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Abe S, Haruyama Y, Kobashi G, Toyoda S, Inoue T, Tomiyama H, Ishizu T, Kohro T, Higashi Y, Takase B, Suzuki T, Ueda S, Yamazaki T, Furumoto T, Kario K, Koba S, Takemoto Y, Hano T, Sata M, Ishibashi Y, Node K, Maemura K, Ohya Y, Furukawa T, Ito H, Yamashina A. Effect of Novel Stratified Lipid Risk by "LDL-Window" and Flow-Mediated Dilation on the Prognosis of Coronary Artery Disease Using the FMD-J Study A Data. Circ J 2022; 86:1444-1454. [PMID: 35871575 DOI: 10.1253/circj.cj-21-1068] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
BACKGROUND Elevated levels of triglyceride (TG) and non-high-density lipoprotein cholesterol (non-HDL-C) are regarded as a residual lipid risk in low-density lipoprotein cholesterol (LDL-C)-lowering therapy. This study investigated the association between lipid risk stratified by TG and non-HDL-C and the prognosis of patients with coronary artery disease (CAD), and the association between stratified lipid risk and flow-mediated dilatation (FMD) index. METHODS AND RESULTS The 624 CAD patients enrolled in flow-mediated dilation (FMD)-J study A were divided into 4 groups: low-risk group (n=413) with TG <150 mg/dL and non-HDL-C <170 mg/dL; hyper-TG group (n=180) with TG ≥150 mg/dL and non-HDL-C <170 mg/dL; hyper-non-HDL group (n=12) with TG <150 mg/dL and non-HDL-C ≥170 mg/dL; and high-risk group (n=19) with TG ≥150 mg/dL and non-HDL-C ≥170 mg/dL. Comparison of the groups showed the cumulative incidence of a 3-point major adverse cardiovascular event (MACE) was different and highest in the high-risk group in all the patients (P=0.009), and in patients with a FMD index ≥7.0% (P=0.021), but not in those with a FMD index <7.0%. Multivariable regression analysis showed that high lipid risk (P=0.019) and FMD <7.0% (P=0.040) were independently correlated with the incidence of a 3-point MACE. CONCLUSIONS Novel stratification of lipid risk, simply using TG and non-HDL-C levels, combined with FMD measurement, is useful for predicting cardiovascular outcomes in patients with CAD.
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Affiliation(s)
- Shichiro Abe
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine
| | - Yasuo Haruyama
- Center for Research Collaboration and Support, Dokkyo Medical University School of Medicine
- Department of Public Health, Dokkyo Medical University School of Medicine
| | - Gen Kobashi
- Center for Research Collaboration and Support, Dokkyo Medical University School of Medicine
- Department of Public Health, Dokkyo Medical University School of Medicine
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine
- Nasu Red Cross Hospital
| | | | - Tomoko Ishizu
- Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba
| | - Takahide Kohro
- Department of Hospital Planning and Management, Medical Informatics, Jichi Medical University School of Medicine
| | - Yukihito Higashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine
| | - Bonpei Takase
- Division of Biomedical Engineering, National Defense Medical College Research Institute
| | - Toru Suzuki
- Cardiovascular Medicine, University of Leicester
| | - Shinichiro Ueda
- Department of Clinical Pharmacology and Therapeutics, University of the Ryukyus School of Medicine
| | - Tsutomu Yamazaki
- Department of Clinical Epidemiology and Systems, Faculty of Medicine, The University of Tokyo
| | | | - Kazuomi Kario
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine
| | - Shinji Koba
- Department of Medicine, Division of Cardiology, Showa University School of Medicine
| | - Yasuhiko Takemoto
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine
| | - Takuzo Hano
- Department of Medical Education and Population-based Medicine, Postgraduate School of Medicine, Wakayama Medical University
| | - Masataka Sata
- Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School
| | - Yutaka Ishibashi
- Department of General Medicine, Shimane University Faculty of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Koji Maemura
- Department of Cardiovascular Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University
| | - Yusuke Ohya
- The Third Department of Internal Medicine, University of the Ryukyus
| | - Taiji Furukawa
- Department of Internal Medicine, Teikyo University School of Medicine
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
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Bonikowske AR, Barillas Lara MI, Koepp KE, Medina Inojosa JR, Squires RW, Lopez-Jimenez F, Olson TP. Fat Mass Index Better Identifies Metabolic Syndrome: Insights from Patients in Early Outpatient Cardiac Rehabilitation. J Clin Med 2019; 8:jcm8122147. [PMID: 31817309 PMCID: PMC6947316 DOI: 10.3390/jcm8122147] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/22/2019] [Accepted: 12/02/2019] [Indexed: 12/29/2022] Open
Abstract
Body mass index (BMI) does not differentiate fat and lean mass or the distribution of adipose tissue. The purpose of this study was to examine the prevalence of metabolic syndrome (MetS) among patients entering outpatient cardiac rehabilitation (CR) across fat mass index (FMI) categories compared with BMI. This retrospective cross-sectional study evaluated dual-energy x-ray absorptiometry in 483 CR patients from 1 January 2014, through 31 December 2017. Clinical data were extracted from the electronic health record. Patients were grouped by FMI and BMI categories. Mean (SD) age of patients was 64.3 (14) years. The normal FMI category had 15 patients; excess fat, 74; and obese, 384. In contrast, 93, 174, and 216 were in the normal, overweight, and obese BMI categories, respectively. Prevalence of MetS was 0 (0%) in normal, 5 (1%) in excess fat, and 167 (54%) in obese FMI, with 97% in the obese category. MetS prevalence was 4 patients (0.8%) in normal, 39 (8%) in overweight, and 129 (27%) in obese BMI categories, with 75% of MetS in the obese category. FMI more accurately classified CR patients with metabolically abnormal fat (p < 0.001). FMI is a more sensitive index than BMI for metabolically abnormal fat of outpatient CR patients.
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Kim JW, Ko YC, Seo TB, Kim YP. Effect of circuit training on body composition, physical fitness, and metabolic syndrome risk factors in obese female college students. J Exerc Rehabil 2018; 14:460-465. [PMID: 30018934 PMCID: PMC6028228 DOI: 10.12965/jer.1836194.097] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/07/2018] [Indexed: 12/28/2022] Open
Abstract
The purpose of this study was to investigate the effect of a 12-week circuit training program on health-related physical fitness and metabolic syndrome risk factors in obese female college students. Twenty subjects with over 30% of accumulated body fat voluntarily participated and were randomly allocated to the control group (n=10) or circuit training group (n=10). The circuit training program consisted of 10 types of resistance and aerobic exercise and was performed 3 times per week for 12 weeks. Health-related physical fitness and metabolic syndrome risk factors were analyzed to elucidate the effect of the circuit training. Significant differences between groups were determined with two-way repeated analysis of variance and paired t-test. As a result of this study, body weight, % body fat, and body mass index in the circuit training group was significantly decreased compared to the control group. All health-related physical fitness indicators such as back strength, sit-up, sit-and-reach, and 1,600 m running time showed relative effects between groups or over time. Among the metabolic syndrome risk factors, waist measurement, triglyceride, and total cholesterol were significantly decreased but blood glucose, high-density lipo-protein cholesterol and low-density lipoprotein cholesterol did not show any significant difference. Therefore, the present data suggested that circuit training for 12 weeks may be effective in improving physical fitness and preventing metabolic diseases.
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Affiliation(s)
- Ji-Woon Kim
- Department of Kinesiology, College of Natural Science, Jeju National University, Jeju, Korea
| | - Yeong-Chan Ko
- Department of Kinesiology, College of Natural Science, Jeju National University, Jeju, Korea
| | - Tae-Beom Seo
- Department of Kinesiology, College of Natural Science, Jeju National University, Jeju, Korea
| | - Young-Pyo Kim
- Department of Kinesiology, College of Natural Science, Jeju National University, Jeju, Korea
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Ketterl TG, Chow EJ, Leisenring WM, Goodman P, Koves IH, Petryk A, Steinberger J, Baker KS. Adipokines, Inflammation, and Adiposity in Hematopoietic Cell Transplantation Survivors. Biol Blood Marrow Transplant 2018; 24:622-626. [PMID: 29197678 PMCID: PMC5831197 DOI: 10.1016/j.bbmt.2017.11.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022]
Abstract
Adult survivors of acute leukemia in childhood have a higher-than-expected frequency of obesity and are at increased risk for metabolic syndrome and early mortality from cardiovascular disease (CVD). Adipose tissue has been recognized as an endocrine and paracrine organ that secretes various adipokines involved in metabolic regulation and inflammatory processes. In this study, we examined inflammatory factors (IL-6 and TNF-α) and adipokines (adiponectin, leptin), in addition to body composition and adiposity, in cancer survivors who underwent hematopoietic cell transplantation (HCT) during childhood compared with sibling controls. Over 2-year survivors of HCT for hematologic malignancies during childhood were recruited from 2 institutions along with a control population of siblings. Participants underwent evaluation for body composition, anthropometric measurements, and assessment of CVD risk factors and adipokines. Cases were stratified by radiation exposure in the preparative regimen (total body irradiation [TBI] + central nervous system [CNS] irradiation, TBI only, chemotherapy only) and adjusted least squares means were estimated for each adipokine and adjusted by age, sex, race, Tanner stage, and percent fat mass (PFM) percentiles (0-24, 25-74, 75+). A total of 151 HCT survivors and 92 siblings underwent evaluation. Significant differences in mean adipokine levels were detected between survivors and siblings; leptin was significantly higher and adiponectin significantly lower in HCT survivors who received TBI with or without CNS irradiation compared with siblings. IL-6 was significantly higher in all groups of HCT survivors compared with siblings. Body mass index (BMI) was similar in survivors and controls, although PFM was significantly higher in all groups of HCT survivors and lean body mass (LBM) was lower in survivors who received TBI with or without CNS radiation compared with siblings. HCT survivors showed an unfavorable profile of inflammation, adipokines, and adiposity, despite similar BMI as controls. Higher PFM and lower LBM may contribute to these findings. TBI exposure is correlated with greater severity of these observations. Increasing LBM may represent a tangible target for mitigating the high cardiometabolic risks of HCT survivors.
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Affiliation(s)
- Tyler G Ketterl
- Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Eric J Chow
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Pam Goodman
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ildi H Koves
- Seattle Children's Hospital, Seattle, Washington
| | - Anna Petryk
- University of Minnesota Medical Center, Minneapolis, Minnesota
| | | | - K Scott Baker
- Fred Hutchinson Cancer Research Center, Seattle, Washington
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Aguirre GA, De Ita JR, de la Garza RG, Castilla-Cortazar I. Insulin-like growth factor-1 deficiency and metabolic syndrome. J Transl Med 2016; 14:3. [PMID: 26733412 PMCID: PMC4702316 DOI: 10.1186/s12967-015-0762-z] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/26/2015] [Indexed: 02/06/2023] Open
Abstract
Consistent evidence associates IGF-1 deficiency and metabolic syndrome. In this review, we will focus on the metabolic effects of IGF-1, the concept of metabolic syndrome and its clinical manifestations (impaired lipid profile, insulin resistance, increased glucose levels, obesity, and cardiovascular disease), discussing whether IGF-1 replacement therapy could be a beneficial strategy for these patients. The search plan was made in Medline for Pubmed with the following mesh terms: IGF-1 and "metabolism, carbohydrate, lipids, proteins, amino acids, metabolic syndrome, cardiovascular disease, diabetes" between the years 1963-2015. The search includes animal and human protocols. In this review we discuss the relevant actions of IGF-1 on metabolism and the implication of IGF-1 deficiency in the establishment of metabolic syndrome. Multiple studies (in vitro and in vivo) demonstrate the association between IGF-1 deficit and deregulated lipid metabolism, cardiovascular disease, diabetes, and an altered metabolic profile of diabetic patients. Based on the available data we propose IGF-1 as a key hormone in the pathophysiology of metabolic syndrome; due to its implications in the metabolism of carbohydrates and lipids. Previous data demonstrates how IGF-1 can be an effective option in the treatment of this worldwide increasing condition. It has to distinguished that the replacement therapy should be only undertaken to restore the physiological levels, never to exceed physiological ranges.
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Affiliation(s)
- G A Aguirre
- Escuela de Medicina, Tecnologico de Monterrey, Avenida Morones Prieto No. 3000 Pte. Col. Los Doctores, 64710, Monterrey, Nuevo León, Mexico.
| | - J Rodríguez De Ita
- Escuela de Medicina, Tecnologico de Monterrey, Avenida Morones Prieto No. 3000 Pte. Col. Los Doctores, 64710, Monterrey, Nuevo León, Mexico.
| | - R G de la Garza
- Escuela de Medicina, Tecnologico de Monterrey, Avenida Morones Prieto No. 3000 Pte. Col. Los Doctores, 64710, Monterrey, Nuevo León, Mexico.
| | - I Castilla-Cortazar
- Escuela de Medicina, Tecnologico de Monterrey, Avenida Morones Prieto No. 3000 Pte. Col. Los Doctores, 64710, Monterrey, Nuevo León, Mexico.
- Fundación de Investigación HM Hospitales, Madrid, Spain.
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Kim JY, Choi EY, Mun HS, Min PK, Yoon YW, Lee BK, Hong BK, Rim SJ, Kwon HM. Usefulness of metabolic syndrome score in the prediction of angiographic coronary artery disease severity according to the presence of diabetes mellitus: relation with inflammatory markers and adipokines. Cardiovasc Diabetol 2013; 12:140. [PMID: 24088407 PMCID: PMC3850730 DOI: 10.1186/1475-2840-12-140] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 09/25/2013] [Indexed: 12/05/2022] Open
Abstract
Background It is a matter of debate whether metabolic syndrome (MS) improves cardiovascular risk prediction beyond the risk associated with its individual components. The present study examined the association of MS score with high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), resistin, adiponectin, and angiographic coronary artery disease (CAD) severity according to the presence of DM. In addition, the predictive value of various clinical and biochemical parameters were analyzed, including the MS score for angiographic CAD. Methods The study enrolled 363 consecutive patients (196 men, 62 ± 11 years of age) who underwent coronary angiography for evaluation of chest pain. Blood samples were taken prior to elective coronary angiography. MS was defined by the National Cholesterol Education Program criteria, with MS score defined as the numbers of MS components. CAD was defined as > 50% luminal diameter stenosis of at least one major epicardial coronary artery. CAD severity was assessed using the Gensini score. Results Of the 363 patients studied, 174 (48%) had CAD and 178 (49%) were diagnosed with MS. When the patients were divided into 4 subgroups according to MS score (0–1, 2, 3, 4–5), IL-6 levels and the CAD severity as assessed by the Gensini score increased as MS scores increased. In contrast, adiponectin levels decreased significantly as MS scores increased. When subjects were divided into two groups according to the presence of DM, the relationships between MS score and IL-6, adiponectin, and Gensini score were maintained only in patients without DM. Age, smoking, DM, MS score, and adiponectin independently predicted angiographic CAD in the whole population. However, age is the only predictor for angiographic CAD in patients with DM. Conclusions In the presence of DM, neither adipokines nor MS score predicted angiographic CAD. However, in non-diabetic patients, IL-6 and adiponectin showed progressive changes according to MS score, and MS score was an independent predictor of CAD in patients without DM.
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Affiliation(s)
- Jong-Youn Kim
- Cardiology Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea.
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Angeloni E, Melina G, Benedetto U, Refice S, Capuano F, Roscitano A, Comito C, Sinatra R. Metabolic Syndrome Affects Midterm Outcome After Coronary Artery Bypass Grafting. Ann Thorac Surg 2012; 93:537-44. [DOI: 10.1016/j.athoracsur.2011.10.066] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 10/22/2011] [Accepted: 10/25/2011] [Indexed: 10/14/2022]
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Lahoz C, Mostaza JM, Mantilla MT, Taboada M, Tranche S, López-Rodríguez I, Monteiro B, Sánchez-Zamorano MA, Martín-Jadraque R. [Prevalence of metabolic syndrome in patients with stable coronary disease: therapeutic objectives and utilization of cardiovascular drugs]. Rev Clin Esp 2010; 211:1-8. [PMID: 21196002 DOI: 10.1016/j.rce.2010.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 04/26/2010] [Accepted: 05/03/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The achievement of the therapeutic objectives in patients with ischemic heart disease and metabolic syndrome is unknown. This study has aimed to evaluate whether the prevalence of risk factors, the prescription rate of evidence-based cardiovascular therapies and the attainment of therapeutic goals differ in coronary patients with and without the metabolic syndrome (MS). METHODS A multicenter, cross-sectional study carried out with the participation of 7,600 patients with stable coronary heart disease (mean age 65.3 years, 82% males, 37.7% with MS) attended in primary care. Data on drug prescription and goal attainment were extracted from clinical records. MS was defined according to the National Cholesterol Education Program (NCEP) criteria. RESULTS Patients with MS had a higher prevalence of cardiovascular risk factors and cardiovascular disease. They also had a higher prescription rate of blood-pressure lowering drugs, statins and antidiabetic agents, without differences in the rate of use of antithrombotics and beta-blockers. After adjusting for cardiovascular risk factors and co-morbidity, only fibrates and angiotensin II receptor blockers were used more frequently in MS patients. A lower percentage of subjects with MS achieved therapeutic goals of LDL cholesterol (23.4% vs 27.7%, P<.001), blood pressure (29.1% vs 52.2%, P<.001) and, in diabetics, of glycated hemoglobin (54.7% vs 75.9%, P<.001). CONCLUSION Patients with stable coronary disease and MS do not reach therapeutic objectives as frequently as those without MS, in spite of receiving a higher amount of cardiovascular drugs.
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Affiliation(s)
- C Lahoz
- Unidad de Arteriosclerosis, Hospital Carlos III, Madrid, España.
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Konstantinou D, Chatzizisis Y, Louridas G, Parcharidis G, Giannoglou G. Non-diabetic hyperglycaemia correlates with angiographic coronary artery disease prevalence and severity. DIABETES & METABOLISM 2010; 36:402-8. [DOI: 10.1016/j.diabet.2010.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 04/25/2010] [Accepted: 04/26/2010] [Indexed: 11/29/2022]
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Kim JY, Mun HS, Lee BK, Yoon SB, Choi EY, Min PK, Yoon YW, Hong BK, Rim SJ, Kwon HM. Impact of metabolic syndrome and its individual components on the presence and severity of angiographic coronary artery disease. Yonsei Med J 2010; 51:676-82. [PMID: 20635441 PMCID: PMC2908873 DOI: 10.3349/ymj.2010.51.5.676] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Metabolic syndrome (MS) has been reported as a potential risk factor of coronary artery disease (CAD). The aims of this study were to assess whether there was a relationship between MS score and CAD angiographic severity, and to assess the predictive value of individual components of MS for CAD. MATERIALS AND METHODS We retrospectively enrolled 632 patients who underwent coronary angiography for suspected CAD (394 men, 61.0 +/- 10.6 years of age). MS was defined by the National Cholesterol Education Program criteria with the waist criterion modified into a body mass index (BMI) of more than 25 kg/m(2). The MS score defined as the number of MS components. CAD was defined as > 50% luminal diameter stenosis of at least one major epicardial coronary artery. CAD angiographic severity was evaluated with a Gensini scoring system. RESULTS Of the patients, 497 (78.6%) had CAD and 283 (44.8%) were diagnosed with MS. The MS score was significantly related to the Gensini score. High fasting blood glucose (FBG) was the only predictive factor for CAD. A cluster including high FBG, high blood pressure (BP), and low high-density lipoprotein cholesterol (HDL-C) showed the highest CAD risk. CONCLUSION The MS score correlates with the angiographic severity of CAD. The predictive ability of MS for CAD was carried almost completely by high FBG, and individual traits with high BP and low HDLC may act synergistically as risk factors for CAD.
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Affiliation(s)
- Jong-Youn Kim
- Cardiology Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee-Sun Mun
- Cardiology Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Kwon Lee
- Cardiology Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Bo Yoon
- Cardiology Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eui-Young Choi
- Cardiology Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Pil-Ki Min
- Cardiology Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Won Yoon
- Cardiology Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Bum-Kee Hong
- Cardiology Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se-Joong Rim
- Cardiology Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuck Moon Kwon
- Cardiology Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Giannoglou GD, Konstantinou DM, Kovatsi L, Chatzizisis YS, Mikhailidis DP. Association of reduced zinc status with angiographically severe coronary atherosclerosis: a pilot study. Angiology 2010; 61:449-55. [PMID: 20529979 DOI: 10.1177/0003319710366702] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In vitro studies attribute antiatherogenic and insulin-like properties to zinc (Zn). However, only a few conflicting clinical data exist concerning the relationship between Zn and coronary artery disease (CAD) as well as glycemic indices. We studied 72 patients without prior history of myocardial infarction or revascularization procedures, who underwent coronary angiography for evaluation of chest pain. Coronary artery disease severity was estimated using 3 angiographic scores. Zn in serum and 24-hour urine, as well as serum Zn/24-hour urine Zn ratio were determined. Serum Zn was not associated with CAD prevalence and severity. However, urinary Zn loss was significantly higher among patients with CAD and showed a positive association with CAD severity. Serum Zn/24-hour urine Zn ratio was inversely associated with CAD, as well as with diabetes mellitus prevalence, fasting glucose, and glycated hemoglobin levels. Low serum Zn/24-hour urine Zn ratio is associated with angiographically severe atherosclerosis and impaired glucose homeostasis.
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Affiliation(s)
- George D Giannoglou
- 1st Cardiology Department, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece.
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12
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Hu J, Wallace DC, Jones E, Liu H. Cardiometabolic health of Chinese older adults with diabetes living in Beijing, China. Public Health Nurs 2010; 26:500-11. [PMID: 19903270 DOI: 10.1111/j.1525-1446.2009.00810.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Using the PRECEDE-PROCEED model, this study examined the presence of metabolic syndrome and modifiable cardiovascular disease (CVD) risk factors associated with metabolic syndrome among Chinese adults with diabetes living in Beijing, China. DESIGN AND SAMPLE The cross-sectional study collected data through face-to-face interviews. The study included 73 Chinese older adults with diabetes. Their mean age was 68 years (+ or - 7.66), with a range from 52 to 90 years. MEASUREMENTS Data were collected on demographic characteristics, blood pressure (BP), body mass index (BMI), waist circumference, lipid profile and fasting glucose, physical activity, diet, and health status. RESULTS The great majority (85%) had metabolic syndrome; 65% had hypertension; 52% had high levels of low-density lipoproteins, and 80.6% had a high level of fasting glucose. Half of the participants (51.4%) were overweight, 16.7% were obese, and 86.3% had central obesity. Age, gender, BMI, income, insurance, smoking history, physical activity, and diet explained 23% of the variance in the metabolic syndrome component, systolic blood pressure. CONCLUSIONS The association of predisposing and enabling factors and health behavior with the metabolic syndrome needs to be further explored. Persons with diabetes should have regular health screenings to check for blood pressure, BMI, cholesterol, glucose, and triglycerides in order to decrease the risks associated with metabolic syndrome and CVD.
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Affiliation(s)
- Jie Hu
- The University of North Carolina at Greensboro, School of Nursing, PO Box 26170, Greensboro, NC 27402-6170,USA.
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Effects of light-to-moderate alcohol consumption on steatosis and steatohepatitis in severely obese patients. Eur J Gastroenterol Hepatol 2009; 21:969-72. [PMID: 19194305 DOI: 10.1097/meg.0b013e328328f3ec] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The effect of light-to-moderate alcohol consumption (LMAC) in nonalcoholic fatty liver disease (NAFLD) remains a controversial subject. The aim of this study was to evaluate the relationship between LMAC and the severity of NAFLD in morbidly obese patients. METHODS We studied 132 patients undergoing liver biopsy during bariatric surgery. The patients were divided into three groups: G1: alcohol intake greater than 20 g/day and less than 40 g/day; G2: alcohol intake less than 20 g/day; G3: no alcohol intake. Insulin resistance was defined by the Homeostasis Model Assessment (>3). NAFLD was classified according to the Matteoni types: type I: steatosis alone; type II: steatosis with inflammation; types III-IV: steatosis with ballooning and/or fibrosis. RESULTS The mean age was 37.3+/-11 years. Sixty-three percent were females and body mass index was 43.9+/-5.6 kg/m. G1, G2, and G3 included 19, 56, and 57 patients, respectively. Histological diagnoses classified by levels of alcohol were: G1: 10.5% normal liver, 89.5% type III or IV; G2: 10.7% normal liver, 1.8% type I or II, and 87.5% grade III or IV; G3: 10.5% normal liver, 3.5% type I or II, and 86% type III or IV (one had cirrhosis). The presence of IR was similar in moderate and no alcohol consumption (81.3 and 78.7%) but significantly less in the light consumption group (54%, P<0.05). CONCLUSION The results suggest that LMAC may have a protection effect against IR in severely obese patients. However, it had no impact on the severity of activity and stage of liver disease.
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Torres-Leal FL, Capitani MDD, Tirapegui J. The effect of physical exercise and caloric restriction on the components of metabolic syndrome. BRAZ J PHARM SCI 2009. [DOI: 10.1590/s1984-82502009000300003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Recent studies of the effects of physical exercise and caloric restriction have found several benefits on the metabolic and cardiovascular risk factors related to metabolic syndrome (MS). This review examines the current state of knowledge of the effects of physical exercise on the main pathologies associated with MS: obesity, insulin resistance, type 2 diabetes mellitus (DM2), dyslipidemias and hypertension. Although there are only a few randomized and controlled studies that evaluated the prevention and treatment of MS, strong evidence from controlled studies indicates that lifestyle changes that include regular physical exercise and caloric restriction are effective in preventing and treating DM2 in overweight individuals with reduced glucose tolerance. Likewise, epidemiologic studies suggest that regular physical exercise prevents the development of DM2 and cardiovascular disease. Based on current recommendations, it is important to increase the level of physical exercise at a moderate intensity to achieve good cardiorespiratory and muscular conditions and to promote fat mass reduction, with consequent reductions of risk of developing metabolic syndrome.
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Khader Y, Khatatbeh M, El-Salem K, Amarin Z, Bateiha A. The metabolic syndrome among patients undergoing cardiac catheterization in Jordan. ACTA ACUST UNITED AC 2009; 3:224-8. [PMID: 19040591 DOI: 10.1111/j.1559-4572.2008.00020.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study was conducted to determine the prevalence of the metabolic syndrome (MeS) and its associated factors among patients undergoing cardiac catheterization in north Jordan. A cross-sectional study was conducted among patients who underwent cardiac catheterization at King Abdullah University Hospital in north Jordan. Data from 360 patients were collected through personal interview, medical records, and anthropometric measurements. MeS was defined using National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and International Diabetes Federation (IDF) criteria. The prevalence of MeS among patients undergoing cardiac catheterization in north Jordan was 64.7% according to NCEP ATP III criteria and 76.7% according to IDF criteria. About 96.7% of the participants had at least 1 metabolic abnormality. Sex, body mass index, and family history of cardiovascular disease were the only variables significantly associated with MeS. The prevalence of MeS among patients undergoing cardiac catheterization in north Jordan is considerably high, especially among women.
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Affiliation(s)
- Yousef Khader
- Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science & Technology, Irbid, Jordan.
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Dunkley AJ, Taub NA, Davies MJ, Stone MA, Khunti K. Is having a family history of type 2 diabetes or cardiovascular disease a predictive factor for metabolic syndrome? Prim Care Diabetes 2009; 3:49-56. [PMID: 19268647 DOI: 10.1016/j.pcd.2009.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 02/01/2009] [Indexed: 12/29/2022]
Abstract
AIMS To determine whether a first degree family history (FH) of diabetes and/or a first degree FH of cardiovascular disease (CVD), can predict prevalent cases of metabolic syndrome (MetS). Also, to establish if the association is different for South Asians compared to White Europeans, and for obese compared to non-obese individuals. METHODS Cross-sectional data were analysed for a mixed-ethnic cohort of 3094 at-risk individuals, aged 40-75 years (29% South Asian), who were screened in Leicestershire (UK) for undiagnosed type 2 diabetes using an oral glucose tolerance test. Logistic regression was used to assess the relationship between FH and prevalent MetS, including adjustment for potential confounders. RESULTS Prevalence of MetS was 39%. Adjusted odds ratios (OR) showed that only a FH of CVD (OR 1.41, 95%CI: 1.18-1.68, p<0.001) was significantly associated with prevalent MetS. Interaction analysis showed no effect modification for obesity and ethnicity. We did not find any association for a FH of diabetes. CONCLUSIONS These findings suggest that a first degree FH of CVD predicts prevalent cases of MetS in a mixed-ethnic population. Evidence of an association may help to identify individuals who should be targeted for screening and early prevention of type 2 diabetes and CVD.
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Affiliation(s)
- Alison J Dunkley
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
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Long-term rates of cardiovascular events in patients with the metabolic syndrome according to severity of coronary-angiographic alterations. Coron Artery Dis 2009; 20:1-8. [DOI: 10.1097/mca.0b013e32831624a5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Cornier MA, Dabelea D, Hernandez TL, Lindstrom RC, Steig AJ, Stob NR, Van Pelt RE, Wang H, Eckel RH. The metabolic syndrome. Endocr Rev 2008; 29:777-822. [PMID: 18971485 PMCID: PMC5393149 DOI: 10.1210/er.2008-0024] [Citation(s) in RCA: 1257] [Impact Index Per Article: 78.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The "metabolic syndrome" (MetS) is a clustering of components that reflect overnutrition, sedentary lifestyles, and resultant excess adiposity. The MetS includes the clustering of abdominal obesity, insulin resistance, dyslipidemia, and elevated blood pressure and is associated with other comorbidities including the prothrombotic state, proinflammatory state, nonalcoholic fatty liver disease, and reproductive disorders. Because the MetS is a cluster of different conditions, and not a single disease, the development of multiple concurrent definitions has resulted. The prevalence of the MetS is increasing to epidemic proportions not only in the United States and the remainder of the urbanized world but also in developing nations. Most studies show that the MetS is associated with an approximate doubling of cardiovascular disease risk and a 5-fold increased risk for incident type 2 diabetes mellitus. Although it is unclear whether there is a unifying pathophysiological mechanism resulting in the MetS, abdominal adiposity and insulin resistance appear to be central to the MetS and its individual components. Lifestyle modification and weight loss should, therefore, be at the core of treating or preventing the MetS and its components. In addition, there is a general consensus that other cardiac risk factors should be aggressively managed in individuals with the MetS. Finally, in 2008 the MetS is an evolving concept that continues to be data driven and evidence based with revisions forthcoming.
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Affiliation(s)
- Marc-Andre Cornier
- University of Colorado Denver, Division of Endocrinology, Metabolism, and Diabetes, Mail Stop 8106, 12801 East 17 Avenue, Room 7103, Aurora, Colorado 80045, USA.
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Title LM, Lonn E, Charbonneau F, Fung M, Mather KJ, Verma S, Anderson TJ. Relationship between brachial artery flow-mediated dilatation, hyperemic shear stress, and the metabolic syndrome. Vasc Med 2008; 13:263-70. [DOI: 10.1177/1358863x08095154] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract Metabolic syndrome (MetSyn) may predispose to cardiovascular disease (CVD) by causing vascular dysfunction. This study aimed to determine the association of MetSyn with vascular function, as assessed by brachial artery flow-mediated dilatation (FMD) and hyperemic shear stress (HSS). A total of 1,417 male firefighters without established diabetes and CVD were classified for MetSyn, according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP) definition. MetSyn was present in 267 individuals (19%). Although FMD was lower in those with versus without MetSyn (8.1 ± 4.1 vs 8.7 ± 4.0%; p = 0.02), this was not significant after adjusting for baseline differences (age, smoking, and brachial artery diameter) ( p = 0.2). However, HSS was significantly lower in those with versus without MetSyn (72.0 ± 27.8 vs 80.9 ± 24.8 dyne/cm2; p < 0.001), and there was a significant inverse graded relationship with the number of NCEP criteria present (mean HSS for those with 0, 1, 2, 3, 4, and 5 criteria: 83.2 ± 22.5, 82.2 ± 24.7, 76.5 ± 27.2, 74.3 ± 27.4, 66.5 ± 28.4, 67.1 ± 27.6 dyne/cm2; p < 0.001 for trend). The individual NCEP criteria of abdominal obesity, systolic hypertension, and impaired fasting glucose were independent predictors for HSS. In conclusion, MetSyn was not associated with impaired FMD. Alternatively, HSS, a measure of microvascular function, was significantly lower in those with MetSyn. Thus, MetSyn may contribute to CVD by causing microvascular dysfunction.
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Affiliation(s)
- Lawrence M Title
- Division of Cardiology at Dalhousie University, Halifax, Nova Scotia, Canada
| | - Evan Lonn
- Division of Cardiology at McMaster University, Hamilton, Ontario, Canada
| | | | - Marinda Fung
- Division of Cardiology at University of Calgary, Calgary, Alberta, Canada
| | - Kieren J Mather
- Division of Endocrinology at Indiana University, Indianapolis, Indiana, USA
| | - Subodh Verma
- Division of Cardiovascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Todd J Anderson
- Division of Cardiology at University of Calgary, Calgary, Alberta, Canada
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Yavuz B, Kabakci G, Aksoy H, Tulumen E, Deveci OS, Aytemir K, Tokgozoglu L, Ozkutlu H, Nazli N, Oto A. Determining the relationship between metabolic syndrome score and angiographic severity of coronary artery disease. Int J Clin Pract 2008; 62:717-22. [PMID: 18266712 DOI: 10.1111/j.1742-1241.2008.01702.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cardiovascular disease is leading cause of mortality and morbidity in developed and developing countries. Metabolic syndrome (MS) is a risk factor for coronary artery disease (CAD). The effect of MS on angiographic severity of CAD is not well defined. The aim of this study was to examine the effect of MS on angiographic severity of CAD by using Gensini score. METHODS The total number of 1003 patients who underwent elective coronary angiography in catheter laboratory were included in the study. MS score based on National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria which ranged between zero and five were calculated for each subject. Gensini scores were determined by examining coronary angiograms of the patients. RESULTS The study population consisted of 634 (63%) male, and 369 (37%) female subjects. The mean age was 59 +/- 11. MS based on NCEP ATP III was present in 246 (25%) patients. CAD was present in 691 patients (69%). The median of Gensini score was five (0-192) in the total sample, 18 (1-192) in the patients with CAD and 25 (0-192) in the patients with MS. A positive correlation was found between MS score and Gensini score (r = 0.402, p < 0.001). CONCLUSIONS In this study, it was determined that as the severity of MS increases, the angiographic severity of CAD increases as well. Besides, the most important factor on Gensini score was diabetes mellitus in male and hypertension in female subjects.
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Affiliation(s)
- B Yavuz
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey.
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Kalantzi K, Korantzopoulos P, Tzimas P, Katsouras CS, Goudevenos JA, Milionis HJ. The relative value of metabolic syndrome and cardiovascular risk score estimates in premature acute coronary syndromes. Am Heart J 2008; 155:534-40. [PMID: 18294493 DOI: 10.1016/j.ahj.2007.10.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Accepted: 10/25/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND To compare the relative value of metabolic syndrome (MetS) and cardiovascular risk score estimates in patients with acute coronary syndromes (ACS) aged <45 years. PATIENTS AND METHODS Two hundred consecutive patients (183 men, mean age 40.8 +/- 3.5 years) presented with a first-ever ACS, and 200 age-and sex-matched controls were evaluated. Metabolic syndrome diagnostic criteria, European Risk SCORE estimation function, and the Framingham Risk Score (FRS) were assessed in all participants. RESULTS The prevalence of the MetS was significantly higher in the patients' group compared with the control group (51.5% vs 26.0%, P < .001). No subjects with a SCORE >1.0% were identified. The mean 10-year FRS for patients and controls was 13.03% +/- 7.96% and 10.02 +/- 8.10%, respectively (P < .001), whereas only 22.5% of ACS patients had a 10-year risk >20.0% compared with 14.5% of controls (P = .04). After controlling for potential confounders, MetS was associated with 1.93 (95% CI 1.13-3.28, P = .01) higher odds of having an ACS. Moreover, the odds had a positive association with the increasing cumulative number of MetS components. Crude and adjusted ORs for the FRS were 1.05 (95% CI 1.029-1.08, P = .001) and 0.98 (95% CI 0.92-1.05, P = NS), respectively. CONCLUSION Metabolic syndrome is highly associated with ACS in subjects <45 years of age and seems to be more valuable than established cardiovascular risk calculators.
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Chen Q, Liu Y, Yin Y, Huang W, Li G, Ke D. Relationship between metabolic syndrome (MS) and coronary heart disease (CHD) in an aged group. Arch Gerontol Geriatr 2008; 46:107-15. [PMID: 17482687 DOI: 10.1016/j.archger.2007.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Revised: 03/05/2007] [Accepted: 03/07/2007] [Indexed: 10/23/2022]
Abstract
Our study aimed at investigating the relationship between metabolic syndrome (MS) and coronary heart disease (CHD) in aged patients, including 125 patients (age> or =60 years). Of them 78 cases belonged to the CHD group, which were subdivided into the CHD-MS group (38 cases) and the simple CHD group (40 cases); the other 47 patients without CHD belonged to the non-CHD group, which were subdivided again into the MS group (11 cases) and the control group (36 cases). Body mass index (BMI), blood lipids, blood uric acid, plasma fibrinogen, blood glucose and blood pressure of every patient were detected. The anatomy of coronary vessels was analyzed by selective coronary angiography to evaluate the relationship between MS and CHD. We found that the prevalence of MS in CHD group was significantly higher as compared to the groups not suffering from CHD (p<0.01). The CHD-MS group showed a higher prevalence of multivessel disease (p<0.05), unstable lesions (p<0.05) and needed more revascularization procedures (p<0.05) than the simple CHD group. The prevalence of CHD and the number of blocked coronary vessels were directly correlated with MS by Spearman correlation analysis (r=0.225, p<0.05; r=0.361, p<0.01). Logistic regression analysis demonstrated that both the risk of having future CHD and the number of blocked coronary vessels were directly correlated with MS (p<0.01; p<0.01), suggesting that MS can predict the prevalence and extent of future CHD in the elderly.
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Affiliation(s)
- Qingwei Chen
- The Second Hospital of Chongqing Medical University, Department of Geriatrics, No. 74 Lin Jiang Road, Yuzhong District, 400010 Chongqing City, People's Republic of China.
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Milionis HJ, Kalantzi KJ, Papathanasiou AJ, Kosovitsas AA, Doumas MT, Goudevenos JA. Metabolic syndrome and risk of acute coronary syndromes in patients younger than 45 years of age. Coron Artery Dis 2007; 18:247-52. [PMID: 17496487 DOI: 10.1097/mca.0b013e328035f8c4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There is a paucity of data with regard to the association of the metabolic syndrome with cardiovascular risk in young adults. We investigated the association of the metabolic syndrome with acute coronary syndrome in adults aged 45 years or younger. PATIENTS AND METHODS A total of 136 consecutive patients (128 men and eight women; mean age, 41.2+/-3.7 years) presenting with a first-ever acute coronary syndrome, and 136 age-matched and sex-matched controls were evaluated. The diagnosis of the metabolic syndrome was established according to the Adult Treatment Panel III criteria. RESULTS The prevalence of the metabolic syndrome was significantly higher in the patients' group compared with the control group (40.4 versus 23.5%; P=0.003). Multivariate logistic regression analysis showed that smoking, positive family history of premature coronary artery disease, and the metabolic syndrome were associated with odds ratios 4.46 (95% confidence interval, 2.30-8.66; P<0.001), 3.11 (95% confidence interval, 1.71-5.66; P<0.001), and 1.97 (95% confidence interval, 1.08-3.56; P=0.02) higher odds, respectively, of having an acute coronary syndrome, after taking into account the matching for age and sex and controlling for potential confounders. Moreover, a 10-mg/dl increase in total cholesterol was associated with 1.06 higher odds of having an acute coronary syndrome. Analysis of interaction showed that smoking and a positive family history of premature coronary artery disease in young individuals with metabolic syndrome had an incremental effect on the odds of suffering an acute coronary syndrome (odds ratio, 7.12; 95% confidence interval, 2.42-20.96; P<0.001). CONCLUSION The metabolic syndrome is highly associated with acute coronary syndrome in patients younger than 45 years of age, indicating the need for early and intensive preventive measures.
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Affiliation(s)
- Haralampos J Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Greece.
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Echahidi N, Pibarot P, Després JP, Daigle JM, Mohty D, Voisine P, Baillot R, Mathieu P. Metabolic Syndrome Increases Operative Mortality in Patients Undergoing Coronary Artery Bypass Grafting Surgery. J Am Coll Cardiol 2007; 50:843-51. [PMID: 17719470 DOI: 10.1016/j.jacc.2007.04.075] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Revised: 04/12/2007] [Accepted: 04/24/2007] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The aim of this study was to determine the impact of the metabolic syndrome (MS) on operative mortality after a coronary artery bypass grafting surgery (CABG). BACKGROUND Diabetes and obesity are highly prevalent among patients undergoing CABG. However, it remains unclear whether these factors have a significant impact on operative mortality after this procedure. We hypothesized that the metabolic abnormalities associated with MS could negatively influence the operative outcome of CABG surgery. METHODS We retrospectively analyzed the data of 5,304 consecutive patients who underwent an isolated CABG procedure between 2000 and 2004. Of these 5,304 patients, 2,411 (46%) patients met the National Cholesterol Education Program-Adult Treatment Panel III criteria for MS. The primary end point was operative mortality. RESULTS The operative mortality after CABG surgery was 2.4% in patients with MS and 0.9% in patients without MS (p < 0.0001). The MS was a strong independent predictor of operative mortality (relative risk 3.04 [95% confidence interval (CI) 1.73 to 5.32], p = 0.0001). After adjusting for other risk factors, the risk of mortality was increased 2.69-fold (95% CI 1.43 to 5.06; p = 0.002) in patients with MS and diabetes and 2.36-fold (95% CI 1.26 to 4.41; p = 0.007) in patients with MS and no diabetes, whereas it was not significantly increased in the patients with diabetes and no MS. CONCLUSIONS This is the first study to report that MS is a highly prevalent and powerful risk factor for operative mortality in patients undergoing a CABG surgery. Thus, interventions that could contribute to reduce the prevalence of MS in patients with coronary artery disease or that could acutely modify the metabolic perturbations of MS at the time of CABG might substantially improve survival in these patients.
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Affiliation(s)
- Najmeddine Echahidi
- Department of Medicine, Centre de Recherche de l'Hôpital Laval/Institut de Cardiologie de Québec, Quebec, Canada
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Tyson GH, Rodriguez E, Elci OC, Koutlas TC, Chitwood WR, Ferguson TB, Kypson AP. Cardiac procedures in patients with a body mass index exceeding 45: outcomes and long-term results. Ann Thorac Surg 2007; 84:3-9; discussion 9. [PMID: 17588372 DOI: 10.1016/j.athoracsur.2007.03.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Revised: 03/08/2007] [Accepted: 03/09/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Obesity has become a public health crisis. Although prior studies in obese patients undergoing cardiac surgical procedures have shown variable effects on outcomes, data are limited for extremely obese patients (body mass index [BMI] > or = 45). We undertook this study to evaluate outcomes in this cohort. METHODS A retrospective analysis was performed on 14,571 patients in our database who underwent cardiac operations from 1992 to 2005. Patient demographics, comorbidities, and outcomes were recorded. A univariate analysis between two groups: BMI 21 to 34.9 and BMI 45 or more was performed. Logistic regression models were used to identify independent risk factors for 30-day mortality. Long-term follow-up of the extreme obese group was achieved. RESULTS We identified 128 extreme obese patients, and 480 patients with a BMI of 21.0 to 34.9 were randomly selected for comparison. Univariate analysis showed significant differences in age, gender, and multiple comorbidities, as well as in cardiopulmonary bypass and cross-clamp times, operative procedure, and transfusion requirements. Extreme obese patients had a higher incidence of infection, acute renal failure, and 30-day mortality. Logistic regression analysis showed BMI, preoperative renal insufficiency, and transfusion status to be independent risk factors for 30-day mortality. Follow-up data did not reveal significant functional improvements. Long-term survival was 33.6% at 12 years. CONCLUSIONS Extreme obese patients undergoing cardiac surgical procedures have higher perioperative morbidity and mortality compared with a lower BMI group. BMI and preoperative renal insufficiency increase mortality in both groups, whereas transfusion does so only in the extreme obese. These patients can realize acceptable outcomes from cardiac procedures, but continue to suffer from the comorbidities of obesity.
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Affiliation(s)
- G Hart Tyson
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina 27834, USA
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Chapidze G, Dolidze N, Enquobahrie DA, Kapanadze S, Latsabidze N, Williams MA. Metabolic syndrome and C-reactive protein among cardiology patients. Arch Med Res 2007; 38:783-8. [PMID: 17845899 DOI: 10.1016/j.arcmed.2007.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Accepted: 03/14/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND Associations between inflammation, metabolic syndrome (MetS), and cardiovascular disease have been reported. Limited information, however, is available on the prevalence of MetS and its relation to inflammation among Georgian cardiology patients. We investigated MetS components (elevated blood pressure, abdominal obesity, elevated triglyceride concentrations, decreased HDL-cholesterol concentrations, and elevated fasting glucose) and their relationships with C-reactive protein (CRP) concentrations in this population. METHODS A total of 167 patients (mean age 53.1 years, 54% male) who attended an Emergency Cardiology Center in Tbilisi, Republic of Georgia were enrolled in this cross-sectional study. In-person interviews and clinical exams, as well as laboratory studies, were conducted to characterize MetS (using the ATP III criteria) and cardiac conditions in the study population. CRP concentrations were determined using standardized immunoassays. RESULTS Overall prevalence of MetS was 40.7%. Patients with coronary heart disease (CHD) had higher CRP concentrations compared with non-CHD patients. A linear relationship between increase in number of MetS components and CRP concentrations was observed among females (p value for linear trend <0.05), but not males. Further, among females, all components of MetS except HDL-C concentrations were correlated with CRP concentrations after adjustment for age and body mass index (all p values <0.05). However, among males, only abdominal obesity was significantly correlated with CRP. CONCLUSIONS MetS is prevalent among Georgian cardiology patients. CRP concentrations are positively associated with MetS. Further prospective studies are required to determine whether combining MetS and CRP data may have utility in the assessment of risk for developing future cardiovascular events in both males and females.
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Sadeghian S, Darvish S, Salimi S, Esfehani FA, Fallah N, Mahmoodian M, Salarifar M, Karimi A. Metabolic syndrome: stronger association with coronary artery disease in young men in comparison with higher prevalence in young women. Coron Artery Dis 2007; 18:163-8. [PMID: 17429288 DOI: 10.1097/mca.0b013e328012a94f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Being overweight, a constituent of the metabolic syndrome, is also an important contributing factor to the development of coronary artery disease in younger patients, compared with the older patient population. Owing to the above-mentioned fact, we sought to assess the association of the metabolic syndrome with premature coronary artery disease. METHODS In an analytic cross-sectional study, 940 patients (553 women<or=55 years and 387 men<or=45 years), 637 with coronary artery disease and 303 without coronary artery disease, were evaluated. The extent of atherosclerosis was assessed with a clinical vessel score. Besides established coronary artery disease risk factors, all patients were evaluated for the presence of metabolic syndrome based on the National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS The overall prevalences of metabolic syndrome and coronary artery disease were 56 and 67.8%, respectively. Metabolic syndrome prevalence was higher in women than in men (69.6 vs. 36.4%, P<0.001). The odds ratio of metabolic syndrome for premature coronary artery disease was 1.82 (95% confidence interval 1.17-2.82) after adjusting for age and multiple established coronary artery disease risk factors; the strength of this association varied by sex (2.17 in men vs. 1.22 in women). CONCLUSIONS This study revealed a stronger association between metabolic syndrome and coronary artery disease in men<or=45 years than in women<or=55 years. It seems that endogenous estrogens may play a role in reducing the effects of metabolic syndrome-related risk and therefore in spite of higher prevalence of metabolic syndrome in young women, the effect of this syndrome on coronary artery disease is more dominant in young men.
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Affiliation(s)
- Saeed Sadeghian
- Research Department Tehran Heart Center, Tehran University of Medical Sciences, Shahed University, Tehran, Iran.
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The metabolic syndrome: An exercise in utility or futility? Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2007. [DOI: 10.1016/j.dsx.2006.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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The Metabolic Syndrome. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Turhan H, Yetkin E. Does metabolic syndrome attenuate the advantages of being a young woman regarding the risk of cardiovascular disease? Int J Cardiol 2007; 114:277-8. [PMID: 16600407 DOI: 10.1016/j.ijcard.2005.11.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Accepted: 11/15/2005] [Indexed: 10/24/2022]
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Aguilar D, Fisher MR, O'Connor CM, Dunne MW, Muhlestein JB, Yao L, Gupta S, Benner RJ, Cook TD, Edwards D, Pfeffer MA. Metabolic syndrome, C-reactive protein, and prognosis in patients with established coronary artery disease. Am Heart J 2006; 152:298-304. [PMID: 16875914 DOI: 10.1016/j.ahj.2005.11.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Accepted: 11/30/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prognosis associated with metabolic syndrome and high-sensitivity C-reactive protein (hs-CRP) in patients with stable coronary artery disease has not been well established. METHODS The WIZARD study was to determine the effects of 12 weeks of antibiotic therapy on coronary heart disease events in patients with stable coronary artery disease and known Chlamydia pneumoniae exposure. Baseline metabolic risk factors were available for 3319 patients enrolled from 1997 to 1998. The primary outcome was the first occurrence of death, recurrent myocardial infarction, coronary revascularization procedure, or hospitalization for angina. RESULTS Of the 3319 subjects, 825 patients experienced the primary outcome during the mean follow-up of 37 months. For the composite outcome, there was an increased hazard ratio (HR) for metabolic syndrome (HR 1.40, 95% CI 1.22-1.61) (unadjusted) and for hs-CRP (HR 1.60, 95% CI 1.38-1.85) (unadjusted). Both the metabolic syndrome and hs-CRP indicated, in a multivariable model including age and sex, an increased HR for the primary outcome (metabolic syndrome: HR 1.33, 95% CI 1.15-1.53; hs-CRP: HR 1.52, 95% CI 1.30-1.76). CONCLUSIONS Although related, the presence of the metabolic syndrome and increased levels of hs-CRP were associated with increased risk of adverse cardiovascular outcomes.
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Affiliation(s)
- David Aguilar
- Cardiology Division, Baylor College of Medicine, Houston, TX 77030, USA.
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Turhan H, Yetkin E, Kose S, Isik E. Does gender modify the detrimental coronary effects of metabolic syndrome? Int J Cardiol 2006; 110:261-2. [PMID: 16249040 DOI: 10.1016/j.ijcard.2005.07.045] [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] [Received: 06/26/2005] [Accepted: 07/24/2005] [Indexed: 11/26/2022]
Abstract
The association between metabolic syndrome and coronary artery disease, either clinical or subclinical, has been well established. There is also a consensus regarding the higher prevalence of metabolic syndrome in females compared with males with coronary artery disease. However, the impact of gender on the coronary artery disease severity has not been investigated in patients with metabolic syndrome. The available data have suggested no significant association between gender and the extent and severity of coronary artery disease.
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Grundy SM. Metabolic Syndrome: Connecting and Reconciling Cardiovascular and Diabetes Worlds. J Am Coll Cardiol 2006; 47:1093-100. [PMID: 16545636 DOI: 10.1016/j.jacc.2005.11.046] [Citation(s) in RCA: 393] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Revised: 10/28/2005] [Accepted: 11/01/2005] [Indexed: 12/18/2022]
Abstract
The metabolic syndrome is a constellation of risk factors of metabolic origin that are accompanied by increased risk for cardiovascular disease and type 2 diabetes. These risk factors are atherogenic dyslipidemia, elevated blood pressure, elevated plasma glucose, a prothrombotic state, and a proinflammatory state. The two major underlying risk factors for the metabolic syndrome are obesity and insulin resistance; exacerbating factors are physical inactivity, advancing age, and endocrine and genetic factors. The condition is progressive, beginning with borderline risk factors that eventually progress to categorical risk factors. In many patients, the metabolic syndrome culminates in type 2 diabetes, which further increases risk for cardiovascular disease. Primary treatment of the metabolic syndrome is lifestyle therapy--weight loss, increased physical activity, and anti-atherogenic diet. But as the condition progresses, drug therapies directed toward the individual risk factors might be required. Ultimately, it might be possible to develop drugs that will simultaneously modify all of the risk factors. At present such drugs are in development but so far have not reached the level of clinical practice.
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Affiliation(s)
- Scott M Grundy
- Center for Human Nutrition and Departments of Clinical Nutrition and Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9052, USA.
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Spies C, Otte C, Kanaya A, Pipkin SS, Schiller NB, Whooley MA. Association of metabolic syndrome with exercise capacity and heart rate recovery in patients with coronary heart disease in the heart and soul study. Am J Cardiol 2005; 95:1175-9. [PMID: 15877989 PMCID: PMC2776681 DOI: 10.1016/j.amjcard.2005.01.045] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2004] [Revised: 01/06/2005] [Accepted: 01/06/2005] [Indexed: 12/16/2022]
Abstract
It is not known whether the metabolic syndrome is associated with poor exercise capacity among patients who have established coronary heart disease. We evaluated the association of the metabolic syndrome with treadmill exercise capacity and heart rate recovery among patients who had coronary heart disease. We measured treadmill exercise capacity (METs) and heart rate recovery (beats per minute) in 943 subjects who had known coronary heart disease. Of these, 377 (40%) had the metabolic syndrome as defined by criteria of the National Cholesterol Education Program. Participants who had the metabolic syndrome were more likely to have poor exercise capacity (METs <5, 33% vs 18%, p <0.0001) and poor heart rate recovery (<or=16 beats/min, 34% vs 21%, p <0.0001) than those who did not have the metabolic syndrome. In ordinal logistic regression analyses, the metabolic syndrome was associated with decreased exercise capacity (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.7 to 2.8, p <0.0001) and decreased heart rate recovery (OR 1.8, 95% CI 1.4 to 2.3, p <0.0001). These associations remained strong after adjusting for potential confounding variables (OR 1.6, 95% CI 1.2 to 2.1, p = 0.003 for decreased exercise capacity; OR 1.4, 95% CI 1.1 to 1.9, p = 0.02 for decreased heart rate recovery). The metabolic syndrome is independently associated with poor exercise capacity and poor heart rate recovery in patients who have established coronary heart disease. Decreased exercise capacity may contribute to the adverse outcomes associated with the metabolic syndrome.
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Affiliation(s)
- Christian Spies
- Section of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
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Savage PD, Banzer JA, Balady GJ, Ades PA. Prevalence of metabolic syndrome in cardiac rehabilitation/secondary prevention programs. Am Heart J 2005; 149:627-31. [PMID: 15990744 DOI: 10.1016/j.ahj.2004.07.037] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Metabolic syndrome (MS) consists of a cluster of obesity-related risk factors that have been linked to the development and progression of coronary heart disease (CHD). The purpose of this study was to examine the prevalence of MS, as defined by the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol, in patients with CHD attending cardiac rehabilitation (CR) after a coronary event. METHODS We analyzed baseline data of 1912 individuals with established coronary artery disease entering CR in Burlington, Vt, and Boston, Mass. RESULTS Overall, 50% of patients entering CR have MS. A significantly greater percentage of women than men have MS (54% vs 48, respectively, P < .001). This is due to higher prevalence of abdominal obesity, high triglycerides, and hypertension (all, P < .05) in women. In women, the prevalence of MS peaked in the eighth decade vs the fifth decade in men. CONCLUSIONS The prevalence of MS in patients with CHD participating in CR is greater than twice that of the general population. The prevalence of MS is higher and occurs at an older age in women than men. This study highlights the need for CR programs to develop specific interventions to assist patients with risk factor modification primarily by targeting physical inactivity and weight control.
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Affiliation(s)
- Patrick D Savage
- Division of Cardiology, University of Vermont College of Medicine, Burlington, Vt, USA
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Mensah GA, Mokdad AH, Ford E, Narayan KMV, Giles WH, Vinicor F, Deedwania PC. Obesity, metabolic syndrome, and type 2 diabetes: emerging epidemics and their cardiovascular implications. Cardiol Clin 2005; 22:485-504. [PMID: 15501618 DOI: 10.1016/j.ccl.2004.06.005] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
As we enter the twenty-first century, the burden of chronic diseases, such as obesity, type 2 diabetes, and CVDs, is expected to increase dramatically. These diseases are a consequence of several factors that include an aging population,changes in demographic composition, and an excess of contemporary lifestyle. The prevention and control of overweight, obesity, metabolic syndrome, and diabetes pose special challenges for clinical and public heath practice as well as for basic, clinical, and population science research.
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Affiliation(s)
- George A Mensah
- National Center for Chronic Disease Prevention & Health Promotion, Centers for Disease Control and Prevention, Mailstop K-47, 4770 Buford Highway, NE, Atlanta, GA 30341, USA.
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Djoussé L, Arnett DK, Eckfeldt JH, Province MA, Singer MR, Ellison RC. Alcohol consumption and metabolic syndrome: does the type of beverage matter? ACTA ACUST UNITED AC 2005; 12:1375-85. [PMID: 15483202 DOI: 10.1038/oby.2004.174] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To examine the association between total and beverage-specific alcohol consumption and the prevalence odds of metabolic syndrome (MS). RESEARCH METHODS AND PROCEDURES Using a cross-sectional design, we studied 4510 white participants of the National Heart, Lung, and Blood Institute Family Heart Study. We used generalized estimating equations adjusting for age, education, risk group, smoking, physical activity, diabetes mellitus, coronary heart disease, energy intake, energy from fat, fruits, and vegetables, dietary cholesterol, dietary fiber, and use of multivitamins to estimate the prevalence odds of MS by alcohol intake. RESULTS Compared with never-drinkers, multivariate odds ratios (95% confidence interval) for MS were 1.12 (0.85 to 1.49), 0.68 (0.36 to 1.28), 0.72 (0.50 to 1.03), 0.66 (0.44 to 0.99), and 0.80 (0.55 to 1.16) among men who were former drinkers and who were current drinkers of 0.1 to 2.5, 2.6 to 12.0, 12.1 to 24.0, and >24.0 g/d of alcohol, respectively (p for linear trend 0.018). Corresponding values for women were 0.86 (0.69 to 1.09), 0.80 (0.43 to 1.34), 0.47 (0.33 to 0.66), 0.47 (0.30 to 0.74), and 0.39 (0.21 to 0.74), respectively (p for trend < 0.0001). The reduced prevalence odds of MS was observed across all beverage types: compared with never-drinkers, multivariate adjusted odds ratios (95% confidence interval) of MS were 0.32 (0.14 to 0.73), 0.42 (0.23 to 0.77), 0.57 (0.30 to 1.09), and 0.56 (0.36 to 0.88) for subjects who consumed >7 drinks/wk of wine only, beer only, spirits only, and more than one type of beverage, respectively. DISCUSSION Our data indicate that alcohol consumption is associated with a lower prevalence of MS irrespective of the type of beverage consumed. Prospective studies are needed to confirm these findings and to assess the influence of drinking patterns on the alcohol-MS association.
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Affiliation(s)
- Luc Djoussé
- Boston University School of Medicine, Room B-612, 715 Albany Street, Boston, Massachusetts 02118, USA.
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Abstract
Obesity has recently been linked to mortality from the majority of cancers. The insulin/insulin-like growth factor (IGF) system may partly explain this effect. The metabolic syndrome, associated with hyperinsulinemia, may modulate this effect. Recent evidence supports the role of insulin and IGF-1 as important growth factors, acting through the tyrosine kinase growth factor cascade in enhancing tumor cell proliferation. In addition, the metabolic syndrome associated with a chronic inflammatory state and accompanying cytokine abnormalities may also contribute to tumor progression. Growing links between insulin and the etiology as well as prognosis in colon, prostate, pancreatic, and, particularly, breast cancer are reviewed. Of particular concern is the evidence that elevated IGF-1 may interfere with cancer therapy, adversely affecting prognosis. The role of insulin is of concern because of the increasing levels of obesity and the associated metabolic syndrome. Weight gain, through typical Western diet; limited levels of activity; and, more recently, stress-related changes in neuroendocrine function may lead to insulin resistance and hyperinsulinemia. The opportunity for a multidisciplinary approach involving nutrition, exercise, and stress reduction in an integrative setting may be crucial to limiting the insulin-resistant state and improving cancer outcomes.
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Solymoss BC, Bourassa MG, Campeau L, Sniderman A, Marcil M, Lespérance J, Lévesque S, Varga S. Effect of increasing metabolic syndrome score on atherosclerotic risk profile and coronary artery disease angiographic severity. Am J Cardiol 2004; 93:159-64. [PMID: 14715340 DOI: 10.1016/j.amjcard.2003.09.032] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The metabolic syndrome (MS) is a frequent cause of coronary artery disease (CAD), and recently the National Cholesterol Education Program Adult Treatment Panel III suggested its diagnosis in the presence of 3 to 5 quantitatively defined markers. Because the consequences of the MS are likely related to the number and diversity of markers, we studied the relation between the number of markers-the MS score-and the degree of abdominal obesity, risk factor profile, and severity of CAD. One thousand one hundred eight subjects of a mostly white population with symptoms of CAD (793 men and 315 women; 58.1 +/- 9.8 years of age) were divided into 6 groups based on their MS scores. A low high-density lipoprotein cholesterol level was the most frequently observed marker, followed by increased blood pressure, triglycerides, waist circumference, and fasting glucose. As the MS score increased so did abdominal obesity, parameters of "nontraditional" dyslipidemia with surrogate markers of dense low-density lipoprotein and high-density lipoprotein particles, blood pressure, fasting glucose, insulin, and the homeostatic model assessment insulin resistance index. Similarly, an increasing MS score was significantly related to more severe coronary angiographic alterations and higher frequencies of unstable angina, myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting. Therefore, the MS score provides a clinically useful index of MS severity and the associated atherosclerotic risk factor profile. It also correlates with the angiographic severity of CAD and its clinical complications.
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Affiliation(s)
- B Charles Solymoss
- Montreal Heart Institute, McGill University Health Centre, Montreal, Quebec, Canada.
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