Association of Waist-Hip Ratio to Sudden Cardiac Death and Severe Coronary Atherosclerosis in Medicolegal Autopsies. Am J Forensic Med Pathol. 2017;38:226-228. [PMID: 28692479 DOI: 10.1097/paf.0000000000000330]

Prevalence of and factors associated with high atherogenic index among adults in Nairobi urban informal settlements: The AWI-Gen study

Dyslipidemia is an important cardiovascular disease predictor. Atherogenic index of plasma (AIP), a ratio of triglycerides (TG) to high density lipoprotein (HDL) cholesterol has been deemed to be more informative as a cardiovascular disease predictor compared to using any single predictor. The aim of this study was to explore the factors associated with elevated atherogenic index among people living in low-income urban areas of Nairobi, Kenya. Data used in this study were obtained from a cross-sectional population-based study with 2,003 participants conducted in Nairobi as part of the Africa Wits-INDEPTH Partnership for Genomic Research, AWI-Gen). Sociodemographic, behavioral, and clinical characteristics were collected from the participants. AIP was derived from the log of TG/HDL cholesterol and categorized into low risk (AIP<0.1), intermediate risk (AIP = 0.1-0.24) and high risk (AIP >0.24). Fifty-four percent (54%) of the study participants were women and the mean age of participants enrolled in this study was 48.8 years. Twenty-nine percent (29%) of study participants had high or medium atherogenic risk. Men, HIV patients, individuals with self-reported uncontrolled diabetes and obese individuals were at higher atherogenic risk. We have identified modifiable risk factors which can be addressed to reduce dyslipidemia in this population. Longitudinal studies may help to precisely determine how these factors relate with cardiovascular diseases.

Anthropometric indices and the risk of incident sudden cardiac death among adults with and without diabetes: over 15 years of follow-up in The Tehran Lipid and Glucose Study

BACKGROUND

We investigated the association of anthropometric indices including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and hip circumference (HC) with the risk of incident sudden cardiac death (SCD) among Iranian population with and without type 2 diabetes mellitus (T2DM).

METHODS

The study population included 9,089 subjects without and 1,185 subjects with T2DM, aged ≥ 20 years. Participants were recruited in 1999-2001 or 2001-2005, and followed for incident SCD annually, up to 20 March 2018. Multivariate Cox proportional hazard models, adjusted for traditional risk factors of cardiovascular disease, were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of anthropometric indices (as continuous and categorical variables).

RESULTS

During a follow-up of over 15 years, 144 (1.58%) and 86 (7.26%) incident SCD occurred in non-T2DM and T2DM groups, respectively. Among non-T2DM group, a 1 standard deviation (SD) increase in WHtR was associated with higher risk of incident SCD by a HR of 1.23 (95% CI: 1.00-1.50) in the multivariable model. From the first quartile to the fourth quartile of WHtR, the trend of SCD risk was significant in age- and sex-adjusted analysis (P-value for trend: 0.041). Other indices did not show significant associations with SCD. Among T2DM group, a 1 SD increase in WHR had a HR of 1.36 (1.05-1.76) in the multivariable model. Considering WHR as categorical variables, the trend of SCD risk across quartiles of WHR was significant. Furthermore, a 1 SD increase in HC led to reduced risk of incident SCD with a HR of 0.75 (0.58-0.97) in multivariable analysis; this lower risk remained significant even after adjustment for WC. Compared to the first quartile, the fourth quartile of HC also showed a HR of 0.50 (0.25-0.99) (P-value for trend = 0.018). BMI, WC, and WHtR did not have significant associations with incident SCD.

CONCLUSION

In our long-term population-based study, we demonstrated central but not general obesity (as assessed by WHR in participants with T2DM, and WHtR in participants without T2DM) as a herald of incident SCD. Moreover, HC can have an inverse association with SCD among participants with T2DM.

Myocardial bridge-related coronary heart disease: Independent influencing factors and their predicting value

BACKGROUND

Myocardial bridge (MB) will compress the mural coronary artery (MCA) during the systole and cause myocardial ischemia. In the diagnosis of coronary heart disease (CHD), because the structure of MB is difficult to be observed by coronary angiography (CAG), the clinical study of the influence of MB on CHD is lacking. With the advancement of computed tomography coronary angiography technology, detailed observations of the MB anatomy have realized.

AIM

To explore the main influencing factors of MB-related CHD and to find potential indicators for predicting MB-related CHD.

METHODS

A total of 1718 patients with suspected CHD due to the symptoms of myocardial ischemia were enrolled as subjects. Patients diagnosed with CHD were included in a CHD group, and patients with no significant abnormalities were included in a control group. In the CHD group, patients were divided into an MB-CHD subgroup if MB-related CHD was found. In the control group, patients were divided into a simple MB subgroup if MB was found. The patient's clinical data and MB-related indicators, including the branch of MB, MB type (superficial/deep type), MB length, MB thickness, systolic and diastolic compression of the MCA, and MCA systolic stenosis rate were recorded and compared. Logistic regression analysis was used to explore the independent influencing factors of MD-related CHD. ROC curve was used to analyze the diagnostic efficacy of potential indicators for MB-related CHD.

RESULTS

There were 1060 cases in the CHD group and 658 cases in the control group, and there were 236 cases in the MB-CHD subgroup and 52 cases in the simple MB subgroup. Multivariate logistic regression analysis showed that the combined MB had a significant effect on the occurrence of CHD (P < 0.05). MB thickness, systolic compression, diastolic compression, and MCA systolic stenosis rate had significant effects on the occurrence of MB-related CHD (P < 0.05). The area under the curve (AUC) of the combination of these influencing factors for the diagnosis of MB-related CHD was 0.959, which was significantly higher than the AUCs of the four indicators separately (P < 0.05). The sensitivity was 97.06% and the specificity was 87.63%.

CONCLUSION

MB thickness, systolic compression, diastolic compression, and MCA systolic stenosis are independent influencing factors for MB-related CHD. The combination of these factors has potential diagnostic value for MB-related CHD.

Impact of Normal Weight Central Obesity on Clinical Outcomes in Male Patients With Premature Acute Coronary Syndrome

There is a lack of studies that evaluate the association between normal weight central obesity and subsequent outcomes in patients with premature acute coronary syndrome (ACS). We evaluated 338 consecutive male patients (aged ≤ 55 years) with premature ACS. The primary outcomes were all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE). We compared the hazard ratios (HRs) in patients with and without normal weight central obesity using multivariable Cox proportional hazard models. All-cause mortality (16.8%) of patients with normal weight central obesity was much higher than those (7.1%) without normal weight central obesity (P = .008). The incidence of MACCE in patients with and without normal weight central obesity were 40.7 and 23.6% (P = .001), respectively. After multivariable adjustment, the risks of all-cause mortality and MACCE were significantly higher in patients with normal weight central obesity than those without normal weight central obesity (adjusted HR: 1.83; 95% confidence interval [CI]: 1.04-3.31; P = .004 and adjusted HR: 1.62; 95% CI: 1.18-2.27; P = .017, respectively). In conclusion, the risks of all-cause mortality and MACCE were significantly higher in male patients with premature ACS with normal weight central obesity than in those without normal weight central obesity.