ApoB/apoA-I ratio is better than LDL-C in detecting cardiovascular risk

Background and aims

Cardiovascular (CV) events occur even when LDL-C are <100 mg/dL. To improve the detection of CV risk we investigated the apoB/apoA-I ratio versus LDL-C in subjects considered normal glucose tolerant (NGT) by oral glucose tolerance test (OGTT).

Methods and results

We enrolled 616 NGT (273 men and 343 women), and we measured insulin resistance, lipid profile, apoB/apoA-I and the factors compounding the metabolic syndrome (MetS). An unfavourable apoB/apoA-I (≥0.9 for males and ≥0.8 for females) was present in 13.9% of 108 patients with LDL-C <100 mg/dL: compared to subjects with lower apoB/apoA-I (<0.9 for males and <0.8 for females), they had more elements of MetS and their lipid profile strongly correlated with high CV risk. Out of 314 patients with lower apoB/apoA-I, 40.12% had LDL-C ≥130 mg/dL: these retained a more favourable lipid profile than corresponding subjects with elevated apoB/apoA-I ratio. Finally, we found a significant correlation between LDL-C and apoB/apoA-I ratio (r = 0.48, p <0.0001).

Conclusions

In NGT with LDL-C <100 mg/dL, a higher apoB/apoA-I exhibited an atherogenic lipid profile, indicating that LDL-C alone is insufficient to define CV risk. Independent from LDL-level, when apoB/apoA-I is lower, the lipid profile is, in fact, less atherogenic. This study demonstrates that apoB/apoA-I is at least complementary to LDL-C in identifying the “effective” CV risk profile of asymptomatic NGT subjects.     

Postmenopausal hypertension,abdominal obesity,apolipoprotein and insulin resistance

This study aimed to evaluate the association of abdominal obesity, apolipoprotein and insulin resistance (IR) with the risk of hypertension in postmenopausal women. We analyzed a total of 242 women aged between 35 and 70 years. Blood pressure (BP), anthropometric indices, lipid profile, fasting glucose, insulin, C-reactive protein (CRP) and apolipoprotein concentrations were measured. Homeostasis model assessment (HOMA) was used to assess IR. Hypertension was defined as a systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg or current treatment with antihypertensive drugs. Women with hypertension showed significantly higher mean values of age, SBP and DBP, waist circumference (WC), fasting plasma glucose (FPG), insulin, HOMAIR and the apolipoprotein B (apoB). When analyses were done according to the menopausal status, higher prevalence of hypertension was observed in postmenopausal women (72.8% vs. 26.0%, p < 0.001) compared to their premenopausal counterparts. Postmenopausal women showed also significantly higher mean values of SBP and DBP, WC, HOMAIR and apoB. Multivariate linear regression analysis revealed that SBP was significantly affected by WC (p = 0.034), apoB (p = 0.038) and log HOMAIR (p = 0.007) in postmenopausal women. The interaction models revealed significant interaction between WC, apoB and log HOMAIR (WC×apoB×log HOMAIR) on SBP (p = 0.001) adjusted for age. In a multivariate logistic regression, adjusting for age and apoB, WC (p = 0.001), log HOMAIR (p = 0.007) and menopause (p = 0.008) were significantly associated with higher risk for hypertension. These results suggest that changes in WC, apoB and IR accompanying menopause lead to a greater prevalence of hypertension in postmenopausal women.     

载脂蛋白A-I／载脂蛋白B值对急性冠脉综合征患者的临床预测价值

目的探讨不同血脂成分及载脂蛋白A-I（apolipoproteinA-I,apoA-I）／载脂蛋白B（apolipoprotein B,apoB）值对急性冠状动脉（冠脉）综合征的临床预测价值。方法收集586例胸痛患者行冠脉造影术的资料,其中急性冠脉综合征组426例,另外160例造影阴性者为对照组。测定并比较两组三酰甘油（TG）,总胆固醇（TC）,高密度脂蛋白胆固醇（HDL-C）,低密度脂蛋白胆固醇（LDL-C）,apoA-I／apoB值及冠脉Gensini积分。结果急性冠脉综合征组apoA-I／apoB值明显高于对照组,差异有统计学意义（P〈0．05）。apoA-I／apoB值与冠脉病变支数负相关（r=0．152．P=0．031）。结论apoA-I／apoB值是急性冠脉综合征强有力的预测因子,且优于其他血脂指标。     

The value of apolipoprotein B/A1 ratio in the diagnosis of metabolic syndrome in a Korean population

Objective The ratio of apolipoprotein B (apoB) to apolipoprotein A1 (apoA1) has been reported to be associated with the metabolic syndrome (MetS). However, the optimal cut‐off value of apoB/A1 ratio for detecting subjects with MetS has remained undetermined. In the present study, we aimed to investigate whether apoB/A1 ratio can be an indicator of MetS and to determine the optimal cut‐off value of apoB/A1 ratio in detecting subjects with MetS in a Korean population. Design This cross‐sectional study was conducted at the Asan Medical Center, Seoul, Republic of Korea. Subjects and measurements We collected the data of 10 940 subjects who participated in a routine health screening examination regarding conventional risk factors and serum levels of apoB and apoA1. Results The odds for MetS were significantly higher in the highest compared with the lowest apoB/A1 ratio quartiles, after adjustment for confounding variables, in both men [odds ratio (OR) = 4·07, 95% CI = 3·42–4·84] and women (OR = 8·41, 95% CI = 5·85–12·08). The optimal apoB/A1 ratio cut‐off value for the detection of MetS was 0·65, which had a sensitivity of 63·5% and a specificity of 61·3% (area under the curve = 0·67, 95% CI = 0·66–0·68, P < 0·001) in men and 0·62, which had a sensitivity of 67·9% and a specificity of 61·9% (area under the curve = 0·70, 95% CI = 0·69–0·71, P < 0·001) in women. Conclusions These results suggest that apoB/A1 ratio is independently associated with MetS and that an apoB/A1 ratio >0·65 in men and 0·62 in women is a marker of MetS independent from conventional risk factors.     

Prognostic value of apolipoprotein B and A-I in the prediction of myocardial infarction in middle-aged men and women: results from the MONICA/KORA Augsburg cohort study.

AIMS: To investigate the association between apolipoprotein B (apoB), A-I (apoA-I), the apoB/apoA-I ratio, and the incidence of coronary events. METHODS AND RESULTS: Analysis included 1414 men and 1436 women aged 35-64 years without a prior coronary event who participated in the population-based MONICA Augsburg survey 1984-85 (median followed-up period 13 years). Incidence of fatal and non-fatal myocardial infarction, and sudden cardiac death was assessed using data of the MONICA/KORA Augsburg coronary event registry. During follow-up, 114 incident coronary events occurred in men and 31 in women. In multivariable analysis, an increase of 1 standard deviation in the serum concentration of apoB was associated with an increased risk of coronary events in men [hazard ratio (HR)=1.49; 95% confidence interval (CI); 1.25-1.78] and in women (HR=1.73; 95% CI; 1.32-2.27). By contrast, elevated concentrations of apoA-I were not associated with a significantly decreased risk of coronary events in either sex (HR=0.91). Furthermore, the predictive power of the apoB/apoA-I ratio was similar to that of the total cholesterol/HDL cholesterol ratio in men and women. CONCLUSION: ApoB and the apoB/apoA-I ratio were strong predictors of coronary events in middle-aged men and women, whereas apoA-I did not add significantly to the estimation of future coronary risk.     

Usefulness of apolipoprotein B/apolipoprotein A-I ratio to predict coronary artery disease independent of the metabolic syndrome in African Americans

Studies have demonstrated that the apolipoprotein B/apolipoprotein A-I (apoB/apoA-I) ratio predicts cardiovascular risk better than any of the cholesterol indexes. A number of factors that define the metabolic syndrome (MS) differ across African-American and European-American ethnicities. We assessed the relation of the apoB/apoA-I ratio to MS and coronary artery disease (CAD) in 224 African Americans and 304 European Americans. The MS was defined using the revised National Cholesterol Education Program Adult Treatment Panel III criteria, and CAD was assessed as ≥50% stenosis or a continuous cardiovascular score (0 to 75). The European Americans had a greater apoB/apoA-I ratio than the African Americans (1.15 vs 1.07, p = 0.008). The apoB/apoA-I ratio was associated with presence of the MS in both European Americans (odds ratio 5.9, 95% confidence interval 2.53 to 13.57, p <0.001) and African Americans (odds ratio 8.3, 95% confidence interval 3.52 to 19.25, p <0.001) and was greater in subjects with the MS than in those without the MS (1.21 vs 1.04, p <0.001, for European Americans and 1.20 vs 0.94, p <0.001, for African Americans). A stepwise increase was seen in the prevalence of the MS across the apoB/apoA-I ratio tertiles in both ethnic groups (chi-square = 13.1, p <0.001, for European Americans and chi-square = 19.6, p <0.001, for African Americans). On multiple regression analyses, the apoB/apoA-I ratio independently predicted CAD in African Americans (β = 0.242, p = 0.011). The cardiovascular score was significantly increased across the apoB/apoA-I ratio tertiles in the European-American subjects with the MS (p = 0.001). However, this association was seen in the African-American subjects without the MS (p = 0.023). In conclusion, the apoB/apoA-I ratio differed across ethnicities and was associated with presence of the MS in both groups. Among African Americans, an elevated apoB/apoA-I ratio independently predicted a greater risk of CAD.     

Different distribution of phenotypes and glucose tolerance categories associated with two alternative proposed cutoffs of insulin resistance

We investigated whether two alternative HOMA-IR thresholds recently proposed identify similar phenotype and have the same impact on gluco-metabolic risk. The two IR cutoffs, IR1 and IR2 (IR1: HOMA-IR >5.9 and IR2: HOMA-IR between 2.8 and 5.9 with HDL-C <51 mg/dl), were applied to a database of 2,360 outpatients, and their association with phenotypes, glucose tolerance, lipids and metabolic syndrome (MetS) was examined. IR1 group showed 5.5 % of overweight versus 27.8 % of IR2 subjects, and obesity was present in 92.3 versus 68.4 %, respectively. We observed the major prevalence of pathological waist in IR1 compared to IR2 subjects: 96.0 versus 80.5 % (p < 0.001). After OGTT, IR1 patients presented higher prevalence of impaired glucose tolerance (IGT: 25.8 vs. 20.2 %, p < 0.001) and DM2 was diagnosed in 39.7 % of IR1 versus 11.3 % of IR2 patients (p < 0.001) with odds ratio (OR) 8.3 (95 % CI 6.1–11.6) versus 0.8 (0.6–1.2), respectively. IR1 versus IR2 cutpoint showed higher significant (mean ± SEM) total cholesterol (224.8 ± 2.6 vs. 213.1 ± 1.7 mg/dl, p < 0.001) and triglyceride (208.1 ± 12.3 vs. 177.4 ± 4.8 mg/dl, p < 0.001) levels. MetS prevalence was significantly higher in IR1 than IR2 (89.0 vs. 78.3 %, p < 0.001). The IR1 cutpoint was associated with a higher OR of MetS 7.3 (5.3–10.2) versus 5.2 (2.8–9.5) of IR2. In summary, the two alternative HOMA-IR cutoffs identify subjects with different distribution of phenotypes and gluco-metabolic risk. The IR1 patients are characterized by higher prevalence of obesity, pathological waist, MetS, dyslipidemia and IGT/DM2.     

Metabolic syndrome in Sjögren’s syndrome patients: a relevant concern for clinical monitoring

Metabolic syndrome (MetS) has been described in autoimmune diseases. However, there are scarce data about MetS and adipocytokine profile in primary Sjögren’s syndrome (pSS). Seventy-one female pSS patients (American-European Consensus Group Criteria, 2002) aged 18–65 years and 71 age-, race-matched control women were enrolled in this case–control study. Clinical data were collected by a standardized protocol. Blood levels of glucose, cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), triglycerides, interleukin-1beta (IL-1beta)/IL-6, B-cell activating factor (BAFF), insulin, and leptin/adiponectin/visfatin/resistin were determined. Patients and controls were comparable regarding body mass index (BMI), smoking, sedentariness, and menopause (p?>?0.05). MetS (39.4 vs. 16.9 %, p?=?0.005), hypertension (p?=?0.004), and dyslipidemia (p?=?0.002) were more frequent in patients than controls. IL-1beta, IL-6, BAFF, resistin, and adiponectin levels were higher in patients than controls (p?<?0.05). pSS patients with MetS (n?=?28) had higher BMI, waist circumference, cholesterol, LDL-C, triglycerides, insulin, leptin and HOMA-IR values, and greater hypertension and diabetes rates than pSS patients without MetS (n?=?43) (p?<?0.05). Current and/or previous prednisone use (75.0 vs. 62.8 %, p?=?0.313), current (3.0?±?4.5 vs. 1.6?±?3.2 mg/day, p?=?0.299), and cumulative prednisone doses (p?=?0.495) were similar in both groups. Otherwise, IL-1beta level was higher in MetS patients than in non-MetS patients (p?=?0.012), and this finding was confirmed (p?=?0.048) by multivariate analysis with adjustments for age, ethnicity, prednisone use, current and cumulative prednisone doses, and duration of use. We identified high MetS frequency and abnormal adipocytokine profile in pSS. The association of MetS with elevated IL-1beta level suggests that inflammation plays an important role in its pathogenesis.     

Insulin-like growth factor-I correlates more closely than growth hormone with insulin resistance and glucose intolerance in patients with acromegaly

In normal subjects growth hormone (GH) and insulin-like growth factor-I (IGF-I) have opposing effects on glucose metabolism. Active acromegaly is associated with insulin resistance (IR) and glucose intolerance although both GH and IGF-I are elevated. Our objective was to compare whether GH or IGF-I correlates more closely with IR and glucose intolerance in acromegaly. Basal serum IGF-I and GH, glucose and insulin during an oral glucose tolerance test were measured in 70 normoglycemic and 44 hyperglycemic acromegalic patients (21 impaired fasting glucose, 11 impaired glucose tolerance and 12 diabetes mellitus) according to American Diabetes Association criteria. 55 patients were assessed before any treatment for acromegaly and 59 after surgery and/or radiotherapy (15 patients had normal IGF-I after treatment). Patients treated with somatostatin analogs, GH-receptor antagonists or antidiabetic drugs were excluded. IR was assessed by various basal and stimulated indices. Homeostatic Model Assessment 2-Insulin Resistance (HOMA2-IR) index correlated more closely with IGF-I (r = 0.65, p < 0.0001) than nadir (r = 0.23, p = 0.008) or random GH (r = 0.26, p = 0.002). HOMA2-IR correlated better with IGF-I than nadir or random GH also in normoglycemic (n = 70; r = 0.74, p < 0.0001 vs. r = 0.36, p = 0.001 vs. r = 0.39, p < 0.001) and hyperglycemic patients (n = 44; r = 0.54, p = 0.0002 vs. r = 0.09, p = 0.4 vs. r = 0.14, p = 0.26). In multivariate logistic regression analysis IGF-I but not GH was a significant risk factor for glucose intolerance after adjusting for age, sex, weight and acromegaly duration (OR = 1.56, p = 0.01). In acromegaly IGF-I correlates more closely than GH with IR. IGF-I levels but not GH are associated with glucose intolerance.     

Among young Sri Lankan patients with diabetes,how do lipid profiles differ between those with and without metabolic syndrome?

AimsMetabolic syndrome (MetS) is a risk factor for cardiovascular disease (CVD). Apolipoproteins are emerging as powerful predictors of CVD. We aimed to study associations of metabolic syndrome and apoB, apoAI, apoB/AI ratio in young Sri Lankans with type 2 diabetes.Materials & methodsBlood samples were available from 690 patients with type 2 diabetes in Sri Lanka Young Diabetes Study, and were analysed for apoB, apoAI, total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), triglycerides (TG) and glycated haemoglobin (HbA_1c). Their associations with MetS as perNCEP/ATPIII criteria were studied.ResultsMetS was present in 60.9% of subjects. Of those with MetS, 76.0% were women. Those with MetS had higher apoB (1.27 V s 1.19 mmol/L; p = 0.001), apoB/AI (0.80 V s 0.75; p = 0.001), non-HDL cholesterol (NHDLC) (4.15 V s 3.98 mmol/L; p = 0.002),and triglycerides (1.51 V s 1.31 mmol/L; p < 0.001) and lower apoAI (1.58 V s 1.60 mmol/L; p = 0.03) and HDLC (1.02 V s 1.16 mmol/L, p < 0.001). ApoB and apoB/AIlevels increased significantly as the number of MetS components increased. ApoB and apoB:AI ratio were independently associated with MetS and components.ConclusionMetS showed a high prevalence among young Sri Lankans with diabetes. Elevated apoB is commonly clustered with other risk indicators in MetS.     

Optimal cut‐off point for homeostasis model assessment of insulin resistance to discriminate metabolic syndrome in non‐diabetic Japanese subjects

We have recently established a ‘health‐associated’ reference interval of homeostasis model assessment of insulin resistance (HOMA‐IR) between 0.4 and 2.4. In the present study, the aim was to establish a ‘decision‐based’ limit of HOMA‐IR for the discrimination of metabolic syndrome (MetS) in non‐diabetic Japanese subjects. The receiver–operating characteristic curve of HOMA‐IR for detecting MetS was developed using data from 6868 non‐diabetic subjects (3727 men, 3141 women). The optimal cut‐off point was determined based on the point that yielded the minimum value of the square root of [(1 – sensitivity)² + (1 – specificity)²]. HOMA‐IR = 1.7 was determined as the optimal cut‐off value, with a sensitivity and specificity of 73.4% and 70.5% for men, and 81.5% and 77.0% for women, respectively. In conclusion, the optimal cut‐off value for HOMA‐IR to discriminate MetS in non‐diabetic Japanese subjects appears to be 1.7. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2012.00194.x , 2012)     

Resting heart rate predicts metabolic syndrome in apparently healthy non-obese Japanese men

Autonomic nervous dysfunction is considered to be one of the mechanisms of metabolic syndrome (MetS). The aim of this study is to investigate whether resting heart rate, a marker of autonomic nervous dysfunction, is a predictor of MetS in apparently healthy non-obese [body mass index (BMI) <25 kg/m²] Japanese men. This is an observational study through 3 years in apparently healthy Japanese 1,265 men and 793 women without MetS and with no history of cardiovascular disease and no use of antihypertensive, antidiabetic, or antihyperlipidemic medication at baseline. Hazard ratios (HRs) of incident MetS were calculated for each 1 SD increase in heart rate stratified by gender and obesity. Incidence of MetS for each tertile of heart rate and HRs of MetS for the highest tertile (T3) compared with the lowest tertile (T1) were calculated stratified by gender and obesity. The HRs [95 % confidence intervals (CIs)] of MetS for each 1 SD increase in heart rate were 1.319 (1.035–1.681) (p = 0.025) in non-obese men, 1.172 (0.825–1.665) (p = 0.377) in obese men, 1.115 (0.773–1.608) (p = 0.560) in non-obese women, and 1.401 (0.944–2.078) (p = 0.094) in obese women adjusted for BMI, age, smoking, alcohol drinking, and physical activity. The HRs (95 % CIs) of MetS for T3 were 2.138 (1.071–4.269) (p = 0.031) in non-obese men and 1.341 (0.565–3.180) (p = 0.506) in obese men adjusted for pre-existing five components of MetS, age, smoking, alcohol drinking, and physical activity. In conclusion, an increase in resting heart rate was a significant predictor of MetS in non-obese Japanese men.     

ApoB/apoA-I ratio is related to femoral artery plaques in 64-year-old women also in cases with low LDL cholesterol

IntroductionThe apolipoproteinB (apoB)/apolipoproteinA-I (apoA-I) ratio mirrors the number of pro-atherogenic and anti-atherogenic lipoprotein particles. This ratio may carry more information on risk for atherosclerosis than LDL in cohorts with impaired glucose tolerance. The aim was to examine the association between the apoB/apoA-I ratio and ultrasound-assessed atherosclerosis in the carotid and femoral arteries in women with varying degrees of glucose tolerance.MethodsPlaque occurrence, and intima-media thickness in the carotid and femoral arteries were examined by B-mode ultrasound in a random sample of 64-year-old women (n = 646) living in Gothenburg, Sweden, representing different degrees of glucose intolerance (diabetes (n = 234), impaired (n = 212) and normal glucose tolerance (n = 200)). Traditional risk factors and serum concentrations of apolipoproteins were analysed.ResultsFor subjects in the lowest LDL tertile, the risk of having a plaque in the femoral artery was three times greater for subjects in the highest apoB/apoA-I tertile compared to subjects in the lowest tertile (OR: 3.0, 95% CI: 1.2–7.5). A clear increase in the occurrence of femoral plaque was observed already at a cut-off value of 0.63 (OR: 1.8, 95% CI: 1.2–2.6). ApoB/apoA-I was also related to femoral plaque occurrence in women with low HbA1c. ApoB/A-I ratio was associated with carotid and femoral IMT but not carotid plaques.ConclusionThe apoB/apoA-I ratio improved the identification of cases with femoral artery atherosclerosis in a cohort of women with varying degrees of glucose tolerance. Such cases could also be identified in women with normal LDL and HbA1c levels. The results indicate that an apoB/apoA-I ratio above 0.63 should be used as a marker of increased risk.     

The association between metabolic syndrome and the anti-aging humoral factor klotho in middle-aged and older adults

Background and aimsThe goal of the present study was to determine the association between metabolic syndrome (MetS) and serum klotho levels (pg/ml) in middle-aged and older adults.Material and methodsThe National Health and Nutrition Examination Survey database from the cycles 2013–2014 and 2015–2016 were used to examine serum klotho levels in subjects with MetS and its components defined according to the 2009 Harmonizing Joint Scientific Statement. Sex-specific general linear models adjusted for potential confounders were assembled to compare mean log klotho levels between subjects with MetS and their healthy counterparts.ResultsOf 5069 participants aged 40–79 years, the prevalence of MetS was 44.8% in men and 45.1% in women. Overall, older adults, men, non-Hispanic whites, smokers, alcohol users, and subjects with decreased renal function were characteristics associated with lower klotho levels. Notably, serum klotho levels in women progressively decreased as the number of MetS components increased. Multivariate models demonstrated that women with MetS had significantly lower mean log klotho levels (6.65 vs. 6.70; P < .05) than those who did not. Likewise, abdominal obesity (6.5 vs. 6.68; P < .05) and elevated triglycerides levels (6.64 vs 6.68; P < .05) were the MetS components independently correlated with lower klotho levels.ConclusionsMetS in middle-aged and older adults was significantly and inversely associated with serum klotho levels. This association was particularly seen in women, and subjects with abdominal obesity or elevated triglycerides.     

Apolipoprotein concentrations during treatment and recurrent coronary artery disease events

The effect of untreated total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) as cardiovascular risk factors in both primary and secondary prevention has been extensively investigated. The predictive value of on-treatment lipid and apolipoprotein levels on subsequent cardiovascular events is as yet uncertain. Eight hundred forty-eight patients (675 men and 173 women) with angiographically proven coronary artery disease (CAD) who received effective statin therapy (>/=30% decrease of baseline TC) were studied. We analyzed the predictive value of on-treatment levels of TC, LDL-C, triglycerides (TG), apolipoprotein A-I (apoA-I) and apolipoprotein B (apoB) on subsequent myocardial infarction (MI) and all cause mortality. On-treatment LDL-C levels were 2.55+/-0.55 mmol/L and 2.58+/-0.62 mmol/L for men and women respectively. Age-adjusted Cox regression analysis showed that only on-treatment apoA-I was predictive for future CAD events in both men and women, whereas on-treatment HDL-C was exclusively predictive in women. On-treatment apoB levels were predictive for recurrent CAD events in the total population but not after separate analysis for men and women. On-treatment levels of TC, LDL-C, and TG did not predict subsequent events. Multivariate analysis showed that on-treatment apoA-I and apoB were the only significant predictors for future cardiovascular events. On-treatment levels of TC, LDL-C, and TG were no longer associated with increased risk of recurrent cardiovascular events in CAD patients treated to target levels, which justifies the current guidelines. However, on-treatment levels of apoB and in particular apoA-I (and HDL-C in women) were significantly predictive for MI and all-cause mortality and may therefore be more suitable for cardiovascular risk assessment in this population.     

ApoB but not LDL-cholesterol is reduced by exercise training in overweight healthy men. Results from the 1-year randomized Oslo Diet and Exercise Study

OBJECTIVES: (i) To estimate changes in apoB and apoB/apoA-I, reflecting the balance between atherogenic and anti-atherogenic lipoprotein particles, by exercise training and compare with changes in LDL-C and TC/HDL-C ratio, and (ii) To compare strengths of relationships between physical fitness and various lipoprotein variables. DESIGN, SETTING, AND SUBJECTS: The study was a 1-year open randomized trial comprising 219 healthy middle-aged subjects aged 40-49 years who were allocated to exercise or no exercise, dietary advice or no advice in a 2 x 2 factorial design. This study includes 188 men who completed the trial, 45 to diet, 48 to exercise, 58 to diet + exercise and 37 to control. INTERVENTIONS: Exercise; supervised endurance exercise three times a week. Diet; reduce weight, increase intake of fish and reduce total fat intake. MAIN OUTCOME MEASURE: One-year change in apoB and apoB/apoA-I ratio. RESULTS: Exercisers decreased their ApoB and ApoB/ApoA-I values significantly compared to non-exercisers. LDL-C was not, but LDL-C/HDL-C was marginally but statistically significantly reduced by exercise. One-year change in ApoB and ApoB/ApoA-I correlated more strongly to 1-year changes in physical fitness than LDL-C or LDL-C/HDL-C. Adjusting for changes in LDL-C or LDL-C/HDL-C did not influence the correlation between changes in fitness and ApoB or ApoB/ApoA-I. However, adjusting for changes in ApoB or ApoB/ApoA-I wiped out the correlation between change in fitness and LDL-C or LDL-C/HDL-C. Relationships weakened when adjusting for changes in waist circumference, but Apo B or ApoB/ApoA-I still correlated significantly to changes in fitness. CONCLUSION: Physical exercise reduced the atherogenic burden as experienced by the reduction in apoB or apoB/apoA-I levels, but not by LDL-C in healthy middle-aged men. Possibly, regular physical activity might increase the LDL-C particle size, thereby making LDL less atherogenic. Monitoring of apolipoproteins rather than the cholesterol moiety of lipoproteins might improve the assessment of lipoprotein changes after exercise training.     

High-sensitivity C-reactive protein and white blood cell count equally predict development of the metabolic syndrome in a Japanese health screening population

To compare high-sensitivity C-reactive protein (hs-CRP) and white blood cell count (WBC) as a predictor of metabolic syndrome (MetS). Hazard ratios (HRs) adjusted for age, smoking, and other confounding covariates and areas under receiver operating characteristic curve (AUCs) of hs-CRP and WBC for developing MetS were calculated in 1,463 men and 920 women from a Japanese health screening population who were free from MetS, diabetes, histories of coronary heart disease, and stroke at baseline and followed through 3 years. The adjusted HRs (95% confidence interval—CI; p value) of MetS for each 1 SD increases in log hs-CRP, and log WBC were 1.345 (1.166–1.553; <0.001) and 1.406 (1.188–1.664; <0.001), respectively, in men and 1.388 (1.110–1.736; 0.004) and 1.358 (1.072–1.721; 0.011), respectively, in women. However, the HRs became nonsignificant after further adjusted for the components of MetS. The AUCs (95% CI; p value) of hs-CRP and WBC for predicting MetS were 0.616 (0.573–0.660; <0.001) and 0.613 (0.566–0.659; <0.001), respectively, in men and 0.636 (0.573–0.698; <0.001) and 0.606 (0.538–0.673; 0.003), respectively, in women. Hs-CRP and WBC equally predict development of MetS, but both are poor predictors of MetS in a Japanese health screening population where obesity is not prevailing.     

Obstructive sleep apnea and the metabolic syndrome in an elderly healthy population: the SYNAPSE cohort

Background

Obstructive sleep apnea syndrome (OSA) has been recently considered as a cause and a component of the metabolic syndrome (MetS), previous studies showing the presence of OSA in about half of middle-aged patients having MetS. To date, no study has considered the association of OSA and MetS in the elderly. In this study we examine the prevalence of MetS and its strength association among healthy elderly OSA subjects.

Methods

A cohort of 806 subjects aged 68.5?years, participants of a 7-year follow-up study, was examined. All subjects underwent clinical evaluation, blood sample measurements, and an at-home polygraphy. OSA was assessed as an apnea/hypopnea index (AHI) >15, and MetS was diagnosed according to the Adult Treatment Panel III.

Results

In the total group, 9.8% of cases met criteria for MetS with a prevalence similar in men and women. Of the entire group with Mets, 51.3% were women and 48.7% men. OSA was diagnosed in 55.9% of the sample, and among the OSA group, 12.5% had MetS. Oxyhemoglobin desaturation index (ODI, p?p?=?0.003) were found significantly higher in subjects with MetS than in those without it. Most of MetS components were significantly associated with AHI and ODI, the relationship stronger with ODI. After adjustment for covariables such as obesity, gender, and presence of diabetes, ODI was independently associated with three MetS components, glycemia (p?p?=?0.002), and triglyceride levels (p?=?0.02). Sleepiness, autonomic arousal index, and sleep duration had no effect on the metabolic parameters.

Conclusions

In elderly subjects, the association between OSA and MetS was stronger for hyperglycemia and hypertension. Among factors explaining this association, hypoxemia appears to be the most important factor without any effect of indices of sleep fragmentation, sleep duration, and sleepiness.     

Electrocardiographic changes associated with insulin resistance

Background and aimCardiac steatosis has been related to increased risk of heart disease. We investigated the association between cardiac steatosis, electrocardiographic (ECG) abnormalities, and individual components of the metabolic syndrome (MetS).Methods and resultsA 12-lead ECG and laboratory data were examined in 31 men with the MetS and in 38 men without the MetS. Myocardial triglyceride (MTG) content was measured with 1.5 T magnetic resonance (MR) spectroscopy and epicardial and pericardial fat by MR imaging. MTG content, epicardial and pericardial fat depots were higher in men with the MetS compared with subjects without the MetS (p < 0.001). The heart rate was increased (p < 0.001), the PR interval was longer (p < 0.044), the frontal plane QRS axis shifted to the left (p < 0.001), and the QRS voltage (p < 0.001) was lower in subjects with the MetS. The frontal plane QRS axis and the QRS voltage were inversely correlated with MTG content, waist circumference (WC), body mass index (BMI), TGs, and fasting blood glucose. High-density lipoprotein cholesterol correlated positively and measures of insulin resistance negatively with the QRS voltage. MTG content and hypertriglyceridemia were determinants of the frontal plane QRS and WC and hyperglycemia were predictors of the QRS voltage.ConclusionThe MetS and cardiac steatosis appear to associate with multiple changes on 12-lead ECG. The frontal plane QRS axis is shifted to the left and the QRS voltage is lower in subjects with the MetS. Standard ECG criteria may underestimate the presence of left ventricular hypertrophy in obese subjects with cardiometabolic risk factors.     

Metabolic syndrome: The association of obesity and unhealthy lifestyle among Malaysian elderly people

The aim of this study is to investigate the prevalence of metabolic syndrome (MetS) and its predictors among Malaysian elderly. A total of 343 elderly aged ≥60 years residing low cost flats in an urban area in the central of Malaysia were invited to participate in health screening in community centers. Subjects were interviewed to obtain socio demography, health status and behavior data. Anthropometric measurements were also measured. A total of 30 ml fasting blood was taken to determine fasting serum lipid, glucose level and oxidative stress. MetS was classified according to The International Diabetes Federation (IDF) criteria. The prevalence of MetS was 43.4%. More women (48.1%) were affected than men (36.3%) (p < 0.05). Being obese or overweight was the strongest predictor for MetS in men and women (p < 0.05, both gender). High carbohydrate intake increased risk of MetS in men by 2.8 folds. In women, higher fat free mass index, physical inactivity and good appetite increased risk of MetS by 3.9, 2.1 and 2.3 folds respectively. MetS affected almost half of Malaysian elderly being investigated, especially women, and is associated with obesity and unhealthy lifestyle. It is essential to develop preventive and intervention strategies to curb undesirable consequences associated with MetS.