Components of the metabolic syndrome, but not the metabolic syndrome per se, are associated with aortic distensibility

Background and aimReduction in aortic distensibility occurs early in the atherosclerosis process and carries a poor prognosis. Metabolic syndrome is common and it is associated with increased cardiovascular mortality. The aim of this cross-sectional study was to investigate the association between metabolic syndrome and aortic distensibility.Methods and resultsA total of 135 subjects without diabetes were studied. Metabolic syndrome was diagnosed using the NCEP-ATP-III criteria. Aortic distensibility was assessed non-invasively by ultrasonography. Multivariate analysis, after controlling for the components of the metabolic syndrome, and, additionally, for body mass index, pulse pressure, presence of coronary artery disease, use of statins and use of angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers, demonstrated an independent association between aortic distensibility and age (p < 0.001), systolic blood pressure, (p = 0.02), diastolic blood pressure (p = 0.005), and history of hypertension (p < 0.001), but not metabolic syndrome status. Moreover, there was a suggestive association with albumin-to-creatinine ratio (p = 0.06).ConclusionsMetabolic syndrome per se is not associated with reduction in aortic distensibility. From the components of the metabolic syndrome, only blood pressure is a strong predictor of aortic distensibility. In addition, ageing and higher values of albumin-to-creatinine ratio are also associated with low aortic distensibility.     

A prospective study of determinants of the metabolic syndrome in adults

Background and aimFew studies have prospectively examined the development of the metabolic syndrome and comprehensive set of risk factors in a cohort. The objective of this study was to evaluate determinants of the metabolic syndrome in adults in a prospective study.Methods and resultsIn this population-based cohort study, a representative sample of 410 subjects (184 men and 226 women), aged 18–74 years, free of the metabolic syndrome at baseline, were studied. In the subsequent 3.5 years metabolic syndrome, defined according to ATP III guidelines, developed in 71 subjects (33men and 38 women) The best determinants of metabolic syndrome were hypertension [odds ratio (OR) by quartiles: 1, 1.2, 1.6, 4.2, p for trend <0.05], waist circumference (1, 1.1, 2, 5.3, p for trend <0.05), triglyceride (1, 1, 2, 3, p for trend <0.05) and HDL cholesterol (1, 0.4, 0.4, 0.3, p for trend <0.05). A prominent dose–response relationship across the carbohydrate and fat intake categories and the odds of metabolic syndrome was observed in univariate analysis. In multivariate analysis high waist circumference was the optimum predictor [OR 8 (4–12.2)].ConclusionThis report confirms importance of blood pressure, waist circumference and lipid measurements in risk stratification of metabolic syndrome in adulthood. Interventions that address obesity and reduce waist circumference and an appropriate diet may reduce the incidence of the metabolic syndrome in adults.     

Metabolic syndrome and menopause: A population-based study

BackgroundMetabolic syndrome has a key role in developing cardiovascular diseases. It has become a major problem in many countries, especially in women. This study was performed to evaluate the metabolic syndrome status and its changes through menopause.MethodsThe 25–64-year-old individuals in Population Lab of Tehran Medical University were studied through a single-stage cluster sampling. The study was designed according to the World Health Organization (WHO) Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) project using the Adult Treatment Panel III (ATP III) criteria. The study population consisted of 607 men and 966 women. The parameters used for the risk analysis were waist circumference, fasting serum triglycerides, high-density lipoprotein-cholesterol, blood pressure and fasting plasma glucose.ResultsThe prevalence was high in women especially after menopause. In post-menopausal women, prevalence exceeded that in men by more than twice (60.0% vs. 19.0%, p < 0.0001). The mean levels of metabolic syndrome-related risk factors were significantly higher in post-menopausal women. Even irregular menses was associated with significantly higher rate of hypertriglyceridemia (p = 0.011) and abdominal obesity (p = 0.044).ConclusionAlthough, previous studies have shown that women are protected against cardiovascular disorders, some factors have changed this pattern. So that prevalence of metabolic syndrome in women is now even higher than in men. This process exacerbates with the decrease in estrogen levels through menopause. Consideration of early prevention and therapy in this specific group is of great importance.     

Screening for the metabolic syndrome using simple anthropometric measurements in south Asian and white Europeans: A population-based screening study. The Leicester Ethnic Atherosclerosis and Diabetes Risk (LEADER) Study

AimsTo estimate the prevalence of metabolic syndrome in a general population sample of south Asians and white Europeans and compare predictors of metabolic syndrome, using ethnic specific definitions of obesity.Methods3099 participants (71.4% white European, 28.6% south Asian) aged 40–75 years were screened using a 75 g oral glucose tolerance test. Metabolic syndrome was defined using National Cholesterol Education Programme and International Diabetes Federation definitions. We compared sensitivity, specificity and area under the curve of waist circumference, body mass index and waist–hip ratio.ResultsThe prevalence of metabolic syndrome using the definitions above was 29.9% (29.2% south Asian, 30.2% white European), and 34.4% (34.2% south Asian, 34.5% white European), respectively. Using the National Cholesterol Education Programme definition, waist circumference was significantly more predictive of metabolic syndrome than body mass index or waist–hip ratio. The area under the curve for waist circumference was 0.75 (95% CI: 0.69–0.80) and 0.76 (0.72–0.81) for south Asian men and women; 0.83 (0.80–0.85) and 0.80 (0.77–0.82) for white European men and women.ConclusionsThe prevalence of metabolic syndrome is high in both south Asian and white European populations. Waist circumference is a simple and effective measure for predicting metabolic syndrome in different populations.     

Determination of most suitable cut off point of waist circumference for diagnosis of metabolic syndrome in Kerman

ObjectivesMetabolic syndrome is a determining indicator of cardiovascular diseases and diabetes. Abdominal obesity, determined by measuring waist circumference, is one of the most important criteria for diagnosing this syndrome. This criterion varies between men and women and among different races. The present study aims at the assessment of the sensitivity and specificity of the commonly used cut off point of waist circumference, and the estimation of the most suitable cut off point of waist circumference for the diagnosis of metabolic syndrome in the urban society of Kerman.Methods5332 subjects consisting of 2966 women and 2366 men, 20 years old and above were studied in a population based, cross sectional study. Waist circumference, blood pressure, blood sugar, and blood lipids were measured. People with at least two of the NCEP ATP III criteria – high blood pressure (BP > 130/80), high triglycerides (TG > 150), high glucose (FBG > 100) and low HDL (HDL < 40 in men and <50 in women) – were taken as population at risk. ROC analysis was used for determining the most suitable cut off point of waist circumference. The prevalence of metabolic syndrome was then assessed based on IDF, NCEP criteria and the proposed criterion, and agreement among the three methods in diagnosing people suffering from metabolic syndrome was examined.ResultsThe average ± standard deviation of waist circumference in women and in men was 83.90 ± 12.55 and 87.99 ± 11.94 cm respectively. The most suitable cut off point of waist circumference for metabolic syndrome diagnosis was 86 in women and 89 in men. These circumferences had the highest specificity and sensitivity. The prevalence of metabolic syndrome in IDF, NCPE, and the proposed criterion was 30.4%, 27.7%, and 35.2% respectively. The new criterion and the NCEP criterion achieved the highest agreement (kappa factor = 83%).ConclusionThe cuts off point of waist circumference in men and women are close. It is possible, then, to determine a common cut off point of waist circumference for both in Iran. Therefore, the cut point of 90-cm of waist circumference proposed by the National Obesity Committee seems to be appropriate for the Iranian society. These clinical findings should nevertheless be verified by simulation.     

Weight change modulates epicardial fat burden: a 4-year serial study with non-contrast computed tomography

IntroductionEpicardial fat volume (EFV) is linked to cardiovascular event risk. We aimed to investigate the relationships between EFV and weight change.MethodsFrom the EISNER (Early Identification of Subclinical Atherosclerosis using Non-invasive Imaging Research) Registry with baseline and follow-up coronary calcium scans (1248 subjects), we selected a cohort of 374 asymptomatic subjects matched using age decade, gender and coronary calcium score (CCS) as a measure of subclinical cardiovascular risk, who underwent 2 scans at an interval of 4.1 ± 0.4 years. Using semi-automated validated software, pericardial contours were generated on all slices by spline interpolation from 5 to 10 control points. EFV was computed as fat volume within the pericardial contours. Weight gain/loss was defined as >5% change.ResultsAt baseline, EFV was moderately correlated to weight, body mass index (BMI) and waist circumference (r = 0.51, 0.41 and 0.50, p < 0.0001). EFV change was weakly correlated to change in weight (r = 0.37, p < 0.0001), BMI (r = 0.39, p < 0.0001) and waist circumference (r = 0.21, p = 0.002). On multivariable linear regression analysis, weight change [β = 1.2, 95% confidence interval (CI) 0.9–1.5, p < 0.001], BMI change (β = 1.2, 95% CI 0.9–1.5, p < 0.001), gender (β = ?6.4, 95% CI ?10.9 to ?1.8, p = 0.006) and hypertension (β = 4.7, 95% CI 0.5–9.0, p = 0.03) predicted EFV change. EFV decreased in 54 subjects with weight loss and increased in 71 subjects with weight gain (?2.3 ± 21.1% vs. 23.3 ± 24.4%, p < 0.001).ConclusionsEFV is related to body weight, BMI and waist circumference. Reduction in weight may stabilize or reduce EFV, while weight gain may promote EFV increase.     

Long-term cardiac rehabilitation and exercise training programs improve metabolic parameters in metabolic syndrome patients with and without coronary heart disease

Background and aimsThe effectiveness of long-term cardiac rehabilitation and exercise training programs on metabolic parameters was evaluated in metabolic syndrome subjects with and without coronary heart disease (CHD).Methods and resultsFifty-nine CHD and 81 non-coronary patients with metabolic syndrome (59 ± 8 vs 56 ± 9 years) were identified retrospectively at entry into identical cardiac rehabilitation and exercise-training programs. Metabolic syndrome was defined using modified Adult Treatment Panel III criteria. Exercise training occurred approximately twice per week. Metabolic and exercise testing data were collected at baseline and after 12 months during the course of the program. Mean duration of cardiac rehabilitation and exercise training programs was over one year in both coronary and non-coronary patients (366 ± 111 vs 414 ± 102 days for CHD and non-coronary CHD cohorts respectively, p < 0.01). Significant improvements in bodyweight, body mass index, blood lipids, triglyceride/HDL ratio and exercise tolerance were noted in both cohorts. At the end of follow-up, 31% of CHD and 20% of non-CHD subjects no longer possessed diagnostic criteria for metabolic syndrome (p < 0.0001 and p < 0.001 respectively).ConclusionsA long-term cardiac rehabilitation program reduces metabolic syndrome prevalence in CHD patients and results in a similar improvement in risk factor control for metabolic syndrome patients without CHD.     

Long-term follow-up of participants in a health promotion program for treated hypertensives (ADAPT)

Background and aimsImprovements in a lifestyle modification program for hypertensives were maintained 1 year later. Longer follow-up in such studies is limited; we therefore re-assessed participants after an additional 2 years in which there was no contact with program facilitators.Methods and resultsParticipants randomised to usual care (N = 118) or a 4-month lifestyle program (N = 123) were previously assessed after 4 months and 1 year. After a further 2 years, diet, alcohol intake, physical activity, weight, waist girth, ambulatory blood pressure (BP), blood lipids, glucose and insulin were measured (usual care N = 64; program N = 76). Statistically significant net changes, relative to usual care, included blood cholesterol (−0.2 mmol/L, 95% CI 0.1–0.4); physical activity (53 min/week, 95% CI 15–91); dietary saturated fat (−1.9% energy, 95% CI −0.1 to −3.8); fish (3.2 serves/month, 95% CI 0.7–5.7); vegetables (9.1 serves/month, 95% CI 3.2–15.1); and sweet foods (−6.2 serves/month, 95% CI −1.1 to −11.3). Between-group changes in weight (−0.7 kg, 95% CI −1.8–0.4), BP (systolic 1.4 mmHg, 95% CI −0.7–3.5)/diastolic 1.0 mmHg, 95% CI −0.3–2.4) and Framingham risk (usual care: men 12.1%, women 3.7%; program: men 12.2%; women 3.5%) did not differ significantly.ConclusionContinued reinforcement with long-term follow-up is needed in lifestyle modification programs.     

Association between leptin and its soluble receptor with cardiometabolic risk factors in a Brazilian population

BackgroundMost studies evaluating the conjoint effects of leptin and human soluble leptin receptor (hs-LR) on cardiometabolic risk factors have been conducted in well-characterized ethnic groups. We aimed to assess the associations of leptin and hs-LR with the cardiometabolic risk factors that reflect the components of metabolic syndrome (MetS) in a Brazilian population with varying degrees of adiposity.MethodsThis is a cross-sectional analysis of adult subjects (n = 173, age 45 ± 12 years, 124 women; body mass index [BMI] 35.6 ± 9.5 kg/m²) for association of leptin and its soluble receptor with cardiometabolic risk factors (glucose, BMI, waist circumference, hip circumference, blood pressure, insulin, cholesterol and triglycerides). Plasma hs-LR was measured by ELISA; insulin and leptin were determined by RIA. Metabolic syndrome was defined by NCEP/ATP III.ResultsLeptin was positively associated with blood pressure, BMI, waist circumference, hip circumference, triglycerides, glucose, insulin and HOMA and inversely correlated with HDL-cholesterol. The hs-LR exhibited inverse relationship with cardiometabolic risk factors (P ≤ 0.006), except for glucose and lipid parameters. Leptin increased, whereas hs-LR decreased, with increasing number of MetS components (P for trend < 0.001). In multivariable models, sex, BMI and insulin were independently associated with leptin, whereas age, sex, BMI and systolic blood pressure were the independent correlates of hs-LR.ConclusionIn a Brazilian population with complex interethnic admixture, levels of hs-LR and leptin were independently associated with systolic blood pressure and insulin, respectively. Leptin increased with increasing number of MetS components. In turn, hs-LR decreased as the number of MetS components increased.     

Perfil lipídico e glicídico de pacientes atendidos em ambulatório e sua correlação com índices antropométricos

Introduction and objectiveObesity is associated with high rates of dyslipidemia and glucose intolerance. The objective of this study was to evaluate the correlation of anthropometric indices with the lipid and glucose profiles of outpatients.MethodsWe performed a cross-sectional study assessing anthropometric and metabolic parameters in a sample of 550 individuals.ResultsThe prevalence of overweight exceeded 80%, with no difference between the sexes. However, 80.9% of women vs. 52.1% of men had waist circumference in the very high risk range (P = 000). Glucose and lipid abnormalities were found in over 40% of the sample. In men, no correlation was found between anthropometric indices and metabolic profile. In women, HDL cholesterol was negatively correlated with body mass index waist circumference and waist-to-height ratio. Triglycerides were positively correlated with body mass index, waist circumference and waist-to-height ratio and fasting plasma glucose with waist circumference and waist-to-height ratio. After adjustment for age and nutritional status, the correlations only remained significant between HDL cholesterol and anthropometric indices.ConclusionsAmong women, the anthropometric indices waist circumference, waist-to-height ratio and body mass index proved good predictors of HDL cholesterol, showing the importance of using these parameters in clinical practice and for screening of cardiovascular risk.     

Lower fasting blood glucose, glucose variability and nocturnal hypoglycaemia with glargine vs NPH basal insulin in subjects with Type 1 diabetes

Background and aimsTo compare switching from NPH insulin (NPH) to insulin glargine (glargine) with continuing NPH for changes in fasting blood glucose (FBG) in patients with Type 1 diabetes on basal–bolus therapy with insulin lispro as bolus insulin. Secondary objectives included self-monitoring blood glucose, mean daily blood glucose (MDBG) and mean amplitude glucose excursion (MAGE) values alongside changes in HbA_1c and safety profiles.Methods and resultsThis was a 30-week, parallel, open-label, multicentre study. Seven-point profiles were used to calculate MDBG and MAGE. Hypoglycaemia and adverse events were recorded by participants. FBG improved significantly with both glargine (baseline–endpoint change: −28.0 mg/dL; 95% CI: −37.3, −18.7 mg/dL; p < 0.001) and NPH (−9.8 mg/dL; 95% CI: −19.1, −0.5 mg/dL; p = 0.0374). The improvement was significantly greater with glargine than NPH (mean difference: −18.2 mg/dL; 95% CI: −31.3, −5.2 mg/dL; p = 0.0064). MDBG (−10.1 mg/dL; 95% CI: −18.1, −2.1 mg/dL; p = 0.0126) and MAGE (−20.0 mg/dL; 95% CI: −34.5, −5.9 mg/dL; p = 0.0056) decreased significantly with glargine, but not NPH although endpoint values were no different with the two insulins. Baseline to endpoint change in HbA_1c was similar (−0.56 vs −0.56%) with no differences at endpoint. Overall hypoglycaemia was no different, but glargine reduced nocturnal hypoglycaemia (“serious episodes” with BG < 42 mg/dl, p = 0.006) whereas NPH did not (p = 0.123), although endpoint values were no different.ConclusionSwitching from NPH to glargine is well tolerated and results into lower FBG, and lower glucose variability while reducing nocturnal hypoglycaemia. These data provide a rationale for more aggressive titration to target with glargine in Type 1 diabetes.     

Uric acid level as a risk marker for metabolic syndrome: a Chinese cohort study

ObjectiveDespite some epidemiologic research demonstrating a positive relationship between serum uric acid (SUA) levels and the prevalence of metabolic syndrome (MetS), prospective data on SUA as a predictor of MetS incidence are limited.MethodsThe authors examined SUA as a risk marker for incident MetS in a prospective study of 3857 subjects who were free of MetS at baseline recruitment. Hyperuricemia was defined as SUA ≥7.7 mg/dL for men and ≥6.6 mg/dL for women. The MetS was defined according to a unified criteria set by several major organizations.ResultsDuring a mean follow-up of 5.41 years, 476 participants developed MetS. A significantly stepwise increase in the incidence of MetS across tertiles of SUA was observed in the whole group (p for trend <0.001). Among women, this association was more robust than in men. After adjustment for age, variations of blood pressure, triglycerides, HDL-C, glucose, and waist circumference, females in the middle and upper tertiles of SUA had significantly higher risk of developing MetS when compared with subjects in the lowest tertile [adjusted-HR (95% CI) was 1.67 (1.12–2.49) and 3.18 (2.20–4.60), respectively; p for trend <0.001]. Overall, hyperuricemia was a significantly independent risk determinant for MetS in women, but it was a non-significant factor for MetS mediating waist circumference and serum triglycerides in men.ConclusionSUA concentration is more closely associated with MetS in females than in males. Future investigations are needed to explore the underlying mechanisms involved in the sex-related association between SUA concentration and MetS risk.     

Increased volume of epicardial fat is an independent risk factor for accelerated progression of sub-clinical coronary atherosclerosis

BackgroundEpicardial adipose tissue (EAT), a metabolically active visceral fat depot surrounding the heart, has been implicated in the pathogenesis of coronary artery disease (CAD) through possible paracrine interaction with the coronary arteries. We examined the association of EAT with metabolic syndrome and the prevalence and progression of coronary artery calcium (CAC) burden.MethodsCAC scan was performed in 333 asymptomatic diabetic patients without prior history of CAD (median age 54 years, 62% males), followed by a repeat scan after 2.7 ± 0.3 years. CAC progression was defined as >2.5 mm³ increase in square root transformed volumetric CAC scores. EAT and intra-thoracic fat volumes were quantified using a dedicated software (QFAT), and were examined in relation to the metabolic syndrome, baseline CAC scores and CAC progression.ResultsBoth epicardial and intra-thoracic fat were associated with metabolic syndrome after adjustment for conventional cardiovascular risk factors, but the association was attenuated after additional adjustment for body mass index. EAT, but not intra-thoracic fat, showed significant association with baseline CAC scores (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.04–1.22, p = 0.04) and CAC progression (OR 1.12, 95% CI 1.05–1.19, p < 0.001) after adjustment for conventional measures of obesity and risk factors.ConclusionEAT volume measured on non-contrast CT is an independent marker for the presence and severity of coronary calcium burden and also identifies individuals at increased risk of CAC progression. EAT quantification may thus add to the prognostic value of CAC imaging.     

Factor analysis of metabolic syndrome components in obese women

Background and aimFactor analysis is a multivariate correlation technique that is frequently employed to characterise the clustering of intercorrelated abnormalities, which underlie the metabolic syndrome in cohorts of individuals with different characteristics. To our knowledge, it has never been used to identify the components of this syndrome in obese subjects. The purpose of this study was to use factor analysis to investigate the clustering of features, which characterise the metabolic syndrome, in a cohort of 552 obese women aged 18–83 years (mean body mass index: 43.0 kg/m² ± 5.7 SD).Methods and resultsPrincipal component analysis reduced ten correlated physiological variables, to four uncorrelated factors that explained 72.2% of the variance in the original parameters. These factors were interpreted as: (1) an insulin resistance factor, with positive loading of fasting serum insulin and homeostatic model assessment of insulin resistance; (2) a metabolic glucose/lipid factor, with positive loading of fasting plasma glucose, triglycerides, waist-to-hip ratio, and inverse loading of high density lipoprotein cholesterol; (3) a body mass factor, with positive loading of body mass and waist circumference; and (4) a blood pressure factor, with positive loading of systolic and diastolic blood pressure.ConclusionThe identification of four independent factors is consistent with previous findings among samples of different populations and may also support, in obese women, the hypothesis that multiple physiological determinants are responsible for the abnormalities underlying the metabolic syndrome. Nonetheless, findings in this cohort of obese women suggest that the absolute degree of adiposity is not correlated with any tested component of the metabolic syndrome, but that the relative fat distribution is highly correlated with the development of hyperglycaemic and dyslipidaemic phenomena. Furthermore, insulin resistance appears to be a major factor in obese individuals, independent of other metabolic and anthropometic abnormalities.     

Normal weight obese (NWO) women: an evaluation of a candidate new syndrome

Background and aimsObesity, an independent risk factor for cardiovascular disease (CVD), has been associated with the early development of coronary atherosclerosis in adolescents and young men. A subset of metabolically obese but normal weight individuals was identified, with potentially increased risks for development of the metabolic syndrome despite their normal body mass index. We determined the relationship among body fat distribution and selected CVD risk factors to distinguish normal weight obese from controls with normal metabolic profiles.Methods and resultsWe analysed anthropometric variables, body composition by DXA, RMR by indirect calorimetry and bioumoral variables of 74 clinically healthy Caucasian Italian women. Significant differences were observed in the biochemical HDL-chol values between NWO and controls and pre-obese-obese. Significant correlations were found among cardiovascular risk indexes, LEAN of the right part of the trunk and TC/HDL (R = −0.69, p < 0.001) and LDL/HDL (R = −0.72, p < 0.001), and LEAN and RMR (R = 0.44, p = 0.022) of NWO women.ConclusionsIn normal weight obese women the cardiovascular risk indexes are related to metabolic variables and to body fat mass distribution. NWO individuals showed a relationship between the decrease in LEAN of the left leg and an increase in CVD risk factors. We suggest that LEAN distribution seems to be a potential predictor of CVD.     

High prevalence of metabolic syndrome among urban subjects in India: A multisite study

ObjectiveMetabolic syndrome is an important cardiovascular risk factor. To determine its prevalence among urban subjects in India we performed a multisite study.MethodsThe study was performed at eleven cities using cluster sampling. 6198 subjects (men 3426, women 2772, response 62%, age 48 ± 10 years) were evaluated for socio-demographic, lifestyle, anthropometric and biochemical factors. Prevalence of metabolic syndrome was determined using harmonized Asian-specific criteria. Significant socioeconomic and lifestyle associations were determined.ResultsAge adjusted prevalence (%, 95% confidence intervals) of metabolic syndrome in men and women was 33.3 (31.7–34.9) and 40.4 (38.6–42.2) (harmonized criteria), 23.9 (22.4–26.4) and 34.5 (32.0–36.1) (modified Adult Treatment Panel-3, ATP-3) and 17.2 (15.3–19.1) and 22.8 (20.1–24.2) (ATP-3). Individual components of metabolic syndrome in men and women, respectively, were: high waist circumference 35.7 (34.1–37.3) and 57.5 (55.6–59.3), high blood pressure 50.6 (48.9–52.3) and 46.3 (44.4–48.1), impaired fasting glucose/diabetes 29.0 (27.5–30.5) and 28.0 (26.3–29.7), low HDL cholesterol 34.1 (32.5–35.7) and 52.8 (50.9–54.7) and high triglycerides 41.2 (39.5–42.8) and 31.5 (29.7–33.2) percent. Prevalence of metabolic syndrome was significantly greater in subjects with highest vs. lowest categories of education (45 vs. 26%), occupation (46 vs. 40%), fat intake (52 vs. 45%), sedentary lifestyle (47 vs. 38%) and body mass index (66 vs. 29%) (p < 0.05).ConclusionThere is high prevalence of metabolic syndrome in urban Indian subjects. Socioeconomic (high educational and occupational status) and lifestyle (high fat diet, low physical activity, overweight and obesity) factors are important.     

Peri-aortic fat,cardiovascular disease risk factors,and aortic calcification: The Framingham Heart Study

ObjectivePerivascular fat through the secretion of paracrine and pro-inflammatory mediators may play a role in obesity-mediated vascular disease. We sought to examine associations between adipose tissue depots immediately surrounding the thoracic aorta, metabolic risk factors, and vascular calcification.MethodsIn participants free of cardiovascular disease (CVD) from the Framingham Heart Study Offspring cohort who underwent computed tomography (n = 1067, mean age 59 years, 56.1% women), thoracic peri-aortic fat depots were quantified. Visceral abdominal tissue (VAT) and calcification of the thoracic and abdominal aorta were also measured.ResultsPeri-aortic fat depots were correlated with body mass index, waist circumference (WC), VAT (all p < 0.0001), hypertension (p = 0.007), low HDL (p < 0.0001), serum triglycerides (p < 0.0001), impaired fasting glucose (p = 0.005), and diabetes (p = 0.02). These associations generally remained significant after adjustment for BMI and WC (all p-values < 0.05), but not after VAT adjustment. Thoracic aortic fat was associated with thoracic calcification in models containing VAT (OR 1.31, 95% CI 1.01–1.71, p = 0.04), but was not significant after adjustment for CVD risk factors (OR 1.16, 95% CI 0.88–1.51, p = 0.30). Thoracic aortic fat, however, was associated with abdominal aortic calcification (OR 1.48, 95% CI 1.11–1.98, p = 0.008) and coronary artery calcification (OR 1.47, 95% CI 1.09–1.98, p = 0.001) even in models including CVD risk factors and VAT.ConclusionsThoracic peri-aortic fat is associated with measures of adiposity, metabolic risk factors, and coronary and abdominal aortic calcification.     

Using brachial-ankle pulse wave velocity to associate arterial stiffness with cardiovascular risks

Background and aimsThis study aimed to elucidate the relationship between brachial-ankle pulse wave velocity (baPWV) and conventional cardiovascular risk factors.Methods and resultsA total of 192 subjects with low to intermediate risk was enrolled in a cardiovascular evaluation program. A multiple regression model was built to find significant cardiovascular biomarkers for predicting baPWV. A logistic regression model was developed to associate baPWV and other biomarkers with the risk of cardiac diastolic dysfunction. A total of 123 men (mean age: 52.6 ± 12.0) and 69 women (mean age: 51.7 ± 10.4) was included. Age, blood pressure, C-reactive protein, serum homocysteine, heart rate, and blood urea nitrogen were positively predictive of increased pulse wave velocity. In turn, baPWV increased the risk (odds ratio: 1.257 for each m/s, 95% CI: 1.105 ∼ 1.430, p < 0.001) and high-density lipoprotein decreased the risk for cardiac diastolic dysfunction (0.962 for each mg/dl, 95% CI: 0.925 ∼ 1.000, p = 0.05). The correlation between baPWV and Framingham 10-year risk was moderate (men: r = 0.306, p = 0.002; women r = 0.548, p < 0.001).ConclusionThe results suggest that baPWV is a composite risk factor for early atherosclerotic change and a predictor for the development of diastolic dysfunction and long-term cardiovascular risk.     

FABP4 predicts atherogenic dyslipidemia development. The PREDIMED study

ObjectiveAtherogenic dyslipidemia (AD), characterized by high plasma triglycerides and low HDL particles, is considered one of the main effectors of vascular damage associated with obesity, metabolic syndrome (MS) and type 2 diabetes. Adipocyte fatty acid-binding protein (FABP4) plasma concentrations have been linked to metabolic alterations that are associated with adiposity. The aim of the present study was to prospectively analyze the predictive value of baseline FABP4 plasma concentrations for the development of AD.MethodsIn the frame of the PREDIMED study, a multicenter dietary interventional trial, we prospectively measured the baseline plasma FABP4 levels and AD incidence over a six-year follow-up period (median 4 [IQR, 3–5 years]) in 578 volunteers who visited their general practitioners because of their cardiovascular risk factors.ResultsDuring follow-up, 103 participants developed AD. Baseline plasma FABP4 levels were associated with new onset AD over the follow-up period (OR 1.03 [95% IC: 1.00–1.05], p = 0.020). This increased risk was observed in women but not in men. Among women, those in the highest tertile of FABP4 had a 2.54-fold increased relative risk of developing AD compared to the lowest tertile (HR 2.54 [95% CI, 1.31–4.93], p for trend = 0.008).ConclusionsElevated plasma FABP4 concentrations should be considered as a potential marker of metabolic derangement, which may predict the development of AD in women.     

High serum levels of remnant lipoproteins predict ischemic stroke in patients with metabolic syndrome and mild carotid atherosclerosis

Background and objectiveMetabolic syndrome is prevalently associated with stroke. Triglyceride-rich lipoproteins contribute to atherothrombotic complications in metabolic syndrome. This study examined whether high levels of remnant lipoprotein, atherogenic triglyceride-rich lipoprotein, may be associated with future ischemic stroke in metabolic syndrome.Methods and resultsWe followed up 292 consecutive patients with metabolic syndrome meeting ATP III criteria and mild carotid plaques for a period of ≤24 months until occurrence of an ischemic stroke. Remnant lipoprotein (remnant-like lipoprotein particles cholesterol; RLP-C) were measured by an immunoseparation method. Twenty-two ischemic stroke events occurred during follow-up. A multivariate Cox proportional hazards models showed that high RLP-C levels were a significant and independent predictor of ischemic stroke events (p < 0.01). Echolucent carotid plaques were also a significant predictor of ischemic stroke that was independent of other carotid ultrasound parameters in Cox proportional hazards models (p < 0.01). High RLP-C levels were intimately and independently associated with carotid plaque echolucency (p < 0.01).ConclusionsHigh RLP-C levels are an independent risk factor for future ischemic strokes in metabolic syndrome. High RLP-C levels may be related to echolucent carotid plaque, partly accounting for high risk for ischemic stroke in metabolic syndrome.