Cardiovascular outcomes for obesity and metabolic syndrome

Metformin use among individuals at risk for type 2 diabetes

Excess total and cardiovascular morbidity and mortality remain very high among those with type 2 diabetes versus those without diabetes. Clinical trials to lower blood glucose have been disappointing probably because the participants were too late in the natural history of diabetes and already had extensive vascular disease. Insulin resistance measured simply by elevated fasting blood insulin is an early marker of β-cell stress and peripheral insulin resistance. Metformin will prevent development of diabetes among patients with impaired fasting glucose but only for the short term. Metformin reduces risk of coronary heart disease. The drug is safe, low cost, and may also prevent cancer. The combination of diet and exercise followed by metformin in the early phase of "insulin resistance" may reduce or delay both atherosclerosis and arteriosclerosis complications associated with diabetes. Preventive therapy must begin much earlier than before clinical diagnosis of diabetes and aim to initially lower blood insulin levels or insulin resistance.

Pinto bean consumption changes SCFA profiles in fecal fermentations, bacterial populations of the lower bowel, and lipid profiles in blood of humans

Beans improve serum lipids and may reduce the risk of colon cancer by increasing colonic SCFA formation. We assessed whether pinto bean consumption affects in vitro fecal bacterial fermentation and production of SCFA, colonic bacterial populations, and serum lipids. Adults grouped as premetabolic syndrome (pre-MetSyn) (n = 40) or controls (n = 40) were randomly assigned to consume either a bean entrée [1/2 cup (130 g) of dried, cooked pinto beans] or an isocaloric chicken soup entrée daily for 12 wk. Measurements included in vitro fecal fermentation of various resistant starch substrates, fecal bacterial speciation, and blood lipids. When expressed as a difference between baseline and treatment, propionate production from fecal material fermented in vitro with bean flour was higher (P < 0.02) in volunteers consuming beans than in those consuming soup. During the treatment period alone, bean consumption did not affect propionic acid production with any substrate but lowered (P < 0.02) butyric acid production when cornstarch was the substrate. In all volunteers, bean consumption decreased fecal production of isovaleric (P < 0.05) and isobutyric (P < 0.002) acids from cornstarch by as much as 50%. Of the bacterial populations tested, only Eubacterium limosum was affected by bean consumption and was approximately 50% lower than in those consuming soup. Beans lowered serum total cholesterol (P < 0.014) by approximately 8% in the controls and 4% in the pre-MetSyn group. Bean consumption lowered serum HDL-cholesterol (P < 0.05) and LDL-cholesterol (P < 0.05) in both groups without affecting serum triglycerides, VLDL cholesterol, or glucose. This study provides evidence that bean consumption can improve lipid profiles associated with cardiovascular disease, but does not clearly confer health benefits related to colon cancer risk.

Calpain-5 gene variants are associated with diastolic blood pressure and cholesterol levels

Background

Genes implicated in common complex disorders such as obesity, type 2 diabetes mellitus (T2DM) or cardiovascular diseases are not disease specific, since clinically related disorders also share genetic components. Cysteine protease Calpain 10 (CAPN10) has been associated with T2DM, hypertension, hypercholesterolemia, increased body mass index (BMI) and polycystic ovary syndrome (PCOS), a reproductive disorder of women in which isunlin resistance seems to play a pathogenic role. The calpain 5 gene (CAPN5) encodes a protein homologue of CAPN10. CAPN5 has been previously associated with PCOS by our group. In this new study, we have analysed the association of four CAPN5 gene variants(rs948976A>G, rs4945140G>A, rs2233546C>T and rs2233549G>A) with several cardiovascular risk factors related to metabolic syndrome in general population.

Methods

Anthropometric measurements, blood pressure, insulin, glucose and lipid profiles were determined in 606 individuals randomly chosen from a cross-sectional population-based epidemiological survey in the province of Segovia in Central Spain (Castille), recruited to investigate the prevalence of anthropometric and physiological parameters related to obesity and other components of the metabolic syndrome. Genotypes at the four polymorphic loci in CAPN5 gene were detected by polymerase chain reaction (PCR).

Results

Genotype association analysis was significant for BMI (p ≤ 0.041), diastolic blood pressure (p = 0.015) and HDL-cholesterol levels (p = 0.025). Different CAPN5 haplotypes were also associated with diastolic blood pressure (DBP) (0.0005 ≤ p ≤ 0.006) and total cholesterol levels (0.001 ≤ p ≤ 0.029). In addition, the AACA haplotype, over-represented in obese individuals, is also more frequent in individuals with metabolic syndrome defined by ATPIII criteria (p = 0.029).

Conclusion

As its homologue CAPN10, CAPN5 seems to influence traits related to increased risk for cardiovascular diseases. Our results also may suggest CAPN5 as a candidate gene for metabolic syndrome.

Common set of genes regulates low-density lipoprotein size and obesity-related factors in Alaskan Eskimos: Results from the GOCADAN Study

Increasing incidence of cardiovascular disease in traditionally low-risk Alaskan Eskimos is a cause for concern. The purpose of this study was to examine the genetic and environmental correlations of low-density lipoprotein (LDL) subfractions with obesity-related factors in Alaskan Eskimos, using data from the first 954 participants of the Genetics of Coronary Artery Disease in Alaska Natives Study. Estimates of genetic and environmental influence were calculated using a maximum likelihood variance component method implemented in SOLAR. Mean values of weight, body mass index (BMI), and waist were 73.4 +/- 0.5 kg, 27.6 +/- 0.2 kg/m2, and 88.0 +/- 0.4 cm, respectively. LDL, and its small (LDL1), medium (LDL2), and large (LDL3) subfractions, had mean values of 115.8 +/- 1.2 mg/dl, 8.3 +/- 0.4 mg/dl, 19.6 +/- 0.8 mg/dl, and 71.5 +/- 1.5 mg/dl, respectively. Bivariate analysis displayed significant genetic correlations between LDL subfractions and obesity-related factors: LDL1 with BMI (rhoG = 0.67, P < 0.05), waist (rhoG = 0.80, P < 0.001), and subscapular and tricep skinfolds (rhoG = 0.93, P < 0.005, and rhoG = 0.78, P < 0.05, respectively); LDL2 with BMI (rhoG = 0.52, P < 0.05), waist (rhoG = 0.46, P < 0.05), and tricep skinfold (rhoG = 0.60, P < 0.05); and mean LDL size with BMI (rhoG = -0.36), waist (rhoG = -0.42,), and subscapular and tricep skinfolds (rhoG = -0.44 and -0.43, respectively) (P < 0.005). These results show that a common set of genes is influencing LDL size and obesity-related factors in Alaskan Eskimos.

Pathophysiologic changes of obesity

This article builds on the well-known changes that occur with obesity by drawing from recent advances reported in the literature for an improved understanding of obese patients. The dissemination of information regarding the health risks with being overweight or obese to both the public and the health care community are widespread and effective from a public health perspective. The mechanisms underlying these associated risks must continue to be explored for physicians' knowledge to truly increase, and lead to advances in our understanding of the pathophysiology of obesity.

Effects of dietary modification to reduce vascular risks and treatment of obesity

This article has considered a vast literature attesting to the efficacy of dietary intervention on risk factors for CHD and on vascular outcomes. Rather than relying solely on pharmacotherapy to improve risk factors and vascular outcomes, physicians, nurses, dietitians, pharmacists, and medical providers should emphasize the benefits of a well-balanced, nutritionally sound dietary program. The diet should be low in saturated fatty acids, controlled in calories to avoid (or reduce) obesity, and rich in fruits, vegetables, whole grain products, and good sources of protein. Emphasis on foods rich in n-3 fatty acids shows promise for reducing cardiovascular outcomes, particularly sudden death.