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Yamazaki Y, Fujihara K, Sato T, Harada Yamada M, Yaguchi Y, Matsubayashi Y, Yamada T, Kodama S, Kato K, Shimano H, Sone H. Usefulness of New Criteria for Metabolic Syndrome Optimized for Prediction of Cardiovascular Diseases in Japanese. J Atheroscler Thromb 2024; 31:382-395. [PMID: 37981330 PMCID: PMC10999718 DOI: 10.5551/jat.64380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/11/2023] [Indexed: 11/21/2023] Open
Abstract
AIMS We attempted to clarify whether the multiple criteria for metabolic syndrome (MetS) can sufficiently predict cardiovascular disease, whether waist circumference (WC) should be required, and whether sex-specific thresholds for each component are necessary. Only a few large-scale studies among East Asians have addressed the ability of MetS to predict cardiovascular disease. METHODS We analyzed the data of 330,051 men and 235,028 women aged 18-74 years with no history of coronary artery disease (CAD) or cerebrovascular disease (CVD) from a nationwide Japanese claims database accumulated during 2008-2016. The association of each MetS component with CAD or CVD (CAD/CVD), MetS associated with CAD/CVD according to various criteria, and utility of modified criteria with more specific optimal values for each component were examined using multivariate Cox regression and receiver operating characteristic (ROC) analysis. RESULTS During the study, 3,934 men (1.19%) and 893 women (0.38%) developed CAD/CVD. For each current MetS criteria, there was a 1.3- to 2.9-fold increased risk of CAD/CVD. Optimal thresholds for predicting CAD/CVD were WCs of 83 and 77 cm, triglycerides levels of 130 and 90 mg/dl, high-density lipoprotein cholesterol levels of 50 and 65 mg/dl, blood pressures of 130/80 and 120/80 mmHg, and fasting plasma glucose levels of 100 and 90 mg/dl for men and women, respectively. The existing MetS criteria and modified criteria were not significantly different in predicting CAD/CVD, but using the modified criteria markedly increased the prevalence of MetS and percentage of people with MetS developing CAD/CVD. CONCLUSIONS Although various criteria for MetS similarly predicted CAD/CVD, the new criteria greatly reduced the number of high-risk individuals, especially women, overlooked by the current criteria.
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Affiliation(s)
- Yurie Yamazaki
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Kazuya Fujihara
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Takaaki Sato
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Mayuko Harada Yamada
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Yuta Yaguchi
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Yasuhiro Matsubayashi
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Takaho Yamada
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Satoru Kodama
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Kiminori Kato
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Hitoshi Shimano
- Department of Endocrinology and Metabolism, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Khashayar P, Heshmat R, Qorbani M, Motlagh ME, Aminaee T, Ardalan G, Farrokhi-Khajeh-Pasha Y, Taslimi M, Larijani B, Kelishadi R. Metabolic Syndrome and Cardiovascular Risk Factors in a National Sample of Adolescent Population in the Middle East and North Africa: The CASPIAN III Study. Int J Endocrinol 2013; 2013:702095. [PMID: 23476647 PMCID: PMC3580930 DOI: 10.1155/2013/702095] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 12/25/2012] [Accepted: 12/25/2012] [Indexed: 12/21/2022] Open
Abstract
Objective. The present study was designed to investigate the prevalence of different combinations of the metabolic syndrome (MetS) risk factors among a nationally representative sample of adolescents in the Middle East and North Africa (MENA). Methods. The study sample, obtained as part of the third study of the school-based surveillance system entitled CASPIAN III, was representative of the Iranian adolescent population aged from 10 to 18 years. The prevalence of different components of MetS was studied and their discriminative value was assessed by receiver operating characteristic (ROC) curve analysis. Results. The study participants consisted of 5738 students (2875 girls) with mean age of 14.7 ± 2.4 years) living in 23 provinces in Iran; 17.4% of participants were underweight and 17.7% were overweight or obese. Based on the criteria of the International Diabetes Federation for the adolescent age group, 24.2% of participants had one risk factor, 8.0% had two, 2.1% had three, and 0.3% had all the four components of MetS. Low HDL-C was the most common component (43.2% among the overweight/obese versus 34.9% of the normal-weight participants), whereas high blood pressure was the least common component. The prevalence of MetS was 15.4% in the overweight/obese participants, the corresponding figure was 1.8% for the normal-weight students, and 2.5% in the whole population studied. Overweight/obese subjects had a 9.68 increased odds of (95% CI: 6.65-14.09) the MetS compared to their normal-weight counterparts. For all the three risk factors, AUC ranged between 0.84 and 0.88, 0.83 and 0.87, and 0.86 and 0.89 in waist circumference, abdominal obesity, and BMI for boys and between 0.78 and 0.97, 0.67 and 0.93, and 0.82 and 0.96 for girls, respectively. Conclusion. The findings from this study provide alarming evidence-based data on the considerable prevalence of obesity, MetS, and CVD risk factors in the adolescent age group. These results are confirmatory evidence for the necessity of primordial/primary prevention of noncommunicable disease should be considered as a health priority in communities facing a double burden of nutritional disorders.
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Affiliation(s)
- Patricia Khashayar
- Osteoporosis Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology, Chronic Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Department of Public Health, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Esmaeil Motlagh
- Bureau of Population, Family and School Health, Ministry of Health and Medical Education, Tehran, Iran
- Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Tahere Aminaee
- Bureau of Population, Family and School Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Gelayol Ardalan
- Bureau of Population, Family and School Health, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Mahnaz Taslimi
- Bureau of Health and Fitness, Ministry of Education and Training, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Vakil KP, Malhotra S, Sawada S, Campbell SR, Sayfo S, Kamalesh M. Waist circumference and metabolic syndrome: the risk for silent coronary artery disease in males. Metab Syndr Relat Disord 2012; 10:225-31. [PMID: 22324791 DOI: 10.1089/met.2011.0099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Waist circumference (WC) is a component used to define metabolic syndrome. However, its role as an independent predictor of silent coronary artery disease (CAD), above its contribution to metabolic syndrome, remains unknown. METHODS Male veterans without known CAD, undergoing cardiac stress testing for indications other than typical angina or its equivalent, were evaluated for the presence of silent CAD. High WC and metabolic syndrome were defined per the revised National Cholesterol Education Program (NCEP-R) and the International Diabetes Federation (IDF) criteria. RESULTS Data on 1,071 patients (age 61±11 years) were analyzed retrospectively. On multivariable logistic regression analysis [odds ratio (OR), 95% confidence interval (CI), P value), a WC ≥94 cm (1.42, 1.04-1.93; P=0.026), metabolic syndrome by NCEP-R (1.73, 1.29-2.33; P<0.0001), and metabolic syndrome by IDF (1.57, 1.17-2.11; P=0.003) were independent predictors of silent CAD. When comparing patients meeting criteria for metabolic syndrome defined by either NCEP-R or IDF, the prevalence of silent CAD was not statistically different (P=0.86). The prevalence of silent CAD associated with a high WC was not inferior to that seen between silent CAD and metabolic syndrome as defined by either criterion. Last, among patients with metabolic syndrome defined by NCEP-R, those with a high WC as a defining component of metabolic syndrome had a higher prevalence of silent CAD (30% vs. 20%; P=0.026). CONCLUSION A WC ≥94 cm in males is independently associated with an increased prevalence of silent CAD. In patients with metabolic syndrome, this prevalence is increased by the presence of high WC.
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Affiliation(s)
- Kairav P Vakil
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Freitas P, Carvalho D, Souto S, Santos AC, Xerinda S, Marques R, Martinez E, Sarmento A, Medina JL. Impact of Lipodystrophy on the prevalence and components of metabolic syndrome in HIV-infected patients. BMC Infect Dis 2011; 11:246. [PMID: 21933422 PMCID: PMC3187742 DOI: 10.1186/1471-2334-11-246] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 09/20/2011] [Indexed: 11/23/2022] Open
Abstract
Background In HIV-infected patients, combination antiretroviral therapy (cART) is associated with clinical lipodystrophy (CL) and metabolic abnormalities (MA). This study aimed to evaluate the prevalence of the metabolic syndrome (MS) and its components, and to determine whether patients with or without CL had a different prevalence of MA. Methods We evaluated 345 HIV-infected patients on cART using two different MS definitions (NCEP-ATPIII-2005 and IDF-2005) and the Framingham risk score. Results CL was present in 58.7% of the patients. The prevalence of the MS was 52.2% (ATPIII) and 43.2% (IDF), and it was not significantly different between patients with (W) or without (WT) CL, regardless of the definition used (ATPIII WCL 52.9% vs WT CL 51.1%; p = 0.738; IDF WCL 41.3% vs WTCL 46.0%; p = 0.379). Moderate concordance was observed between the 2 definitions (kappa = 0.484; p < 0.001) and after gender stratification there was good concordance in women (kappa = 0.759; p < 0.001). Patients with CL had lower waist circumference and HDL-C and higher triglycerides levels. In women, CL was significantly associated with MS, hypertriglyceridemia and low HDL cholesterol independently of age, cART and BMI. Patients with CL had a significantly higher risk of coronary heart disease at 10 years, measured by the Framingham risk score, than patients without CL. Those with CL and with MS had higher frequencies of moderate and high risk categories than those without MS. Conclusions The prevalence of the MS was high in these HIV-infected patients with an age average of 40 years and this finding could explain why HIV patients have an increased risk for cardiovascular disease (CVD).
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Affiliation(s)
- Paula Freitas
- Endocrinology, Diabetes and Metabolism Department of Centro Hospitalar São João, E.P.E., University of Porto Medical School, Alameda Hernani Monteiro, 4200 - 319 Porto, Portugal.
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Yoon SE, Ahn SG, Kim JY, Park JS, Shin JH, Tahk SJ, Lee SK, Kim TJ, Han N. Differential relationship between metabolic syndrome score and severity of coronary atherosclerosis as assessed by angiography in a non-diabetic and diabetic Korean population. J Korean Med Sci 2011; 26:900-5. [PMID: 21738343 PMCID: PMC3124720 DOI: 10.3346/jkms.2011.26.7.900] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 04/21/2011] [Indexed: 01/08/2023] Open
Abstract
Whether the metabolic syndrome (MetS) has prognostic value for coronary artery disease (CAD) beyond its individual components is controversial. We compared the relationship between the number of MetS components and CAD severity as assessed by angiography in non-diabetic and diabetic subjects. We consecutively enrolled 527 patients who underwent their first coronary angiography. Patients were divided into four groups according to the number of MetS components: 0/1, 2, 3, and 4/5. A coronary atherosclerosis score was used to quantify the extent of atherosclerotic involvement. The relationship between the MetS score and angiographic CAD severity or clinical presentation was compared between non-diabetic and diabetic subjects. Individuals with the MetS (n = 327) had a higher prevalence of CAD (60% vs 32%, P < 0.001), multi-vessel disease (34% vs 16%, P < 0.001), and acute coronary syndromes (49% vs 26%, P < 0.001) than those without the MetS. In the non-diabetic group, atherosclerosis score increased with the MetS score (1.0 ± 2.1, 2.0 ± 2.9, 2.8 ± 2.9, and 3.6 ± 3.9, P < 0.001) whereas there was no significant difference in the diabetic group (0.5 ± 1.0, 5.2 ± 4.7, 4.2 ± 2.9, and 4.4 ± 3.5, P = 0.102). The MetS score is related to CAD severity in non-diabetic patients but the association between the MetS score and angiographic CAD severity may be obscured in the presence of diabetes.
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Affiliation(s)
- Shin-Eui Yoon
- Department of Medicine, Sunlin Hospital, Pohang, Korea
| | - Sung Gyun Ahn
- Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Jang-Young Kim
- Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Jin-Sun Park
- Deparment of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Joon-Han Shin
- Deparment of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Seung-Jea Tahk
- Deparment of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Su-Kyeong Lee
- Department of Medicine, Sunlin Hospital, Pohang, Korea
| | - Tae-Jin Kim
- Department of Medicine, Sunlin Hospital, Pohang, Korea
| | - Na Han
- Department of Medicine, Sunlin Hospital, Pohang, Korea
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Shahar E. Metabolic syndrome? A critical look from the viewpoints of causal diagrams and statistics. J Cardiovasc Med (Hagerstown) 2010; 11:772-9. [DOI: 10.2459/jcm.0b013e32833b9088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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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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Sadikot SM. WITHDRAWN: Is it "science"… or is it "turf" guarding? Diabetes Metab Syndr 2010:S1871-4021(10)00043-3. [PMID: 25376593 DOI: 10.1016/j.dsx.2010.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Kamalesh M, Campbell S, Ligler L, Meda M, Eckert GJ, Sawada S. Metabolic Syndrome Does Not Predict an Increased Risk of Coronary Disease in Patients with Traditional Risk Factors Referred for Stress Imaging Study. Metab Syndr Relat Disord 2010; 8:223-8. [DOI: 10.1089/met.2009.0079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Masoor Kamalesh
- Krannert Institute of Cardiology and Roudebush VA Medical Center, Indiana University, Indianapolis
| | - Steffanie Campbell
- Krannert Institute of Cardiology and Roudebush VA Medical Center, Indiana University, Indianapolis
| | - Lindsay Ligler
- Krannert Institute of Cardiology and Roudebush VA Medical Center, Indiana University, Indianapolis
| | - Mythily Meda
- Krannert Institute of Cardiology and Roudebush VA Medical Center, Indiana University, Indianapolis
| | - George J. Eckert
- Krannert Institute of Cardiology and Roudebush VA Medical Center, Indiana University, Indianapolis
| | - Stephen Sawada
- Krannert Institute of Cardiology and Roudebush VA Medical Center, Indiana University, Indianapolis
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Is it “science” … or is it “turf” guarding? Diabetes Metab Syndr 2010. [DOI: 10.1016/j.dsx.2010.05.022] [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: 11/23/2022]
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Sadikot S, Hermans M. Here we go again … The metabolic syndrome revisited! Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2010. [DOI: 10.1016/j.dsx.2010.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Cameron A. The metabolic syndrome: Validity and utility of clinical definitions for cardiovascular disease and diabetes risk prediction. Maturitas 2010; 65:117-21. [DOI: 10.1016/j.maturitas.2009.11.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 11/25/2009] [Accepted: 11/26/2009] [Indexed: 01/18/2023]
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Kang G, Guo L, Guo Z, Hu X, Wu M, Zhou Z, Zhou H, Liu S, Chen F. Impact of Blood Pressure and Other Components of the Metabolic Syndrome on the Development of Cardiovascular Disease. Circ J 2010; 74:456-61. [DOI: 10.1253/circj.cj-09-0422] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Lu Guo
- Department of Radiology & Public Health, Soochow University
| | - Zhirong Guo
- Department of Radiology & Public Health, Soochow University
| | | | - Ming Wu
- Center for Diseases Control of Jiangsu Province
| | | | - Hui Zhou
- Department of Radiology & Public Health, Soochow University
| | - Shijun Liu
- Department of Radiology & Public Health, Soochow University
| | - Fengmei Chen
- Department of Radiology & Public Health, Soochow University
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Sadikot S. Will we now play harmonious melodies or will the cacophony start again? Diabetes Metab Syndr 2009. [DOI: 10.1016/j.dsx.2009.11.001] [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: 10/20/2022]
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Do NOT forget to “KISS”! Diabetes Metab Syndr 2009. [DOI: 10.1016/j.dsx.2009.04.013] [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]
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Abstract
AIMS The value of clinical definitions of the metabolic syndrome has been questioned, with confusion surrounding their intended use and purpose. Our aim was to construct a mission statement that outlines the value of the metabolic syndrome in clinical and public health settings. METHODS Case studies have been used to demonstrate three key points. RESULTS We argue here for recognition of obesity as being a crucial element within the metabolic syndrome but perhaps even more important before its development. We also contend that the concept does indeed have a role as a risk prediction tool, and that it could provide a useful metric for the scale and progress of the looming global epidemic of diabetes and cardiovascular disease. CONCLUSIONS Through appreciation of its purpose, and recognition of both its limitations and those attributes that make it unique and valuable, we believe we have demonstrated here that the metabolic syndrome deserves its place in the global toolbox of diabetes and CVD prevention.
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Affiliation(s)
- A J Cameron
- Department of Epidemiology and Clinical Diabetes, Baker IDI Heart and Diabetes Institute, Newcastle upon Tyne, UK.
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Godsland IF, Johnston DG. Co-associations between insulin sensitivity and measures of liver function, subclinical inflammation, and hematology. Metabolism 2008; 57:1190-7. [PMID: 18702943 DOI: 10.1016/j.metabol.2008.04.010] [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: 06/20/2007] [Accepted: 04/22/2008] [Indexed: 01/14/2023]
Abstract
Clustering of risk factors for coronary heart disease and diabetes is well established, particularly in relation to insulin resistance. To determine whether evaluation of risk factor clustering will contribute to risk assessment, it is first necessary to discriminate co-association between risk factors from correlation. We undertook this in a large homogenous group, using a sophisticated measure of insulin sensitivity and a broad range of risk factors. Cross-sectional analysis of an occupational cohort using regression and factor analyses was performed. Subjects were 472 apparently healthy white men. The main outcome measures were insulin sensitivity, S(I), by minimal model analysis of the intravenous glucose tolerance test plus liver function and hematologic variables, including the inflammation indices, leukocyte count, and erythrocyte sedimentation rate. The S(I) correlated independently with serum gamma-glutamyl transferase (GGT), aspartate transaminase, and alkaline phosphatase activities; blood pressure; leukocyte count; and erythrocyte sedimentation rate (P < .01). On factor analysis, the factor that explained the greatest proportion of the variance (56.7%) included, in decreasing order of factor loading, triglycerides, S(I) (negative), body mass index, high-density lipoprotein cholesterol (negative), insulin, uric acid, and GGT activity (loadings >0.40). Mean arterial pressure was not a feature (loading 0.29), neither were indices of subclinical inflammation. In apparently healthy men, blood pressure and indices of subclinical inflammation do not cluster with other insulin resistance-related risk factors, despite correlating with insulin sensitivity. In contrast, both GGT activity and uric acid concentrations correlated with insulin sensitivity and co-associated with insulin resistance-related risk factors and are therefore components of a true risk factor cluster.
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Affiliation(s)
- Ian F Godsland
- Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, W2 1NY London, UK.
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Kwok S, McElduff P, Ashton DW, Lowe GD, Wood D, Humphries SE, Charlton-Menys V, Durrington PN. Indices of obesity and cardiovascular risk factors in British women. Obes Facts 2008; 1:190-5. [PMID: 20054180 PMCID: PMC6452116 DOI: 10.1159/000148778] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obesity increases cardiovascular risk through effects on blood pressure, lipoproteins, coagulation factors and inflammatory cytokines, but in women variation in fat distribution complicates these relationships. Central (male-type or visceral) obesity confers greater risk than the more generalised (female) type. This is recognised by the metabolic syndrome which employs waist circumference rather than body mass index (BMI). We examined the relationships of several indices of fat distribution with cardiovascular risk factors in a large cohort of UK women. MATERIAL AND METHODS 13,389 female department store employees aged 30-65 years not receiving exogenous hormones completed a health questionnaire. Their blood pressure, weight, height, waist and hip circumference, serum cholesterol low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglycerides, C-reactive protein (CRP) and plasma fibrinogen were measured. RESULTS There was a progressive rise in blood pressure, total cholesterol, LDL-C, triglycerides, fibrinogen and CRP with age. After adjustment for these age effects, BMI was most closely related to blood pressure, whereas the waist to height ratio (WHTR) correlated more closely with the other risk factors than BMI, waist circumference or waist to hip ratio (WHPR). CONCLUSIONS Inclusion of height in the definition of metabolic syndrome will produce a clearer association between waist circumference and cardiovascular risk factors. Hypertension may be linked to the metabolic syndrome by its association with general obesity rather than specifically by central obesity.
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Affiliation(s)
- See Kwok
- School of Clinical and Laboratory Sciences, University of Manchester, UK
| | | | - David W. Ashton
- National Heart & Lung Institute Faculty of Medicine, Imperial College of Science Technology & Medicine, Charing Cross Hospital Cardiology Department, London
| | - Gordon D.O. Lowe
- University of Glasgow, Department of Medicine, Glasgow Royal Infirmary, Glasgow
| | - D. Wood
- National Heart & Lung Institute Faculty of Medicine, Imperial College of Science Technology & Medicine, Charing Cross Hospital Cardiology Department, London
| | - Stephen E. Humphries
- Centre for Cardiovascular Genetics, Royal Free & University College Medical School, Division of Medicine, The Rayne Building, London, UK
| | | | - Paul N. Durrington
- School of Clinical and Laboratory Sciences, University of Manchester, UK
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Abstract
OBJECTIVE In the present study we assessed the impact of metabolic syndrome (MS) and its components on markers of cardiovascular and renal damage in a population of essential hypertensives. METHODS A total of 651 consecutive, untreated and non-diabetic hypertensives (age 54 +/- 12 years, 340 males) who were included in the 3H Study, an ongoing registry of hypertension-related target organ damage, were considered for analysis. Left ventricular mass was indexed both for body surface area (LVMBSA) and for height2.7 (LVMheight2.7). Diastolic function was estimated by means of both conventional and tissue Doppler imaging (TDI) methods. Arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (c-f PWV) and microalbuminuria (MA) as albumin to creatinine ratio (ACR) 22-300 mg/g in men and 31-300 mg/g in women in two non-consecutive morning spot urine samples. RESULTS MS (Adult Treatment Panel III criteria) was present in 201 hypertensives (30.9%). Hypertensives with MS had increased logACR (by 10%, P = 0.01) and higher prevalence of MA (17 versus 8%, P < 0.001). Both groups exhibited similar values of LVMBSA, transmitral and TDI-derived indexes and c-f PWV (NS for all) while LVMheight2.7 was significantly higher in hypertensives with MS (by 2.6 g/m2.7, P = 0.023). Multiple regression analysis revealed that MS was an independent predictor only of logACR (beta = 0.110, P = 0.007) and MA (odds ratio = 2.577, P < 0.001), while components of blood pressure affected all studied indices of organ damage. CONCLUSIONS MS per se does not deteriorate cardiac adaptations and aortic stiffness beyond haemodynamic load in hypertension. The MS-related unfavourable effect is limited to the level of the glomerulus.
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Affiliation(s)
- Richard Kahn
- American Diabetes Association, Alexandria, VA 22307, USA.
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22
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Kamalesh M. Heart Failure in Diabetes and Related Conditions. J Card Fail 2007; 13:861-73. [DOI: 10.1016/j.cardfail.2007.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Revised: 07/19/2007] [Accepted: 07/24/2007] [Indexed: 02/07/2023]
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23
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Balkau B, Valensi P, Eschwège E, Slama G. A review of the metabolic syndrome. DIABETES & METABOLISM 2007; 33:405-13. [PMID: 17981485 DOI: 10.1016/j.diabet.2007.08.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 08/02/2007] [Indexed: 12/21/2022]
Abstract
While the concept of this syndrome has been described more than 60 years ago, and more formally almost 20 years ago, the controversy continues as to its utility, which of the various syndrome definitions should be used and their ability to predict diabetes and/or cardiovascular disease. The metabolic syndrome, of cardiovascular risk factors, provides an early warning of at risk subjects and emphasises the need to treat more aggressively (by at least lifestyle modification) patients with multiple abnormalities even though the abnormalities might be slight. Further, the syndrome can be easily used in clinical practice and when it is assessed against the background of the patient's age, sex and smoking habits, it provides an evaluation of potential cardiovascular risk. Prospective intervention studies are the only means of definitively accepting or refuting the usefulness of the syndrome. The metabolic syndrome is an entity which merits attention from both the medical profession and public health authorities.
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Affiliation(s)
- B Balkau
- Inserm U780-IFR69, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France.
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24
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Misra A, Khurana L, Vikram NK, Goel A, Wasir JS. Metabolic syndrome in children: current issues and South Asian perspective. Nutrition 2007; 23:895-910. [DOI: 10.1016/j.nut.2007.08.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 08/14/2007] [Accepted: 08/29/2007] [Indexed: 01/19/2023]
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25
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Obunai K, Jani S, Dangas GD. Cardiovascular morbidity and mortality of the metabolic syndrome. Med Clin North Am 2007; 91:1169-84, x. [PMID: 17964915 DOI: 10.1016/j.mcna.2007.06.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Cardiovascular disease remains the single leading cause of morbidity and mortality in the United States. The metabolic syndrome has received increased attention in recent years, partly because of the growing prevalence of obesity and its association with cardiovascular disease. This article reviews current evidence from longitudinal observational studies that evaluated the impact of metabolic syndrome on cardiovascular morbidity and mortality in various population subsets. The approach to cardiovascular risk assessment in individuals who have multiple risk factors and the clinical implications of diagnosing the metabolic syndrome are also discussed.
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Affiliation(s)
- Kotaro Obunai
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, Columbia University Medical Center, 161 Fort Washington Avenue, HIP 5th Floor, New York, NY 10032, USA.
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Azevedo A, Bettencourt P, Almeida PB, Santos AC, Abreu-Lima C, Hense HW, Barros H. Increasing number of components of the metabolic syndrome and cardiac structural and functional abnormalities--cross-sectional study of the general population. BMC Cardiovasc Disord 2007; 7:17. [PMID: 17555566 PMCID: PMC1894986 DOI: 10.1186/1471-2261-7-17] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Accepted: 06/07/2007] [Indexed: 01/12/2023] Open
Abstract
Background We aimed to assess whether we could identify a graded association between increasing number of components of the metabolic syndrome and cardiac structural and functional abnormalities independently of predicted risk of coronary heart disease by the Framingham risk score. Methods We conducted a cross-sectional study on a random sample of the urban population of Porto aged 45 years or over. Six hundred and eighty-four participants were included. Data were collected by a structured clinical interview with a physician, ECG and a transthoracic M-mode and 2D echocardiogram. The metabolic syndrome was defined according to ATPIII-NCEP. The association between the number of features of the metabolic syndrome and the cardiac structural and functional abnormalities was assessed by 3 multivariate regression models: adjusting for age and gender, adjusting for the 10-year predicted risk of coronary heart disease by Framingham risk score and adjusting for age, gender and systolic blood pressure. Results There was a positive association between the number of features of metabolic syndrome and parameters of cardiac structure and function, with a consistent and statistically significant trend for all cardiac variables considered when adjusting for age and gender. Parameters of left ventricular geometry patterns, left atrial diameter and diastolic dysfunction maintained this trend when taking into account the 10-year predicted risk of coronary heart disease by the Framingham score as an independent variable, while left ventricular systolic dysfunction did not. The prevalence of left ventricular diastolic dysfunction, and the mean left ventricular mass, left ventricular diameter and left atrial diameter increased significantly with the number of features of the metabolic syndrome when additionally adjusting for systolic blood pressure as a continuous variable. Conclusion Increasing severity of metabolic syndrome was associated with increasingly compromised structure and function of the heart. This association was independent of Framingham risk score for indirect indices of diastolic dysfunction but not systolic dysfunction, and was not explained by blood pressure level.
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Affiliation(s)
- Ana Azevedo
- Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal
- Department of Internal Medicine, Hospital de S. João and University of Porto Medical School, Porto, Portugal
| | - Paulo Bettencourt
- Department of Internal Medicine, Hospital de S. João and University of Porto Medical School, Porto, Portugal
| | - Pedro B Almeida
- Department of Cardiology, University of Porto Medical School, Porto, Portugal
| | - Ana C Santos
- Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal
| | - Cassiano Abreu-Lima
- Department of Cardiology, University of Porto Medical School, Porto, Portugal
| | - Hans-Werner Hense
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Henrique Barros
- Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal
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27
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Affiliation(s)
- Gerald M Reaven
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Falk Cardiovascular Research Center, 300 Pasteur Drive, Stanford, CA 94305, USA.
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28
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Affiliation(s)
- Richard Kahn
- American Diabetes Association, 1701 N Beauregard St, Alexandria, VA 22311, USA.
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Stürmer T, Buring JE, Lee IM, Gaziano JM, Glynn RJ. Metabolic abnormalities and risk for colorectal cancer in the physicians' health study. Cancer Epidemiol Biomarkers Prev 2007; 15:2391-7. [PMID: 17164361 PMCID: PMC1764627 DOI: 10.1158/1055-9965.epi-06-0391] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Obesity and diabetes are established risk factors for colorectal cancer but have mainly been assessed independently. There are few data about whether the metabolic syndrome, which refers to a clustering of cardiovascular disease risk factors thought to be related to insulin resistance, including obesity, type 2 diabetes, hyperlipidemia, and hypertension, is associated with colorectal cancer risk. METHODS During and after the randomized trial of aspirin and beta-carotene, 22,071 healthy male physicians, initially ages 40 to 84 years, reported overweight (body mass index, >or=27 kg/m2), diabetes, elevated blood pressure (>or=130/85 mmHg or use of antihypertensive medication), hypercholesterolemia (>or=240 mg/dL or use of lipid-lowering medication), and occurrence of cancer on annual questionnaires. Adjusted relative risks (RR) and 95% confidence intervals (95% CI) for time-varying metabolic abnormalities and colorectal cancer were estimated using a multivariable proportional hazards model. RESULTS During 369,966 person-years of follow-up (median, 19 years), 494 physicians developed colorectal cancer. With aging of the cohort, the prevalence of having two or more abnormalities increased from 13% to 35%. Overweight (RR, 1.4; 95% CI, 1.1-1.7) and diabetes (RR, 1.5; 95% CI, 1.1-2.0) were associated with increased risk for colorectal cancer, whereas elevated blood pressure (RR, 1.1; 95% CI, 0.9-1.3) and hypercholesterolemia (RR, 0.9; 95% CI, 0.7-1.1) were not. This model assessing metabolic abnormalities independently was more predictive for colorectal cancer than a model based on the number of abnormalities (each additional abnormality RR, 1.16; 95% CI, 1.05-1.29). CONCLUSIONS Out of the markers of the metabolic syndrome assessed, overweight and diabetes are risk factors for colorectal cancer, whereas, in contrast to their role in cardiovascular disease, elevated blood pressure and hypercholesterolemia are not.
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Affiliation(s)
- Til Stürmer
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue East, Boston, MA 02215, USA.
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Dalmau Serra J, Alonso Franch M, Gómez López L, Martínez Costa C, Sierra Salinas C. Obesidad Infantil. Recomendaciones del Comité de Nutrición de la Asociación Española de Pediatría. Parte II. Diagnóstico. Comorbilidades. Tratamiento. An Pediatr (Barc) 2007; 66:294-304. [PMID: 17349257 DOI: 10.1157/13099693] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The present article reviews the diagnostic criteria for pediatric obesity and its comorbidities. Treatment is also reviewed, including promotion of physical activity, and dietetic, pharmacologic and surgical treatment.
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Affiliation(s)
- J Dalmau Serra
- Unidad de Nutrición y Metabolopatías, Hospital Infantil La Fe, Valencia, España
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31
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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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Borrás X, Barrios V, Escobar C, Pedreira M. Novedades en el síndrome metabólico, envejecimiento poblacional y visión del clínico de las nuevas guías en fibrilación auricular. Rev Esp Cardiol (Engl Ed) 2007; 60 Suppl 1:101-10. [PMID: 17352860 DOI: 10.1157/13099717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article reviews the main developments reported during the last year concerning metabolic syndrome, population aging, and new atrial fibrillation guidelines. The principal aim was to provide the clinical cardiologist with an overview of recent 2006 publications and conference reports on these topics, which have been selected for their broad clinical implications.
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Affiliation(s)
- Xavier Borrás
- Hospital de la Santa Creu i Sant Pau, Barcelona, España.
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Forouhi NG, Sattar N, Tillin T, McKeigue PM, Chaturvedi N. Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK. Diabetologia 2006; 49:2580-8. [PMID: 16972045 DOI: 10.1007/s00125-006-0393-2] [Citation(s) in RCA: 194] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Accepted: 06/30/2006] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS We examined prospectively whether measured risk factors can explain the higher CHD mortality in South Asians compared with Europeans. MATERIALS AND METHODS Conventional CHD risk factors and those associated with insulin resistance were measured in 1,787 European and 1,420 South Asian men aged 40 to 69 years at baseline in the population-based Southall and Brent studies (London) between 1988 and 1990. Participants were followed up for mortality. RESULTS By February 2006, there were 202 CHD deaths (108 Asian, 94 European). South Asian men had double the CHD mortality of European men in Cox regression analyses adjusted for age, smoking, and cholesterol (hazard ratio [HR] 2.14, 95% CI 1.56-2.94, p<0.001). Nearly half of all South Asian CHD deaths versus 13% of deaths among Europeans were among persons with diabetes. Asian men had greater CHD mortality than Europeans, both in the with- and the without-diabetes categories at baseline. CHD mortality remained significantly higher in South Asian men in multivariable models that adjusted for conventional risk factors and diabetes and/or impaired glucose regulation, features of insulin resistance, or the metabolic syndrome (HR 1.6-1.9). Accounting for co-morbidity and socio-economic status did not materially alter the findings. CONCLUSIONS/INTERPRETATION These data confirm that South Asian men have significantly higher CHD mortality than their European counterparts, while indicating that neither conventional risk factors, nor insulin resistance parameters or metabolic syndrome criteria as currently defined can account for this excess risk. The contribution of unmeasured factors to the elevated vascular risk in South Asians should be addressed in future studies.
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Affiliation(s)
- N G Forouhi
- MRC Epidemiology Unit, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK.
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Abstract
PURPOSE OF REVIEW Many studies have recommended use of metabolic syndrome as an 'alternative' means to assess vascular disease risk, but few have been rigorous, leading to confusion amongst physicians regarding risk screening. This review critically appraises this evidence and also evaluates the data linking metabolic syndrome to type 2 diabetes. RECENT FINDINGS Although presence of metabolic syndrome predicts vascular events, such prediction is inferior and does not enhance simpler Framingham-based risk scores which can be determined using nonfasting blood samples. The dichotomous nature of metabolic syndrome criteria and lack of age, low-density lipoprotein cholesterol, and smoking in part account for their inferior predictive ability. Metabolic syndrome criteria better predict type 2 diabetes but diabetes screening, if adopted, will likely require a two-stage process, with the first stage not dependent on blood sampling. Nevertheless, recent interest in metabolic syndrome has contributed to greater interaction between diabetologists and cardiologists and highlighted more strongly the relevance of obesity to vascular risk. SUMMARY Best evidence suggests that current metabolic syndrome criteria should not be used as an alternative to established charts for risk prediction for vascular disease. Clinical focus should remain on established risk factors to determine and reduce risk of vascular events.
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Eckel RH, Kahn R, Robertson RM, Rizza RA. Preventing cardiovascular disease and diabetes: a call to action from the American Diabetes Association and the American Heart Association. Diabetes Care 2006; 29:1697-9. [PMID: 16801605 DOI: 10.2337/dc06-9911] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Robert H Eckel
- Department of Physiology and Biophysics, University of Colorado Health Science Center, Aurora, USA
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Akosah KO, McHugh VL, Mathiason MA, Kulkarni A, Barnhart SI. Metabolic Syndrome and Coronary Heart Disease Equivalent Conditions in Predicting Cardiovascular Events in Young to Middle-Aged Adults. ACTA ACUST UNITED AC 2006; 1:173-7. [PMID: 17679809 DOI: 10.1111/j.1559-4564.2006.05780.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There are questions concerning the validity of the metabolic syndrome as a diagnostic entity and whether the syndrome predicts coronary heart disease (CHD) better than global risk stratification. The use of the metabolic syndrome as a potential adjunct to improve global risk stratification has received less attention. The authors evaluated the relationship between the metabolic syndrome and cardiovascular disease compared with coronary heart disease equivalent. Two hundred thirty-six subjects undergoing elective coronary angiography had bilateral carotid ultrasound studies and global risk scores calculated. Mean total, low-density lipoprotein, and high-density lipoprotein cholesterol and triglyceride values were normal. The metabolic syndrome was associated with carotid atherosclerosis (odds ratio, 2.3; confidence interval, 1.2-4.2), coronary disease (odds ratio, 2.9; confidence interval, 1.6-5.4), and future cardiovascular events. Rates for future events and coronary and carotid atherosclerosis were similar for subjects with the metabolic syndrome compared with coronary heart disease equivalent. Combined, the two conditions identified 70% of subjects who developed events. The metabolic syndrome is associated with cardiovascular disease and provides additive information to clinical risk stratification.
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