Liver enzymes and vitamin D levels in metabolically healthy but obese individuals: Korean National Health and Nutrition Examination Survey

Objective

Increased liver enzymes and decreased vitamin D levels are associated with insulin resistance and type 2 diabetes. We examined liver enzymes and vitamin D levels in metabolically healthy but obese (MHO) individuals and compared the values with those of other body size phenotypes in the Korean population.

Materials/Methods

A total of 16,190 people over the age of 18 years were analyzed using data from the Fourth Korean National Health and Nutrition Examination Survey, which is a nationally representative survey. Body size phenotypes were classified into four groups by body mass index (BMI) and number of metabolic syndrome components.

Results

The prevalence of MHO was 14.9% in the entire population and 47.7% in the obese population. In a correlation analysis adjusted for age, sex, and BMI, AST and ALT levels were positively correlated with insulin resistance and cardiometabolic risk factors of the metabolic syndrome, whereas vitamin D level was negatively correlated with these variables. MHO individuals had significantly lower concentrations of AST and ALT compared to metabolically abnormal obese (MAO) subjects, although vitamin D levels were not significantly different. Furthermore, a multiple logistic regression analysis revealed that MHO individuals had lower risk of liver enzyme abnormality compared to MAO after adjusting for potential confounding factors. However, the risk of vitamin D deficiency was not significantly different among groups with different body size phenotypes.

Conclusions

Although both liver enzymes and vitamin D levels are related to insulin resistance and metabolic syndrome, only liver enzymes were independently associated with MHO phenotype.     

The impact of serum uric acid level on arterial stiffness and carotid atherosclerosis: The Korean Multi-Rural Communities Cohort study

Objective

Serum uric acid level has been found to be associated with a risk factor for cardiovascular diseases. However, the topic has not been explored in the general population, especially in Korea. This study was designed to determine whether serum uric acid is associated with carotid atherosclerosis and arterial stiffness in the Korean Multi-Rural Communities Cohort study.

Methods

A total of 5568 participants from the Korean Multi-Rural Communities Cohort were evaluated for the risk of hyperuricemia in cardiovascular atherosclerosis. Important surrogates for cardiovascular atherosclerosis such as intima–media thickness (IMT) and brachial-ankle pulse wave velocity (baPWV) were assessed. We evaluated the association between these atherosclerosis indices and serum uric acid level or hyperuricemia through multivariate-adjusted logistic and linear regression analyses.

Results

There was a significant difference of carotid IMT and baPWV between males and females (p < 0.0001, respectively). Both male and female subjects with hyperuricemia showed higher baPWV than subjects without hyperuricemia (p = 0.0004 for males; p = 0.001 for females). Serum uric acid level was positively correlated with baPWV in males (β = 0.0006, p < 0.0001) and in females (β = 0.0001, p = 0.04), whereas no association between serum uric acid and carotid IMT was found in either gender. A linear relationship of baPWV with increasing serum uric acid level was observed in males (p = 0.0005) and in females (p = 0.004).

Conclusion

Serum uric acid level could be considered an important risk factor for arterial stiffness in Korean population, whereas carotid IMT is not associated with serum uric acid in either gender when using data from the Korean Multi-Rural Communities Cohort study.     

IGF-1 levels link estimated glomerular filtration rate to insulin resistance in obesity: A study in obese, but metabolically healthy, subjects and obese, insulin-resistant subjects

Background and Aims

Metabolically healthy but obese (MHO) subjects have a favourable cardio-metabolic risk profile, but whether they are also at lower risk for kidney dysfunction is still questionable.

Methods and Results

A total of 106 MHO, 122 normal-weight and 212 insulin-resistant obese (IRO) subjects were stratified on the basis of their insulin sensitivity and body mass index (BMI). The CKD-EPI equation was used to estimate glomerular filtration rate (eGFR) and ISI index was used to estimate insulin sensitivity.eGFR was significantly lower in IRO as compared to MHO subjects after adjusting for age, gender and BMI (P = 0.008). In a logistic regression model adjusted for age, gender and BMI, IRO subjects showed an increased risk of having eGFR in the lowest quartile (odds ratio (OR) 1.91, 95% confidence interval (CI) 1.01-3.58; P = 0.04) as compared with MHO subjects. This association was maintained when waist, lean body mass, blood pressure, HDL cholesterol, triglyceride, fasting glucose and insulin levels were additionally included into the model (OR 2.49, 95%CI 1.17-5.27; P = 0.01), but its independence was not retained with further inclusion of insulin-like growth factor-1 (IGF-1) levels (OR 2.16, 95%CI 0.93-5.04; P = 0.07) No differences in eGFR were observed between non-obese and MHO individuals.

Conclusions

These results indicate that heterogeneity in obese phenotypes may account for conflicting evidence regarding the significance of obesity as a risk factor for chronic kidney disease. Our findings suggest that obesity is associated with lower kidney function only when insulin sensitivity is reduced, and that plasma IGF-1 is likely to be an important mechanism linking the IRO phenotype with reduced eGFR.     

Prevalence and determinants of metabolically healthy obesity in Spain

Background and aims

Obesity is a heterogeneous disorder, so some obese individuals do not have cardiometabolic abnormalities (CA) which mediate the association between obesity and coronary heart disease. This study assessed the prevalence of metabolically healthy obesity and its determinants in Spain.

Methods

The data were taken from a cross-sectional study conducted in 2008–2010 among 11,520 individuals representative of the population of Spain aged ≥18 years. Normal-weight was defined as body mass index (BMI) <25 kg/m², and obesity as BMI ≥30 kg/m². Six CA were considered: elevated blood pressure, low high-density lipoprotein cholesterol, and elevated levels of triglycerides, fasting glucose, homeostasis model assessment of insulin resistance value, and C-reactive protein. Then, two phenotypes were defined: healthy (0–1 CA) and abnormal (≥2 CA).

Results

The prevalence of metabolically healthy obesity was 6.5% overall (95% confidence interval: 6.0–7.1), and corresponds to 28.9% of obese individuals. Lower age, being female, current smoking, moderate alcohol consumption, and high level of physical activity were independently associated with the healthy phenotype among the obese. The prevalence of normal weight with a metabolically abnormal phenotype was 6.4% overall (95% confidence interval: 5.8–6.9) and corresponds to 16.8% of normal-weight subjects. Factors associated with this phenotype in normal-weight persons were higher age, being male, never smoking, no alcohol consumption and larger waist circumference.

Conclusion

Metabolically healthy obesity represents almost one-third of the obese population in Spain. Since this was a cross-sectional study, the association of metabolic healthy obesity with smoking consumption, alcohol intake and physical activity warrants more research.     

Role of rs1466535 low density lipoprotein receptor-related protein 1 (LRP1) gene polymorphism in carotid artery disease

Objective

An association between rs1466535 low density lipoprotein receptor-related protein 1 (LRP1) gene polymorphism and abdominal aortic aneurysm (AAA) was recently demonstrated. It has not yet been defined if this association is specific for AAA or related to atherosclerosis per se. Therefore, we aimed to evaluate the role of the rs1466535 polymorphism in conferring genetic susceptibility for carotid artery stenosis (CAS).

Methods

The rs1466535 polymorphism was evaluated in n = 814 patients with CAS and n = 814 subjects without evidence of carotid atherosclerosis by TaqMan technology.

Results

The percentage of T allele rs1466535 carriers was significantly higher in CAS patients (49.3%) than in controls (43.9%, p = 0.032). At the multiple logistic regression analysis, the allele T carrier status did not remain a significant determinant of CAS.

Conclusions

The rs1466535 LRP1 polymorphism is not a significant and independent risk factor for CAS. Our result suggests this polymorphism in the LRP1 gene is not associated with atherosclerosis in general as it is not associated with CAS (this study), whereas it is strictly associated with AAA (our previous paper).     

Associations of metabolically healthy obesity with prevalence and progression of coronary artery calcification: Results from the Heinz Nixdorf Recall Cohort Study

Background and aims

There is controversy on the potentially benign nature of metabolically healthy obesity (MHO), i.e., obese persons with few or no metabolic abnormalities. So far, associations between MHO and coronary artery calcification (CAC), a measure of subclinical atherosclerosis, have mainly been studied cross-sectionally in Asian populations. We assessed cross-sectional and longitudinal MHO CAC associations in a Caucasian population.

Predominance of small dense LDL differentiates metabolically unhealthy from metabolically healthy overweight adults in Korea

Objective

The purposes of this study were (1) to determine the association between lipoprotein subfraction profiles and metabolically healthy overweight (MHO) phenotype, as defined by visceral adiposity; and (2) to identify the strongest predictor of metabolic health among the lipoprotein measurements.

Materials/Methods

This cross-sectional study was comprised of 462 overweight patients, who were classified as MHO or non-MHO based on their visceral adipose tissue (VAT) area to subcutaneous adipose tissue area (SAT) ratio (VAT/SAT ratio). Serum lipoprotein subfraction analyses and other metabolic parameters were measured.

Results

Among the overweight participants, two hundred fifty-five individuals (53.7%) had the MHO phenotype. After adjusting for age, sex, medication, lifestyle factors, and confounding metabolic characteristics, the non-MHO group showed significantly higher lipid levels and a greater prevalence of unfavorable lipid profiles. LDL subclass pattern type B was the most significant predictor of the non-MHO phenotype (odds ratio 2.70; 95% CI 1.55–4.69), while serum LDL cholesterol level was not a significant predictor of the non-MHO phenotype.

Conclusions

Lipoprotein subfraction particle measurements were significantly associated with the non-MHO phenotype and a higher VAT/SAT ratio, with small dense LDL predominance being the most significant predictor of MHO phenotype. These findings will help identify MHO and non-MHO phenotypes and perhaps lead to a development of cost-effective individualized treatments.     

Association of obesity phenotypes with electrocardiographic left ventricular hypertrophy in the general population

Objective

Increasing evidence doubts the benign nature of metabolically healthy obesity (MHO). An investigation of the association of MHO and other obesity phenotypes with electrocardiographic left ventricular hypertrophy (ECG-LVH), a risk factor for cardiovascular disease (CVD), can give insight into the pathophysiological basis for increased risk of CVD linked to these phenotypes.

Weight gain in infancy is associated with carotid extra-medial thickness in later childhood

Objective

Early life is an important period for determining future risk of cardiovascular disease. Carotid extra-medial thickness is a novel noninvasive measure that estimates arterial adventitial thickness, information concerning vascular health not captured by assessment of arterial intima-media thickness alone. We sought to determine whether fetal growth and early postnatal growth are associated with carotid extra-medial thickness in 8 year old children.

Methods

Carotid extra-medial thickness was assessed by high-resolution ultrasound in 379 non-diabetic children aged 8-years, with complete data for birth weight, gestational age, early postnatal weight gain and carotid extra-medial thickness.

Results

Weight gain during infancy, from birth to 18 months of age, was significantly and positively associated with carotid EMT (11 μm per kg length-adjusted weight gain [95% CI 3, 18], P = 0.007). This association was significantly stronger in boys than girls (P_{heterogeneity} = 0.005). By contrast, there was no significant association between birth weight and carotid EMT (6 μm/kg birth weight [95% CI −12, 24], P = 0.51).

Conclusion

Excessive weight gain during infancy is associated with increased carotid extra-medial thickness, indicating that the alterations to the vasculature associated with excessive early postnatal growth likely include arterial adventitial thickening.     

Obesity,metabolic abnormality,and knee osteoarthritis: A cross-sectional study in Korean women

Abstract

Background. This study aimed to analyze the association between knee osteoarthritis and four body size phenotypes defined by the presence or absence of metabolic abnormality and obesity.

Mehods. This was a cross-sectional study using data from 1,549 female participants of the Fifth Korean National Health and Nutrition Examination Survey. Knee osteoarthritis was defined as a Kellgren–Lawrence grade of ≥ 2. Metabolically abnormal state was defined as presence of more than one abnormality among five metabolic risk factors. Obesity was defined using body mass index. Participants were grouped into one of the four body size phenotypes: metabolically healthy normal weight (MHNW), metabolically abnormal but normal weight (MANW), metabolically healthy obesity (MHO), and metabolically abnormal obesity (MAO).

Results. The distribution of each body size phenotype was as follows: MHNW 54.7%, MANW 30.7%, MHO 4.3%, and MAO 10.3%. Prevalence of symptomatic knee osteoarthritis was higher in MANW than in MHNW, and in MAO than in MHO. In multivariable analysis, the association between symptomatic knee osteoarthritis and the body size phenotypes was as follows (OR [95% CI]): MHNW 1.00 (reference), MANW 1.54 (1.15–2.07), MHO 1.61 (0.83–3.13), and MAO 3.47 (2.35–5.14).

Conclusions. Obesity showed closest association with knee osteoarthritis when accompanied by metabolic abnormality.     

Incidence of type 2 diabetes,hypertension, and dyslipidemia in metabolically healthy obese and non-obese

Background and aims

Metabolically healthy obese (MHO) individuals are devoid of many metabolic abnormalities, but how this condition is maintained over time remains debated. We assessed the prevalence of MHO over time and the incidence of hypertension (HTN), dyslipidemia, and type 2 diabetes mellitus (T2DM) in MHO as compared with metabolically healthy non obese (MHNO).

In Vivo Imaging of Enhanced Leukocyte Accumulation in Atherosclerotic Lesions in Humans

Background

Understanding how leukocytes impact atherogenesis contributes critically to our concept of atherosclerosis development and the identification of potential therapeutic targets.

Objectives

The study evaluates an in vivo imaging approach to visualize peripheral blood mononuclear cell (PBMC) accumulation in atherosclerotic lesions of cardiovascular (CV) patients using hybrid single-photon emission computed tomography/computed tomography (SPECT/CT).

Methods

At baseline, CV patients and healthy controls underwent ¹⁸fluorodeoxyglucose positron emission tomography-computed tomography and magnetic resonance imaging to assess arterial wall inflammation and dimensions, respectively. For in vivo trafficking, autologous PBMCs were isolated, labeled with technetium-99m, and visualized 3, 4.5, and 6 h post-infusion with SPECT/CT.

Results

Ten CV patients and 5 healthy controls were included. Patients had an increased arterial wall inflammation (target-to-background ratio [TBR] right carotid 2.00 ± 0.26 in patients vs. 1.51 ± 0.12 in controls; p = 0.022) and atherosclerotic burden (normalized wall index 0.52 ± 0.09 in patients vs. 0.33 ± 0.02 in controls; p = 0.026). Elevated PBMC accumulation in the arterial wall was observed in patients; for the right carotid, the arterial-wall-to-blood ratio (ABR) 4.5 h post-infusion was 2.13 ± 0.35 in patients versus 1.49 ± 0.40 in controls (p = 0.038). In patients, the ABR correlated with the TBR of the corresponding vessel (for the right carotid: r = 0.88; p < 0.001).

Conclusions

PBMC accumulation is markedly enhanced in patients with advanced atherosclerotic lesions and correlates with disease severity. This study provides a noninvasive imaging tool to validate the development and implementation of interventions targeting leukocytes in atherosclerosis.     

Cardio-ankle vascular index (CAVI) correlates with aortic stiffness in the thoracic aorta using ECG-gated multi-detector row computed tomography

Background

The cardio-ankle vascular index (CAVI) is an arterial stiffness index based on the stiffness parameter β, which is essentially independent of blood pressure. The objective of this study was to determine whether CAVI correlates with the regional stiffness parameter β and pulse wave velocity (PWV) in the thoracic aorta calculated from ECG-gated multi-detector row computed tomography (MDCT).

Methods and results

Forty-nine patients who underwent coronary MDCT for suspicious coronary artery disease were recruited. The largest and smallest vessel luminal cross-sectional areas of the thoracic aorta were measured from MDCT images to calculate PWV and stiffness parameter β of the ascending and descending aorta. CAVI was also measured by VaSera VS-1000.In univariate analysis, CAVI significantly correlated with regional stiffness parameter β and PWV, which was influenced by the inevitable part of the aging process in the ascending (r = 0.485, P < 0.001; r = 0.483, P < 0.001) and descending aortas (r = 0.304, P = 0.034; r = 0.327, P = 0.022), respectively. The regional stiffness parameter β did not correlate with systolic blood pressure (SBP), although the PWV correlated with SBP. In multivariate analysis, CAVI independently correlated with the stiffness parameter β, but not with the PWV.

Conclusion

These data suggest that CAVI, which correlated with stiffness parameter β in the thoracic aorta, has a potential role in evaluating integrated arterial stiffness including that of the central aorta.     

Intensive Lifestyle Intervention Improves Cardiometabolic and Exercise Parameters in Metabolically Healthy Obese and Metabolically Unhealthy Obese Individuals

Background

The effects of an intensive lifestyle intervention including Mediterranean diet nutritional counselling and high-intensity interval training (HIIT) on body composition, cardiometabolic, and exercise parameters were studied in metabolically unhealthy obese (NMHO) and metabolically healthy but obese (MHO) subjects.

Methods

Fifty-five MHO (51 ± 8 years; waist circumference, 109 ± 13 cm) and 79 NMHO subjects (54 ± 9 years; waist circumference, 112 ± 13 cm) participated in an intensive lifestyle modification program based on Mediterranean diet nutritional counselling and HIIT 2-3 times per week. Body composition, cardiometabolic, and exercise parameters were measured at baseline and after 9 months.

Results

Initially, MHO patients had a lower blood pressure (BP), fasting glycemia, triglycerides, and a higher high-density lipoprotein cholesterol and peak oxygen uptake (VO₂ peak) (P < 0.05) vs NMHO patients. Body mass (P < 0.05), waist circumference (P < 0.0001), total and trunk fat mass (P < 0.001), systolic and diastolic BP (P < 0.001), fasting glucose (P < 0.0001), insulin sensitivity (P < 0.05), VO₂ peak and muscle endurance (P < 0.0001) were similarly improved in both groups after the program. Prevalence of NMHO was reduced by 17.91% (P < 0.01) after the program. Similar improvements in body composition, BP, and exercise parameters were found for MHO and NMHO men and women (P < 0.05). In all patients, improvement of VO₂ peak was negatively correlated with improvements in body composition, systolic blood pressure, and resting heart rate (HR) (R = −0.61 to −0.24; P < 0.05).

Conclusions

A long-term intensive lifestyle program including Mediterranean diet nutritional counselling and HIIT is an appropriate intervention in MHO and NMHO subjects with similar potential clinical health benefits including an improved body composition, BP, fasting glycemia, insulin sensitivity, VO₂ peak, and muscle endurance.     

APOE polymorphism and carotid atherosclerosis in Korean population: The Dong-gu Study and the Namwon Study

Objective

We evaluated the association between APOE polymorphism and carotid atherosclerosis in two large independent cohorts from South Korea.

Methods

The datasets were from the Dong-gu Study (N = 9056) and the Namwon Study (N = 10,158). Carotid ultrasonography was performed to measure carotid intima-media thickness (IMT) and the presence of carotid plaques. The APOE polymorphism was determined by PCR-RFLP. We performed combined and separate analyses for the two datasets.

Results

In the combined analysis, individuals with E2E2 or E2E3 genotype had a lower common carotid IMT compared with individuals with E3E3 genotype (0.684 mm vs. 0.736 mm, p = 0.007; 0.718 mm vs. 0.736 mm, p < 0.001, respectively). This association was very slightly attenuated but remained statistically significant after adjustment for blood lipids (0.690 mm vs. 0.736 mm, p = 0.033; 0.725 mm vs. 0.736 mm, p = 0.005, respectively). Compared with individuals with E3E3 genotype, individuals with E2E3 genotype had lower risk for carotid plaque (odds ratio (OR) = 0.83, 95% confidence interval (CI) = 0.75–0.93), while individuals with E3E4 genotype had a higher risk for carotid plaque (OR = 1.09, 95% CI = 1.00–1.20). After adjustment for blood lipids, ORs of E2E3 genotype for carotid plaque was slightly attenuated but remained significant (OR = 0.87 95% CI = 0.78–0.97), while OR of E3E4 genotype were slightly attenuated and not significant (OR = 1.08, 95% CI, 0.99–1.18).

Conclusions

We found that APOE polymorphism is associated with carotid atherosclerosis and this association was partly mediated through blood lipid. Our results suggest that APOE polymorphism may influence atherosclerosis through non-lipid pathways.     

Increased augmentation index is paradoxically associated with lower in-hospital mortality in patients with acute ischemic stroke

Objective

To evaluate the association between arterial stiffness and stroke severity and in-hospital outcome in patients admitted with acute ischemic stroke.

Methods

We prospectively studied 415 consecutive patients who were admitted with acute ischemic stroke (39.5% males, age 78.8 ± 6.6 years). On the third day of hospitalization, the following markers of arterial stiffness were recorded: central systolic blood pressure (cSBP), diastolic BP (cDBP), mean pressure (cMP), pulse pressure (cPP), augmentation index (AIx) and pulse wave velocity (PWV). The severity of stroke was assessed on admission with the National Institutes of Health Stroke Scale (NIHSS) score. The outcome was evaluated with rates of dependency at discharge (modified Rankin scale score between 2 and 5) and in-hospital mortality.

Results

None of the markers of arterial stiffness showed significant correlation with the NIHSS score on admission. However, there was a trend for an inverse correlation with AIx (r = −0.142, p = 0.064) and for a positive correlation with PWV (r = 0.235, p = 0.054). None of the markers of arterial stiffness differed between patients who were dependent at discharge and those who were independent. Patients who died during hospitalization had higher cDBP and cMP but lower cPP and AIx than patients who were discharged. In binary logistic regression analysis, independent predictors of in-hospital mortality were NIHSS score on admission (relative risk (RR) 1.16, 95% confidence interval (CI) 1.08–1.25, p < 0.001), presence of atrial fibrillation (RR 6.41, 95% CI 1.37–29.93, p = 0.018) and AIx (RR 0.94, 95% CI 0.89–0.99, p = 0.030).

Conclusions

Increased AIx appears to be associated with lower in-hospital mortality rates in elderly patients with acute ischemic stroke. Other markers of arterial stiffness do not appear to be associated with short-term outcome in this population.     

Erythrocyte membrane n-3 fatty acid levels and carotid atherosclerosis in Chinese men and women

Objective

Prospective studies have supported the beneficial effects of n-3 fatty acid consumption on cardiac deaths, but limited data focused on atherosclerosis. We investigated the associations between n-3 fatty acids in erythrocytes and atherosclerosis in middle-aged and older Chinese.

Methods

847 subjects (285 men and 562 women), aged 40–65 years, from Guangzhou, China were included in this community-based cross-sectional study between December 2005 and January 2008. The levels of α-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in erythrocytes were measured by gas chromatography. Carotid ultrasound examination was conducted to obtain intima–media thickness of the common carotid artery and the carotid bifurcation. Dietary data and other covariates were collected using interviewer-administered questionnaires.

Results

After adjustment for age, sex, and other confounders, negative dose–response associations between the contents of individual n-3 polyunsaturated fatty acids in the erythrocyte membrane and the prevalence of carotid artery wall thickening and plaque were observed. A comparison in the highest and lowest tertiles gave odds ratios (95% confidence interval) for thickening in the walls of the common carotid artery of 0.58 (0. 34–0.97; P-trend = 0. 037) for DHA, and 0.39 (0.23–0.67; P-trend < 0.001) for ALA. However, EPA was not significantly associated with carotid atherosclerosis. Similar results were found for thickening at the carotid bifurcation and the occurrence of carotid artery plaque.

Conclusions

Higher levels of DHA and ALA in the erythrocyte membrane were significantly associated with a lower burden of subclinical atherosclerosis.     

Association of Lp-PLA2 with digital reactive hyperemia,coronary flow reserve,carotid atherosclerosis and arterial stiffness in coronary artery disease

Background

Lipoprotein-associated Phospholipase A2 (Lp-PLA2), has a powerful inflammatory and atherogenic action in the vascular wall and is an independent marker of poor prognosis in coronary artery disease (CAD). We investigate the association of Lp-PLA2 with markers of vascular dysfunction and atherosclerosis with proven prognostic value in CAD.

Methods

In 111 patients with angiographically documented chronic CAD, we measured 1) carotid intima-media thickness (CIMT), 2) reactive hyperemia using fingertip peripheral arterial tonometry (RH-PAT), 3) coronary flow reserve (CFR), by Doppler echocardiography 4) pulse wave velocity (PWV) and 5) blood levels of Lp-PLA2.

Results

Patients with Lp-PLA2 concentration >234.5 ng/ml (50th percentile) had higher CIMT (1.44 ± 0.07 vs. 1.06 ± 0.06 mm), PWV (11.0 ± 2.36 vs. 9.7 ± 2.38 m/s) and lower RH-PAT(1.24 ± 0.25 vs. 1.51 ± 0.53) and CFR (2.39 ± 0.75 vs. 2.9 ± 0.86) compared to those with lower Lp-PLA (p < 0.05 for all comparisons). Lp-PLA2 was positively associated with CIMT (regression coefficient b: 0.30 per unit of Lp-PLA2, p = 0.02), PWV (b:0.201, p = 0.04) and inversely with RHI-PAT (b: −0.371, p < 0.001) and CFR (b:−0.32, p = 0.002). In multivariate analysis, Lp-PLA2 was an independent determinant of RHI-PAT, CFR, CIMT and PWV in a model including age, sex, smoking, diabetes, dyslipidemia and hypertension (p < 0.05 for all vascular markers). Lp-PLA2, RHI-PAT and CFR were independent predictors of cardiac events during a 3-year follow-up.

Conclusions

Elevated Lp-PLA2 concentration is related with endothelial dysfunction, carotid atherosclerosis, impaired coronary flow reserve and increased arterial stiffness and adverse outcome in CAD patients. These findings suggest that the prognostic role of Lp-PLA2 in chronic CAD may be explained by a generalized detrimental effect of this lipase on endothelial function and arterial wall properties.     

Metabolically healthy obese and unhealthy normal weight in Iranian adult population: Prevalence and the associated factors

Aims

The objective of this study was to determine the prevalence and the associated factors of metabolically unhealthy in normal-weight and metabolically healthy in obese.

Associations between periodontal disease and cardiovascular surrogate measures among Indigenous Australians

Background/objectives

Inflammation is a key pathogenetic factor in atherogenesis. Periodontitis is a chronic inflammatory source which can have systemic impacts. Indigenous Australians have a higher prevalence of periodontal disease and experience cardiovascular disease earlier than non-Indigenous Australians. The aim was to describe the association between severity of periodontal inflammatory disease and measures of arterial structure and function.

Methods

Periodontal disease in a convenience sample of Indigenous Australians was assessed clinically; for those with periodontal disease, the extent of periodontal pockets ≥ 4 mm was stratified into quartiles. Vascular health was measured non-invasively via carotid-dorsalis pedis pulse-wave velocity (PWV), and via B-mode ultrasound of the common carotid intima-media (IMT). Non-fasting blood samples were collected for lipid and inflammatory marker evaluation. Linear regression models were constructed to determine the associations between extent of periodontal pocketing and vascular health, adjusting for traditional cardiovascular common risk factors.

Results

273 Indigenous Australian adults were recruited and complete data was available for 269 participants (154 males), median age 39 years. Arterial stiffness (PWV) significantly increased with increasing extent of periodontal pocketing (p trend = 0.001). By contrast, carotid IMT did not differ across quartiles.

Conclusions

Periodontal pocketing was associated with central arterial stiffness, a marker of presymptomatic arterial dysfunction, in Indigenous Australian adults with periodontal disease.