Inverse association between fruit, legume, and cereal fiber and the risk of metabolic syndrome: Tehran Lipid and Glucose Study

Aims

To evaluate the association between total dietary fiber and its types and sources with the risk of MetS.

Methods

This population-based cross-sectional study was conducted on a representative sample of 2 457 adults (1 327 male and 1 130 female), aged 19-84 years. Dietary intake was assessed using a validated semiquantitative food-frequency questionnaire. Anthropometrics, blood pressure, and fasting blood glucose and lipids were measured according to standard protocols. The MetS was defined according to definition by Adult Treatment Panel III.

Results

Multivariate-adjusted odds ratio of MetS between highest and lowest quartiles was 0.53 (95% CI: 0.39-0.74; P for trend <0.05) for total dietary fiber, 0.60 (0.43-0.84; P for trend <0.05) for soluble fiber, and 0.51 (0.35-0.72; P for trend <0.05) for insoluble fiber. Among sources of dietary fiber, fruit fiber (OR: 0.51; 95% CI: 0.37-0.72), cereal fiber (0.74; 0.57-0.97), and legume fiber (0.73; 0.53-0.99) were inversely associated with the risk of MetS, after adjustment for confounding factors. Intake of vegetable fiber and nut fiber were unrelated to the risk of MetS.

Conclusions

Total dietary fiber, soluble- and insoluble fiber, fruit fiber, cereal fiber and legume fiber were associated with a protective effect for the presence of MetS among this Tehranian population.     

Metabolic syndrome and the development of type 2 diabetes among professionals living in Beijing, China

Aims

The magnitude of the association between metabolic syndrome (MetS) and incident diabetes is still not widely evaluated in China. This study explored the association of MetS and its components with the development of diabetes among professionals living in Beijing.

Methods

Population-based 6-year prospective study. The cohort consisted of 7922 eligible persons aged ≥20. Either fasting glucose (FPG) level ≥7.0 mmol/l at the follow-up survey or diagnoses of diabetes during the 6-year period were considered incident diabetes cases. MetS was identified by both the definitions proposed by the National Cholesterol Education Program (NCEP) and the International Diabetes Federation (IDF).

Results

The accumulated incidence of diabetes was 3.6% for men and 2.5% for women. MetS associated a 4.7- and 5.7-fold increase of the diabetic risk in men and women, respectively. Hyperglycemia exhibited the highest association with diabetes. FPG of 5.6-5.79 mmol/l already presented a risk of diabetes. However, without hyperglycemia in the clustering of any 1, 2, 3 to 4 metabolic components, the tendency of increased diabetic risk was still observed.

Conclusions

MetS has a strong association with incident diabetes. Of the individual components, hyperglycemia is the strongest predictor of diabetes. Additional numbers of metabolic components increase the risk of developing diabetes.     

Metabolic syndrome in adolescents in the Balearic Islands, a Mediterranean region

Background and aims

To determine the prevalence of metabolic syndrome (MetS) and its components in adolescents in the Balearic Islands, in the western Mediterranean Sea.

Methods and results

A cross-sectional nutritional survey was carried out in the Balearic Islands (2007-2008). A random sample (n = 362, 143 boys and 219 girls) of the adolescent population (12-17 years) was interviewed, anthropometrically measured, and provided a fasting blood sample. The MetS prevalence was determined by the ATP III criteria adapted for youths. Adherence to the Mediterranean diet (MD) was defined according to a score constructed considering the consumption of MD components: high monounsaturated fatty acids (MUFA)/saturated fatty acids (SFA) ratio, moderate ethanol consumption, high legume, cereals and roots, fruit, vegetables, and fish consumption, and low meat and milk consumption.The overall MetS prevalence was 5.8% (boys 10.5%, girls 2.7%). MetS criteria were met by 10.0% of overweight, 45.5% of obese and in 1.8% of normal weight adolescents. Half of the adolescents (49.7%) had at least one MetS component. None of the adolescents had all five risk factors. High triglyceride level (90.5%), hypertension (85.7%), low HDL cholesterol level (78.9%) and central obesity (71.4%) were common among adolescents with MetS whereas hyperglycaemia (0.6%) was infrequent. Higher adherence to MD was associated with significantly lower odds ratio of having MetS, but half of the adolescents showed high adherence to MD.

Conclusion

MetS prevalence was significant among adolescents in the Balearic Islands, especially among obese boys. A high adherence to MD in adolescents was associated with a low prevalence of the MetS criteria.     

Omentin-1 is associated with carotid atherosclerosis in patients with metabolic syndrome

Aim

The goal of this study was to investigate the association between omentin-1 and carotid atherosclerosis in patients with metabolic syndrome (MetS).

Method

We enrolled randomly 60 MetS patients, evaluated their carotid atherosclerosis employing ultrasonography and then divided them into two subgroups, MetS with atherosclerosis (MetS + AS) and MetS without atherosclerosis (MetS−AS) according to the level of carotid intima-media thickness (CIMT) and presence of plaque. Stiffness, strain and distensibility were calculated. Waist circumference and blood pressure (BP) were measured. Fasting blood sample was collected to determine biochemical indicators and insulin resistance index (HOMA-IR). Omentin-1 plasma level was assessed by ELISA. Association of omentin-1 with CIMT and metabolic markers were studied.

Results

Levels of omentin-1 were lower in MetS than in controls and reduced further in MetS + AS compared with MetS−AS. In correlation analysis, omentin-1 was negative associated with CIMT, stiffness, waist circumference, body mass index (BMI), systolic blood pressure (SBP), fast blood glucose (FBG), and HOMA-IR.

Conclusions

Omentin-1 is closely related to MetS and might play an important role in atherosclerosis in MetS patients.     

Increased levels of microparticles originating from endothelial cells, platelets and erythrocytes in subjects with metabolic syndrome: Relationship with oxidative stress

Background and aims

The Metabolic Syndrome (MetS) is associated with increased cardiovascular risk. Circulating microparticles (MP) are involved in the pathogenesis of atherothrombotic disorders and are raised in individual with CVD. We measured their level and cellular origin in subjects with MetS and analyzed their associations with 1/anthropometric and biological parameters of MetS, 2/inflammation and oxidative stress markers.

Methods and results

Eighty-eight subjects with the MetS according to the NCEP-ATPIII definition were enrolled in a bicentric study and compared to 27 healthy controls. AnnexinV-positive MP (TMP), MP derived from platelets (PMP), erythrocytes (ErMP), endothelial cells (EMP), leukocytes (LMP) and granulocytes (PNMP) were determined by flow cytometry. MetS subjects had significantly higher counts/μl of TMP (730.6 ± 49.7 vs 352.8 ± 35.6), PMP (416.0 ± 43.8 vs 250.5 ± 23.5), ErMP (243.8 ± 22.1 vs 73.6 ± 19.6) and EMP (7.8 ± 0.8 vs 4.0 ± 1.0) compared with controls. LMP and PNMP were not statistically different between groups. Multivariate analysis demonstrated that each criterion for the MetS influenced the number of TMP. Waist girth was a significant determinant of PMP and EMP level and blood pressure was correlated with EMP level. Glycemia positively correlated with PMP level whereas dyslipidemia influenced EMP and ErMP levels. Interestingly, the oxidative stress markers, plasma glutathione peroxydase and urinary 8-iso-prostaglandin F₂ α, independently influenced TMP and PMP levels whereas inflammatory markers did not, irrespective of MP type.

Conclusion

Increased levels of TMP, PMP, ErMP and EMP are associated with individual metabolic abnormalities of MetS and oxidative stress. Whether MP assessment may represent a marker for risk stratification or a target for pharmacological intervention deserves further investigation.     

Overweight, obesity, and elevated serum cystatin C levels in adults in the United States

Background

Although high body mass index (BMI) is a risk factor for hypertension, diabetes, and cardiovascular disease, limited data exist on the association of overweight and obesity with early stages of kidney disease.

Methods

Cross-sectional data for 5083 participants of the nationally representative Third National Health and Nutrition Examination Survey with an estimated glomerular filtration rate ≥ 60 mL/min/1.73 m² without micro- or macroalbuminuria were analyzed to determine the association between BMI and elevated serum cystatin C. Normal weight, overweight, class I obesity, and class II to III obesity were defined as a BMI of 18.5 to 24.9 kg/m², 25.0 to 29.9 kg/m², 30.0 to 34.9 kg/m², and ≥ 35.0 kg/m², respectively. Elevated serum cystatin C was defined as ≥ 1.09 mg/L (≥99th percentile for participants 20-39 years of age without diabetes, hypertension, micro- or macroalbuminuria, or stage 3-5 chronic kidney disease).

Results

The age-standardized prevalence of elevated serum cystatin C was 9.6%, 12.9%, 17.4%, and 21.5% among adults of normal weight, overweight, class I obesity, and class II to III obesity, respectively (P trend < .001). After multivariate adjustment for demographics, behaviors, systolic blood pressure, and serum biomarkers, and compared with participants of normal weight, the odds ratio (95% confidence interval) of elevated serum cystatin C was 1.46 (1.02-2.10) for overweight, 2.36 (1.56-3.57) for class I obesity, and 2.82 (1.56-5.11) for class II to III obesity.

Conclusion

A graded association exists between higher BMI and elevated serum cystatin C. Further research is warranted to assess whether reducing BMI favorably affects elevated serum cystatin C and the development of chronic kidney disease.     

Artificially sweetened versus regular mixers increase gastric emptying and alcohol absorption

Background

Mixed alcoholic drinks are increasingly being consumed in “diet” varieties, which could potentially empty more rapidly from the stomach and thereby increase the rate of alcohol absorption when compared with “regular” versions containing sugar.

Methods

We studied 8 healthy males twice in randomized order. On each day, they consumed an orange-flavored vodka beverage (30 g ethanol in 600 mL), made with either “regular” mixer containing sucrose (total 478 kcal), or “diet” mixer (225 kcal).

Results

Gastric half-emptying time measured by ultrasound (mean ± standard deviation) was less for the “diet” than the “regular” drink (21.1 ± 9.5 vs 36.3 ± 15.3 minutes, P <.01). Both the peak blood ethanol concentration (0.053 ± 0.006 vs 0.034 ± 0.008 g%, P <.001) and the area under the blood ethanol concentration curve between 0 and 180 minutes (5.2 ± 0.7 vs 3.2 ± 0.7 units, P <.001) were greater with the “diet” drink.

Conclusions

Substitution of artificial sweeteners for sucrose in mixed alcoholic beverages may have a marked effect on the rate of gastric emptying and the blood alcohol response.     

Impact of introducing HbA1c into the diagnostic criteria on prevalence and cardiovascular risk profiles of individuals with newly diagnosed diabetes in Japan: the Toranomon Hospital Health Management Center Study 2 (TOPICS 2)

Objective

To evaluate the impact of HbA1c for diagnosis of diabetes and investigate whether cardiovascular risks profiles differ among individuals with diabetes diagnosed by HbA1c or fasting plasma glucose (FPG).

Methods

This cross-sectional study involved 26,884 participants (30.6% women; aged 20-91 years) without known diabetes. Subjects were categorized into 4 groups according to the presence or absence of FPG ≥7.0 mmol/L and/or HbA1c ≥6.5%, which were American Diabetes Association criteria. Oral glucose tolerance test data were not available.

Results

Prevalence of undiagnosed diabetes was 3.6%. Of those individuals, 47.5% fulfilled both two criteria and 26.0% fulfilled only HbA1c criterion. Individuals with diabetes according to FPG ≥7.0 mmol/L alone were characterized as having poorly controlled hypertension while those with HbA1c ≥6.5% alone were characterized as older, female, and having lower blood pressure and γ-glutamyltransferase values. Persons with newly diagnosed diabetes by HbA1c had low HDL cholesterol and high LDL or non-HDL cholesterol levels.

Conclusions

Introducing HbA1c into the diagnosis allowed detection of many previously undiagnosed cases of diabetes in Japanese individuals. Those diagnosed by FPG were characterized by hypertension and those diagnosed by HbA1c had unfavorable lipid profiles, reflecting an atherosclerotic trait.     

Erythrocyte ribavirin concentration for assessing hemoglobin reduction in interferon and ribavirin combination therapy

Background

Ribavirin-induced hemolytic anemia is one of the important adverse effects for the premature cessation of interferon and ribavirin combination therapy for hepatitis C virus clearance. To elucidate the mechanism of this matter, we examined the effects of plasma and erythrocyte ribavirin concentration on hemoglobin (Hb) reduction to assess hemolytic anemia in this combination therapy.

Method

Nineteen patients, treated with the interferon alpha-2b and ribavirin combination therapy, were included. Plasma and erythrocyte ribavirin concentrations were monitored for the first 28 days of the combination therapy, in relation to changes in hematological parameters, Hb and hematocrit values. The initial dose of ribavirin was 11.5 ± 1.5 mg/kg/day.

Results

Steady-state plasma and erythrocyte ribavirin concentrations were 8.9 ± 2.6 and 1218 ± 270 μM, respectively. Significant correlation was observed between erythrocyte ribavirin and Hb reduction (r = 0.360, p < 0.05), but not between plasma ribavirin and Hb reduction. The patients with higher levels of erythrocyte ribavirin (≥1000 μM) had greater Hb reduction compared to those with lower levels (<1000 μM) (3.8 ± 1.2 g/dL versus 2.6 ± 0.9 g/dL, p < 0.05). Nine cases out of 12 patients who developed anemia within the first 28 days of the combination therapy had higher levels of erythrocyte ribavirin (≥1000 μM).

Conclusion

We confirmed that erythrocyte ribavirin was strongly associated with Hb reduction in interferon and ribavirin combination therapy.     

Chronic kidney disease prevalence and rate of diagnosis

Background

Chronic kidney disease is a major public health problem. However, no study to date has estimated the prevalence of chronic kidney disease based on the clinical guidelines established by the National Kidney Foundation and few studies have explored the rate of diagnoses by primary care providers.

Subjects and Methods

Cross-sectional study of ambulatory patients in Rochester, NY. The purpose of this study was to estimate the prevalence of chronic kidney disease and the rate of primary caregiver diagnosis in ambulatory patients with chronic kidney disease.

Results

Among the 24,492 outpatients that had at least 2 glomerular filtration rate estimates ≥3 months apart, 6895 had an estimated glomerular filtration rate <60 mL/min/1.73 m², indicating a 28.2% period prevalence of chronic kidney disease. The rate of clinical diagnosis among those with chronic kidney disease was 26.5% (95% confidence interval, 17.9 to 35.1), suggesting that 74% of patients with chronic kidney disease are undiagnosed.

Conclusions

We demonstrate that the prevalence of chronic kidney disease is substantially higher in health-seeking individuals than in the general population. Moreover, we demonstrate that laboratory reporting of estimated glomerular filtration rate using the Modification of Diet in Renal Disease equation alone does not result in an optimal rate of clinical diagnosis.     

Prevalence and incidence of mental illness in diabetes: a national population-based cohort study

Background

: This study aimed to investigate the prevalence and incidence of mental illness among diabetic patients in Taiwan.

Methods

: Study subjects were identified by at least one service claim for ambulatory or inpatient care with a principal diagnosis of mental illness, and at least two claims for ambulatory care or one claim for inpatient care with a principal diagnosis of diabetes from 2000 to 2004.

Results

: The one-year prevalence of mental illness among diabetic patients was 20.6% in 2000, and the cumulative prevalence increased to 42.2% in 2004. Diabetic patients had a higher cumulative prevalence and annual incidence than the general population throughout the observation period. A higher prevalence was associated with age ≥45 and low income, and a lower prevalence with male gender and residing in rural areas. Cox regression analysis revealed that a higher incidence was associated with female gender, age ≥45, and low income.

Conclusions

: The prevalence and annual incidence density of mental illness in diabetic patients were significantly higher than in the general population. Females had higher prevalence and incidence density of mental illness among diabetic patients. Mental illness in diabetic patients was more prevalent in elderly females of low income, and less in rural areas.     

Anticoagulation remains underused in prevention of stroke associated with atrial fibrillation: Insights from two consecutive national surveys

Background

Atrial fibrillation (AF) is a major risk factor of ischemic stroke. We tested whether the adoption of the CHADS₂ score in clinical guidelines has impacted treatment strategies for stroke prevention, and examined how AF affects stroke outcome.

Methods

In the setting of two national surveys [National Acute Stroke Israeli Surveys; all patients hospitalized for stroke in Israel during February-March 2004, and March-April 2007] data of patients with and without AF were analyzed with respect to patient characteristics, use of anticoagulation, stroke severity, clinical course, and long-term outcome.

Results

Of 3040 patients with acute ischemic stroke, 586 patients (19%) had a history of AF. Severe strokes on admission were significantly more frequent in patients with AF, as was the proportion of total anterior circulation strokes. Ischemic stroke associated with AF predicted poor outcome at discharge (adjusted OR 1.56; 95%CI 1.24-1.96) and higher mortality rates throughout follow-up. Among patients with a CHADS₂ score ≥ 2 prior to the index stroke and without known contraindications, 41% received anticoagulation. This proportion increased to only 62% after the index stroke, even after excluding patients with severe disability and no significant increase between 2004 and 2007 was detectable. Increasing age, in-hospital infectious complications, and unfavorable functional status at discharge were independently associated with decreased likelihood of receiving anticoagulation.

Conclusions

In deviation from current recommendations and in spite of the introduction of CHADS₂ criteria, anticoagulation for stroke prevention remains underutilized, despite the particularly poor outcome of strokes associated with AF.     

Contribution of first trimester fasting plasma insulin levels to the incidence of glucose intolerance in later pregnancy: Tanaka women's clinic study

Aims

To clarify risk factors predictive of glucose intolerance in later pregnancy.

Methods

We prospectively studied 509 pregnant women who visited the obstetrics clinic in Tokyo prior to week 13 of gestation, between September 2008 and January 2010. Biochemical parameters were measured in fasting plasma samples collected at week 8.0 ± 2.0 of gestation. A 50 g glucose challenge test (GCT) was performed between weeks 26 and 29: plasma glucose levels ≥7.8 mmol/l 1 h after ingestion indicated a positive GCT. Logistic regression was performed, adjusting for relevant covariates.

Results

We identified 114 patients with positive GCTs, including 8 with gestational diabetes mellitus (GDM). After correcting for baseline body mass index, only the homeostasis model assessment of insulin resistance value remained a significant predictor of GCT positivity (OR 2.07; 1.21-3.55). We identified threshold values of fasting plasma glucose (FPG) ≥3.66 mmol/l and fasting plasma insulin (FPI) ≥36.69 pmol/l as indicative of a higher risk of positive GCT (OR 2.38; 1.49-3.80).

Conclusions

First trimester FPI levels improve the predictive ability of FPG level on subsequent GCT positivity.     

Adopting moderate alcohol consumption in middle age: subsequent cardiovascular events

Purpose

Moderate alcohol use is part of a healthy lifestyle, yet current guidelines caution nondrinkers against starting to drink alcohol in middle age. The purpose of this study was to evaluate whether adopting moderate alcohol consumption in middle age would result in subsequent lower cardiovascular risk.

Methods

This study examined a cohort of adults aged 45-64 years participating in the Atherosclerosis Risk in Communities study over a 10-year period. The primary outcome was fatal or nonfatal cardiovascular events.

Results

Of 7697 participants who had no history of cardiovascular disease and were nondrinkers at baseline, within a 6-year follow-up period, 6.0% began moderate alcohol consumption (2 drinks per day or fewer for men, 1 drink per day or fewer for women) and 0.4% began heavier drinking. After 4 years of follow-up, new moderate drinkers had a 38% lower chance of developing cardiovascular disease than did their persistently nondrinking counterparts. This difference persisted after adjustment for demographic and cardiovascular risk factors (odds ratio 0.62, 95% confidence interval, 0.40-0.95). There was no difference in all-cause mortality between the new drinkers and persistent nondrinkers (odds ratio 0.71, 95% confidence interval, 0.31-1.64).

Conclusion

People who newly begin consuming alcohol in middle age rarely do so beyond recommended amounts. Those who begin drinking moderately experience a relatively prompt benefit of lower rates of cardiovascular disease morbidity with no change in mortality rates after 4 years.     

Facteurs de risque cardiovasculaire chez les travailleurs postés d’une centrale de production d’électricité au centre tunisien

The purpose of the study

The aim of the present study was to investigate relationship between shift work and the cardiovascular risk factors.

Methods

A cross-sectional study was included 330 subjects worked in a company of electricity production in the Centre of Tunisia. The collection of data was based on a questionnaire, a clinical exam and biomarkers.

Results

A total of 290 workers was participated in our study (128 shift workers and 162 daytime workers). A raised prevalence but not statistically significant of some factors of cardiovascular risks was found in the shift workers: obesity (25.8 % versus 17.9 %), smoking (44.5 % versus 39.5 %), impaired fasting glucose (11.7 % versus 9.9 %), hypertriglyceridemia (28.1 % versus 25.9 %) and hypercholesterolemia (14.8 % versus 12.4 %). Whereas the prevalence of the alcohol consumption (25.8 % versus 16.0 %) was significantly higher in the shift workers (p = 0.04).

Conclusion

The high prevalence of the cardiovascular risk factors, observed in our shift workers, justify the adoption of measures to protect this category of workers.     

Quantitative regional wall motion analysis with early contrast ventriculography for the assessment of myocardium at risk in acute myocardial infarction

Background

Several techniques have been used to quantify the myocardium at risk, including measurement of regional ventricular function with contrast ventriculography and measurement of perfusion defect size with tomographic technetium-99m-sestamibi imaging. This study evaluates the correlation between these 2 techniques.

Methods

Twenty-three patients with angiographically documented coronary occlusion and acute myocardial infarctions (10 anterior, 13 inferior) were studied. All patients had contrast left ventriculography at the time of their acute angiogram before any revascularization therapy. Regional wall motion parameters measured with the centerline method were the severity, circumferential extent, and global circumferential extent of hypokinesis and the mean standardized motion in predefined areas. Technetium-99m-sestamibi was injected before reperfusion therapy with measurement of the myocardium at risk using single photon emission computed tomography imaging.

Results

The tomographic sestamibi-measured myocardium at risk was significantly greater for anterior infarctions compared with inferior infarctions (40% ± 18% vs 14.0 ± 8.5%, P = .0001). The only parameter of regional wall motion to show a significant difference by infarct location was global circumferential extent of hypokinesis (43% ± 25% vs 22% ± 15%, P = .02). The other parameters were not significantly different between anterior and inferior myocardial infarctions. For anterior infarctions, these parameters of regional wall motion correlated with myocardium at risk assessed with sestamibi: global circumferential extent of hypokinesis (r = .88, P < .01), circumferential extent of hypokinesis (r = .78, P < .01), mean standardized motion in predefined areas (r = -.74, P < .05), and severity of hypokinesis (r = -.70, P < .05). For inferior infarctions, there was no significant correlation between any of these parameters of regional wall motion and myocardium at risk assessed with sestamibi imaging.

Conclusion

The assessment of regional ventricular function with contrast ventriculography correlates with the area of myocardium at risk measured with tomographic technetium-99m-sestamibi for anterior, but not for inferior, myocardial infarctions. Therefore, these parameters of regional wall motion are a poor measure of the efficacy of reperfusion therapies.     

Atrioventricular nodal reentrant tachycardia associated with idiopathic ventricular tachycardia: clinical and electrophysiologic characteristics

Background

Case reports have described the coexistence of ventricular tachycardia (VT) and supraventricular tachycardia in the same patient. This study examines the frequency of dual atrioventricular nodal (AVN) physiology, AVN echo beats, and atrioventricular nodal reentrant tachycardia (AVNRT) in patients with VT.

Methods

Programmed atrial and ventricular stimulation was performed in 132 consecutive patients referred for electrophysiologic study of symptomatic VT. Of the 132, 99 patients had structural heart disease, and 33 patients had idiopathic ventricular tachycardia (IVT).

Results

Among the 33 patients with IVT, 23 had dual AVN physiology. Compared with patients with structural heart disease undergoing VT ablation, dual AVN pathways (70% vs 27%, P < .0001), dual AVN pathways with echo beats (24% vs 8%, P = 0.03), and AVNRT (21% vs 1%, P = .0002) were more common in patients with IVT.

Conclusion

Dual AVN physiology and AVNRT appear to be associated with IVT. This finding suggests that patients with IVT should undergo a complete electrophysiologic evaluation, and the diagnosis of coexistent AVNRT should be considered in this population.     

Serum Phosphorus and Cardiovascular Mortality in Type 2 Diabetes

Background

Although serum phosphorus, calcium, and calcium-phosphorus product levels have been associated with cardiovascular events and mortality in patients with normal kidney function, most studies have not examined the association of these minerals with outcomes when collected repeatedly over time.

Methods

We evaluated the association of serum phosphorus, calcium, and calcium-phosphorus product levels with cardiovascular events and mortality in 950 participants of the Appropriate Blood Pressure Control in Diabetes trial by both time-dependent Cox regression models using the cumulative average of minerals measured over time and fixed covariate Cox regression models with only baseline values of these minerals.

Results

There were 42 deaths and 193 cardiovascular events among the participants, who were followed for an average of 4.8 years following randomization. A significant association was noted between baseline serum phosphorus >3.9 mg/dL and baseline calcium-phosphorus product >36.8 mg²/dL² compared with the lowest referent category with the adjusted risk of cardiovascular death (hazard ratio [HR] 5.00; 95% confidence interval [CI], 1.70-14.72) and (HR 10.01; 95% CI, 2.55-39.31), respectively. However, in time-dependent models using mineral values repeated during the course of the study, only the average of serum phosphorus remains significant (HR 4.25; 95% CI, 1.15 to 16.65).

Conclusions

In the Appropriate Blood Pressure Control in Diabetes cohort, serum phosphorus, but not serum calcium or calcium-phosphorus product, was associated with cardiovascular mortality in time-dependent Cox regression models. Thus, serum phosphorus levels may be more reliable in predicting cardiovascular mortality in patients with type 2 diabetes.     

Hyperleptinaemia positively correlated with metabolic syndrome in hemodialysis patients

Objective

To evaluate the relationship between metabolic syndrome (MetS) and the fasting serum leptin concentration in hemodialysis (HD) patients.

Patients and methods

Fasting blood samples were obtained from 101 HD patients. MetS and its components were defined using the diagnostic criteria of the International Diabetes Federation.

Results

Forty-eight patients (47.5%) had MetS. Serum leptin concentrations were positively correlated with MetS (p < 0.001). Serum leptin levels correlated with increasing numbers of MetS criteria in HD patients (p = 0.001). Univariate linear regression analysis showed that the pre-HD body weight (p < 0.001), waist circumference (p < 0.001), body mass index (p = 0.001), triglycerides (p = 0.003), insulin level (p = 0.043), and homeostasis model assessment of insulin resistance (p = 0.003) positively correlated with serum leptin levels in HD patients and high-density lipoprotein-cholesterol (p = 0.016) negatively correlated with serum leptin levels in HD patients. Multivariate forward stepwise linear regression analysis of the significant variables revealed that pre-HD body weight (R² = 0.175; p < 0.001) was the independent predictor of the fasting serum leptin concentration.

Conclusion

Fasting serum leptin levels positively correlated with MetS and the pre-HD body weight could influence serum leptin in HD patients.     

Metabolic syndrome may be associated with increased arterial stiffness even in the absence of hypertension: A study in 84 cases and 82 controls

Objective

To evaluate the hemodynamic characteristics of metabolic syndrome (MetS) in the absence and presence of hypertension.

Materials/Methods

Altogether 166 subjects without previously diagnosed cardiovascular disease, diabetes, or antihypertensive medication, were allocated to four groups: control, hypertension only, MetS without hypertension, and MetS with hypertension (mean age 44–46 years). Cut-point for hypertension was blood pressure ≥ 140/90 mmHg. Other criteria of MetS were as defined by Alberti et al. 2009. Hemodynamic variables were measured using whole-body impedance cardiography and pulse wave analysis.

Results

Pulse wave velocity was higher in hypertensive and normotensive subjects with MetS than controls (p < 0.05), and in the hypertensive MetS group than subjects with hypertension only (p < 0.05). Aortic pulse pressure was higher in the two hypertensive groups than the two normotensive groups (p < 0.05). Systemic vascular resistance index was higher in the hypertensive than normotensive MetS group (p < 0.05), and in the group with hypertension alone than in controls (p < 0.05). Heart rate was higher in the hypertensive Mets group than in controls and subjects with hypertension only (p < 0.05). Cardiac index did not differ, while stroke index was lower in both groups with MetS than groups without MetS. Augmentation pressure was higher in the hypertensive MetS group than in controls and normotensive MetS group (p < 0.05).

Conclusions

Pulse wave velocity, an acknowledged marker of arterial stiffness, was associated with MetS even in the absence of hypertension. This emphasizes the importance of the prevention and treatment of MetS.