Measurement of blood pressure with tricuff

Associations between serum insulin and homocysteine in a Swedish population-a potential link between the metabolic syndrome and hyperhomocysteinemia: the Skaraborg project

The objective of this study is to examine the association between serum levels of insulin and homocysteine (Hcy) in a population-based sample of Swedish men and women. Men and women (537 and 571, respectively) 40 years or older, who were randomly selected from the population in Skara, southwestern Sweden, with valid information on serum levels of Hcy and insulin, were subject to a physical examination, including anthropometric measurement. Lifestyle factors were assessed by a questionnaire, and venous blood samples were drawn after an overnight fast. Insulin resistance was estimated by the homeostasis model assessment index. Homocysteine was higher in men (11.0 micromol/L) than in women (9.7 micromol/L) (P < .001) and was positively associated with age (P < .001 in both sexes) and serum creatinine (P = .009 in men, P < .001 in women), but inversely associated with leisure time physical activity (P = .012 in men, P = .001 in women). There was a positive association between serum insulin and serum Hcy independent of age and sex (P = .004). Upon exclusion of patients with diabetes and individuals with serum creatinine level greater than 130 microcat/L, this association was significant in the remaining 999 individuals also after adjustment for age, sex, serum creatinine, leisure time physical activity, body mass index, and smoking status (P = .003). A 1 SD difference in serum insulin corresponded to a difference of 0.5 micromol/L in serum Hcy. A similar association was found between insulin resistance and serum Hcy. In conclusion, there is an association between serum insulin and Hcy that may constitute a link between the metabolic syndrome and Hcy, either unilaterally or as part of a vicious circle.

Multilevel analysis of systolic blood pressure and ACE gene I/D polymorphism in 438 Swedish families--a public health perspective

Background

Individuals belonging to the same family share a number of genetic as well as environmental circumstances that may condition a common SBP level. Among the genetic factors, the angiotensin converting enzyme (ACE) gene I/D polymorphism appears as a possible candidate as it might influence both SBP and the pharmacological effect of ACE inhibitors. We aimed to combine genetic epidemiology with public health ideas concerning life-course and multilevel epidemiology in order to understand the role of familial factors regarding individual SBP.

Methods

We applied multilevel regression analysis on 1926 individuals nested within 438 families from South Sweden. Modelling familial SBP variance as a function of age and use of ACE inhibitors we calculates a variance partition coefficient and the proportional change in familial SBP variance attributable to differences in ACE gene I/D polymorphism

Results

Our results suggest the existence of genetic or environmental circumstances that produce a considerable familial clustering of SBP, especially among individuals using ACE-inhibitors. However, ACE gene I/D polymorphism seems to play a minor role in this context. In addition, familial factors – genetic, environmental or their interaction – shape SBP among non-users of ACE inhibitors but their effect is expressed later in the life-course.

Conclusion

Strategies directed to prevent hypertension should be launched in younger rather than in older ages and both prevention of hypertension and its treatment with ACE inhibitors should be focused on families rather than on individuals.

Inverse association between plasma homocysteine, sulphonylurea exposure and physical activity: a community-based sample of type 2 diabetes patients in the Skaraborg hypertension and diabetes project

AIM

This study aimed to investigate levels of Homocysteine (tHcy) and folate in a population-based sample of patients with type 2 diabetes. In particular, the study explored modifiable determinants such as treatment for diabetes, life style, glucose control and kidney function.

PATIENTS AND METHODS

In a community-based surveillance of patients with type 2 diabetes, 196 men and 191 women were consecutively identified in primary care and characterized by cardiovascular disease (CVD) risk factors focusing on components in the metabolic syndrome. For categorical associations plasma tHcy was dichotomized using the upper 10 percentiles of the distribution.

RESULTS

Treatment with sulphonylurea was associated with lower serum levels of tHcy compared to those on diet alone. The association was confined to women [odds ratio 0.14; confidence interval 0.03-0.8] and remained significant when differences in factors related to the metabolic syndrome, life style and previous CVD were accounted for, but was lost when adjusted for HbA1c. There was an inverse dose-related association between physical activity and plasma levels of tHcy (men p = 0.006, women p = 0.034), and a positive association with serum levels of creatinine (men p = 0.004, women p < 0.001).

CONCLUSIONS

The association with physical activity might be one contributing explanation for its well-known protective effect on cardiovascular disease. The over risk for vascular complications in diabetic patients with kidney disease may be partially explained by high levels of tHcy and should be further explored. Prospective studies are particularly needed on various treatment for type 2 diabetes and tHcy to explore possible implications for clinical procedures and for public health.