Metabolic syndrome and carotid atherosclerosis: role of elevated blood pressure

It is not known whether subjects with metabolic syndrome and elevated blood pressure are at the same cardiovascular risk as subjects with metabolic syndrome but without elevated blood pressure. Using B-mode ultrasonography, carotid IMT was measured in 1,297 patients (593 men and 704 women) in the medical department of Seiyo Municipal Nomura Hospital between August 1996 and April 2005. The prevalence of metabolic syndrome was 32.5% among men and 35.9% among women. On comparing subjects with an equal number of components of metabolic syndrome, it was found that the prevalence of carotid atherosclerosis was significantly higher in subjects with elevated blood pressure than in those without, and increased with the number of components in the former group (p for trend = 0.0277), but not in the latter (p for trend = 0.5159). In a stepwise multiple logistic regression analysis, after adjustment for confounding factors, elevated blood pressure (OR, 1.771; 95% CI, 1.246-2.519), low HDL-C (OR, 1.391; 95% CI, 1.053-1.836) and number of components of metabolic syndrome (OR, 1.561; 95% CI, 1.103-2.209) were significantly associated with carotid atherosclerosis. The diagnosis of metabolic syndrome per se might not adequately identify subjects at increased cardiovascular risk.     

Gender differences in the prevalence and determinants of the metabolic syndrome in screened subjects at risk for coronary heart disease

Background: The metabolic syndrome is prevalent among individuals with coronary heart disease (CHD) risk factors. This study's goal was to compare gender differences in the prevalence and determinants of the metabolic syndrome in subjects who were re-examined after a cardiovascular risk factor screening program. Methods: In a population-based cross-sectional study of 14,811 screened men and women aged 30, 40, 45, and 59 to 60 years, 1,491 subjects in the predetermined risk categories of high glucose (n = 64, 69% male), cholesterol (n = 496, 66.3% male), and blood pressure (n = 362, 63.5% male) or Framingham risk score (n = 253, 93.7% male) or low HDL cholesterol (n = 316, 79.1% male) underwent further examination. Results: The metabolic syndrome was more prevalent among women than among men in the same risk categories with the exception of the blood pressure category. Women with the metabolic syndrome had a higher BMI and C reactive protein (CRP) levels, and were more likely to meet the waist circumference criterion than men (92% versus 70%; P < 0.0001). In multivariate analysis, BMI (odds ration(OR) 25.8, 95% CI 14.3-46.3 for >/=30 kg/m(2) versus < 25 kg/m(2)), CRP (OR 1.9, 95% CI 1.3-2.7 for the highest versus the lowest tertile) and female gender (OR 1.7, 95% CI 1.2-2.3 versus male) were associated with the metabolic syndrome after adjustment for age, physical activity, smoking, and family history of premature cardiovascular disease. Conclusion: The metabolic syndrome was more prevalent and more strongly characterized by obesity and low grade inflammation in women than men. These findings underscore the need to study gender-specific approaches to screen for CHD risk.     

机关工作人员阻塞性睡眠呼吸暂停综合征状况分析

目的 调查分析机关工作人员打鼾人群中阻塞性睡眠呼吸暂停综合征（OSAS）与代谢综合征的关系.方法 采用整群抽样法,于2007年10月至2009年4月将江苏省老年医院体检中心接受健康体检的机关干部中的546名打鼾者纳入研究.先行现场抽样问卷调查,按嗜睡量表（ESS）评分将546人分为Ⅰ组（ESS评分＜9）、Ⅱ组（ESS评分≥9）.全部进行口服葡萄糖耐量试验及血液生化检测,并对前期连续入选的175人进行多导睡眠仪监测.统计学分析采用直线回归分析及多元回归分析等.结果 （1）该组打鼾者ESS评分为0～20,中位分值为5.546人中Ⅰ组398人（72.9%）;Ⅱ组148人（27.1%）.（2）直线回归分析显示,代谢综合征构成比=0.1433＋0.0337×ESS评分（r2=0.7414,P＜0.01）,ESS评分每增加1分,代谢综合征构成比增加3.37%.两组间代谢综合征构成比比较,差异具有统计学意义（x2=4.605,P＜0.05）.（3）经多导睡眠仪检查175人,呼吸暂停低通气指数（AHI）为0.3～90.0次/h,中位值34.20.确诊OSAS（AHI＞5次/h＋ESS评分≥9）50例;高危OSAS（AHI＞5次/h＋ESS评分＜9）118例;排除（AHI＜5次/h）OSAS共7人.Pearson相关分析显示ESS评分与AHI呈直线相关（r=0.721,P＜0.01）.AHI与HOMA法胰岛素抵抗指数（HOMA-IR）的相关分析显示,OSAS组的HOMA-IR平均值高于高危OSAS组和非OSAS组（P＜0.01、P＜0.05）.OSAS患者罹患代谢综合征的风险较对照组高1.6倍（OR=1.647,95%CI为0.795～3.414）.（4）多元回归分析显示影响代谢综合征的主要因素是体重指数（OR=2.303,P＜0.01）、呼吸紊乱指数（OR=1.083,P＜0.01）、平均最低脉氧饱和度（OR=0.443,P＜0.05）.结论 机关工作人员的打鼾人群中OSAS患者具有更多代谢综合征的危险因素和显著的胰岛素抵抗,需要对其中高危人群进行早期干预.     

C-reactive protein and the development of the metabolic syndrome and diabetes in middle-aged men

Aims/hypothesis Low-grade inflammation has been implicated in the development of Type 2 diabetes and cardiovascular disease, but its role in the pathogenesis of the metabolic syndrome is unclear. We investigated the association between C-reactive protein (CRP) levels and the development of the metabolic syndrome and diabetes in men.Methods Serum CRP concentrations and factors related to insulin resistance were determined in middle-aged Finnish men who participated in a population-based cohort study and were free of diabetes at baseline.Results At the 11-year follow-up, 143 of 680 men had developed the metabolic syndrome as defined by the National Cholesterol Education Program (NCEP) and 103 of 598 men had developed the metabolic syndrome as defined by the World Health Organization (WHO). Our analyses excluded men with the metabolic syndrome by the respective definition at baseline. In all, 78 of 762 men developed diabetes over the same period. Men with CRP concentrations 3 mg/l had a several-fold higher age-adjusted risk of developing the metabolic syndrome (NCEP definition: odds ratio [OR]=3.2, 95% CI 1.9–5.5; WHO definition: OR=3.4, 95% CI 2.0–6.1) or diabetes (OR=4.1, 95% CI 2.1–8.0) than men whose CRP levels were <1.0 mg/l. Even after further adjustment for potentially confounding lifestyle factors and factors related to insulin resistance, the risk of diabetes (OR=2.3, 95% CI 1.0–5.1) was still increased in men with CRP concentrations 3 mg/l, but the association with the metabolic syndrome was no longer significant.Conclusions/interpretation Low-grade inflammation may increase the risk of the metabolic syndrome and diabetes in middle-aged men, but some of the risk is mediated through obesity and factors related to insulin resistance.Abbreviations CRP C-reactive protein - KIHD Kuopio Ischaemic Heart Disease Risk Factor Study - NCEP National Cholesterol Education Program - WHO World Health Organization     

Low socioeconomic status is a risk factor for cardiovascular disease among adult obstructive sleep apnea syndrome patients requiring treatment

STUDY OBJECTIVE: To evaluate the possible role of low socioeconomic status (SES) as a risk factor for cardiovascular disease (CVD) among obstructive sleep apnea syndrome (OSAS) patients requiring treatment. DESIGN: Polysomnographic and demographic characteristics and associated morbidity were measured in 686 prospectively recruited adult OSAS patients from two regions in Israel. SETTING: Two university-affiliated sleep laboratories. MEASUREMENTS AND RESULTS: The multiple logistic regression (after adjusting for gender, body mass index [BMI], and smoking) revealed that the following are independent determinants for CVD in OSAS patients requiring treatment: each decrease in income level category (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1 to 1.7), age > or = 1 year (OR, 1.07; 95% CI, 1.04 to 1.1), hypertension (OR, 2.0; 95% CI, 1.3 to 3.1), and hyperlipidemia (OR, 3.7; 95% CI, 2.4 to 5.8); area under the receiver operating characteristic (ROC) = 81.9%. The multivariate determinants describing the low-SES OSAS patients included: minorities and immigrants combined (OR, 6.0; 95% CI, 2.9 to 12), female gender (OR, 2.4; 95% CI, 1.6 to 3.9), increased BMI (OR, 1.9; 95% CI, 1.3 to 2.9), unmarried status (OR, 1.9; 95% CI, 1.2 to 3.1), and years of education (> or = 1 year) [OR, 0.8; 95% CI, 0.7 to 0.8]; area under the ROC = 78.1%. CONCLUSION: In addition to the already known traditional risk factors, low SES was found to be a novel independent risk factor for CVD among adult OSAS patients requiring treatment.     

Marital quality and occurrence of the metabolic syndrome in women

BACKGROUND: Marital status is associated with the early stages and progression of cardiovascular disease, an association that may stem in part from the influence of marital quality on metabolic factors. The objective of this study was to examine whether women reporting marital satisfaction are at reduced risk of developing the metabolic syndrome compared with other women. METHODS: Four hundred thirteen middle-aged women from the Pittsburgh Healthy Women Study completed measures of marital status and marital satisfaction at baseline and 3 years later. Metabolic syndrome (diagnosed according to the criteria of the National Cholesterol Education Program) was assessed at baseline and at the last follow-up visit (an average of 11.5 years later). RESULTS: Compared with maritally satisfied women, maritally dissatisfied (odds ratio [OR], 3.02; 95% confidence interval [CI], 1.46-6.24), divorced (OR, 2.47; 95% CI, 1.02-5.97), and widowed (OR, 5.82; 95% CI, 1.88-18.03) women were significantly more likely to have the metabolic syndrome at follow-up. The differences between maritally satisfied women and dissatisfied (OR, 3.18; 95% CI, 1.42-7.15) and widowed (OR, 5.69; 95% CI, 1.70-9.04) women remained significant in the full multivariate model. The difference between maritally satisfied women and divorced women (OR, 2.35; 95% CI, 0.89-6.18) was reduced to marginal significance in the full multivariate model. Single (OR, 2.84; 95% CI, 0.84-9.64) and moderately satisfied (OR, 1.06; 95% CI, 0.35-3.21) women did not differ significantly from maritally satisfied women. CONCLUSIONS: Women in high-quality marriages are at lower risk of developing the metabolic syndrome. Social histories of patients should include assessment of marital quality.     

Hypertension is the most common component of metabolic syndrome and the greatest contributor to carotid arteriosclerosis in apparently healthy Japanese individuals.

The cluster of metabolic and hemodynamic risk factors known as metabolic syndrome is known to be a risk factor for ischemic cardiovascular diseases and stroke. By analyzing the cross-sectional data from 8,144 individuals (age 19-88 years) who underwent general health screening, we have investigated the prevalence of metabolic syndrome, as diagnosed by modified-National Cholesterol Education Program (NCEP) criteria corresponding to the following five categories: triglycerides > or = 150 mg/dl; high density lipoprotein (HDL)-cholesterol < 40 mg/dl in men or < 50 mg/dl in women; fasting plasma glucose > or = 110 mg/dl; systolic/diastolic blood pressure > or = 130/85 mmHg; and body mass index > 25 kg/m2. We found that the prevalence of metabolic syndrome was 19% in men and 7% in women. After adjustment for age, metabolic syndrome was found to be significantly more prevalent in men than in women, with an odds ratio of 3.08 (95% confidence interval [CI] 2.62-3.61, p < 0.0001). Among the five metabolic/hemodynamic risk factor components, hypertension was observed most frequently in individuals with metabolic syndrome, at 85% in men and 87% in women. In addition, multivariate logistic regression analysis adjusted for age, sex, serum total cholesterol levels, and smoking status showed that hypertension possessed the greatest odds ratio (1.43, 95% CI 1.27-1.60) for carotid plaque among the metabolic/hemodynamic risk factors. These data emphasize the importance of controlling blood pressure for reducing the risk of both metabolic syndrome and carotid arteriosclerosis in apparently healthy individuals.     

Association between microalbuminuria and the metabolic syndrome: NHANES III

BackgroundWe investigated whether microalbuminuria was associated with the metabolic syndrome by comparing the strength of the association between microalbuminuria and the syndrome as a whole and its individual components.MethodsThis investigation included 5659 women and men aged 20 to 80 years from the cross-sectional, nationally representative, Third National Health and Nutrition Examination Survey (NHANES III: 1988–1994). Metabolic syndrome was defined as any three of the following: increased waist circumference, increased triglycerides, decreased HDL cholesterol, increased blood pressure, or high fasting glucose. Microalbuminuria was defined as urinary albumin/creatinine ratio of 30 to 300 mg/g.ResultsMicroalbuminuria was present in 7.8% of women and 5.0% of men. Log linear analysis revealed a significant association between the metabolic syndrome and microalbuminuria in both genders (women χ² = 44.1; men χ² = 59.6; P < .0001 for both). Microalbuminuria was more common in both women (odds ratio [OR] = 2.2; 95% confidence interval [CI] 1.44, 3.34) and men (OR = 4.1; 95% CI 2.45, 6.74) with metabolic syndrome compared to those without it; 34% of women and 42% of men with microalbuminuria also had metabolic syndrome. After adjusting for other components of the metabolic syndrome, hypertension demonstrated the strongest association with microalbuminuria in both women (OR = 3.34; 95% CI 2.45, 4.55) and men (OR = 2.51; 95% CI 1.63, 3.86).ConclusionsMicroalbuminuria and metabolic syndrome are associated in a large, nationally representative cohort, possibly due to early renal effects of hypertension, and it may be useful to consider microalbuminuria as a component of the metabolic syndrome.     

The influence of sex and age on the relationship between sleep duration and metabolic syndrome in Korean adults

Aims

To investigate the influence of sex and age on the relationship between sleep duration and metabolic syndrome in a nationally representative population.

Methods

We used data from the Korea National Health and Nutrition Examination Survey (2001–2010) and enrolled 24,511 participants aged 20–79 years. Sleep duration was categorized into five groups: ≤5, 6, 7 (referent), 8, and ≥9 h/day. Age was categorized into three groups: younger (20–39 y), middle-aged (40–59 y), and older (60–79 y). The association between sleep duration and metabolic syndrome was assessed in the total, separately in men and women, then in six groups based on sex and age.

Results

The prevalence of metabolic syndrome by sleep category demonstrated a U-shaped pattern in the total population. However, after adjusting for age, education, occupation, exercise, smoking, alcohol, and body mass index, the prevalence of metabolic syndrome increased in long sleepers (OR 1.31; 95% CI 1.14–1.51) but not in short sleepers (OR 1.00; 95% CI 0.89–1.11). The relationship between sleep duration and metabolic syndrome varied by sex and age–long sleep (≥9 h/day) was positively associated with metabolic syndrome only in younger (OR 2.13; 95% CI 1.38–3.28) and middle-aged (OR 1.63; 95% CI 1.21–2.21) women. Short sleep (≤5 h/day) was not associated with metabolic syndrome in any sex and age groups. However, extremely short sleep (≤4 h/day) was associated with metabolic syndrome in middle-aged men (OR 1.76, 95% CI 1.05–2.96).

Conclusion

These data suggest that sex and age significantly modify the relationship between sleep duration and metabolic syndrome.     

老年阻塞性睡眠呼吸暂停患者血管内皮功能和心脑血管事件的相关性

目的 回顾性分析老年阻塞性睡眠呼吸暂停综合征(OSAS)患者的血管内皮功能和心脑血管事件的相关性及对预后的影响. 方法 OSAS患者79例(OSAS组),老年OSAS组和非老年OSAS组分别为39例和40例;排除OSAS诊断的老年患者60例(老年非OSAS组).通过电话和门诊进行随访,随访时间中位数25个月.所有患者均接受:(1)彩色多普勒超声测定肱动脉血流介导的血管舒张功能(FMD);(2)检查和测定睡眠呼吸事件、血清生化指标;(3)随访心脑血管事件. 结果 (1)老年OSAS组FMD低于老年非OSAS组(P<0.05).(2)老年OSAS组体质指数高于老年非OSAS组(P<0.01),最低血氧饱和度、平均血氧饱和度低于老年非OSAS组(P<0.01,P<0.05).多因素Logistic回归分析结果显示,空腹血糖升高是FMD主要危险因素(OR=1.83,95%CI:1.11～3.03),其次是最低血氧饱和度(OR=0.92,95% CI:0.85～1.00).(3)老年OSAS组心脑血管事件发生率高于非老年OSAS组和老年非OSAS组(χ~2=7.339,P<0.05).多因素Logistic回归分析结果显示,FMD与患者预后密切相关(OR=1.33,95%CI:1.06～1.66),其次是超敏C反应蛋白(OR=0.51,95% CI:0.34～0.76). 结论 老年OSAS患者血管内皮功能受损更为严重,心脑血管事件发生率增加.OSAS可能通过间歇低氧和炎性反应等多种机制损伤血管内皮功能,参与影响患者预后.     

Early postpartum metabolic syndrome in women with or without gestational diabetes: Results from Life after Gestational Diabetes Ahvaz cohort study

Aims

This study aimed to determine the prevalence rate of metabolic syndrome and its potential risk factors, 6–12 weeks postpartum in women with GDM compared to women with normal glucose tolerance.

Factors associated with metabolic syndrome in patients with systemic lupus erythematosus from Puerto Rico

The aim of this study was to determine the factors associated with metabolic syndrome in patients with systemic lupus erythematosus from Puerto Rico. A total of 204 patients with systemic lupus erythematosus (per the American College of Rheumatology classification criteria) were evaluated. Metabolic syndrome was assessed using the American Heart Association and the National Heart, Lung, and Blood Institute classification. Socioeconomic-demographic parameters, health-related behaviours, clinical manifestations, autoantibodies, pharmacological treatments, disease activity (per the Systemic Lupus Activity Measure--Revised), and damage accrual (per the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) were determined at study visit. Factors associated with metabolic syndrome were examined by univariable analyses and multivariable logistic regression models. A total of 196 (96.2%) were women. The mean age at study visit was 43.6 +/- 13.0 years, and the mean disease duration was 8.7 +/- 7.7 years. Seventy-eight patients (38.2%) had metabolic syndrome. In the multivariable analysis, age (odds ratio [OR] = 1.05; 95% confidence interval [CI] 1.02-1.09), government health insurance (OR = 2.06; 95% CI 1.07-4.22), exercise (OR = 0.33; 95% CI 0.14-0.92), thrombocytopenia (OR = 4.19; 95% CI 1.54-11.37), erythrocyte sedimentation rate (OR = 1.64; 95% CI 1.03-2.63), disease activity (OR = 1.14; 95% CI 1.00-1.30), and prednisone >10 mg/day (OR = 3.69; 95% CI 1.22-11.11) were associated with metabolic syndrome. In conclusion, older age, low socioeconomic status, lack of exercise, thrombocytopenia, increased erythrocyte sedimentation rate , higher disease activity, and prednisone >10 mg/day were independently associated with metabolic syndrome in patients with systemic lupus erythematosus from Puerto Rico.     

Continuous positive airway pressure improves daytime baroreflex sensitivity and nitric oxide production in patients with moderate to severe obstructive sleep apnea syndrome.

Individuals with obstructive sleep apnea syndrome (OSAS) are at high risk for cardiovascular morbidity and mortality. The effects of OSAS severity and nocturnal continuous positive airway pressure (CPAP) on daytime baroreflex sensitivity (BRS) and nitric oxide (NO) production were investigated in OSAS patients. Fifty-one consecutive males with OSAS and 29 age-matched healthy men underwent the Valsalva test and standard polysomnography. Patients with an apnea-hypopnea index (AHI) of >or=20 episodes per hour were randomized to receive CPAP treatment for 3 months (n=14) or no such treatment (n=19). The BRS index measured from the overshoot phase (phase IV) of the Valsalva maneuver and plasma NO concentration were significantly lower, whereas the AHI, oxygen desaturation time, arousal index, percentage of sleep stage 1, and systolic blood pressure were significantly greater, in patients with an AHI of >or=20/h than in those with an AHI of <20/h or in controls. The 24-h urinary excretion of norepinephrine was significantly reduced and the plasma NO concentration was significantly increased after one night of CPAP. The BRS index for phase IV and the Valsalva ratio were significantly increased in the CPAP group after the 3-month treatment period but remained unchanged in the non-CPAP group of OSAS patients. The daytime BRS index and NO production were thus inversely related to the severity of OSAS, and successful CPAP treatment improved these parameters in patients with moderate to severe OSAS. CPAP may therefore reduce the risk of cardiovascular complications due to endothelial dysfunction or increased sympathetic activity.     

Serum uric acid and metabolic syndrome in Taiwanese adults

A positive association between serum uric acid and metabolic syndrome has been reported, but little information is available about the association between serum uric acid and metabolic syndrome in Taiwanese adults. The purpose of this study was to investigate the association between serum uric acid levels and metabolic syndrome in Taiwanese adults. We performed a cross-sectional study of 2085 men and 1557 women. All of the participants underwent a health screening during the period from January 2005 to December 2005 at a health center of the Shin Kong Wu Ho-Su Memorial Hospital. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria. The results showed that hyperuricemia was significantly associated with increased risk for hypertriglyceridemia, low high-density lipoprotein cholesterol level, and high blood pressure in men and women. The risk of metabolic syndrome was significantly higher in the fourth quartile than in the first quartile of uric acid level in men (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.06-2.14) and women (OR, 2.33; 95% CI, 1.39-3.93). In addition, uric acid level was inversely associated with hyperglycemia in men. The ORs of hyperglycemia for the second, third, and fourth quartile of uric acid were 0.69 (95% CI, 0.46-1.03), 0.55 (95% CI, 0.37-0.83), and 0.45 (95% CI, 0.29-0.69), respectively, compared with the lowest quartile of uric acid. The results demonstrate that there is a positive association between serum uric acid levels and metabolic syndrome and an inverse association between uric acid and fasting plasma glucose in Taiwanese adults.     

Metabolic syndrome, diabetes, and cardiovascular disease in an elderly Caucasian cohort: the Italian Longitudinal Study on Aging

BACKGROUND: The metabolic syndrome (MetS) is represented by a cluster of risk factors for cardiovascular diseases (CVDs). In spite of its high frequency and strong association with morbidity and mortality in the adult population, little is known about its magnitude in elderly persons. METHODS: We assessed the prevalence of MetS by diabetic status and sex in the participants in the Italian Longitudinal Study on Aging (ILSA), a population-based study on a sample of 5632 individuals 65-84 years old at baseline (1992). We measured the association of MetS with stroke, coronary heart disease, and diabetes at baseline and with CVD mortality at 4-year follow-up. RESULTS: The prevalence of MetS was 25.9% in nondiabetic men and 55.2% in nondiabetic women; in diabetic individuals it was 64.9% and 87.1% in men and women, respectively. At baseline, in both men and women there was a significant association with stroke (odds ratio [OR]=1.67, 95% confidence interval [CI], 1.02-2.75 in men and OR=1.72, CI, 1.01-2.93 in women) and diabetes (OR=4.58, CI, 3.12-6.74 in men and OR=5.15, CI, 3.23-8.20 in women). A significant association with chronic heart disease was found in men only (OR=1.40; CI, 1.02-1.97). During the approximately 4-year follow-up, nondiabetic men with MetS had a risk of CVD mortality 12% higher compared to those without MetS, whereas no significant differences were found in women. CONCLUSIONS: MetS is very common in aged Italians, and it is associated with stroke and diabetes in both sexes, and with chronic heart disease in men. In men, it increases significantly the risk of CVD mortality.     

Association between alcohol intake and metabolic syndrome in patients with hypertension

The aim of this study was to determine how alcohol consumption influences metabolic syndrome in patients with hypertension. The subjects were 3938 male workers being treated with anti-hypertensive drugs and they were divided into four groups by average ethanol intake [non-, light (<22 g/day), moderate (≥22 and <44 g/day), and heavy (≥44 g/day) drinkers]. The relationships of alcohol intake with atherosclerotic risk factors and metabolic syndrome were investigated. Waist circumference and hemoglobin A1c were significantly smaller and lower, respectively, in light, moderate, and heavy drinkers than in nondrinkers. Systolic blood pressure and log-converted triglyceride were significantly higher in heavy drinkers than in nondrinkers. HDL cholesterol was significantly higher in all of the drinker groups than in nondrinkers and tended to be higher as alcohol intake increased. Prevalence of metabolic syndrome was significantly lower in light, moderate, and heavy drinkers than in nondrinkers. Age- and smoking history-adjusted odds ratios (ORs) vs. nondrinkers for metabolic syndrome were significantly low in light drinkers (OR = 0.71, 95% confidence interval [CI]: 0.56-0.89), moderate drinkers (OR = 0.64, 95% CI: 0.54-0.75) and heavy drinkers (OR = 0.68, 95% CI: 0.57-0.82). The results suggest that alcohol drinking is associated with a lower risk of metabolic syndrome in patients with hypertension.     

High prevalence of paroxysmal atrial fibrillation and/or atrial flutter in metabolic syndrome.

BACKGROUND: Because metabolic syndrome is associated with cardiovascular diseases, its association with the risk of paroxysmal atrial fibrillation (PAF) and/or atrial flutter (PAFL) was examined in the present study. METHODS AND RESULTS: A prospective analysis was performed in 592 consecutive hospitalized patients without obvious structural heart diseases. Sinus rhythm was confirmed by electrocardiography in all patients. PAF/PAFL occurred in 32 (5%) and metabolic syndrome was present in 127 (21%) of the patients enrolled. PAF/PAFL occurred in 12 (9%) of the patients with metabolic syndrome, but only 20 (4%) of patients without metabolic syndrome (p=0.02). Multivariate logistic regression analysis showed that metabolic syndrome was a significant risk factor for PAF/PAFL that was independent of left atrial diameter (> 44 mm) or age (> 70 years) (odds ratio (OR) 2.8, 95% confidence interval (CI) 1.3-6.2, p<0.01). Among the 5 components of the metabolic syndrome, body mass index > or = 25 kg/m2 was the most strongly associated with PAF/PAFL (OR; 3.0, 95% CI 1.2-7.4, p=0.02). CONCLUSIONS: Metabolic syndrome is highly associated with PAF/PAFL in patients without structural heart diseases and obesity may be an underlying mechanism for the higher prevalence.     

Nutritional Alterations in Drug Abusers With and Without HIV

The frequency of coronary heart disease (CHD) is increasing among HIV seropositive persons. This phenomenon may be related to HIV disease itself, the use of antiretroviral medications and increased length of survival, or the synergism of these factors. In this study we have calculated the 10-year CHD risk estimate and the prevalence of metabolic syndrome in a cohort of 118 HIV seropositive chronic drug users, including those who are on HAART with or without protease inhibitors (PI). The results showed that the 10-year coronary heart disease risk among the HIV seropositive drug users was 4.8 ± 5.7, which is within the range of results published for other HIV infected cohorts. The 10-year CHD risk was significantly higher in men (5.9±6.1, p<0.001) than in women (1.7±2.4), due to their gender and the pre-menopausal mean age of the women (39.4±7.3 years of age), despite a significantly higher rate of abdominal obesity (54.8% in women vs. 8.1% in men, p<0.001) and lower HDL (61.3% in women vs. 40% in men, p=0.042). The rate of metabolic syndrome among our female HIV seropositive drug users was significantly higher (29% vs 10.3%, p=0.013) compared to men (10.3%). Participants with metabolic syndrome had a significantly higher 10-year CHD risk (27.8% vs. 10.2%, p=0.041) and higher mean BMI (28.6 ± 4.1 vs. 24.2±4, p<0.001) than those without the syndrome. The predominant proportion of the cohort had a high viral load, suggesting that their use of illicit drugs has an influence on either adherence or effectiveness of antiretroviral medication. Increased viral load was significantly associated with metabolic syndrome (OR=2.23, 95% CI:1.12, 4.47; p=0.023), high fasting glucose (OR=1.61, 95% CI: 1.02, 2.55; p=0.042) and low HDL levels (OR=1.41, 95% CI: 1.01, 1.98; p=0.046), after controlling for age gender, smoking, PI exposure, BMI and CD4. HAART with or without PI did not significantly impact the 10-year CHD risk estimate or metabolic syndrome in this cohort. The estimated effect of PI, however, was positively and significantly related to triglyceride levels (effect estimate=95.81; 95% CI:39.40, 152.21; p<0.01) after controlling for age, gender, smoking, viral load, CD4 cell count and BMI. Heavy use of cigarettes and crack/cocaine was inversely associated with obesity (OR=0.84, 95% CI:0.67, 0.99; p=0.049; OR=0.43, 95% CI:0.19, 0.98; p=0.044, respectively), while use of marijuana tended to be associated with increased central obesity (p=0.08). Heavy cigarette smoking was significantly associated with low HDL (OR=3.06, 95% CI:1.18; 7.95, p=0.02). The significant association of higher viral load with CHD risk indicates that controlling viral load may be important in reducing CHD risk in HIV infected drug users.     

Endogenous sex hormones and metabolic syndrome in aging men

BACKGROUND: Sex hormone levels in men change during aging. These changes may be associated with insulin sensitivity and the metabolic syndrome. METHODS: We studied the association between endogenous sex hormones and characteristics of the metabolic syndrome in 400 independently living men between 40 and 80 yr of age in a cross-sectional study. Serum concentrations of lipids, glucose, insulin, total testosterone (TT), SHBG, estradiol (E2), and dehydroepiandrosterone sulfate (DHEA-S) were measured. Bioavailable testosterone (BT) was calculated using TT and SHBG. Body height, weight, waist-hip circumference, blood pressure, and physical activity were assessed. Smoking and alcohol consumption was estimated from self-report. The metabolic syndrome was defined according to the National Cholesterol Education Program definition, and insulin sensitivity was calculated by use of the quantitative insulin sensitivity check index. RESULTS: Multiple logistic regression analyses showed an inverse relationship according to 1 sd increase for circulating TT [odds ratio (OR) = 0.43; 95% confidence interval (CI), 0.32-0.59], BT (OR = 0.62; 95% CI, 0.46-0.83), SHBG (OR = 0.46; 95% CI, 0.33-0.64), and DHEA-S (OR = 0.76; 95% CI, 0.56-1.02) with the metabolic syndrome. Each sd increase in E2 levels was not significantly associated with the metabolic syndrome (OR = 1.16; 95% CI, 0.92-1.45). Linear regression analyses showed that higher TT, BT, and SHBG levels were related to higher insulin sensitivity; beta-coefficients (95% CI) were 0.011 (0.008-0.015), 0.005 (0.001-0.009), and 0.013 (0.010-0.017), respectively, whereas no effects were found for DHEA-S and E2. Estimates were adjusted for age, smoking, alcohol consumption, and physical activity score. Further adjustment for insulin levels and body composition measurements attenuated the estimates, and the associations were similar in the group free of cardiovascular disease and diabetes. CONCLUSIONS: Higher testosterone and SHBG levels in aging males are independently associated with a higher insulin sensitivity and a reduced risk of the metabolic syndrome, independent of insulin levels and body composition measurements, suggesting that these hormones may protect against the development of metabolic syndrome.