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Mahadevan A, Adivi S, Akella SA, Doshi P, Salian RB, Kohli M, Radhareddy AR, Krishnakumar M, Pinnamaneni M, Desai R. Acute ischemic stroke in young adults: comparative analysis of outcomes and mortality in metabolically healthy obese or overweight vs. non-obese or overweight hospitalizations, 2016-2019 cohort. J Stroke Cerebrovasc Dis 2024; 33:107847. [PMID: 38977229 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/21/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024] Open
Abstract
INTRODUCTION Rising obesity rates and the increasing prevalence of stroke in the metabolically healthy obese and overweight (MHOO) necessitate examining its association in younger (18-44 year) populations and analyzing acute ischemic stroke (AIS) trends and outcomes in MHOO vs. metabolically healthy non-obese or overweight (MHnOO). METHODS Data from the United States National Inpatient Sample (2016-2019) was analyzed to identify young MHOO and MHnOO AIS patients using ICD-10-CM codes. Metabolically healthy status was defined by excluding hospitalization records with diagnostic codes for hypertension, diabetes, and dyslipidemia. Demographics, trends, and outcomes were compared using appropriate statistical approaches. RESULTS Of 26,949,310 young metabolically healthy hospitalizations between 2016 and 2019, 47,795 had AIS, of which 4,985 were MHOO and 42,810 were MHnOO. The median age of AIS hospitalization was 35 years, and primarily female and white. From 2016 to 2019, AIS incidence rose slightly, which was significant only for the MHnOO cohort. The in-hospital mortality rate was significantly lower in the MHOO cohort (6.0 % vs. 8.6 %, p < 0.001). Hospitalization length and cost did not differ substantially between groups. Adjusted multivariable analysis revealed no significant difference in AIS hospitalization risk between MHOO and MHnOO (aOR: 1.02, p=0.701), with subgroup analysis in males (aOR: 0.88, p=0.161) or females (aOR: 1.06, p=0.363). However, all-cause in-hospital mortality (ACIHM) in AIS had lower odds in the MHOO vs. MHnOO cohorts (aOR: 0.60, p=0.021). CONCLUSION Our study finds a rising trend of AIS hospitalizations in young metabolically healthy adults, with obesity or overweight status not being associated with AIS hospitalization. We identify an "obesity paradox" of lower odds for ACIHM for AIS hospitalizations in the MHOO cohort.
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Affiliation(s)
- Arankesh Mahadevan
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA.
| | - Santoshini Adivi
- Department of Medicine, NRI Medical College & Hospital, Mangalagiri, India
| | - Sai Anusha Akella
- Department of Internal Medicine, Kakatiya Medical College, Warangal, India
| | - Preet Doshi
- Department of Internal Medicine, SUNY Upstate University, Syracuse, NY, USA
| | | | - Muskan Kohli
- Department of Medicine, Anna Medical College, Mauritius
| | | | - Manaswini Krishnakumar
- Department of Internal Medicine, SRM Medical College Hospital and Research Centre, Kattankulathur, India
| | - Monitha Pinnamaneni
- Department of Internal Medicine, SRM Medical College Hospital and Research Centre, Kattankulathur, India
| | - Rupak Desai
- Independent Outcome Researcher, Atlanta, GA, USA
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Sedaghat Z, Khodakarim S, Sabour S, Valizadeh M, Barzin M, Nejadghaderi SA, Azizi F. The effect of obesity phenotype changes on cardiovascular outcomes in adults older than 40 years in the prospective cohort of the Tehran lipids and glucose study (TLGS): joint model of longitudinal and time-to-event data. BMC Public Health 2024; 24:1126. [PMID: 38654182 DOI: 10.1186/s12889-024-18577-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Obesity is a worldwide health concern with serious clinical effects, including myocardial infarction (MI), stroke, cardiovascular diseases (CVDs), and all-cause mortality. The present study aimed to assess the association of obesity phenotypes and different CVDs and mortality in males and females by simultaneously considering the longitudinal and survival time data. METHODS In the Tehran Lipid and Glucose Study (TLGS), participants older than three years were selected by a multi-stage random cluster sampling method and followed for about 19 years. In the current study, individuals aged over 40 years without a medical history of CVD, stroke, MI, and coronary heart disease were included. Exclusions comprised those undergoing treatment for CVD and those with more than 30% missing information or incomplete data. Joint modeling of longitudinal binary outcome and survival time data was applied to assess the dependency and the association between the changes in obesity phenotypes and time to occurrence of CVD, MI, stroke, and CVD mortality. To account for any potential sex-related confounding effect on the association between the obesity phenotypes and CVD outcomes, sex-specific analysis was carried out. The analysis was performed using packages (JMbayes2) of R software (version 4.2.1). RESULTS Overall, 6350 adults above 40 years were included. In the joint modeling of CVD outcome among males, literates and participants with a family history of diabetes were at lower risk of CVD compared to illiterates and those with no family history of diabetes in the Bayesian Cox model. Current smokers were at higher risk of CVD compared to non-smokers. In a logistic mixed effects model, odds of obesity phenotype was higher among participants with low physical activity, family history of diabetes and older age compared to males with high physical activity, no family history of diabetes and younger age. In females, based on the results of the Bayesian Cox model, participants with family history of diabetes, family history of CVD, abnormal obesity phenotype and past smokers had a higher risk of CVD compared to those with no history of diabetes, CVD and nonsmokers. In the obesity varying model, odds of obesity phenotype was higher among females with history of diabetes and older age compared to those with no history of diabetes and who were younger. There was no significant variable associated with MI among males in the Bayesian Cox model. Odds of obesity phenotype was higher in males with low physical activity compared to those with high physical activity in the obesity varying model, whereas current smokers were at lower odds of obesity phenotype than nonsmokers. In females, risk of MI was higher among those with family history of diabetes compared to those with no history of diabetes in the Bayesian Cox model. In the logistic mixed effects model, a direct and significant association was found between age and obesity phenotype. In males, participants with history of diabetes, abnormal obesity phenotype and older age were at higher risk of stroke in the Bayesian Cox model compared to males with no history of diabetes, normal obesity phenotype and younger persons. In the obesity varying model, odds of obesity phenotype was higher in males with low physical activity, family history of diabetes and older age compared to those with high physical activity, no family history of diabetes and who were younger. Smokers had a lower odds of obesity phenotype than nonsmokers. In females, past smokers and those with family history of diabetes were at higher risk of stroke compared to nonsmokers and females with no history of diabetes in the Bayesian Cox model. In the obesity varying model, females with family history of diabetes and older ages had a higher odds of obesity phenotype compared to those with no family history of diabetes and who were younger. Among males, risk of CVD mortality was lower in past smokers compared to nonsmokers in the survival model. A direct and significant association was found between age and CVD mortality. Odds of obesity phenotype was higher in males with a history of diabetes than in those with no family history of diabetes in the logistic mixed effects model. CONCLUSIONS It seems that modifications to metabolic disorders may have an impact on the heightened incidence of CVDs. Based on this, males with obesity and any type of metabolic disorder had a higher risk of CVD, stroke and CVD mortality (excluding MI) compared to those with a normal body mass index (BMI) and no metabolic disorders. Females with obesity and any type of metabolic disorder were at higher risk of CVD(, MI and stroke compared to those with a normal BMI and no metabolic disorders suggesting that obesity and metabolic disorders are related. Due to its synergistic effect on high blood pressure, metabolic disorders raise the risk of CVD.
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Affiliation(s)
- Zahra Sedaghat
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Khodakarim
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Siamak Sabour
- Safety Promotion and Injury Prevention Research Centre, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Aria Nejadghaderi
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sedaghat Z, Khodakarim S, Nejadghaderi SA, Sabour S. Association between metabolic syndrome and myocardial infarction among patients with excess body weight: a systematic review and meta-analysis. BMC Public Health 2024; 24:444. [PMID: 38347488 PMCID: PMC10863149 DOI: 10.1186/s12889-024-17707-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are a major cause of morbidity and mortality worldwide. Controversial views exist over the effects of metabolically unhealthy obesity phenotypes on CVDs. This study aimed to perform a meta-analysis to assess the association between metabolic syndrome and myocardial infarction (MI) among individuals with excess body weight (EBW). METHODS We searched PubMed/Medline, Scopus, and Web of Science databases as of December 9, 2023. Cohort studies involving patients with overweight or obesity that reported the relevant effect measures for the association between metabolic syndrome and MI were included. We excluded studies with incomplete or unavailable original data, reanalysis of previously published data, and those that did not report the adjusted effect sizes. We used the Newcastle Ottawa Scale for quality assessment. Random-effect model meta-analysis was performed. Publication bias was assessed by Begg's test. RESULTS Overall, nine studies comprising a total of 61,104 participants were included. There was a significant positive association between metabolic syndrome and MI among those with obesity (hazard ratio (HR): 1.68; 95% confidence interval (CI): 1.27, 2.22). Subgroup analysis showed higher HRs for obesity (1.72; 1.03, 2.88) than overweight (1.58; 1.-13-2.21). Meta-regression revealed no significant association between nationality and risk of MI (p = 0.75). All studies had high qualities. There was no significant publication bias (p = 0.42). CONCLUSIONS Metabolic syndrome increased the risk of MI in those with EBW. Further studies are recommended to investigate other risk factors of CVDs in EBW, in order to implement preventive programs to reduce the burden of CVD in obesity.
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Affiliation(s)
- Zahra Sedaghat
- Student Research Center, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Khodakarim
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Aria Nejadghaderi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Siamak Sabour
- Department of Clinical Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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He Q, Wang W, Li H, Xiong Y, Tao C, Ma L, You C. Genetic insights into the risk of metabolic syndrome and its components on stroke and its subtypes: Bidirectional Mendelian randomization. J Cereb Blood Flow Metab 2023; 43:126-137. [PMID: 37198928 PMCID: PMC10638990 DOI: 10.1177/0271678x231169838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/19/2023] [Accepted: 01/31/2023] [Indexed: 05/19/2023]
Abstract
The role of metabolic syndrome (MetS) on stroke has been explored only in many observational studies. We conducted Mendelian randomization (MR) to clarify whether or not the genetically predicted MetS and its components are causally associated with stroke and its subtypes. Genetic instruments of MetS and its components and outcome data sets for stroke and its subtypes came from the gene-wide association study in the UK Biobank and MEGASTROKE consortium, respectively. Inverse variance weighting was utilized as the main method. Genetically predicted MetS, waist circumference (WC), and hypertension increase the risk of stroke. WC and hypertension are related to increased risk of ischemic stroke. MetS, WC, hypertension, and triglycerides (TG) are causally associated with the increasing of large artery stroke. Hypertension increased the risk of cardioembolic stroke. Hypertension and TG lead to 77.43- and 1.19-fold increases, respectively, in small vessel stroke (SVS) risk. The protective role of high-density lipoprotein cholesterol on SVS is identified. Results of the reverse MR analyses show that stroke is related to hypertension risk. From the genetical variants perspective, our study provides novel evidence that early management of MetS and its components are effective strategies to decrease the risk of stroke and its subtypes.
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Affiliation(s)
- Qiang He
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wenjing Wang
- Department of Pharmacy, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Li
- State Key Laboratory of Proteomics, National Center for Protein Sciences at Beijing, Beijing Institute of Radiation Medicine, Beijing, China
| | - Yang Xiong
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Chuanyuan Tao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
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Xie K, Han X, Hu X. Balance ability and all-cause death in middle-aged and older adults: A prospective cohort study. Front Public Health 2023; 10:1039522. [PMID: 36699907 PMCID: PMC9868834 DOI: 10.3389/fpubh.2022.1039522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/08/2022] [Indexed: 01/11/2023] Open
Abstract
Objective The present study aimed to explore the relationship between balance ability and all-cause death in middle-aged and elderly people and to provide a basis for formulating a balanced training plan for middle-aged and older people in China. Methods Based on data from the China Health and Retirement Longitudinal Study (CHARLS) carried out in the years 2011, 2013, 2015, and 2018, 18,888 participants aged 45 years and above were included. Cox proportional hazard models were designed to evaluate the effect of balance ability on death events. Results The present study found that there was an association between balance ability and death among middle-aged and older people. Multivariate Cox proportional hazard regression model analysis showed that the risk of death decreased by 10% (HR = 0.90,95% CI: 0.85-0.95) for every second increase in balance ability. With balance ability <10 s as the reference group, the adjusted HRs were 0.61 (0.44-0.85) among middle-aged and elderly people. The death density of balance ability of <10 s was 73.87 per thousand person-years higher than that of ≥10 s. There was no interaction between balance ability and chronic disease, overweight, and obesity (P > 0.05). Conclusion The risk of all-cause death in middle-aged and older people increased with the decrease in balance ability and showed no statistical significance between chronic disease, overweight, and obesity, as corroborated by the present study.
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Affiliation(s)
- Kaihong Xie
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiao Han
- School of Health Humanities, Peking University Health Science Center, Beijing, China
| | - Xuanhan Hu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China,*Correspondence: Xuanhan Hu ✉
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Rıfkı Çora A, Çelik E. Relationship between peripheral arterial disease severity determined by the Glass classification and triglyceride-glucose index; novel association and novel classification system. INVESTIGACIÓN CLÍNICA 2022. [DOI: 10.54817/ic.v63n4a04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Peripheral arterial disease is a serious clinical manifestation caused by atherosclerosis. It is one common cause of morbidity and mortality worldwide. It is commonly seen in males, and its (prevelance) increases with age. It is most prevalent with smoking, hypertension, diabetes mellitus and hyperlip-idemia. Novel studies investigate the relationship between triglyceride-glucose index (TyG) and cardiovascular diseases. Studies investigating the association of this index and peripheral arterial disease and disease severity are generally done by using The Trans-Atlantic Inter-Society Consensus (TASC) classification. We aimed to study this association by using the new Global Limb Anatomic Staging System (GLASS) classification. Two hundred patients between 25 to 90 years old diagnosed with peripheral arterial disease and admitted to the hospital for peripheral arterial angiography between July 2021 and December 2021, were evaluated retrospectively with blood parameters and angiographic images. Patients were divided into two groups: moderate (group 1; n=58) and severe (group 2; n=142) according to the GLASS classification. No statistical differences were observed for comorbidities and repeated interventional pro-cedure rates (p=0.164). Triglyceride values were found to be statistically dif-ferent between groups (p=0.040). TyG was found higher in group 2 (p= 0.04). According to the binary logistic regression model, only TyG was found to have a significant effect as a diagnostic factor (p=0.011). TyG was also significantly correlated with the Rutherford (p=0.012) and GLASS classification severity (p<0.001). Peripheral arterial disease and disease severity could be easily moni-tored with simple calculable TyG. In this way, precautions could be taken, and morbidities could be prevented.
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Affiliation(s)
- Ahmet Rıfkı Çora
- Cardiovascular Surgery Department, Isparta City Hospital, Isparta; Turkey
| | - Ersin Çelik
- Cardiovascular Surgery Department, Isparta City Hospital, Isparta; Turkey
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Pan J, Wang Z, Dong C, Yang B, Tang L, Jia P, Yang S, Zeng H. Association between obese phenotypes and risk of carotid artery plaque among chinese male railway drivers. BMC Public Health 2022; 22:1859. [PMID: 36199053 PMCID: PMC9533504 DOI: 10.1186/s12889-022-14253-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China has the world's highest rail transportation network density, and the prevalence of obesity among railway workers in China is more than twice that of adults in the world. Carotid artery plaque (CAP) is a simple and noninvasive predictor of early atherosclerosis, while the association between different obese phenotypes and CAP risk among Chinese male railway drivers is unclear. METHODS This cross-sectional study was performed among 8,645 Chinese male railway drivers. Obese phenotypes were assessed based on the obesity status (the body mass index ≥ 28 kg/m2 as obesity vs. < 28 kg/m2 as non-obesity) and metabolic status (metabolically healthy vs. metabolically unhealthy). Metabolically unhealthy was defined as the presence of at least one dysfunction, including elevated blood pressure, elevated fasting blood glucose, elevated triglyceride, and reduced high-density-lipoprotein cholesterol. Four obese phenotypes were defined based on the body mass index and metabolic status, i.e., metabolically healthy non-obesity (MHNO), metabolically healthy obesity (MHO), metabolically unhealthy obesity (MUO), and metabolically unhealthy non-obesity (MUNO). Multivariable logistic regression was employed to estimate the association between different obese phenotypes and the risk of CAP. Subgroup analysis was performed to examine the variation of the association by age, circadian rhythm disorders, and history of smoking and drinking. RESULTS The prevalence of CAP among male railway drivers in MHO, MUO, MUNO, and MHNO was 8.75%, 18.67%, 17.82%, and 5.36%, respectively. Compared to those with MHNO, an increased risk for CAP was observed among those with MHO (OR = 2.18, 95% CI: 0.82, 5.10), MUO (OR = 1.78, 95% CI:1.44, 2.21), and MUNO (OR = 2.20, 95% CI: 1.67, 2.89). The subgroup analysis showed that both of the metabolically unhealthy groups (MUNO and MUO) aged < 45 years were prone to a higher risk of CAP (for the MUNO group, OR = 4.27, 95% CI:2.71, 7.10; for the MUO group, OR = 4.00, 95%CI: 2.26, 7.17). CONCLUSION The obese phenotypes are associated with CAP risk in male railway drivers, especially those with metabolically unhealthy conditions aged < 45 years.
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Affiliation(s)
- Jia Pan
- Department of Health Management Center, Affiliated Hospital of Chengdu University , Chengdu, Sichuan, China
| | - Zihang Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chaohui Dong
- Department of Health Management Center, Affiliated Hospital of Chengdu University , Chengdu, Sichuan, China
| | - Bo Yang
- Department of Health Management Center, Affiliated Hospital of Chengdu University , Chengdu, Sichuan, China
| | - Lei Tang
- Department of Health Management Center, Affiliated Hospital of Chengdu University , Chengdu, Sichuan, China
| | - Peng Jia
- School of Resources and Environmental Sciences, Wuhan University, Wuhan, China
- International Institute of Spatial Health Epidemiology (ISLE), Wuhan University, Wuhan, China
| | - Shujuan Yang
- Department of Health Management Center, Affiliated Hospital of Chengdu University , Chengdu, Sichuan, China.
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
- International Institute of Spatial Health Epidemiology (ISLE), Wuhan University, Wuhan, China.
| | - Honglian Zeng
- Department of Health Management Center, Affiliated Hospital of Chengdu University , Chengdu, Sichuan, China.
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Meng M, Guo Y, Kuang Z, Liu L, Cai Y, Ni X. Risk of Stroke Among Different Metabolic Obesity Phenotypes: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:844550. [PMID: 35548434 PMCID: PMC9081493 DOI: 10.3389/fcvm.2022.844550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/17/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose Overweight/obesity is a modified risk factor for stroke. This systematic review and meta-analysis aimed to assess the impact of different obesity phenotypes on stroke risk in adults. Methods The PubMed, Embase, and Cochrane Library databases were searched from their inception to 7 March 2021 to identify the prospective cohort studies investigating stroke risk among different metabolic overweight/obesity phenotypes. The methodological quality of the included studies was evaluated using the Newcastle–Ottawa Scale. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Results A total of eleven prospective cohorts (n = 5,609,945 participants) were included in the systematic review, nine of which were included in the meta-analysis. All metabolically unhealthy phenotypes had a higher risk of stroke than the metabolically healthy normal-weight phenotypes, including metabolically unhealthy normal weight (HR = 1.63, 95% CI: 1.41–1.89, I2 = 89.74%, n = 7 cohort studies, 1,042,542 participants), metabolically unhealthy overweight (HR = 1.94, 95% CI: 1.58–2.40, I2 = 91.17%, n = 4 cohort studies, 676,166 participants), and metabolically unhealthy obese (HR = 1.99, 95% CI: 1.66–2.40, I2 = 93.49%, n = 6 cohort studies, 1,035,420 participants) phenotypes. However, no risk of stroke was observed in the populations with metabolically healthy overweight (MHOW) (HR = 1.07, 95% CI: 1.00–1.14, I2 = 69.50%, n = 5 studies, 4,171,943 participants) and metabolically healthy obese (MHO) (HR = 1.07, 95% CI: 0.99–1.16, I2 = 54.82%, n = 8 studies, 5,333,485 participants) phenotypes. The subgroup analyses for the MHO studies suggested that the risk of stroke increased only when the MHO participants were mainly females, from North America, and when the World Health Organization standard was applied to define obesity. In the subgroup analysis of the risk of stroke in MHOW, a longer follow-up duration was also associated with a higher risk of stroke. Conclusion The risk of stroke increase for all metabolically unhealthy phenotypes irrespective of the body mass index (BMI). The associated risk of stroke with metabolic health but high BMI shows substantial heterogeneity, which requires future research considering the impact of sex and transition of the metabolic status on the risk of stroke. Systematic Review Registration The study protocol was prospectively registered in PROSPERO (No. CRD42021251021).
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Affiliation(s)
- Miaomiao Meng
- The Second Clinical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yixin Guo
- The Second Clinical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhuoran Kuang
- The Second Clinical School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Lingling Liu
- The Second Clinical School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Yefeng Cai
- The Second Clinical School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Xiaojia Ni
- The Second Clinical School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- *Correspondence: Xiaojia Ni,
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Hu L, Bao H, Huang X, Zhou W, Wang T, Zhu L, Liu X, Li M, Cheng X. Relationship Between the Triglyceride Glucose Index and the Risk of First Stroke in Elderly Hypertensive Patients. Int J Gen Med 2022; 15:1271-1279. [PMID: 35173466 PMCID: PMC8841443 DOI: 10.2147/ijgm.s350474] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/31/2021] [Indexed: 12/23/2022] Open
Abstract
Background Several recent studies have shown the relationship between the triglyceride glucose (TyG) index and the risk of stroke in the general population and in a few patient cohorts; however, the role of the TyG index on stroke risk in elderly hypertensive patients has not been determined. Thus, we aimed to investigate the association of the TyG index with first stroke and first ischemic stroke in elderly individuals with hypertension. Methods We included 8487 elderly subjects with hypertension from the China H-type Hypertension Registry Study for the current analysis. The TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). Outcomes were the first stroke and first ischemic stroke. Results During a median follow-up of 1.72 years, the first stroke was diagnosed in 82 patients (0.97%), and the first ischemic stroke was diagnosed in 48 patients (0.57%). Multivariable Cox proportional hazards models revealed that the TyG index was positively associated with the risk of first stroke (per 1-unit increment; HR: 1.72; 95% CI: 1.07, 2.76) and first ischemic stroke (HR: 2.31; 95% CI: 1.32, 4.05). When the TyG index was assessed as quartiles, significantly higher risks of first stroke (HR: 1.90; 95% CI: 1.04, 3.45) and first ischemic stroke (HR: 2.45; 95% CI: 1.16, 5.20) were found in participants in quartile 4 compared with those in quartiles 1–3. Conclusion The TyG index is potentially useful in the early identification of elderly hypertensive patients at high risk of experiencing a first stroke.
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Affiliation(s)
- Longlong Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Huihui Bao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Xiao Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Wei Zhou
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Tao Wang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Lingjuan Zhu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Xi Liu
- Center of Cardiovascular Medicine, Inner Mongolia People’s Hospital, Hohhot, Inner Mongolia, People’s Republic of China
| | - Minghui Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
- Center of Cardiovascular Medicine, Inner Mongolia People’s Hospital, Hohhot, Inner Mongolia, People’s Republic of China
- Correspondence: Minghui Li, Center of Cardiovascular Medicine, Inner Mongolia People’s Hospital, No. 20 Zhaowuda Road, Hohhot, Inner Mongolia, 010017, People’s Republic of China, Tel +8615389819973, Fax +86-791-86262262, Email
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
- Xiaoshu Cheng, Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, Jiangxi, 330006, People’s Republic of China, Tel +8613607089128, Fax +86-791-86262262, Email
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10
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Vidal-Ostos F, Ramos-Lopez O, Blaak EE, Astrup A, Martinez JA. The triglyceride-glucose index as an adiposity marker and a predictor of fat loss induced by a low-calorie diet. Eur J Clin Invest 2022; 52:e13674. [PMID: 34453322 DOI: 10.1111/eci.13674] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND This study aimed to investigate the putative role of the triglyceride-glucose index (TyG index) computed as ln[TG (mg/dl) × glucose (mg/dl)/2] and derived proxies as predictors of adiposity and weight loss changes after a low-calorie diet (LCD) intervention. METHODS A total of 744 adult participants from the multicentre DIOGenes intervention study were prescribed a LCD (800 kcal/day) during 8 weeks. Body composition and fat content at baseline and after 8 weeks were estimated by DEXA/BIA. A multivariate analysis approach was used to estimate the difference in ΔWeight1-2 (kg), ΔBMI1-2 (kg/m2 ) or ΔFat1-2 (%) between the basal value (point 1) and after 8 weeks following a LCD (point 2), respectively. The TyG index at baseline (TyG1 ), after following the LCD for 8 weeks (TyG2 ) or the TyG index differences between both time points (ΔTyG1-2 ) were analysed as predictors of weight and fat changes. RESULTS TyG1 was associated with ΔWeight1-2 (kg) and ΔBMI1-2 (kg/m2 ), with β = 0.812 (p = .017) and β = 0.265 (p = .018), respectively. Also, TyG2 values were inversely related to ΔFat1-2 (%), β = -1.473 (p = .015). Moreover, ΔTyG1-2 was associated with ΔWeight1-2 (kg) and ΔFat1-2 (%), β = 0.689 (p = .045) and β = 1.764 (p = .002), respectively. Furthermore, an association between TyG2 and resistance to fat loss was found (p = .015). CONCLUSION TyG1 index is a good predictor of weight loss induced by LCD. Moreover, TyG2 was closely related to resistance to fat loss, while ΔTyG1-2 values were positively associated with body fat changes. Therefore, TyG index and derived estimations could be used as markers of individualized responses to energy restriction and a surrogate of body composition outcomes in clinical/epidemiological settings in obesity conditions.
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Affiliation(s)
| | - Omar Ramos-Lopez
- Medicine and Psychology School, Autonomous University of Baja California, Tijuana, Mexico
| | - Ellen E Blaak
- Department of Human Biology, NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Jose Alfredo Martinez
- Navarra's Health Research Institute (IdiSNA), Pamplona, Spain.,CIBERobn Physiopathology of Obesity and Nutrition, Carlos III Health Institute, Madrid, Spain.,Precision Nutrition Program, IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
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11
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Zou S, Xu Y. Association of the triglyceride-glucose index and major adverse cardiac and cerebrovascular events in female patients undergoing percutaneous coronary intervention with drug-eluting stents: A retrospective study. Diabetes Res Clin Pract 2021; 181:109073. [PMID: 34592393 DOI: 10.1016/j.diabres.2021.109073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/25/2021] [Accepted: 09/23/2021] [Indexed: 01/11/2023]
Abstract
AIMS We aimed to examine the association between the Triglyceride-glucose (TyG) index and clinical outcome of percutaneous coronary intervention (PCI) patients with drug-eluting stents (DESs). METHODS From July 2009 to August 2011, 2533 patients who underwent at least one PCI with DESs were enrolled to determine the relationship between the TyG index and MACCEs with a 29.8-month follow-up. In addition, the Logistic regression proportional hazard model was applied to assess the prognostic value of the TyG index. RESULTS The MACCEs was associated with, history of heart failure (p = 0.049), third degree AVB (p = 0.008) and stroke (p = 0.033), SBP (p < 0.001), DBP (p = 0.001), number of diseased vessels, location of target lesions, characteristics of lesion, number of treated vessels, number of stents, length of stents (p = 0.003) and stent diameter (p < 0.001). The multivariate Logistic regression analysis revealed that the TyG index was an independent prognostic factor for MACCEs in female patients (OR = 1.68, 95 %CI = 1.12-2.54, p = 0.013) but not in male (OR = 0.95, 95 %CI = 0.74-1.21, p = 0.657). CONCLUSION The TyG index was independently associated with MACCEs in female patients undergoing PCI with DESs, but not in men.
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Affiliation(s)
- Su Zou
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
| | - Yingjia Xu
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China.
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12
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Horn JW, Feng T, Mørkedal B, Strand LB, Horn J, Mukamal K, Janszky I. Obesity and Risk for First Ischemic Stroke Depends on Metabolic Syndrome: The HUNT Study. Stroke 2021; 52:3555-3561. [PMID: 34281375 DOI: 10.1161/strokeaha.120.033016] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Obesity is one of the most prevalent modifiable risk factors of ischemic stroke. However, it is still unclear whether obesity itself or the metabolic abnormalities due to obesity increase the risk of ischemic stroke. We therefore investigated the association between metabolic health, weight, and risk of ischemic stroke in a large prospective cohort study. METHODS In the Norwegian HUNT study (Trøndelag Health Study), we included 35 105 participants with complete information on metabolic risk factors and relevant covariates. Metabolically unhealthy state was defined as sex specific increased waist circumference in addition to 2 or more of the following criteria: hypertension, increased blood pressure, decreased high-density lipoprotein, triglycerides or glucose, or self-reported diagnosis of diabetes. We then applied Cox proportional hazard models to estimate the risk for ischemic stroke among overweight and obese metabolically healthy and unhealthy participants compared with metabolically healthy, normal weight participants. RESULTS A total of 1161 ischemic stroke cases occurred after an average observation time of 11.9 years. In general, metabolically unhealthy participants were at increased risk of ischemic stroke (for obese participants: hazard ratio, 1.30 [95% CI, 1.09-1.56] compared with metabolically healthy participants with a normal body mass index). Hypertension appeared to be the most important metabolic risk factor. Metabolically healthy participants with overweight or obesity were at similar risk of ischemic stroke compared with normal weight participants (hazard ratio, 1.02 [95% CI, 0.81-1.28] for participants with obesity). Obesity and overweight even over an extended period of time seems to be benign about ischemic stroke, as long as it was not associated with metabolic abnormalities. CONCLUSIONS Obesity was not an independent ischemic stroke risk factor in this cohort, and the risk depended more on the metabolic consequences of obesity.
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Affiliation(s)
- Jens W Horn
- Department of Internal Medicine, Levanger Hospital, Health Trust Nord-Trøndelag, Norway (J.W.H.).,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway (J.W.H., L.B.S., J.H., I.J.)
| | - Tingting Feng
- Department of Health Register, The Norwegian Directorate of Health, Norway (T.F.)
| | - Bjørn Mørkedal
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (B.M.)
| | - Linn Beate Strand
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway (J.W.H., L.B.S., J.H., I.J.)
| | - Julie Horn
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway (J.W.H., L.B.S., J.H., I.J.).,Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Norway (J.H.)
| | - Kenneth Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston (K.M.)
| | - Imre Janszky
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway (J.W.H., L.B.S., J.H., I.J.).,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden (I.J.)
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13
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The risk of Alzheimer's disease according to dynamic changes in metabolic health and obesity: a nationwide population-based cohort study. Aging (Albany NY) 2021; 13:16974-16989. [PMID: 34237705 PMCID: PMC8312469 DOI: 10.18632/aging.203255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 06/18/2021] [Indexed: 12/29/2022]
Abstract
We evaluated the association of metabolic health and obesity phenotypes with the risk of Alzheimer's disease (AD). This study enrolled 136,847 elderly participants aged 60 or above from the Korean National Health Insurance System. At baseline examinations in 2009 and 2010, subjects were categorized into four groups: the metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO) groups. Based on the phenotypic transition after 2 years, the subjects were further categorized into 16 subgroups. They were followed from 2009 to 2015 to monitor for AD development. The MHO phenotype protected subjects from AD, relative to the MHNO phenotype (HR, 0.73; 95% CI, 0.65-0.81). Among subjects initially classified as MHO, 41.8% remained MHO, with a significantly lower risk of AD compared with the stable MHNO group (HR, 0.62; 95% CI, 0.50-0.77). Among MUO subjects at baseline, those who changed phenotype to MUNO were at higher risk of AD (HR, 1.47; 95% CI, 1.28-1.70), and the transition to the MHO phenotype protected subjects from AD (HR, 0.62; 95% CI, 0.50-0.78). The MHO phenotype conferred a decreased risk of AD. Maintenance or recovery of metabolic health might mitigate AD risk among obese individuals.
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14
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Zhang Y, Ren L, Ren M, Yang H, Li K, Cong H, Guo Z. Correlation Between the Triglyceride-Glucose Index and High Risk of Cardiovascular Disease: A Cohort Study of 102,061 Subjects from Tianjin, China. Risk Manag Healthc Policy 2021; 14:2803-2810. [PMID: 34239336 PMCID: PMC8260047 DOI: 10.2147/rmhp.s316484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aims to investigate the correlation between triglyceride–glucose index (TyG) and the risk of cardiovascular disease (CVD). Methods A total of 102,061 permanent residents of Tianjin, China, aged 35–75 years were surveyed. A questionnaire, physical examination, and blood tests for biochemical markers were conducted for all subjects. The risk of CVD was judged based on the results, identifying the population with a high risk of CVD. TyG was calculated for all subjects who were then grouped into TyG quartiles. The correlation between TyG and the detection rate of subjects with a high risk of CVD was analyzed using the chi-square test and Pearson’s correlation analysis. The cut-off points and the magnitude of the predictive effect of TyG in determining a high risk of CVD were identified by calculating the TyG through analysis of the receiver operator characteristic (ROC) curve. Results The surveyed population consisted of 39,598 males (38.8%) and 62,463 females (61.2%). The average age was 55.84 ± 10.27 years. A statistically significant difference in the incidence of a high CVD risk between subjects in the four groups divided by the TyG levels was identified (p < 0.01). Pearson’s correlation analysis showed that TyG was correlated with all risk factors for CVD (p < 0.01). The maximum Youden’s J statistic for determining the high risk of CVD was found at a TyG of 9.04 (specificity 0.575, sensitivity 0.754). The area under the ROC curve was 0.780 (confidence interval [CI]: 0.777, 0.783, p < 0.01). Conclusion TyG index is closely related to the aggregation of cardiovascular risk factors and is correlated with the judgment results of the screening population’s high risk of CVD, suggesting that more attention should be paid to the identification and control of multiple risk factors in the population with significantly elevated TyG.
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Affiliation(s)
- Yingyi Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, 300222, People's Republic of China
| | - Libin Ren
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, 300222, People's Republic of China
| | - Min Ren
- Tianjin Cardiovascular Institute, Tianjin, 300222, People's Republic of China
| | - Hua Yang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, 300222, People's Republic of China
| | - Kunmeng Li
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, 300222, People's Republic of China
| | - Hongliang Cong
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, 300222, People's Republic of China
| | - Zhigang Guo
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, 300222, People's Republic of China
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15
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Zhang N, Liang G, Liu M, Zheng G, Yu H, Shi Y, Zhang Y, Wang H, Li Y, Xu Y, Lu J. Metabolically healthy obesity increases the prevalence of stroke in adults aged 40 years or older: Result from the China National Stroke Screening survey. Prev Med 2021; 148:106551. [PMID: 33862034 DOI: 10.1016/j.ypmed.2021.106551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 02/16/2021] [Accepted: 04/11/2021] [Indexed: 12/29/2022]
Abstract
Debate over the cardio-cerebrovascular risk associated with metabolically healthy obesity (MHO) continues. In this study we investigated the association of MHO with the risk of stroke among 221,114 individuals aged 40 years or older based on data from the China National Stroke Screening and Prevention Project (CNSSPP), a nationally representative cross-sectional study, during 2014 to 2015. Different metabolic health and obesity phenotypes were defined according to the Adult Treatment Panel III (ATP III) criteria, where obesity was defined as a body mass index (BMI) ≥28 kg/m2. Logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for stroke risk associated with different metabolically healthy phenotypes. BMI was used to estimate the mediation effect for metabolic abnormalities to stroke. Compared with the metabolically healthy non-obesity (MHNO) group, individuals with MHO (adjusted OR: 1.21, 95% CI: 1.10,1.33), metabolically unhealthy non-obesity (MUNO) (adjusted OR:1.41, 95% CI: 1.36,1.46), or metabolically unhealthy obesity (MUO) (adjusted OR: 1.70, 95% CI: 1.61,1.80) were found to have an increased risk of stroke. The findings were confirmed robustly by various sensitivity analyses and subgroup analyses. Furthermore, obesity and metabolic abnormalities had an additive interaction for stroke risk with an attributable proportion (AP) of 14.0% in females. BMI played a partial mediating role with the proportion of the effect (PE) at 11.1% in the relationship between metabolic abnormalities and stroke. This study strengthens the evidence that management and interventions in the MHO population may contribute to the primary prevention of stroke.
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Affiliation(s)
- Ningning Zhang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Ge Liang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Mengying Liu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Guowei Zheng
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Hailan Yu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yage Shi
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yihe Zhang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Hao Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yapeng Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jie Lu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China.
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16
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Hou Z, Pan Y, Yang Y, Yang X, Xiang X, Wang Y, Li Z, Zhao X, Li H, Meng X, Wang Y. An Analysis of the Potential Relationship of Triglyceride Glucose and Body Mass Index With Stroke Prognosis. Front Neurol 2021; 12:630140. [PMID: 33967936 PMCID: PMC8101495 DOI: 10.3389/fneur.2021.630140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/30/2021] [Indexed: 12/15/2022] Open
Abstract
Background: The inverse association between obesity and outcome in stroke patients (known as the obesity paradox) has been widely reported, yet mechanistic details explaining the paradox are limited. The triglyceride glucose (TYG) index has been proposed as a marker of insulin resistance. We sought to explore possible associations of the TYG index, body mass index (BMI), and stroke outcome. Methods: We identified 12,964 ischemic stroke patients without a history of diabetes mellitus from the China National Stroke Registry and classified patients as either low/normal weight, defined as a BMI <25 kg/m2, or overweight/obese, defined as a BMI ≥ 25 kg/m2. We calculated TYG index and based on which the patients were divided into four groups. A Cox or logistic regression model was used to evaluate the association between BMI and TYG index and its influence on stroke outcomes, including stroke recurrence all-cause mortality and poor outcome (modified Rankin Scale score of 3-6) at 12 months. Results: Among the patients, 63.3% were male, and 36.7% were female, and the mean age of the patient cohort was 64.8 years old. The median TYG index was 8.62 (interquartile range, 8.25-9.05). After adjusting for multiple potential covariates, the all-cause mortality of overweight/obese patients was significantly lower than that of the low/normal weight patients (6.17 vs. 9.32%; adjusted hazard ratio, 0.847; 95% CI 0.732-0.981). The difference in mortality in overweight/obese and low/normal weight patients with ischemic stroke was not associated with TYG index, and no association between BMI and TYG index was found. Conclusion: Overweight/obese patients with ischemic stroke have better survival than patients with low/normal weight. The association of BMI and stroke outcome is not changed by TYG index.
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Affiliation(s)
- Zongyi Hou
- Department of Neurology, Hongqi Hospital, Mudanjiang Medical University, Mudanjiang, China
- Heilongjiang Key Laboratory of Ischemic Stroke Prevention and Treatment, Mudanjiang, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yindong Yang
- Department of Neurology, Hongqi Hospital, Mudanjiang Medical University, Mudanjiang, China
- Heilongjiang Key Laboratory of Ischemic Stroke Prevention and Treatment, Mudanjiang, China
| | - Xiaofan Yang
- Department of Neurology, Hongqi Hospital, Mudanjiang Medical University, Mudanjiang, China
- Heilongjiang Key Laboratory of Ischemic Stroke Prevention and Treatment, Mudanjiang, China
| | - Xianglong Xiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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17
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Zhang Y, Ding X, Hua B, Liu Q, Gao H, Chen H, Zhao XQ, Li W, Li H. High Triglyceride-Glucose Index is Associated with Poor Cardiovascular Outcomes in Nondiabetic Patients with ACS with LDL-C below 1.8 mmol/L. J Atheroscler Thromb 2021; 29:268-281. [PMID: 33536384 PMCID: PMC8803555 DOI: 10.5551/jat.61119] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim:
To evaluate the prognostic value of triglyceride-glucose (TyG) index in nondiabetic patients with acute coronary syndrome (ACS) with low-density lipoprotein cholesterol (LDL-C) below 1.8 mmol/L.
Methods:
A total of 1655 nondiabetic patients with ACS with LDL-C below 1.8 mmol/L were included in the analysis. Patients were stratified into two groups. The incidence of acute myocardial infarction (AMI), infarct size in patients with AMI, and major adverse cardiac and cerebral event during a median of 35.6-month follow-up were determined and compared between the two groups. The TyG index was calculated using the following formula: ln [fasting triglycerides (mg/dL)×fasting plasma glucose (mg/dL)/2].
Results:
Compared with the TyG index <8.33 group, the TyG index ≥ 8.33 group had a significantly higher incidence of AMI (21.2% vs. 15.2%,
p
=0.014) and larger infarct size in patients with AMI [the peak value of troponin I: 10.4 vs. 4.8 ng/ml,
p
=0.003; the peak value of Creatine kinase MB: 52.8 vs. 22.0 ng/ml,
p
=0.006; the peak value of myoglobin: 73.7 vs. 46.0 ng/ml,
p
=0.038]. Although there was no significant difference in mortality between the two groups, the incidence of revascularization of the TyG index ≥ 8.33 group was significantly higher than that of the TyG index <8.33 group (8.9% vs. 5.0%,
p
=0.035). A multivariable Cox regression revealed that the TyG index was positively associated with revascularization [hazard ratio, 1.67; 95% confidence interval, 1.02–2.75;
p
=0.043].
Conclusions:
In nondiabetic patients with ACS with LDL-C below 1.8 mmol/L, a high TyG index level was associated with higher incidence of AMI, larger infarct size, and higher incidence of revascularization. A high TyG index level might be a valid predictor of subsequent revascularization.
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Affiliation(s)
- Yue Zhang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
| | - Xiaosong Ding
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
| | - Bing Hua
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
| | - Qingbo Liu
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
| | - Hui Gao
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
| | - Xue-Qiao Zhao
- Clinical Atherosclerosis Research Lab, Division of Cardiology, University of Washington
| | - Weiping Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University.,Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University.,Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease.,Department of Geriatrics, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
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18
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Lee H, Oh J, Kang H, Lim TH, Ko BS, Choi HJ, Park SM, Jo YH, Lee JS, Park YS, Yoon YH, Kim SJ, Min YG. Association between the body mass index and outcomes of patients resuscitated from out-of-hospital cardiac arrest: a prospective multicentre registry study. Scand J Trauma Resusc Emerg Med 2021; 29:24. [PMID: 33509251 PMCID: PMC7842019 DOI: 10.1186/s13049-021-00837-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/14/2021] [Indexed: 12/15/2022] Open
Abstract
Background The effects of the body mass index (BMI) on outcomes of patients resuscitated from cardiac arrest are controversial. Therefore, the current study investigated the association between the BMI and the favourable neurologic outcomes and survival to discharge of patients resuscitated from out-of-hospital cardiac arrest (OHCA). Methods This multicentre, prospective, nationwide OHCA registry-based study was conducted using data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC). We enrolled hospitals willing to collect patient height and weight and included patients who survived to the hospital between October 2015 and June 2018. The included patients were categorised into the underweight (< 18.5 kg/m2), normal weight (≥18.5 to < 25 kg/m2), overweight (≥25 to < 30 kg/m2), and obese groups (≥30 kg/m2) according to the BMI per the World Health Organization (WHO) criteria. The primary outcome was a favourable neurologic outcome; the secondary outcome was survival to discharge. Univariate and multivariate analyses were performed to investigate the association between BMI and outcomes. Results Nine hospitals were enrolled; finally, 605 patients were included in our analysis and categorised per the WHO BMI classification. Favourable neurologic outcomes were less frequent in the underweight BMI group than in the other groups (p = 0.002); survival to discharge was not significantly different among the BMI groups (p = 0.110). However, the BMI classification was not associated with favourable neurologic outcomes or survival to discharge after adjustment in the multivariate model. Conclusion The BMI was not independently associated with favourable neurologic and survival outcomes of patients surviving from OHCA. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00837-x.
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Affiliation(s)
- Heekyung Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Byuk Sung Ko
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Hyuk Joong Choi
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Seung Min Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jong Suk Lee
- Department of Emergency Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Hoon Yoon
- Department of Emergency Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Su Jin Kim
- Department of Emergency Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Young-Gi Min
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
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Kalyoncuoglu M, Ozkan A, Kaya A, Yuksel Y, Dogan N, Gurmen A. A new predictor of in-stent restenosis in patients undergoing elective percutaneous coronary İntervention: triglyceride glucose İndex. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2021. [DOI: 10.4103/ijca.ijca_15_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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da Silva A, Caldas APS, Rocha DMUP, Bressan J. Triglyceride-glucose index predicts independently type 2 diabetes mellitus risk: A systematic review and meta-analysis of cohort studies. Prim Care Diabetes 2020; 14:584-593. [PMID: 32928692 DOI: 10.1016/j.pcd.2020.09.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Our objective was to perform a systematic review and meta-analysis of cohort studies evaluating the triglyceride-glucose (TyG) index as a tool for type 2 diabetes (T2D) prediction in adults and older adults. METHODS Studies were identified in PubMed, Cochrane, Scopus, and Lilacs. Studies with cohort design, which evaluated the T2D incidence through the hazard ratio (HR) or relative risk (RR) or odds ratio values were included. Were included both studies that evaluated the incidence of T2D from tertiles, quartiles, quintiles, or single TyG index values. First, a meta-analysis only for studies that reported data in HR values was performed. Additionally, given the different association measurements used, the number of T2D cases, non-T2D cases, and the total number of participants were extracted from exposed and non-exposed groups when available. Then the risk ratio was calculated. A meta-analysis using the inverse variance method and the random-effects model was performed. Heterogeneity was assessed by I2 statistics and by inspecting funnel plots. RESULTS Thirteen cohort studies with a total of 70,380 subjects, both sexes, adults, and older adults were included in the meta-analysis. Ten studies showed a significant association of the TyG index with T2D risk through HR estimative (overall HR: 2.44, 95% CI: 2.17-2.76). After estimating RR for nine studies, we also observed a significant association of the TyG index with T2D risk (RR: 3.12, 95 CI: 2.31-4.21). For all analyses, high heterogeneity was verified by I2 and visual inspection of funnel plots. CONCLUSIONS TyG index has a positive and significant association with T2D risk, suggesting that the TyG index may become an applicable tool to identify subjects with T2D risk. However, due to the high heterogeneity observed in overall HR and RR analysis, more studies could be necessary to confirm these results.
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Affiliation(s)
- Alessandra da Silva
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil.
| | - Ana Paula Silva Caldas
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | | | - Josefina Bressan
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
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Zhang Y, Ding X, Hua B, Liu Q, Gao H, Chen H, Zhao XQ, Li W, Li H. High triglyceride-glucose index is associated with adverse cardiovascular outcomes in patients with acute myocardial infarction. Nutr Metab Cardiovasc Dis 2020; 30:2351-2362. [PMID: 32917496 DOI: 10.1016/j.numecd.2020.07.041] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Triglyceride glucose (TyG) index is considered a new surrogate marker of insulin resistance that associated with the development of vascular disease. The aim of this study was to evaluate the prognostic value of TyG index in patients with acute myocardial infarction (AMI). METHODS AND RESULTS A total of 3181 patients with AMI were included in the analysis. Patients were stratified into 2 groups according to their TyG index levels: the TyG index <8.88 group and the TyG index ≥8.88 group. The incidence of major adverse cardiovascular events (MACEs) during a median of 33.3-month follow-up were recorded. Multivariable Cox regression models revealed that the TyG index was positively associated with all-cause death [HR (95% CI): 1.51 (1.10,2.06), p = 0.010], cardiac death [HR (95% CI): 1.68 (1.19,2.38), p = 0.004], revascularization [HR (95% CI): 1.50 (1.16,1.94), p = 0.002], cardiac rehospitalization [HR (95% CI): 1.25 (1.05,1.49), p = 0.012], and composite MACEs [HR (95% CI): 1.19 (1.01,1.41), p = 0.046] in patients with AMI. The independent predictive effect of TyG index on composite MACEs was mainly reflected in the subgroups of male gender and smoker. The area under the curve (AUC) of the TyG index predicting the occurrence of MACEs in AMI patients was 0.602 [95% CI 0.580,0.623; p < 0.001]. CONCLUSION High TyG index levels appeared to be associated with an increased risk of MACEs in patients with AMI. The TyG index might be a valid predictor of cardiovascular outcomes of patients with AMI. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Yue Zhang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaosong Ding
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bing Hua
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qingbo Liu
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Gao
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xue-Qiao Zhao
- Clinical Atherosclerosis Research Lab, Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Weiping Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, China
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, China; Department of Geriatrics, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Zhang B, Liu L, Ruan H, Zhu Q, Yu D, Yang Y, Men X, Lu Z. Triglyceride-Glucose Index Linked to Hospital Mortality in Critically Ill Stroke: An Observational Multicentre Study on eICU Database. Front Med (Lausanne) 2020; 7:591036. [PMID: 33195355 PMCID: PMC7655911 DOI: 10.3389/fmed.2020.591036] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/05/2020] [Indexed: 01/04/2023] Open
Abstract
Objective: The triglyceride-glucose (TyG) index is a reliable surrogate of insulin resistance and a marker for ischemic stroke (IS) incident. Whether the TyG index predicts stroke outcome remains uncertain. This study investigated the prognostic value of the TyG index in critically ill stroke patients. Methods: This was a retrospective observational study that included stroke patients, and all data were extracted from the eICU Collaborative Research Database. The TyG index was calculated as the ln [fasting glucose level (mg/dL) × triglyceride level (mg/dL)/2]. Outcomes included the hospital and intensive care unit (ICU) death. Multivariate logistic regression was used to determine independent risk factors. The smoothing curves and forest plots were illustrated. Results: A total of 4,570 eligible subjects were enrolled. The mean level of TyG index was 9.1 ± 0.7. The hospital and ICU mortality rate were 10.3 and 5.0%, respectively. TyG index as a continuous variable was associated hospital mortality in univariate analysis (OR 1.723, 95% CI 1.524-1.948, P < 0.001), adjusted model 1 (OR 1.861, 95% CI 1637-2.116, P < 0.001), and adjusted model 2 (OR 2.543, 95% CI 1.588-4.073, P < 0.001). TyG was also associated ICU mortality in univariate analysis (OR 2.146, 95% CI 1.826-2.523, P < 0.001), adjusted model 1 (OR 2.183, 95% CI 1.847-2.580, P < 0.001), and adjusted model 2 (OR 2.672, 95% CI 1.376-5.188, P < 0.001). The smoothing curves observed a continuous linear association after adjusting all covariates both in hospital and ICU mortality. Subgroup analysis demonstrated TyG index was associated with increased risk of hospital and ICU death in critically ill IS (P < 0.05), but not in hemorrhage stroke (P > 0.05). Conclusion: The TyG index is a potential predictor for hospital and ICU mortality in critically ill stroke patients, especially in IS patients.
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Affiliation(s)
- Bingjun Zhang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lingling Liu
- Department of Hematology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hengfang Ruan
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiang Zhu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dafan Yu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yu Yang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuejiao Men
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Duran Karaduman B, Ayhan H, Keleş T, Bozkurt E. The triglyceride-glucose index predicts peripheral artery disease complexity. Turk J Med Sci 2020; 50:1217-1222. [PMID: 32718124 PMCID: PMC7491281 DOI: 10.3906/sag-2006-180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/25/2020] [Indexed: 01/12/2023] Open
Abstract
Background/aim High levels of triglyceride (TG) and fasting blood glucose (FBG) values increase atherosclerosis risk. This study evaluates the relationship between peripheral artery disease (PAD) severity and complexity, as assessed by TransAtlantic InterSociety Consensus-II (TASC-II) classification and the triglyceride-glucose (TyG) index. Materials and methods A total of 71 consecutive patients with PAD (males 93%, mean age 63.3 ± 9.7), who underwent percutaneous peripheral intervention were included retrospectively. The patients were divided into two groups according to the angiographically detected lesions. Those with TASC A-B lesions were included in Group 1, and those with TASC C-D lesions were included in Group 2. TyG index was calculated as formula: ln[fasting TG (mg/dL) × fasting plasma glucose (mg/dL)/2]. Results There were 40 patients in Group 1 (90.3% men, with a mean age of 63.6 ± 9.3 years) and 31 patients in Group 2 (96.8% men, with a mean age of 62.0 ± 8.6 years). In the majority of patients in both groups, the target vessels are iliac arteries and femoral arteries. In Group 2, platelet count and TyG index were significantly high, according to Group 1. The TyG index was significantly correlated with TASC-II, Rutherford category, HbA1c, and HDL-C. Conclusion In this present study, we showed that the TyG index was an independent predictor of peripheral artery disease complexity, according to TASC-II classification, for the first time in the literature.
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Affiliation(s)
- Bilge Duran Karaduman
- Department of Cardiology, Faculty of Medicine, Atılım University, Medicana International Ankara Hospital, Ankara, Turkey
| | - Hüseyin Ayhan
- Department of Cardiology, Faculty of Medicine, Atılım University, Medicana International Ankara Hospital, Ankara, Turkey
| | - Telat Keleş
- Department of Cardiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Engin Bozkurt
- Department of Cardiology, Medicana International Ankara Hospital, Ankara, Turkey
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Frey S, Patouraux S, Debs T, Gugenheim J, Anty R, Iannelli A. Prevalence of NASH/NAFLD in people with obesity who are currently classified as metabolically healthy. Surg Obes Relat Dis 2020; 16:2050-2057. [PMID: 32788075 DOI: 10.1016/j.soard.2020.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/28/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND While metabolic health in obesity may confer a protective status, recent studies indicate that nonalcoholic fatty liver disease (NAFLD) or even nonalcoholic steatohepatitis (NASH) may exist in this category of individuals. Although cardiovascular and diabetic risks have been well described, the risk of NAFLD and NASH among this population requires further investigation. OBJECTIVE Our goal was to compare the prevalence of steatosis, NAFLD, and NASH between individuals with metabolically healthy obesity (MHO) and individuals with metabolically abnormal obesity (MAO) and to identify preoperative risk factors for these conditions in a prospective cohort with morbid obesity scheduled for bariatric surgery. SETTINGS Tertiary referral university hospital in France. METHODS The prospective cohort included 837 bariatric patients who also had an intraoperative liver biopsy between 2002 and 2015. Obese individuals fulfilling none of the criteria in the strict definition of metabolic syndrome were considered metabolically healthy. Preoperative blood samples and liver pathology examinations were reviewed. Steatosis, NAFLD, and NASH were carefully identified allowing comparison of prevalence and risk factors between the 2 cohorts. RESULTS In total, 149 patients (17.8%) had MHO and the remaining 688 (82.2%) had MAO. The cohort with MHO was significantly younger, had a significantly lower glycosylated hemoglobin, a lower homeostasis model assessment of insulin resistance, and increased C-reactive protein. In individuals with MHO, 44 patients (29.5%) had at least moderate steatosis (>33% macrovesicular steatosis) and 5.4% had NASH. Using logistic regression, waist circumference was positively associated with NASH, whereas body mass index and alanine aminotransferase were significantly associated with severe steatosis (>66%). CONCLUSION Our study indicates that obese individuals without metabolic syndrome may develop subclinical liver involvement. Therefore, the occurrence of NAFLD and NASH in this population needs further investigation.
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Affiliation(s)
- Sébastien Frey
- Université Côte d'Azur, Nice, France; Department of Digestive surgery and liver transplantation, Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Stéphanie Patouraux
- Université Côte d'Azur, Nice, France; Department of Pathology, Pasteur Hospital, University Hospital of Nice, Nice, France
| | - Tarek Debs
- Department of Digestive surgery and liver transplantation, Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Jean Gugenheim
- Université Côte d'Azur, Nice, France; Department of Digestive surgery and liver transplantation, Archet 2 Hospital, University Hospital of Nice, Nice, France; Inserm, U1065, Team 8 "Hepatic complications of obesity and alcohol," Nice, France
| | - Rodolphe Anty
- Université Côte d'Azur, Nice, France; Inserm, U1065, Team 8 "Hepatic complications of obesity and alcohol," Nice, France; Department of Hepathology, Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Antonio Iannelli
- Université Côte d'Azur, Nice, France; Department of Digestive surgery and liver transplantation, Archet 2 Hospital, University Hospital of Nice, Nice, France; Department of Hepathology, Archet 2 Hospital, University Hospital of Nice, Nice, France.
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Ph - myeloproliferative neoplasms and the related risk factors for stroke occurrence: Results from a registry of patients treated with Anagrelide. J Thromb Thrombolysis 2020; 51:112-119. [PMID: 32578055 DOI: 10.1007/s11239-020-02175-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Arterial thrombosis is a common complication in patients with Ph- myeloproliferative neoplasms (MPN). We searched for the risk factors of stroke in MPN patients from anagrelide registry. We analyzed the potential risk factors triggering a stroke/TIA event in 249 MPN patients with previous stroke (n = 168) or Transient Ischemic Attack (TIA) (n = 140), and in 1,193 MPN control subjects (without clinical history of thrombosis). These patients were registered in a prospective manner, providing a follow-up period after Anagrelide treatment. The median age of the patients in the experimental group was of 56 years of age (ranging from 34-76) and of 53 years of age (ranging from 26-74) in the control group (p < 0.001). Using a multivariate model, we determined the following as risk factors: JAK2V617F mutation (OR 2.106, 1.458-3.043, p = 0.006), age (OR 1.017/year, 1.005-1,029, p = 0.006), male gender (OR 1.419, 1.057-1.903, p = 0.020), MPN diagnosis (OR for PMF 0.649, 0.446-0.944, p = 0.024), BMI (OR 0.687 for BMI > 25, 0.473-0.999, p = 0.05) and high TAG levels (OR 1.734, 1.162-2.586, p = 0.008), all of which were statistically significant for CMP development. Concerning the risk factors for thrombophilia, only the antiphospholipid syndrome (OR 1.994, 1.017-3.91, p = 0.048) was noteworthy in a stroke-relevant context. There was no significant difference between the blood count of the patients prior to a stroke event and the control group, both of which were under a cytoreductive treatment. We found that age, male gender, JAK2V617F mutation, previous venous thrombosis, and hypertriglyceridemia represent independent risk factors for the occurrence of a stroke in Ph- MPN patients.
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Shi W, Xing L, Jing L, Tian Y, Yan H, Sun Q, Dai D, Shi L, Liu S. Value of triglyceride-glucose index for the estimation of ischemic stroke risk: Insights from a general population. Nutr Metab Cardiovasc Dis 2020; 30:245-253. [PMID: 31744716 DOI: 10.1016/j.numecd.2019.09.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 08/26/2019] [Accepted: 09/16/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Recent studies have recognized triglyceride-glucose index (TyG) as a practical surrogate of insulin resistance. Previous studies have demonstrated that insulin resistance contributes to ischemic stroke via multiple mechanisms. Our study aimed to investigate the association between TyG and prevalent ischemic stroke, exploring the value of TyG to optimize the risk stratification of ischemic stroke. METHODS AND RESULTS This cross-sectional study included 10,900 subjects (mean age: 59.95 years, 59.8% females) from rural areas of northeast China between September 2017 to May 2018. TyG was calculated as ln[fasting triglyceride (mg/dl) × fasting plasma glucose (mg/dl)/2]. The prevalence of ischemic stroke was 5.49%. After adjusting for all covariates, each SD increment of TyG caused 22.8% additional risk for ischemic stroke. When dividing TyG into quartiles, the top quartile had a 1.776 times risk for ischemic stroke against the bottom category. Furthermore, smoothing curve fitting demonstrated this association was linear in the whole range of TyG. Finally, AUC revealed an improvement when introducing TyG into clinical risk factors (0.746 vs 0.751, p = 0.029). Consistently, category-free net reclassification index (0.195, 95% CI: 0.112-0.277, P < 0.001) and integrated discrimination index (0.003, 95% CI: 0.001-0.004, P < 0.001) confirmed the improvement by TyG to stratify ischemic stroke risk. CONCLUSION The prevent ischemic stroke correlated proportionally with the increment of TyG, implicating the linearity of TyG as an indicator of ischemic stroke. Our findings suggest the potential value of TyG to optimize the risk stratification of ischemic stroke in a general population.
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Affiliation(s)
- Wenrui Shi
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Liying Xing
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China; Liaoning Provincial Center for Disease Control and Prevention, Shenyang, Liaoning, People's Republic of China
| | - Li Jing
- Liaoning Provincial Center for Disease Control and Prevention, Shenyang, Liaoning, People's Republic of China
| | - Yuanmeng Tian
- Liaoning Provincial Center for Disease Control and Prevention, Shenyang, Liaoning, People's Republic of China
| | - Han Yan
- Liaoning Provincial Center for Disease Control and Prevention, Shenyang, Liaoning, People's Republic of China
| | - Qun Sun
- Disease Control and Prevention of Chao Yang City, Chaoyang, Liaoning, People's Republic of China
| | - Dong Dai
- Disease Control and Prevention of Dan Dong City, Dandong, Liaoning, People's Republic of China
| | - Lei Shi
- Disease Control and Prevention of Liao Yang City, Liaoyang, Liaoning, People's Republic of China
| | - Shuang Liu
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, 110005, Liaoning, People's Republic of China.
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Metabolically Healthy Obesity-Heterogeneity in Definitions and Unconventional Factors. Metabolites 2020; 10:metabo10020048. [PMID: 32012784 PMCID: PMC7074352 DOI: 10.3390/metabo10020048] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 02/06/2023] Open
Abstract
The concept of heterogeneity among obese individuals in their risk for developing metabolic dysfunction and associated complications has been recognized for decades. At the origin of the heterogeneity idea is the acknowledgement that individuals with central obesity are more prone to developing type 2 diabetes and cardiovascular disease than those with peripheral obesity. There have been attempts to categorize subjects according to their metabolic health and degree of obesity giving rise to different obese and non-obese phenotypes that include metabolically unhealthy normal-weight (MUHNW), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Individuals belonging to the MHO phenotype are obese according to their body mass index although exhibiting fewer or none metabolic anomalies such as type 2 diabetes, dyslipidemia, hypertension, and/or unfavorable inflammatory and fribinolytic profiles. However, some authors claim that MHO is only transient in nature. Additionally, the phenotype categorization is controversial as it lacks standardized definitions possibly blurring the distinction between obesity phenotypes and confounding the associations with health outcomes. To add to the discussion, the factors underlying the origin or protection from metabolic deterioration and cardiometabolic risk for these subclasses are being intensely investigated and several hypotheses have been put forward. In the present review, we compare the different definitions of obesity phenotypes and present several possible factors underlying them (adipose tissue distribution and cellularity, contaminant accumulation on the adipose tissue, dysbiosis and metabolic endotoxemia imposing on to the endocannabinoid tone and inflammasome, and nutrient intake and dietary patterns) having inflammatory activation at the center.
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Chiu H, Tsai HJ, Huang JC, Wu PY, Hsu WH, Lee MY, Chen SC. Associations between Triglyceride-Glucose Index and Micro- and Macro-angiopathies in Type 2 Diabetes Mellitus. Nutrients 2020; 12:nu12020328. [PMID: 31991925 PMCID: PMC7071226 DOI: 10.3390/nu12020328] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 01/31/2023] Open
Abstract
The aim of this study was to investigate the associations between the triglyceride-glucose (TyG) index, a marker of insulin resistance, and microangiopathies and macroangiopathies in patients with type 2 diabetes mellitus (DM). Our study enrolled 1990 type 2 diabetic patients from local hospitals in Taiwan during the period of 2002–2004. Multivariate logistic regression analysis was used to identify the factors related to microangiopathies, macroangiopathiess and TyG index. The patients were stratified by TyG index quartile (Q1–Q4). Adjusted odds ratios (aORs) of albuminuria for Q3 versus Q1 and Q4 versus Q1 were 1.424 (95% confidence interval [CI], 1.062–1.910, p = 0.018) and 1.948 (95% CI, 1.437–2.642, p < 0.001), respectively. The aOR of cerebrovascular disease (CVA) was 2.264 for Q4 versus Q1 (95% CI, 1.243–4.122, p = 0.008), but there were no significant associations with diabetic retinopathy (DR), coronary artery disease (CAD) or peripheral artery occlusive disease (PAOD). Significant stepwise increases were found in CVA (p = 0.0013) and albuminuria ≥30 mg/g (p < 0.001) corresponding to TyG index quartiles, but not DR (p = 0.573), CAD (p = 0.880) or PAOD (p = 0.223). There was a significant association between a high TyG index and a high risk of microalbuminuria and CVA in the study cohort. Further studies to investigate the use of medications in patients with DM to prevent micro- and macro-angiopathies are thus warranted.
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Affiliation(s)
- Hsuan Chiu
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Hui-Ju Tsai
- Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Jiun-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (J.-C.H.); (P.-Y.W.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Pei-Yu Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (J.-C.H.); (P.-Y.W.)
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Wei-Hao Hsu
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Mei-Yueh Lee
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence: ; Tel.: +886-7-312-1101 (ext. 7375)
| | - Szu-Chia Chen
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (J.-C.H.); (P.-Y.W.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
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Lee H, Oh J, Lee J, Kang H, Lim TH, Ko BS, Cho Y, Song SY. Retrospective Study Using Computed Tomography to Compare Sufficient Chest Compression Depth for Cardiopulmonary Resuscitation in Obese Patients. J Am Heart Assoc 2019; 8:e013948. [PMID: 31766971 PMCID: PMC6912977 DOI: 10.1161/jaha.119.013948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022]
Abstract
Background This study aimed to investigate the relationship between body mass index (BMI) and sufficient chest compression depth (CCD) in obese patients by a mathematical model. Methods and Results This retrospective analysis was performed with chest computed tomography images conducted between 2006 and 2018. We classified the selected individuals into underweight (<18.5), normal weight (≥18.5, <25), overweight (≥25, <30), and obese (≥30) groups according to BMI (kg/m2). We defined heart compression fraction (HCF) as [Formula: see text] and estimated under-HCF (the value of HCF <20%), and over-HCF (the residual depth <2 cm after simulation with chest compression depth 5 and 6 cm). We compared these outcomes between BMI groups. Of 30 342 individuals, 8856 were selected and classified into 4 BMI groups from a database. We randomly selected 100 individuals in each group and analyzed a total of 400 individuals' cases. Higher BMI groups had a significantly decreased HCF with both 5 and 6 cm depth (P<0.001). The proportion of under-HCF with both depths increased according to BMI group, whereas the proportion of over-HCF decreased except for the 5 cm depth (P<0.001). The adjusted odds ratio of under-HCF, according to BMI group after adjustment of age and sex, was 7.325 (95% CI, 3.412-15.726; P<0.001), with 5 cm and 10.517 (95% CI, 2.353-47.001; P=0.002) with 6 cm depth, respectively. Conclusions The recommended chest compression depth of 5 to 6 cm in the current international guideline is unlikely to provide sufficient ejection fraction during cardiopulmonary resuscitation in obese patients.
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Affiliation(s)
- Heekyung Lee
- Department of Emergency MedicineCollege of MedicineHanyang UniversitySeoulRepublic of Korea
| | - Jaehoon Oh
- Department of Emergency MedicineCollege of MedicineHanyang UniversitySeoulRepublic of Korea
- Machine Learning Research Center for Medical DataHanyang UniversitySeoulRepublic of Korea
| | - Juncheol Lee
- Department of Emergency MedicineCollege of MedicineHanyang UniversitySeoulRepublic of Korea
- Department of Emergency MedicineArmed Forces Capital HospitalSeongnamRepublic of Korea
| | - Hyunggoo Kang
- Department of Emergency MedicineCollege of MedicineHanyang UniversitySeoulRepublic of Korea
| | - Tae Ho Lim
- Department of Emergency MedicineCollege of MedicineHanyang UniversitySeoulRepublic of Korea
| | - Byuk Sung Ko
- Department of Emergency MedicineCollege of MedicineHanyang UniversitySeoulRepublic of Korea
| | - Yongil Cho
- Department of Emergency MedicineCollege of MedicineHanyang UniversitySeoulRepublic of Korea
| | - Soon Young Song
- Department of RadiologyCollege of MedicineHanyang UniversitySeoulRepublic of Korea
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Luo E, Wang D, Yan G, Qiao Y, Liu B, Hou J, Tang C. High triglyceride-glucose index is associated with poor prognosis in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention. Cardiovasc Diabetol 2019; 18:150. [PMID: 31722708 PMCID: PMC6852896 DOI: 10.1186/s12933-019-0957-3] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 10/28/2019] [Indexed: 02/07/2023] Open
Abstract
Background Insulin resistance (IR) is considered a pivotal risk factor for cardiometabolic diseases, and the triglyceride–glucose index (TyG index) has emerged as a reliable surrogate marker of IR. Although several recent studies have shown the association of the TyG index with vascular disease, no studies have further investigated the role of the TyG index in acute ST-elevation myocardial infarction (STEMI). The objective of the present study was to evaluate the potential role of the TyG index as a predictor of prognosis in STEMI patients after percutaneous coronary intervention (PCI). Methods The study included 1092 STEMI patients who underwent PCI. The patients were divided into 4 quartiles according to TyG index levels. Clinical characteristics, fasting plasma glucose (FPG), triglycerides (TGs), other biochemical parameters, and the incidence of major adverse cardiovascular and cerebral events (MACCEs) during the follow-up period were recorded. The TyG index was calculated using the following formula: ln[fasting TGs (mg/dL) × FPG (mg/dL)/2]. Results The incidence of MACCEs and all-cause mortality within 30 days, 6 months and 1 year after PCI were higher among STEMI patients with TyG index levels in the highest quartile. The TyG index was significantly associated with an increased risk of MACCEs in STEMI patients within 1 year after PCI, independent of confounding factors, with a value of 1.529 (95% CI 1.001–2.061; P = 0.003) for those in the highest quartile. The area under the curve (AUC) of the TyG index predicting the occurrence of MACCEs in STEMI patients after PCI was 0.685 (95% CI 0.610–0.761; P = 0.001). The results also revealed that Killip class > 1, anaemia, albumin, uric acid, number of stents and left ventricular ejection fraction (LVEF) were independent predictors of MACCEs in STEMI patients after PCI (all P < 0.05). Conclusions This study indicated an association between higher TyG index levels and increased risk of MACCEs in STEMI patients for the first time, and the TyG index might be a valid predictor of clinical outcomes in STEMI patients undergoing PCI. Trial Registration ChiCTR1900024577.
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Affiliation(s)
- Erfei Luo
- School of Medicine, Southeast University, Nanjing, 210009, China
| | - Dong Wang
- Department of Cardiology, Zhongda Hospital, Southeast University, Hunan Road, Nanjing, 210009, Jiangsu, China.
| | - Gaoliang Yan
- Department of Cardiology, Zhongda Hospital, Southeast University, Hunan Road, Nanjing, 210009, Jiangsu, China
| | - Yong Qiao
- Department of Cardiology, Zhongda Hospital, Southeast University, Hunan Road, Nanjing, 210009, Jiangsu, China
| | - Bo Liu
- School of Medicine, Southeast University, Nanjing, 210009, China
| | - Jiantong Hou
- School of Medicine, Southeast University, Nanjing, 210009, China
| | - Chengchun Tang
- Department of Cardiology, Zhongda Hospital, Southeast University, Hunan Road, Nanjing, 210009, Jiangsu, China.
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da Silva A, Caldas APS, Hermsdorff HHM, Bersch-Ferreira ÂC, Torreglosa CR, Weber B, Bressan J. Triglyceride-glucose index is associated with symptomatic coronary artery disease in patients in secondary care. Cardiovasc Diabetol 2019; 18:89. [PMID: 31296225 PMCID: PMC6625050 DOI: 10.1186/s12933-019-0893-2] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/01/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The triglyceride-glucose index (TyG index) is a tool for insulin resistance evaluation, however, little is known about its association with coronary artery disease (CAD), which is the major cardiovascular death cause, and what factors may be associated with TyG index. OBJECTIVE To evaluate the association between the TyG index and the prevalence of CAD phases, as well as cardiovascular risk factors. METHODS The baseline data of patients in secondary care in cardiology from Brazilian Cardioprotective Nutritional Program Trial (BALANCE Program Trial) were analyzed. Anthropometric, clinical, socio-demographic and food consumption data were collected by trained professionals. The TyG index was calculated by the formula: Ln (fasting triglycerides (mg/dl) × fasting blood glucose (mg/dl)/2) and regression models were used to evaluate the associations. RESULTS We evaluated 2330 patients, which the majority was male (58.1%) and elderly (62.1%). The prevalence of symptomatic CAD was 1.16 times higher in patients classified in the last tertile of the TyG index (9.9 ± 0.5) compared to those in the first tertile (8.3 ± 0.3). Cardiometabolic risk factors were associated with TyG index, with the highlight for higher carbohydrate and lower lipid consumption in relation to recommendations that reduced the chance of being in the last TyG index tertile. CONCLUSION The TyG index was positively associated with a higher prevalence of symptomatic CAD, with metabolic and behavioral risk factors, and could be used as a marker for atherosclerosis. Trial registration ClinicalTrials.gov identifier: NCT01620398. Registered 15 June, 2012.
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Affiliation(s)
- Alessandra da Silva
- Department of Nutrition and Health, Universidade Federal de Viçosa, Avenida PH Rolfs s/n, Viçosa, Minas Gerais, 36570-900, Brazil.
| | - Ana Paula Silva Caldas
- Department of Nutrition and Health, Universidade Federal de Viçosa, Avenida PH Rolfs s/n, Viçosa, Minas Gerais, 36570-900, Brazil
| | - Helen Hermana Miranda Hermsdorff
- Department of Nutrition and Health, Universidade Federal de Viçosa, Avenida PH Rolfs s/n, Viçosa, Minas Gerais, 36570-900, Brazil
| | | | | | | | - Josefina Bressan
- Department of Nutrition and Health, Universidade Federal de Viçosa, Avenida PH Rolfs s/n, Viçosa, Minas Gerais, 36570-900, Brazil
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Leszczak J, Czenczek-Lewandowska E, Przysada G, Baran J, Weres A, Wyszyńska J, Mazur A, Kwolek A. Association Between Body Mass Index and Results of Rehabilitation in Patients After Stroke: A 3-Month Observational Follow-Up Study. Med Sci Monit 2019; 25:4869-4876. [PMID: 31257360 PMCID: PMC6618340 DOI: 10.12659/msm.915586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background We assessed the relationship between body mass index and results of rehabilitation in stroke patients. Material/Methods The study was carried out at the Clinical Rehabilitation Ward with Early Neurological Rehabilitation Unit at the Clinical Hospital. The examinations were performed 3 times. Based on inclusion and exclusion criteria, 128 subjects were qualified for the first examination, the second examination involved 114 subjects, and 100 stroke patients participated in the third examination. Body mass was examined with an accuracy of 0.1 kg, using a Tanita MC–780 MA body composition analyser. Body mass index (BMI) was calculated for all of the subjects. Effects of rehabilitation were assessed with the Barthel index and Ashworth scale. Results Higher functional status in daily life, measured with the Barthel scale, was found in patients with normal body mass, compared to the overweight and obese subjects (examination I, II, and II). Exam I showed that before rehabilitation the overweight patients obtained significantly higher results in assessment of upper limbs, based on the Ashworth scale (mean=0.35±0.54) compared to the obese patients (mean=0.03±0.32) and those with normal body weight (mean=0.24±0.75). Conclusions Following hospital-based rehabilitation, patients with normal body mass achieved greater functional efficiency. The findings also show a trend towards normalization of BMI. The positive effect of rehabilitation was sustained for 3 months (Exam III), which may contribute to decreased risk of cardiovascular diseases and complications such as stroke.
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Affiliation(s)
| | | | - Grzegorz Przysada
- Medical Faculty, University of Rzeszów, Rzeszów, Poland.,Clinical Regional Hospital No. 2 in Rzeszów, Rzeszów, Poland
| | - Joanna Baran
- Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | - Aneta Weres
- Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | | | - Artur Mazur
- Medical Faculty, University of Rzeszów, Rzeszów, Poland.,Clinical Regional Hospital No. 2 in Rzeszów, Rzeszów, Poland
| | - Andrzej Kwolek
- University of Rzeszów, University of Rzeszów, Medical Faculty, Rzeszów, Poland
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Mirzababaei A, Djafarian K, Mozafari H, Shab-Bidar S. The long-term prognosis of heart diseases for different metabolic phenotypes: a systematic review and meta-analysis of prospective cohort studies. Endocrine 2019; 63:439-462. [PMID: 30671787 DOI: 10.1007/s12020-019-01840-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/03/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE This meta-analysis aimed to assess the association of different categories of weight and metabolic status with risk of heart diseases including myocardial infarction (MI), cardiovascular diseases (CVDs), and heart failure (HF). METHODS Data from relevant studies were identified systematically by searching PubMed and Scopus search engines up to 29 May 2018. Prospective studies were included in the analyses with metabolically healthy normal weight (MHNW) as the reference. Pooled RRs and 95% CI were calculated using random-effects or fixed-effect models when appropriate. Subgroup analysis was applied to define possible sources of heterogeneity. RESULTS Overall, 21 studies (n = 778,401 participants) were eligible for the present meta-analysis. Generally, the risk of CVDs for all metabolic phenotypes in metabolically unhealthy obese increased compared with the MHNW group. A significant positive association between all metabolic phenotypes and the risk of HF was also observed expect for MHOW (RR = 1.10, 95% CI: 0.60-2.00, P = 0.76) and MHO phenotypes (RR = 0.96, 95% CI: 0.25-3.77, P = 0.95). Moreover, MUHO phenotype was associated with greater risk of MI compared with the MHNW phenotype (RR = 1.82, 95% CI: 1.50-2.22, P < 0.001, respectively). CONCLUSIONS Our findings showed that all metabolically unhealthy phenotypes in different categories of weight were associated with increased incident of CVDs/HF and MI. Furthermore, healthy overweight and obese subjects had increased risk of CVDs.
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Affiliation(s)
- Atieh Mirzababaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Student's Scientific Research Center, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Kurosh Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hadis Mozafari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Ampuero J, Aller R, Gallego-Durán R, Banales JM, Crespo J, García-Monzón C, Pareja MJ, Vilar-Gómez E, Caballería J, Escudero-García D, Gomez-Camarero J, Calleja JL, Latorre M, Albillos A, Salmeron J, Aspichueta P, Lo Iacono O, Francés R, Benlloch S, Fernández-Rodríguez C, García-Samaniego J, Estévez P, Andrade RJ, Turnes J, Romero-Gómez M. The effects of metabolic status on non-alcoholic fatty liver disease-related outcomes, beyond the presence of obesity. Aliment Pharmacol Ther 2018; 48:1260-1270. [PMID: 30353552 DOI: 10.1111/apt.15015] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/08/2018] [Accepted: 09/16/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Metabolically healthy obesity (MHO) shows a reduced risk compared with obese patients with adverse metabolic conditions. Lean people suffering some metabolic derangements also have non-alcoholic fatty liver disease (NAFLD)-related outcomes compared with non-obese subjects with a few metabolic risks. AIM To define the impact of the metabolic status on the NAFLD-related outcomes, beyond the presence of obesity. METHODS We designed a multicentre cross-sectional study, including 1058 biopsy-proven NAFLD patients. Metabolically healthy status was strictly defined by the lack of metabolic risk factors (diabetes mellitus, low HDL, hypertriglyceridemia, arterial hypertension). Non-alcoholic steatohepatitis (NASH) and significant fibrosis (F2-F4) were identified by liver biopsy. Chronic kidney disease epidemiology collaboration equation was calculated for kidney function and the atherogenic index of plasma (AIP) for cardiovascular risk. RESULTS Metabolically healthy (OR 1.88; P = 0.050) and unhealthy obesity (OR 3.47: P < 0.0001), and unhealthy non-obesity (OR 3.70; P < 0.0001) were independently associated with NASH together with homeostatic model assessment (HOMA), ALT, and platelets. Significant fibrosis was more frequently observed in the presence of adverse metabolic conditions in obese (OR 3.89; P = 0.003) and non-obese patients (OR 3.92; P = 0.002), and independently associated with platelets, albumin, ALT, HOMA, and age. The number of metabolic factors determined the risk of NASH and significant fibrosis. Glomerular filtration rate was lower in unhealthy (91.7 ± 18) than healthy metabolism (95.6 ± 17) (P = 0.007). AIP was higher in adverse metabolic conditions (P = 0.0001). Metabolically unhealthy non-obesity showed higher liver damage (NASH 55.8% vs 42.4%; P < 0.05; significant fibrosis 31.7% vs 11.4%; P < 0.0001) and cardiovascular risk (P < 0.0001) than healthy obesity. CONCLUSIONS Metabolic unhealthy status showed a greater impact on NASH, significant fibrosis, kidney dysfunction, and atherogenic profile than obesity. However, metabolically healthy obesity was not a full healthy condition. We should focus our messages especially on patients with adverse metabolic conditions.
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Roever L, Resende ES, Diniz ALD, Penha-Silva N, O’Connell JL, Gomes PFS, Zanetti HR, Roerver-Borges AS, Veloso FC, de Souza FR, Duarte PRA, Fidale TM, Casella-Filho A, Dourado PMM, Chagas ACP, Ali-Hasan-Al-Saegh S, Reis PEO, Pinto RDMC, Oliveira GB, Avezum Á, Neto M, Durães AR, da Silva RMFL, Grande AJ, Denardi C, Lopes RD, Nerlekar N, Alizadeh S, Hernandez AV, da Rosa MI, Biondi-Zoccai G. High-density lipoprotein-cholesterol functionality and metabolic syndrome: Protocol for review and meta-analysis. Medicine (Baltimore) 2018; 97:e11094. [PMID: 29901625 PMCID: PMC6023647 DOI: 10.1097/md.0000000000011094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/23/2018] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The prevalence of metabolic syndrome (MetS) and MetS-related stroke is set to increase dramatically in coming decades. MetS is a complex disease that includes endothelial dysfunction, insulin resistance, diabetes, hypertension, ectopic obesity, and dyslipidaemia and an increased risk of cardiovascular events. One function of high-density lipoprotein (HDL) cholesterol (HDL-C) is the cholesterol-efflux pathway, which is the pathway where cholesterol is removed from macrophages within the arterial walls back into the bloodstream and out to the liver. As one of the key functions of HDL, their hypothesis was that if they could measure HDL-C-efflux capacity, they would have a better handle on the role of HDL in atherosclerosis. However, there are no systematic analyses or well-conducted meta-analyses to evaluate the relationship between HDL-C functionality and MetS. The aim of this study is to examine this association of HDL-C functionality with MetS in different ages and sex. METHODS AND ANALYSIS The update systematic review and meta-analysis will be conducted using published studies that will be identified from electronic databases (i.e., PubMed, EMBASE, Web of Science, and Google Scholar). Studies that examined the association between HDL-C functionality and MetS; focused on cohort, case-control, and cross-sectional studies; were conducted among in adults aged 40 to 70 years; provided sufficient data for calculating odds ratio or relative risk with a 95% confidence interval; were published as original articles written in English or other languages; and have been published until January 2018 will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted based on discussions among investigators. ETHICS AND DISSEMINATION Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. TRIAL REGISTRATION NUMBER PROSPERO (CRD42018083465).
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Affiliation(s)
- Leonardo Roever
- Federal University of Uberlândia, Department of Clinical Research, Heart Institute (InCor), Master Institute of Education President Antonio Carlos, IMEPAC, Araguari
| | - Elmiro Santos Resende
- Federal University of Uberlândia, Department of Clinical Research, Heart Institute (InCor), Master Institute of Education President Antonio Carlos, IMEPAC, Araguari
| | - Angélica Lemos Debs Diniz
- Federal University of Uberlândia, Department of Clinical Research, Heart Institute (InCor), Master Institute of Education President Antonio Carlos, IMEPAC, Araguari
| | - Nilson Penha-Silva
- Federal University of Uberlândia, Department of Clinical Research, Heart Institute (InCor), Master Institute of Education President Antonio Carlos, IMEPAC, Araguari
| | - João Lucas O’Connell
- Federal University of Uberlândia, Department of Clinical Research, Heart Institute (InCor), Master Institute of Education President Antonio Carlos, IMEPAC, Araguari
| | - Paulo Fernando Silva Gomes
- Federal University of Uberlândia, Department of Clinical Research, Heart Institute (InCor), Master Institute of Education President Antonio Carlos, IMEPAC, Araguari
| | - Hugo Ribeiro Zanetti
- Federal University of Uberlândia, Department of Clinical Research, Heart Institute (InCor), Master Institute of Education President Antonio Carlos, IMEPAC, Araguari
- Department of Clinical Research, HCFMUSP- University of São Paulo Medical School, Department of Cardiology, São Paulo
| | - Anaisa Silva Roerver-Borges
- Department of Clinical Research, HCFMUSP- University of São Paulo Medical School, Department of Cardiology, São Paulo
| | - Fernando César Veloso
- Federal University of Uberlândia, Department of Clinical Research, Heart Institute (InCor), Master Institute of Education President Antonio Carlos, IMEPAC, Araguari
| | - Fernanda Rodrigues de Souza
- Federal University of Uberlândia, Department of Clinical Research, Heart Institute (InCor), Master Institute of Education President Antonio Carlos, IMEPAC, Araguari
| | - Poliana Rodrigues Alves Duarte
- Federal University of Uberlândia, Department of Clinical Research, Heart Institute (InCor), Master Institute of Education President Antonio Carlos, IMEPAC, Araguari
| | - Thiago Montes Fidale
- Federal University of Uberlândia, Department of Clinical Research, Heart Institute (InCor), Master Institute of Education President Antonio Carlos, IMEPAC, Araguari
| | | | | | - Antonio Carlos Palandri Chagas
- Department of Cardiology, Faculty of Medicine ABC, Santo André, Brazil
- Department of Cardiology, Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | | | - Rogério de Melo Costa Pinto
- Federal University of Uberlândia, Department of Clinical Research, Heart Institute (InCor), Master Institute of Education President Antonio Carlos, IMEPAC, Araguari
| | - Gustavo B.F. Oliveira
- Department of Health and Sciences, Graduate Program in Medicine and Health, Federal University of Bahia, Bahia
| | - Álvaro Avezum
- Department of Health and Sciences, Graduate Program in Medicine and Health, Federal University of Bahia, Bahia
| | - Mansueto Neto
- Department of Cardiology, Federal University of Minas Gerais, MG
| | | | | | | | - Celise Denardi
- Department of Clinical Research, Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Renato Delascio Lopes
- Department of Cardiology, Monash Cardiovascular Research Centre and MonashHeart, Clayton, Victoria, Australia
| | - Nitesh Nerlekar
- Department of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahab Alizadeh
- Department of Comparative Effectiveness and Outcomes Research Health Outcomes, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, CT
| | - Adrian V. Hernandez
- Laboratory of Epidemiology, University of Extremo Sul Catarinense, Criciúma, Brazil
| | - Maria Inês da Rosa
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina
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Roever L, Resende ES, Diniz ALD, Penha-Silva N, O’Connell JL, Gomes PFS, Zanetti HR, Roerver-Borges AS, Veloso FC, Fidale TM, Casella-Filho A, Dourado PMM, Chagas ACP, Ali-Hasan-Al-Saegh S, Reis PEO, Pinto RDM, Oliveira GB, Avezum Á, Neto M, Durães A, da Silva RMFL, Grande AJ, Denardi C, Lopes RD, Nerlekar N, Alizadeh S, Hernandez AV, Biondi-Zoccai G. Metabolic syndrome and risk of stroke: Protocol for an update systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e9862. [PMID: 29642227 PMCID: PMC5908602 DOI: 10.1097/md.0000000000009862] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The metabolic syndrome is composed of several cardiovascular risk factors and has a high prevalence throughout the world. However, there are no systematic analyses or well-conducted meta-analyses to evaluate the relationship between metabolic syndrome and stroke. The aim of this study is to examine this association of metabolic syndrome with stroke in different ages and sex. METHODS AND ANALYSIS The update systematic review and meta-analysis will be conducted using published studies that will be identified from electronic databases (i.e., PubMed, EMBASE, Web of Science, and Google Scholar. Studies that examined the association between metabolic syndrome and stroke, had a longitudinal or prospective cohort design, were conducted among in adults aged 40 to 70 years, provided sufficient data for calculating ORs or relative risk with a 95% CI, were published as original articles written in English or other languages, and have been published until December 2017 will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted based on discussions among investigators. ETHICS AND DISSEMINATION Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. The findings from this study could be useful for assessing metabolic syndrome risk factors in stroke, and determining approaches for prevention of stroke in the future.
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Affiliation(s)
- Leonardo Roever
- Federal University of Uberlândia, Department of Clinical Research
| | | | | | | | | | | | - Hugo Ribeiro Zanetti
- Federal University of Uberlândia, Department of Clinical Research
- Heart Institute (InCor), Master Institute of Education President Antonio Carlos, Department of Clinical Research, IMEPAC, Araguari, Brazil
| | | | | | | | | | | | - Antonio Carlos Palandri Chagas
- HCFMUSP—University of São Paulo Medical School, Department of Cardiology, São Paulo
- Faculty of Medicine ABC, Department of Cardiology Santo André, Brazil
| | - Sadeq Ali-Hasan-Al-Saegh
- Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Department of Cardiology, Yazd, Iran
| | - Paulo Eduardo Ocke Reis
- Department of Specialized and General Surgery, Fluminense Federal University, Rio de Janeiro
| | | | - Gustavo B.F. Oliveira
- Dante Pazzanese Institute of Cardiology, São Paulo, Brazil; Dante Pazzanese Institute of Cardiology, Department of Clinical Research São Paulo
| | - Álvaro Avezum
- Dante Pazzanese Institute of Cardiology, São Paulo, Brazil; Dante Pazzanese Institute of Cardiology, Department of Clinical Research São Paulo
| | - Mansueto Neto
- Graduate Program in Medicine and Health, Department of Heath and Sciences, Federal University of Bahia
| | - André Durães
- Graduate Program in Medicine and Health, Department of Heath and Sciences, Federal University of Bahia
| | | | | | | | - Renato Delascio Lopes
- Division of Cardiology, Duke University Medical Center, Department of Clinical Research, Durham, NC
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre and Monash Heart, Department of Cardiology, Clayton, Victoria, Australia
| | - Shahab Alizadeh
- Tehran University of Medical Sciences, Department of Medicine, Iran
| | - Adrian V. Hernandez
- University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, Department of Comparative Effectiveness and Outcomes Research Health Outcomes, CT
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli, Italy
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Lee HJ, Choi EK, Lee SH, Kim YJ, Han KD, Oh S. Risk of ischemic stroke in metabolically healthy obesity: A nationwide population-based study. PLoS One 2018; 13:e0195210. [PMID: 29601602 PMCID: PMC5877885 DOI: 10.1371/journal.pone.0195210] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/19/2018] [Indexed: 11/20/2022] Open
Abstract
Background Whether metabolically healthy obese (MHO) individuals are at increased risk of ischemic stroke is not well known. We investigated the association of the MHO phenotype with ischemic stroke. Methods A total of 354,083 adults (age 45.8 ± 14.2 years) from the Korean National Health Insurance Service–National Sample Cohort enrolled in 2004–2008 were followed-up for incident ischemic stroke until 2013. Subjects meeting none of the metabolic syndrome criteria were classified as ‘metabolically healthy’. The cohort was categorized into four groups according to obesity and metabolic status: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), MHO, and metabolically unhealthy obese (MUO). Results Ischemic stroke was newly diagnosed in 4,884 (1.4%) individuals during a mean follow-up of 7.4 ± 1.5 years. Stroke incidence rates for the MHNW, MUNW, MHO, and MUO groups were 0.56, 2.61, 0.61, and 2.76 per 1,000 person-years, respectively. While risk for stroke increased significantly in metabolically unhealthy groups, it was not increased in MHO compared to the MHNW group on multivariate analysis. In metabolically healthy individuals, obesity did not increase the risk for ischemic stroke, regardless of the severity of obesity. Meanwhile, in metabolically unhealthy individuals, being obese was significantly associated with increased risk of stroke. Conclusions MHO individuals were not at increased risk for ischemic stroke. However, obesity increased risk for ischemic stroke in persons with metabolic risk factors; therefore, maintaining normal weight may be more important for this population. Also, metabolic unhealthiness showed greater association than obesity with stroke.
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Affiliation(s)
- Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- * E-mail:
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Liu Q, Li YX, Hu ZH, Jiang XY, Li SJ, Wang XF. Comparing associations of different metabolic syndrome definitions with ischemic stroke in Chinese elderly population. Eur J Intern Med 2018; 47:75-81. [PMID: 29092746 DOI: 10.1016/j.ejim.2017.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 10/01/2017] [Accepted: 10/11/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Studies have showed the associations between different definitions of metabolic syndrome (MetS) and risk of ischemic stroke were inconsistent. In this study, we compared associations of different MetS definitions with ischemic stroke in Chinese elderly population. METHODS A total of 1713 individuals aged 70-84years from Rugao Longevity and Ageing Study were analyzed. The MetS was defined by four different criteria: Chinese Adult Dyslipidemia Prevention Guide, International Diabetes Federation (IDF), Updated ATPIII (Updated ATPIII) by American heart association/American heart, lung and blood institute (AHA/NHLBI), and Joint Interim Statement(JIS) recommended by IDF and the American heart association/American national institutes of health/American heart, lung and blood institute (AHA/NIH/NHLBI). RESULTS Prevalence of MetS in the whole population was 24.0% (Chinese guide), 32.5% (IDF), 38.8% (Updated ATPIII) and 24.0% (JIS) and in stroke population was 27.1% (Chinese guide), 41.1% (IDF), 48.8% (Updated ATPIII) and 27.1% (JIS), respectively. The agreement between definitions was highest in Updated ATPIII vs. IDF (kappa=0.863). It showed that only definitions of IDF (OR 1.55, 95%CI 1.04-2.31, p=0.031) and Updated ATPIII (OR 1.64, 95%CI 1.11-2.42, p=0.013) were independently associated with risk of ischemic stroke in multivariable logistic regression analysis. The risk of ischemic stroke increased with the increasing of numbers of Mets components in Updated ATPIII (p<0.05). CONCLUSION In this population, Updated ATPIII criteria was a more suitable definition of Mets than definitions of Chinese guide, IDF and JIS for screening high-risk individuals of ischemic stroke, and the additive effects of Mets components might play a greater role than its composition alone in ischemic stroke.
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Affiliation(s)
- Qian Liu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Yan-Xun Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Zhi-Hao Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Xiao-Yan Jiang
- Department of Pathology and Pathophysiology, School of Medicine, Tongji University, Shanghai 200092,China
| | - Shu-Juan Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
| | - Xiao-Feng Wang
- College of Life Sciences, Fudan University, Shanghai 200433, China.
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