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Shamu T, Egger M, Mudzviti T, Chimbetete C, Manasa J, Anderegg N. Body weight and blood pressure changes on dolutegravir-, efavirenz- or atazanavir-based antiretroviral therapy in Zimbabwe: a longitudinal study. J Int AIDS Soc 2024; 27:e26216. [PMID: 38332525 PMCID: PMC10853595 DOI: 10.1002/jia2.26216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Dolutegravir (DTG) is widely used for antiretroviral therapy (ART). We compared weight and blood pressure trends and examined the association between high blood pressure and weight gain among people living with HIV (PLHIV) switching to or starting DTG-based, efavirenz (EFV)-based and ritonavir-boosted atazanavir (ATV/r)-based ART in Zimbabwe. METHODS PLHIV aged 18 years or older who started or switched to DTG, EFV or ATV/r-based ART between January 2004 and June 2022 at Newlands Clinic in Harare, Zimbabwe, were eligible. Weight was measured at all visits (Seca floor scales); blood pressure only at clinician-led visits (Omron M2 sphygmomanometer). We used Bayesian additive models to estimate trends in weight gain and the proportion with high blood pressure (systolic >140 mmHg or diastolic >90 mmHg) in the first 2 years after starting or switching the regimen. Finally, we examined whether trends in the proportion with high blood pressure were related to weight change. RESULTS We analysed 99,969 weight and 35,449 blood pressure records from 9487 adults (DTG: 4593; EFV: 3599; ATV/r: 1295). At 24 months after starting or switching to DTG, estimated median weight gains were 4.54 kg (90% credibility interval 3.88-5.28 kg) in women and 3.71 kg (3.07-4.45 kg) in men, around twice that observed for ATV/r and over four-times the gain observed for EFV. Prevalence of high blood pressure among PLHIV receiving DTG-based ART increased from around 5% at baseline to over 20% at 24 months, with no change in PLHIV receiving EFV- or ATV/r-based ART. High blood pressure in PLHIV switching to DTG was associated with weight gain, with stronger increases in the proportion with high blood pressure for larger weight gains. CONCLUSIONS Among PLHIV starting ART or switching to a new regimen, DTG-based ART was associated with larger weight gains and a substantial increase in the prevalence of high blood pressure. Routine weight and blood pressure measurement and interventions to lower blood pressure could benefit PLHIV on DTG-based ART. Further studies are needed to elucidate the mechanisms and reversibility of these changes after discontinuation of DTG.
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Affiliation(s)
- Tinei Shamu
- Newlands ClinicHarareZimbabwe
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Graduate School of Health SciencesUniversity of BernBernSwitzerland
| | - Matthias Egger
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public HealthUniversity of Cape TownCape TownSouth Africa
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Tinashe Mudzviti
- Newlands ClinicHarareZimbabwe
- Department of Pharmacy and Pharmaceutical SciencesUniversity of ZimbabweHarareZimbabwe
| | | | | | - Nanina Anderegg
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public HealthUniversity of Cape TownCape TownSouth Africa
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Ma Z, Li D, Zhan S, Sun F, Xu C, Wang Y, Yang X. Analysis of risk factors of metabolic syndrome using a structural equation model: a cohort study. Endocrine 2019; 63:52-61. [PMID: 30132261 DOI: 10.1007/s12020-018-1718-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 08/10/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE We aimed to use a structural equation model (SEM) to determine the interrelations between various risk factors, including latent variables, involved in the development of metabolic syndrome(MetS). METHODS This study used data derived from the MJ Longitudinal Health Check-up Population Database for participants aged 20 to 70 years, who were asymptomatic for MetS at enrollment and were followed up for 5 years. A SEM was applied to investigate the attributions of MetS and the interrelations between different risk factors. RESULTS Socioeconomic status (SES), living habits, components of metabolic syndrome (COMetS), and blood pressure had a diverse impact on the onset of MetS, directly and (or) indirectly. When investigating the latent risk factors and the interrelations between different risk factors. The standardized total effect (the sum of the direct and indirect effects, βt) of SES, living habits, blood pressure and COMetS on the onset of MetS was 0.084, -0.179, 0.154, and 0.353, respectively. SES, as a distal risk factor, directly influenced living habits, blood pressure, and COMetS with standardized regression coefficients (βr) of -0.079 (P < 0.001), 0.200 (P < 0.001), and -0.163 (P < 0.001) respectively. Unfavorable living habits exerted an inverse effect on blood pressure and COMetS (βr = -0.101, P < 0.001; βr = -0.463, P < 0.001), which was an important path way for developing MetS. CONCLUSIONS These results demonstrate that individuals with a higher level of SES are susceptible to high blood pressure and are at increased risk for MetS. Additionally, there is a decrease in exercise and an increase in smoking and consumption of alcohol corresponded to an increase in metabolic risk factors.
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Affiliation(s)
- Zhimin Ma
- School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Ditian Li
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Chaonan Xu
- School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yunfeng Wang
- School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xinghua Yang
- School of Public Health, Capital Medical University, Beijing, China.
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
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Li Z, Yang X, Yang J, Yang Z, Wang S, Sun F, Zhan S. The Cohort Study on Prediction of Incidence of All-Cause Mortality by Metabolic Syndrome. PLoS One 2016; 11:e0154990. [PMID: 27195697 PMCID: PMC4873211 DOI: 10.1371/journal.pone.0154990] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 04/23/2016] [Indexed: 12/31/2022] Open
Abstract
AIM The aim was to evaluate the impact of metabolic syndrome (MS), MS individual components and 32 kinds of MS specific component combinations on all-cause mortality risk in a fixed cohort of MJ check-up population. METHODS We observed the events of death in a fixed cohort, where the population was composed of 45,542 individuals aged 35-74 who were examined at MJ Health check-up Center in 1997 as baseline examination, and were followed up to 2005. Median duration of follow-up was 7.44 years. MS was defined according to the National Cholesterol Educational Program (the revised NCEP-ATPIII for Asian in 2004), the prevalence of MS was standardized according to China's fifth census data. We constructed common Cox regression model, simultaneously adjusting the classic risk factors (such as age, sex, smoking, alcohol drinking, physical activity, family history, etc.) to examine the relationship between MS, MS individual components and 32 kinds of MS specific component combinations on the occurrence of death with the fixed cohort. RESULTS The standardized prevalence of MS was 29.75% (male: 30.36%, female: 29.51%). There were 1,749 persons who died during the median 7.44-years follow-up, the mortality rate was 46 per 10,000 person years. The mortality rates were 71 and 35 per 10,000 person years for those with and without MS, respectively. After adjustment for age, sex and classical risk factors, compared with subjects without MS, the hazard ratio of all-cause mortality was 1.26 (95% CI: 1.14-1.40). The all-cause mortality were more highly significant than other combinations (P <0.05) when the following combinations exist: "elevated blood pressure", "elevated fasting plasma glucose + low high-density lipoprotein cholesterol", "elevated blood pressure + elevated triglyceride + elevated fasting plasma glucose", "elevated fasting plasma glucose + low high-density lipoprotein cholesterol + elevated blood pressure + elevated triglyceride". After adjusting age, sex and classical risk factors, the HRs for those with 0 to 5 components were 1, 1.22, 1.25, 1.33, 1.66, and 1.92, respectively. There was a significant dose-response relationship (P for liner trend <0.001) between the number of MS components and the risk of all-cause mortality in the overall fixed cohort sample. CONCLUSION In a large scale middle-aged Taiwan check-up population, MS may be associated with a much higher risk for all-cause mortality. These results may underline the fact that MS is a non-homogeneous syndrome and have a significant impact on detecting high-risk individuals suffering from metabolic disorders for preventing and controlling death.
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Affiliation(s)
- Zhixia Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Xinghua Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Jun Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhirong Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- * E-mail: (SYZ); (FS)
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- * E-mail: (SYZ); (FS)
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Hsu JH, Chien IC, Lin CH. Increased risk of hyperlipidemia in patients with bipolar disorder: a population-based study. Gen Hosp Psychiatry 2015; 37:294-8. [PMID: 25892153 DOI: 10.1016/j.genhosppsych.2015.04.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We conducted this nationwide study to examine the epidemiology of hyperlipidemia among Taiwanese patients with bipolar disorder. METHODS We used a random sample of 766,427 subjects who were ≥18 years old in 2005. Subjects with at least one primary diagnosis of bipolar disorder were identified. Individuals with a primary or secondary diagnosis of hyperlipidemia or medication treatment for hyperlipidemia were also identified. We compared the prevalence of hyperlipidemia in patients with bipolar disorder with the general population in 2005. Furthermore, we investigated this cohort from 2006 to 2010 to detect the incident cases of hyperlipidemia. RESULTS The prevalence of hyperlipidemia in patients with bipolar disorder was higher than that of the general population [13.5% vs. 7.9%; odds ratio, 1.75; 95% confidence interval (CI), 1.52-2.02] in 2005. The average annual incidence of hyperlipidemia in patients with bipolar disorder was also higher than that of the general population (4.37% vs. 2.55%; risk ratio, 1.66; 95% CI, 1.47-1.87) from 2006 to 2010. CONCLUSIONS Patients with bipolar disorder had a higher prevalence and incidence of hyperlipidemia compared with the general population. Patients with bipolar disorder coexisting hypertension exhibited a higher likelihood of hyperlipidemia.
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Affiliation(s)
- Jer-Hwa Hsu
- Chia-Yi Hospital, Ministry of Health and Welfare, 600 Chiayi City, Taiwan
| | - I-Chia Chien
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, 54249 Nantou County, Taiwan; Department of Public Health and Institute of Public Health, National Yang-Ming University, 112 Taipei City, Taiwan.
| | - Ching-Heng Lin
- Taichung Veteran General Hospital, 407 Taichung City, Taiwan
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Kim OY, Paik JK, Lee JY, Lee SH, Lee JH. Follow-ups of metabolic, inflammatory and oxidative stress markers, and brachial-ankle pulse wave velocity in middle-aged subjects without metabolic syndrome. Clin Exp Hypertens 2012; 35:382-8. [PMID: 23148723 PMCID: PMC3740820 DOI: 10.3109/10641963.2012.739232] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This study investigates the association among metabolic risk factors, inflammatory and oxidative stress markers, and brachial–ankle pulse wave velocity (ba-PWV). We conducted a 3-year longitudinal, observational study of 288 middle-aged adults not meeting the criteria for metabolic syndrome (MetS) at the initial screening. We measured metabolic risk factors, inflammatory and oxidative stress markers, and ba-PWV. Within the 3-year study period, 15.6% (45 out of 288) of participants developed MetS. At the 3-year follow-up, patients were categorized as those with MetS (n = 45) and those without MetS (n = 243). Patients with MetS had significantly unfavorable initial measurements of baseline body mass index (BMI), waist circumference (WC), blood pressure (BP), triglyceride (TG), high-density lipoprotein (HDL)-cholesterol, glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR) index, and ba-PWV. After 3 years, participants without MetS showed significant increases in WC, diastolic BP (DBP), total- and low-density lipoprotein (LDL)-cholesterol, malondialdehyde (MDA), oxidized-LDL (ox-LDL), and ba-PWV and a significant decrease in HDL-cholesterol and free fatty acids (FFA). Subjects who developed MetS showed significant increases in BMI, WC, BP, TG, glucose, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), MDA, ox-LDL, and ba-PWV and a significant decrease in HDL-cholesterol. Changes in BMI, WC, BP, TG, HDL-cholesterol, glucose, HOMA-IR index, FFA, C-reactive protein (P = .022), IL-6 (P = .004), leukocyte count (P < .001), MDA (P = .002), ox-LDL (P = .015), and ba-PWV (P = .001) differed significantly between the two groups after adjustment for baseline values. Changes in ba-PWV were positively correlated with the changes in systolic and DBP, total-cholesterol, glucose, leukocyte count, and MDA. The age-related increase in arterial stiffness is greater in the presence of MetS with higher levels of inflammatory and oxidative stress markers.
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Affiliation(s)
- Oh Yoen Kim
- Department of Food Science and Nutrition, Dong-A University, Busan, Republic of Korea
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Hsu JH, Chien IC, Lin CH, Chou YJ, Chou P. Hyperlipidemia in patients with schizophrenia: a national population-based study. Gen Hosp Psychiatry 2012; 34:360-7. [PMID: 22460002 DOI: 10.1016/j.genhosppsych.2012.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Revised: 02/07/2012] [Accepted: 02/07/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective was to examine hyperlipidemia among Taiwanese patients with schizophrenia. METHODS We obtained a random sample of 766,427 subjects aged ≥18 years in 2005. Subjects with at least one primary diagnosis of schizophrenia and with a primary or secondary diagnosis of hyperlipidemia or medication for hyperlipidemia were identified. We compared the prevalence and incidence of hyperlipidemia in schizophrenic patients with the general population. RESULTS The prevalence of hyperlipidemia in patients with schizophrenia was higher than that in the general population (8.15% vs. 8.10%; odds ratio 1.17; 95% confidence interval, 1.04-1.31) in 2005. Compared with the general population, schizophrenic patients had a higher prevalence of hyperlipidemia in individuals aged <50 years, among those with higher insurance amount, and among persons living in northern and central regions and in urban areas. The average annual incidence of hyperlipidemia in schizophrenic patients with second-generation antipsychotic use from 2006 to 2008 was higher than that in the general population (1.57% vs. 1.29%; odds ratio 1.31; 95% confidence interval, 1.11-1.55). CONCLUSIONS Patients with schizophrenia had a much higher prevalence of hyperlipidemia in young adulthood than that in the general population. Schizophrenic patients with second-generation antipsychotic exposure had a higher incidence of hyperlipidemia than individuals in the general population.
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Affiliation(s)
- Jer-Hwa Hsu
- Chia-Yi Hospital, Department of Health, Chiayi, Taiwan
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Xu D, Guo Y, Wang H, Gu B, Liu G, Zhou C, Wu X, Wang J, Cao K. The angiographic and clinical outcomes after coronary stenting in patients with metabolic syndrome. Atherosclerosis 2011; 221:416-21. [PMID: 22296884 DOI: 10.1016/j.atherosclerosis.2011.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/07/2011] [Accepted: 12/13/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Metabolic syndrome (MetS) is regarded as a risk factor for coronary artery disease (CAD). But the influence of MetS on morbidity and mortality after stent implantation in CAD patients remains unknown. METHODS This article presents a meta-analysis of available data on the association between the MetS and the risk of angiographic and clinical outcomes following stent implantation. RESULTS MetS was associated with a significant increased risk of post-stent all-cause mortality (odd ratio (OR), 2.17, 95% CI, 1.56-3.01), in-lesion restenosis (OR, 1.35, 95% CI, 1.00-1.84) and major adverse cardiac events (MACE) (OR 1.35, 95% CI 1.13-1.61) in CAD patients. Even with drug-eluting stent (DES) implantation, significant increased risk in all-cause mortality (OR, 2.25, 95% CI, 1.61-3.15) and MACE (OR 1.42, 95% CI 1.14-1.76) were remain in patients with MetS. However, the OR of cardiovascular (CV) mortality (1.25, 95% CI 0.71-2.22), MI (1.27, 95% CI 0.87-1.85) and TLR (OR 1.21, 95% CI 0.96-1.53) was not statistically different between the patients with and without metabolic syndrome. CONCLUSIONS Metabolic syndrome is an important risk factor in patients with CAD following stent implantation. Although DES implantation decreased the incidence of angiographic events, further progress in adequate treatment of MetS is still required to improve the clinical outcome.
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Affiliation(s)
- Di Xu
- Department of Gerontology, the first affiliated hospital of Nanjing Medical University, Nanjing 210029, PR China
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Maron DJ, Boden WE, Spertus JA, Hartigan PM, Mancini GJ, Sedlis SP, Kostuk WJ, Chaitman BR, Shaw LJ, Berman DS, Dada M, Teo KK, Weintraub WS, O'rourke RA. Impact of Metabolic Syndrome and Diabetes on Prognosis and Outcomes With Early Percutaneous Coronary Intervention in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) Trial. J Am Coll Cardiol 2011; 58:131-7. [DOI: 10.1016/j.jacc.2011.02.046] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 02/03/2011] [Accepted: 02/22/2011] [Indexed: 11/24/2022]
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Huang CM, Wang KL, Cheng HM, Chuang SY, Sung SH, Yu WC, Ting CT, Lakatta EG, Yin FC, Chou P, Chen CH. Central versus ambulatory blood pressure in the prediction of all-cause and cardiovascular mortalities. J Hypertens 2011; 29:454-9. [PMID: 21252703 DOI: 10.1097/HJH.0b013e3283424b4d] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Central systolic (SBP-C) and/or pulse pressure (PP-C) better predicts cardiovascular events than does peripheral blood pressure. The present study compared the prognostic significance of office central blood pressure with multiple measurements of out-of-office ambulatory peripheral blood pressure, with reference to office peripheral systolic (SBP-B) or pulse pressure (PP-B). METHODS In a community-based population of 1014 healthy participants, SBP-C and PP-C were estimated using carotid tonometry, and 24-h systolic (SBP-24 h) and pulse pressure (PP-24 h) were obtained from 24-h ambulatory blood pressure monitoring. Associations of SBP-B, PP-B, SBP-C, PP-C, SBP-24 h, and PP-24 h with all-cause and cardiovascular mortalities over a median follow-up of 15 years were examined by Cox regression analysis. RESULTS In multivariate analyses accounting for age, sex, BMI, smoking, fasting plasma glucose, and total cholesterol/high-density lipoprotein cholesterol ratio, only PP-C (hazard ratio 1.16, 95% confidence interval 1.01-1.32, per one standard deviation increment) was significantly predictive of all-cause mortality, whereas all but PP-B were significantly predictive of cardiovascular mortality. When SBP-B was simultaneously included in the models, SBP-24 h (2.01, 1.42-2.85) and SBP-C (1.71, 1.21-2.40) remained significantly predictive of cardiovascular mortality. When SBP-C was simultaneously included in the models, SBP-24 h (1.71, 1.16-2.52) remained significantly predictive of cardiovascular mortality. CONCLUSION Office central blood pressure is more valuable than office peripheral blood pressure in the prediction of all-cause and cardiovascular mortalities. Out-of-office ambulatory peripheral blood pressure (SBP-24 h) may be superior to central blood pressure in the prediction of cardiovascular mortality, but PP-C may better predict all-cause mortality than SBP-24 h or PP-24 h.
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Lin YC, Chen JD, Chen PC. Excessive 5-year weight gain predicts metabolic syndrome development in healthy middle-aged adults. World J Diabetes 2011; 2:8-15. [PMID: 21537445 PMCID: PMC3083901 DOI: 10.4239/wjd.v2.i1.8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 12/01/2010] [Accepted: 12/08/2010] [Indexed: 02/05/2023] Open
Abstract
AIM: To quantitatively examine the impacts of an easy-to-measure parameter - weight gain - on metabolic syndrome development among middle-aged adults.
METHODS: We conducted a five-year interval observational study. A total of 1384 middle-aged adults not meeting metabolic syndrome (MetS) criteria at the initial screening were included in our analysis. Baseline data such as MetS-components and lifestyle factors were collected in 2002. Body weight and MetS-components were measured in both 2002 and 2007. Participants were classified according to proximal quartiles of weight gain (WG) in percentages (%WG ≤ 1%, 1% < %WG ≤ 5%, 5% < %WG ≤ 10% and %WG > 10%, defined as: control, mild-WG, moderate-WG and severe-WG groups, respectively) at the end of the follow-up. Multivariate models were used to assess the association between MetS outcome and excessive WG in the total population, as well as in both genders.
RESULTS: In total, 175 (12.6%) participants fulfilled MetS criteria within five years. In comparison to the control group, mild-WG adults had an insignificant risk for MetS development while adults having moderate-WG had a 3.0-fold increased risk for progression to MetS [95% confidence interval (CI), 1.8-5.1], and this risk was increased 5.4-fold (95% CI, 3.0-9.7) in subjects having severe-WG. For females having moderate- and severe-WG, the risk for developing MetS was 3.6 (95% CI, 1.03-12.4) and 5.5 (95% CI, 1.4-21.4), respectively. For males having moderate- and severe-WG, the odds ratio for MetS outcome was respectively 3.0 (95% CI, 1.6-5.5) and 5.2 (95% CI, 2.6-10.2).
CONCLUSION: For early-middle-aged healthy adults with a five-year weight gain over 5%, the severity of weight gain is related to the risk for developing metabolic syndrome.
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Affiliation(s)
- Yu-Cheng Lin
- Yu-Cheng Lin, The Department of Occupational Medicine, En Chu Kong Hospital, New Taipei City, 23742, Taiwan, China
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Lin YC, Chen JD, Lo SH, Chen PC. Worksite health screening programs for predicting the development of Metabolic Syndrome in middle-aged employees: a five-year follow-up study. BMC Public Health 2010; 10:747. [PMID: 21126351 PMCID: PMC3003648 DOI: 10.1186/1471-2458-10-747] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Accepted: 12/02/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) management programs conventionally focus on the adults having MetS. However, risk assessment for MetS development is also important for many adults potentially at risk but do not yet fulfill MetS criteria at screening. Therefore, we conducted this follow-up study to explore whether initial screening records can be efficiently applied on the prediction of the MetS occurrence in healthy middle-aged employees. METHODS Utilizing health examination data, a five-year follow-up observational study was conducted for 1384 middle-aged Taiwanese employees not fulfilling MetS criteria. Data analyzed included: gender, age, MetS components, uric acid, insulin, liver enzymes, sonographic fatty liver, hepatovirus infections and lifestyle factors. Multivariate logistic regression was used to estimate the adjusted odds ratios (OR) and 95% confidence interval (CI) of risk for MetS development. The synergistic index (SI) values and their confidence intervals of risk factor combinations were calculated; and were used to estimate the interacting effects of coupling MetS components on MetS development. RESULTS Within five years, 13% (175 out of 1384) participants fulfilled MetS criteria. The ORs for MetS development among adults initially having one or two MetS components were 2.8 and 7.3, respectively (both p < 0.01), versus the adults having zero MetS component count at screening. Central obesity carried an OR of 7.5 (p < 0.01), which far exceeded other risk factors (all ORs < 2.7). Synergistic effects on MetS development existed between coupling MetS components: 1. High blood pressure plus low-HDL demonstrated an OR of 11.7 (p < 0.01) for MetS development and an SI of 4.7 (95% CI, 2.1-10.9). 2. High blood pressure plus hyperglycemia had an OR of 7.9 (p < 0.01), and an SI of 2.7 (95% CI, 1.2-6.4). CONCLUSION MetS component count and combination can be used in predicting MetS development for participants potentially at risk. Worksite MetS screening programs simultaneously allow for finding out cases and for assessing risk of MetS development.
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Affiliation(s)
- Yu-Cheng Lin
- Health Management Center, Tao-Yuan General Hospital, Tao-Yuan, Taiwan
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Akbaraly TN, Kivimaki M, Ancelin ML, Barberger-Gateau P, Mura T, Tzourio C, Touchon J, Ritchie K, Berr C. Metabolic syndrome, its components, and mortality in the elderly. J Clin Endocrinol Metab 2010; 95:E327-32. [PMID: 20810578 PMCID: PMC2968732 DOI: 10.1210/jc.2010-0153] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CONTEXT AND OBJECTIVE The metabolic syndrome (MetS) has been shown to predict mortality in the middle-aged, but less is known on the impact of MetS and its components on mortality risk in the elderly. Our objectives were 1) to examine the association of MetS with the risk of all-cause and cause-specific mortality in a French elderly community-dweller cohort and 2) to determine the main components driving these associations. PARTICIPANTS AND METHODS Prospective analyses were carried out on 7118 men and women aged 65 yr and over from the Three-City cohort. Association between MetS (defined using the National Cholesterol Education Program Adult Treatment Panel III criteria) and mortality risk over the 7-yr follow-up was assessed using Cox proportional hazards models. RESULTS After adjusting for sociodemographic variables, health behaviors, and health status, a 50% increased risk for all-cause mortality was observed in participants with MetS at baseline compared with those without, with a hazard ratio of 1.54 [95% confidence interval (CI) = 1.24-1.92]. Elevated fasting blood glucose, high triglycerides, and low high-density lipoprotein cholesterol were the major contributors to this association, acting synergistically on mortality risk. For coronary heart disease mortality and cancer mortality, the hazard ratios associated with MetS were 2.21 (95% CI = 1.07-4.55) and 1.49 (95% CI = 1.04-2.14), respectively. CONCLUSIONS By showing that an elevated fasting blood glucose potentiates the excess mortality risk associated with lipid abnormality, our study supports the status of MetS as a risk factor for mortality in the elderly. Our findings emphasize the importance of MetS screening and managing dyslipidemia and hyperglycemia in older persons in general practice.
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Affiliation(s)
- Tasnime N Akbaraly
- Institut National de la Santé et de la Recherche Médicale (INSERM) Unité (U)888, Université Montpellier, Montpellier, France.
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Chen YC, Wu HP, Hwang SJ, Li IC. Exploring the components of metabolic syndrome with respect to gender difference and its relationship to health-promoting lifestyle behaviour: a study in Taiwanese urban communities. J Clin Nurs 2010; 19:3031-41. [DOI: 10.1111/j.1365-2702.2010.03280.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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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: 1753] [Impact Index Per Article: 125.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Chuang SY, Hsu PF, Sung SH, Chou P, Chen CH. Diabetes and 15-year cardiovascular mortality in a Chinese population: Differential impact of hypertension and metabolic syndrome. J Chin Med Assoc 2010; 73:234-40. [PMID: 20685589 DOI: 10.1016/s1726-4901(10)70051-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 04/14/2010] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND It remains unclear if the risk for cardiovascular (CV) mortality in patients with diabetes mellitus (DM) is equivalent to that in patients with a history of cardiac disease in Asian populations. The aims of the present study were to investigate whether or not non-heart disease (HD) DM subjects have a similar risk of CV mortality as HD patients without DM (non-DM HD), and whether or not hypertension (HT) or metabolic syndrome (MS) is a CV mortality marker for diabetic subjects identified from a community-based population. METHODS We followed 11,058 Chinese people aged > or = 30 years on Kinmen island for a median of 15.0 years. RESULTS The age-, sex- and smoking-adjusted hazard ratios for CV mortality were 3.56 [95% confidence interval (CI): 1.99-6.36] for DM subjects with HD, 1.64 (95% CI: 1.25-2.16) for DM without HD (non-HD DM) subjects, and 1.63 (95% CI: 1.09-2.44) for non-DM HD patients, when compared with subjects without DM and HD. Among the 827 non-HD DM subjects identified at the baseline survey, the age-, sex- and smoking-adjusted hazard ratios for CV mortality were 2.36 (95% CI: 1.30-4.28) for the presence versus absence of HT, and 1.23 (95% CI: 0.65-2.34) for the presence versus absence of MS. CONCLUSION Non-HD DM subjects had a similar risk of CV mortality to non-DM HD subjects in this Chinese population. The presence of HT but not MS substantially increased CV mortality risk in the DM subjects.
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Affiliation(s)
- Shao-Yuan Chuang
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan, R.O.C
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Hui WS, Liu Z, Ho SC. 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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 04/15/2010] [Indexed: 02/07/2023]
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Rodrigues SL, Baldo MP, de Sá Cunha R, Andreão RV, del Carmen Bisi Molina M, Gonçalves CP, Dantas EM, Mill JG. Salt excretion in normotensive individuals with metabolic syndrome: a population-based study. Hypertens Res 2009; 32:906-10. [DOI: 10.1038/hr.2009.122] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chirovsky DR, Fedirko V, Cui Y, Sazonov V, Barter P. Prospective studies on the relationship between high-density lipoprotein cholesterol and cardiovascular risk: a systematic review. ACTA ACUST UNITED AC 2009; 16:404-23. [DOI: 10.1097/hjr.0b013e32832c8891] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Epidemiological studies have extensively evaluated the association between high-density lipoprotein cholesterol (HDL-C) and cardiovascular disease (CVD) risk. The objective of this systematic review was to enumerate the number of original prospective studies that showed a significant association between HDL-C and CVD risk and provided evidence of the consistency of this association across other lipid risk factors. A systematic MEDLINE literature search identified 53 prospective cohort and five nested case-control studies that provided multivariate assessments of the association between HDL-C and CVD risk. Among these 58 prospective studies, 31 studies found a significant inverse association between HDL-C and CVD risk for all CVD outcomes and subpopulations studied, whereas 17 studies found a significant association for some CVD outcomes and/or subpopulations assessed. The ratio of studies that found a significant association out of the total studies identified was similar across all CVD outcomes, although there was less evidence for stroke and atherosclerotic outcomes. Only seven studies tested for the consistency of this association across other lipid risk factors, of which six studies suggested that the association was consistent across other lipid levels. In conclusion, the association between HDL-C and CVD risk is significant and strong, although further evidence may be needed to establish whether this association is consistent across other lipid risk factors. Furthermore, uncertainties remain regarding the mechanism in which HDL-C exerts its effects, suggesting a need for further research focused on new methods for reliable measurement.
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Keenan JD, Fan AZ, Klein R. Retinopathy in nondiabetic persons with the metabolic syndrome: findings from the Third National Health and Nutrition Examination Survey. Am J Ophthalmol 2009; 147:934-44, 944.e1-2. [PMID: 19243735 DOI: 10.1016/j.ajo.2008.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 12/04/2008] [Accepted: 12/05/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE To study whether the metabolic syndrome is associated with retinopathy independent of the presence of diabetes. DESIGN Nationally representative, population-based, cross-sectional study. METHODS The association between the metabolic syndrome and retinopathy was studied in persons 40 years of age and older with gradable fundus photographs in the Third National Health and Nutrition Examination Survey (NHANES III). Fundus photographs were graded for retinopathy, and clinical and laboratory data were used to define the metabolic syndrome. Logistic regression was performed using the presence of the metabolic syndrome or one of the metabolic syndrome components as the independent variable and with the presence of retinopathy as the dependent variable. The main outcome measures were the odds ratios (OR) of retinopathy in persons with the metabolic syndrome, analyzed both for the total NHANES III population (n = 8,205) and for those in the nondiabetic population (n = 6,582). RESULTS 5.4% of all persons and 3.5% of nondiabetic persons from the civilian noninstitutionalized United States population 40 years of age and older had retinopathy, as estimated from NHANES III sample. The relationship between the metabolic syndrome and retinopathy (OR, 2.23; 95% confidence interval [CI], 1.69 to 2.95) disappeared in analyses stratified by diabetes status. Among the nondiabetic population, there was no association between the metabolic syndrome and retinopathy (OR, 1.23; 95% CI, 0.77 to 1.99), but there was an association between high blood pressure and retinopathy (OR, 1.61; 95% CI, 1.09 to 2.37). CONCLUSIONS In this population-based, cross-sectional study, there was no evidence of an association between the metabolic syndrome and retinopathy independent of diabetes status. Prospective studies are warranted to determine the significance of the metabolic syndrome for predicting risk of ocular and systemic disease independent of diabetes.
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Liao C, Chiang H. Erectile dysfunction, testosterone deficiency, metabolic syndrome and prostatic disease in Taiwan. Journal of Men's Health 2008; 5:289-296. [DOI: 10.1016/j.jomh.2008.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Ishizaka N, Ishizaka Y, Yamakado M, Toda E, Koike K, Nagai R. Association between metabolic syndrome and carotid atherosclerosis in individuals without diabetes based on the oral glucose tolerance test. Atherosclerosis 2008; 204:619-23. [PMID: 19056083 DOI: 10.1016/j.atherosclerosis.2008.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 10/20/2008] [Accepted: 10/21/2008] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Whether or not metabolic syndrome is predictive of atherosclerotic disorders may depend on the population studied. We investigated whether metabolic syndrome is associated with carotid atherosclerosis in individuals who were shown not to have diabetes mellitus based on results of the 75-g oral glucose tolerance test (OGTT). METHODS AND RESULTS Between 1994 and 2003, 3904 individuals underwent general health screening that included the OGTT. Among these 3904 individuals, 3679 had a fasting plasma glucose of <126 mg/dL (subgroup 1), and 3488 had a 2-h post-OGTT glucose value of <200mg/dL (subgroup 2). In both subgroups, metabolic syndrome was found to be a risk factor for carotid plaque and for carotid intima-media thickening in men, and tended to be a risk factor for carotid plaque in women after adjustment for age. Among 3473 individuals who had both a fasting plasma glucose value of <126 mg/dL and a 2-h post-OGTT glucose of <200mg/dL, 2440 did not have hypertension, which was defined as systolic and diastolic blood pressure of <140/90 mmHg and absence of use of anti-hypertensive medication. In these non-diabetic non-hypertensive individuals, the association between metabolic syndrome and carotid plaque or carotid intima-media thickening was not statistically significant even with adjustment only for age. CONCLUSIONS In men who did not have impaired fasting glycemia and/or in those without impaired glucose tolerance, metabolic syndrome was a predictor of carotid atherosclerosis after age adjustment, although metabolic syndrome was not found to be a predictor of carotid atherosclerosis when hypertensive individuals were excluded from the study population.
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Affiliation(s)
- Nobukazu Ishizaka
- Department of Cardiovascular Medicine, University of Tokyo, Graduate School of Medicine, Hongo 7-3-1 Bunkyo-ku, Tokyo 113-8655, Japan.
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