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Watanabe J, Kotani K. Metabolic Syndrome for Cardiovascular Disease Morbidity and Mortality Among General Japanese People: A Mini Review. Vasc Health Risk Manag 2020; 16:149-155. [PMID: 32368073 PMCID: PMC7182458 DOI: 10.2147/vhrm.s245829] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/05/2020] [Indexed: 12/17/2022] Open
Abstract
Background The importance of management of metabolic syndrome (MetS) for risk reduction of cardiovascular disease (CVD) has been recognized worldwide. Because of the comparatively unique characteristics of bodily figure/obesity and incident CVD in Japan, the relevance of MetS on CVD can be still discussed among Japanese people. The present study aimed to review briefly the relationship of MetS with CVD morbidity/mortality among general Japanese people. Methods Population-based prospective cohort studies evaluating the predictive value of MetS on CVD morbidity/mortality via a PubMed search up to 2019 were summarized. Results We identified two studies on morbidity that reported MetS to predict CVD morbidity. We identified three studies on mortality, and these studies showed an increased direction of hazard ratio (HR) of CVD mortality, while one study reported an insignificant prediction of MetS for CVD mortality. In the meta-analysis method, MetS significantly predicted CVD morbidity (HR=1.71 [95% confidence interval=1.34–2.18] in men and HR=1.89 [95% confidence interval=1.45–2.46] in women) as well as CVD mortality (HR=1.68 [95% confidence interval=1.37–2.06] in men and HR=1.73 [95% confidence interval=1.39–2.15] in women). Conclusion Among general Japanese people, MetS can be a positive predictor of CVD morbidity/mortality. Since the studies are limited, more research is needed to establish the findings.
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Affiliation(s)
- Jun Watanabe
- Center for Community Medicine, Jichi Medical University, Shimotsuke-City, Japan
| | - Kazuhiko Kotani
- Center for Community Medicine, Jichi Medical University, Shimotsuke-City, Japan
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Mazloomzadeh S, Karami Zarandi F, Shoghli A, Dinmohammadi H. Metabolic syndrome, its components and mortality: A population-based study. Med J Islam Repub Iran 2019; 33:11. [PMID: 31086790 PMCID: PMC6504944 DOI: 10.34171/mjiri.33.11] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 11/18/2022] Open
Abstract
Background: The association between Metabolic syndrome (MetS), its components and mortality has not been clearly established. The aim of this study was to determine the effects of Mets and its components on all cause and cause-specific mortality and to examine whether MetS or its components were better predictors of mortality.
Methods: In this retrospective cohort study, we used data from the Zanjan Healthy Heart Study performed in 2003 on 4000 persons. Based on the definitions provided by the NCEP- ATPIII, 1051 participants with MetS and 1219 with none or one of its components at study entry were enrolled. Information regarding the mortality and morbidity of 502 participants with MetS and 523 controls was collected in 2013 by telephone. Cause of death was defined as Cardio-Vascular Disease (CVD) or non-CVD. Data were analyzed using the Cox Proportional Hazards model to estimate the hazard ratios predicted by MetS and its individual components.
Results: The median duration of follow-up was 104±10.7 months. Thirty-five deaths occurred, including 18 cardiovascular deaths. The proportion of those with CVD, hypertension, diabetes or hospital stay was statistically higher in MetS patients than controls (p<0.0001). The hazard ratios of all-cause and cardiovascular mortality for those with MetS were 1.75 (%95CI: 0.88-3.47) and 3.66 (%95CI: 1.2-11.1) higher than controls, respectively. Among the components of MetS, only hypertension predicted a higher risk of all-cause and CVD mortality after adjusting for age and sex.
Conclusion: The results of this study indicated that MetS was associated with a higher risk of CVD mortality, morbidity, and hospital stay. Among the components of MetS, the association of hypertension was stronger compared to MetS as a whole. Therefore, this study confirms that MetS is a risk factor for CVD mortality, but not beyond the risk associated with its individual components.
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Affiliation(s)
- Saeideh Mazloomzadeh
- Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Fatemeh Karami Zarandi
- Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Alireza Shoghli
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hossain Dinmohammadi
- Molecular Medicine Department, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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Amouzegar A, Mehran L, Hasheminia M, Kheirkhah Rahimabad P, Azizi F. The predictive value of metabolic syndrome for cardiovascular and all-cause mortality: Tehran Lipid and Glucose Study. Diabetes Metab Res Rev 2017; 33. [PMID: 27155315 DOI: 10.1002/dmrr.2819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 04/11/2016] [Accepted: 04/25/2016] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The association of total and cardiovascular disease (CVD) mortality with metabolic syndrome (Mets) is controversial. We estimated the predictive value of MetS and its components for total and CVD mortality. MATERIALS AND METHODS A total of 7932 subjects aged ≥ 30 years; participants of the Tehran Lipid and Glucose Study were enrolled and followed for 9.0 ± 2.3 years. MetS was defined according to three different definitions: World Health Organization (WHO), International Diabetes Federation (IDF) and Joint Interim Statement (JIS). RESULTS WHO-MetS remained a significant predictor of total and CVD mortality in men (HR 1.66, 95%CI 1.23-2.24, p < 0.001; 1.93 HR 1.93, 95%CI 1.26-2.94, p = 0.002) and women (HR 2.01, 95%CI 1.39-2.88, p < 0.001; HR 2.71, 95%CI 1.44-5.09, p = 0.002), respectively. IDF-MetS was associated with increased risk of total mortality only in women (HR 1.51, 95%CI 1.07-2.12, p = 0.01), but after controlling for diabetes, IDF and WHO-MetS lost their associations. The incidence of CVD mortality was highest in WHO group (13.4) compared with IDF (8.5), JIS (8.14) and control (5.5) groups. The incidence of total mortality for WHO (27.1) was highest compared with IDF (17.7), JIS (16.5) and control (12.9) groups. In men, hypertension, impaired fasting glucose (IFG) and abdominal obesity and in women, IFG (WHO criteria) and high triglycerides levels increased the risk of CVD mortality. In men, hypertension and IFG directly and high triglycerides inversely were associated with total mortality. In women, IFG and obesity increased the risk of all-cause mortality. CONCLUSION Diagnosis of MetS seems no more informative than its individual components in predicting mortality. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Hasheminia
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parnian Kheirkhah Rahimabad
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Prevalence and risk factors of metabolic syndrome among an endangered tribal population in Malaysia using harmonized IDF criteria. Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-016-0487-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Katakami N, Kaneto H, Funahashi T, Shimomura I. Type 2 diabetes and atherosclerosis: focusing on metabolic syndrome. Diabetol Int 2013. [DOI: 10.1007/s13340-013-0131-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Kojima C, Kubota M, Nagai A, Adachi S, Watanabe KI, Nakahata T. Adipocytokines in childhood cancer survivors and correlation with metabolic syndrome components. Pediatr Int 2013; 55:438-42. [PMID: 23745514 DOI: 10.1111/ped.12087] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 12/09/2012] [Accepted: 02/22/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although there are several studies on the prevalence of metabolic syndrome (MetS) in childhood cancer survivors (CCS), the association between MetS components and serum adipocytokine level has not been elucidated. METHODS The charts of 49 patients (27 male, 22 female) who had attended the CCS clinic of the Department of Pediatrics, Kyoto University Hospital, between April 2009 and March 2010 were retrospectively reviewed. Median age was 10.7 years, and the median interval since the completion of chemotherapy was 5.1 years. The diagnosis of MetS was made based on the Japanese criteria for either children or adults. RESULTS Three (6.1%) of 49 patients fulfilled the criteria for MetS, and 28 (57.1%) had at least one component of MetS. High leptin level was seen in 18 patients (36.7%), and low total adiponectin level was seen in 20 (40.8%). The number of patients with high leptin was correlated with body mass index z-score (>2.0), abdominal circumference/height (≥0.5), diastolic blood pressure and fasting blood sugar. The number of patients with low total adiponectin was correlated with systolic blood pressure and triglyceride. When the patients were divided into three groups based on the number of positive MetS components (0, 1 and 2-4), leptin and adiponectin tended to be higher and lower in the third group, respectively. CONCLUSIONS Adipocytokines may play a role in the pathogenesis of MetS occurring in CCS. It is recommended that adipocytokines be evaluated together with MetS components at the CCS follow-up clinics.
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Affiliation(s)
- Chiaki Kojima
- Department of Human Life and Environment, Nara Women's University, Kyoto, Japan
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Jeong SJ, Chin BS, Chae YT, Jin SJ, Ku NS, Baek JH, Han SH, Kim CO, Choi JY, Song YG, Lee HC, Kim JM. Serum retinol-binding protein-4 levels are increased in HIV-infected subjects with metabolic syndrome receiving highly active antiretroviral therapy. Yonsei Med J 2012; 53:1211-5. [PMID: 23074124 PMCID: PMC3481373 DOI: 10.3349/ymj.2012.53.6.1211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Metabolic syndrome is an important long term complication in chronic asymptomatic HIV-infected subjects under highly active antiretroviral therapy (HAART), because it can contribute to morbidity and mortality via cardiovascular disease (CVD). Therefore, a predictive marker for early detection of metabolic syndrome may be necessary to prevent CVD in HIV-infected subjects. Retinol-binding protein- 4 (RBP-4) has been shown to be associated with metabolic syndrome in various non-HIV-infected populations. We performed a cross-sectional study to evaluate whether serum RBP-4 levels are correlated with metabolic syndrome in HIV-infected subjects receiving HAART. In total, 98 HIV-infected Koreans who had been receiving HAART for at least 6 months were prospectively enrolled. Metabolic syndrome was diagnosed according to the Adult Treatment Panel III criteria, and serum RBP-4 concentrations were measured using human RBP-4 sandwich enzyme- linked immunosorbent assay. Serum RBP-4 levels were significantly higher in HIV-infected subjects receiving HAART with metabolic syndrome (n=33, 33.9±7.7 μg/mL) than in those without it (n=65, 29.9±7.2 μg/mL) (p=0.012). In multivariate linear regression analysis, the number of components of metabolic syndrome presented and waist circumference were independently, significantly correlated with RBP-4 (p=0.018 and 0.030, respectively). In conclusion, we revealed a strong correlation between RBP-4 and the number of components of metabolic syndrome in HIV-infected subjects receiving HAART.
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Affiliation(s)
- Su Jin Jeong
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Bum Sik Chin
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Tae Chae
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Joon Jin
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Su Ku
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyeon Baek
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Han
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Oh Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Goo Song
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Chul Lee
- Department of Internal Medicine and Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - June Myung Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Kotani K, Taniguchi N. The association between reactive oxygen metabolites and metabolic syndrome in asymptomatic Japanese men. J Clin Med Res 2011; 3:247-51. [PMID: 22383912 PMCID: PMC3279486 DOI: 10.4021/jocmr668w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2011] [Indexed: 11/25/2022] Open
Abstract
Background The association between the oxidative status and metabolic syndrome (MetS) should be studied in various populations with various oxidative stress-related markers. The aim of this cross-sectional study was to investigate the association between oxidative status, as assessed by the reactive oxygen metabolites (d-ROMs) test, and MetS in asymptomatic Japanese men, in relation to age. Methods The serum d-ROMs levels were measured in cardiovascular disease-free, non-smoking, non-medicated males (n = 140), who were divided into groups as follows: Group 1, < 60 years (n = 75, mean age 46 ± 9 [SD] years), and Group 2, ≥ 60 years (n = 65, mean 68 ± 6 years). The MetS was determined by the NCEP-ATP recommendations with minor modifications for a Japanese population. Results There was no significant difference in the d-ROMs levels between the subjects with and without MetS in Group 2 (≥ 60 years), but the subjects with MetS (n = 38, 324 ± 59 U. Curr.) exhibited significantly higher d-ROMs levels than those without MetS (n = 37, 290 ± 49 U. Curr., P < 0.01) in Group 1 (< 60 years). These differences did not change even after adjustments for basic confounders. Conclusions These results suggest that oxidative status, as assessed by the d-ROMs, can be enhanced among asymptomatic younger, but not older, Japanese males with MetS. Further studies are required to establish the observed associations. Keywords Oxidative stress; Reactive oxygen species; D-ROMs; Obesity; Metabolic syndrome
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Affiliation(s)
- Kazuhiko Kotani
- Department of Clinical Laboratory Medicine, Jichi Medical University, Tochigi, Japan
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Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, Rinfret S, Schiffrin EL, Eisenberg MJ. The Metabolic Syndrome and Cardiovascular Risk. J Am Coll Cardiol 2010; 56:1113-32. [PMID: 20863953 DOI: 10.1016/j.jacc.2010.05.034] [Citation(s) in RCA: 1823] [Impact Index Per Article: 130.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 05/10/2010] [Accepted: 05/13/2010] [Indexed: 11/16/2022]
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Metabolic syndrome and all-cause mortality: a meta-analysis of prospective cohort studies. Eur J Epidemiol 2010; 25:375-84. [DOI: 10.1007/s10654-010-9459-z] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 04/15/2010] [Indexed: 02/07/2023]
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Niwa Y, Ishikawa S, Gotoh T, Kayaba K, Nakamura Y, Kajii E. Association between stroke and metabolic syndrome in a Japanese population: Jichi Medical School (JMS) Cohort Study. J Epidemiol 2009; 20:62-9. [PMID: 19966508 PMCID: PMC3900781 DOI: 10.2188/jea.je20081041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Metabolic syndrome increases the morbidity and mortality of cardiovascular diseases. However, few studies have examined the association between the incidence of stroke and metabolic syndrome, as defined by Japanese criteria. The aim of this study was to identify the association between stroke and metabolic syndrome, as defined by criteria used in Japan. METHODS A total of 2205 subjects (920 men and 1285 women) were examined between 1992 and 1995 as part of the Jichi Medical School Cohort Study. Metabolic syndrome was defined using the Japanese criteria. Medical records, computed tomography, and magnetic resonance imaging were used to diagnose stroke. The Cox proportional-hazards model was used to analyze the association between metabolic syndrome and incident stroke. RESULTS The prevalence of metabolic syndrome at baseline was 9.0% in men and 1.7% in women. There were 96 incident strokes during an 11.2-year follow-up period, 14 of which occurred in subjects with metabolic syndrome. Among subjects with metabolic syndrome, the age-adjusted hazard ratio (95% confidence interval) for stroke was 1.93 (0.94-3.96) in men and 6.85 (2.68-17.47) in women. After adjusting for age, smoking status, and alcohol drinking status, the hazard ratio was 1.89 (0.88-4.08) in men and 7.24 (2.82-18.58) in women. Age-adjusted hazard ratios associated with having 2 or more components of metabolic syndrome, with and without central obesity, were 2.93 (1.21-7.08) and 3.20 (1.23-8.31) in men and 1.75 (0.69-4.44) and 8.64 (2.82-28.03) in women, respectively. CONCLUSIONS The presence of metabolic syndrome, as defined by Japanese criteria, increases the risk of stroke; this effect was highly significant among women.
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Affiliation(s)
- Yasunori Niwa
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.
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Hatano Y, Matsumoto M, Ishikawa S, Kajii E. Plasma adiponectin level and myocardial infarction: the JMS Cohort Study. J Epidemiol 2009; 19:49-55. [PMID: 19265272 PMCID: PMC3924114 DOI: 10.2188/jea.je20080057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Adiponectin is associated with many cardiovascular risk factors. Thus, a relation between adiponectin and subsequent coronary heart disease has been hypothesized. However, the results of prospective studies have been conflicting. Methods In this nested case-control study, blood samples were collected from 5243 of 12 490 community residents enrolled in the Jichi Medical School Cohort Study. The samples were taken between 1992 and 1995 and stored until 2007, at which point the plasma adiponectin level was measured. Results During an average of 9.4 years of follow-up, 38 patients with myocardial infarction and 89 controls matched for age, sex, and community were identified. Plasma adiponectin concentration did not significantly differ between cases and controls (geometric mean 7.6 [interquartile range, 5.0–12.2] versus 7.4 [5.4–11.0] mg/L, respectively, P = 0.57). The odds of myocardial infarction in the lowest tertile of adiponectin concentration was not significantly different from that in the highest tertile, after adjustment for age and sex (OR 1.33; 95% CI, 0.50–3.55) or after further adjustment for other cardiovascular risk factors (OR 1.68; 95% CI, 0.45–6.25). Similarly, there was no significant difference in odds of myocardial infarction between the lowest and highest quartiles of adiponectin concentration. Conclusion The results do not support an association between hypoadiponectinemia and myocardial infarction.
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Affiliation(s)
- Yu Hatano
- Jichi Medical University, Shimotsuke, Tochigi 329-0498, Japan
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Teramoto T, Fujita T, Kawamori R, Miyazaki S, Teramukai S, Igarashi M. OMEGA study: design, baseline data, metabolic syndrome prevalence in a large-scale observational study of hypertensive patients: The Olmesartan Mega Study to Determine the Relationship between Cardiovascular Endpoints and Blood Pressure Goal Achievement study. Hypertens Res 2009; 31:2011-7. [PMID: 19098372 DOI: 10.1291/hypres.31.2011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Elevated systolic blood pressure increases the risk of cardiovascular events, as shown by a number of meta-analyses of large-scale clinical trials. As concerns the prognostic impact of the metabolic syndrome on cardiovascular events, few large-scale studies are available in the Japanese hypertensive population. The prospective, large-scale, observational OMEGA (Olmesartan Mega Study to Determine the Relationship between Cardiovascular Endpoints and Blood Pressure Goal Achievement) study sought to examine the relationship between the incidence of cardiovascular disease (CVD) and achieved blood pressure, metabolic syndrome, lifestyle factors and other risk factors for CVD in patients with hypertension. Of the 15,313 enrolled patients from 2,219 institutions in Japan, we report here the baseline characteristics of the 14,841 eligible patients whose baseline data were collected as of October 31, 2007. Men and women 50 to 79 years old (mean age 65) with physician-diagnosed hypertension were enrolled, and all patients were treated with open-label olmesartan medoxomil (5 to 40 mg daily). The majority of patients (75%) had mild to moderate hypertension. The prevalences of dyslipidemia and diabetes mellitus were 48% and 24%, respectively. The metabolic syndrome was identified in 48% and 19% of the evaluable men and women, respectively, using the criteria of the Japanese Society of Internal Medicine. Men with the metabolic syndrome were at the greatest risk for CVD, and a greater proportion of men than of women had all five metabolic syndrome components. The complete follow-up data from the OMEGA study will provide much-needed information to guide treatment in patients with hypertension and the metabolic syndrome. (Hypertens Res 2008; 31: 2011-2017).
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Affiliation(s)
- Tamio Teramoto
- Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashiku, Tokyo 173-8605, Japan.
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