166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 03/10/2013] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Type-2 diabetes is mainly the metabolic defect involving multiple organs. To conclude their intricate relationships, the term 'ominous octet' had been proposed to denote this phenomenon. In this study, we enrolled older men without any medications for MetS components to further elucidate the relationships between normoglycaemic state and MetS. METHODS We enrolled male subjects with FPG less than 100 mg/dl and aged 65 and older undergoing routine health check-ups in Taiwan. After excluding subjects taking medications that might affect the components of MetS, a total of 6679 men were eligible for the analysis. Study subjects were further grouped into FPG tertiles (< 91 mg/dl, 92-95 mg/dl and > 95 mg/dl for tertil 1, tertil 2 and tertil 3, respectively). RESULTS There was a significant trend between the FPG and percentages of subjects having MetS (p = 0.009). The relationships between the MetS components were higher in FPG 2 and FPG 3 than FPG 1. In simple correlation, all of the MetS and LDL-C were positively correlated with FPG level and multiple regression further confirmed the same result except for HDL-C that became non-significant. Subjects in FPG3 had significantly higher ORs (ORs = 1.19) for having MetS than those in FPG1. CONCLUSIONS In conclusion, higher FPG still had higher risk of having MetS in normoglycaemic range in elderly male. More strict FPG level control may be valuable in CVD prevention and warrants further investigations.
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Affiliation(s)
- W-C Lian
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital and School of Medicine, Tzu Chi University, Hualian, Taiwan
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Hsiao FC, Hsieh CH, Wu CZ, Hsu CH, Lin JD, Lee TI, Pei D, Chen YL. Elevated fasting glucose levels within normal range are associated with an increased risk of metabolic syndrome in older women. Eur J Intern Med 2013; 24:425-9. [PMID: 23647841 DOI: 10.1016/j.ejim.2013.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 03/19/2013] [Accepted: 03/21/2013] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The prevalence of cardiovascular disease (CVD) and metabolic syndrome (MetS) increases with increasing fasting plasma glucose (FPG) levels in an elderly population with pre-diabetes or diabetes. However, it remains unknown whether the relationship between elevated FPG and increased risks of MetS exists in older women with normoglycemia (FPG<100mg/dL). Therefore, the present study was conducted to fill the lack of information in that area. MATERIALS AND METHODS We included 6505 apparently healthy women, aged 65years and older, with normoglycemia who participated in routine health checkups at health screening centers in Taiwan. Components of MetS (FPG, waist circumference (WC), high-density lipoprotein cholesterol (HDL-C), triglycerides, and systolic/diastolic blood pressure), body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), total cholesterol, and percentage body fat (PBF) were examined in all subjects. RESULTS Subjects were sub-grouped by FPG levels (<90mg/dL, 91-95mg/dL and >95mg/dL for group 1, group 2 and group 3, respectively). Subjects in group 2 and group 3 were 1.22-fold (P=0.017) and 1.25-fold (P=0.007) more likely to have MetS compared with those in group 1. Age, WC, BMI, PBF, systolic and diastolic blood pressure, total cholesterol, triglycerides, and HDL-C were significantly correlated with FPG, whereas HDL-C was negatively correlated with FPG. In a multivariate stepwise regression analysis, PBF, LDL-C, triglycerides, and age were significantly and independently associated with FPG. CONCLUSION Among older women, the risk of MetS was significantly associated with elevated FPG even for subjects with normal FPG. Lifestyle interventions for reducing PBF and controlling dyslipidemia could help reduce the risk of MetS in this population.
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Affiliation(s)
- Fone-Ching Hsiao
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Kakafika AI, Mikhailidis DP, Karagiannis A, Athyros VG. The Role of Endocannabinoid System Blockade in the Treatment of the Metabolic Syndrome. J Clin Pharmacol 2013; 47:642-52. [PMID: 17392496 DOI: 10.1177/0091270007299358] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This review considers the use of the first selective blocker of the cannabinoid receptor type 1, rimonabant, to reduce weight and improve cardiovascular disease risk factors in obese patients with metabolic syndrome or multiple cardiovascular disease risk factors. In 4 large trials-Rimonabant in Obesity (RIO)-Lipids, RIO-Europe, RIO-North America, and RIO-Diabetes-after 1 to 2 years of treatment, rimonabant (20 mg/day) led to a significantly greater weight loss and reduction in waist circumference compared with placebo. Treatment with rimonabant was also associated with other favorable changes, including better glycemic control in type 2 diabetes mellitus, improved lipid profile, reduced blood pressure, increased adiponectin levels, fall in high-sensitivity C-reactive protein concentrations, and an overall decrease in the prevalence of the metabolic syndrome. Initial experience with rimonabant shows that it is generally well tolerated with the most common side effect of mild nausea. Rimonabant may be a useful adjunct to lifestyle and behavior modification in the treatment of obese subjects with metabolic syndrome or multiple cardiometabolic risk factors.
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Affiliation(s)
- Anna I Kakafika
- FFPM, FRCP, FRCPath, Department of Clinical Biochemistry, Royal Free Hospital, Royal Free University College School of Medicine, Pond Street, London NW3 2QG, United Kingdom
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Jin YL, Zhu T, Xu L, Zhang WS, Liu B, Jiang CQ, Yu H, Huang LM, Cheng KK, Thomas GN, Lam TH. Uric acid levels, even in the normal range, are associated with increased cardiovascular risk: the Guangzhou Biobank Cohort Study. Int J Cardiol 2013; 168:2238-41. [PMID: 23453878 DOI: 10.1016/j.ijcard.2013.01.214] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 01/18/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To examine the association between serum uric acid (UA) levels and cardiovascular risk factors in subjects without diabetes or hyperuricemia. METHODS 6172 women and 2662 men aged 50+ years without diabetes from Phase 1 of the Guangzhou Biobank Cohort Study were included. Data on personal history, physical examination and biochemical parameters were collected. Subjects were categorized by serum UA concentration, and the association between UA levels and cardiovascular risk factors was examined using generalized linear models. RESULTS In both men and women with normouricemia (UA<420 μmol/l in men and <360 μmol/l in women), tertiles of UA levels were adversely associated with body mass index, waist circumference, waist-to-hip ratio, total- and HDL-cholesterol, apolipoprotein A1, systolic and diastolic blood pressures, pulse pressure, fasting plasma glucose and white blood cell count (P value for trend ranged from 0.04 to <0.001), and also consistently associated with metabolic disorders including obesity, hypertension, hypertension treatment, dyslipidemia, waist circumference increased since the age of 18 years and the metabolic syndrome (P value for trend ranged from 0.02 to <0.001). CONCLUSION Increasing UA levels, even in subjects with normouricemia and without diabetes, were associated with increasing prevalence of cardiovascular risk factors, suggesting that clinically dichotomous definition of hyperuricemia may be inadequate and high-normal value of UA may warn of metabolic disorders.
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Affiliation(s)
- Ya Li Jin
- Guangzhou No.12 Hospital, Guangzhou, China
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Elwell-Sutton TM, Jiang CQ, Zhang WS, Cheng KK, Lam TH, Leung GM, Schooling CM. Inequality and inequity in access to health care and treatment for chronic conditions in China: the Guangzhou Biobank Cohort Study. Health Policy Plan 2012; 28:467-79. [DOI: 10.1093/heapol/czs077] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zhang L, Qiao Q, Tuomilehto J, Hammar N, Alberti KGMM, Eliasson M, Heine RJ, Stehouwer CDA, Ruotolo G. Blood lipid levels in relation to glucose status in European men and women without a prior history of diabetes: the DECODE Study. Diabetes Res Clin Pract 2008; 82:364-77. [PMID: 18922596 DOI: 10.1016/j.diabres.2008.08.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 08/22/2008] [Accepted: 08/26/2008] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Dyslipidaemia is present not only in diabetic but also in prediabetic subjects. The purpose of this study is to investigate the relationship between lipid and glucose levels in a large European population without a prior history of diabetes. RESEARCH DESIGN AND METHODS Data from the population-based studies of 8960 men and 10,516 women aged 35-74 years representing 15 cohorts in 8 European countries were jointly analyzed. Multivariate adjusted linear regression analyses with standardized coefficients (beta) were performed to estimate the relationship between lipid and plasma glucose. RESULTS In subjects without a prior history of diabetes, positive relationships were shown between fasting plasma glucose (FPG) and total cholesterol (TC) (beta=0.06 and 0.03, respectively for men and women, p<0.01), triglycerides (TG) (beta=0.14 and 0.12, p<0.001), non-high-density lipoprotein cholesterol (non-HDL-C) (beta=0.06 and 0.03, p<0.01) and TC to HDL ratio (beta=0.06 and 0.05, p<0.001) but a negative trend between FPG and HDL-C (beta=-0.02, p>0.05 in men and beta=-0.03, p<0.05 in women). The relationship between lipid and 2-h plasma glucose (2hPG) followed a similar pattern as that for FPG, except that TC was not increased and HDL-C was reduced in both sexes in subjects with impaired glucose tolerance (IGT). CONCLUSIONS For cardiovascular prevention, the different lipid patterns between impaired fasting glucose (IFG) and IGT may deserve further attention to evaluate the combined risks of dyslipidaemia and elevated glucose levels below the diagnostic threshold of diabetes.
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Affiliation(s)
- L Zhang
- Department of Public Health, University of Helsinki, Helsinki, Finland.
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Relationship between the metabolic syndrome and the development of hypertension in the Hong Kong Cardiovascular Risk Factor Prevalence Study-2 (CRISPS2). Am J Hypertens 2008; 21:17-22. [PMID: 18091739 DOI: 10.1038/ajh.2007.19] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The metabolic syndrome is a predictor of diabetes and coronary events. We hypothesized that it also predicts hypertension. METHODS A total of 1,944 subjects (901 men and 1,043 women; age 46 +/- 12 years) from the Hong Kong Cardiovascular Risk Factor Prevalence Survey were recruited in 1995-1996 and restudied in 2000-2004. The prevalence of hypertension and factors predicting its development were determined. RESULTS In 2000-2004, hypertension was found in 23.2% of the men and 17.2% of the women. Of the 1,602 subjects who were normotensive at baseline, 258 subjects developed hypertension after a median interval of 6.4 years. According to the National Cholesterol Education Program (NCEP) and International Diabetes Federation (IDF) criteria, the hazard ratios associated with the metabolic syndrome were 1.89 (95% confidence interval (CI): 1.41-2.54) and 1.72 (95% CI: 1.24-2.39), respectively. The positive and negative predictive values of the metabolic syndrome for identifying subjects who will develop hypertension in this population were 34.7 and 85.4% (NCEP criteria), and 33.1 and 85.5% (IDF criteria), respectively. The development of hypertension was related to the number of components of the metabolic syndrome (other than raised blood pressure), present in men (P = 0.003) and in women (P = 0.001). Using multivariate analysis, age, baseline systolic blood pressure (SBP), body mass index (BMI), and the triglycerides/high-density lipoprotein (HDL) ratio were found to be significant predictors of the development of hypertension. Compared with optimal blood pressure, the hazards of developing hypertension associated with normal or high-normal blood pressure were 2.31 (95% CI: 1.68-3.17) and 3.48 (95% CI: 2.52-4.81), respectively. CONCLUSIONS Blood pressure, when not optimal, is the predominant predictor of hypertension. The metabolic syndrome contributes to the risk, especially when blood pressure is optimal.
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Abstract
While obesity has a high prevalence in developed countries, the routine abnormalities seen from the clinical biochemistry laboratory that may be caused by obesity related pathology do not seem to be as common. Insulin resistance, which is often associated with obesity, is difficult to assess as formal procedures are too complex for clinical practice. Furthermore the interpretation of insulin levels is hampered by their in vivo variability, assay differences and the lack of reference intervals from an unaffected reference population. Interpretation of fasting glucose levels between 5.5 and 6.0mmol/L are also being debated however, it is useful to understand the age related changes in this parameter, which may also be due to increasing obesity in the reference population. The association of obesity and dyslipidaemia in the metabolic syndrome should focus on elevated triglycerides (>1.5mmol/L), which is associated with low HDLC and correlates with atherogenic small dense LDL. High triglycerides are also predictive of fatty liver and the common abnormality of an elevated ALT may not be appreciated if laboratories allow their reference intervals to increase as the population gets more obese with aging. SHBG levels fall with insulin resistance/hyperinsulinaemia and this needs to be taken into account when testosterone is measured. However, low SHBG is showing huge potential as a disease and prognostic marker in obesity. These commonly available tests provide useful insights for the obese patient and their utility may improve with future research into the growing problem of obesity.
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Jiang C, Thomas GN, Lam TH, Schooling CM, Zhang W, Lao X, Adab P, Liu B, Leung GM, Cheng KK. Cohort profile: The Guangzhou Biobank Cohort Study, a Guangzhou-Hong Kong-Birmingham collaboration. Int J Epidemiol 2006; 35:844-52. [PMID: 16844769 DOI: 10.1093/ije/dyl131] [Citation(s) in RCA: 179] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Chaoqiang Jiang
- Guangzhou Occupational Disease Prevention and Treatment Centre, Guangzhou No. 12 Hospital, Guangzhou, People's Republic of China
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