Association between hypertriglyceridemic-waist phenotype and cardiovascular disease: A cohort study and meta-analysis

Relationship between plasma atherogenic index and incidence of cardiovascular diseases in Chinese middle-aged and elderly people

The atherogenic index of plasma (AIP), a novel composite lipid index, is closely linked to cardiovascular disease (CVD). However, lipid levels fluctuate dynamically, and it is unclear whether there are differences in the association of single-timescale, multiple-timescale, or AIP change trajectories with new-onset cardiovascular disease. Hence, the aim of this study was to investigate the correlation between different AIP parameters and the occurrence of CVD. Data were derived from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011, 2015, 2018, and 2020, focusing on middle-aged and elderly populations aged over 45 years. Changes in AIP were classified into three groups using K-means cluster analysis: the low-level growth group (Class 1), the medium-level growth group (Class 2), and the high-level decline group (Class 3). Furthermore, participants were grouped based on tertiles (T) of cumulative AIP (Cum-AIP). Our multivariate logistic regression model integrated adjustments for potential confounders in order to investigate the association between Cum-AIP and the occurrence of CVD. Additionally, we employed restricted cubic spline (RCS) modeling to illustrate the dose-response relationship of baseline AIP, mean AIP, and Cum-AIP with CVD risk. During the 5-year follow-up period, 927 participants experienced the onset of CVD. After controlling for various potential confounding factors, it was observed that individuals in Class 2 demonstrated a notably heightened risk of CVD (OR = 1.23, 95% CI: 1.03, 1.46) and stroke (OR = 1.35, 95% CI: 1.02, 1.80) in comparison to those in Class 1. However, there was no significant difference in the risk of heart disease (OR = 1.21, 95% CI: 0.99, 1.48). In contrast, a noteworthy correlation was solely observed in the Class 3 group concerning the risk of stroke occurrence (OR = 1.60, 95% CI: 1.06, 2.42). The adjusted OR (95% CI) for CVD in the T2 and T3 groups were 1.21 (1.00, 1.46) and 1.30 (1.05, 1.62), respectively, compared to the T1 Cum-AIP group (P for trend = 0.017). Through the RCS model, we identified a positive and linear relationship between baseline AIP, mean AIP, and Cum-AIP with the incidence of CVD. However, the association between baseline AIP and CVD was weak. Sustained elevation of AIP is linked to a heightened risk of CVD in the general population. The elevated mean, and Cum-AIP levels are associated with a heightened risk of CVD. These findings indicate that AIP can serve as a valuable indicator of dyslipidemia, and continuous monitoring and early intervention targeting AIP may contribute to a further reduction in the incidence of CVD.

The long-term impact of hypertriglyceridemia-waist phenotype on major adverse cardiovascular events in elderly patients with OSA

INTRODUCTION

The hypertriglyceridemia-waist (HTGW) phenotype is a prevalent risk factor for cardiovascular diseases and obstructive sleep apnea (OSA). However, the impactof the HTGW phenotype on the simultaneous occurrence of OSA and cardiovascular diseases remains unexplored. This study aimed to determine whether the HTGW phenotype elevates the incidence of major adverse cardiovascular events (MACE) in patients with OSA, such as hospitalization for unstable angina and heart failure, myocardial infarction, and cardiovascular death, in patients with OSA.

METHODS

A total of 1,290 patients with OSA were recruited from six hospitals for follow-up. According to the Chinese population criteria recommended by the International Diabetes Federation, the patients were divided into four groups: normal triglyceride waist circumference (NTNW) phenotype, pure high triglyceride (HTNW) phenotype, pure high waist circumference (NTGW) phenotype, and HTGW phenotype. The prognosis for MACE was evaluated using Cox proportional hazards analysis. The prognosis of MACE was evaluated using Cox proportional hazards analysis.

RESULTS

207 (17.9%) developed an HTGW phenotype. After a median of 42 months of follow-up, 119 (10.3%) experienced MACE. Cox proportional hazards analysis revealed that patients exhibiting the HTGW phenotype had a 1.963-fold higher risk of developing MACE than patients with the NTNW phenotype (P = 0.012). These results remained significant after adjusting for confounders, and a 2.186-fold increased risk of MACE was found in patients with NTGW phenotype (P = 0.012). Subgroup analyses revealed an increased risk of MACE in OSA patients with HTGW phenotype and NTGW phenotype that were older than or equal to 70 years, male, and had moderate-to-severe OSA (all P-values < 0.05).

CONCLUSION

The HTGW and NTGW phenotypes significantly increase MACE risk among elderly patients with OSA.

The Hypertriglyceridemic Waist Phenotype is Associated with an Adverse Cardiometabolic Profile in this Cohort of Nigerians

Background

The hypertriglyceridemic waist (HTGW) phenotype was introduced as a means of identifying individuals at risk of developing metabolic syndrome as well as cardiovascular diseases and diabetes. However, studies surrounding the prevalence of the phenotype and its relationship with established markers of cardiometabolic risk, especially in the Nigerian population, remain sparse. This study aimed to determine the prevalence of the HTGW phenotype and explore its relationship with cardiovascular risk markers, namely Castelli Risk Indices I and II (CRI-I and CRI-II), Atherogenic Index of Plasma (AIP) and serum triglyceride-HDL cholesterol ratio (TG/HDL).

Methodology

In this retrospective cross-sectional study, the records of 206 patients presenting at a cardiac hospital from November 2022 to October 2023 were analysed. The HTGW phenotype was deemed present with a waist circumference of at least 94cm in men or 80cm in women and a serum triglyceride level of 150mg/dl or more in both sexes.

Results

At-risk waist circumference was more prevalent in women (92.7% vs 77.3%; p=0.002). The prevalence of the HTWG phenotype in the patient cohort was 29.6%, with more males than females (31.8% vs 27.1%) presenting with the phenotype (p=0.004). Patients with the phenotype also had higher systolic blood pressure, waist circumference, body mass index, triglycerides, AIP, and TG/HDL (all p<0.0005). The HTWG phenotype was also associated with a lower HDL and LDL cholesterol (p<0.0005) as well as a lower CRI-II (p=0.049).

Conclusion

The HTWG phenotype correlates with an increased cardiometabolic risk among Nigerians. This finding warrants the implementation of routine anthropometric and serum triglyceride measurements in screening programmes and hospitals for the early detection of individuals at risk of developing cardiovascular diseases.

Association of hypertriglyceridemic waist phenotype with metabolic syndrome traits and its diagnostic potential to predict metabolic syndrome in adults with excess body weight: A community-based cross-sectional study

BACKGROUND

The hypertriglyceridemic waist (HTGW) phenotype is a simple measure to identify individuals at increased risk of metabolic syndrome (MetS) traits. The present study aimed to describe the HTGW prevalence, and its associations with MetS traits, and also determine the diagnostic potential of the mirror indices of HTGW phenotype to predict MetS and its components in community-dwelling adults with overweight or obesity in Southern, Sri Lanka.

METHODS

In a cross-sectional study, 300 adults with excess body weight (body mass index >23 kg/m2) were enrolled and examined for the HTGW phenotype (fasting plasma triglyceride concentration ≥1.695 mmol/L and waist circumference >90 and >85 cm in males and females, respectively).

RESULTS

One in five adults with excess body weight had the HTGW phenotype. Phenotype-positive adults had significantly higher fasting plasma glucose (FPG) (p = 0.010), low-density lipoprotein cholesterol (HDL-C) (p < 0.001), total cholesterol (p < 0.001), atherogenic index (p < 0.001), coronary risk index (p = 0.001), triglyceride glucose index (p = 0.040), bioimpedance visceral fat (p = 0.041) and significantly lower HDL-C (p = 0.001) and cardioprotective index (p = 0.009) than those without the HTGW phenotype. Adults with excess body weight and the HTGW phenotype had an increased risk of FPG (odds ratio [OR] = 1.294; 95% confidence interval [CI] 1.051-1.594), atherogenic index (OR = 3.138; 95% CI = 1.559-6.317) and triglyceride glucose index (OR = 3.027; 95% CI = 1.111-8.249). The HTGW phenotype was strongly associated with MetS traits (OR = 16.584; 95% CI = 6.230-44.147). The cut-off values for the product of waist circumference × triglyceride, to identify the risk of having MetS and dyslipidemia among adults with excess body weight were 158.66 and 160.15 cm × mmol/L, respectively.

CONCLUSIONS

The readily available and inexpensive measures of the HTGW phenotype could serve as a clinically useful marker to identify MetS traits in adults with excess body weight.

Cumulative residual cholesterol predicts the risk of cardiovascular disease in the general population aged 45 years and older

BACKGROUND

Numerous studies have affirmed a robust correlation between residual cholesterol (RC) and the occurrence of cardiovascular disease (CVD). However, the current body of literature fails to adequately address the link between alterations in RC and the occurrence of CVD. Existing studies have focused mainly on individual RC values. Hence, the primary objective of this study is to elucidate the association between the cumulative RC (Cum-RC) and the morbidity of CVD.

METHODS

The changes in RC were categorized into a high-level fast-growth group (Class 1) and a low-level slow-growth group (Class 2) by K-means cluster analysis. To investigate the relationship between combined exposure to multiple lipids and CVD risk, a weighted quantile sum (WQS) regression analysis was employed. This analysis involved the calculation of weights for total cholesterol (TC), low-density lipoprotein (LDL), and high-density lipoprotein (HDL), which were used to effectively elucidate the RC.

RESULTS

Among the cohort of 5,372 research participants, a considerable proportion of 45.94% consisted of males, with a median age of 58. In the three years of follow-up, 669 participants (12.45%) had CVD. Logistic regression analysis revealed that Class 2 individuals had a significantly reduced risk of developing CVD compared to Class 1. The probability of having CVD increased by 13% for every 1-unit increase in the Cum-RC according to the analysis of continuous variables. The restricted cubic spline (RCS) analysis showed that Cum-RC and CVD risk were linearly related (P for nonlinearity = 0.679). The WQS regression results showed a nonsignificant trend toward an association between the WQS index and CVD incidence but an overall positive trend, with the greatest contribution from TC (weight = 0.652), followed by LDL (weight = 0.348).

CONCLUSION

Cum-RC was positively and strongly related to CVD risk, suggesting that in addition to focusing on traditional lipid markers, early intervention in patients with increased RC may further reduce the incidence of CVD.

The relationship between hypertriglyceridemic wait-to-height ratio and hypertension-diabetes comorbidity among older adult

Objective

Limited information is available on the effect of hypertriglyceridemic waist-to-height ratio (HTHWH) and hypertension-diabetes comorbidity (HAD) in older adult people. We aimed to explore the relationship between HTHWH and HAD for the co-management of hypertension and diabetes mellitus in the older adult.

Methods

A cross-sectional study, randomized cluster sampling from 10 community health service centers, and multivariate logistic regression were used in this study. A total of 3,501 participants aged 65 years or older recruited between January 2019 and December 2019 completed the study.

Results

Among 3,501 participants, the median age was 69.96 years, and 42.50% were men. A total of 1,207 subjects were in the HTHWH group, and the prevalence rate of HAD was 17.23% in this group. Multivariate logistic regression analysis showed that, as compared with the normal group, the risk of HAD in the HTHWH group increased by 2.05 times (OR = 3.05, 95% CI: 2.06-4.51). The risks of hypertension or diabetes mellitus (HOD), hypertension, and diabetes mellitus were also increased in the HTHWH group, with their ORs (95%CIs) being 1.82 (1.44-2.29), 1.73 (1.38-2.17), and 2.28 (1.66-3.13), respectively.

Conclusion

HTHWH significantly increases the risk of HAD and can be used as a reliable tool to screen the high-risk population for HAD.

Independent association between age- and sex-specific metabolic syndrome severity score and cardiovascular disease and mortality

Traditional metabolic syndrome (MetS) criteria have several limitations, which hinder its use in clinical practice. To overcome the limitations, we investigated the association between age- and sex-specific continuous MetS severity score (cMetS-S) and cardiovascular disease (CVD) and mortality beyond MetS components in the framework of the Tehran Lipid and Glucose Study. Participants aged 20-60 years at baseline were included in the study. We excluded participants with CVD, cancer, use of corticosteroids, estimated glomerular filtration rate < 30 ml/min/1.73 m2, and those who were pregnant. We evaluated the association between cMetS-S with CVD and mortality over 18 years of follow-up among 8500 participants with continuous and quantile approaches using the Cox proportional hazard regression model. In addition, the model performance of cMetS-S for predicting CVD events was compared to the conventional MetS criteria. Participants with higher cMetS-S had a significantly increased risk for CVD, coronary (CHD) and non-coronary heart disease (non-CHD), and all-cause, cardiovascular, and sudden cardiac death. Independent of the confounders and MetS components, the cMetS-S had the HRs of 1.67 (95% CI 1.47-1.89), 1.60 (95% CI 1.37-1.86), and 1.88 (95% CI 1.50, 2.35) for CVD, CHD, and non-CHD events upon 1-SD increment, respectively. The risk of mortality was increased for 1-SD of cMetS-S (all-cause mortality, HR 1.24; 95% CI 1.09-1.41; CVD mortality, HR 1.72; 95% CI 1.20-2.45; sudden cardiac death, HR 1.60; 95% CI 1.03-2.49). The model fitness of cMetS-S was superior to the conventional MetS criteria in predicting CVD and mortality. The cMetS-S provided an additional risk for CVD and mortality beyond the individual MetS components. Standardized cMetS-S could be a potential universal measure to define MetS severity while considering the weighted contribution of MetS components and their variations by age, sex, and ethnicity.

Development and validation of a continuous metabolic syndrome severity score in the Tehran Lipid and Glucose Study

Metabolic syndrome (MetS), defined as the coexistence of interrelated cardiometabolic risk factors, is limited by ignoring the severity of the disease and individuals with a pre-metabolic state. We aimed to develop the first age- and sex-specific continuous MetS severity score in the adult population using confirmatory factor analysis (CFA) based on the MetS components in the Middle East. Using data from the population-based Tehran Lipid and Glucose Study (TLGS) I and II datasets, we conducted CFA of the single factor MetS on 8933 adults (20-60 years old) totally, and in age and sex subgroups. We allowed for different factor loadings across the subgroups to formulate age- and sex-specific continuous MetS severity score equations. Thereafter, we validated these equations in the dataset of TLGS III participants. Triglyceride had the highest factor loading across age and sex subgroups, indicating the most correlation with MetS. Except for women aged 40-60 years, waist circumference was the second most significant factor contributing to MetS. Systolic blood pressure was more closely related to MetS in women than in men. Systolic blood pressure and fasting plasma glucose had the weakest correlation with MetS among the 40-60 age group. Moreover, as women age, the contribution of fasting plasma glucose to MetS tended to decline, while it remained relatively constant in men. The resulting MetS severity score was correlated with age and homeostasis model assessment of insulin resistance. Furthermore, the continuous MetS severity score well predicted the traditional MetS according to receiver operating characteristic analysis in the validation dataset. The age- and sex-specific continuous MetS severity score for the West Asian adult population provides a tangible quantitative measure of MetS enabling clinicians to screen and monitor the individuals at risk and assess their metabolic trends.

White Adipose Tissue Dysfunction: Pathophysiology and Emergent Measurements

White adipose tissue (AT) dysfunction plays an important role in the development of cardiometabolic alterations associated with obesity. AT dysfunction is characterized by the loss of the expansion capacity of the AT, an increment in adipocyte hypertrophy, and changes in the secretion profile of adipose cells, associated with accumulation of macrophages and inflammation. Since not all people with an excess of adiposity develop comorbidities, it is necessary to find simple tools that can evidence AT dysfunction and allow the detection of those people with the potential to develop metabolic alterations. This review focuses on the current pathophysiological mechanisms of white AT dysfunction and emerging measurements to assess its functionality.