糖耐量受损:心血管疾病的重要危险因子

学术背景:糖耐量受损阶段的异常血糖水平已导致机体组织器官损害,尤其是心血管病变.此阶段心血管疾病的患病率和死亡率均显著高于正常糖代谢人群,其心血管病变的危险性已接近糖尿病.目的:探讨糖耐量受损发生心血管疾病的危险性及其伴随的相关危险因素.检索策略:由该论文的研究人员应用计算机检索Pubmed、Blackwell Synergy数据库1997-01/2007-06的相关文献,检索词“impaired glucose tolerance,diabetes mellitus,cardiovascular disease“,并限定文章语言种类为English.同时计算机检索中国期刊全文数据库1998-01/2007-06的相关文献,检索词为“糖耐量受损,糖尿病,心血管疾病,血糖漂移“,并限定语种为中文.共检索到109篇文献,对资料进行初审,纳入标准:评估糖代谢状况的检测方法,糖耐量受损与2型糖尿病,糖耐量受损与心血管疾病.排除标准:重复性研究.文献评价:文献的来源主要是通过对糖耐量受损的定义、流行病学特点、评估方式及其危害性进行汇总分析.所选用的36篇文献中,6篇为综述,其余为临床或基础实验研究.资料综合:糖耐量受损与正常血糖者相比,已呈现明显的糖代谢紊乱.糖耐量受损进展为糖尿病的风险增大,且常合并一系列的心血管危险因子,致发生心血管疾病的危险性亦显著增加,糖耐量受损阶段心血管疾病的危险性已接近糖尿病.结论:糖耐量受损是心血管疾病的重要危险因子.有必要进一步研究及评估糖耐量受损阶段高血糖对机体的损害,早期采取干预措施,能降低及延缓心血管疾病的发生、进展.     

Abnormal glucose tolerance and increased risk for cardiovascular disease in Japanese-Americans with normal fasting glucose

OBJECTIVE: To compare the American Diabetes Association (ADA) fasting glucose and the World Health Organization (WHO) oral glucose tolerance test (OGTT) criteria for diagnosing diabetes and detecting people at increased risk for cardiovascular disease (CVD). RESEARCH DESIGN AND METHODS: Study subjects were 596 Japanese-Americans. Fasting insulin, lipids, and C-peptide levels; systolic and diastolic blood pressures (BPs); BMI (kg/m2); and total and intra-abdominal body fat distribution by computed tomography (CT) were measured. Study subjects were categorized by ADA criteria as having normal fasting glucose (NFG), impaired fasting glucose (IFG), and diabetic fasting glucose and by WHO criteria for a 75-g OGTT as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and diabetic glucose tolerance (DGT). RESULTS: Of 503 patients with NFG, 176 had IGT and 20 had DGT These patients had worse CVD risk factors than those with NGT . The mean values for NGT, IGT, and DGT, respectively, and analysis of covariance P values, adjusted for age and sex, are as follows; intra-abdominal fat area by CT 69.7, 95.0, and 101.1 cm2 (P < 0.0001); total CT fat area 437.7, 523.3, and 489.8 cm2 (P < 0.0001); fasting triglycerides 1.40, 1.77, and 1.74 mmol/l (P = 0.002); fasting HDL cholesterol 1.56, 1.50, and 1.49 mmol/l (P = 0.02); C-peptide 0.80, 0.90, 0.95 nmol/l (P = 0.002); systolic BP 124.9, 132.4, and 136.9 mmHg (P = 0.0035); diastolic BP 74.8, 77.7, and 78.2 mmHg (P = 0.01). CONCLUSIONS: NFG patients who had IGT or DGT had more intra-abdominal fat and total adiposity; higher insulin, C-peptide, and triglyceride levels; lower HDL cholesterol levels; and higher BPs than those with NGT. Classification by fasting glucose misses many Japanese-Americans with abnormal glucose tolerance and less favorable cardiovascular risk profiles.     

Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes Study.

OBJECTIVE: To determine whether the new category of impaired fasting glucose (IFG) recently proposed by the Expert Committee of the American Diabetes Association is a risk factor for cardiovascular disease. RESEARCH DESIGN AND METHODS: Death certificates and residence transfer documents from the cohort population consisting of participants of the diabetes prevalence study in Funagata, Yamagata prefecture, Japan, 1990-1992, were analyzed up through the end of 1996. First, the cohort population was classified into three groups: normal glucose tolerance (NGT) (n = 2,016), impaired glucose tolerance (IGT) (n = 382), and diabetic (n = 253). Then the same population was reclassified into normal fasting glucose (NFG), IFG, and diabetic. The cumulative survival rates among the groups were compared using the classical life-table method, and age-adjusted analyses, the person-year method, and Cox's proportional hazard model were adopted. RESULTS: At the end of seven observed years, the cumulative survival rates from cardiovascular disease of IGT and diabetes were 0.962 and 0.954, respectively, both significantly lower than that of NGT (0.988). The Cox's proportional hazard model analysis showed that the hazard ratio of IGT to NGT on death from cardiovascular disease was 2.219 (95% CI 1.076-4.577). However, the cumulative survival rate of IFG from cardiovascular disease was 0.977, not significantly lower than that of NFG (0.985). The Cox's hazard ratio of IFG to NFG on death from cardiovascular disease was 1.136 (0.345-3.734), which was not significant either. CONCLUSIONS: IGT was a risk factor for cardiovascular disease, but IFG was not.     

Fasting and postchallenge glycemia and cardiovascular disease risk: the Framingham Offspring Study

OBJECTIVE: To test the hypothesis that fasting hyperglycemia (FHG) and 2-h postchallenge glycemia (2hPG) independently increase the risk for cardiovascular disease (CVD). RESEARCH DESIGN AND METHODS: During 1991-1995, we examined 3,370 subjects from the Framingham Offspring Study who were free from clinical CVD (coronary heart disease, stroke, or intermittent claudication) or medication-treated diabetes, and we followed them for 4 years for incident CVD events. We used proportional-hazards regression to assess the risk associated with FHG (fasting plasma glucose > or =7.0 mmol/l) and 2hPG, independent of the risk predicted by standard CVD risk factors. RESULTS: Mean subject age was 54 years, 54% were women, and previously undiagnosed diabetes was present in 3.2% by FHG and 4.9% (164) by FHG or a 2hPG > or =11.1 mmol/l. Of these 164 subjects, 55 (33.5%) had 2hPG > or =11.1 without FHG, but these 55 subjects represented only 1.7% of the 3,261 subjects without FHG. During 12,242 person-years of follow-up, there were 118 CVD events. In separate sex- and CVD risk-adjusted models, relative risk (RR) for CVD with fasting plasma glucose > or =7.0 mmol/l was 2.8 (95% CI 1.6-5.0); RR for CVD per 2.1 mmol/l increase in 2hPG was 1.2 (1.1-1.3). When modeled together, the RR for FHG decreased to 1.5 (0.7-3.6), whereas the RR for 2hPG remained significant (1.1, 1.02-1.3). The c-statistic for a model including CVD risk factors alone was 0.744; with addition of FHG, it was 0.746, and with FHG and 2hPG, it was 0.752. CONCLUSIONS: Postchallenge hyperglycemia is an independent risk factor for CVD, but the marginal predictive value of 2hPG beyond knowledge of standard CVD risk factors is small.     

心血管危险因素在老年糖耐量低减病人中的聚集及护理干预

[目的]通过对老年糖耐量低减病人的调查，为心血管危险因素在老年糖耐量低减病人中聚集提供依据，同时探索有效的护理干预措施。[方法]根据葡萄糖耐量试验结果，将131例老年病人分为糖耐量正常（NGT）组，糖耐量低减（IGT）组，比较两组病人的心血管疾病危险因素的聚集性及冠心病、脑卒中的患病率．[结果]IGT组与NGT组相比，三酰甘油明显升高，高密度脂蛋白胆固醇明显降低．（P〈0，05）。IGT组的收缩压、舒张压、体重指数均值亦较NGT组明显增高，（P〈0．01）；纤维蛋白原比较（P〉0．05）。IGT组合并高血压、肥胖、血脂异常等各项心血管疾病危险因素的比例及≥两个危险因素（2RFs）的比例均明显高于NGT组（P〈0．01）。≥2RFs的IGT病人其冠心痛、脑卒中的患病率明显高于NGT组（P〈0.05）。[结论]IGT病人已存在明显的心血管疾病风险．该阶段已有心血管疾病危险因素聚集的现象，冠心病、脑卒中的患病率明显增加，应通过有效的护理措施对IGT病人给予积极干预。     

心血管危险因素在老年糖耐量低减病人中的聚集及护理干预

[目的]通过对老年糖耐量低减病人的调查,为心血管危险因素在老年糖耐量低减病人中聚集提供依据,同时探索有效的护理干预措施。[方法]根据葡萄糖耐量试验结果,将131例老年病人分为糖耐量正常(NGT)组,糖耐量低减(IGT)组,比较两组病人的心血管疾病危险因素的聚集性及冠心病、脑卒中的患病率。[结果]IGT组与NGT组相比,三酰甘油明显升高,高密度脂蛋白胆固醇明显降低,(P<0.05)。IGT组的收缩压、舒张压、体重指数均值亦较NGT组明显增高,(P<0.01);纤维蛋白原比较(P>0.05)。IGT组合并高血压、肥胖、血脂异常等各项心血管疾病危险因素的比例及≥两个危险因素(2RFs)的比例均明显高于NGT组(P<0.01)。≥2RFs的IGT病人其冠心病、脑卒中的患病率明显高于NGT组(P<0.05)。[结论]IGT病人已存在明显的心血管疾病风险,该阶段已有心血管疾病危险因素聚集的现象,冠心病、脑卒中的患病率明显增加,应通过有效的护理措施对IGT病人给予积极干预。     

Burden and rates of treatment and control of cardiovascular disease risk factors in obesity: the Framingham Heart Study

OBJECTIVE— Obesity is associated with an increased risk for cardiovascular disease (CVD). We sought to determine rates of treatment and control of CVD risk factors among normal weight, overweight, and obese individuals in a community-based cohort.RESEARCH DESIGN AND METHODS— Participants free of CVD (n = 6,801; mean age 49 years; 54% women) from the Framingham Offspring and Third Generation cohorts who attended the seventh Offspring examination (1998–2001) or first Third Generation (2002–2005) examination were studied.RESULTS— Obese participants with hypertension were more likely to receive antihypertensive treatment (62.3%) than normal weight (58.7%) or overweight (59.0%) individuals (P = 0.002), but no differences in hypertension control across BMI subgroups among participants with hypertension were observed (36.7% [normal weight], 37.3% [overweight], and 39.4% [obese]; P = 0.48). Rates of lipid-lowering treatment were higher among obese participants with elevated LDL cholesterol (39.5%) compared with normal weight (34.2%) or overweight (36.4%) participants (P = 0.02), but control rates among those with elevated LDL cholesterol did not differ across BMI categories (26.7% [normal weight], 26.0% [overweight], and 29.2% [obese]; P = 0.11). There were no differences in diabetes treatment among participants with diabetes across BMI groups (69.2% [normal weight], 50.0% [overweight], 55.0% [obese]; P = 0.54), but obese participants with diabetes were less likely to have fasting blood glucose <126 mg/dl (15.7%) compared with normal weight (30.4%) or overweight (20.7%) participants (P = 0.02).CONCLUSIONS— These findings emphasize the suboptimal rates of treatment and control of CVD risk factors among overweight and obese individuals.Obesity affects more than one-third of the adult population in the U.S. Excess weight is associated with multiple cardiovascular disease (CVD) risk factors, including hypertension, dyslipidemia, diabetes, and the metabolic syndrome.Although the incidence and mortality of CVD have declined markedly during the past decades, some studies suggested that the increasing prevalence of obesity and diabetes may have slowed this rate of decline (1). In addition, recent data suggest that the prevalence of chronic kidney disease is increasing, in part because of the increasing rates of diabetes (2). Unfortunately, the efficacy of current therapies for obesity, including lifestyle and pharmacological interventions, is limited (3). Although bariatric surgery is an effective method of weight loss among severely obese individuals, eligibility criteria limit its use to only the most significantly affected patients.Given the current limitations of effective weight loss therapies, minimizing the risk of complications of obesity and diabetes due to CVD risk factors is essential. Few studies have focused on a comprehensive approach to CVD risk factor burden, treatment, and control among obese individuals. Therefore, the aim of this study was to examine the burden of CVD risk factors as well as rates of treatment and control among normal weight, overweight, and obese individuals in an unselected population-based cohort. As abdominal fat accumulation is strongly associated with metabolic and CVD risk factors, and as recent guidelines have emphasized the importance of measuring waist circumference as part of clinical cardiovascular risk assessment, we also studied individuals with and without abdominal obesity.     

Association between postprandial lipoprotein subclasses and Framingham cardiovascular disease risk stratification

ObjectiveTo determine the ability of postprandial lipoprotein subclass concentrations to stratify patients with respect to their risk for cardiovascular disease (CVD).MethodsUsing the Framingham cardiovascular disease risk score (FRS) algorithm, a total of 112 consecutive patients referred for community health screening were stratified into two groups: (a) low-risk (FRS < 10%) and (b) intermediate/high-risk (FRS ≥ 10%). Serum lipoprotein subclass concentrations were determined by Vertical Auto Profile (VAP-II).ResultsFasting and postprandial levels of LDL4, HDL2, VLDL1 + 2, VLDL3, and RLP, as well as fasting levels of ApoB and postprandial levels of LDL3 and IDL1, were significantly different in the intermediate/high risk FRS group vs. the low-risk group (P < 0.05). Correlations between Framingham CVD risk and LDL3, LDL4, IDL1, VLDL1 + 2, VLDL3, RLP, and ApoB were positive while negative for HDL2 in both the fasting and postprandial states. Intermediate/high risk for CVD was shown to be significantly associated with both fasting and postprandial levels of VLDL1 + 2 and RLP, as well as with postprandial LDL4 and VLDL3, as determined using forward conditional logistic regression analysis. Postprandial levels of VLDL1 + 2 were better at identifying patients in the intermediate/high-risk FRS group than fasting levels, although the differences were not significant due to overlapping reference intervals. In addition, the association between RLP and VLDL subclasses relative to Framingham CVD risk increased significantly in the postprandial state (ΔR² = 0.023; ΔF = 7.178; ΔP = 0.025) but not in the fasting state.ConclusionsThe use of postprandial lipoprotein subclass concentrations is not inferior to the use of fasting levels in identifying intermediate/high-risk FRS individuals. In addition, changes in RLP and VLDL subclass concentrations in fasting vs. postprandial states may reveal lipid metabolic mechanisms associated with CVD.     

Framingham评分预测关节型银屑病患者心血管疾病风险及危险因素分析

目的应用Framingham评分预测关节型银屑病(PsA)患者未来10年心血管疾病的患病风险,并明确PsA患者未来10年发生心血管疾病的相关危险因素。方法选取2014年1月至2018年12月该院皮肤科收治的PsA患者112例作为观察组;选取同期体检健康人群(性别、年龄等相匹配)68例作为对照组。比较2组一般资料和总胆固醇(TC)、三酰甘油(TG)、血尿酸(UA)等生化指标;应用Framingham评分预测PsA患者未来10年发生心血管疾病的患病风险,Pearson相关分析、Logistic回归分析评估PsA患者发生心血管疾病的相关因素和危险因素。结果观察组男性多于女性(男∶女=1.29∶1);初发关节炎发病年龄为(48.18±13.24)岁;患者皮损中位病程和关节炎中位病程分别为13.1(11.6,14.6)年和4.5(3.0,6.0)年;观察组患者收缩压、吸烟史、既往史、TG、UA明显高于对照组(P<0.05),高密度脂蛋白胆固醇(HDL-C)明显低于对照组(P<0.05);TC、低密度脂蛋白胆固醇(LDL-C)、临床用药2组之间差异无统计学意义(P>0.05)。观察组和对照组患者Framingham评分结果分别为18.0(16.0,20.0)分、6.0(4.0,7.0)分,且Mann-Whitney检验证实2组之间差异有统计学意义(P<0.05)。10年Framingham评分与性别、年龄、初发年龄、TG、UA相关(P<0.05),且年龄、既往史、TG、UA是PsA患者发生心血管事件的独立危险因素(P<0.05)。结论PsA患者心血管疾病患病风险高,关注患者年龄、是否伴有高血压和糖尿病及定期监测TG、UA可有效评估患者发生心血管疾病的患病风险。     

Traditional and emerging risk factors for cardiovascular disease

Cardiovascular disease (CVD) is the leading cause of death in the United States and most western societies, further, approximately 50% of CVD is related to coronary heart disease (CHD). Most CVD results from an athero-thrombotic pathologic process in the body's arterial beds, and is largely preventable through risk factor reduction. Risk factors are diseases, physiologic states, biologic markers, or other identifiable factors associated with increased incidence of CVD. This article breaks down traditional, emerging,and possible risk factors for discussion.     

'Healthy living' and sulphonylurea theraphy have different effects on glucose tolerance and risk factors for vascular disease in subject with impaired glucose tolerance

This study was undertaken to determine whether impaired glucosetolerance and associated risk factors for cardiovascular diseasecan be improved with ‘healthy living’ by diet andexercise or with sulphonylurea therapy. Patients were recruitedby screening subjects with either a family history of type IIdiabetes, previous gestational diabetes, or a previously raisedplasma glucose (5.6–6.6 mmol/l). Impaired glucose tolerancewas defined as hyperglycaemia on two separate tests, an achievedglucose level after a glucose infusion test above the 90th percentileof an age-matched normal population (> 9.3 mmol/l) or a fastingplasma glucose above the 95th percentile (> 5.6 mmol/l).Thirty-seven subjects with impaired glucose tolerance were enteredinto a randomized, prospective study for 6 months with allocationsto healthy living or double blind to sulphonylurea (gliclazide40 mg twice daily) or placebo tablets. The study took placein an outpatient setting, with three times weekly exercise sessionsat a Sports Centre. After 6 months the placebo group showedno change in plasma glucose, cholesterol and blood pressure.The subjects receiving gliclazide showed improved glucose levels(mean fasting plasma glucose levels fell from 5.8 to 5.1 mmol/l,p<0.05) but no significant change in plasma cholesterol orblood pressure. The healthy living group, after exclusion offour non-compliant subjects, showed no change in glucose levels,but a decreased systolic blood pressure (fall in mean from 124to 116 mmHg, p<0.05) and plasma cholesterol levels (fallin mean from 5.2 to 4.5 mmol/l, p0.01) with an increase in HDL:LDLratio (rise in mean from 0.39 to 0.46, p<0.05). Subjectswith impaired glucose tolerance may benefit in different waysfrom gliclazide and healthy living. The metabolic responsesto each therapy may help to decrease the risk of developingdiabetes and cardiovascular disease.     

护理干预对老年糖耐量异常患者心血管危险因素的影响

目的 探讨护理干预对老年糖耐量异常患者的心血管危险因素的影响.方法 选取2009年5月至2011年6月在我院门诊就诊的糖耐量异常(IGT)的老年患者216例,随机分为干预组和对照组各108例.对照组采用传统的常规护理,干预组在此基础上进行护理干预.随访6个月.收集2组患者基本状况,并检测2组患者随访前后的血压、血糖、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)的变化.结果 干预后2组患者血糖水平均有所下降,干预组下降水平高于对照组.结论 对糖耐量异常的老年患者实施护理干预,有利于减少患者心血管危险因素.     

Assessment of novel risk factors in patients at low risk for cardiovascular events based on Framingham risk stratification

BACKGROUND: Coronary heart disease (CHD) risk assessed by the Framingham risk score does not take into account the various "novel" markers that are of increasing interest. In this paper we examine a low-risk population to determine which novel markers may be of additive value to the Framingham assessment of CHD risk. METHODS: Levels of high-sensitivity C-reactive protein (hs-CRP), soluble vascular cell adhesion molecule (s-VCAM), soluble intercellular adhesion molecule (s-ICAM-1), endothelial selectin (e-selectin), homocysteine and von Willebrand factor (vWF) were measured in 53 apparently healthy subjects recruited from a risk-reduction referral clinic. Carotid intima medial thickness (IMT) and number of plaques were determined by ultrasonography. Brachial ultrasound flow-mediated dilation (FMD) was also measured. Framingham risk scores were calculated and univariate and multivariate analyses of the resulting percent CHD risk over 10 years and novel markers were undertaken. RESULTS: Abnormal carotid IMT and presence of plaques, hs-CRP, homocysteine, FMD and s-ICAM-1 were detected with a high frequency in this low-risk cohort. Average IMT, number of plaques and homocysteine were highly correlated with the calculated percent CHD whereas measures of hs-CRP, s-ICAM-1 and FMD were independent of the percent CHD calculation. CONCLUSIONS: FMD, as a reflection of the functional status of the vasculature, and hs-CRP and s-ICAM-1, as indicators of inflammatory processes, were independent of Framingham risk assessment in patients at low risk for cardiovascular disease.     

The relationship between homeostasis model assessment and cardiovascular risk factors in Iranian subjects with normal fasting glucose and normal glucose tolerance

BACKGROUND: Insulin resistance is a complex problem which may not always correlate with all its cardiovascular risk factors in various populations. We investigated the relationship between homeostasis model assessment of insulin resistance (HOMA-IR) with cardiovascular risk factors in Iranian subjects with normal fasting glucose (NFG) and normal glucose tolerance (NGT). METHODS: Of the 605 subjects aged 25-79 y enrolled in this study, after the oral glucose tolerance test, 366 subjects aged 25-50 y and 135 aged >50 y were classified as NFG and NGT. Insulin resistance was estimated by the HOMA-IR. RESULTS: Women had higher values of body mass index (BMI), insulin and HOMA-IR than men in both age groups. The prevalence of insulin resistance, general and abdominal obesity, low HDL-C and physical inactivity was higher in women than men in the 2 age groups. Men had a higher prevalence of hypertension and hypertriglyceridemia in the group with age 25-50 y. The Pearson correlation controlled for age, BMI, waist circumference and physical activity showed that HOMA-IR had significant correlation with triglyceride and inversely associated with HDL-C in both sexes. In addition, the results of HOMA-IR quartiles demonstrated that the prevalence of hypertension, obesity, and low HDL-C was particular high in women with HOMA-IR >2.39. Multiple regression indicated that log HOMA-IR was independently predicted by BMI, triglyceride and HDL-C in men and BMI, HDL-C and waist-to-hip (WHR) ratio in women. CONCLUSIONS: HOMA-IR is associated with the features of metabolic syndrome with a sex difference in the degree and predictors of HOMA-IR and the frequency of cardiovascular risk factors.     

Fasting and 2-hour plasma glucose and insulin: relationship with risk factors for cardiovascular disease in overweight nondiabetic children

OBJECTIVE

To determine whether elevated fasting or 2-h plasma glucose and/or insulin better reflects the presence of cardiovascular disease (CVD) risk markers in an overweight pediatric population with normal glucose tolerance.

RESEARCH DESIGN AND METHODS

A total of 151 overweight youths (8–17 years old) were evaluated with oral glucose tolerance tests and measurement of CVD risk factors. The study population was categorized according to quartiles of fasting and 2-h glucose and insulin levels. ANCOVA, adjusted for age, sex, race, Tanner stage, and percent body fat (measured by dual-energy X-ray absorptiometry), was used to compare metabolic variables between the quartiles of glucose and insulin groups.

RESULTS

Increasing quartiles of fasting and 2-h insulin were associated with increasing CVD risk factors. Glucose quartiles on the other hand, either fasting or at 2 h, were not.

CONCLUSIONS

These data suggest that hyperinsulinemia may be the earliest and/or primary metabolic alteration in childhood associated with risk markers for CVD. Prospective studies are needed.The prevalence of childhood overweight is increasing relentlessly (1–2). An increase in the rates of pre-diabetes and type 2 diabetes seems to follow the upward trend of obesity (3). Longitudinal studies in adults demonstrate that cardiovascular disease (CVD) changes are established before a diagnosis of diabetes is made and correlate better with 2-h glucose levels (4–5). Guidelines on diabetes and CVD from the European Society of Cardiology and the European Association for the Study of Diabetes have summarized that 2-h glucose provides better information about risk for CVD than fasting glucose and predicts increased cardiovascular risk in subjects with normal fasting glucose levels (6).Meta-analyses of prospective data from 11 populations have shown that hyperinsulinemia, defined by the highest quartile cutoff for fasting insulin, was associated with cardiovascular mortality independently of other risk factors (7). A review of 19 Western prospective studies showed that the odds ratio (OR) for coronary heart disease for raised fasting insulin as well as nonfasting insulin were more modest than previously suspected (OR 1.12 [95% CI 0.98–1.28] and 1.35 [1.14–1.60], respectively) (8).No studies have evaluated whether a fasting or 2-h glucose and/or insulin value reflects better the presence of CVD risk factors in overweight children with normal glucose tolerance. The purpose of this investigation was to assess the relationship between glucose and insulin quartiles and CVD risk factors in an overweight pediatric population.     

Plasma lipid peroxides: relationships to cardiovascular risk factors and prevalent cardiovascular disease

BACKGROUND: The epidemiology of plasma lipid peroxides, which may play a role in atherogenesis, has not been well defined. AIM: To study the relationships of plasma lipid peroxides to cardiovascular risk factors in a random population sample. DESIGN: Random, age- and sex-stratified population sample. METHODS: We studied 739 men and women aged 25-74 years. Lipid peroxides were assayed by the thiobarbituric acid (TBA) assay for malondialdehyde (MDA) in stored plasma samples. RESULTS: Lipid peroxide levels increased with age. In men, lipid peroxides were significantly associated with smoking habit. Lipid peroxides correlated with non-fasting serum triglycerides (r = 0.33; p < 0.0001) in both sexes. Weaker associations were observed for cholesterol, high-density lipoprotein cholesterol (inversely), body mass index, fibrinogen and white cell count; as well as an inverse association with serum vitamin C in men. DISCUSSION: These findings clarify the relationships of plasma lipid peroxides to cardiovascular risk factors; and are consistent with the hypothesis that lipid peroxidation may be one mechanism through which several risk factors may promote cardiovascular disease.