Cardiovascular Metabolic Syndrome Research Articles

Is There a Connection between Hyperhomocysteinemia and the Cardiometabolic Syndrome?

This study investigates the distribution of hyperhomocysteinemia and cardiovascular metabolic syndrome (SM) among participants, shedding light on their prevalence and co-occurrence within the study cohort. Through an analysis of demographic characteristics and health parameters, including age, gender, and body mass index (BMI), alongside nutritional data, correlations between these factors and health risks are explored. Results reveal a notable prevalence of hyperhomocysteinemia, with 45.3% of participants exhibiting this condition. Furthermore, 31.4% of the cohort does not present hyperhomocysteinemia or SM, while 23.3% shows SM without hyperhomocysteinemia. The study underscores gender-specific dietary recommendations due to significant variations in nutrient intake patterns. Additionally, inverse correlations between health risks like obesity, hypertension, and hypercholesterolemia and nutrient requirements highlight the need for tailored dietary interventions. Age-related changes in nutrient needs and the positive correlation between physical activity levels and certain nutrient demands further emphasize the importance of personalized dietary strategies. Variations in nutrient intake by gender, inverse correlations with health risks, and age-related changes underscore the need for tailored dietary strategies. These findings provide valuable insights for healthcare professionals in developing targeted nutritional interventions to mitigate disease risk and promote overall health and well-being.

Association between vitamin D deficiency and prevalence of metabolic syndrome in female population: a systematic review.

The increasing prevalence of metabolic syndrome (MS) especially in female population, has become a major problem in health care systems. In this regards, it is necessary to identify the risk factors. Vitamin D deficiency is now proposed as one of the possible risk factors for metabolic syndrome, we investigated the relationship between vitamin D status and MS in female. We searched observational studies with keywords Vitamin D, metabolic syndrome, metabolic syndrome X, insulin-resistance syndrome, metabolic cardiovascular syndrome and Reaven Syndrome X and female in pubmed, scopus, science direct, cochrane, web of science, google scholar and SID databases, regardless of publication time. Two hundred ninety five studies were found, and finally only 12 articles were selected according to exclusion and inclusion criteria. In nine studies that reported the prevalence of MS, the prevalence of MS among women with vitamin D deficiency was higher than female with normal vitamin D (34.5 vs. 30.2%). The prevalence of abdominal obesity, high blood pressure, high TG and HDL deficiency is higher in women with vitamin D deficiency. Also, the mean waist circumference, blood pressure, fast blood sugar (FBS), TG and BMI were higher. The most incident factor was high blood pressure (61.4 vs. 56.5%) and the lowest prevalence is associated with high FBS (32.2 vs. 33.5% in the other group). The prevalence of MS is significantly associated with vitamin D deficiency, and among related factors, HDL, TG and blood pressure are statistically associated with vitamin D status.

Systematic review of shift work and nurses’ health

Nursing is characterized by a working articulation in shifts to ensure continuity of care throughout the 24 h. However, shift work and the resulting desynchronization of circadian rhythms may have adverse effects on nurses' health. To describe the effects of shift work and desynchronization of circadian rhythms on nurse's health. Databases: PubMed, Cinahl, Scopus, Embase and Ilisi. Search terms (free terms, MeSH): 'nurses', 'shiftwork', 'nightwork', 'sleep disorder, circadian rhythm', 'work schedule tolerance', 'breast neoplasm', 'metabolic syndrome X', 'metabolic cardiovascular syndrome', 'Cardiovascular disease', 'stress', 'diabetes'. We included all randomized controlled trials, observational studies, reviews and papers studying nurses' shift work. Quality assessment of the retrieved papers was verified according to Dixon-Woods checklist. Twenty-four articles were analyzed. Literature review has shown that shift work involves an alteration in psychophysical homeostasis, with a decrease in performance. It is an obstacle for social and family relationships, as well as a risk factor for stress, sleep disorders, metabolic disorders, diabetes, cardiovascular disorders and breast cancer. An organized ergonomic turnaround can be less detrimental to the health of nurses and more beneficial for the healthcare providers. Therefore, we suggest organizing studies to assess whether improving nurses' health would lead to a reduction in miscarriages, absenteeism and work-related stress.

Epicardial Adipose Tissue Thickness in Patients With Subclinical Hypothyroidism and the Relationship Thereof With Visceral Adipose Tissue Thickness.

BackgroundSubclinical hypothyroidism (SH) is associated with cardiovascular metabolic syndromes, especially dislipidemia and abdominal obesity. Visceral abdominal adipose tissue (VAAT) and epicardial adipose tissue (EAT) have the same ontogenic origin and produce many proinflammatory and proatherogenic cytokines. We evaluated EAT and VAAT thickness in patients with SH.MethodsForty-one patients with SH and 35 controls were included in the study. Demographical and anthropometric features of both patients and controls were recorded. Thyroid and metabolic parameters were measured. EAT was measured using 2D-transthoracic echocardiography.ResultsThe age and gender distributions were similar in the two groups (P = 0.998 and P = 0.121, respectively). Body mass index (BMI), fat mass, waist circumference (WC), hip circumference (HC), the WC/HC ratio, and the thicknesses of VAAT and abdominal subcutaneous adipose tissue were higher in the case group than the control group (all P values < 0.01). However, both groups had similar EAT thickness (P = 0.532), which was positively correlated with BMI, fat mass, WC, HC, VAAT thickness, abdominal subcutaneous adipose tissue thickness, and serum triglyceride (TG) level (all P values < 0.01). We found no correlation between EAT thickness and thyroid-stimulating hormone (TSH) level, free thyroxine (FT4) level, or low-density lipoprotein-cholesterol (LDL-C) level, and anti-TPO level (all P values > 0.05). We found no difference between the two groups in fasting plasma glucose (FPG) level (P = 0.780), but the levels of LDL-C and TG differed significantly (P = 0.002 and P = 0.026, respectively). The serum TSH level was higher and the FT4 level was lower in the case than the control group (both P values <0.01).ConclusionIncreased abdominal adipose tissue thickness in patients with SH is associated with atherosclerosis. To detemine the risk of atherosclerosis in such patients, EAT measurements are valuable; such assessment is simple to perform.

The relationship between epicardial fat tissue thickness and visceral adipose tissue in lean patients with polycystic ovary syndrome.

BackgroundPolycystic ovary syndrome (PCOS) is related to metabolic syndrome, insulin resistance, and cardiovascular metabolic syndromes. This is particularly true for individuals with central and abdominal obesity because visceral abdominal adipose tissue (VAAT) and epicardial adipose tissue (EAT) produce a large number of proinflammatory and proatherogenic cytokines. The present study aimed to determine whether there are changes in VAAT and EAT levels which were considered as indirect predictors for subclinical atherosclerosis in lean patients with PCOS.MethodsThe clinical and demographic characteristics of 35 patients with PCOS and 38 healthy control subjects were recorded for the present study. Additionally, the serum levels of various biochemical parameters were measured and EAT levels were assessed using 2D-transthoracic echocardiography.ResultsThere were no significant differences in mean age (p = 0.056) or mean body mass index (BMI) (p = 0.446) between the patient and control groups. However, the body fat percentage, waist-to-hip ratio, amount of abdominal subcutaneous adipose tissue, and VAAT thickness were higher in the PCOS patient group than in the control group. The amounts of EAT in the patient and control groups were similar (p = 0.384). EAT was correlated with BMI, fat mass, waist circumference, and hip circumference but not with any biochemical metabolic parameters including the homeostasis model assessment of insulin resistance index or the levels of triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein (HDL) cholesterol. However, there was a small positive correlation between the amounts of VAAT and EAT. VAAT was directly correlated with body fat parameters such as BMI, fat mass, and abdominal subcutaneous adipose thickness and inversely correlated with the HDL cholesterol level.ConclusionsThe present study found that increased abdominal adipose tissue in patients with PCOS was associated with atherosclerosis. Additionally, EAT may aid in the determination of the risk of atherosclerosis in patients with PCOS because it is easily measured.

Hyperinsulinemia and hyperleptinemia , a possible threat for metabolic cardiovascular syndrome in obese prepubertal children.

Background: Childhood obesity is a condition where excess body fat negatively affects child's health or wellbeing. Due to the rising prevalence of obesity with its many adverse health effects in children, it has been recognized as a serious public health concern. Adipose tissue or body fat is composed of adipocytes specialized in storing energy as fat. Adipose tissue also serves as an important endocrine organ by producing hormones such as leptin, resistin, and the cytokine. Aim: to explore the relationship between serum insulin and leptin in order to detect the presence of any impairment of these parameters as risk factors for metabolic cardiovascular syndrome in obese prepubertal children, in an attempt to overcome the increased health risk associated with obesity in children. Subjects and methods: Fifty healthy obese children and 30 normal weight children who were selected from subjects attended the hospital and students of primary schools age range of children was between 5 to 11 years. Sera were obtained after centrifugation at 4000 rpm for 15 minutes and were used to measure the levels of insulin and leptin. Results: Insulin was significantly higher in obese children than in leans. However leptin was increased in obese but with no significance when compared to leans. Conclusion: Obesity in children increases the risk of metabolic syndrome with hyperinsulinemia and hyper leptinemia. However with proper intervention hyperinsuilinemia could be reversible. In the light of these results one should take intervention measures which are necessary to prevent excessive increase in weight during childhood.

Oxidative stress and lipid peroxidation may be risk factors for metabolic cardiovascular syndrome in obese prepubertal children

Background: Metabolic cardiovascular syndrome is a combination of factors that augment a person's risk for heart disease, diabetes and stroke. Features of which are obesity, insulin resistance, dyslipidemia [including increased triglycerides and decreased HDL], impaired glucose tolerance, and hypertension. Obesity has the central role in this syndrome. The prevalence of obesity in children has increased dramatically over the last 20 years, leading to higher health risk associated with complications such as type 2 diabetes, high blood pressure and cardiovascular disease. Aim: The aim of this study is to search for a possible relationship between oxidative stress (as interpreted by lipid peroxidation) and risk factors for metabolic cardiovascular syndrome in obese prepubertal children, in an attempt to overcome the increased health risk associated with obesity in children. Subjects and methods: Eighty prepubertal children aged (5-11) years were enrolled in this study. According to their body mass index (BMI) they were divided into two groups: 1. Obese group of which 50 subjects were selected 2. Lean group consisted 30 aged matched subjects. Random cholesterol, high density lipoproteins (HDL) and malondialdehyde were measured in sera spectrophotometricaly Results: Both cholesterol and MDA serum concentrations were significantly higher in obese children than leans ( P < 0.000 ). However HDL was lower in obese children and no significant value was found when compared to leans. Conclusion: Obese children exhibited hypercholesterolemia and increased lipid peroxidation. This might be a potential risk of hypertension and cardiovascular diseases especially when HDL decreases as was found. These findings might shed a light on a possible relationship between oxidative stress metabolic cardiovascular syndrome. A case where interventional measures might be necessary to prevent excessive weight gain during childhood.

Leptin and IL-6 as risk factors for metabolic cardiovascular syndrome in obese prepubertal children

Background: Potential risk factors for cardiovascular diseases (CVD) tend to cluster in childhood and are strongly associated with obesity. The prevalence of obesity in children has increased dramatically over the last 20 years, leading to higher health risk associated with complications such as type 2 diabetes, high blood pressure and cardiovascular disease. Leptin is a hormone produced by the adipocytes to regulate food intake, its circulating levels directly correlate with the amount of body fat and body mass index (BMI). Previous researchers had provided evidence suggesting that ob gene expression is up regulated by some inflammatory cytokines such as IL-6. Aim: The aim of this study is to explore the relationship between serum leptin, and interluikin-6 in order to detect the presence of any impairment of these parameters as risk factors for metabolic cardiovascular syndrome in obese prepubertal children, in an attempt to overcome the increased health risk associated with obesity in children. Subjects and methods: Eighty prepubertal children age range between (5-11) years old were enrolled in this study. Divided according to their weight into two groups: Obese group 50 subjects Lean group 30 aged matched subjects. Circulating serum leptin and IL-6 were measured by ELISA technique. Results: both parameters studied showed a significantly higher values in obese children than in leans. No significant correlations were found to exist between these parameters in both groups. However correlations were much more prominent in obese group compared to lean groups. Conclusion: Obese children exhibited a high prevalence of metabolic syndrome. The children with greater insulin resistance exhibited more risk factors. In the light of these findings intervention measures are necessary in order to prevent excessive weight gain during childhood.

FROM LANG TO REAVEN History of the First Department of Internal Medicine at Pavlov St Petersburg State Medical University

The review provides evidence that in the early twentieth century the research on the mechanisms of «metabolic cardiovascular syndrome» was started at the Department of Faculty Therapy in Pavlov St Petersburg State Medical University (that was called St Petersburg Women’s Medical University at that time). The investigations were initiated by G.F. Lang, and extended by A.L. Myasnikov, D.M. Grotel, B.V. Ilyinskiy, V.M. Dilman, V.A. Almazov and others, and based on the results they proposed the concept of a cascade of metabolic syndrome and its main components — obesity, insulin resistance and hyperinsulinemia. Nowadays, as the continuation of those studies, the first epidemiological Russian study NICA (National Investigation of Cardiovascular Complications in mеtАbolic syndrome) is conducted by the employees of the Department of Faculty Therapy and Almazov Federal Heart, Blood and Endocrinology Centre.

Adiposopathy as a key factor in the development of insulin resistance

The metabolic cardiovascular syndrome (MS) is a common cluster of metabolic abnormalities (abdominal obesity, hypertension, dyslipidemia and carbohydrate metabolism disorders) that are related to insulin resistance and hyperinsulinemia and are associated with accelerated atherogenesis. Insulin excess is known to promote the development of the whole metabolic cascade. Recently it has been shown that the inflammatory and hemostatic abnormalities, immunological disorders, endothelial dysfunction, hyperhomocysteinemia and hyperuricemia are also important features of MS. Despite the numerous studies of MS its underlying cause is still not established. The dysfunction of visceral adipocytes (adiposopathy) might be genetically determined, and is considered nowadays as the main factor contributing to the development of the MS. Understanding the underlying mechanisms is of particular interest for prevention and target therapy of all the components of MS.

Metabolic syndrome as a clinical manifestation of endothelial dysfunction

Metabolic syndrome (MS) has recently gained more clinical attention due to its increasing prevalence and association with adverse prognosis. One of the main pathological features of MS is endothelial dysfunction. It plays a key role in the development of cardiovascular MS complications. Therefore, effective therapy aimed at the normalization of endothelial function should be a part of pathogenetic management of MS patients.

Cardiovascular Metabolic Syndrome: Mediators Involved in the Pathophysiology from Obesity to Coronary Heart Disease

Patients with obesity and diabetes mellitus are at increased risk for cardiovascular events and have a higher cardiovascular morbidity and mortality. This worse prognosis is partly explained by the late recognition of coronary heart disease in these patients, due to the absence of symptoms. Early identification of coronary heart disease is vital, to initiate preventive medical therapy and improve prognosis. At present, with the use of cardiovascular risk models, the identification of coronary heart disease in these patients remains inadequate. To this end, biomarkers should improve the early identification of patients at increased cardiovascular risk. The first part of this review describes the pathophysiologic pathway from obesity to coronary heart disease. The second part evaluates several mediators from this pathophysiologic pathway for their applicability as biomarkers for the identification of coronary heart disease.

Mechanisms of arterial hypertension in metabolic syndrome

Arterial hypertension in patients with metabolic cardiovascular syndrome (MS) has a number of features which are of great theoretical and practical significance. It has been shown that hypertension is the most frequent component of MS and chronologically follows abdominal obesity while clinical manifestations of atherosclerosis and carbohydrate metabolism disturbances develop much later. In addition, the disorders of hypothalamic-pituitary-adrenal axis contribute to the development of arterial hypertension in patients with abdominal obesity. Besides the abnormalities of central regulatory mechanisms, increased sympathetic tone, insulin resistance and hyperinsulinemia, functional state of adipose tissue is an established important factor for the development of systemic hypertension in patients with abdominal obesity, and in some cases the dysfunction of adipocytes, which can be genetically determined or acquired, may cause the whole cascade of MS. Search for the causes and mechanisms of arterial hypertension in patients with MS can help to find the possible targeted treatment and prevention of the disease.

Intervenções nutricionais em Síndrome Metabólica: uma revisão sistemática

There is no consensus on the most appropriate nutritional strategy for treating metabolic syndrome (MS), such that cardiovascular risk is reduced. This study was designed to assess the strength of evidence of the benefits of various nutritional interventions in MS remission. Performed in Medline, Cochrane Library and PubMed databases, the virtual search consisted of randomized clinical trials published between 1999 and 2009 in any language, studies involving individuals aged 18 or older and diagnosed with MS, regardless of the criterion. The Boolean operator and was used in the combination of the MeSH terms "Metabolic Syndrome", "Metabolic x Syndrome" and "Metabolic Syndrome X", the entry terms "Dysmetabolic Syndrome X", Metabolic Cardiovascular Syndrome," "Metabolic X Syndrome" and "Syndrome X, Metabolic", plus the terms "diet", "intervention and diet", "treatment and diet" and "supplementation". For each study included in the review, we estimated the prevalence of MS and the calculation of effectiveness after the follow-up period. Relative risk measures for each study were described by Forest Plot. We identified 131 articles, which, after eligibility criteria, resulted in 15 studies. These studies were divided into four groups: normocaloric diet associated with exercise; isolated normocaloric diet, low-calorie diet combined with exercises; and isolated low-calorie diet. Tests with low-calorie diet associated with exercising revealed higher efficiency values, helping to emphasize the global aspects of lifestyle change in the treatment of MS, in which healthy and low-calorie diet should be complemented with the practice of physical activity.

Menstrual cycle characteristics and risk of coronary heart disease and type 2 diabetes

In a prospective cohort study, we observed that women with a history of irregular cycles have a 28% increased coronary heart disease risk and tended to have a higher type 2 diabetes risk as compared with women who had a regular cycle length of 27 to 29 days. This association could not be explained by metabolic risk factors or altered hormone levels.

Efficacy of different doses of aspirin in decreasing blood levels of inflammatory markers in patients with cardiovascular metabolic syndrome

Abstract Objectives Inflammation and platelet aggregation and activation are key processes in the initiation of a cardiovascular event. Patients with metabolic syndrome have a high risk of cardiovascular events. This study determined whether small and medium doses of aspirin have anti-inflammation and antiplatelet aggregation effects in patients with metabolic syndrome. Methods One hundred and twenty-one consecutive patients with metabolic syndrome were randomized into three groups, receiving 100 mg/day of aspirin, 300 mg/day of aspirin or a placebo, respectively, for 2 weeks. The blood levels of thromboxane B2 (TXB2), a stable product of the platelet aggregation mediator TXA2, 6-keto-prostaglandin F1-α (6-keto-PGF1-α), a stable product of the endogenous cyclooxygenase metabolite prostaglandin I2, and inflammatory mediators including high-sensitivity C-reactive protein (hs-CRP), tumour necrosis factor-α (TNF-α) and interleukin-6 (IL-6), were determined by ELISA and radioimmunoassay. Key findings The blood levels of hs-CRP, TNF-α, IL-6 and TXB2 were significantly decreased after 2 weeks of treatment with 300 mg/day of aspirin. Patients who received 100 mg/day of aspirin had decreased blood levels of hs-CRP and TXB2. The blood level of IL-6 in the 300 mg/day aspirin group was significantly lower than that in the other two groups after 2 weeks of therapy. Aspirin at either dose did not affect the blood level of 6-keto-PGF1-α. Conclusions Aspirin at all doses suppresses the blood levels of inflammatory markers and the platelet aggregation mediator TXA2 in Chinese patients with metabolic syndrome. Since the suppression induced by 300 mg/day of aspirin was greater than that induced by 100 mg/day of aspirin, these data suggest that 300 mg/day of aspirin may be beneficial in decreasing the risk of cardiovascular events in Chinese patients with metabolic syndrome.

Efficacy of different doses of aspirin in decreasing blood levels of inflammatory markers in patients with cardiovascular metabolic syndrome

Inflammation and platelet aggregation and activation are key processes in the initiation of a cardiovascular event. Patients with metabolic syndrome have a high risk of cardiovascular events. This study determined whether small and medium doses of aspirin have anti-inflammation and antiplatelet aggregation effects in patients with metabolic syndrome. One hundred and twenty-one consecutive patients with metabolic syndrome were randomized into three groups, receiving 100 mg/day of aspirin, 300 mg/day of aspirin or a placebo, respectively, for 2 weeks. The blood levels of thromboxane B2 (TXB2), a stable product of the platelet aggregation mediator TXA2, 6-keto-prostaglandin F1-alpha (6-keto-PGF1-alpha), a stable product of the endogenous cyclooxygenase metabolite prostaglandin I2, and inflammatory mediators including high-sensitivity C-reactive protein (hs-CRP), tumour necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6), were determined by ELISA and radioimmunoassay. The blood levels of hs-CRP, TNF-alpha, IL-6 and TXB2 were significantly decreased after 2 weeks of treatment with 300 mg/day of aspirin. Patients who received 100 mg/day of aspirin had decreased blood levels of hs-CRP and TXB2. The blood level of IL-6 in the 300 mg/day aspirin group was significantly lower than that in the other two groups after 2 weeks of therapy. Aspirin at either dose did not affect the blood level of 6-keto-PGF1-alpha. Aspirin at all doses suppresses the blood levels of inflammatory markers and the platelet aggregation mediator TXA2 in Chinese patients with metabolic syndrome. Since the suppression induced by 300 mg/day of aspirin was greater than that induced by 100 mg/day of aspirin, these data suggest that 300 mg/day of aspirin may be beneficial in decreasing the risk of cardiovascular events in Chinese patients with metabolic syndrome.

Obesity and insulin resistance associated with lower plasma vitamin B12 in PCOS

Polycystic ovary syndrome (PCOS) shares some or most components of metabolic cardiovascular syndrome, manifested by abdominal obesity, insulin resistance, dyslipidaemia and atherosclerosis. It has been previously demonstrated that folate and vitamin B(12) treatment improved insulin resistance in patients with metabolic syndrome. This study first investigated whether PCOS patients have lower or higher vitamin B(12), folate and homocysteine concentrations when compared with healthy, age and body mass index matched controls, and, then examined associations between vitamin B(12), folate, homocysteine and insulin resistance and obesity in PCOS patients. Homocysteine concentrations and homeostasis model assessment index were higher, whereas concentrations of vitamin B(12) were lower in PCOS patients with insulin resistance compared with those without insulin resistance. Serum vitamin B(12) concentrations were significantly lower in obese PCOS women in comparison with obese control women (P < 0.05). Fasting insulin, insulin resistance and homocysteine are independent determinants of serum vitamin B(12) concentrations in PCOS patients. Insulin resistance, obesity, and elevated homocysteine were associated with lower serum vitamin B(12) concentrations in PCOS patients.

Long-term consequences of polycystic ovary syndrome on cardiovascular risk

Most available data suggest that the prevalence of cardiovascular diseases in women with polycystic ovary syndrome (PCOS) is smaller than expected based on risk calculations during fertile years; therefore, more studies are needed on long-term cardiovascular consequences. Evidence is accumulating that postmenopausal women with PCOS have an increased risk of cerebrovascular events and cardiovascular morbidity. These events are partially related to persisting hyperandrogenism but are mostly correlated with excessive body weight (mainly visceral obesity); this suggests that our best long-term strategy is to ensure that women with PCOS are informed about their high risk for metabolic and cardiovascular diseases.

Lipoprotein-Associated Phospholipase A 2: An Independent Predictor of Coronary Artery Disease Events in Primary and Secondary Prevention

In recent years, atherosclerosis has become recognized as an inflammatory disease whose activity can be assessed by circulating biomarkers. Along with C-reactive protein (CRP), lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) may now be considered as a biomarker with sufficient accumulated evidence to support its application in clinical practice. Lp-PLA(2) is especially appealing because of its vascular specificity, which directly derives from its role in plaque pathophysiology. This article reviews the highlights of the >25 prospective epidemiologic studies now published on Lp-PLA(2) as a risk marker in primary or secondary prevention. These trials demonstrate generally consistent correlations between elevated Lp-PLA(2) levels and the increased risk for cardiovascular events, even after multivariable adjustment for traditional risk factors, with roughly a doubling of risk associated with upper quantile levels. Furthermore, Lp-PLA(2) as a risk predictor has been shown to be independent of and complementary to high-sensitivity CRP. These study results combined with recommendations from the American Heart Association/Centers for Disease Control (AHA/CDC) and the National Cholesterol Education Program III (NCEP III) suggest that Lp-PLA(2) might best be used in current clinical practice to refine risk prediction in those at intermediate cardiovascular risk. An increasingly prevalent group at intermediate risk shown to benefit from Lp-PLA(2) risk modification is the population with the cardiovascular metabolic syndrome, clinically identified as overweight patients with features of mixed dyslipidemia, dysglycemia, and hypertension. An additional application supported by these studies is further risk stratification of high- (often secondary-) risk patients into a group at very high risk, for whom a more aggressive target for low-density lipoprotein of <70 mg/dL (1 mg/dL = 0.02586 mmol/L) is now recommended as a reasonable therapeutic goal.