Adult Treatment Panel III 2001 but not International Diabetes Federation 2005 criteria of the metabolic syndrome predict clinical cardiovascular events in subjects who underwent coronary angiography

Effects of the Mediterranean Diet on the Components of Metabolic Syndrome Concerning the Cardiometabolic Risk

Metabolic syndrome is a cluster of risk factors, including abdominal obesity, insulin resistance, hypertension, dyslipidemia (intended as an increase in triglyceride levels and a reduction in HDL cholesterol levels), and elevated fasting glucose, that increase the risk of cardiovascular disease and type 2 diabetes. With the rising prevalence of metabolic syndrome, effective dietary interventions are essential in reducing these health risks. The Mediterranean diet, rich in fruits, vegetables, whole grains, legumes, nuts, and olive oil and moderate in fish and poultry, has shown promise in addressing metabolic syndrome and its associated components. This diet's anti-inflammatory and antioxidant properties, primarily due to its unsaturated fats, polyphenols, and fiber, have improved blood pressure, lipid levels, and insulin sensitivity. Adherence to the Mediterranean diet has been linked to reductions in central obesity and insulin resistance, both key elements in managing metabolic syndrome. Regarding lipid management, the Mediterranean diet lowers triglyceride levels and low-density lipoprotein (LDL) cholesterol while raising high-density lipoprotein (HDL) cholesterol, enhancing lipid profiles. It also helps regulate blood glucose levels, reducing the likelihood of developing type 2 diabetes. Additionally, the diet promotes weight loss and improves body composition, particularly by decreasing visceral fat, a primary driver of metabolic syndrome according to IDF classification. The Mediterranean diet offers a holistic approach to managing metabolic syndrome and reducing the risk of related chronic diseases. Its positive impact on metabolic health, combined with lifestyle changes like increased physical activity, provides a sustainable method for addressing the global burden of this syndrome. This review aimed to summarize the positive effects of the Mediterranean diet on the component of the metabolic syndrome with subsequent positive effects on cardiometabolic risk profile.

Prevalence and influencing factors of metabolic syndrome among rural adult population in a district of South India

Background

Metabolic syndrome has increased globally due to sedentary lifestyles, unhealthy diets and obesity, which is posing a substantial burden on healthcare systems. Understanding the determinants of metabolic syndrome like lifestyle factors, socioeconomic status and the environment are vital for devising effective prevention and management. Research into these determinants helps to identify high-risk populations and develop interventions to reduce its occurrence.

Objectives

i. To estimate the prevalence of metabolic syndrome among the adult population. ii. To determine the factors associated with metabolic syndrome among the adult population.

Methodology

A cross-sectional study was carried out among 410 adults (≥18 years). A semi-structured questionnaire was used to collect data and National Cholesterol Education Program's Adult Treatment Panel III criteria was used to diagnose metabolic syndrome. Continuous and categorical data were represented as mean and proportion, respectively. The strength of the association was determined using the prevalence ratio and adjusted prevalence ratio.

Results

The mean age of the participants was 44.97 ± 14.7, about 58.3% of them were females. Metabolic syndrome prevalence was 39.8%. Multivariate regression analysis demonstrated that being over 40 years old, marital status, higher socioeconomic status, skilled workers, physical inactivity and obesity were independently linked to metabolic syndrome.

Conclusions

The burden can be reduced by identifying the risk factors at the early stage through screening and by adopting a healthy lifestyle.

Comparing the association of two metabolic syndrome definitions, NCEP ATP III and IDF, with the risk of developing atherosclerotic cardiovascular disease: An analytical cross-sectional study

INTRODUCTION

Atherosclerotic cardiovascular diseases (ASCVD) are significant sources of mortality and morbidity with substantial economic implications and preventive measures play key roles in this regard. Metabolic syndrome (MetS) is a common condition, and its association with ASCVD and mortality has made it clinically important. However, controversies persist regarding the best definition for MetS. Here in, we investigated the ability of the International Diabetes Federation (IDF) and the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) in the prediction of ASCVD incidence.

METHODS

We conducted an investigation on individuals diagnosed with MetS as part of the "Kerman Coronary Artery Diseases Risk Factor Study" (KERCADRS). This study was a cohort study conducted on a population aged 15-75 years residing in Kerman, Iran to assess the risk of ASCVD. We employed ACC/AHA ASCVD Risk Estimator for predicting ASCVD occurrence in the future and then compared the results with different definitions of MetS including IDF and NCEP ATP III.

RESULTS

Patients with MetS consistent with NCEP ATP III had higher ASCVD risk scores than those with IDF (10.63 ± 10.989 vs. 9.50 ± 9.357). NCEP ATP III had better overall performance in terms of specificity, accuracy, sensitivity and positive and negative predictive values especially in higher ASCVD risk score categories. The agreement between IDF and NCEP ATP III was none to slight (Cohen's Kappa <0.2) except for IDF in the group of ASCVD >30%, which revealed no agreement (Cohen's Kappa = 0).

CONCLUSION

NCEP ATP III has better overall performance compared to IDF. The ability of NCEP ATP III increases as the ASCVD risk score goes higher. IDF may be useful in primary screening and patients with lower ASCVD risk scores.

Impact of excluding hyperglycemia from international diabetes federation metabolic syndrome diagnostic criteria on prevalence of the syndrome and its association with microvascular complications, in adult patients with type 1 diabetes

BACKGROUND

We aimed to determine, in patients with type 1 diabetes (T1DM), the impact of excluding hyperglycemia as a criterion from the International Diabetes Federation (IDF) definition of the metabolic syndrome (MetS), both on its prevalence and on its association with micro and macrovascular complications and markers of subclinical inflammation.

METHODS

A cross-sectional design, including 280 patients with T1DM. We defined MetS by three different models: (i) the standard IDF criteria, (ii) a modification consisting of excluding of hyperglycemia as a criterion (modified IDF criteria) and (iii) a modification consisting in changing the hyperglycemia by insulin resistance (MetS + IR model) defined by the estimated glucose disposal rate. Microvascular complications and cardioautonomic neuropathy were assessed. We measured an inflammatory panel including high sensitivity C reactive protein, erythrocyte sedimentation rate, homocysteine, and fibrinogen concentrations.

RESULTS

After excluding hyperglycemia, the prevalence of MetS was 6.4% (95%CI: 4.1 to 9.9) compared with 20.7% (95%CI: 16.3 to 25.8) using standard IDF criteria. After adjusting for duration of diabetes, all three MetS definitions increased the odds for having microvascular complications [OR: 6.012 (2.208-16.307) for modified definition; OR: 5.176 (2.555-10.486) for standard definition and [OR: 3.374 (1.649-8.456) for MetS+IR model]. However, the both modified IDF models for MetS showed better predictive performance than standard criteria for suffering from neuropathy, nephropathy, cardiovascular disease and were associated with markers of subclinical inflammation.

CONCLUSIONS

The prevalence of MetS significantly varies as a function whether or not hyperglycemia is included as a diagnostic criterion. The subset of patients fulfilling the modified MetS definitions may reflect better the concept of metabolic syndrome in T1DM. These modified definitions were accompanied by a poorer metabolic control and lipid profile, showing the worse inflammatory biomarker profiles and higher odds for micro- and macrovascular complications. In patients with T1DM, the inclusion of insulin resistance instead of hyperglycemia as a criterion of MetS may be of interest in routine clinical practice.

Metabolic syndrome and its pharmacologic treatment are associated with the time to castration-resistant prostate cancer

BACKGROUND

Metabolic syndrome and its pharmacologic treatment can potentially influence the progression of prostate cancer in men receiving androgen deprivation therapy (ADT). We aimed to evaluate the association between metabolic syndrome and its pharmacologic treatment with time to castration-resistant prostate cancer (CRPC).

METHODS

We identified 409 men with metastatic castration-sensitive prostate cancer receiving first line ADT from 1996 to 2014 at our institution. Information concerning metabolic syndrome, statin use, aspirin use, and metformin use at initiation of ADT was collected from medical records. Time to CRPC was defined as the duration between initiating ADT and diagnosis of CRPC based on the Prostate Cancer Working Group 3 definition. Flexible parametric survival models were used to calculate hazard ratios (HR, and 95% confidence intervals, CI) of the association between metabolic conditions and time from ADT initiation to CRPC.

RESULTS

During a median follow-up of 59 months, 87% (N = 356) men progressed to CRPC. Median time to CRPC was 19 months. Fifty-six percent of men met the definition of metabolic syndrome. Controlling for demographic and prostate cancer-specific variables, metabolic syndrome was associated with shorter time to CRPC (HR 1.41, 95% CI 1.09-1.81). Importantly, in men with metabolic syndrome, statin use was associated with a slower progression to CRPC (HR 0.70, 95% CI 0.49-0.98).

CONCLUSIONS

Our study suggests that metabolic syndrome is a risk factor for earlier progression from castration-sensitive to castration-resistant prostate cancer and raises the possibility that treatment, such as statin use, may slow the time to progression.

The Effect of Curcumin Supplementation on Pulse Wave Velocity in Patients with Metabolic Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial

Cardiovascular disease is a leading cause of death in many societies. Arterial stiffness is an initial sign of structural and functional changes in the arterial wall. Pulse wave velocity (PWV) is the gold standard for non-invasive evaluation of aortic stiffness and a modifiable cardiovascular risk factor. Curcumin is a major component of turmeric with known anti-inflammatory and anti-oxidative effects. Since arterial stiffness is affected by inflammation and oxidative stress, it may be improved by curcumin supplementation. The purpose of this clinical trial was to investigate the potential effects of curcumin on improving arterial stiffness in patients with metabolic syndrome. This placebo-controlled, double-blind, randomized clinical trial was conducted among metabolic syndrome patients. Sixty-six eligible individuals were randomly assigned to active intervention or control groups. The active intervention group received curcumin supplement at a dose of 500 mg daily for 12 weeks, whereas the control group received placebo capsule. Physical activity, daily dietary energy intake, anthropometric body composition, and biochemical hemodynamic and arterial stiffness parameters were evaluated at baseline and at the end of the study. Body weight decreased significantly in the curcumin group compared to placebo. Also, curcumin intervention improved PWV, which remained significant after adjustment for potential confounding factors (p = 0.011). The current clinical trial demonstrated that daily intake of 500 mg of curcumin for 12 weeks can lead to the improvement of arterial stiffness and weight management among subjects with metabolic syndrome.

Association of Serum Galectin-3-Binding Protein and Metabolic Syndrome in a Chinese Adult Population

BACKGROUND

Galectin-3-binding protein (GAL-3BP) is a ubiquitous and multifunctional secreted glycoprotein, which functions in innate immunity and has been highlighted as a potential mediator of adipose inflammation in obesity. In this study, we aimed to identify whether GAL-3BP is a novel biological marker for metabolic syndrome (MetS).

METHODS

The biochemical and anthropometric variables of the 570 participants in this study were evaluated using standard procedures. Their serum GAL-3BP levels were measured using enzyme-linked immunosorbent assay (ELISA), while the association between the glycoprotein and MetS was analyzed using multiple logistic regression analyses. Moreover, an experimental MetS model was established. The expression of GAL-3BP in serum and adipose tissue was measured using ELISA and western blotting. Lipid accumulation was determined with the use of immunohistochemistry and immunofluorescent staining.

RESULTS

The serum GAL-3BP level was found to be positively associated with MetS. The logistic regression analyses demonstrated that participants expressing the upper levels of GAL-3BP were more likely to develop MetS than those expressing less of the glycoprotein (OR = 2.39, 95%CI: 1.49, 3.83). The association between the serum GAL-3BP level and MetS was found preferentially in postmenopausal women (OR = 2.30, 95%CI: 1.31, 4.05). In addition, GAL-3BP was increased in the serum and visceral adipose tissue (VAT) of high fat diet (HFD) mice. Moreover, GAL-3BP was highly expressed in VAT macrophages.

CONCLUSIONS

This study confirmed serum GAL-3BP to be positively associated with MetS, highlighting it as a useful biological marker of MetS in Chinese participants.

The prevalence of metabolic syndrome in cardiovascular patients in Iran: a systematic review and meta-analysis

BACKGROUND

Cardiovascular disease is the cause of more than 50% of mortalities globally, and this rate has grown by 8.6% since the 60 s. One of the risk factors associated with cardiovascular disease and its resulting mortality rate is the metabolic syndrome. Different studies have reported inconsistent rates for the metabolic syndrome. However, no comprehensive study has been conducted to combine the results of existing studies. Thus, the present study was performed with the aim of determining the prevalence of metabolic syndrome among cardiovascular patients in Iran through a systematic review and meta-analysis.

METHOD

In this review study, the Scientific Information Database, Google Scholar, Science Direct, Scopus, PubMed, and Web of Science (ISI), databases were searched from January 2005 and until May 2020, to identify and extract related articles. To conduct the analysis, a random effects model was used, and the heterogeneity of the studies was examined using the I2 index. Data analysis was performed within Comprehensive Meta-Analysis (version 2) software.

RESULTS

The prevalence of metabolic syndrome in cardiovascular patients in Iran in the 27 papers examined with a sample size of 44,735 patients was 34.2% (95% CI: 26.8-42.6%). A sensitivity analysis was performed to ensure the stability of the results, these results show that by omitting the prevalence from each study, the overall prevalence (34.2%) does not change significantly. the highest prevalence of metabolic syndrome in studies conducted in the period between 2015 and 2020, and this was reported as 55.3 (95% CI: 47.9-62.3) and the highest prevalence of metabolic syndrome in studies conducted in the methods of diagnosis IDF, and the rate was reported as 48 (95% CI: 36.5-59.8). based on meta-regression as the year of research increased, the prevalence of metabolic syndrome in cardiovascular patients in Iran also increased. However, with the increase in sample size, this prevalence decreased (p < 0.05).

CONCLUSIONS

The results of this study indicate that metabolic syndrome is high in cardiovascular patients in Iran. Accordingly, by understanding its etiology and supervision at all levels, suitable solutions could be offered by providing feedback to hospitals.

Low Serum Vitamin B12 Levels Are Associated with Adverse Lipid Profiles in Apparently Healthy Young Saudi Women

An abnormal lipid profile is an independent risk factor for cardiovascular diseases. The relationship between vitamin B12 deficiency and lipid profile is inconclusive, with most studies conducted in unhealthy populations. In this study, we aimed to assess the relationship between serum vitamin B12 levels and lipid profiles in a cross-sectional study that included 341 apparently healthy Saudi women, aged 19-30 years, from different colleges at King Saud University, Saudi Arabia. Sociodemographic, anthropometric, biochemical, and lifestyle data were collected, including diet and physical activity. Serum vitamin B12 deficiency was defined as serum B12 level of <148 pmol/L. The prevalence of vitamin B12 deficiency was approximately 0.6%. Using multivariable linear regression models, serum vitamin B12 levels were found to be inversely associated with total cholesterol (B = -0.26; p < 0.001), low-density lipoprotein cholesterol levels (B = -0.30; p < 0.001), and triglyceride (B = -0.16; p < 0.01) after adjusting for potential confounders, while obesity indices of body mass index, central obesity, and fat percentage showed no association. Therefore, we conclude that low serum vitamin B12 levels are independently associated with abnormal lipid profiles in healthy young Saudi women. Further interventional studies are needed to determine whether improving serum vitamin B12 levels in a healthy population can improve lipid profiles.

The MC4R SNPs, their haplotypes and gene-environment interactions on the risk of obesity

Background

Little is known about the correlation between the melanocortin 4 receptor gene (MC4R) single nucleotide polymorphisms (SNPs) and the risk of obesity. This research sought to test the MC4R rs17782313, rs476828 and rs12970134 SNPs, their haplotypes and gene-environment interactions on the risk of obesity in the Maonan ethnic group, an isolated minority in China.

Methods

A case-control study comprised of 1836 participants (obesity group, 858; and control group, 978) was conducted. Genotypes of the three SNPs were determined by the next-generation sequencing (NGS) technology.

Results

The genotypic frequencies of the three SNPs were different between the obesity and control groups (P <  0.05 for all). The minor allelic frequency of the MC4R rs17782313C, rs476828C and rs12970134A was higher in obesity than in control groups (13.8% vs. 8.3%, P <  0.001, 17.1% vs. 10.9%, P <  0.001; and 15.5% vs. 11.5%, P <  0.001; respectively). Additionally, the dominant model of rs17782313 and rs476828 SNPs revealed an increased morbidity function on the risk of obesity (P <  0.05). A correlation between SNP-environment and the risk of obesity was also observed. The rs17782313C-rs476828C-rs12970134A haplotype was associated with high risk of obesity (OR = 1.796, 95% CI = 1.447–2.229), whereas the rs17782313T-rs476828T-rs12970134G and rs17782313T-rs476828T-rs12970134A haplotypes were associated with low risk of obesity (OR = 0.699, 95% CI = 0.586–0.834 and OR = 0.620, 95% CI = 0.416–0.925; respectively). The interactions between haplotype and waist circumference on the risk of obesity were also noted.

Conclusions

We discovered that the MC4R rs17782313, rs476828 and rs12970134 SNPs and their haplotypes were associated with the risk of obesity in the Chinese Maonan population.

Metabolic syndrome is associated with peripheral endothelial dysfunction amongst men

Purpose: Metabolic syndrome (MetS) and peripheral endothelial dysfunction (PED) are both independently associated with an increased risk of cardiovascular disease (CVD). PED provides prognostic information beyond that provided by conventional risk factors. However, the association between MetS and PED remains uncertain. We evaluated the association between MetS and PED. Patients and methods: We performed a retrospective analysis of patients who were referred to Mayo Clinic between 2006 and 2014 for evaluation of chest pain and/or an assessment of CVD risk that included an assessment of PED measured with reactive hyperemia peripheral arterial tonometry. MetS was defined as the presence of at least 3 of the following: body mass index≥25 kg/m², impaired fasting glucose or diabetes, high blood pressure or hypertension, hypertriglyceridemia, or low high-density lipoprotein cholesterol. Results: Six hundred seventy-eight patients were included (mean age 51.9±13.5 years, 418 (61.6%) women), of which 293 (43.2%) had PED, and 249 (36.7%) had MetS. In multivariable analyses adjusted for age, sex, CVD, smoking status, and elevated low-density lipoprotein, MetS was significantly associated with PED (Odds Ratio (OR) 2.06; P=0.0090). Of the individual MetS components, only being overweight and MetS range high-density lipoprotein had a similar association. After stratifying by sex, the association between MetS and PED persisted only in men (OR 3.16, P=0.0094). Conclusions: MetS is associated with PED in men undergoing an assessment of chest pain and/or CVD risk. Identifying PED in individuals with MetS could provide an abridged assessment of risk, potentially allowing for earlier and more intensive management of risk factors.

Data on the impact of peripheral artery disease and of type 2 diabetes mellitus on the risk of cardiovascular events

Here, we provide additional data addressing the individual and combined associations of type 2 diabetes (T2DM) and of peripheral artery disease (PAD) with future cardiovascular events in a prospective cohort study including 338 PAD patients and 711 patients who did not have PAD. Subgroup analyses regarding patient age as well as additional Cox regression models taking into account medications are presented. This data article is related to a research article titled “Single and combined effects of peripheral artery disease and of type 2 diabetes mellitus on the risk of cardiovascular events: a prospective cohort study” (Saely et al., 2018).

Nonfunctioning adrenal incidentaloma: A novel predictive factor for metabolic syndrome

CONTEXT

Although metabolic syndrome has been studied in patients with autonomous cortisol secretion, there are limited data for those with nonfunctioning adrenal incidentaloma (NFAI).

OBJECTIVE

To assess metabolic syndrome frequency in NFAI patients and controls without adrenal adenoma according to World Health Organization (WHO), National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III), American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) and International Diabetes Federation (IDF) criteria.

DESIGN

Retrospective and transversal study.

PATIENTS

Seventy-four NFAI and 90 controls were evaluated. NFAI diagnosis was established according to current guidelines. The control group was selected based on normal adrenal imaging examinations.

MEASUREMENTS

Subjects were categorized by metabolic syndrome presence according to WHO, NCEP-ATP III, AACE/ACE and IDF.

RESULTS

Age, gender, ethnicity, body mass index, smoking, menopause, statin and fibrate use were comparable between patients and controls. The frequency of prediabetes, dyslipidaemia and hypertension as well as waist circumference were significantly higher in the NFAI patients compared to the controls. The metabolic syndrome frequency in the NFAI group was significantly higher compared to the normal adrenal group: WHO: 69.2% × 31.0% (P < 0.001); NCEP-ATP III: 81.7% × 44.9% (P < 0.001); AACE/ACE: 77.1% × 31.9% (P < 0.001); IDF: 78.6% × 45.5% (P < 0.001). Logistic regression analysis showed that NFAI was a predictor of metabolic syndrome according to WHO (P = 0.001), NCEP-ATP III (P = 0.005) and AACE/ACE (P = 0.007).

CONCLUSIONS

Metabolic syndrome is frequently found in patients with NFAI, and this frequency is higher in NFAI patients than in those with normal adrenal imaging.

Metabolic syndrome and its components among women with polycystic ovary syndrome: a systematic review and meta-analysis

Introduction: The objectives of this study were to provide an estimate of the prevalence of metabolic syndrome (MetS ) and its components among women with PCOS; and calculate the odds ratio (OR) for MetS (using different definitions of MetS) in women with PCOS, compared to healthy controls.

Methods: All of the relevant databases were used to search for appropriate articles that were published during the period 2003-2016. We included observational studies (cross-sectional, comparative cross-sectional) among women who met the inclusion criteria. The random-effect models were used to pool the prevalence of MetS and its components among PCOS women. This model was also applied to the pooled OR assessing the association between MetS and PCOS.

Results: The pooled prevalence of MetS among PCOS women was found to be 26.30% (95% CI: 23.68–28.93), but varied from 7.10% (95% CI: 1.64-12.56) to 37.50% (95% CI: 28.84-46.16), depending upon the diagnostic criteria used. Low high-density lipoprotein cholesterol (HDL) - 61.87% (95% CI: 53.31–70.43) and high waist circumference (WC)- 52.23% (95% CI: 43.84–60.61) were the most common components of MetS in PCOS women. Compared to healthy controls, the overall pooled (OR) of MetS in PCOS patients was 2.09 (95% CI: 1.67-2.60), but this ranged from 0.31 (95% CI: 0.13-0.74) to 4.69 (95% CI: 2.09-10.52), depending upon the diagnostic criteria used.

Conclusion: Women with PCOS had a much higher prevalence of MetS than was found among the healthy controls. Furthermore, as low HDL and high WC were the most common components of MetS in PCOS women, these two components specifically need to be addressed in prevention strategies.

Metabolic Syndrome Increases Mortality Risk in Dialysis Patients: A Systematic Review and Meta-Analysis

CONTEXT

Metabolic syndrome (MetS) is documented to increase the risk of mortality in the general population. However, there are reports of lower mortality in end stage renal disease (ESRD) patients with obesity. Since obesity is a major component of MetS, this meta-analysis was conducted to determine the risk of all-cause mortality, cardiovascular disease (CVD) mortality, and cardiovascular disease events (CVE) associated with MetS in ESRD subjects.

EVIDENCE ACQUISITION

Eligible studies from inception to March 2017 assessing the clinical outcome of MetS in ESRD subjects were comprehensively searched in MEDLINE, EMBASE, and CENTRAL. ESRD participants treated with hemodialysis (HD) or peritoneal dialysis (PD) were included, but renal transplant subjects were excluded. Two authors independently assessed article quality and extracted the data. The primary outcome was all-cause mortality and, secondary outcomes were CVD death and CVE.

RESULTS

Fifty full-text articles were reviewed and eight studies were included in the meta-analysis, based on the random effects model. ESRD subjects with MetS, as compared with the non-MetS, had significant increased risk of all-cause mortality (pooled RR = 1.92; 95% confidence interval [CI] 1.15 - 3.21; P = 0.01) and CVE (pooled RR = 6.42; 95% CI 2.00 - 20.58). Age, type of dialysis, triglycerides, and HDL-C were significant predictors of risk of mortality, based on univariate meta-regression analyses.

CONCLUSIONS

Metabolic syndrome is associated with an increased risk of all-cause mortality in ESRD patients.

The association between ghrelin levels and markers of arterial stiffness and inflammatory markers in Saudi subjects with metabolic syndrome

BACKGROUND

Arterial stiffness is a principal cardiovascular risk factor. Metabolic syndrome (MetS) is a predisposing factor to arterial stiffness and persistent MetS circumstances can deteriorate the arterial stiffness severity. Low concentrations of plasma ghrelin are meticulously connected to arterial stiffness. This work targeted to judge the relationship between plasma ghrelin levels and intima-media thickness (IMT) and brachial-ankle pulse wave velocity (baPWV) as markers of arterial stiffness and inflammatory markers and in Saudi subjects with MetS.

PATIENTS AND METHODS

Eighty-four young adults were recruited from the visitors of the outpatient clinics of Taif hospitals, and then they were divided into a control group that involves subjects without MetS and a study group involving those with MetS. Anthropometric measurements, blood pressure, plasma ghrelin levels, fasting plasma glucose levels (FPG) and lipid profile were assessed. baPWV was measured by a volume plethysmograph while IMT was evaluated by ultrasonography.

RESULTS

Plasma ghrelin values were significantly (P<0.001) decreased in the MetS group versus control group. Arterial stiffness was noticed in MetS group by significantly (P<0.01) increased IMT and baPWV (P<0.001) matched with control group. Plasma ghrelin concentrations were negatively associated with age, smoking, FPG, HbA1c, CRP, TNF-alpha, baPWV, and Lt Carotid IMT.

CONCLUSIONS

Depending on our outcomes showing the valuable properties of ghrelin in the cardiovascular system in patients with metabolic syndrome, it can be postulated that ghrelin may be associated with markers of atherosclerosis.

Austrian Lipid Consensus on the management of metabolic lipid disorders to prevent vascular complications: A joint position statement issued by eight medical societies. 2016 update

In 2010, eight Austrian medical societies proposed a joint position statement on the management of metabolic lipid disorders for the prevention of vascular complications. An updated and extended version of these recommendations according to the current literature is presented, referring to the primary and secondary prevention of vascular complications in adults, taking into consideration the guidelines of other societies. The "Austrian Lipid Consensus - 2016 update" provides guidance for individualized risk stratification and respective therapeutic targets, and discusses the evidence for reducing vascular endpoints with available lipid-lowering therapies. Furthermore, specific management in key patient groups is outlined, including subjects presenting with coronary, cerebrovascular, and/or peripheral atherosclerosis; diabetes mellitus and/or metabolic syndrome; nephropathy; and familial hypercholesterolemia.

Therapeutic Effects of Curcumin on Ultrasonic Morphological Characteristics of Liver in Patients with Metabolic Syndrome

Introduction:

Metabolic syndrome (METS) represent a simultaneous presence of multiple metabolic disorders in one person. Prevalence is increasing worldwide, which is probably related to increased obesity and sedentary lifestyle. Non-alcoholic steatosis or “fatty liver” is a metabolic disease caused by fat dysfunction. It can be a sign of some other disease, and can often be found in patients with metabolic disorders. Ultrasound is an acceptable method for the identification of fatty steatosis. There is evidence that when turmeric is used as a herbal diet, with its active metabolite of curcumin, can repair fatty acidosis and thus prevent progression of fatty steatosis complications such as cirrhosis and liver cancer. Goal. The aim of the study was to determine the effects of 400 mg curcuminaddition to the nutrition on ultrasound morphological characteristics of the liver in METS patients.

Methodology:

A prospective cohort study was conducted on 100 subjects with METS, treated in the family medicine practice of the Tuzla Canton, aged 35-70 years. The therapeutic effects of 400 mg curcumin on ultrasound-morphological characteristics of the liver were followed, validated by ultrasound in 50 respondents of experimental groups with METS. The data were processed by the IBM SPSS Statistics 21 statistical analysis program using parametric techniques andStudent’s t-test for paired samples.

Results:

There were 65% of women in the study. There were no statistically significant differences in the age of respondents within the analyzed groups. The use of 400 mg curcumin per day was statistically significantly improved ultrasound morphological characteristics of the liver in subjects with METS.

Conclusion:

All respondents with METS who used curcumin had beneficial effects on the morphological characteristics of the liver. Curcumin had stronger effects on subjects with METS and DM type 2 than others.

Association between Helicobacter pylori infection and metabolic syndrome: a systematic review and meta-analysis

OBJECTIVE

To systematically review and quantify the effect of Helicobacter pylori (H. pylori) infection on the risk of metabolic syndrome (MS) and metabolic parameters in individuals with H. pylori infection.

METHODS

A systematic search of MEDLINE and EMBASE was performed. Inclusion criteria were observational studies assessing the association between H. pylori infection and MS in adult participants. We calculated the pooled effect estimate of MS with 95% confidence interval (CI) between patients infected with H. pylori and those without by using a random-effects model. The secondary outcomes were the differences between groups in homeostatic model assessment of insulin resistance (HOMA-IR), triglyceride, high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), body mass index (BMI) and systolic blood pressure (SBP).

RESULTS

Altogether 18 trials with 27 544 participants met the inclusion criteria. Six trials were included in the analysis of MS. There was a statistically significant association between H. pylori and MS with a pooled odds ratio of 1.34 (95% CI 1.17-1.53, I(2)  = 39%, Pheterogeneity < 0.01). Between the infected and non-infected groups there were significant differences in FBG, HDL-C, BMI, triglyceride, HOMA-IR and SBP (all P < 0.05).

CONCLUSION

H. pylori infection is positively associated with MS. Infection with H. pylori is also associated with higher triglyceride, FBG, BMI, HOMA-IR, SBP and lower HDL-C.

Relationship between Branched-Chain Amino Acids, Metabolic Syndrome, and Cardiovascular Risk Profile in a Chinese Population: A Cross-Sectional Study

Objective. This study aimed to evaluate the relationship between branched-chain amino acids (BCAAs), metabolic syndrome (MS), and other cardiovascular (CV) risk factors in middle-aged and elderly Chinese population at high risk for the development of cardiovascular disease (CVD). Methods. 1302 subjects were enrolled from the Huai'an Diabetes Prevention Program. Results. BCAAs levels were positively correlated with MS, its components, and CV risk profile. The odds ratio (OR) for MS among subjects in the fourth quartile of BCAAs levels showed a 2.17-fold increase compared with those in the first quartile. BCAAs were independently associated with high Framingham risk score even after adjusting for MS and its components (P < 0.0001). Additionally, the OR for high CV risk was 3.20-fold (P < 0.0001) in participants in the fourth BCAAs quartile with MS compared with participants in the first BCAAs quartile without MS. Conclusions. Increased BCAAs levels are independent risk factors of MS and CVD in addition to the traditional factors in middle-aged and elderly Chinese population. The development of CVD in MS patients with high level BCAAs is accelerated. Intervention studies are needed to investigate whether the strategy of BCAAs reduction has impacts on endpoints in patients with higher CV risk. This study is registered with ChiCTR-TRC-14005029.

Society for maternal and fetal medicine workshop on pregnancy as a window to future health: Clinical utility of classifying women with metabolic syndrome

Women with preeclampsia, gestational diabetes, and obesity during pregnancy are at risk for medical complications later in life. Therefore, practitioners should identify those who can benefit from early diagnosis and interventions. Metabolic syndrome is a cluster of risk factors including hypertension, elevated triglycerides, low high-density lipoprotein cholesterol, glucose intolerance, and obesity, which also identifies those at risk for cardiovascular disease. Taking the time to classify women with the metabolic syndrome does not necessarily offer risk stratification superior to that offered by identifying the individual components. This article will offer conclusions regarding the need for busy obstetrician/gynecologists to make this classification.

Impact of the albumin to creatinine ratio and the coronary artery state on vascular events

Albuminuria is an important indicator of cardiovascular risk. However, whether albuminuria predicts cardiovascular events independently of the baseline coronary artery state has not yet been investigated. We measured urinary albumin and creatinine concentrations in 867 consecutive patients who underwent coronary angiography for the evaluation of suspected or established stable coronary artery disease (CAD). Albuminuria was defined as a urinary albumin to creatinine ratio of 30 μg/mg or greater. Prospectively, we recorded the vascular events over 3.2 ± 1.2 years. From our patients, 318 had neither albuminuria nor significant CAD (i.e., coronary stenoses ≥ 50%) at baseline angiography, 69 had albuminuria but no significant CAD, 343 did not have albuminuria but significant CAD, and 137 had both albuminuria and significant CAD. Compared with the event rate among patients with neither albuminuria nor significant CAD (8.2%), event rates were significantly higher in patients with albuminuria without significant CAD (18.8%; p = 0.002) and in normoalbuminuric patients with significant CAD (19.2%; p <0.001); it was highest in patients with both albuminuria and significant CAD (33.6%; p <0.001). Importantly, event rates were similar in patients with albuminuria free of significant CAD and those with significant CAD but normoalbuminuria (p = 0.767). In conclusion, this is the first study demonstrating that albuminuria per se is a CAD risk equivalent after adjusting for the angiographically proven atherosclerotic state at baseline.

[Effects of gastric bypass on estimated cardiovascular risk in morbidly obese patients with metabolic syndrome]

INTRODUCTION

The major goal of surgical treatment in morbid obesity is to decrease morbidity and mortality associated with excess weight. In this sense, the main factors of death are cardiovascular disease and metabolic syndrome. The objective of this study is to evaluate the effects of gastric bypass on cardiovascular risk estimation in patients after bariatric surgery.

MATERIAL AND METHODS

We retrospectively evaluated pre and postoperative cardiovascular risk estimation of 402 morbidly obese patients who underwent laparoscopic gastric bypass. The major variable studied is the cardiovascular risk estimation that is calculated preoperatively and after 12 months. Cardiovascular risk estimation analysis has been performed with the REGICOR Equation. REGICOR formulation allows calculating a 10 year risk of cardiovascular events adapted to the Spanish population and is expressed in percentages.

RESULTS

We reported an overall 4.1±3.0 mean basal REGICOR score. One year after the operation, cardiovascular risk estimation significantly decreased to 2,2±1,6 (P<.001). In patients with metabolic syndrome according to ATP-III criteria, basal REGICOR score was 4.8±3.1 whereas in no metabolic syndrome patients 2.2±1.8. Evaluation 12 months after surgery, determined a significant reduction in both groups (metabolic syndrome and non metabolic syndrome) with a mean REGICOR score of 2.3±1.6 and 1.6±1.0 respectively.

CONCLUSION

The results of our study demonstrate favorable effects of gastric bypass on the cardiovascular risk factors included in the REGICOR equation.

Bone mineral density, metabolic syndrome, and vitamin D in indigenous from south of Brazil

Bone mineral density (BMD), metabolic syndrome (MS), and vitamin D levels were evaluated in 73 indigenous from south of Brazil aged between 40 and 86 years. BMD loss in lumbar spine was detected in 63 %, MS was detected in 76.7 %, and vitamin D levels were altered in 67 % of subjects.

PURPOSE

This study aims to evaluate bone mineral density and its relationship with metabolic syndrome (MS) and vitamin D levels in indigenous from south of Brazil.

METHODS

Transversal, descriptive, analytical study was developed in Nonoai City between October and December 2011. Seventy-three indigenous people aged between 40 and 86 years were enrolled. MS was defined according to NCEP-III. Serum levels of vitamin D and other parameters were quantified to define metabolic syndrome. Spine and femur bone mineral density was measured by dual-energy X-ray absorptiometry. Bone mineral loss was classified using the World Health Organization criteria.

RESULTS

Sixty-three percent of indigenous participants presented bone mineral loss in lumbar spine, and 19 % in femur. Overall frequency of MS was 76.7 % and more prevalent in females. Lower serum levels of vitamin D were observed in 67 % of the participants. Among the risk factors related to MS criteria, only the HDL levels were associated with bone mineral loss. Regarding nutritional habits, there were positive correlations between fat foods and meat intakes, MS, and low levels of vitamin D.

CONCLUSIONS

The elderly indigenous people present a high incidence of low bone mineral density, mainly in the lumbar spine, low levels of vitamin D, and a high prevalence of metabolic syndrome. Public health policy should also prioritize chronic degenerative diseases prevention and care for indigenous people. Healthier lifestyle in this population should be a focus for health promotion program by the governments.

Associations of CXCL16/CXCR6 with carotid atherosclerosis in patients with metabolic syndrome

BACKGROUND & AIMS

Chemokine CXC ligand 16 (CXCL16) has chemokine, adhesion molecule and scavenger receptor functions involving the immune function. Atherosclerosis is an inflammatory disease. We aimed to study the association of chemokine CXCL16/CXCR6 and carotid atherosclerosis in patients with metabolic syndrome.

METHODS

Carotid ultrasonography was determined in 30 patients with metabolic syndrome and 30 controls. The mRNA levels of CXCL6/CXCR6 were detected by real-time RT-PCR. The activation of T cells and expression of CXCR6 in T lymphocyte cells and natural killer T (NKT) cells was detected by flow cytometry. The serum level of sol-CXCL6 was determined by ELISA.

RESULTS

Compared with controls, patients with metabolic syndrome showed significantly increased waist circumference and levels of total cholesterol, triglycerides and low-density lipoprotein cholesterol (all P < 0.001), with increased abnormalities of the structure and function of the carotid artery (P < 0.05). In metabolic syndrome, the levels of sol-CXCL16 and CXCL16mRNA were increased and associated with max IMT and plaque index. Patients with metabolic syndrome showed increased number of CXCR6+ T cells and CXCR6+ NKT cells, which was associated with max IMT and plaque index.

CONCLUSIONS

CXCL16 and CXCR6 may be associated the formation of carotid atherosclerotic plaque in metabolic syndrome, and T cells may be the important effector cells in the pathogenesis of the atherosclerosis.

Cardiovascular risk and the metabolic syndrome

Clustering of metabolic syndrome (MetS) components within individuals helps in the identification of subjects who are at increased risk for both cardiovascular disease (CVD) and diabetes. In this review we describe how the presence of MetS influences CVD risk. Our review focuses on published studies through May 2006 referring to incident CVD in relation to the National Cholesterol Education Program Adult Treatment Panel III (NCEP) definition of the MetS. We present data suggesting that the Framingham risk function is the most appropriate method for assessing CVD risk in subjects with or without MetS. We show how the CVD risk associated with MetS is influenced by the inclusion of subjects with diabetes and CVD at baseline, and by the development of diabetes during follow-up, and that this might explain why MetS may be a stronger risk factor for CVD in women than in men. We present data suggesting that CVD risk associated with MetS does not appear to be greater than the sum of its parts, and that adding CRP to MetS variables does not improve population CVD risk prediction. Lifestyle intervention and treatment of specific abnormal MetS components are appropriate until a better understanding of the pathogenesis of MetS is available. At such time we may be able to target the underlying causes of the syndrome and ultimately prevent the development of both CVD and diabetes.

Cardio-metabolic features of type 2 diabetes subjects discordant in the diagnosis of metabolic syndrome

BACKGROUND

The aim of this study is to investigate the cardio-metabolic parameters and surrogate markers of insulin resistance in a discordant group of type 2 diabetes (T2DM) subjects who satisfy the Adults Treatment Panel (ATP) III criteria, but not the International Diabetes Federation (IDF) criteria, for metabolic syndrome (MetS).

METHODS

We assessed the prevalence of MetS in T2DM subjects (n=167) who were selected from subjects registered at the diabetes center of Dong-A University Medical Center. We used the ATP III criteria and the IDF criteria for the diagnosis of MetS and sorted the subjects into 2 MetS groups: one group diagnosed per ATP III criteria (MetSa) and one diagnosed per IDF criteria (MetSi). We then compared the clinical characteristics, metabolic parameters (homeostasis model assessment of insulin resistance, aspartate aminotransferase, alanine aminotransferase, and uric acid values) and co-morbidities (prevalence of microalbuminuria, fatty liver, and cardiovascular disease) between the MetSa, MetSi, and discordant MetS groups.

RESULTS

The prevalence of MetS in the MetSa group (73.6%) was higher than in the MetSi group (62.2%). The MetS prevalence in the discordant group was 11.4%. The discordant group showed no significant differences in clinical characteristics (except waist circumference and body mass index), metabolic parameters, or prevalence of co-morbidities, as compared with subjects with MetS by both criteria.

CONCLUSION

In this study, cardio-metabolic features of the subjects diagnosed with MetS using ATP III criteria, but not IDF criteria, are not significantly different from those of subjects diagnosed with MetS using both criteria.

Arsenic methylation, GSTO1 polymorphisms, and metabolic syndrome in an arseniasis endemic area of southwestern Taiwan

Previous studies have shown that hair arsenic (As) levels are associated with an increased prevalence of metabolic syndrome (MetS), which is a strong predictor for type 2 diabetes. The objective of this study was to evaluate whether urinary arsenic methylation is related to MetS in an arseniasis endemic area of southwestern Taiwan, taking genetic factors into account. Subjects were from a community-based cohort recruited in 1990 from three villages in Putai Township. In 2002-2003, we successfully followed 247 subjects and measured their urinary arsenic species including inorganic arsenic, monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA), as well as the coding region polymorphisms of three genes known to involve in arsenic methylation. Results showed that subjects of MetS had a history of consuming well water of higher arsenic concentration as compared to those without MetS. We also found a significant association between urinary arsenic species and risk for MetS, where the odds ratio of MetS was increased with decreasing proportion of MMA and low rate of primary methylation (defined as MMA/inorganic As). The increased risk associated with low primary methylation rate was further modified by the GSTO1 A140D polymorphism, with the D allele carriers showing a slightly higher risk for MetS. Our results suggest that a low MMA% is associated with increased risk for MetS among As-exposed subjects and the genetic polymorphism of GSTO1, an enzyme responsible for the reduction of pentavalent arsenic species, may also play a modest modification role.

Glucose tolerance status is a better predictor of diabetes and cardiovascular outcomes than metabolic syndrome: a prospective cohort study

BACKGROUND

To evaluate the importance of oral glucose tolerance test (OGTT) in predicting diabetes and cardiovascular disease in patients with and without Metabolic Syndrome from a population treated in a primary care unit.

RESEARCH DESIGN AND METHODS

A prospective cohort study was conducted with subjects regularly attending the primary care unit of Hospital de Clínicas de Porto Alegre. Participants underwent a 75 g OGTT. Metabolic syndrome definition was based on the criteria of IDF/AHA/NHLBI-2010.

RESULTS

Participants mean age was 61 ± 12 years (males: 38%; whites: 67%). Of the 148 subjects included, 127 (86%) were followed for 36 ± 14 months, 21 (14%) were lost. Subjects were classified into four groups based on baseline OGTT: 29% normal (n = 43), 28% impaired fasting glucose (IFG; n = 42), 26% impaired glucose tolerance (IGT; n = 38), and 17% diabetes (n = 25). Metabolic syndrome prevalence was lower in normal group (28%), intermediate in IFG (62%) and IGT (65%) groups, and higher among subjects with diabetes (92%; P <0.001). Incidence of diabetes increased along with the stages of glucose metabolism disturbance (normal: 0%, IFG: 16%, IGT: 28%; P = 0.004). No patient with normal OGTT developed diabetes, regardless metabolic syndrome presence. Diabetes at baseline was the major determinant of cardiovascular disease occurrence (normal: 0%, IFG: 4%, IGT: 0%, diabetes: 24%; P = 0.001). In Cox-regression analysis, only the 2 h OGTT results were associated with diabetes (OR = 1.03; 95%CI 1.01-1.06; P <0.001) and cardiovascular disease development (OR = 1.013; 95%CI 1.002-1.025; P = 0.024).

CONCLUSIONS

In this sample of subjects undergoing diabetes screening, the OGTT predicted diabetes and cardiovascular disease more effectively than the metabolic syndrome status.

Prediction model with metabolic syndrome to predict recurrent vascular events in patients with clinically manifest vascular diseases

BACKGROUND

Although the overall average 10-year cardiovascular risk for patients with manifest atherosclerosis is considered to be more than 20%, actual risk for individual patients ranges from much lower to much higher. We investigated whether information on metabolic syndrome (MetS) or its individual components improves cardiovascular risk stratification in these patients.

DESIGN AND METHODS

We conducted a prospective cohort study in 3679 patients with clinical manifest atherosclerosis from the Secondary Manifestations of ARTerial disease (SMART) study. Primary outcome was defined as any cardiovascular event (cardiovascular death, ischemic stroke or myocardial infarction). Three pre-specified prediction models were derived, all including information on established MetS components. The association between outcome and predictors was quantified using a Cox proportional hazard analysis. Model performance was assessed using global goodness-of-fit fit (χ(2)), discrimination (C-index) and ability to improve risk stratification.

RESULTS

A total of 417 cardiovascular events occurred among 3679 patients with 15,102 person-years of follow-up (median follow-up 3.7 years, range 1.6-6.4 years). Compared to a model with age and gender only, all MetS-based models performed slightly better in terms of global model fit (χ(2)) but not C-index. The Net Reclassification Index associated with the addition of MetS (yes/no), the dichotomous MetS-components or the continuous MetS-components on top of age and gender was 2.1% (p = 0.29), 2.3% (p = 0.31) and 7.5% (p = 0.01), respectively.

CONCLUSIONS

Prediction models incorporating age, gender and MetS can discriminate between patients with clinical manifest atherosclerosis at the highest vascular risk and those at lower risk. The addition of MetS components to a model with age and gender correctly reclassifies only a small proportion of patients into higher- and lower-risk categories. The clinical utility of a prediction model with MetS is therefore limited.

The Influence of Risk Factors for Metabolic Syndrome on Vascular Complications

We assessed the influence of metabolic syndrome (MetS) characteristics on vascular complications. The study included 108 patients (72 women and 36 men, age 57.0 ± 8.5 years) with MetS that was diagnosed according to International Diabetes Federation criteria. The prevalence of micro- and macrovascular complications was assessed: vascular changes in the fundus of the eye—72%, ischemic heart disease—54.9%, estimated glomerular filtration rate (eGFR) <90 mL/min—38.9%, diabetic foot—5.55%, and cerebrovascular accident—3.7% of patients. A negative correlation between high-density lipoprotein cholesterol (HDL-C) concentration, creatinine levels, and level of vascular changes in the fundus of the eye was found. Moreover, the level of obesity and fasting glucose level had positive correlation with the intensity of vascular changes in the fundus of the eye. Characteristics of MetS (obesity and fasting glucose level) have high impact on advancing vascular complications in these patients. High level of HDL-C decreases the intensity of vascular changes in patients with MetS.

The severity of coronary atherosclerosis in diabetic and non-diabetic metabolic syndrome patients diagnosed according to different criteria and undergoing elective angiography

Our aim in this study was to evaluate the relationship between metabolic syndrome (MS) as defined by different criteria and the severity of coronary lesions in a sample of diabetic and non-diabetic patients undergoing elective coronary angiography. All patients had blood and urine tests, physical examinations were performed before angiography, and finally they were classified based on three criteria (World Health Organisation-WHO, Adult Treatment Panel-ATP III and International Diabetes Federation-IDF). Eighty-eight patients were diabetic, and 96 patients were non-diabetic. Among all patients, diabetics had significantly higher Gensini scores (P < 0.001). According to WHO criteria (P = 0.005) and IDF criteria (P = 0.015) metabolic syndrome patients had higher Gensini scores, but for ATP III criteria difference was not significant. When we evaluated diabetics and non-diabetics separately, non-diabetic patients with MS had significantly higher scores with WHO definition (P = 0.015) and mildly higher but not significant values with other MS criteria (P = 0.057 for both IDF and ATP III). Neither any one of MS components nor gender revealed significant relationship with coronary disease severity. In our study with a cohort of Turkish patients undergoing elective coronary angiography; we concluded that MS should be taken into consideration, especially in non-diabetic patients.

Insulin resistance is associated with the metabolic syndrome and is not directly linked to coronary artery disease

BACKGROUND

Insulin resistance (IR) is the key feature of the metabolic syndrome (MetS). Its association with directly visualized coronary atherosclerosis is unclear. We hypothesised that insulin resistance is associated with both angiographically determined coronary artery disease (CAD) and with the MetS.

METHODS

In 986 consecutive patients undergoing coronary angiography for the evaluation CAD, IR was determined by the HOMA index; the MetS was defined according to NCEP-ATPIII criteria; and significant CAD was diagnosed when coronary stenoses ≥50% were present.

RESULTS

HOMA IR scores were higher in MetS patients than in subjects without the MetS (4.9±6.4 vs. 2.2±2.0; p<0.001). HOMA IR did not differ significantly between patients with significant CAD and those who did not have significant CAD. When both, the presence of MetS and of significant CAD were considered, HOMA IR was significantly higher in patients with the MetS both among those who had significant CAD (4.9±6.8 vs. 2.2±1.8; p<0.001) and among those who did not have significant CAD (5.0±5.8 vs. 2.1±2.3; p<0.001), it did not differ significantly between patients with significant CAD and subjects without significant CAD among patients with the MetS nor among those without MetS. Similar results were obtained with the IDF definition of the MetS.

CONCLUSION

IR is significantly associated with the MetS but not with angiographically determined CAD. IR may play a greater role in the eventual precipitation of thrombosis than in the gradual progression of atherosclerosis.

Evidence on the applicability of the ATPIII, IDF and CDS metabolic syndrome diagnostic criteria to identify CVD and T2DM in the Chinese population from a 6.3-year cohort study in mid-eastern China

AIMS

This study evaluates the effectiveness of three metabolic syndrome (MS) criteria in identifying cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) in the Chinese population.

METHODS

3598 subjects were recruited from a cohort study on Prevention of Multiple Metabolic disorders and MS in Jiangsu of China (PMMJS), followed at 6.3 years. MS was diagnosed using criteria of the National Cholesterol Education Program's Adult Treatment Panel III (ATPIII), the International Diabetes Federation (IDF) and Chinese Diabetes Society (CDS). Cox regression model was used to analysis the association between MS and onset of CVD and T2DM. Receiver operating characteristic (ROC) curve, sensitivity and specificity were also used to test the ability of three MS criteria to identify CVD or T2DM.

RESULTS

Among three criteria, CDS has the highest specificity but lowest sensitivity. Using the CDS criterion, over 50 percent of patients would be misdiagnosed. ATPIII criterion has the shortest distance in ROC curve, lowest false positive rate and false negative rate for identifying CVD and T2DM. ATPIII+/IDF+ has lower ability to predict CVD than ATPIII+/IDF-. ATPIII+/IDF+ and ATPIII+/IDF- has similar ability to predict T2DM.

CONCLUSIONS

The ATPIII-MS criterion has the highest ability to predict CVD and T2DM. ATPIII is the best MS criterion for the Chinese population.

Low bone mineral density is not associated with angiographically determined coronary atherosclerosis in men

This study for the first time investigates the association of bone mineral density (BMD) with angiographically determined coronary atherosclerosis in men. Our data show that the prevalence of low BMD is very high in men undergoing coronary angiography. However, neither osteopenia nor osteoporosis is associated with an increased prevalence of angiographically determined coronary atherosclerosis.

INTRODUCTION

The association of low BMD with angiographically determined coronary atherosclerosis in men is unknown.

METHODS

We enrolled 623 consecutive men undergoing coronary angiography for the evaluation of established or suspected coronary artery disease (CAD). BMD was assessed by dual X-ray absorptiometry. CAD was diagnosed in the presence of any coronary artery lumen narrowing at angiography; coronary stenoses with lumen narrowing > or =50% were considered significant.

RESULTS

From the total study cohort (mean age of 64 +/- 11 years), 207 patients (33.2%) had osteopenia and 65 (10.4%) had osteoporosis; at angiography, CAD was diagnosed in 558 patients (89.6%) and 403 (64.7%) had significant coronary stenoses. In multivariate logistic regression analysis neither osteopenia nor osteoporosis was associated with an increased prevalence of CAD (adjusted odds ratios (ORs) = 0.71 [95% confidence interval 0.40-1.23]; p = 0.222 and 1.03 [0.38-2.80]; p = 0.955, respectively) or with significant coronary stenoses (OR 0.74 [0.52-1.07], p = 0.112 and 0.72 [0.41-1.26]; p = 0.251, respectively). Also, as a continuous variable, BMD was not associated with angiographically diagnosed CAD.

CONCLUSIONS

The prevalence of low BMD is very high in men undergoing coronary angiography. However, low BMD is not associated with angiographically determined coronary atherosclerosis in men.

Mechanisms and significance of progenitor cell reduction in the metabolic syndrome

Bone marrow-derived progenitor cells are involved in the homeostasis of the cardiovascular system through differentiation into endothelium, smooth muscle, and cardiomyocytes. Alterations of these extremely plastic cells have been recognized as both markers of cardiovascular risk and pathophysiological links between risk factors and development of atherosclerosis. Metabolic syndrome, as a cluster of well-defined cardiovascular risk factors, represents a strong predictor of cardiovascular events and death. Moreover, components of the syndrome interact with one another and synergistically increase this risk. Here we describe all metabolic syndrome components as being characterized by alterations in circulating progenitor cells, especially endothelial cells. We also highlight how endothelial progenitors may mediate the interactions between cardiometabolic risk factors in a complex interplay and discuss potential implications for prevention and therapy.

Roles of the metabolic syndrome, HDL cholesterol, and coronary atherosclerosis in subclinical inflammation

OBJECTIVE

The metabolic syndrome (MetS) and coronary artery disease (CAD) frequently coincide; their individual contribution to inflammation is unknown.

RESEARCH DESIGN AND METHODS

We enrolled 1,010 patients undergoing coronary angiography. Coronary stenoses >or=50% were considered significant. The MetS was defined according to American Heart Association-revised National Cholesterol Education Program Adult Treatment Panel III criteria.

RESULTS

C-reactive protein (CRP) did not differ between patients with significant CAD and subjects without significant CAD (P = 0.706) but was significantly higher in MetS patients than in those without MetS (P < 0.001). The MetS criteria low HDL cholesterol (P < 0.001), large waist (P < 0.001), high glucose (P < 0.001), and high blood pressure (P = 0.016), but not high triglycerides (P = 0.352), proved associated with CRP. When all MetS traits were considered simultaneously, only low HDL cholesterol proved independently associated with CRP (F = 44.19; P < 0.001).

CONCLUSIONS

CRP is strongly associated with the MetS but not with coronary atherosclerosis. The association of the MetS with subclinical inflammation is driven by the low HDL cholesterol feature.

Variations in prevalent cardiovascular disease and future risk by metabolic syndrome classification in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study

BACKGROUND

The International Diabetes Federation (IDF) and Adult Treatment Panel (ATP) III define metabolic syndrome (MetSyn) differently, with unclear implications for cardiovascular disease (CVD) risk.

METHODS

We examined 22,719 participants in the REGARDS study. We classified participants as: no MetSyn, MetSyn by ATP-III and IDF criteria, MetSyn by ATP-only, or MetSyn by IDF-only. To assess current CVD, we determined the odds of self-reported CVD by MetSyn category using multivariable logistic regression, controlling for socio-demographic and behavioral factors. To estimate future coronary heart disease risk, we calculated Framingham risk scores (FRS).

RESULTS

Overall, 10,785 individuals (47%) had MetSyn. Of these, 79% had MetSyn by both definitions, 6% by ATP-only, and 14% by IDF-only. Compared to those without MetSyn, ATP-only individuals had the highest odds of current CVD and of having a FRS >20%. Also compared to those without MetSyn, IDF-only individuals had 43% higher odds of current CVD and 2-fold increased odds of having a FRS >20%.

CONCLUSIONS

Consistent with previous reports, ATP-III MetSyn criteria identified individuals with increased odds of CVD and elevated future coronary heart disease risk. However, the IDF definition identified a clinically important number of additional individuals at excess CVD risk.