Increasing impact of obesity on serum lipids and lipoproteins in young adults. The Bogalusa Heart Study

Obesity is an important determinant of serum lipids and lipoproteins in adults. Since obesity begins early in life, the impact of obesity of serum lipid and lipoprotein levels was examined in 3311 children and young adults (ages 5 to 26 years) from a totally biracial community. Study subjects were grouped according to race, sex, and age categories (5 to 10 years, 11 to 16 years, 17 to 22 years, and 23 to 26 years), excluding females using oral contraceptives or who were pregnant. Overall, associations increase with age, being most prominently noted in white males. The strong positive relation of ponderosity to low-density lipoprotein cholesterol was indicated in the older age groups with correlation coefficients ranging from r = -.09 in the youngest black males to r = .47 in white males aged 17 to 22 years. A negative association was noted between ponderosity and high-density lipoprotein cholesterol with correlation coefficients ranging from r = .08 in black females aged 17 to 22 years to r = -.39 in the oldest white males. Similar results were seen using subscapular skin-fold thickness as a measure of central obesity. Overweight was defined as exceeding 20% above the National Health Anthropometric and Nutritional Examination Survey II survey 50th percentiles. The prevalence of overweight individuals increased with age, being most prominent in black females. The percent(s) of hypercholesterolemic cases, based on the National Cholesterol Education Program criteria, likewise increased with age. A marked proportion of older white males were classified as borderline high and high for low-density lipoprotein cholesterol. A regression model using subscapular skinfold to predict serum lipids and lipoproteins within each age group indicated a consistent increase in the adverse nature of the lipid profile. Intervention and education programs aimed at reducing obesity at younger ages are recommended to reduce serum lipid and lipoprotein levels developing in young adulthood.     

Prevalence of cardiovascular risk factors in schoolchildren in a rural Georgia community

BACKGROUND: In the context of a national childhood obesity epidemic, this study sought to document the cardiovascular risk status of children in a rural Georgia community. METHODS: Anthropometrics and blood pressure were measured in 211 children, and fasting glucose and lipid profile in 160, recruited from schools in 2002 (grades 2 to 11, ages 7 to 18 years). RESULTS: Nearly half the schoolchildren (48%) were overweight or at risk of overweight; 15% had metabolic syndrome. Overweight children were at higher risk for metabolic syndrome and had more risk factors. Blood pressure: 19% had elevated systolic blood pressure; 4% had elevated diastolic blood pressure. Glycemia: 14% had impaired fasting glucose levels; no diabetes cases were detected. Lipid profile: 26% had high total cholesterol (>170 mg/dL), 20% had high low-density lipoprotein (>110 mg/dL), 13% had high triglycerides (>150 mg/dL), 43% had low high-density lipoprotein (females, <50 mg/dL; males, <40 mg/dL). Ethnicity, gender, and grade level were not predictive of risk except that fewer black children had low high-density lipoprotein, and blood pressure and body mass index increased with grade, as expected. CONCLUSIONS: Results from this study indicate a significant problem with overweight and cardiovascular risk in rural schoolchildren. Notably, younger children were just as likely to have risk factors as adolescents, suggesting that screening and intervention ought to begin by school age. Ethnic and gender differences in prevalence were not found, suggesting that contextual factors in a rural setting may outweigh demographic influences on risk.     

Effect of body mass index on insulin resistance and lipids in prepubertal and postpubertal children: SCHOOL observations

As part of the School Children Have Early Onset of Leading Risk Factors for Cardiovascular Disease and Diabetes Mellitus (SCHOOL) project, this study examines the effect of elevated body mass index on metabolic parameters and its relationship to insulin resistance in prepubertal and postpubertal students from the Wausau School District in central Wisconsin. Two hundred forty-seven nondiabetic students were randomly selected (125 prepubertal [2nd graders] and 122 postpubertal [11th graders]). Waist/hip ratio and body mass index corrected for age and sex were calculated. Fasting insulin, glucose, and nuclear magnetic resonance lipid profiles were measured. Relative insulin resistance was defined as quantitative insulin sensitivity check index > 1 SD below the mean of normal-weight children. Twenty-eight percent of 2nd graders and 33% of 11th graders were overweight. Relative insulin resistance was present in 47% of overweight 2nd graders and 51 % of overweight 11th graders and was associated with higher triglycerides, lower high-density lipoprotein, smaller low-density lipoprotein particles and, in 11th graders, higher waist/hip ratio. Relative insulin resistance prevalence is high among overweight children and adolescents. Biomarkers of increased risk of adverse cardiovascular outcomes are already present in overweight school children.     

Association of Lipid Abnormalities With Measures and Severity of Adiposity and Insulin Resistance Among Overweight Children and Adolescents

Obesity and lipid abnormalities in children may increase premature cardiovascular disease risk, but the relationship of dyslipidemia with adiposity among obese children is not well defined. The authors performed a cross-sectional analysis of children and adolescents (N=698) in 3 age groups (3–8 years, 9–11 years, and 12–18 years; 53% female, 81% African American, and 16% Hispanic) attending an obesity treatment program. More than 50% of the sample had abnormal levels of triglycerides (TG) or high-density lipoprotein (HDL) cholesterol or both. Only HDL cholesterol and TG were significantly associated with adiposity measures and insulin resistance (measured by homeostasis model assessment [HOMA]) and only in adolescents. All measures of adiposity, adjusted for age and sex, among adolescents were modest predictors of abnormal TG and HDL cholesterol, but these associations were attenuated when adjusting for HOMA. Despite the high prevalence of dyslipidemia in overweight children and adolescents, severity of adiposity appears to be a poor predictor of lipid values except among adolescents. Insulin resistance may in part mediate the relationship of adiposity and dyslipidemia among obese adolescents.     

Rate of change in adiposity and its relationship to concomitant changes in cardiovascular risk variables among biracial (black-white) children and young adults: The Bogalusa Heart Study

To assess the annual rate of change in adiposity and its relationship to concomitant changes in cardiovascular risk variables during childhood and young adulthood, serial data on black and white children (n = 3,459; initial and follow-up mean age, 8.1 and 14.4 years) and young adults (n = 1,263; initial and follow-up mean age, 22.5 and 30.9 years) enrolled in the Bogalusa Heart Study were examined. Body mass index (BMI) and sum of subscapular and triceps skinfolds were used as indicators of adiposity. In addition, measurements were made of systolic and diastolic blood pressure and fasting levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, insulin, and glucose. Annualized rate of change for each variable was estimated. The rate of increase in adiposity was significantly more pronounced during childhood versus adulthood. Race difference (blacks > whites) in the rate of increase in adiposity was seen only among females. Females, black females in particular, displayed greater rate of increase in adiposity than males. In a multivariate analysis, the rate of increase in adiposity was related independently of baseline age and baseline adiposity to adverse changes in measured cardiovascular risk variables, except glucose. Many of these associations were modulated significantly by race, sex, and age group. The impact was relatively greater for blood pressure and LDL cholesterol in adults and for triglycerides in children. The changes in blood pressure, LDL cholesterol, and HDL cholesterol were greater in whites, while the rate of increase in insulin was greater in blacks. Females displayed greater changes in blood pressure, HDL cholesterol, and insulin. On the other hand, the rate of increase in triglycerides was greater in males. These results indicate that increases in adiposity regardless of initial status of body fatness alter cardiovascular risk variables towards increased risk beginning in childhood, and that this deleterious trend underscores the importance of weight control early in life.     

Lipid abnormalities in coronary heart disease: a population-based case-control study

BACKGROUND: We performed a case-control study to estimate lipid-cholesterol fractions in patients with coronary heart disease and compared them with population-based controls. METHODS AND RESULTS: A total of 635 newly diagnosed patients with coronary heart disease (518 males and 117 females) and 632 subjects (346 males and 286 females) obtained from an ongoing urban coronary heart disease risk factor epidemiological study were evaluated. Age-specific lipid values (total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, and total:high-density lipoprotein cholesterol ratio) were compared using the t-test. Age-adjusted prevalence of dyslipidemia as defined by the US National Cholesterol Education Program was compared using the Chi-square test. In all the age groups, and in both males and females, levels of total and low-density lipoprotein cholesterol were not significantly different. In males, the high-density lipoprotein cholesterol (mg/dl) was significantly lower in patients with coronary heart disease as compared to controls in the age groups 30-39 years (35.1+/-11 v. 43.7+/-9), 40-49 years (39.0+/-10 v. 47.1+/-8), 50-59 years (38.9+/-11 v. 43.8+/-9) and 60-69 years (38.6+/-11, v. 42.8+/-7) (p<0.05). In females, high-density lipoprotein cholesterol was less in the age groups 30-39 years (30.2+/-9 v. 40.7+/-9), 50-59 years (39.7+/-12 v. 44.7+/-8) and 60-69 years (35.6+/-11 v. 42.2+/-9). The level of triglycerides was significantly higher in male patients in the age groups 40-49 years (195.3+/-96 v. 152.8+/-78), 50-59 years (176.7+/-76 v. 162.9+/-97), 60-69 years (175.5+/-93 v. 148.1+/-65) and >70 years (159.8+/-62 v. 100.0+/-22); and in female patients in the age group 30-39 years (170.8+/-20 v. 149.9+/-9) (p<0.05). The total:high-density lipoprotein cholesterol ratio was significantly higher in all age groups in male as well as female patients with coronary heart disease (p<0.05). CONCLUSIONS: An age-adjusted case-control comparison showed that the prevalence of hypertension, diabetes, high total cholesterol (> or =200 mg/dl) (males 48.8% v. 20.2%; females 59.8% v. 33.4%) and high low-density lipoprotein cholesterol (> or =130 mg/dl) (males 42.1% v. 15.0%; females 52.1% v. 31.0%) was significantly more in cases than in controls. The prevalence of low high-density lipoprotein cholesterol (<35 mg/dl) (males 39.6% v. 6.2%; females 39.3% iv 9.5%), high total:high-density lipoprotein ratio (> or = 5.0) and high triglycerides (> or =200 mg/ dl: males 39.6%, v. 10.2%; females 17.1% v. 11.9%) was also significantly higher in cases (p<0.05).     

Significant association of insulin and proinsulin with clustering of cardiovascular risk factors

AIM: To investigate the association between true insulin and proinsulin and clustering of cardiovascular risk factors. METHODS: Based on the random stratified sampling principles, 1196 Chinese people (533 males and 663 females, aged 35-59 years with an average age of 46.69 years) were recruited. Biotin-avidin based double monoclonal antibody ELISA method was used to detect the true insulin and proinsulin, and a risk factor score was set to evaluate individuals according to the number of risk factors. RESULTS: The median (quartile range) of true insulin and proinsulin was 4.91 mIu/L (3.01-7.09 mIu/L) and 3.49 pmol/L (2.14-5.68 pmol/L) respectively, and the true insulin level of female subjects was significantly higher than that of male subjects (P=0.000), but the level of proinsulin displayed no significant difference between males and females (P = 0.566). The results of covariate ANOVA after age and sex were controlled showed that subjects with any of the risk factors had a significantly higher true insulin level (P=0.002 for hypercholesterolemia, P=0.021 for high low-density lipoprotein cholesterol, P= 0.003 for low high-density lipoprotein cholesterol, and P=0.000 for other risk factors) and proinsulin level (P=0.001 for low high-density lipoprotein cholesterol, and P=0.000 for other risk factors) than those with no risk factors. Furthermore, subjects with higher risk factor scores had a higher true insulin and proinsulin level than those with lower risk factor scores (P=0.000). The multiple linear regression models showed that true insulin and proinsulin were significantly related to cardiovascular risk factor scores respectively (P=0.000). CONCLUSION: True insulin and proinsulin are significantly associated with the clustering of cardiovascular risk factors.     

Effect of aging on the relationship between multiple risk factors and waist circumference

OBJECTIVE: To examine the relationship between various coronary risk factors and the different levels of fat distribution in younger (<65 years) and older (> or = 65 years) men and women, using the classifications proposed by the National Heart, Lung and Blood Institute (NHLBI) and the World Health Organization (WHO). DESIGN: Cross-sectional study of subjects enrolled in the Baltimore Longitudinal Study of Aging. MEASUREMENTS: Systolic blood pressure, diastolic blood pressure, fasting glucose, 2-hour glucose, fasting insulin, homeostasis model assessment insulin resistance (HOMAIR), triglyceride, total cholesterol, high-density lipoprotein (HDL)-cholesterol, and low-density lipoprotein (LDL)-cholesterol were measured as risk factors. The proportion of subjects with abnormal risk factor levels by waist circumference classifications was determined in the age and gender subgroups. RESULTS: There were significant adverse effects of age per se on all risk factors with the exception of fasting insulin and HOMAIR in both men and women, total cholesterol in men, and diastolic blood pressure in women. HDL-cholesterol was higher in older subjects. There were significant correlations between waist circumference and all of the risk factors in the younger group. Waist circumference did not have a significant correlation with total cholesterol in older men, or with total cholesterol and LDL-cholesterol in older women. The proportion of subjects with an abnormal risk factor level increased with increasing waist circumference for most risk factors in both younger and older subjects, but proportions of subjects in each individual waist group were higher in older than in younger groups for systolic blood pressure, diastolic blood pressure, fasting glucose, and 2-hour glucose in men, and for systolic blood pressure, fasting glucose, 2-hour glucose, total and LDL-cholesterol, and triglyceride in women. CONCLUSIONS: Our data indicate that the waist circumference cutpoints proposed by NHLBI and WHO standards are useful for the prediction of cardiovascular disease risk factors in older as well as in younger men and women.     

Effect of age on interdependence and hierarchy of cardiovascular risk factors in hypertensive patients

The prognostic significance, interdependence, and hierarchy of cardiovascular risk factors could evolve with advancing age. Our study reports on the interdependence among blood pressure (BP), other metabolic syndrome components, and high-sensitivity C-reactive protein according to age in hypertensive subjects. A total of 5,712 nondiabetic patients (50.1% men, age range 40 to 95 years) evaluated in outpatient hypertension clinics were included and divided into 5 age groups (age 40 to 49, 50 to 59, 60 to 69, 70 to 79, and >80 years). BP, evaluated by both office and 24-hour ambulatory BP monitoring, and the metabolic and inflammation parameters were determined after a ≥2-week drug washout period. The prevalence of the metabolic syndrome (Adult Treatment Panel III definition) remained stable across the age groups. We observed a stable or increased association between waist circumference and insulin resistance (Homeostasis Model of Assessment-Insulin Resistance index) and fasting plasma glucose. However, the association between waist circumference and ambulatory BP monitoring systolic BP (r(2) decrease from 9.9% to 1.0%, p <0.001), high-density lipoprotein cholesterol (r(2) decreased from 21% to 4.9%, p = 0.002), and triglyceride levels (r(2) decreased from 17.5% to 1.9%, p <0.001) decreased with age. High-sensitivity C-reactive protein correlated with all metabolic syndrome components in all age groups (p <0.001 for all). It became the strongest determinant of ambulatory BP monitoring systolic BP (p <0.001) and high-density lipoprotein cholesterol (p <0.05) in patients >80 years old. In contrast, its association with waist circumference markedly decreased. In conclusion, hypertension and dyslipidemia, but not fasting plasma glucose, dissociate from central obesity with advancing age. They are increasingly determined by low-grade inflammation, independently of central obesity. These changing associations might underlie the weakening of obesity as a cardiovascular risk factor in older persons.     

Association of serum retinol binding protein 4 and insulin resistance in apparently healthy adolescents

Insulin resistance constitutes a pathophysiologic link between obesity, atherosclerosis, and/or cardiovascular complications. Retinol binding protein 4 (RBP4) is a newly discovered adipocyte product that modulates glucose metabolism and consequently induces insulin resistance. We investigated the association between serum RBP4 levels and insulin resistance in obese and nonobese adolescents. A total of 87 nonobese (60 males and 27 females) and 85 obese (62 males and 23 females) apparently healthy adolescents, 12 to 18 years old, were included in this study. A questionnaire was used to obtain participant medical history and lifestyle information, such as smoking and alcohol ingestion habits. Subjects' anthropometric measurements were taken to calculate for body mass index and waist-to-hip ratio. Serum RBP4 levels were measured by an enzyme immunoassay kit. High-sensitivity C-reactive protein, fasting glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, and fasting insulin were measured. Low-density lipoprotein cholesterol level and homeostatic model assessment of insulin resistance (HOMA-IR) were calculated. Males had significantly higher RBP4 levels than females. Serum RBP4 levels were significantly higher in the obese group compared with the nonobese group. In all subjects, RBP4 was positively correlated with adiposity index (body mass index, waist circumference, waist-to-hip ratio), systolic and diastolic blood pressures, glucose tolerance index (fasting glucose, insulin, HOMA-IR), lipid profile (total cholesterol, triglycerides), and inflammatory indices (high-sensitivity C-reactive protein, white blood cell count). In multiple linear regression analysis, RBP4 was independently associated with age, HOMA-IR, and triglyceride levels in the nonobese group and with sex and triglyceride levels in the obese group. These results suggest that serum RBP4 might have clinical implications for lipid metabolism and insulin action in adolescents.     

Depressive disorders and the metabolic syndrome of insulin resistance

Metabolic syndrome of insulin resistance and depression are both considered important cardiovascular risk factors. The aim of this study was to ascertain a possible association between these conditions in a population sample of 116 subjects (54 males, 62 females, aged 60 +/- 8 and 60 +/- 9 years, respectively). A standard questionnaire-the Hospital Anxiety Depression Scale-was used for the assessment of depressive disorder and clinical definition of insulin resistance, requiring the presence of three or more of the following factors: triglycerides > 1.7 mmol/L; and high-density lipoprotein cholesterol < 1.0 mmol/L; blood pressure >/= 130/85 mm Hg; waist circumference > 102 cm in males and > 88 cm in females; fasting glucose 6.1-7.8 mmol/L. Depressive disorders prevailed significantly more in women than in men (39% and 26%, respectively), and prevalence of depression in subjects with metabolic syndrome of insulin resistance (by definition) was about four times higher than in subjects without depression. Depressive subjects had also higher heart rate, waist circumference, lower high-density lipoprotein cholesterol, higher triglycerides, and higher body mass index. Higher sympathetic nervous activity in insulin-resistant subjects with depression was indicated.     

上海市社区60岁以上人群脂肪肝患病率及危险因素的横断面研究

目的了解上海市社区60岁以上人群脂肪肝的患病率及危险因素。方法对闵行区梅陇社区7534名60岁以上人群定期体检,填写统一设计的调查表,内容包括:一般情况、实验室检查、B型超声检查结果等。结果其中女性4198名,男性3336名,女男之比为1.26:1,平均年龄(68.8±7.0)岁。经B型超声检出脂肪肝3074例,占40.80%。60岁以上老年人脂肪肝患病率随着年龄增加而呈下降趋势,患病率最高的年龄段为60～64岁,达到45.20%。80岁以下,女性患病率显著高于男性。脂肪肝组的体质指数(BMI)、腰围、腰臀比(WHR)、三酰甘油、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、收缩压(SBP)、ALT、γ-谷氨酸转肽酶(GGT)等指标显著高于非脂肪肝组,而高密度脂蛋白胆固醇(HDL-C)则低于非脂肪肝组。相比正常对照组,肥胖、中心性肥胖和高脂血症分别增加脂肪肝患病风险15.2倍、10.8倍和8.6倍(P<0.01)。多元回归分析发现,女性、BMI、SBP、三酰甘油、HDL-C、LDL-C、TC、ALT、GGT等9项指标与脂肪肝密切相关。结论上海市社区60～64岁人群脂肪肝患病率较高,与肥胖及脂代谢紊乱密切相关。     

Menopause does not affect blood pressure and risk profile, and menopausal women do not become similar to men

OBJECTIVE: Menopause is considered to be a cardiovascular risk factor, but this belief is based on opinions rather than on evidence. Confounding effects of age are often neglected. DESIGN: Population-based study with further subanalysis of case-to-case age-matched cohorts of men and fertile and menopausal women. SETTING: Epidemiology in primary, public, institutional frame. PARTICIPANTS: Nine thousand three hundred and sixty-four men and women aged 18-70 years representative of Italian general population followed-up for 18.8 +/- 7.7 years. MAIN OUTCOME MEASURES: Blood pressure (BP), prevalence and incidence of hypertension, serum total, high-density lipoprotein and low-density lipoprotein cholesterol, glucose tolerance, body adiposity, vascular reactivity, target organ damage, overall and cardiovascular mortality and morbidity, by gender and by menopausal status. RESULTS: Cross-sectional: crude BP, pressor response to cold, orthostatic BP decrease, BMI, skinfold thickness, fasting and postload blood glucose and insulin, serum lipids, left ventricular mass, serum creatinine, microalbuminuria and augmetantion index were higher in menopausal than in fertile women, and comparable in menopausal women and men, a difference that was no longer present when adjusting for age or considering age-matched cohorts. Longitudinal: BP increase during follow-up, cardiovascular mortality and morbidity were greater in menopausal than in fertile women, and comparable in menopausal women and men, a difference no longer present in age-matched cohorts. Menopausal status was rejected from multivariate Cox analysis also including age. CONCLUSION: The cardiovascular effects usually attributed to menopause seem to be a mere consequence of the older age of menopausal women.     

Metabolic Syndrome Risk Factors Among a Sample of Overweight and Obese Mexican Children

J Clin Hypertens (Greenwich). The objective of this study was to estimate the prevalence and correlations of components of the metabolic syndrome (MetS) using the International Diabetes Federation (IDF) pediatric definition in a cross-sectional study of 215 overweight/obese Mexican children aged 6 to 12. There are no previous studies of this kind in Mexican children. Clinical, anthropometric, and laboratory measurements were performed. The prevalence of MetS using the pediatric IDF criteria was 6.7% (95% confidence interval, 4.0–11.1). A higher proportion of children in the younger age group had waist circumference above the cutoff, while a higher proportion in the older age group had hyperglycemia. Children with MetS had higher percentages of body fat, body mass index, total cholesterol, and low-density lipoprotein cholesterol. Increased triglycerides, decreased high-density lipoprotein cholesterol, and waist circumference were most highly associated with MetS. This has significant implications for public health.     

Diabetes, blood lipids, lipoproteins, and change of environment: restudy of the "new immigrant Yemenites" in Israel.

Restudy of 306 "new immigrant Yemenite" Jews, an ethnic group in which, upon their arrival in Israel, no diabetes was detected, revealed, 25 yr after their immigration, an increased incidence of diabetes and higher plasma and lipoprotein-lipid levels. The prevalence of diabetes (defined as "glucose intolerance") rose to 11.8% (13.2% males and 9.7% females). Obesity in females resulted in increased prevalence of diabetes in all age groups, while in males it affected the older age group only. The male/female diabetic ratio was affected by weight status--in the underweight, diabetes was more prevalent in males, in the overweight, the rate of diabetes in females equaled that of males. In nondiabetics (those with normal glucose tolerance), neither the glucose tolerance nor the insulin response deteriorated with aging. Most diabetics had a delayed insulin response. However, about 50% of nondiabetics and diabetics had insulin response peak at 60 min and similar insulin levels. It appears that in newly discovered adult-onset diabetics in this population there is no shortage of insulin, but rather shortage of insulin action. In nondiabetics, the levels of plasma cholesterol and triglycerides (TG) were higher than levels upon their arrival. In diabetics, the plasma TG, cholesterol, and LDL-cholesterol levels were higher when compared to those of nondiabetics, especially in the group of overweight males. Hyperlipoproteinemia was diagnosed in 27.7% of diabetics and 11.0% of nondiabetics. In diabetics, the HDL/LDL cholesterol ratio was found to be reduced, significantly so in overweight diabetics.     

High blood pressure and associated cardiovascular risk factors in France

OBJECTIVE: To estimate, with respect to age and gender, the prevalence of high blood pressure (BP) in treated and non-treated subjects and its association with other cardiovascular risk factors. DESIGN: A cross-sectional study. SETTING: Healthcare centres in the centre of France. PARTICIPANTS: All subjects (n = 61,108) who had a free health check-up, between February 1995 and September 1996. MAIN OUTCOME MEASURES: High BP (systolic blood pressure (SBP) > 140 mmHg, diastolic blood pressure (DBP) > 90 mmHg or antihypertensive therapy); diabetes (fasting glucose plasma concentration > 1.26 g/l or antidiabetic therapy); hypercholesterolaemia (total cholesterol > 2 g/l or lipid-lowering therapy); hypertriglyceridaemia (fasting triglycerides plasma concentration > 2 g/l or triglyceridaemia-lowering therapy); overweight (body mass index >or= 25 kg/m2); abdominal fat distribution (waist to hip ratio > 0.9 in males and > 0.8 in females). RESULTS: Prevalence of high BP was 37.7% in males and 22.2% in females. BP was normalized in 29.7% of treated males and 44.1% of treated females. High BP was associated with at least another cardiovascular risk factor in 83.8% of the males and 76.7% of the females with high BP. Hypercholesterolaemia was the most frequently associated risk factor. Except smoking, the prevalence of each cardiovascular risk factor was shown to increase with the severity of hypertension. Two or more other cardiovascular risk factors were present in 22.9% of the males and 9.8% of the females with high BP. CONCLUSIONS: Rate of high BP, even in treated subjects, is high. More than three out of four subjects with high BP have at least one other cardiovascular risk factor.     

The metabolic syndrome in overweight Hispanic youth and the role of insulin sensitivity

The prevalence of the metabolic syndrome is highest among Hispanic adults. However, studies exploring the metabolic syndrome in overweight Hispanic youth are lacking. Subjects were 126 overweight children (8-13 yr of age) with a family history for type 2 diabetes. The metabolic syndrome was defined as having at least three of the following: abdominal obesity, low high-density lipoprotein (HDL) cholesterol, hypertriglyceridemia, hypertension, and/or impaired glucose tolerance. Insulin sensitivity was determined by the frequently sampled iv glucose tolerance test and minimal modeling. The prevalence of abdominal obesity, low HDL cholesterol, hypertriglyceridemia, systolic and diastolic hypertension, and impaired glucose tolerance was 62, 67, 26, 22, 4, and 27%, respectively. The presence of zero, one, two, or three or more features of the metabolic syndrome was 9, 22, 38, and 30%, respectively. After controlling for body composition, insulin sensitivity was positively related to HDL cholesterol (P < 0.01) and negatively related to triglycerides (P < 0.001) and systolic (P < 0.01) and diastolic blood pressure (P < 0.05). Insulin sensitivity significantly decreased (P < 0.001) as the number of features of the metabolic syndrome increased. In conclusion, overweight Hispanic youth with a family history for type 2 diabetes are at increased risk for cardiovascular disease and type 2 diabetes, and this appears to be due to decreased insulin sensitivity. Improving insulin resistance may be crucial for the prevention of chronic disease in this at-risk population.     

The Dubbo study of the health of elderly: correlates of coronary heart disease at study entry

A prospective study of the health of elderly Australians recently commenced in Dubbo, NSW, the study population comprising 1,237 males and 1,568 females 60 years and older. The prevalence rates of coronary heart disease (CHD) and its associated risk factors have been examined in the baseline data. The age-standardized rate of CHD was 23.8/100 in males and 18.1/100 in females. The prevalence rate increased with age until 79 years in males, thereafter declining. The rate increased steadily with age in females. In a multiple logistic model, the following possible predictors of CHD were included: age, cigarette smoking, use of alcohol, exercise, religiosity, years of education, hypertension, diabetes, family history of CHD, body mass index, lipid and lipoprotein variables. The presence of CHD in males was significantly predicted by age, hypertension (odds ratio, OR = 1.40), family history (OR = 2.05), and high density lipoprotein (HDL) cholesterol (OR = 0.78). The significant predictors in females were age, years of education (OR = 0.82), hypertension (OR = 1.45), family history (OR = 1.77), serum triglycerides (OR = 1.30), and HDL cholesterol (OR = 0.73). Hypertension was found to be a stronger predictor of CHD in the younger age group (60-69 years), while diabetes was a predictor of CHD in older males (70-79 years). Our findings require confirmation in the prospective study now in progress.     

Comparative effects of overweight on cardiovascular risk in younger versus older men

The relation of age and body mass index (BMI) to atherosclerosis risk factors was examined in 357 men. Older (greater than or equal to 45 years) men had higher (p less than 0.01) systolic and diastolic blood pressures, fasting cholesterol and glucose, and 1-hour glucose and insulin levels. Fasting insulin and triglyceride levels were not significantly different between the 2 age groups. Although older men (n = 170) had greater values for several risk factors, overweight (BMI greater than 25.5 kg/m2) increased risk factors more in men younger than 45 years (n = 187). In younger men, those with higher BMIs had a greater prevalence, respectively, of blood pressure greater than 140/90 mm Hg (35.2 vs 11.2%, p less than 0.0001), cholesterol greater than 200 mg/dl (53.5 vs 29.3%, p less than 0.001), fasting triglycerides greater than 150 mg/dl (38.0 vs 10.3%, p less than 0.0001), 1-hour glucose greater than 160 mg/dl (15.5 vs 5.2%, p less than 0.05), fasting insulin greater than 11 microU/ml (28.2 vs 5.2%, p less than 0.0001), and 1-hour insulin greater than 110 microU/ml (28.2 vs 9.5%, p less than 0.001). In contrast, among older men, the prevalence of elevated blood pressure, cholesterol, triglycerides and glucose values was not significantly greater in the subgroup with high BMI. However, elevations of fasting (19.6 vs 6.4%, p less than 0.05) and 1-hour insulin (29.3 vs 11.5%, p less than 0.01) values were more common among older men with higher BMIs.(ABSTRACT TRUNCATED AT 250 WORDS)     

Current status of coronary risk factors among rural Malays in Malaysia

BACKGROUND: Coronary heart disease (CHD) is the leading cause of death in Malaysia, despite its status as a developing country. The rural population is thought to be at low risk. OBJECTIVE: To investigate the prevalence of risk factors and global risk profile among rural Malays in Malaysia. METHODS: We studied 609 rural Malay subjects (346 females, 263 males; age range 30-65 years). Blood pressure (BP), body mass index (BMI), waist-hip ratio (WHR), smoking habits and family history of premature CHD were documented. Fasting blood samples were analysed for serum lipids, lipoprotein (a), plasma glucose and fibrinogen. Oral glucose tolerance tests were performed using 75 g anhydrous glucose. RESULTS: The prevalence of hypercholesterolaemia for total cholesterol concentrations of > or = 5.2, > or =6.5 and > or =7.8 mmol/l were 67.3, 30.5 and 11.8% respectively. There was a high prevalence of low serum high-density lipoprotein cholesterol (13.1%), hypertension (30.3%), smokers (24.4%), diabetes (6.4%), impaired fasting glucose or glucose tolerance (13.9%), overweight or obesity (44.7%) and increased WHR (48.5%). Global risk assessment showed that 67.3% of the study population were at risk, with 15.9, 18.9 and 32.5% in the mild, moderate and high risk categories respectively. CONCLUSION: Prevalence of risk factors was high in the rural population. Global risk assessment showed a high-risk profile with two-thirds being at risk, and one-third being categorized into the high-risk group. Although rural communities were considered at low risk of developing CHD, this is changing fast, possibly due to the rapid socio-economic development, in addition to underlying genetic predisposition.