Gender Differences and Cardiometabolic Risk: The Importance of the Risk Factors

Dietary patterns derived by Gaussian graphical models and metabolic profiles among overweight and obese individuals

BACKGROUND

The increasing prevalence of metabolic syndrome (MetS) and its associated risk factors highlights the critical need to understand dietary patterns that influence health outcomes, particularly among overweight and obese individuals. Identifying dietary networks provides valuable insights into the complex interactions between food groups within typical dietary patterns. This study aimed to derive dietary networks using Gaussian graphical models (GGM) and evaluate their associations with the risk of MetS components in a sample of the Iranian population.

METHODS

This cross-sectional study involved 647 participants who were overweight or obese. The study included assessments of body composition and anthropometric measurements. Dietary fatty acid consumption was evaluated using a validated Food Frequency Questionnaire (FFQ) containing 168 items. Additionally, biochemical parameters, including serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), fasting serum glucose (FSG), and insulin levels, were measured using enzymatic methods. GGM was utilized to explore the networks of participants' dietary intake, and the association between these networks and risk factors related to MetS was assessed using logistic regression.

RESULTS

GGM analysis identified six major networks of dietary intake, where 28 food items were allocated into six dietary networks of vegetable, grain, fruit, snack, fish/dairy, and fat/oil dietary networks, with raw vegetables, grain, fresh fruit, snack, margarine, and red meat were central to the networks respectively. In the vegetable network, TC was significantly lower in the higher tertiles of this network, and HDL was higher in the third tertile compared with the first tertile in sex, age, and fully adjusted models. In the grain network, lower SBP, DBP, TG, LDL, and higher HDL were shown in the higher tertile (P < 0.05).

CONCLUSION

This study showed that vegetables and grains are associated with decreased risk of MetS components, including reduced blood pressure and cholesterol. Therefore, these results emphasize that dietary networks can be valuable for analyzing nutritional habits and consumption trends.

Predictive association between the γ-glutamyltransferase-high-density lipoprotein cholesterol ratio and all-cause mortality in the Korean genome and epidemiology study: health examinees cohort

OBJECTIVE

The ratio of γ-glutamyl transferase (GGT) and high-density lipoprotein cholesterol (HDL-C) is a novel noninsulin-based marker for assessing the risk of nonalcoholic fatty liver disease and type 2 diabetes mellitus. However, it is unclear whether the GGT/HDL-C ratio is related to all-cause mortality. Therefore, we aimed to investigate the longitudinal association of GGT/HDL-C on all-cause mortality in a large cohort of Korean adults.

METHODS

Data were assessed for 87,668 participants (25,767 men and 61,901 women) from the Korean Genome and Epidemiology Study-Health Examinees cohort. These data were combined with the death certificate database from the National Statistical Office. The participants were divided into four groups according to GGT/HDL-C quartiles. We prospectively assessed hazard ratios (HRs) with 95% confidence intervals (CIs) for all-cause mortality in the 11.7 years following the baseline survey using multivariate Cox proportional hazard regression models including age, BMI, smoking status, and drinking habits, which are known to be major confounders.

RESULTS

During the follow-up period, 3,214 individuals (3.6%; 1,728 men and 1,486 women) died. The respective HRs (95% CIs) of mortality for GGT/HDL-C quartiles 2-4 were 1.15 (0.99-1.33), 1.48 (1.28-1.71), and 1.97 (1.70-2.29) in men and 1.22 (1.02-1.45), 1.36 (1.15-1.61), and 1.69 (1.42-2.00) in women after adjusting for confounders.

CONCLUSIONS

GGT/HDL-C may be a useful predictive marker for all-cause mortality in men and women. We believe that GGT/HDL-C ratio will provide a complementary tool to help clinicians make decisions about prevention and disease management to improve survival.

Sexual Dimorphism in Cardiometabolic Diseases: From Development to Senescence and Therapeutic Approaches

The global incidence and prevalence of cardiometabolic disorders have risen significantly in recent years. Although lifestyle choices in adulthood play a crucial role in the development of these conditions, it is well established that events occurring early in life can have an important effect. Recent research on cardiometabolic diseases has highlighted the influence of sexual dimorphism on risk factors, underlying mechanisms, and response to therapies. In this narrative review, we summarize the current understanding of sexual dimorphism in cardiovascular and metabolic diseases in the general population and within the framework of the Developmental Origins of Health and Disease (DOHaD) concept. We explore key risk factors and mechanisms, including the influence of genetic and epigenetic factors, placental and embryonic development, maternal nutrition, sex hormones, energy metabolism, microbiota, oxidative stress, cell death, inflammation, endothelial dysfunction, circadian rhythm, and lifestyle factors. Finally, we discuss some of the main therapeutic approaches, responses to which may be influenced by sexual dimorphism, such as antihypertensive and cardiovascular treatments, oxidative stress management, nutrition, cell therapies, and hormone replacement therapy.

Mothers with obesity and gestational diabetes did not induce brain pathologies or premature brain aging in their adolescent and early adult offspring in rats

This study investigated the effect of a medium high-fat diet (HFD)-induced maternal obesity and gestational diabetes mellitus (GDM) on rat offspring to verify the hypothesis that maternal obesity and GDM cause brain pathologies and premature brain aging in the prefrontal cortex and hippocampus of the adolescent and early adult offspring. Maternal obesity and GDM were generated by a medium HFD and HFD combined with streptozotocin, respectively. Metabolic parameters were used to confirm the successful model in mothers. Systemic alterations and brain pathology were investigated in their adolescent and early adult offspring. During pregnancy, HFD-fed rats exhibited obesity, while GDM rats had hyperglycemia with insulin resistance. Offspring from high-fat diet dams (OHFD) had higher body weight when compared with offspring from normal diet dams (OND), while offspring from gestational diabetes mellitus dams (OGDM) had lower body weight than OHFD but comparable with OND. No significant alterations were found in glucose tolerance, systemic oxidative stress, and inflammation in the offspring. Additionally, neither adolescent nor early adult rats OHFD or OGDM developed brain pathologies or premature aging with no difference in oxidative stress, inflammation, mitochondrial dynamics, mitophagy, blood-brain barrier, synaptic plasticity, apoptosis, and aging markers among the offspring groups. Our results indicated that maternal obesity and GDM did not cause brain pathologies or premature brain aging at the adolescent and early adult stages of offspring in rats. Our study highlights the importance of maintaining a healthy diet in the offspring of obese and GDM mothers to keep healthy later in their lives.

Cardiometabolic Risk Factors Associated with Physical Fitness and Activity Levels: An Exploratory Study of US College Students

College students are a vulnerable population at risk of developing and/or experiencing poor physical fitness and insufficient physical activity (PA) levels, both associated with poor cardiometabolic health. Thus, this study assessed the association of physical fitness and domain-specific PA levels on cardiometabolic risk factors (CMRFs) among college students. A volunteer sample of students enrolled in general health and wellness courses at a large, Northeastern U.S. institution from Spring 2023 - Spring 2024 (n=1418, 69.0% male, 89.9% non-Hispanic White) completed an objective health assessment as part of a required course assignment. CMRFs (e.g., cholesterol, blood pressure, fasting blood glucose, triglycerides, waist circumference), cardiorespiratory fitness (e.g., VO2 max), and markers of muscular strength and endurance (e.g., pushups, curl ups, hand grip, sit and reach) were assessed. Participants were then invited to complete a subjective health assessment (e.g., demographics, PA). Separate, unadjusted linear regressions examined the association of physical fitness and domain-specific PA levels (e.g., moderate and vigorous PA, active transportation PA, muscle-strengthening, meeting PA guidelines) on CMRFs, by biological sex. Socio-demographics of race/ethnicity, sexual orientation, semester standing, and grade point average served as covariates in separate, adjusted models to assess potential associations. Among males and females, cardiorespiratory fitness and markers of muscular strength and endurance were significantly associated with CMRFs, while PA levels and socio-demographics were not. Tailored screening approaches may provide students with the required support to reduce later-life adverse coronary events. Future work is required to improve our understanding of the potential role socio-demographics play in CMRFs among young adults.

Sex differences in the prediction of metabolic abnormalities via body mass index in an Eastern Chinese population

Objective

Body mass index (BMI) is important for predicting the occurrence of metabolic abnormality, but sex differences exist. We aimed to investigate potential sex differences in the predictive value of BMI for metabolic abnormality and to calculate the optimal BMI cut-offs for predicting metabolic abnormality for each sex.

Methods

Participants (n = 4,623) who attended a health check-up centre continuously in Eastern China between January 2022 and December 2023 were evaluated for metabolic abnormalities. We calculated the proportions of different metabolic abnormalities in different sexes. Receiver operating characteristic (ROC) curves were calculated to determine the optimal BMI cut-off values for predicting metabolic abnormality in males and females. The recognition rate of each metabolic abnormality using different BMI cut-off values for men and women were evaluated.

Results

Among 4,623 participants (2,234 men and 2,389 women), the age-adjusted prevalence of all metabolic abnormalities was significantly greater among males than among females (p < 0.001). The optimal cut-off values for predicting metabolic abnormalities were 23.5 kg/m2 (males) and 21.8 kg/m2 (females). When BMI ≥24 kg/m2 was used as the cut-off value the recognition rates of each abnormal metabolic factor in the male group were all above 50%, while they were mostly below 50% in the female group, except for the recognition of hyperglycaemia and hypertriglyceridemia. However, in females, when BMI ≥22 kg/m2 was used as the cut-off value, the recognition rates for each abnormal metabolic factor were all above 50%, greater than that when BMI ≥24 kg/m2 was used (p < 0.001).

Conclusion

There were sex differences in the BMI thresholds for predicting metabolic abnormalities in the health check-up population.

Metabolic dysfunction-associated steatotic liver disease increases cardiovascular disease risk in young adults

Although a robust association between metabolic dysfunction-associated fatty liver disease (MASLD) and cardiovascular disease (CVD) has been established, the impact of MASLD on CVD risk in young adults has not been fully evaluated. This population-based study included adults aged 20-39 years who underwent health screening examinations from 2009 to 2012 based on Korean National Health Insurance Service database. MASLD was defined as a fatty liver index ≥ 30 without any other cause of steatosis, and presence of one or more cardiometabolic risk factors. The primary outcome was newly developed CVD, including myocardial infarction, ischemic stroke, and congestive heart failure. During the median 10.6 years of follow-up, MASLD was observed in 1,435,659 (25.3%) of the 5,666,728 participants. Cumulative incidence of major adverse cardiovascular events was significantly higher in individuals with MASLD compared those without steatosis (P < 0.001). The adjusted hazard ratio (HR) for myocardial infarction was 1.23 [95% CI (confidence interval): 1.18-1.27] in individuals with MASLD compared to those without steatosis. The HR for ischemic stroke and congestive heart failure were higher in individuals with MASLD compared to those without steatosis (HR, 1.12; 95% CI, 1.07-1.17 and HR, 1.18; 95% CI, 1.15-1.21, respectively]. In the subgroup analysis, the elevated HR for CVD in the MASLD group was prominent among individuals who were female and obese. MASLD was associated with an increased risk of CVD in young adults. These findings highlight the need for early intervention in patients with MASLD before they reach middle to reduce the risk of CVD, particularly among young adults in South Korea.

Evaluating the discriminatory capacity of traditional and novel anthropometric indices in cardiovascular disease risk factors, considering sex differences

OBJECTIVE

Cardiovascular disease (CVD) rates are rising rapidly worldwide, making it crucial to implement simple and effective screening measures to identify individuals at increased risk for CVD risk factors. This study aims to examine the relationship between innovative anthropometric indices and the occurrence of cardiovascular risk factors among the population of Mashhad, located in northeastern Iran, over a ten-year follow-up period.

METHODS

In this cohort study, a total of 9704 individuals aged 35-65 years were recruited at baseline, with 7560 individuals completing the study. Anthropometric indices were measured and calculated using standardized methods. After a 10-year follow-up, the incidence of hypertension (HTN), diabetes mellitus (DM), dyslipidemia, obesity, and metabolic syndrome (MetS) and their association with each anthropometric index were determined using Cox regression analysis. Receiver operating characteristic (ROC) analysis was employed to assess the predictive capacity of each index for the CVD risk factors.

RESULTS

We found that WHtR exhibited the strongest association with various CVD risk factors. However, the predictive capacity of BMI was higher than other indices in DM and MetS (AUCs: 0.69 and 0.78, respectively). Moreover, BMI, WHtR, and BRI showed equal discriminatory power to predict HTN (AUCs: 0.61). Our analysis indicated that Iranian individuals with a BMI of more than 24.71, 26, and 25.2 kg/m2 are at a 54%, 88%, and 121% increased risk for the development of HTN, DM, and MetS over 10 years; respectively.

CONCLUSION

In this study, BMI was identified as the most powerful predictor of CVD risk factors among the anthropometric indices examined. These findings support previous research indicating that BMI is a valuable screening tool for identifying individuals at higher risk of developing CVDs and associated conditions.

Cardiometabolic Aspects of Congenital Adrenal Hyperplasia

Treatment of classic congenital adrenal hyperplasia (CAH) is directed at replacing deficient hormones and reducing androgen excess. However, even in the era of early diagnosis and lifelong hormonal substitution, the presence of CAH is still associated with numerous complications and also with increased mortality. The aim of this article was to create an authoritative and balanced review concerning cardiometabolic risk in patients with CAH. The authors searched all major databases and scanned reference lists of all potentially eligible articles to find relevant articles. The risk was compared with that in other forms of adrenal insufficiency. The reviewed articles, most of which were published recently, provided conflicting results, which can be partially explained by differences in the inclusion criteria and treatment, small sample sizes, and gene-environment interactions. However, many studies showed that the presence of CAH is associated with an increased risk of weight gain, worsening of insulin sensitivity, high blood pressure, endothelial dysfunction, early atherosclerotic changes in the vascular wall, and left ventricular diastolic dysfunction. These complications were more consistently reported in patients with classic than nonclassic CAH and were in part related to hormonal and functional abnormalities associated with this disorder and/or to the impact of overtreatment and undertreatment. An analysis of available studies suggests that individuals with classic CAH are at increased cardiometabolic risk. Excess cardiovascular and metabolic morbidity is likely multifactorial, related to glucocorticoid overtreatment, imperfect adrenal hormone replacement therapy, androgen excess, and adrenomedullary failure. Cardiometabolic effects of new therapeutic approaches require future targeted studies.

Sexually dimorphic ATF4 expression in the fat confers female stress tolerance in Drosophila melanogaster

Metabolic differences between males and females have been well documented across many species. However, the molecular basis of these differences and how they impact tolerance to nutrient deprivation is still under investigation. In this work, we use Drosophila melanogaster to demonstrate that sex-specific differences in fat tissue metabolism are driven, in part, by dimorphic expression of the Integrated Stress Response (ISR) transcription factor, ATF4. We found that female fat tissues have higher ATF4 activity than their male counter parts under homeostatic conditions. This dimorphism was partly due to a female bias in transcript abundance of specific ATF4 splice isoforms. We found that the canonical sex determinants transformer (tra) and doublesex (dsx) drive such dimorphic ATF4 transcript abundance. These differences persist in a genetic model of nutrient deprivation, where female animals showed greater resistance to lethality than males in an ATF4-dependent manner. These results suggest that higher ATF4 activity confers higher tolerance to stress in females. Together, our data describe a previously unknown facet of ISR signaling wherein sexual identity of adipose tissue confers differential stress tolerance in males and females. Since energy storage mechanisms are known to be dimorphic and have been linked to ATF4 regulation, our studies provide a mechanistic starting point for understanding how sexual identity influences metabolic disease outcomes.

Prevalence of cardiometabolic outcomes in women who underwent salpingo-oophorectomy to prevent hereditary breast and ovarian cancer: a meta-analysis

Risk reduction salpingo-oophorectomy (RRSO) is usually performed in women with hereditary breast and ovarian cancer (HBOC) syndrome for BRCA1 and BRCA2 gene mutation carriers, resulting in surgical menopause, which is more associated with a high risk of cardiovascular and metabolic disease than in premenopausal and natural menopausal women. This study assessed the prevalence of cardiovascular and metabolic outcomes in women who underwent salpingo-oophorectomy as a preventive measure against HBOC. This meta-analysis assessed prevalence rates for four metabolic/cardiovascular conditions: myocardial infarction, hypertension, hypercholesterolemia, and type 2 diabetes mellitus. DerSimonian and Laird random-effects models were applied to all analyses, with 95% confidence interval (CI). Heterogeneity was assessed with I². We used OpenMeta Analyst software for statistical analysis. A total of five retrospective studies and one observational study involving 1,320 patients were included. The average body mass index (BMI) was 25.97 kg/m2 and the average waist circumference was 87.94 cm. The analysis across a mean 4.94-year follow-up revealed prevalence rates for acute myocardial infarction of 1.5% (95% CI 0.3-2.7; P = 0.077; I²=56.25%), hypertension of 28% (95% CI 6.9-49.1; P < 0.001; I2 = 98.42%), hypercholesterolemia of 27.2% (95% CI 6.8-47.6; P < 0.001; I²=98.67%), and type 2 diabetes mellitus of 3.3% (95% CI 1.1-5.5; P < 0.001; I²=82.44%). Our findings suggest that there is no marked increase in cardiovascular risk among women with HBOC undergoing RRSO.

Sex differences in the prevalence of metabolic syndrome and associated factors in the general population of Mongolia: A nationwide study

The prevalence and factors associated with metabolic syndrome (MetS) between men and women in Mongolia were compared using secondary data from the STEPwise approach to non-communicable disease risk factor surveillance conducted in 2019. In total, 5,695 participants (2,577 males and 3,118 females) aged 18-69 years old were enrolled in the study. The prevalence of MetS was 37.4% in total and the prevalence was significantly higher in women (39.2%) than men (35.2%, P = 0.002). The most prevalent MetS components were abdominal obesity in women (74.2%) and high blood glucose levels in men (58.7%). All of the 2,128 participants who were categorized into MetS met the criteria of abdominal obesity. Factors associated with MetS included being 30-69 years old compared to 18-29 years old, low and moderate physical activity levels compared to high levels, history of hypertension and diabetes mellitus, and a high body mass index (overweight and obesity) compared to a normal body mass index in both sexes. Additional factors included Buryat ethnicity compared to Khalkh ethnicity, living in Ulaanbaatar, no education compared to primary education, higher monthly income, and currently drinking in men; and smoking and sufficient fruit and vegetable intake in women. Significant differences were observed between men and women in terms of the prevalence of MetS, components of MetS, and factors associated with MetS. To reduce MetS prevalence in Mongolia, sex-specific programs should be designed to promote health behavior, such as reducing alcohol consumption in men and smoking in women.

Vasodilator reactive oxygen species ameliorate perturbed myocardial oxygen delivery in exercising swine with multiple comorbidities

Multiple common cardiovascular comorbidities produce coronary microvascular dysfunction. We previously observed in swine that a combination of diabetes mellitus (DM), high fat diet (HFD) and chronic kidney disease (CKD) induced systemic inflammation, increased oxidative stress and produced coronary endothelial dysfunction, altering control of coronary microvascular tone via loss of NO bioavailability, which was associated with an increase in circulating endothelin (ET). In the present study, we tested the hypotheses that (1) ROS scavenging and (2) ETA+B-receptor blockade improve myocardial oxygen delivery in the same female swine model. Healthy female swine on normal pig chow served as controls (Normal). Five months after induction of DM (streptozotocin, 3 × 50 mg kg-1 i.v.), hypercholesterolemia (HFD) and CKD (renal embolization), swine were chronically instrumented and studied at rest and during exercise. Sustained hyperglycemia, hypercholesterolemia and renal dysfunction were accompanied by systemic inflammation and oxidative stress. In vivo ROS scavenging (TEMPOL + MPG) reduced myocardial oxygen delivery in DM + HFD + CKD swine, suggestive of a vasodilator influence of endogenous ROS, while it had no effect in Normal swine. In vitro wire myography revealed a vasodilator role for hydrogen peroxide (H2O2) in isolated small coronary artery segments from DM + HFD + CKD, but not Normal swine. Increased catalase activity and ceramide production in left ventricular myocardial tissue of DM + HFD + CKD swine further suggest that increased H2O2 acts as vasodilator ROS in the coronary microvasculature. Despite elevated ET-1 plasma levels in DM + HFD + CKD swine, ETA+B blockade did not affect myocardial oxygen delivery in Normal or DM + HFD + CKD swine. In conclusion, loss of NO bioavailability due to 5 months exposure to multiple comorbidities is partially compensated by increased H2O2-mediated coronary vasodilation.

Anthropometric indices in predicting 10-year cardiovascular risk among males and females aged 40-74 years in south and southeast Asia: analysis of 12 WHO STEPS survey data

Background

The relevance of anthropometric indices in predicting cardiovascular disease (CVD) or CVD risk factors is established across different countries, particularly in the high-income countries. However, past studies severely lacked representation from the south and southeast Asian countries. The main aim of this study was to determine the performance of conventional and new anthropometric indices to best predict 10-year cardiovascular disease (CVD) risk in south Asian and southeast Asian populations.

Methods

The present study examined data from 14,532 participants in three south Asian and 13,846 participants (all aged between 40 and 74 years) in six southeast Asian countries, drawn from twelve cross-sectional studies (WHO STEPwise approaches to NCD risk factor surveillance [STEPS] survey data from 2008 to 2019). A Predictive performance of ten anthropometric indices were examined for predicting 10-year CVD risk ≥ 10% (CVD-R ≥ 10%). The 10-year CVD-R ≥ 10% was calculated by utilising the WHO CVD risk non-laboratory-based charts. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal anthropometric index.

Findings

Among the ten anthropometric indices, a body shape index (ABSI), body adiposity index (BAI), body roundness index (BRI), hip index (HI), and waist-height ratio (WHtR) performed best in predicting 10-year CVD risk among south Asian males and females. Improved performances were found for ABSI, BRI, conicity index (CI), WHtR, and waist-hip ratio (WHR) for 10-year CVD-R ≥ 10% predictions among southeast Asian males. Contrastingly, among southeast Asian females, ABSI and CI demonstrated optimal performance in predicting 10-year CVD-R ≥ 10%.

Interpretation

The performance of anthropometric indices in predicting CVD risk varies across countries. ABSI, BAI, BRI, HI, and WHtR showed better predictions in south Asians, whereas ABSI, BRI, CI, WHtR, and WHR displayed enhanced predictions in southeast Asians.

Funding

None.

Prevalence of metabolic syndrome among adults treated at a district hospital outpatient department

BACKGROUND

Metabolic syndrome (MetS) is a collection of risk factors, including hypertension, high fasting blood glucose, high fasting triglyceride and low high-density lipoprotein (HDL) cholesterol levels that may increase the risk for cardiovascular disease and type 2 diabetes. The study aimed to determine the prevalence of MetS among adults attending a Free State district hospital's outpatient department.

METHODS

A cross-sectional study included a consecutive sample of consenting patients 18 years and older from 18 October 2021 to 19 November 2021. Patients' waist circumference was measured, and data were extracted from patients' files.

RESULTS

The 409 participants were predominantly females (64.2%). The median age was 60 years. Triglyceride and HDL cholesterol levels were available for 27.4% and 26.9% of patients, respectively. Of the 278 (68.0%) patients with sufficient information to determine their MetS status, 187 (67.3%) had MetS. Of the males with sufficient information, 49.1% (n = 56/114) had MetS compared to 79.9% (n = 131/164) of the females with sufficient information (p  0.001). The age group 60-79 years had the highest prevalence (76.7%, p  0.001). In all race groups, at least two-thirds of patients had MetS (p = 0.831).

CONCLUSION

Incomplete patient notes and failure to do investigations led to a third of patients not having sufficient information to determine their MetS status. In patients with sufficient information, a high prevalence of MetS was found.Contribution: This study highlights the challenges of determining MetS retrospectively in an outpatient population and the need for completeness of medical note keeping and routine investigations in high-risk patients. It also notes the high prevalence of MetS.

Is it time to revise the fighting strategy toward type 2 diabetes? Sex and pollution as new risk factors

Diabetes mellitus, a metabolic condition affecting around 537 million individuals worldwide, poses significant challenges, particularly among the elderly population. The etiopathogenesis of type 2 diabetes (T2D) depends on a combination of the effects driven by advancing age, genetic background, and lifestyle habits, e.g. overnutrition. These factors influence the development of T2D differently in men and women, with an obvious sexual dimorphism possibly underlying the diverse clinical features of the disease in different sexes. More recently, environmental pollution, estimated to cause 9 million deaths every year, is emerging as a novel risk factor for the development of T2D. Indeed, exposure to atmospheric pollutants such as PM2.5, O3, NO2, and Persistent Organic Pollutants (POP)s, along with their combination and bioaccumulation, is associated with the development of T2D and obesity, with a 15 % excess risk in case of exposure to very high levels of PM2.5. Similar data are available for plasticizer molecules, e.g. bisphenol A and phthalates, emerging endocrine-disrupting chemicals. Even though causality is still debated at this stage, preclinical evidence sustains the ability of multiple pollutants to affect pancreatic function, promote insulin resistance, and alter lipid metabolism, possibly contributing to T2D onset and progression. In addition, preclinical findings suggest a possible role also for plastic itself in the development of T2D. Indeed, pioneeristic studies evidenced that micro- or nanoplastics (MNP)s, particles in the micro- or nano- range, promote cellular damage, senescence, inflammation, and metabolic disturbances, leading to insulin resistance and impaired glucose metabolism in animal and/or in vitro models. Here we synthesize recent knowledge relative to the association between air-related or plastic-derived pollutants and the incidence of T2D, discussing also the possible mechanistic links suggested by the available literature. We then anticipate the need for future studies in the field of candidate therapeutic strategies limiting pollution-induced damage in preclinical models, such as SGLT-2 inhibitors. We finally postulate that future guidelines for T2D prevention should consider pollution and sex an additional risk factors to limit the diabetes pandemic.

Sex Differences in Cardiovascular Diseases: Exploring the Role of Microbiota and Immunity

Cardiovascular diseases (CVDs) are the most common cause of mortality and morbidity in Western countries, thus representing a global health concern. CVDs show different patterns in terms of the prevalence and presentation in men and women. The role of sex hormones has been extensively implicated in these sex-specific differences, due to the presence of the menstrual cycle and menopause in women. Moreover, the gut microbiota (GM) has been implicated in cardiovascular health, considering the growing evidence that it is involved in determining the development of specific diseases. In particular, gut-derived metabolites have been linked to CVDs and kidney disorders, which can in turn promote the progression of CVDs. Considering the differences in the composition of GM between men and women, it is possible that gut microbiota act as a mediator in regard to the sex disparities in CVDs. This narrative review aims to comprehensively review the interplay between sex, GM, and CVDs, discussing potential mechanisms and therapeutic options.

Evaluation of Cardiovascular Disease Risk in Patients with Type 2 Diabetes Mellitus Using Clinical Laboratory Markers

Background: Cardiovascular diseases (CVD) are the main cause of death in the population with diabetes mellitus. This study purposed to determine clinical laboratory markers that might be correlated with the risk of CVD in individuals with type 2 diabetes mellitus (T2DM). Methods: Using data from the Clinical Center of the University of Debrecen from 2016 to 2020, we assessed cardiovascular risk in 5593 individuals with T2DM over a five-year follow-up period. There were 347 new cases of acute myocardial infarction (AMI) and stroke during the period. Following the stratification of these individuals into two groups according to the diagnosis of these CVDs until 2020, the risk of these CVDs was assessed through the utilization of the Chi-square test and Cox proportional hazards regression. Results: The findings of the Cox proportional hazards regression model showed that the number of HbA1C measurements per year (HR = 0.46, 95% CI 0.31-0.7), decreased levels of estimated glomerular filtration rate (eGFR) (HR = 1.6, 95% CI 1.04-2.47), and elevated triglyceride levels (HR = 1.56, 95% CI 1.06-2.29) were correlated with CVD in patients with T2DM. The area under the curve (AUC) was increased from 0.557 (95% CI 0.531-0.582) to 0.628 (95% CI 0.584-0.671) after the inclusion of the laboratory variables into the model showing improved discrimination for AMI and stroke. Conclusions: These findings indicated that eGFR, triglyceride, and the number of HbA1C per year are correlated with AMI and stroke in patients with T2DM.

Disparities in Metabolic Syndrome and Neurocognitive Function Among Older Hispanics/Latinos with Human Immunodeficiency Virus

Neurocognitive impairment and metabolic syndrome (MetS) are prevalent in persons with HIV (PWH). We examined disparities in HIV-associated neurocognitive function between Hispanic and non-Hispanic White older PWH, and the role of MetS in explaining these disparities. Participants included 116 community-dwelling PWH aged 50-75 years enrolled in a cohort study in southern California [58 Hispanic (53% Spanish speaking) and 58 age-comparable non-Hispanic White; overall group: age: M = 57.9, standard deviation (SD) = 5.7; education (years): M = 13, SD = 3.4; 83% male, 58% AIDS, 94% on antiretroviral therapy]. Global neurocognition was derived from T-scores adjusted for demographics (age, education, sex, ethnicity, language) on a battery of 10 cognitive tests. MetS was ascertained via standard criteria that considered central obesity, and fasting elevated triglycerides, low high-density lipoprotein cholesterol and elevated glucose, or medical treatment for these conditions. Covariates examined included sociodemographic, psychiatric, substance use and HIV disease characteristics. Compared with non-Hispanic Whites, Hispanics showed worse global neurocognitive function (Cohen's d = 0.56, p < 0.05) and had higher rates of MetS (38% vs. 56%, p < 0.05). A stepwise regression model including ethnicity and significant covariates showed Hispanic ethnicity was the sole significant predictor of worse global neurocognition (B = -3.82, SE = 1.27, p < 0.01). A model also including MetS showed that both Hispanic ethnicity (B = -3.39, SE = 1.31, p = 0.01) and MetS (B = -2.73, SE = 1.31, p = 0.04) were independently associated with worse neurocognition. In conclusion, findings indicate that increased MetS is associated with worse neurocognitive function in both Hispanic and non-Hispanic White older PWH, but does not explain neurocognitive disparities. MetS remains an important target for intervention efforts to ameliorate neurocognitive dysfunction among diverse older PWH.

Sex- and gender-related disparities in chest pain syndromes: the feminine mystique of chest pain

Chest pain syndromes encompass a wide range of different clinical conditions, being coronary artery disease one of the most important and feared aetiology. Sex and gender disparities have been reported in pathophysiology, clinical presentations, diagnostic work-up and outcomes of patients admitted for chest pain. Biological differences in sexual hormones and neurological pain procession pathways have been proposed as contributors to disparities between men and women; however, gender-related disparities in socio-economic and psychological status have emerged as additional factors involved in these conditions. A better understanding of gender- and sex-related disparities will lead to improved clinical care and management of chest pain syndromes in both men and women. In this comprehensive review, we describe the existing knowledge regarding sex and gender-based differences in management and outcomes of chest pain syndromes in order to stimulate and promote the development of a more sex- and gender-oriented approach to these conditions.

Development of novel tools for dissection of central versus peripheral dopamine D2-like receptor signaling in dysglycemia

Dopamine (DA) D2-like receptors in both the central nervous system (CNS) and the periphery are key modulators of metabolism. Moreover, disruption of D2-like receptor signaling is implicated in dysglycemia. Yet, the respective metabolic contributions of CNS versus peripheral D2-like receptors including D2 (D2R) and D3 (D3R) receptors remain poorly understood. To address this, we developed new pharmacological tools, D2-like receptor agonists with diminished and delayed blood-brain barrier capability, to selectively manipulate D2R/D3R signaling in the periphery. We designated bromocriptine methiodide (BrMeI), a quaternary methiodide analogue of D2/3R agonist and diabetes drug bromocriptine, as our lead compound based on preservation of D2R/D3R binding and functional efficacy. We then used BrMeI and unmodified bromocriptine to dissect relative contributions of CNS versus peripheral D2R/D3R signaling in treating dysglycemia. Systemic administration of bromocriptine, with unrestricted access to CNS and peripheral targets, significantly improved both insulin sensitivity and glucose tolerance in obese, dysglycemic mice in vivo. In contrast, metabolic improvements were attenuated when access to bromocriptine was restricted either to the CNS through intracerebroventricular administration or delayed access to the CNS via BrMeI. Our findings demonstrate that the coordinated actions of both CNS and peripheral D2-like receptors are required for correcting dysglycemia. Ultimately, the development of a first-generation of drugs designed to selectively target the periphery provides a blueprint for dissecting mechanisms of central versus peripheral DA signaling and paves the way for novel strategies to treat dysglycemia.

Gender Effect on Clinical Profiles, Pharmacological Treatments and Prognosis in Patients Hospitalized for Heart Failure

Heart failure (HF) is a significant disease affecting 1-2% of the general population. Despite its general aspects, HF, like other cardiovascular diseases, presents various gender-specific aspects in terms of etiology, hemodynamics, clinical characteristics, therapy, and outcomes. As is well known, HF with preserved ejection fraction more frequently affects females, with diabetes and arterial hypertension representing the most critical determinants of HF. On the other hand, women are traditionally underrepresented in clinical trials and are often considered undertreated. However, it is not clear whether such differences reflect cultural behaviors and clinical inertia or if they indicate different clinical profiles and the impact of sex on hard clinical outcomes. We aimed to review the sex-related differences in patients affected by HF.

Metabolically healthy obesity, transition from metabolic healthy to unhealthy status, and carotid atherosclerosis

BACKGROUND

Evidence of the effects of metabolically healthy obesity (MHO) on atherosclerosis is limited; the transition effects of metabolic health and obesity phenotypes have been ignored. We examined the association between metabolic health and the transition to atherosclerosis risk across body mass index (BMI) categories in a community population.

METHODS

This cross-sectional study was based on a national representative survey that included 50,885 community participants aged ≥40 years. It was conducted from 01 December 2017 to 31 December 2020, in 13 urban and 13 rural regions across Hunan China. Metabolic health was defined as meeting less than three abnormalities in blood pressure, glucose, high-density lipoprotein cholesterol, triglycerides, or waist circumference. The participants were cross-classified at baseline based on their metabolic health and obesity. In addition, the relationship between atherosclerosis and transitions in metabolic health status based on 4733 participants from baseline to the second survey after 2 years was considered. The relationship between metabolic health status and the risk of transition to Carotid atherosclerosis (CA) was assessed using logistic regression and Cox proportional hazards regression analyses.

RESULTS

In this study, the mean age of the participants was 60.7 years (standard deviation [SD], 10.91), 53.0% were female, and 51.2% had CA. As compared with metabolically healthy normal weight (MHN), those with MHO phenotype (odd ratio [OR] 1.10, 95% confidence interval [CI] 1.02-1.21), metabolically unhealthy normal weight (OR 1.27, 95% CI 1.19-1.35), metabolically unhealthy overweight (OR 1.41, 95% CI 1.33-1.48), and metabolically unhealthy obese (OR 1.54, 95% CI 1.44-1.64) had higher risk for CA. However, during the follow-up of 2 years, almost 33% of the participants transitioned to a metabolically unhealthy status. As compared with stable healthy normal weight, transition from metabolically healthy to unhealthy status (hazard ratios [HR] 1.21, 95% [CI] 1.02-1.43) and stable metabolically unhealthy overweight or obesity (MUOO) (HR 1.32, 95% CI 1.17-1.48) were associated with higher risk of CA.

CONCLUSIONS

In the community population, obesity remains a risk factor for CA despite metabolic health. However, the risks were highest for metabolically unhealthy status across all BMI categories. A large proportion of metabolically healthy overweight or participants with obesity converts to an unhealthy phenotype over time, which is associated with an increased risk of CA.

The effects of sex hormones on the size of intestinal lipoproteins

Larger intestinal lipoproteins are more likely to be retained longer in the intestinal wall, allowing more time for their fat to be hydrolyzed and subsequently taken up by the abdominal viscera. Since men generally accumulate more abdominal visceral fat than women, we sought to determine if males produce larger intestinal lipoproteins compared to females. Using the conscious lymph fistula mouse model, we discovered that the male mice indeed produced larger intestinal lipoproteins than the female mice when they were intraduodenally infused with lipid emulsion. We then employed our differentiated Caco-2 cell model with semipermeable membrane system to determine the effects of sex hormones on the size of intestinal lipoproteins. Lipoprotein size was quantitatively measured by calculating the ratio of triglycerides (TG)/Apolipoprotein B (ApoB) and by analyzing their transmission electron micrographs. Our studies showed that while there was no dose-dependent effect of estrogen and progesterone, testosterone significantly increased the size of lipoproteins. When these hormones were combined to resemble the physiological concentrations observed in males and the different ovarian cycle phases in premenopausal females, both the male and luteal groups had significantly larger lipoproteins than the ovulatory group; and the male group also had significantly larger lipoproteins than the follicular group. The ovulatory group secreted a significantly lower amount of TG than the male and luteal groups. ApoB was comparable among all these groups. These findings support our hypothesis that, through their testosterone effects, males are more likely to produce larger intestinal lipoproteins. Larger lipoproteins tend to remain longer in the intestinal wall and may facilitate fat uptake preferentially by the abdominal viscera. Our studies may partly explain why men are more prone to accumulating abdominal visceral fat, which is an independent predictor of mortality.

Latent class analyses of multimorbidity and all-cause mortality: A prospective study in Chilean adults

Multimorbidity patterns can lead to differential risks for all-cause mortality. Within the Chilean context, research on morbidity and mortality predominantly emphasizes individual diseases or combinations thereof, rather than specific disease clusters. This study aimed to identify multimorbidity patterns, along with their associations with mortality, within a representative sample of the Chilean population. 3,701 participants aged ≥18 from the Chilean National Health Survey 2009-2010 were included in this prospective study. Multimorbidity patterns were identified from 16 chronic conditions and then classified using latent class analyses. All-cause mortality data were extracted from the Chilean Civil Registry. The association of classes with all-cause mortality was carried out using Cox proportional regression models, adjusting by sociodemographic and lifestyle variables. Three classes were identified: a) Class 1, the healthiest (72.1%); b) Class 2, the depression/cardiovascular disease/cancer class (17.5%); and c) Class 3, hypertension/chronic kidney disease class (10.4%). Classes 2 and 3 showed higher mortality risk than the healthiest class. After adjusting, Class 2 showed 45% higher mortality risk, and Class 3 98% higher mortality risk, compared with the healthiest class. Hypertension appeared to be a critical underlying factor of all-cause morbidity. Particular combinations of chronic diseases have a higher excess risk of mortality than others.

Which Comes First, Nonalcoholic Fatty Liver Disease or Arterial Hypertension?

Non-alcoholic fatty liver disease (NAFLD) and arterial hypertension (AH) are widespread noncommunicable diseases in the global population. Since hypertension and NAFLD are diseases associated with metabolic syndrome, they are often comorbid. In fact, many contemporary published studies confirm the association of these diseases with each other, regardless of whether other metabolic factors, such as obesity, dyslipidemia, and type 2 diabetes mellites, are present. This narrative review considers the features of the association between NAFLD and AH, as well as possible pathophysiological mechanisms.

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.

The impact of macrosomia on cardiometabolic health in preteens: findings from the ROLO longitudinal birth cohort study

BACKGROUND

Macrosomia (birthweight ≥ 4 kg or ≥ 4.5 kg) is strongly associated with a predisposition to childhood obesity, which in turn is linked with adverse cardiometabolic health. Despite this, there is a lack of longitudinal investigation on the impact of high birthweight on cardiometabolic outcomes in youth. The preteen period represents an important window of opportunity to further explore this link, to potentially prevent cardiometabolic profiles worsening during puberty.

METHODS

This is a secondary analysis of 9-11-year-olds (n = 405) born to mothers in the ROLO longitudinal birth cohort study, who previously delivered an infant with macrosomia. Preteens were dichotomised into those born with and without macrosomia, using two common cut-off criteria (birthweight ≥ 4 kg (n = 208) and < 4 kg; ≥ 4.5 kg (n = 65) and < 4.5 kg). Cardiometabolic health was assessed using anthropometry, dual-energy x-ray absorptiometry, blood pressure, heart rate, cardiorespiratory endurance (20-m shuttle run test), and non-fasting serum biomarkers for a subgroup (n = 213). Statistical comparisons between the two groups were explored using independent t-tests, Mann-Whitney U tests, and Chi-square tests. Crude and adjusted linear regression models investigated associations between macrosomia and preteen cardiometabolic outcomes.

RESULTS

In total, 29.3% (n = 119) of preteens had overweight/obesity based on their BMI z-score. Preteens born ≥ 4 kg had lower median (IQR) C3 concentrations (1.38 (1.22, 1.52) g/L vs. 1.4 (1.26, 1.6) g/L, p = 0.043) and lower median (IQR) ICAM-1 concentrations (345.39 (290.34, 394.91) ng/mL vs. 387.44 (312.91, 441.83) ng/mL, p = 0.040), than those born < 4 kg. Those born ≥ 4.5 kg had higher mean (SD) BMI z-scores (0.71 (0.99) vs. 0.36 (1.09), p = 0.016), and higher median (IQR) lean mass (24.76 (23.28, 28.51) kg vs. 23.87 (21.9, 26.79) kg, p = 0.021), than those born < 4.5 kg. Adjusted linear regression analyses revealed birthweight ≥ 4 kg was negatively associated with C3 concentration (g/L) (B = - 0.095, 95% CI = - 0.162, - 0.029, p = 0.005) and birthweight ≥ 4.5 kg was positively associated with weight z-score (B = 0.325, 95% CI = 0.018, 0.633, p = 0.038), height z-score (B = 0.391, 95% CI = 0.079, 0.703, p = 0.014), lean mass (kg) (B = 1.353, 95% CI = 0.264, 2.442, p = 0.015) and cardiorespiratory endurance (B = 0.407, 95% CI = 0.006, 0.808, p = 0.047).

CONCLUSION

This study found no strong evidence to suggest that macrosomia is associated with adverse preteen cardiometabolic health. Macrosomia alone may not be a long-term cardiometabolic risk factor. Trial registration ISRCTN54392969 registered at  www.isrctn.com .

Sex differences in cardiovascular risk, lifestyle, and psychological factors in patients with type 2 diabetes: the Fukuoka Diabetes Registry

BACKGROUND

The excess risk of cardiovascular diseases associated with diabetes is greater in women than in men. The present study aimed to examine sex differences in the control of cardiovascular risk factors, as well as lifestyle and psychological factors, in patients with type 2 diabetes.

METHODS

A total of 4923 Japanese patients with type 2 diabetes were included in this cross-sectional study. Female/male differences in cardiovascular risk factor levels, and corresponding odds ratios for achieving recommended ranges for preventing cardiovascular diseases and having unhealthy lifestyle and psychological factors were computed by linear and logistic regression models.

RESULTS

Women were less likely than men to achieve recommended ranges for glycated hemoglobin, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and obesity-related anthropometric indices such as body mass index and waist circumference, but were more likely than men to be on target for high-density lipoprotein cholesterol and triglycerides. Women were also more likely than men to have an unhealthy lifestyle and psychological factors, including less dietary fiber intake, less leisure-time physical activity, shorter sleep duration, more constipation, and more depressive symptoms. Similar findings were observed when the participants were subgrouped by age (< 65 and ≥ 65 years) and past history of cardiovascular disease.

CONCLUSIONS

We observed significant sex differences for a range of cardiovascular risk factors, as well as lifestyle and psychological factors, suggesting the importance of adopting a sex-specific approach for the daily clinical management of diabetes.