Insulin Resistance Syndrome

The triglycerides-glucose index and the triglycerides to high-density lipoprotein cholesterol ratio are both effective predictors of in-hospital death in non-diabetic patients with AMI

Background

The triglycerides-glucose index (TyG) and the triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) are simple indicators for assessing insulin resistance in epidemiological studies. We aimed to clarify the relationship between indicators of insulin resistance and prognosis in non-diabetic acute myocardial infarction (AMI) patients.

Methods

A total of 1,648 AMI patients without diabetes were enrolled from the Department of Cardiology, Zhongda Hospital, between 2012.03 and 2018.12. The medical history, laboratory and imaging data of patients were collected through the medical record system, and all-cause death events were recorded. Pearson analysis was used to study the correlation among different variables. Logistic regression analysis was used to analyze the predictive effect of TyG and TG/HDL-C in in-hospital death of AMI patients.

Results

1. In AMI group, the TyG index was significantly increased in death groups compared to no-death groups (P = 0.025). TG/HDL-C was not significantly increased in the death group of AMI patients (P = 0.588). The patients were respectively divided into Q1-Q4 groups and T1-T4 groups according to the quartiles of TyG and TG/HDL-C. The trends of in-hospital mortality in the Q4 group of TyG and T4 group of TG/HDL-C were higher than in other groups, although these differences were not significant. 2. Pearson correlation analysis showed that TyG was positively correlated with lipid-related markers, including ApoB (r = 0.248, P < 0.001), total cholesterol (TC) (r = 0.270, P < 0.001), low-density lipoprotein cholesterol (LDL-C) (r = 0.238, P < 0.001). Spearman analysis showed that TG/HDL-C was also positively associated with TC (r = 0.107, P < 0.001), ApoB (r = 0.180, P < 0.001) and LDL-C (r = 0.164, P < 0.001). 3. Logistic regression analysis showed that TyG (OR = 3.106, 95% CI [2.122-4.547], P < 0.001) and TG/HDL-C (OR = 1.167, 95% CI [1.062-1.282], P = 0.001) were both important factors to predict the in-hospital death of AMI patients without diabetes.

Conclusions

TyG index and TG/HDL-C, as emerged simple markers of insulin resistance, were both important predictors of in-hospital death in AMI patients without diabetes.

Potential Effects of Soy Isoflavones on the Prevention of Metabolic Syndrome

Isoflavones are polyphenols primarily contained in soybean. As phytoestrogens, isoflavones exert beneficial effects on various chronic diseases. Metabolic syndrome increases the risk of death due to arteriosclerosis in individuals with various pathological conditions, including obesity, hypertension, hyperglycemia, and dyslipidemia. Although the health benefits of soybean-derived isoflavones are widely known, their beneficial effects on the pathogenesis of metabolic syndrome are incompletely understood. This review aims to describe the association between soybean-derived isoflavone intake and the risk of metabolic syndrome development. We reviewed studies on soy isoflavones, particularly daidzein and genistein, and metabolic syndrome, using PubMed, ScienceDirect, and Web of Science. We describe the pathological characteristics of metabolic syndrome, including those contributing to multiple pathological conditions. Furthermore, we summarize the effects of soybean-derived daidzein and genistein on metabolic syndrome reported in human epidemiological studies and experiments using in vitro and in vivo models. In particular, we emphasize the role of soy isoflavones in metabolic syndrome-induced cardiovascular diseases. In conclusion, this review focuses on the potential of soy isoflavones to prevent metabolic syndrome by influencing the onset of hypertension, hyperglycemia, dyslipidemia, and arteriosclerosis and discusses the anti-inflammatory effects of isoflavones.

Diabetes and atherothrombosis: The circadian rhythm and role of melatonin in vascular protection

Obesity-related euglycaemic insulin resistance clusters with cardiometabolic risk factors, contributing to the development of both type 2 diabetes and cardiovascular disease. An increased thrombotic tendency in diabetes stems from platelet hyperactivity, enhanced activity of prothrombotic coagulation factors and impaired fibrinolysis. Furthermore, a low-grade inflammatory response and increased oxidative stress accelerate the atherosclerotic process and, together with an enhanced thrombotic environment, result in premature and more severe cardiovascular disease. The disruption of circadian cycles in man secondary to chronic obesity and loss of circadian cues is implicated in the increased risk of developing diabetes and cardiovascular disease. Levels of melatonin, the endogenous synchronizer of circadian rhythm, are reduced in individuals with vascular disease and those with deranged glucose metabolism. The anti-inflammatory, antihypertensive, antioxidative and antithrombotic activities of melatonin make it a potential therapeutic agent to reduce the risk of vascular occlusive disease in diabetes. The mechanisms behind melatonin-associated reduction in procoagulant response are not fully known. Current evidence suggests that melatonin inhibits platelet aggregation and might affect the coagulation cascade, altering fibrin clot structure and/or resistance to fibrinolysis. Large-scale clinical trials are warranted to investigate the effects of modulating the circadian clock on insulin resistance, glycaemia and cardiovascular outcome.

Trelagliptin succinate: DPP-4 inhibitor to improve insulin resistance in adipocytes

Trelagliptin inhibits the enzyme dipeptidyl-4 (DPP-4) to treat type 2 diabetes and it may possess the potential to improve insulin resistance. However, the molecular mechanism is not known. In this study, the effect of trelagliptin succinate in improving insulin resistance was investigated. The differentiation system of 3T3-L1 mouse preadipocytes was used to determine the content of adipokines and the content of GLUT4 in the outer membrane. The expression of AKT, P-AKT, IRS-1 and P-IRS-1 in differentiated 3T3-L1 adipocytes was determined by western blotting. Our results demonstrated that trelagliptin succinate increased the expression of AKT, P-AKT, IRS-1 and P-IRS-1 in the PI-3K/AKT insulin signaling pathway. These events promote the trans-membrane function of GLUT4 and concomitant glucose intake in adipocytes. In addition, the secretion of free fatty acids and resistin were decreased. In conclusion, our study suggested that trelagliptin succinate improved insulin resistance in adipocytes via regulation of PI-3K/AKT/GLUT4 insulin signaling pathway.

Antiplatelet, anticoagulant, and fibrinolytic activity in vitro of extracts from selected fruits and vegetables

A diet rich in fruits and vegetables is known to decrease the risk of cardiovascular disease. However, the information regarding the antithrombotic activity (antiplatelet, anticoagulant, and fibrinolytic) of fruits and vegetables is scarce. The aim of this study was to assess the antithrombotic activity of extracts from fruits and vegetables widely consumed in central Chile. The study included samples of 19 fruits and 26 vegetables, representative of the local diet. The extracts prepared from each sample included an aqueous (juice or pressed solubles) and/or methanol-soluble fraction. The extracts were evaluated for antiplatelet, anticoagulant, and fibrinolytic activity in vitro at a final concentration of 1 mg/ml. The antiplatelet activity was assessed by platelet aggregation inhibition; anticoagulant activity was measured by the prothrombin time (PT), diluted prothrombin time (dPT), activated partial thromboplastin time (APTT), kaolin clotting time (KCT), and thrombin time. The fibrinolytic effect was determined with the euglobin clot lysis time and fibrin plate methods. Extracts of green beans and tomatoes inhibited platelet aggregation induced by ADP and arachidonic acid, in a concentration-dependent manner. The methanolic extracts of grapes prolonged the PT and dPT. Finally, extracts of raspberry prolonged the APTT and also presented fibrinolytic activity. In conclusion, from a screening that included a variety of fruits and vegetables, we found antiplatelet activity in green beans and tomatoes, anticoagulant activities in grapes and raspberries, whereas fibrinolytic activity was observed only in raspberries. Further investigations are necessary to advance in knowledge of the active compounds of these fruits and vegetables and their mechanisms of action.

Metabolic syndrome as a risk factor for nonalcoholic fatty liver disease

BACKGROUND

Metabolic syndrome has been linked to nonalcoholic fatty liver disease (NAFLD).

OBJECTIVES

The purpose of the current study was to evaluate metabolic syndrome as a risk factor for NAFLD in Taiwanese adults.

METHODS

A cross-sectional study was conducted in which 876 subjects were enrolled. The diagnosis of NAFLD was made by abdominal ultrasonography. The Asia-Pacific modification of the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines was used to establish the diagnosis of metabolic syndrome.

RESULTS

NAFLD was diagnosed in 373 (42.6%) of the study population. Metabolic syndrome was diagnosed in 202 (23.1%) of the study population, and it was independently associated with NAFLD (odds ratio [OR] = 2.37; P < 0.001). Among the components of metabolic syndrome, hypertriglyceridemia (OR = 2.24; P < 0.001), hyperglycemia (OR = 2.23; P = 0.001), increased waist circumference (OR = 1.76; P = 0.013), and the diagnostic components of metabolic syndrome were independently associated with NAFLD.

CONCLUSION

Metabolic syndrome and some of its diagnostic components are independent risk factors for NAFLD.

Modifying Women’s Risk for Cardiovascular Disease

OBJECTIVE

To present current recommendations for cardiovascular disease risk reduction in women.

DATA SOURCES

Medline databases were searched from 1990 to 2006 using keywords women and cardiovascular risk, hypertension, cholesterol, and hormone replacement therapy, as well as Web sites from scientific associations such as the American Heart Association, American College of Cardiology, Agency for Health Research and Quality, and the Centers for Disease Control for relevant scientific statements and guidelines.

STUDY SELECTION

Randomized controlled trials, particularly those that have influenced current practice recommendations, scientific statements, and clinical practice guidelines were selected.

DATA EXTRACTION AND SYNTHESIS

Factors contributing to women's particular risk and current practice recommendations.

CONCLUSIONS

Current research has clarified the importance of regular exercise (at least 30 minutes/day most days of the week); abstinence from smoking; a diet focused on whole grains, fruits, vegetables, and low-fat protein sources; and maintenance of normal weight. This lifestyle combined with a partnership with a health care provider to maintain a normal blood pressure (115/75 mm Hg) and optimal lipoproteins through pharmacotherapy when indicated can prevent 82% of cardiovascular disease events in women.

Risk indicators of metabolic syndrome in young adults: A preliminary investigation on the influence of tobacco smoke exposure and gender

BACKGROUND

Metabolic syndrome is characterized by hypertension, dyslipidemia, insulin resistance, and obesity. Limited investigations have studied early indicators of metabolic syndrome in healthy young adults before diagnosis of disease.

PURPOSE

The purpose of this investigation is to identify shifts in cardiovascular (CV), metabolic, and immune variables consistent with metabolic syndrome but occurring before development of the disorder, and to determine whether these variables are influenced by gender or cigarette smoking.

METHODS

A pilot study of 41 subjects ages 18 to 39 years, with 20 smokers and 21 nonsmokers, was undertaken. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured to evaluate CV status; cholesterol, body mass index, leptin, percent glycated albumin, and homocysteine were measured to evaluate metabolic status; C-reactive protein, interleukin-1beta, and interleukin-10 were measured to evaluate immunologic status. Risk scores were assigned to each indicator, and total risk score was computed.

RESULTS

Men had higher SBP (P<.001), DBP (P=.046), and body mass index (P=.01), whereas women had higher leptin (P=.002). Total risk scores in men were greater (P=.02). There was no effect of smoking on risk score, related to the increase in two risks for smokers (SBP, P=.04, DBP; P=.027) reciprocated by a decrease in another (percentage of glycated albumin; P=.02).

CONCLUSION

Risk factors contributing to metabolic syndrome are present and highest in young men compared with women, whereas the effects of cigarette smoking on the syndrome are mixed. Early intervention to reduce modifiable risks may prevent full expression of disease.