Gender differences in global cardiovascular risk factors of obstructive sleep apnea patients

The morbidity and mortality of obstructive sleep apnea (OSA) are related principally to its cardiovascular complications. Metabolic syndrome (MBS) is recognized as raising the risk of cardiovascular disease. In this study, we analysied the diagnostic value of MBS to predict the diagnosis of severe OSA. Eight-seven subjects (54 males and 33 females) without any cardiac or pulmonary disease referred for evaluation of OSA, had overnight polysomnography. MBS were diagnosed according to NCEP criteria. According to apnea-hypopnea index (AHI), subjects were divided into two groups: severe OSA (AHI>or=30, 26 males, 15 females) and non-severe OSA (AHI<30, 28 males, 18 females). Ages were similar in both OSA groups for both genders. In the severe OSA group, number of patients with MBS was especially higher (in females n=13, 86.6%; in males n=19, 73%) than non-severe OSA (in females 6, 33%, in males 9, 32%). The mean values of the five diagnostic criteria of MBS were significantly higher in severe OSA than non-severe groups in both genders. Analysis of diagnostic value (criteria>or=3) of MBS for predicting the diagnosis of severe OSA in males and females revealed the sensitivity 73% and 86.6%, the specificity 67.8% and 94.4%, positive predictive value 67.9% and 86.7%, negative predictive value 73% and 85.7% respectively. Especially in female patients referred to the sleep clinics, evaluation of MBS criteria may play an important role in predicting severe OSA with high sensitivity and negative predictivity. Furthermore, the presence of MBS in OSA patients might increase cardiovascular complications.     

Diabetes mellitus abolishes ethnic differences in cardiovascular risk factors: lessons from a multi-ethnic population

Aims: To compare cardiovascular risk factors in diabetic subjects of different ethnic groups, and between new and known diabetic subjects, in the Singapore National Health Survey '92. Methods: Disproportionate stratified sampling followed by systematic sampling were used in 3568 (total) respondents of whom 2743 were non-diabetics, 179 newly diagnosed diabetics and 150 known diabetics. Amongst the diabetics, there were 185 Chinese, 66 Malays and 78 Asian Indians. Diagnosis of diabetes mellitus (DM) was based on the 2 h glucose alone, after a 75 g oral glucose tolerance test. Blood pressure (BP), lipid profile, glucose, insulin and anthropometric indices were obtained from all subjects. Results: Subjects with diabetes (new and known) exhibited significantly higher triglyceride (TG), lower high density lipoprotein cholesterol (HDL-C) and low density lipoprotein (LDL)/apolipoprotein B (apo B) ratio (LDL size) compared with normoglycaemic subjects. They were more obese (generalised and central) and had higher systolic and diastolic BP. There was no difference in lipid risk factors between the two groups with diabetes although those with new diabetes were more obese whilst those with known diabetes had higher fasting glucose. Amongst subjects with diabetes, there were no significant differences between ethnic groups in TG, HDL-C, LDL/apo B ratio, or waist to hip ratio (WHR). Female Malays with diabetes had higher total cholesterol and were more obese whilst male Asian Indians with diabetes had higher fasting insulin. Conclusion: Asian Indians had lower HDL-C and LDL/apo B ratio than Chinese or Malays amongst normoglycaemic subjects. However, these differences between ethnic groups were not seen in subjects with DM.     

广西桂平市城乡男女居民高血压影响因素调查分析

目的：分析城乡男女居民高血压的影响因素,为在一般人群中制定性别差异化的高血压预防策略提供科学依据。方法采用整群二阶段抽样方法,共调查1057名成年常住居民,分别按男女性别进行高血压影响因素的单因素及多因素的Logistic回归分析。结果共检出347例高血压居民,其中男性107例（30.84％）,女性240例（69.16％）。 Logistic回归分析结果显示,男性高血压的危险因素包括年龄较高（OR＝1.045,95％CI：1.011～1.063）、无业或休息（ OR＝4.596,95％CI：1.657～12.734）、吸烟（ OR＝1.058,95％CI：1.073～1.524）;女性高血压的危险因素包括年龄较高（ OR＝1.074,95％CI：1.052～1.091）、绝经（ OR＝2.022,95％CI：1.082～3.775）、常食用动物内脏（ OR＝1.043,95％CI：1.009～1.054）、体质指数≥24 kg／m2（ OR＝2.204,95％CI：1.641～2.973）、糖尿病（ OR＝2.122,95％CI：1.313～3.442）。结论城乡男女高血压影响因素存在差异性,在预防人群高血压时,需要根据性别差异制定高血压的预防策略和措施。     

Gender differences in cardiovascular risk factors among adolescents in Aseer Region,southwestern Saudi Arabia

ObjectiveThe objective of this study was to explore gender differences in the prevalence of silent and clinical apparent cardiovascular risk factors among adolescents in Aseer Region, southwestern Saudi Arabia.Materials and methodsA cross-sectional study on a stratified sample of 1869 adolescents was carried out. They were interviewed and examined for weight and height, systolic and diastolic blood pressure using standardized techniques.ResultsThe study revealed high prevalence of some potential behavioral and biological cardiovascular diseases (CVD) risk factors among adolescent males and females in the study area. Behavioral risk factors included inadequate low consumption of fruits and vegetables, physical inactivity, and smoking. Physical inactivity was significantly more prevalent among females than males (42.9% and 25.7%, respectively). Smoking was significantly more among females than males (11.8% and 1.3%, respectively). Biological risk factors found were family history of CVD, obesity and high blood pressure. Obesity was significantly prevalent among females (29.4%) compared to males (20.6%). Males had significantly more high blood pressure than females. In logistic regression analysis, being male (aOR = 2.992, 95% CI = 1.933–4.742) and obesity (aOR = 2.995, 95% CI = 2.342–3.991) were found to be significant risk factors in developing high blood pressure among adolescents in the region.ConclusionsPresence of cardiovascular risk factors among adolescents is a public health problem in the region. There is a need for a national program in the country to prevent and control cardiovascular risk factors among adolescents.     

Sex‐specific risk factors of carotid atherosclerosis progression in a high‐risk population of cardiovascular disease

BackgroundThe progression of carotid intima‐media thickness (cIMT) and plaques are associated with cardiovascular health, especially for high‐risk population of cardiovascular disease (CVD).HypothesisRisk factors for atherosclerosis may vary by sex. This study aimed to investigate the sex‐specific risk factors of cIMT and plaque progression.MethodsWe selected subjects who were identified as high‐risk population of CVD, and collected their carotid ultrasound data and baseline characteristics. Linear regression and logistic regression analyses were used to identify risk factors for cIMT and plaque progression. Sex‐specific risk factors were identified respectively.ResultsA total of 7908 participants were included. The mean age was 57.75 ± 9.45 years and 61.51% were female. During mean follow‐up of 1.92 ± 0.89 years, the median annual cIMT change rate was −7.25 μm/year. Seven hundred and fifteen subjects free from plaques at baseline developed plaque. Age, smoking, hypertension, and diabetes were common risk factors for carotid atherosclerosis progression in all participants. Smoking and alcohol drinking were significantly associated with increased cIMT change in women, while hypertension and antihypertensive medication were significant in men. Increased total cholesterol and diabetes were significantly associated with new plaque presence in women, while smoking, increased triglyceride, and dyslipidemia were significant in men (p ˂ .05 for all cases). The association of baseline cIMT and smoking with annual cIMT change rate and increased total cholesterol with new plaque presence were significantly differentiated between both sexes (p for interaction ˂ .05).ConclusionsThe risk factors for cIMT and plaque progression differed by sex.     

Body size and cardiovascular risk factors in a preschool population

Data on weight, height, blood pressure, and blood lipids were obtained for 1215 children entering New York Head Start preschools from 1995–1997. In this population, 17% were overweight and 15% were obese; the risk was greatest in Hispanic children. Overall, 13% had high blood pressure. African-American children were at increased risk of elevated blood pressure but had a more favorable lipid profile (high high-density lipoprotein cholesterol level and low triglycerides level) than white or Hispanic children. Body size was a significant predictor of elevated blood pressure, low high-density lipoprotein cholesterol, and increased triglycerides. The association between obesity and blood pressure was evident in white and Hispanic children only. Neither ethnicity nor obesity was associated with total cholesterol level. Obese preschoolers had approximately three times the risk of having high systolic blood pressure and twice the risk of low high-density lipoprotein cholesterol level compared with nonobese children, indicating that at-risk populations can be identified and primary prevention begun at a young age.     

Gender differences in metabolic risk factor prevalence in a South African student population

Summary

We determined selected risk factors for the metabolic syndrome and assessed the metabolic risk status (using IDF criteria) of third-year physiology students at Stellenbosch University (88 males and 178 females). Outcome measures included anthropometry [body mass index (BMI), waist circumference, waist-to-hip ratio], blood pressure (BP), resting pulse rate, and fasting blood glucose, total cholesterol and triglyceride levels. In addition, students completed a lifestyle questionnaire.A number of gender-based differences were found, with male students displaying a greater incidence of risk factors for the metabolic syndrome: 6% of males versus 3% of females displayed a cluster of three risk factors. Twenty-five per cent of female students (but only 14% of males) exhibited waist circumferences above the accepted range, which was positively correlated, for males and females, with both systolic and diastolic BP, and in females only, also with total cholesterol levels. Male students on average exercised more than their female counterparts, but also exhibited poorer eating habits. Average blood triglyceride levels for both male and female students exceeded the accepted threshold (1.85 ± 1.62 mmol/l and 2.15 ± 1.79 mmol/l, respectively).We concluded that metabolic risk factors were evident in a much younger population than commonly expected. Moreover, the gender-specific differences observed may impact on future risk assessment and preventative measures adopted.     

Relation between androgens and cardiovascular risk factors in a young population

Objective The relationship between androgens and blood pressure, insulin resistance, lipid profile, adiponectin and hs‐CRP in a young Middle‐Eastern population has not been examined previously. We studied this relationship in a randomly selected population of Lebanese students. Methods Three hundred and sixty‐eight subjects (201 men and 167 women) aged 18–30 years were included in the study. Anthropometric and biological parameters [waist circumference (WC), systolic and diastolic blood pressure (SBP and DBP), triglycerides, total cholesterol, HDL cholesterol, homeostasis model assessment of insulin resistance (HOMA‐IR), total testosterone (TT), dehydroepiandrostenedione sulphate (DHEAS), sex hormone‐binding globulin (SHBG), adiponectin (ADP) and hs‐CRP] were measured. Results In men, there were inverse associations of both TT and SHBG with body mass index (BMI), WC, HOMA‐IR, triglycerides and hs‐CRP. After adjustment for major confounders (BMI, WC, age and smoking), associations disappeared except for those between TT and hs‐CRP, and for SHBG HOMA‐IR, hs‐CRP and triglycerides. In women, only SHBG was inversely associated with BMI, WC, HOMA‐IR and hs‐CRP and positively correlated with adiponectin. Except for the association between SHBG and adiponectin, these correlations disappeared after adjustment for confounders. Although DHEAS appeared to correlate negatively with blood pressure in men, this relationship disappeared after adjustment for confounders, while a relationship between DHEAS and triglycerides in women persisted after such adjustment. In multivariate regression analysis, SHBG was an independent predictor of hs‐CRP, triglycerides and HOMA‐IR in men and of adiponectin in women. Conclusion Our results suggest that SHBG is independently associated with HOMA‐IR, adiponectin, hs‐CRP and triglycerides. A gender difference in these associations is observed. Further studies are needed to elucidate these findings.     

Acid phosphatase, genetic polymorphism and cardiovascular risk factors in a pediatric population.

BACKGROUND: Although the clinical expression of cardiovascular disease usually occurs in adulthood, it is unanimously accepted that atherosclerosis begins in the pediatric age. Because of the early onset of the disease, it is of great importance to screen for major risk factors since pre-school age, especially in risk families. Recent investigations have shown a great interest not only in studying the classic risk factors, but also in the evaluation of oxidative stress and the main antioxidant defense systems. The major cause of this interest is the knowledge of the deleterious effect of reactive oxygen species on lipids, the endothelial membrane of arteries and, finally, on the occurrence of cardiovascular disease. POPULATION AND METHODS: 51 children of both genders, aged 9-12 years, randomly selected from a rural community, were observed. A possible association between low molecular acid phosphatase genetic polymorphism of the erythrocyte and the prooxidant status markers (epinephrine oxidase and low molecular protein phosphotyrosine phosphatase from the erythrocyte), some enzymatic systems of the body antioxidant defense (transmembranar reductase of ferricyanide and metahemoglobin reductase) and finally some intermediate phenotypes of cardiovascular disease (lipid profile and blood pressure) were studied. RESULTS: The study of prooxidant status markers and antioxidant enzymes shows significant differences for acid phosphatase and epinephrine oxidase activities in relation to low molecular acid phosphatase genetic polymorphism, the highest values observed being in those homozygous to the B allele (p < 0.05). The inter-relation study between variables showed, among other things, a significant inverse correlation between acid phosphatase and transmembrane reductase and a direct correlation between apolipoprotein B, acid phosphatase and metahemoglobin reductase. A positive family history for cardiovascular disease also showed a direct and significant correlation to total cholesterol, LDL-cholesterol and apolipoprotein B. CONCLUSIONS: The polymorphic variants of low molecular acid phosphatase and protein phosphotyrosine phosphatase with greater activity are strongly associated, not with the classic parameters of cardiovascular risk factors, but with oxidative stress indicators, such as low molecular protein phosphotyrosine phosphatase and epinephrine oxidase. Family history indicators of cardiovascular risk are clearly associated, since early ages, to some conventional risk factors, such as lipid profile and blood pressure.     

Gender differences in the relation of insulin-like growth factor binding protein-1 to cardiovascular risk factors: a population-based study

OBJECTIVE: A possible involvement of insulin-like growth factor-I (IGF-I) and its binding protein IGFBP-1 in the pathogenesis of cardiovascular disorder has been suggested. However, few publications have addressed the gender differences in cardiovascular risk factors in relation to the IGF/IGFBP system. The aim of the present study was to study gender differences in the relationship between fasting serum levels of IGFBP-1 and cardiovascular risk factors in a normal population of men and women. DESIGN: Cross-sectional study. Patients A normal population of 273 men and women aged 20-74 years. MEASUREMENTS: A medical examination was performed and blood drawn in the morning after subjects had been fasting overnight. Before the examination, they were asked to fill out a questionnaire concerning lifestyle and psychosocial factors. RESULTS: Fasting IGFBP-1 was lower in men than in women and was positively correlated to age in men but not in women. The men had in general a more disadvantageous cardiovascular risk profile than women, with several indicators of the metabolic syndrome: higher blood pressure and higher serum levels of total cholesterol, triglycerides, low density lipoprotein cholesterol (LDL-C), plasma-glucose and insulin, as well as lower IGFBP-1. Women had lower physical activity, lower consumption of alcohol, and lower values on indicators of psychosocial and mental health but had a healthier diet. Our findings indicate that low circulating levels of IGFBP-1 are associated with the well-known risk factors of cardiovascular disease; however, the association showed a different pattern for men and women. In men we found a negative association with body mass index (BMI), insulin resistance and diastolic blood pressure, and a positive association with SHBG, cortisol and testosterone. For women low IGFBP-1 appears in negative associations with BMI, waist-hip ratio (WHR), insulin resistance and testosterone, and in positive associations with SHBG and cortisol. Significant gender differences in the correlation with IGFBP-1 are seen for testosterone, cortisol, SHBG, WHR and oestradiol. For HDL-C and diastolic blood pressure the gender difference in correlation was at the limit of significance (P < 0.10). CONCLUSION: Low circulating levels of IGFBP-1 are associated with the well-known risk factors of cardiovascular disease; however, the association showed a different pattern for men and women. The most marked gender differences in the correlation with IGFBP-1 are seen for testosterone, cortisol, SHBG, WHR, oestradiol, HDL-C and diastolic blood pressure. Our study emphasizes the importance of separate analyses for men and women. The results presented are a step towards gaining a better understanding of the gender differences in cardiovascular disease and in the regulation of IGFBP-1, though further prospective studies are needed.     

Microalbuminuria, cardiovascular risk factors and cardiovascular morbidity in a British population: the EPIC-Norfolk population-based study.

BACKGROUND: Microalbuminuria is independently associated with increased cardiovascular risk and renal function deterioration in diabetes and hypertension, but the clinical relevance of raised albuminuria in the general population is less certain. We examined the prevalence of microalbuminuria and its relationship to cardiovascular risk factors and cardiovascular morbidity in the UK general population. METHODS: Cross-sectional population-based study of 23,964 individuals, aged 40-79 years recruited in 1993-1997 for the EPIC-Norfolk Study. Smoking status, prevalent physician diagnosed diabetes, hypertension, cardiovascular disease and cancer were derived from a health and lifestyle questionnaire. Albumin-to-creatinine ratios were estimated from random spot urine specimens collected at the survey visit, and using these ratios participants were categorized into normoalbuminuria, microalbuminuria (2.5-25 mg/mmol), and macroalbuminuria. RESULTS: The prevalence of microalbuminuria and macroalbuminuria was 11.8% and 0.9% respectively in the total population and significantly higher in women (14.4%) compared with men (8.9%) (P<0.001). Independent determinants of microalbuminuria were age, sex, systolic blood pressure and current smoking. Microalbuminuria was independently associated with cardiovascular morbidity, after adjusting for known cardiovascular risk factors, with odds ratio (95% confidence interval) for prevalent cardiovascular disease of 1.30 (1.12-1.51) in all men and women. CONCLUSION: Microalbuminuria was present in approximately 12% of this population. It was independently associated with cardiovascular risk factors and prevalent cardiovascular disease. Microalbuminuria may be a useful indicator of high absolute cardiovascular risk in the community but prospective data are needed to establish its independent predictive value for future events.     

Ten-year cardiovascular risk in a Hong Kong population.

BACKGROUND: Cardiovascular disease is a major health issue in Hong Kong. We conducted a screening program to assess the 10-year risk for the population and to assess the potential benefit of large-scale screening in Hong Kong. METHOD: A local screening program for cardiovascular risk was carried out in a health service network with a total of 17,716 participants. Retrospective data analysis for the prevalence and distribution of the various risk factors was performed. The data were then applied to calculate the 10-year risk of each individual, according to the European Task Force coronary risk chart. RESULTS: Of the participants, 54.2% had total cholesterol levels > 5.2 mmol/l; 28.7% had body mass index > 25 kg/m2; 18.5% were hypertensive; 15.1% were smokers; and 3.7% had diabetes mellitus. There were 35.5% of the screened population who had at least two risk factors and 10.9% had at least three risk factors. A total of 9049 individuals satisfied the criteria for the European Task Force guidelines and were selected for 10-year cardiovascular risk analysis. We calculated that 68.0% of the male population had at least 10% risk and 41.5% had at least 20% risk of developing a coronary heart event within 10 years. Among women, 48.2% of the population carried at least 10% risk and 2.8% carried at least 20% risk. CONCLUSION: The calculated 10-year risk of the population, particularly for men, is significant. Our study demonstrated that mass screening is feasible, and has the benefit of early identification of high-risk individuals, which could be a reasonable strategy for cost-effective medicine.     

Identifying cardiovascular risk factors in a patient population with coronary artery ectasia

Coronary artery ectasia (CAE) is frequently considered as a form of coronary artery disease. Cardiovascular risk factors were determined in a patient population with CAE. The 51 patients with isolated CAE (group 1), 61 patients with CAE coexisting with significant coronary stenosis (group 2), and 62 subjects with significant coronary stenosis (group 3) were included in the study, and the distribution of cardiovascular risk factors was compared. Thirty of 51 patients with isolated CAE had presented with typical angina pectoris, 8 patients with unstable angina pectoris, and 13 patients had atypical chest pain or palpitation. The 21 of 51 patients with isolated CAE had definitive positive treadmill exercise test results. Positive family history was similar in each group. The history of smoking was similar in group 1 and group 2 but higher than group 3. Frequency of hypertension was similar in group 1 and group 2 but higher than that in group 3. Frequency of diabetes mellitus was similar in group 1 and group 2 but lower than group 3. Plasma lipid levels and the number of patients with lipid disturbances were also similar in each group. In addition, C-reactive protein (CRP) levels were above the normal limits and there was no difference among groups with respect to plasma CRP levels. CAE appears to be associated with traditional cardiovascular risk factors such as hypertension, smoking, and hyperlipidemia. In addition, elevated CRP level in patients with CAE may suggest the role of inflammatory process in development of CAE.     

C-reactive protein, adiposity and cardiovascular risk factors in a Mediterranean population

BACKGROUND: Understanding the distribution of high-sensitivity C-reactive protein (CRP) and its relations with classic cardiovascular risk factors in specific populations is important for further diagnostic use. METHODS: We studied 1,157 adult subjects (652 women and 505 men) participating in the Health Study of Catalonia. CRP concentrations were measured with a high-sensitivity turbidimetric assay. RESULTS: Median levels of CRP were 1.57 mg/l and 25% of both men and women had CRP values >3 mg/l. No differences were observed between men and women even after adjustment for age and body mass index (BMI). After patients with CRP values above the 97.5th percentile (n = 31) had been excluded, CRP concentrations increased significantly with increasing levels of cardiovascular risk factors in both men and women. Men and women with metabolic syndrome showed significantly higher levels of CRP than their counterparts, even after adjustment for BMI and age. In a multiple regression analysis, BMI, triglycerides and fasting glucose were independent predictors of CRP in women and together explained 42% of its variance. In men, CRP was independently and positively associated to waist circumference, smoking, diastolic blood pressure, uric acid and triglycerides, and negatively associated to HDL-cholesterol. Altogether these variables explained 51% of its variability. CONCLUSIONS: The present study describes, for the first time, CRP concentrations in a sample that is representative of a Spanish Mediterranean community. CRP distribution and correlates are very similar to those reported previously in spite of the different lifestyle and nutritional habits, and the lower rates of cardiovascular diseases in our population.     

Prevalence of cardiovascular risk factors in the Spanish working population

INTRODUCTION AND OBJECTIVES: The routine medical check-up provides a good opportunity for screening workers early for cardiovascular risk factors. The aim of the present study was to investigate the prevalence of cardiovascular risk factors in the Spanish working population. METHODS: The study included 216 914 working people (mean age 36.4 years, range 16-74 years, 73.1% male) undergoing routine medical check-up, which involved a structured questionnaire, physical examination, and standard serum biochemical analysis. RESULTS: Cardiovascular disease had been diagnosed previously in 0.7% of workers, hypertension in 6.2%, diabetes in 1.2%, and dyslipidemia in 8.9%. Routine check-up showed that 49.3% (51.3% of males and 43.8% of females) were smokers, 22.1% (27.0% of males and 8.8% of females) had high blood pressure (< or =140/90 mm Hg), 15.5% (18.3% of males and 13.3% of females) were obese (body mass index > or =30), 6.2% (7.8% of males and 1.9% of females) were hyperglycemic (blood glucose >110 mg/dL), and 64.2% had dyslipidemia (total cholesterol > or =200 mg/dL, LDL cholesterol > or =160 mg/dL, triglycerides > or =200 mg/dL, or HDL cholesterol < 40 mg/dL in males or < 50 mg/dL in females). When compared with workers in the service sector and after adjustment for potential confounders, workers in manufacturing, and particularly those in construction, had higher prevalences of both high blood pressure and smoking. CONCLUSIONS: The prevalence of cardiovascular risk factors in the Spanish working population is high, particularly in males and in certain types of employment.