Individual Cardiometabolic Risk Factors Research Articles

Intake of fibers and its association with cardiometabolic risk factors in individuals on a secondary prevention for cardiovascular diseases: a multicenter study.

Among the non-pharmacologic measures for the prevention and treatment of cardiovascular diseases (CVD), which are the first cause of death worldwide, the adequate intake of dietary fibers (DF) has shown an important role. To evaluate the association between the intake of DF and the cardio-metabolic risk factors in individuals on a secondary prevention for CVD. Transversal study with basal data of the study's DICA Br participants belonging to collaborative centers in the states of Maranhão (MA), Bahia (BA) and Rio de Janeiro (RJ). Sociodemographic and clinical data were used, as well as the daily intake of DF in individuals of both sexes, with age ≥ 45 years and manifest evidence of arteriosclerosis. The association between the intake of dietary fibers and the cardio-metabolic risk factors was obtained through Poisson's regression model. With 141 evaluated individuals, high frequency of non-appropriateness of DF intake was observed. The participants in the centers of RJ (PR = 0.63; CI 95% = 0.49-0.80) and BA (PR = 0.79; CI 95% = 0.66-0.95), former smokers (PR = 0.59; CI 95% = 0.45-0.78) and non-smokers (PR = 0.62; CI 95% = 0.66-0.95) had fewer chances of having non appropriate intake of DF. On the other hand, overweight individuals showed 28.0% more chances of non-appropriate intake of DF. Results showed that the majority of the observed population presented non-appropriate intake of DF and that this low intake was significantly associated with overweight, smoking and location of the collaborative center.

Sedentary Behaviors and Cardiometabolic Risk: An Isotemporal Substitution Analysis.

Evidence suggests that time spent engaging in sedentary behaviors is associated with a greater risk of adverse cardiometabolic outcomes. We investigated the cross-sectional associations of 6 unique sedentary tasks (watching television, using the computer, completing paperwork, reading, talking on the telephone, and sitting in a car) with cardiometabolic risk factors, and also examined the effect of replacing one type of sedentary behavior with another on the level of cardiometabolic risk. Participants consisted of 3,211 individuals from the Coronary Artery Risk Development in Young Adults Study who visited the clinic between 2010 and 2011. Linear regression models examined the independent and joint associations of sedentary tasks with a composite cardiometabolic risk score, as well as with individual cardiometabolic risk factors (waist circumference, blood pressure, fasting glucose, insulin, triglycerides, and high density lipoprotein cholesterol) after adjusting for physical activity and other covariates. Replacing 2 hours of television viewing with 2 hours spent performing any other sedentary activity was associated with a lower cardiometabolic risk score of 0.06-0.09 standard deviations (all 95% confidence intervals: -0.13, -0.02). No other replacements of one type of sedentary task for another were significant. Study findings indicate that television viewing has a more adverse association with cardiometabolic risk factors than other sedentary behaviors.

Moderate-to-vigorous physical activity, but not sedentary time, predicts changes in cardiometabolic risk factors in 10-y-old children: the Active Smarter Kids Study ,

Background: Cross-sectional data have suggested an inverse relation between physical activity and cardiometabolic risk factors that is independent of sedentary time. However, little is known about which subcomponent of physical activity may predict cardiometabolic risk factors in youths.Objective: We examined the independent prospective associations between objectively measured sedentary time and subcomponents of physical activity with individual and clustered cardiometabolic risk factors in healthy children aged 10 y.Design: We included 700 children (49.1% males; 50.9% females) in which sedentary time and physical activity were measured with the use of accelerometry. Systolic blood pressure, waist circumference (WC), and fasting blood sample (total cholesterol, high-density lipoprotein cholesterol, triglycerides, glucose, fasting insulin) were measured with the use of standard clinical methods and analyzed individually and as a clustered cardiometabolic risk score standardized by age and sex (z score). Exposure and outcome variables were measured at baseline and at follow-up 7 mo later.Results: Sedentary time was not associated with any of the individual cardiometabolic risk factors or clustered cardiometabolic risk in prospective analyses. Moderate physical activity at baseline predicted lower concentrations of triglycerides (P = 0.021) and homeostatic model assessment for insulin resistance (P = 0.027) at follow-up independent of sex, socioeconomic status, Tanner stage, monitor wear time, or WC. Moderate-to-vigorous physical activity (P = 0.043) and vigorous physical activity (P = 0.028) predicted clustered cardiometabolic risk at follow-up, but these associations were attenuated after adjusting for WC.Conclusions: Physical activity, but not sedentary time, is prospectively associated with cardiometabolic risk in healthy children. Public health strategies aimed at improving children's cardiometabolic profile should strive for increasing physical activity of at least moderate intensity rather than reducing sedentary time. This trial was registered at clinicaltrials.gov as NCT02132494.

Self-Reported Screen Time is Independently Associated with Cardiometabolic Disease Risk Factors in Young Adults

Research has shown that self-reported screen time is linked to cardiometabolic disease risk factors in children. Whether this association extends to young adults has not been investigated. PURPOSE: To determine the associations between self-reported screen time and individual cardiometabolic disease risk factors in young adults. METHODS: Sixty-six young adults volunteered for the study (mean±SD: age 20.6±1.4 y; BMI 24.3±3.6 kg/m2; body fat 22.7±8.8%; peak oxygen consumption [VO2peak] 45.7±7.7 ml/kg/min). Sedentary behavior and screen time (television viewing, video games and computer games) were self-reported using the Sedentary Behavior Questionnaire. Moderate-to-vigorous physical activity (MVPA) was objectively measured by 7 d of accelerometer wear. Cardiometabolic disease risk factors were measured using standard procedures and included waist circumference, blood pressure, glucose, triglycerides (TG), high-density lipoprotein cholesterol (HDL) and low-density lipoprotein cholesterol (LDL). Body composition was estimated by BOD POD and VO2peak was measured by indirect calorimetry using an incremental treadmill test to exhaustion. Multiple regression was used to analyze the independent associations between screen time and individual cardiometabolic disease risk factors with sedentary behavior, MVPA, age, and sex used as covariates in the models. RESULTS: On average, screen time (14.8±11.6 h/week) accounted for 25% of total sedentary behavior (59.0±25.8 h/week). Screen time was positively associated with BMI (R2=0.19, β=0.35, p=0.02), waist circumference (R2=0.19, β=0.43, p<0.01), fat mass (R2=0.39, β=0.34, p=0.01), and TG (R2=0.24, β=0.43, p<0.01), and negatively associated with VO2peak (R2=0.66, β=-0.39, p<0.01). These associations were independent of total sedentary behavior, MVPA, age and sex. Screen time was not associated with blood pressure, glucose, HDL or LDL (p>0.05). CONCLUSIONS: Our findings suggest that screen time is related to individual cardiometabolic disease risk factors in young adults. Screen time accounted for 25% of sedentary time and may be an important area to target for chronic disease prevention programs in young adults. Funded by CTR-IN NIH NIGMS #1U54GM104944-01A1

Longitudinal Analysis of Sleep Duration and Cardiometabolic Risk in Young Children.

The aim of this study is to determine if sleep duration in early childhood is associated with cardiometabolic risk (CMR) in later childhood as assessed by a CMR cluster score [sum of age- and sex-standardized z-scores of waist circumference (WC), systolic blood pressure, triglycerides, glucose, and (inverse) high-density lipoprotein (HDL)]. Secondary objectives included examining sleep duration and the individual CMR factors and BMI z-score. A prospective cohort study was conducted using data from the TARGet Kids! practice-based research network in Toronto, Canada. Children (n = 597) with parent-reported 24-hour sleep duration in early childhood (12-36 months) and a follow-up visit (36-96 months) with all five CMR factors were included in the analysis. Multivariable linear regression was used to assess the relationship between early childhood sleep duration and later childhood CMR, adjusting for relevant covariates. Average 24-hour sleep duration in early childhood [mean age: 28.1 (6.6) months] was 11.8 (1.4) hours, with 87% meeting or exceeding total sleep recommendations for their age. Sleep duration in early childhood was not associated with the CMR cluster score in later childhood. Shorter sleep duration was associated with higher HDL concentrations [adjusted β = -0.028 (95% confidence interval: -0.049 to -0.007), p = 0.009]. Further research is needed to determine if early childhood sleep duration is associated with HDL in later childhood. Future studies, which investigate sleep quality in addition to sleep duration, may be helpful.

The gut microbiota metabolism of pomegranate or walnut ellagitannins yields two urolithin-metabotypes that correlate with cardiometabolic risk biomarkers: Comparison between normoweight, overweight-obesity and metabolic syndrome

Urolithins are microbial metabolites produced after consumption of ellagitannin-containing foods such as pomegranates and walnuts. Parallel to isoflavone-metabolizing phenotypes, ellagitannin-metabolizing phenotypes (urolithin metabotypes A, B and 0; UM-A, UM-B and UM-0, respectively) can vary among individuals depending on their body mass index (BMI), but correlations between urolithin metabotypes (UMs) and cardiometabolic risk (CMR) factors are unexplored. We investigated the association between UMs and CMR factors in individuals with different BMI and health status. UM was identified using UPLC-ESI-qToF-MS in individuals consuming pomegranate or nuts. The associations between basal CMR factors and the urine urolithin metabolomic signature were explored in 20 healthy normoweight individuals consuming walnuts (30g/d), 49 healthy overweight-obese individuals ingesting pomegranate extract (450mg/d) and 25 metabolic syndrome (MetS) patients consuming nuts (15g-walnuts, 7.5g-hazelnuts and 7.5g-almonds/d). Correlations between CMR factors and urolithins were found in overweight-obese individuals. Urolithin-A (mostly present in UM-A) was positively correlated with apolipoprotein A-I (P≤0.05) and intermediate-HDL-cholesterol (P≤0.05) while urolithin-B and isourolithin-A (characteristic from UM-B) were positively correlated with total-cholesterol, LDL-cholesterol (P≤0.001), apolipoprotein B (P≤0.01), VLDL-cholesterol, IDL-cholesterol, oxidized-LDL and apolipoprotein B:apolipoprotein A-I ratio (P≤0.05). In MetS patients, urolithin-A only correlated inversely with glucose (P≤0.05). Statin-treated MetS patients with UM-A showed a lipid profile similar to that of healthy normoweight individuals while a poor response to lipid-lowering therapy was observed in MB patients. UMs are potential CMR biomarkers. Overweight-obese individuals with UM-B are at increased risk of cardiometabolic disease, whereas urolithin-A production could protect against CMR factors. Further research is warranted to explore these associations in larger cohorts and whether the effect of lipid-lowering drugs or ellagitannin-consumption on CMR biomarkers depends on individuals' UM. NCT01916239 (https://clinicaltrials.gov/ct2/show/NCT01916239) and ISRCTN36468613 (http://www.isrctn.com/ISRCTN36468613).

Effects of muscle strength and endurance on blood pressure and related cardiometabolic risk factors from childhood to adolescence.

This study aimed to examine the evolution of relationships between measures of muscle strength and endurance with individual cardiometabolic risk factors from childhood to late adolescence in a prospective population-based cohort. Participants from the Western Australian Pregnancy Cohort (Raine) Study at ages 10, 14 and 17 were analysed, using longitudinal linear mixed model analyses. Handgrip strength after adjusting for the confounding effects of BMI was positively associated with SBP, but not DBP. The association between handgrip strength and SBP was stronger in men than women at all time points [coefficient (women): 0.18, P < 0.001; sex × handgrip strength coefficient: 0.09, P = 0.002]. The association was strongest at 10 years and significantly attenuated over time (year × handgrip coefficient from 10 to 14 years: -0.11, P = 0.003; year × handgrip coefficient from 10 to 17 years: -0.19, P ≤ 0.001). After the inclusion of BMI as a confounder, handgrip strength was significantly negatively associated with homeostatic model assessment of insulin resistance and high-sensitivity C-reactive protein over time in both sexes. Back muscle endurance was positively associated with SBP, but not DBP, after adjustment for the confounding effects of BMI (coefficient: 0.01, P = 0.002). There were small, albeit significant, inverse associations between back muscle endurance and log homeostatic model assessment of insulin resistance and log high-sensitivity C-reactive protein. The positive association between handgrip strength and back muscle endurance with SBP throughout childhood and adolescence contrasts with beneficial effects on other related traditional cardiometabolic risk factors. Mechanisms underlying these paradoxical effects on SBP warrant further investigation.

Amelioration of Cardiometabolic Risk Factors With a Pecan‐rich Diet in Overweight and Obese Adults

Evidence from in vitro and observational studies indicates tree nuts may reduce the risk of cardiovascular diseases (CVD) and type 2 diabetes mellitus (T2DM), though support from controlled feeding trials is limited. Most nut intervention studies to date have counseled subjects to incorporate nuts into their usual diet, an approach that can neither control for inter‐individual variability in the background diet, nor fully account for the intake of other food/beverage components that can influence CVD and T2DM risk, e.g., antioxidants, fatty acids, and fiber. We conducted a 12 wk randomized, controlled, cross‐over feeding trial to examine the effects of pecans in overweight and obese men and postmenopausal women ≥45 y with central adiposity. Subjects (n=25) were randomized to either a diet resembling the average American diet (control) or the same diet with whole pecans (intervention) incorporated at ~15% of energy (1.5 oz/2000 kcal) for 4 wk, and then the opposite diet for the final 4 wk. Total fat and fiber in these isocaloric diets were similar, and all meals/snacks were provided. During the 2 wk run‐in and 4 wk washout periods, subjects were counseled to consume the control diet. A multivariate multilevel model was used to simultaneously analyze change in z‐scores of insulin, glucose, total cholesterol, triglycerides, and LDL. An interim analysis (n=18) yielded a mean increase of 0.11 SD in the control arm and a decrease of 0.23 SD in the intervention arm (mean difference between arms = 0.34 SD, P=0.047). Although differences in favor of the intervention arm were observed for all individual cardiometabolic risk factors, the sample size was too small for them to reach statistical significance. Preliminary evidence suggests a pecan‐rich diet may have a benefit in modifying cardiometabolic risk factors.Support or Funding InformationSupported by USDA and the National Pecan Shellers Association

Contributions of maternal and paternal adiposity and smoking to adult offspring adiposity and cardiovascular risk: the Midspan Family Study

ObjectiveObesity has some genetic basis but requires interaction with environmental factors for phenotypic expression. We examined contributions of gender-specific parental adiposity and smoking to adiposity and related cardiovascular risk in...

Sugar-containing beverage intake at the age of 1 year and cardiometabolic health at the age of 6 years: the Generation R Study.

BackgroundConsumption of sugar-containing beverages (SCBs) in adults has been associated with an increased risk of metabolic syndrome. Although the effect of SCB on body weight in children is well established, little is known about the cardiometabolic effects in young children. We studied the associations of SCB intake at the age of 1 year with cardiometabolic health at age 6 years.MethodsThis study was performed among 2,045 Dutch children from a population based prospective birth cohort. SCB intake was assessed with a semi-quantitative food frequency questionnaire at the age of 13 months and sex-specific tertiles were created. Children visited the research center at the age of 6 years. We created a continuous cardiometabolic risk factor score including: body fat percentage, blood pressure, insulin, HDL-cholesterol and triglycerides. Age-and sex-specific standard deviation (SD) scores were created for all outcomes. Multivariable linear regression was performed with adjustment for socio-demographic and lifestyle variables of mother and child.ResultsIn the total population, we observed an association between higher SCB intake at 13 months of age and a higher cardiometabolic risk factor score at the age of 6 years (0.13SD (95 % CI 0.01; 0.25), highest vs. lowest tertile) After stratification by sex, we found that boys in the highest tertile of SCB intake had a higher cardiometabolic risk factor score (0.18 SD (95 % CI 0.01; 0.34)), as compared to boys in the lowest tertile of SCB intake. There was no significant association in girls. We did not find associations of SCB intake with the individual cardiometabolic risk factors in the total population, or in the stratified analyses.ConclusionHigher SCB intake at 1 year of age was associated with a higher cardiometabolic risk factor score at age 6 years in boys, but not in girls. Further research on sex-specific effects of SCBs is needed.

Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial.

The aims of the study were to determine the prevalence of cardiometabolic risk factors and establish the proportion of people with psychosis meeting criteria for the metabolic syndrome (MetS). The study also aimed to identify the key lifestyle behaviours associated with increased risk of the MetS and to investigate whether the MetS is associated with illness severity and degree of functional impairment. Baseline data were collected as part of a large randomized controlled trial (IMPaCT RCT). The study took place within community mental health teams in five Mental Health NHS Trusts in urban and rural locations across England. A total of 450 randomly selected out-patients, aged 18-65 years, with an established psychotic illness were recruited. We ascertained the prevalence rates of cardiometabolic risk factors, illness severity and functional impairment and calculated rates of the MetS, using International Diabetes Federation (IDF) and National Cholesterol Education Program Third Adult Treatment Panel criteria. High rates of cardiometabolic risk factors were found. Nearly all women and most men had waist circumference exceeding the IDF threshold for central obesity. Half the sample was obese (body mass index ≥ 30 kg/m2) and a fifth met the criteria for type 2 diabetes mellitus. Females were more likely to be obese than males (61% v. 42%, p < 0.001). Of the 308 patients with complete laboratory measures, 57% (n = 175) met the IDF criteria for the MetS. In the UK, the prevalence of cardiometabolic risk factors in individuals with psychotic illnesses is much higher than that observed in national general population studies as well as in most international studies of patients with psychosis.

Sleep duration and cardiometabolic risk factors among individuals with type 2 diabetes

ObjectiveTo examine the association between sleep duration and cardiometabolic risk factors among individuals with recently diagnosed type 2 diabetes (n = 391). MethodsSleep duration was derived using a combination of questionnaire and objective heart rate and movement sensing in the UK ADDITION-Plus study (2002–2007). Adjusted means were estimated for individual cardiometabolic risk factors and clustered cardiometabolic risk (CCMR) by five categories of sleep duration. ResultsWe observed a J-shaped association between sleep duration and CCMR – individuals sleeping 7 to <8 h had a significantly better CCMR profile than those sleeping ≥9 h. Independent of physical activity and sedentary time, individuals sleeping 7 to <8 h had lower triacylglycerol (0.62 mmol/l (0.29, 1.06)) and higher high-density lipoprotein (HDL)-cholesterol levels (0.23 mmol/l (0.16, 0.30)) compared with those sleeping ≥9 h, and a lower waist circumference (7.87 cm (6.06, 9.68)) and body mass index (BMI) (3.47 kg/m2 (2.69, 4.25)) than those sleeping <6 h. Although sleeping 7 to <8 h was associated with lower levels of systolic and diastolic blood pressure, HbA1c, total cholesterol, and low-density lipoprotein (LDL)-cholesterol, these associations were not statistically significant. ConclusionsSleep duration has a J-shaped association with CCMR in individuals with diabetes, independent of potential confounding. Health promotion interventions might highlight the importance of adequate sleep in this high-risk population.

The Association Between Cardiorespiratory Fitness and Cardiometabolic Risk in Children is Mediated by Abdominal Adiposity: The HAPPY Study.

It is unclear whether cardiorespiratory fitness (CRF) is independently linked to cardiometabolic risk in children. This study investigated a) the association between CRF level and presence of cardiometabolic risk disorders using health-related cut points, and b) whether these associations were mediated by abdominal adiposity in children. This was a cross-sectional design study. Anthropometry, biochemical parameters and CRF were assessed in 147 schoolchildren (75 girls) aged 10 to 14 years. CRF was determined using a maximal cycle ergometer test. Children were classified as 'fit' or 'unfit' according to published thresholds. Logistic regression was used to investigate the odds of having individual and clustered cardiometabolic risk factors according to CRF level and whether abdominal adiposity mediated these associations. Children classified as unfit had increased odds of presenting individual and clustered cardiometabolic risk factors (P < .05), but these associations no longer remained after adjusting for abdominal adiposity (P > .05). This study suggests that the association between CRF and cardiometabolic risk is mediated by abdominal adiposity in 10- to 14-year-old children and that abdominal adiposity may be a more important determinant of adverse cardiometabolic health in this age group.

Metabolic Syndrome: A Construct with Limited Relevance to Children

The prevalence of obesity in youth has increased dramatically over the last 3 decades. Similar to adults, obese children often display clusterings of risk factors associated with heightened risk for future cardiovascular disease. In adults, this clustering is commonly referred to as the metabolic syndrome and is used to identify individuals at high risk for premature cardiovascular disease and diabetes. Conversely, the relevance of a pediatric metabolic syndrome diagnosis to predict future adult cardiovascular outcomes is less clear. Many pediatric definitions of the metabolic syndrome have been proposed, yet no consensus has been adopted due to inconsistent study results, lack of translational relevance of childhood classifications to future disease, and instability of the criteria used for various definitions. Given absence of substantial evidence for using a dichotomous metabolic syndrome diagnosis over individual cardiometabolic risk factors, clinicians and experts must proceed with caution when diagnosing metabolic syndrome to guide treatments recommendations.

Elevated 1 h postload plasma glucose levels identify adults with normal glucose tolerance but increased risk of non-alcoholic fatty liver disease

ObjectiveTo determine the ability of the proposed diagnostic value of a 1-h OGTT glucose ≥155mg/dL to identify individuals with non-alcoholic fatty liver disease (NAFLD) diagnosed by ultrasonography in a cohort...

Clustering of cardiometabolic risk factors and risk of elevated HbA1c in non-Hispanic White, non-Hispanic Black and Mexican-American adults with type 2 diabetes

AimTo determine which cardiometabolic risk factors and clusters of cardiometabolic risk factors that are mostly associated with elevated HbA1c in non-Hispanic White (NHW), non-Hispanic Black (NHB) and Mexican-American (MA) adults who have type 2 diabetes. MethodsData (n=2910) from the United States National Health and Nutritional Examination Surveys were used in this study. Elevated HbA1c was defined as having HbA1c value was 7% or greater. Race/ethnicity-specific associations of individual and clustered (2–5 factors) cardiometabolic risk factors with elevated HbA1c were determined using prevalence odds ratio from multivariate logistic regression analyses. Statistical adjustments were made for sex, age, education, income and marital status. ResultsJoint occurrence of abdominal obesity, high blood pressure, and elevated triglycerides and joint occurrence of high blood pressure, elevated triglycerides and low HDL were more highly associated with elevated odds of HbA1c compared to other cardiometabolic risk factors joint occurrences. Joint occurrences of abdominal obesity, high blood pressure, and elevated triglycerides was associated with 2.3 (95% CI: 1.2–3.3), 9.1 (95% CI: 2.9–28.7) and 4.8 (95% CI: 2.0–11.5) increased odds of elevated HbA1c in NHW, NHB and MA, respectively. The corresponding values for the joint occurrence of high blood pressure, elevated triglycerides and low HDL was associated with 2.4 (95% CI: 1.2–3.7), 3.5 (95% CI: 1.1–5.5) and 2.6 (95% CI: 1.5–4.7) increased odds of elevated HbA1c in NHW, NHB and MA, respectively. ConclusionThis finding calls for consideration of cardiovascular risk factor clustering in deciding medical therapies to optimize glycemic control in individuals with type 2 diabetes. Interventions designed to achieve glycemic control coupled with modification of cardiometabolic risk factors may be crucial in alleviating sequelae resulting from type 2 diabetes.

Identification of Cardiometabolic Risk: Visceral Adiposity Index Versus Triglyceride/HDL Cholesterol Ratio

BackgroundThe plasma concentration ratio of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) can identify cardiometabolic risk and cardiovascular disease. The visceral adiposity index is a sex-specific index, in which measurements of body mass index and waist circumference are combined with TG and HDL-C concentrations. The current analysis was initiated to see if the visceral adiposity index would improve the ability of the TG/HDL-C to identify increased cardiometabolic risk and outcome. MethodsCardiometabolic data were obtained in 2003 from 926 apparently healthy individuals, 796 of whom were evaluated in 2012 for evidence of incident cardiovascular disease. The relationship between TG/HDL-C and values for visceral adiposity index was evaluated by Pearson's correlation coefficient. The relative risks for first cardiovascular event between individuals above and below the TG/HDL-C sex-specific cut points, and in the top quartile of visceral adiposity index versus the remaining 3 quartiles, were estimated using Cox proportional hazard models. ResultsTG/HDL-C concentration and visceral adiposity index were highly correlated (r = 0.99) in both men and women. Although more men (133 vs121) and women (73 vs 59) were identified as being at “high risk” by an elevated TG/HDL-C ratio, the individual cardiometabolic risk factors were essentially identical with either index used. However, the hazard ratio of developing cardiovascular disease was significantly increased in individuals with an elevated TG/HDL-C, whereas it was not the case when the visceral adiposity index was used to define “high risk.” ConclusionThe visceral adiposity index does not identify individuals with an adverse cardiometabolic profile any better than the TG/HDL-C.

Sleep time and cardiovascular risk factors in adolescents: The HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study

ObjectiveWe aimed to examine the association between adolescents’ sleep time and a cardiometabolic risk score. A second aim was to examine associations between sleep time and individual cardiometabolic risk factors. MethodsAdolescents (N=699; ages, 12.5–17.5years) participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study were examined. Sleep time was reported by a questionnaire. Physical activity (PA) was assessed by accelerometry (n=497). Cardiometabolic risk factors measurements included insulin resistance, blood pressure, adiposity markers, cardiorespiratory fitness, and blood lipids. A cardiovascular disease risk score was computed. Associations were examined by a multilevel regression analysis (linear for individual risk factors and Poisson for the clustered risk score). ResultsFor school days no association was found between sleep time and cardiometabolic risk factors. At weekend days, the prevalence ratio (PR) of having a clustered risk score increased by 15% for each additional hour of sleep controlling for age, sex, and socioeconomic status (SES); however, the prevalence disappeared when adjusting for PA. ConclusionsIn European adolescents sleep time is not associated with cardiometabolic risk factors when important confounders are considered. Future research about sleep cardiovascular risk factors should register other sleep dimensions (sleep patterns or disturbances) to provide a better insight in this scientific field.

Cardiometabolic risks during anabolic hormone supplementation in older men

There is little prospective information on the cardiometabolic risks of testosterone and growth hormone (GH) replacement therapy to youthful levels during aging. We conducted a double-masked, partially placebo controlled study in 112 men 65–90 years-old. Transdermal testosterone (5g-vs-10g/day) using a Leydig Cell Clamp and subcutaneous recombinant GH (rhGH) (0-vs-3-vs-5ug/kg/day) were administered for 16-weeks. Measurements included testosterone and IGF-1 levels, body composition by DEXA, and cardiometabolic risk factors (upper body fat, blood pressure, insulin sensitivity, fasting triglycerides, HDL-cholesterol, and serum adiponectin) at baseline and after 16 weeks of treatment. Some cardiometabolic factors improved (total and trunk fat, triglycerides, HDL-cholesterol) and others worsened (systolic blood pressure, insulin sensitivity index [QUICKI], adiponectin). Cardiometabolic risk composite scores (CRCS) improved (−0.69±1.55, p<0.001). In multivariate analyses, QUICKI, triglycerides, and HDL-cholesterol contributed 33%, 16%, and 14% of the variance in CRCS, respectively. Pathway analyses indicated that changes in fat and lean mass were related to individual cardiometabolic variables and CRCS in a complex manner. Changes in BMI, reflecting composite effects of changes in fat and lean mass, were more robustly associated with cardiometabolic risks than changes in fat mass or LBM individually. In conclusion, testosterone and rhGH administration was associated with diverse changes in individual cardiometabolic risk factors, but in aggregate appeared not to worsen cardiometabolic risk in healthy older men after 4-months. The long term effects of these and similar anabolic therapies on cardiovascular events should be investigated in populations with greater funtional limitations along with important health disabilities including upper body obesity and other cardiometabolic risks.

Clinical Implications

HomeHypertensionVol. 61, No. 4Clinical Implications Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBClinical Implications Originally published1 Apr 2013https://doi.org/10.1161/HYP.0b013e31828e0de3Hypertension. 2013;61:745Aldosterone Physiology and Cardiometabolic Risk (page 886)Normal aldosterone regulation is dynamic and responsive. Therefore, single cross-sectional aldosterone measurements capture only a limited range of aldosterone physiology. Quantifying the dynamic nature of aldosterone physiology may improve the understanding of the relationship between aldosterone and cardiometabolic diseases. In this issue of Hypertension, Vaidya et al hypothesized that progressive cardiometabolic abnormalities would predict a blunted dynamic range of aldosterone. Novel indices of aldosterone responses to dietary sodium manipulation were developed, the Sodium-modulated Aldosterone Suppression-Stimulation Index (for serum and SAUSSI for urine), and tested with risk factors in 539 human participants. These indices were calculated as the ratio of aldosterone on a high dietary sodium balance (maximally suppressed aldosterone) to aldosterone on restricted dietary sodium balance (stimulated aldosterone), thereby reflecting the full dynamic range of aldosterone to dietary sodium modulation. Individual cardiometabolic risk factors and components of the metabolic syndrome strongly predicted higher Sodium-modulated Aldosterone Suppression-Stimulation Index and SAUSSI and captured more predictive power than cross-sectional aldosterone measurements alone. These results suggest that abnormal aldosterone physiology, an impaired ability to appropriately stimulate and suppress aldosterone, may contribute to, and result from, progressive cardiometabolic abnormalities.Download figureDownload PowerPointAntihypertensive Therapy and Insulin Action (page 800)Meta-analysis of studies in hypertensive patients using β-blockers and thiazide diuretics indicates that although lowering blood pressure is associated with significantly fewer coronary heart disease events, the benefit is less than that expected from prospective observational data. One explanation is that these older drugs adversely affect cardiovascular risk factors through deleterious effects on insulin action, thereby reducing the impact of blood pressure lowering. This has led to increasing use of newer antihypertensive agents such as angiotensin-converting enzyme inhibitors and calcium channel blockers known to have neutral metabolic effects. Despite this, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), the largest antihypertensive study to date, has shown diuretics to be superior to these newer agents in lowering some cardiovascular outcomes. In this issue of Hypertension, McHenry et al report results from a small study of carefully selected nondiabetic hypertensive patients. In a randomized double-blind crossover protocol, the authors find that sensitive measures of insulin action assessed by the euglycemic hyperinsulinemic clamp technique are no different after treatment with an angiotensin-converting enzyme inhibitor combined with low-dose thiazide compared with an angiotensin-converting enzyme inhibitor alone. These results contrast with the authors’ previous studies in diabetic hypertensive patients, where even low doses of thiazides had a negative impact on glucose metabolism. Overall, the current study is reassuring and should encourage physicians to include low-dose thiazide diuretics in treatment regimens for essential hypertension.Left Ventricular Global Function Index: Predictive Value (page 770)Current indices of left ventricular (LV) function are adequate at reflecting the heart’s actual functional state with respect to the vascular system and the body’s needs. However, they do not take into account how much structural remodeling has occurred and the lifetime evolution of the cardiovascular (CV) system for 1 specific individual. Our intent with proposing this novel approach was to integrate information on ventricular remodeling into the functional capacity of the heart for a given vascular system of an individual.By assessing stroke volume with respect to size of LV cavity and myocardium, the LV global function index combines LV mass, volume, and stroke volume into 1 index. In a multiethnic population free of symptomatic CV disease at baseline, the LV global function index was strongly and consistently associated with adverse CV events during follow-up, whereas LV ejection fraction was not associated with hard CV events beyond heart failure. LV global function index’s predictive power was better and more consistent than LV mass-to-volume ratio and LV ejection fraction and was comparable with indexed LV mass.By conventional indices, the impact of long-standing increased workload, such as hypertension, is manifested on LV structure before LV function. It is, therefore, essential to have a reliable and reproducible assessment of both LV structure as well as LV function in the risk stratification of cardiac patients. Therefore, LV global function index may provide unique information in the CV risk assessment and therapeutic follow-up of hypertensive patients.Download figureDownload PowerPoint Previous Back to top Next FiguresReferencesRelatedDetails April 2013Vol 61, Issue 4 Advertisement Article InformationMetrics © 2013 American Heart Association, Inc.https://doi.org/10.1161/HYP.0b013e31828e0de3 Originally publishedApril 1, 2013 PDF download Advertisement