Prevalence of the metabolic syndrome in acute myocardial infarction and its impact on hospital outcomes

Association of myocardial infarction and angina pectoris with obesity and biochemical indices in the South Korean population

The best obesity index for myocardial infarction or angina pectoris (MIAP) risk assessment remains controversial. Furthermore, the association between biochemical indices and these diseases is unclear. This study examined associations of obesity and biochemical indices with MIAP in the Korean population. This large-scale cross-sectional study was based on the Korea National Health and Nutrition Survey dataset from 2010 to 2019. A total of 22,509 subjects (9452 men and 13,057 women) aged ≥ 50 years were included. Participants consisted of 21,426 individuals without MIAP (men = 8869, women = 12,557) and 1083 with MIAP (men = 583, women = 500). Binary logistic regression was performed to examine the association of MIAP with obesity and biochemical indices. The prevalence of MIAP in Korean adults aged ≥ 50 years was 4.81% (6.57% among men, 3.98% among women). MIAP was more strongly associated with total cholesterol than other variables in men (adjusted OR = 0.436 [0.384-0.495], adjusted p < 0.001) and women (adjusted OR = 0.541 [0.475-0.618], adjusted p < 0.001). The waist-to-height ratio (adjusted OR = 1.325 [1.082-1.623], adjusted p = 0.007) and waist circumference (adjusted OR = 1.290 [1.072-1.553], adjusted p = 0.007) showed a significant association with MIAP in men, with no association between obesity indices and MIAP in women after adjustment. The association between biochemical indices and MIAP differed slightly according to sex. Only total cholesterol, creatinine, and platelets were associated with MIAP in both men and women.

Association of metabolic syndrome and level of hs-CRP, Lp(a), and serum ferritin in young Asian patients (≤45 years) with acute myocardial infarction

Aims

This study was aimed to determine the levels of hs-CRP, serum ferritin, and Lp(a) and to study the prevalence of metabolic syndrome (MetS) in young patients (≤45 years) with and without acute myocardial infarction (AMI).

Methods

This was a cross-sectional, case–control study conducted at a tertiary care center in India. Equal number of patients with matched age and sex (n = 51) were included in case group (with AMI) and in control group (without AMI). Subjects were assessed for the presence of MetS as per modified ATP III criteria. The hs-CRP, Lp(a), and serum ferritin were also measured.

Results

The prevalence of MetS was found to be 62.74% in case group, whereas 33.33% in control group with decreased HDL level as the most prevalent parameter. The hs-CRP level was found to be 15.35 ± 8.27 mg/dl in case group and 1.85 ± 1.05 mg/dl in control group and Lp(a) was 33.84 ± 23.69 mg/dl in case group and 19.68 ± 10.39 mg/dl in control group. No significant difference was observed in the serum ferritin level in case (264.2 ± 40.6 ng/dl) and control (225.51 ± 45.35 ng/dl) groups.

Conclusion

From this study, we can conclude that the assessment of these novel risk factors [hs-CRP, Lp(a), and MetS] may be used for the risk estimation and can help to prevent future mortality and morbidity due to CVD.

Troxerutin abrogates mitochondrial oxidative stress and myocardial apoptosis in mice fed calorie-rich diet

Mitochondrial oxidative stress plays a major role in the pathogenesis of myocardial apoptosis in metabolic syndrome (MS) patients. In this study, we investigated the effect of troxerutin (TX), an antioxidant on mitochondrial oxidative stress and apoptotic markers in heart of mice fed fat and fructose-rich diet. Adult male Mus musculus mice were fed either control diet or high fat, high fructose diet (HFFD) for 60 days to induce MS. Mice from each dietary group were divided into two on the 16th day and were either treated or untreated with TX (150 mg/kg bw, p.o) for the next 45 days. At the end of the study, mitochondrial reactive oxygen species (ROS) generation, oxidative stress markers, levels of intracellular calcium, cardiolipin content, cytochrome c release and apoptotic markers were examined in the myocardium. HFFD-feeding resulted in diminution of antioxidants and increased ROS production, lipid peroxidation and oxidatively modified adducts of 8-OHG, 4-HNE and 3-NT. Further increase in Ca²⁺ levels, low levels of calcium transporters and decrease in cardiolipin content were noted. Changes in the mitochondrial structure were observed by electron microscopy. Furthermore, cytochrome c release, increase in proapoptotic proteins (APAF-1, BAX, caspases-9 and-3) and decrease in antiapoptotic protein (BCL-2) in HFFD-fed mice suggest myocardial apoptosis. These changes were significantly restored by TX supplementation. TX administration effectively attenuated cardiac apoptosis and exerted a protective role by increasing antioxidant potential and by improving mitochondrial function. Thus, TX could be a promising therapeutic candidate for treating cardiac disease in MS patients.

Incidence of Metabolic Syndrome in Patients Admitted to Medical Wards with ST Elevation Myocardial Infarction

INTRODUCTION

Metabolic Syndrome (MS) consists of a cluster of metabolic abnormalities that confer exaggerated risk of cardiovascular disease. MS is a novel risk factor for Coronary Artery Disease (CAD) and is a rising disease entity in Asia. Incidence of ST Elevation Myocardial Infarction (STEMI) is high in patients with MS. There is limited data on prevalence of MS in patients with Acute Myocardial Infarction (AMI).

AIM

To determine frequency of MS in patients admitted with STEMI.

MATERIALS AND METHODS

Hundred Consecutive patients between 25 to 75 years who were admitted with STEMI at Govt medical college Thrissur were included in this prospective study. Subjects were assessed for five-component conditions of metabolic syndrome. Criteria to identify MS were based on a "Consensus statement for diagnosis of metabolic syndrome for Asian Indians". Presence of three or more of following suggest MS, Waist Circumference (WC)>90 cm in men and 80 cm in women, Blood pressure >130/85 mm Hg, Fasting Plasma Glucose (FPG) >100 mg%, serum triglycerides >150 mg/dl, High Density Lipoprotein (HDL)<40 mg/dl in male and<50 mg/dl in female. Statistical analysis was performed using Epi-Info software. Data expressed as numbers and percents were compared by Chi-square test.

RESULTS

Study enrolled 100 patients (males 80, females 20) with a mean age of 58. Frequency of MS in patients with STEMI was 40% (36% of males and 55% of females). Prevalence of components in the MS group was WC >80/90 -31(71%), BP>130/85- 23(58%), FPG >100 - 37(93%), HDL <40 (male)/ 50 (female) - 18(45%), TG >150 -15(37.5%).

CONCLUSION

The present study concluded that there is a remarkably high occurrence of metabolic syndrome and central obesity in patients with ST elevation Myocardial Infarction (MI) in our local population especially in females. Considering this fact the role of specific and targeted intervention for clinical detection and management of MS including lifestyle modifications needs to be addressed.

Prevalence of Metabolic Syndrome and Its Clinical and Angiographic Profile in Patients With Naive Acute Coronary Syndrome in North Indian Population

BACKGROUND

Data of isolated metabolic syndrome as risk factor in patients presenting with acute coronary syndrome (ACS) especially in context to Indian subcontinent are sparse. Therefore, we studied the prevalence of metabolic syndrome (MetS), and its clinical and angiographic profile in naive ACS patients in North Indian population.

METHODS

A single-center, prospective, observational study of 324 patients was conducted at LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, India with newly diagnosed ACS patients with MetS, as per modified NCEP-ATP III criteria. They were divided into two groups with and without MetS, and their clinical and angiographic profiles were studied.

RESULTS

Prevalence of MetS in our study was 37.65%. Patients with MetS were significantly older than without MetS (60.3 ± 8.4 vs. 57.6 ± 7.9), and had females preponderance (35.24% vs. 24.25%), less tobacco abuse (30.32% vs. 42.57%), more non-ST-segment elevation ACS (58.19% vs. 36.14%), less ST-segment elevation myocardial infarction (STEMI) (41.80% vs. 63.86%), more cardiogenic shock (27.04% vs. 17.32%), recurrent ischemia (14.75% vs. 7.42%) and on angiogram, lesser single vessel disease (21.13% vs. 53.96%), more double vessel disease (39.34 vs. 24.26%), triple vessel disease (19.67% vs. 10.39%), left main (13.11% vs. 4.45%) and complex coronary lesions (tubular 40.98% vs. 31.68%; diffuse 26.23% vs. 18.32%). However, there was a trend of lower but insignificant mortality with MetS (5.44% vs. 6.55%).

CONCLUSION

There was high prevalence of MetS among patients with ACS in North Indian population with more advanced coronary artery disease. To the best of our knowledge, this is the first study from North India documenting clinical and angiographic profile of patients with MetS and ACS.

The association between Metabolic Syndrome and serum levels of lipid peroxidation and interleukin-6 in Gorgan

BACKGROUND

There are limited studies on the relationship between inflammatory marker such as IL-6 and lipid peroxidation and metabolic syndrome.

OBJECTIVE

The aim of present study was to assess IL-6 and lipid peroxidation in subjects with and without the metabolic syndrome and their association with metabolic syndrome components.

METHODS

Age and gender matched 40 subjects with metabolic syndrome and 40 control groups took part in this study.

RESULTS

The mean malondialdehyde level was significantly higher in overweight and obese subjects with metabolic syndrome than control groups (P<0.05). The mean level of IL-6 in men and the mean level of malondialdehyde in women with metabolic syndrome was significantly higher than control groups (p<0.05). There were significant positive correlation between malondialdehyde and fasting blood glucose, triglyceride and systolic blood pressure (p<0.05).

CONCLUSIONS

Our results suggest that higher levels of IL-6 and malondialdehyde may cause insulin resistance and metabolic disorders in all subjects with metabolic syndrome. Malondialdehyde level shows strong association with some metabolic syndrome components. This means the greater risk of metabolic syndrome.

Hyperglycemia in acute coronary syndromes: from mechanisms to prognostic implications

Hyperglycemia is a frequent condition in patients with acute coronary syndromes (ACS). Hyperglycemia during ACS is caused by an inflammatory and adrenergic response to ischemic stress, when catecholamines are released and glycogenolysis induced. Although the involved pathophysiological mechanisms have not yet been fully elucidated, it is believed that hyperglycemia is associated with an increase in free fat acids (which induce cardiac arrhythmias), insulin resistance, chemical inactivation of nitric oxide and the production of oxygen reactive species (with consequent microvascular and endothelial dysfunction), a prothrombotic state, and vascular inflammation. It is also related to myocardial metabolic disorders, leading to thrombosis, extension of the damaged area, reduced collateral circulation, and ischemic preconditioning. In the last few years, several observational studies demonstrated that hyperglycemia in ACS is a powerful predictor of survival, increasing the risk of immediate and long-term complications in patients both with and without previously known diabetes mellitus. Glucose management strategies in ACS may improve outcomes in patients with hyperglycemia, perhaps by reducing inflammatory and clotting mediators, by improving endothelial function and fibrinolysis and by reducing infarct size. Recent clinical trials of insulin in ACS have resulted in varying levels of benefit, but the clinical benefit of an aggressive treatment with insulin is yet unproved.

Survey of the relationship between metabolic syndrome and myocardial infarction in hospitals of Urmia University of medical sciences

BACKGROUND & AIM

The aim of this study was to determine the relationship between metabolic syndrome and myocardial infarction in patients admitted to the hospitals of Urmia University of medical sciences.

METHODS

A case-control study population consisted of 172 patients with heart failure who were admitted to Seyedolshohada Hospital. In this method, the researchers present in the units and along with demographic questionnaire of patients, laboratory results needed for the survey (fasting blood glucose, triglycerides and HDL) with waist circumference size, blood pressure, height and weight were examined. Data after collection were analyzed using SPSS statistical software.

RESULTS

In this study of 172 patients with myocardial infarction, 56 patients (38.4%) patients were females and 112 (17.9%) were males. 1.2% of the patients were single, 84.8% were married, 0.6 were divorced and 13.5% were widowed, 116 patients (67.4%) with features of metabolic syndrome and 56 patients (32.6%) were lacking. In this study, females with myocardial infarction had more metabolic syndrome than males and in people whom relatives have a history of heart disease and also people who are overweight as well as obesity and also have features of metabolic syndrome and mean profiles of HDL, LDL, BMI, fasting blood glucose, triglyceride and waist circumference in males compared to males is higher. However, history of smoking, average number of cigarettes used per day, height and weight of males is higher than females. Other findings indicate a significant relationship between age and sex and having or not having a family history of heart failure, having or not having history of certain drugs and BMI of patient with metabolic syndrome. But a significant relationship was not found between the marital status, education, residence, income, previous history of heart disease, PCI, LDL, history of drug use, type of infarction, the extent of ejection and location with syndrome patients. In terms of survival, because none of the subjects in the study period had expired, this extent was not quantifiable.

CONCLUSION

Considering the high prevalence of this disorder in Iran and that the high incidence of serious effects imposes on the health care system and that these disorders are somewhat flexible, effort towards lifestyle changes particularly healthy diets, physical activity, weight management and blood pressure, especially in women should be considered. 

Exercise Training suppresses vascular fibrosis in aging obesity induced rats

[Purpose]

The aim of this study was to investigate the effects of exercise training (ET) on vascular fibrosis in aging model rats with diet-induced obesity.

[Methods]

Twenty-four male Sprague-Dawley rats were divided into 3 groups: Aging control (A-C), A-C with high fat diet (AHF), AHF with ET (AHF + ET). Aging was induced by D-galactose (D-gal) and obesity was induced by HFD (60% fat) for 9 weeks. The experimental rats performed swimming (60 min/day, 5 days/week) for 8 weeks. All rat aorta samples were harvested for RT-PCR and morphologic analyses.

[Results]

The exercise training significantly decreased levels of AT-1, TGF-ß and Coll-1 gene expression compared to AHF group. The AHF + ET group showed a reduced collagen accumulation in the aorta media compared to AHF group.

[Conclusion]

These results suggest that ET could protect the aging obesity aorta against down-regulation of fibrotic factors (AT-1, TGF-ß and Coll-1 gene) and fibrosis by inhibition of collagen accumulation in the aorta media.

Prevalence & correlates of metabolic syndrome in alcohol & opioid dependent inpatients

BACKGROUND & OBJECTIVES

The research on the association of metabolic syndrome (MS) and substance abuse is scanty. The present research aimed to study the prevalence and correlates of MS among the inpatients at a Drug De-addiction Centre in north India.

METHODS

Consecutive male subjects (N=110) admitted to a drug de-addiction centre during July to December 2009 with a primary diagnosis of alcohol or opioid dependence were evaluated for the presence of MS as per the International Diabetes Federation (IDF) criteria.

RESULTS

The prevalence of MS was 24.6 and 29.3 per cent in alcohol and opioid dependent groups, respectively. MS showed a significant association with the age and body mass index (BMI) in the opioid dependent group. Co-morbid tobacco use was not associated with MS in either group.

INTERPRETATION & CONCLUSIONS

The prevalence of MS in our sample of alcohol and opioid dependent male inpatients was greater than the prevalence of MS in general population, however it was comparable to that reported in physical and other psychiatric disorder populations. Even though the absence of any comparative study limits the generalizability of our findings, results indicate towards a need for screening of the patients with substance dependence especially for those aged above 30 years and/or having a high BMI for MS.

Biochemical and genetic studies on cardiometabolic syndrome

Cardiometabolic syndrome is one of the major public health issues of this century which describes a cluster of clinical characteristics. Seventy two patients with coronary artery disease (CAD) and cardiometabolic syndrome and forty healthy age and sex matched normal controls were selected for this study. Detailed clinical epidemiological and anthropometric characteristics were noted. Lipid profile and Cytokinesis-block micronuclei (CBMN) assay using cytochalasin B were carried out in all the subjects. Serum total cholesterol, triglyceride and LDL-cholesterol was significantly higher and HDL cholesterol was significantly lower in patients compared to their normal counter-parts (P<0.05). CBMN frequency of the patients was significantly higher at all ages compared to their normal counter parts (P<0.05). Various risk factors like diabetes, hypertension, dyslipidemia, abdominal obesity, smoking and alcoholism were found influenced the CBMN frequency; but the changes were not significant. From this study it can be concluded that DNA damage was found to be higher in patients with cardiometabolic syndrome which may be attributed to the generation of free radicals associated with alcohol consumption, tobacco use, dyslipidemia and glucose intolerance and the accumulation of free radicals with increase in age.