Clustering Of Cardiovascular Risk Factors Research Articles

Exploring metabolic syndrome and dietary quality in Iranian adults: a cross-sectional study

BackgroundMetabolic syndrome (MetS) is a cluster of cardiovascular risk factors affecting a quarter of the global population, with diet playing a significant role in its progression. The aim of this study is to compare the effectiveness of the Dietary Diabetes Risk Reduction Score (DDRRS) and the Macronutrient Quality Index (MQI) scoring systems in assessing the diet-related risk of metabolic syndrome.MethodsIn this cross-sectional study, data from 7431 individuals aged between 30 and 70 years, obtained from the Mashhad Cohort Study, were utilized to evaluate the risk factors of metabolic syndrome. A valid semi-quantitative food frequency questionnaire was used to assess participants’ dietary intake. The MQI was calculated based on carbohydrate, fat, and healthy protein components, while the DDRRS was also computed. Anthropometric measurements and blood samples were taken to determine the presence of metabolic syndrome. Logistic regression analyses were conducted to assess the association between MQI and DDRRS with metabolic syndrome and its components.ResultsAccording to the crude model, we observed lower odds of MetS in the highest quartile of DDRRS and MQI compared to the lowest quartile (P-trend < 0.001). This trend persisted in the fully adjusted models, revealing odds ratios of 0.399 (95% CI: 0.319-0.500) and 0.597 (95% CI: 0.476–0.749) for DDRRS and MQI, respectively. After controlling for all potential confounders, we observed lower odds of central obesity in the highest quartile of MQI (OR: 0.818, 95% CI: 0.676–0.989, P-trend = 0.027). Furthermore, we found that the odds of high triglyceride levels were lower in the highest quartile of DDRRS compared to the lowest quartile (OR: 0.633, 95% CI: 0.521, 0.770, P-trend < 0.001).ConclusionIn conclusion, our study indicates that greater adherence to both DDRRS and MQI is linked to a decreased risk of metabolic syndrome and its components. These findings hold significant implications for public health and the development of personalized nutrition strategies.

Obstructive Sleep Apnea in Metabolic Syndrome.

The metabolic syndrome (MetS), a cluster of cardiovascular risk factors, is associated with obstructive sleep apnea (OSA). OSA is a major contributor to cardiac, cerebrovascular, and metabolic disorders as well as to premature death. This cross-sectional study was done for 1 year in 103 patients of MetS diagnosed by the International Diabetes Federation criteria. All patients were subjected to the STOP-Bang questionnaire, and they were classified into low, intermediate, and high risks depending on the score. Patients falling in intermediate-high risk (score 3-8) were taken for overnight polysomnography to confirm the diagnosis of OSA (apnea-hypopnea index [AHI] ≥5) and were considered Group I. Patients with STOP-Bang score ≤2 or score ≥3 with AHI <5 were considered Group II (non-OSA). Out of 103 MetS patients enrolled in the study, only 70 (68.0%) were diagnosed with OSA, so the prevalence of OSA in MetS patients was 68%. The majority of the OSA cases had moderate-to-severe OSA (68.5%), and only 31.4% had mild OSA. The age of patients enrolled in the study ranged between 29 and 78 years, and the mean age of patients was 54.8 ± 9.4 years. Out of 103 MetS enrolled in the study, 59 (57.3%) were male and the rest were female, so the prevalence of severe OSA was higher in males than in females. The prevalence increases with an increase in age groups. Weight, body mass index (BMI), circumference, and waist circumference (WC) of cases of OSA were found to be significantly higher as compared to that of non-OSA. An incremental trend of increase in weight, BMI, neck circumference, and WC was observed with the increase in the severity of OSA. Patients of OSA as compared to non-OSA had significantly increased WC, blood pressure (BP), fasting, postprandial, random blood sugar, and triglyceride (TG) levels. A trend of increase in WC, BP fasting, postprandial, random blood sugar, and TG levels was associated with an increase in the severity of OSA. Snoring and daytime sleepiness were observed in a significantly higher proportion of OSA cases as compared to non-OSA cases. This study shows that OSA has a high prevalence in subjects with MetS. A high index of clinical suspicion is required for early diagnosis.

Identifying patterns of co-occurring chronic conditions preceding dementia: An unsupervised machine learning approach using health administrative data

ObjectivesIndividual risk factors for dementia are well known, but the influence of co-occurring chronic conditions has not been considered. We identified clusters of chronic conditions using an unsupervised machine learning approach and examined associations with incident dementia. ApproachUsing linked population-based administrative databases, we followed all community-dwelling adults aged 40-54 years in Ontario, Canada from April 2002 until March 2019 for incident dementia. We estimated the prevalence of 29 chronic conditions using validated algorithms and/or diagnosis codes. We reduced dataset dimensionality using multiple correspondence analysis and a fuzzy c-means clustering algorithm identified the optimal number of clusters (between 3-6 tested). Associations between clusters and incident dementia were examined using a cause-specific hazard model adjusted for sociodemographic characteristics and accounting for the competing risk of death. ResultsWe identified 82,359 eligible individuals (random 3% sample of total eligible individuals; mean age 46.5 years; 50.4% female). Regression analyses were based on 5 comorbidity clusters (fuzzy silhouette index:0.69). Compared to the low comorbidity cluster, persons in the cerebrovascular disease/metabolic (HRadj=3.06, 95%CI[2.42,3.86]) and neuro-related/mental health clusters (HRadj=2.51, 95%CI[2.05,3.07]) had the highest rates of incident dementia, followed by the cardiovascular risk factor cluster (HRadj=1.66,95%CI[1.32,2.09]). Persons in the cancer cluster did not have an increased incidence of dementia (HRadj=0.96,95%CI[0.77,1.20]). ConclusionsWe found significant associations between machine learning-derived clusters of chronic conditions and dementia. ImplicationsUnsupervised machine learning approaches to identify clusters of chronic conditions may be a useful tool for considering the impact of multimorbidity on dementia risk.

Global Blood Pressure Screening During and After Pregnancy: May Measurement Month 2019.

Hypertensive disorders of pregnancy are associated with high maternal and fetal morbidity and mortality. There are limited global data on the characteristics of women during and after pregnancy hypertension. May Measurement Month is a global campaign to raise awareness of the importance of blood pressure. Adults (≥18 years) recruited through opportunistic sampling during May 2019 had blood pressure measured and comorbidities and lifestyle data collected. This secondary analysis included 16 519 pregnant women and 529 172 nonpregnant women (16 457 with previous raised blood pressure in pregnancy) from 64 countries. Almost half of the pregnant women (43.3%) reported not having had their blood pressure measured in the past year, and 14.3% (95% CI, 12.1-16.6) had hypertension (blood pressure ≥140/90 mm Hg or taking antihypertensive medication). Diabetes was self-reported in 7.6% (5.9-9.3) of pregnant women with hypertension and 2.8% (1.9-3.6) of pregnant women without hypertension. In nonpregnant women with and without a history of pregnancy hypertension, age-standardized proportions with current hypertension were 53.2% (50.8-55.7) versus 33.3% (29.3-37.3); with diabetes were 14.4% (11.8-17.0) versus 8.5% (6.3-10.9); and with body mass index ≥30 kg/m2 were 28.4% (23.5-33.3) versus 16.6% (13.0-20.2). Hypertension in pregnancy was common in this global sample but many cases had not previously been identified. There was a clustering of cardiovascular risk factors in both pregnant women with current hypertension and previously raised blood pressure in pregnancy. This work highlights the importance of screening pregnant women for hypertension, which remains a challenge in large parts of the world.

Updates on the Renin-Angiotensin-Aldosterone System and the Cardiovascular Continuum.

The cardiovascular continuum describes how several cardiovascular risk factors contribute to the development of atherothrombosis, ischemic heart disease, and peripheral arteriopathy, leading to cardiac and renal failure and ultimately death. Due to its multiple valences, the renin-angiotensin-aldosterone system plays an important role in all stages of the cardiovascular continuum, starting from a cluster of cardiovascular risk factors, and continuing with the development of atherosclerosis thorough various mechanisms, and culminating with heart failure. Therefore, this article aims to analyze how certain components of the renin-angiotensin-aldosterone system (converting enzymes, angiotensin, angiotensin receptors, and aldosterone) are involved in the underlying pathophysiology of the cardiovascular continuum and the possible arrest of its progression.

Prognostic Implications of Coronary Artery Sclerosis in Troponin-Positive Patients with Non-Obstructive Coronary Arteries.

Coronary sclerosis is a risk factor for the progression to obstructive coronary artery disease (CAD). However, understanding its impact on the outcomes of patients with myocardial infarction and non-obstructive coronary arteries is limited. This study aimed to explore the prognostic influence of coronary sclerosis on in- and out-of-hospital events in troponin-positive patients with non-obstructive coronary arteries. This study was a retrospective cohort analysis based on prospectively collected data. A total of 24,775 patients who underwent coronary angiography from 2010 to 2021 in a German university hospital were screened, resulting in a final study cohort of 373 troponin-positive patients with non-obstructive coronary arteries and a follow-up period of 6.2 ± 3.1years. Coronary sclerosis was defined as coronary plaques without angiographically detectable stenotic lesions of 50% or more in the large epicardial coronary arteries. The primary study endpoint was the occurrence of in-hospital events. Secondary endpoints included events during follow-up. Patients with coronary sclerosis were significantly older (70 ± 12 vs. 58 ± 16years, p < 0.001), had ST-segment elevation less frequently on electrocardiogram (9.4% vs. 18.7%, p = 0.013), and suffered more often from diabetes mellitus (23.3% vs. 13.1%, p = 0.009), arterial hypertension (79.6% vs. 59.8%, p < 0.001), chronic obstructive pulmonary disease (17.1% vs. 9.4%, p = 0.028), chronic kidney disease (22.2% vs. 8.4%, p < 0.001), atrial fibrillation (19.8% vs. 12.2%, p = 0.045), and valvular diseases than patients without CAD. Patients with coronary sclerosis were more likely to receive medication for primary/secondary prevention on admission and at discharge. The incidence of in- and out-of-hospital events was significantly higher in patients with coronary sclerosis (in-hospital: 42.8% vs. 29.9%, p = 0.010; out-of-hospital: 46.0% vs. 26.1%, p < 0.001). Mortality rates tended to be higher in the coronary sclerosis group (29.4% vs. 20.0%, p = 0.066). Patients diagnosed with coronary sclerosis presented a higher incidence of comorbidities and increased medication use, and experienced higher rates of both in-hospital and out-of-hospital events, primarily due to the clustering of cardiovascular risk factors.

Impact of Exercise-Based Cardiac Rehabilitation on Metabolic Syndrome in Post-Acute Coronary Syndrome Patients

Abstract Background Metabolic syndrome (MetS) is characterized by a cluster of cardiovascular risk factors including hypertension (HTN), impaired fasting blood sugar (FBS), increased central obesity (WC) and dyslipidemia; hypertriglyceridemia (TG) and low high-density lipoprotein- cholesterol (HDL-C). The MetS adversely affects cardiovascular outcomes, individuals with at least 4 out of 5 features of MetS have a 3.7-fold increased risk of coronary artery diseases at a 5-year follow-up. Objective to determine the effectiveness of exercise based-cardiac rehabilitation (CR) program on MetS in post-Acute Coronary Syndrome (ACS) patients versus guideline directed medical therapy over a 12 weeks period. Patients and Methods The study included 62 patients who suffered from ACS with evidence of MetS. All patients were recruited from Ain Shams University Hospitals (ASUHs) from July 2021 to December 2021 and were assessed at baseline and after 12 weeks of follow up for MetS parameters. After approval by the local ethics committee all patients were provided voluntary informed consent. The study subjects were classified into two groups: Group A (case group): included 32 patients who completed at least 80% of 12 weeks of CR program in ASUHs. Group B (control group): included 30 patients who did not attend the CR program and completed 12 weeks of guideline directed medical therapy alone. Results The results revealed that -when compared group A at baseline and after 12 weeks of CR-program there was a significant reduction in WC, FBS and TG levels, while there was a significant rise in HDL-C level. However, there was no statistically significant difference found regarding BP in this group. Regarding group B there was no statistically significant difference between the baseline MetS parameters and at follow up after 12 weeks of guideline directed medical therapy alone. Conclusion The present study revealed that there was a statistically significant improvement regarding WC, FBS, TG and HDL after completion of 12 weeks of the CR Program, while there was no statistically significant difference found regarding BP in the study group. In the control group there was no statistically significant difference found at baseline and follow up after 12 weeks of guideline directed medical care alone. Thus, the exercise-based CR program is superior than the regular medical care alone in improving the WC, FBS, TG and HDL. Key words: Metabolic Syndrome, Cardiac Rehabilitation, Exercise Training, ACS. Abbreviations and Acronyms. Acronyms: ACS: Acute Coronary Syndrome ASUHs: Ain Shams University Hospitals BP: Blood Pressure CR: Cardiac Rehabilitation FBS: Fasting Blood Sugar HDL-C: High Density Lipoprotein-Cholesterol HTN: Hypertension MetS: Metabolic Syndrome TG: Triglyceridemia WC: Central Obesity

Prevalence, Clustering, and Current Management of Cardiovascular Risk Factors Upon First Referral to Hypertension Specialists: the APPROACH Study.

Several observational studies have been conducted to assess the prevalence of cardiovascular risk factors in hypertensive patients; however, none has yet investigated prevalence, clustering, and current management of cardiovascular risk factors upon first referral to hypertension specialists, which is the aim of the present study. Consecutive adult outpatients with essential/secondary hypertension were included at the time of their first referral to hypertension specialists at 13 Italian centers in the period April 2022-2023 if they had at least one additional major cardiovascular risk factor among LDL-hypercholesterolemia, type 2 diabetes, and cigarette smoking. Prevalence, degree of control, and current management strategies of cardiovascular risk factors were assessed. A total of 255 individuals were included, 40.2% women and 98.4% Caucasian. Mean age was 60.3±13.3years and mean blood pressure [BP] was 140.3±17.9/84.8±12.3mmHg). Most participants were smokers (55.3%), had a sedentary lifestyle (75.7%), suffered from overweight/obesity (51%) or high LDL-cholesterol (41.6%), had never adopted strategies to lose weight (55.7%), and were not on a low-salt diet (57.4%). Only a minority of patients reported receiving specialist counseling, and 27.9% had never received recommendations to correct unhealthy lifestyle habits. Nearly 90% of individuals with an estimated high/very high cardiovascular risk profile did not achieve recommended LDL-cholesterol targets. In patients with hypertension, both pharmacological and lifestyle therapeutic advice are yet to improve before referral to hypertension specialists. This should be considered in the primary care setting in order to optimize cardiovascular risk management strategies.

Correlation between Metabolic Syndrome and Gastric Cancer: Results of an Evidence-Based Strategy in Oriental Populations.

Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors, including abdominal obesity, hyperglycemia, hypertension, and dyslipidemia. Gastric cancer (GC) is a common malignancy with significant mortality rates. The relationship between MetS and GC risk remains controversial. This systematic review and meta-analysis aimed to evaluate the correlation between MetS and GC. Case-control studies investigating the association between MetS and GC were obtained from various databases, including China National Knowledge Infrastructure (CNKI), SinoMed, Embase, Web of Science, The Cochrane Library, and PubMed. The search was performed from the inception of each database up until September, 2023. Two researchers independently screened the literature, extracted data, and assessed the quality of the included studies. A meta-analysis of the included literature was conducted using Stata 12.0 software. The study protocol is registered in PROSPERO (CRD42023490410). A total of eight studies involving a combined sample size of forty-four thousand eight hundred and seventy participants were included in the meta-analysis. The findings revealed that the risk of developing GC was not significantly associated with body mass index, triglycerides, hypertension, high fasting glucose, or MetS. However, it was found to be positively correlated with high-density lipoprotein cholesterol (OR = 1.69, 95%CI: 1.35-2.12). This meta-analysis suggests that MetS is not significantly associated with an increased risk of GC. The risk of GC increases with the presence of individual MetS components, such as high-density lipoprotein cholesterol. Therefore, GC prevention strategies should include lifestyle modifications and targeted interventions to manage MetS and its components. CRD42023490410 (PROSPERO).

Clustering of Cardiovascular Risk Factors and Heart Failure in Older Adults from the Brazilian Far North.

Given the aging global population, identifying heart failure (HF) phenotypes has become crucial, as distinct disease characteristics can influence treatment and prognosis in older adults. This study aimed to analyze the association between clustering of cardiovascular risk factors and HF in older adults. A cross-sectional epidemiological study was conducted with 1322 older adults (55% women, mean age 70.4) seen in primary health care. Diagnosis of HF was performed by a cardiologist based on diagnostic tests and medical history. Cardiovascular risk factors included hypertension, diabetes, hypercholesterolemia, and smoking. Using logistic regression, potential associations were tested. Individual risk factor analysis showed that older adults with hypertension, diabetes, or hypercholesterolemia had up to 7.6 times higher odds to have HF. The cluster where older adults had only one risk factor instead of none increased the odds of HF by 53.0%. Additionally, the odds of older patients having HF ranged from 3.59 times for the two-risk factor cluster to 20.61 times for the simultaneous presence of all four factors. The analysis of clusters substantially increasing HF risk in older adults revealed the importance of individualizing subgroups with distinct HF pathophysiologies. The clinical significance of these clusters can be beneficial in guiding a more personalized therapeutic approach.

Comparison of waist circumference and waist-to-height ratio as predictors of clustering of cardiovascular risk factors among middle-aged people in rural Khanh Hoa, Vietnam.

Given the population-level variation in stature, a universal cut-off for waist circumference (WC) may not be appropriate for some populations. We compared the performance of WC and waist-to-height ratio (WHtR) to detect the clustering of cardiovascular disease (CVD) risk factors in rural Vietnam. We obtained data from a baseline survey of the Khanh Hoa Cardiovascular Study comprising 2942 middle-aged residents (40-60 years). We used areas under the receiver operating characteristics curve (AUROC), net reclassification index (NRI), and integrated discrimination improvement (IDI) to compare the performance of WC and WHtR in predicting CVD risk clustering (≥2 of the following risk factors: hypertension, diabetes, dyslipidemia, and elevated C-reactive protein). The optimal cut-off values for WC were 81.8 and 80.7 cm for men and women, respectively. Regarding the clustering of CVD risk factors, the AUROC (95% CI) of WC and WHtR were 0.707 (0.676 to 0.739) and 0.719 (0.689 to 0.749) in men, and 0.682 (0.654 to 0.709) and 0.690 (0.663 to 0.717) in women, respectively. Compared with WC, WHtR had a better NRI (0.229; 0.102-0.344) and IDI (0.012; 0.004-0.020) in men and a better NRI (0.154; 0.050-0.257) in women. The optimal WC cut-off for Vietnamese men was approximately 10 cm below the recommended Asian cut-off. WHtR might perform slightly better in predicting the clustering of CVD risk factors among the rural population in Vietnam.

Metabolic syndrome risk in adult coffee drinkers with the rs301 variant of the LPL gene

BackgroundMetabolic syndrome (MetS), a cluster of metabolic and cardiovascular risk factors is influenced by environmental, lifestyle, and genetic factors. We explored whether coffee consumption and the rs301 variant of the lipoprotein lipase (LPL) gene are related to MetS.MethodsWe conducted multiple logistic regression analyses using data gathered from 9523 subjects in Taiwan Biobank (TWB).ResultsOur findings indicated that individuals who consumed coffee had a reduced odds ratio (OR) for MetS (0.750 (95% confidence interval [CI] 0.653–0.861) compared to non-coffee drinkers. Additionally, the risk of MetS was lower for individuals with the ‘TC’ and ‘CC’ genotypes of rs301 compared to those with the ‘TT’ genotype. Specifically, the OR for MetS was 0.827 (95% CI 0.721–0.949) for the ‘TC’ genotype and 0.848 (95% CI 0.610–1.177) for the ‘CC’ genotype. We observed an interaction between coffee consumption and the rs301 variant, with a p-value for the interaction of 0.0437. Compared to the reference group (‘no coffee drinking/TT’), the ORs for MetS were 0.836 (95% CI 0.706–0.992) for ‘coffee drinking/TT’, 0.557 (95% CI 0.438–0.707) for ‘coffee drinking/TC’, and 0.544 (95% CI 0.319–0.927) for ‘coffee drinking/CC’. Notably, MetS was not observed in non-coffee drinkers regardless of their rs301 genotype.ConclusionOur findings suggest that rs301 genotypes may protect against MetS in Taiwanese adults who consume coffee compared to non-coffee drinkers.

Dietary Patterns and Metabolic Syndrome Risk in Adults Living with HIV: A Cross-Sectional Study in Lusaka District, Zambia

Background: Metabolic syndrome, a cluster of cardiovascular risk factors, affects approximately 25% of the global population, with a significant impact on the 37,900,000 people living with HIV in 2017. Objective: This cross-sectional study (April-July 2020) in Lusaka District aimed to assess dietary patterns and metabolic syndrome risk in 180 randomly sampled HIV-positive individuals (aged 18 and above) from three health facilities. Methods: Participants underwent anthropometric measurements, blood pressure checks, and biochemical assessments. High prevalence rates were observed for factors like high waist-hip ratio (39%), high total cholesterol (52%), high triglycerides (46%), and high blood pressure (33%). Results: Three dietary clusters (omnivorous, vegetarian, unclassified) showed no significant association with metabolic syndrome or its components (p &gt; 0.05). Conclusion: While metabolic syndrome prevalence among HIV-positive individuals is low, there are notable occurrences of high blood pressure and predictors of non-communicable diseases. Commonly consumed foods did not show a significant association with metabolic syndrome predictors (p &gt; 0.05).

Cardiometabolic Complications of PCOS

Polycystic ovary syndrome (PCOS) has reproductive, metabolic, dermatological, and psychological clinical features. While the reproductive features have been the best recognised; however, in more in recent times, the metabolic characteristics and extended cardiometabolic sequelae of PCOS have gained increasing acknowledgment. Women with PCOS have higher rates of obesity, longitudinal weight gain and central adiposity compared to women without PCOS ( 1 , 2 ). Insulin resistance is a key pathophysiological feature in PCOS, is present independent of obesity and is exacerbated by obesity ( 3 ) and contributes to metabolic complications. Women with PCOS have a 1.9-fold increased risk of metabolic syndrome and clustering of cardiovascular risk factors ( 4 ). The incidence of type 2 diabetes is higher and onset earlier in women with PCOS, independent of body mass index ( 5 ). Dyslipidaemia is increased in women with PCOS, with the relationship largely mediated by obesity ( 6 ). Despite clustering of cardiovascular risk factors, the question of whether women with PCOS face an elevated risk of cardiovascular disease have remained uncertain. Nevertheless, more recent, and substantial evidence indicates that women with PCOS are indeed at an increased risk of cardiovascular disease. This is supported by higher odds ratios and/or incidence rate ratios for composite cardiovascular disease, ischaemic heart disease, stroke, and cardiovascular mortality. It is important to acknowledge, however, that the overall risk of cardiovascular disease among pre-menopausal women remains low ( 7 ).

Metabolic Syndrome Score is Associated with Lower Myelin in Cognitively Healthy Adults

AbstractBackgroundMetabolic syndrome (MetS) is a cluster of cardiovascular risk factors, including abdominal obesity, glucose intolerance, elevated blood pressure (BP), and dyslipidemia. MetS is a known risk factor for cognitive dysfunction and dementia (Yaffe et al., 2004. YAMA), and has been linked to brain atrophy and altered WM microstructure measured with diffusion tensor MR (Alfaro et al., 2018, Metabolism). The metabolic cost of myelin maintenance makes WM particularly vulnerable to metabolic dysfunction. Here, we aim to explore the relationships between MetS and myelin, as well as test whether WC‐myelin association (Bouhrara et al., 2021, Int J Obes) is independent from systolic BP.MethodSample included 90 cognitively and neurologically healthy adults (Bookheimer et al., 2019, Neuroimage), aged 20 to 79 (M = 53, SD = 17) with 76% women. Additional exclusion criteria included systolic blood pressure &gt;140, BMI&gt;33, and &gt;2 on modified Hachinski Ischemic Scale. Myelin water imaging was collected using a 3T Siemens Skyra with a 32‐channel coil and 3D‐gradient and spin‐echo (GRASE) sequence (1.9×1.9×4mm, TR = 1000ms, echoes = 32, first echo = 10ms, echo spacing = 10ms). Myelin Water Fraction maps were nonlinearly aligned to FMRIB58_FA using TBSS in FSL. MetS score was calculated as a sum of z‐scored waist circumference (WC), systolic BP, BMI, and self‐reports history of elevated cholesterol and glucose.ResultA linear regression analysis with MWF as the dependent variable, adjusting for sex, race, ethnicity, age, and age2, income and education, indicated that greater MetS score was associated with lower MWF in several regions including the genu corpus callosum, anterior corona radiata, and external capsule. WC was negatively associated with whole WM MWF (B = ‐.265, t(79,9) = ‐2.150, p = 0.035) after controlling for the above covariates and systolic BP.ConclusionAssociations between MetS with myelin content were detected especially in the late‐myelinating regions. This aligns with the development‐to‐degeneration hypothesis of WM aging, with lower oligodendrocyte‐to‐axon ratio as a possible factor contributing to metabolic vulnerability of late‐myelinating tracts. We also replicated the WC‐myelin association, although in fewer regions and with smaller effects sizes. Together, our results suggest that different metabolic syndrome components may exert both additive/synergistic, and independent effects on myelin integrity across adulthood.

Metabolic Syndrome Among Patients with Myelodysplastic Syndrome: A Population Analysis

Introduction: Metabolic syndrome (MS) comprises a cluster of cardiovascular risk factors, including central obesity, dysglycemia, elevated blood pressure (BP), increased triglyceride levels (HyperTG), and low HDL cholesterol levels. Epidemiologic and clinical data suggest that MS may be an important etiologic factor in the progression of certain cancer types. These studies have excluded patients with myelodysplastic syndromes (MDS), but MS may be relevant in these patients owing to the link between cardiovascular disease and MDS derived from clonal hematopoiesis. We conducted a population-based analysis to define the prevalence of MS and its components among patients with MDS and explore the effect of MS on MDS outcomes. Methods: We identified patients aged 66 and older diagnosed with MDS between 2007 and 2017 using the SEER-Medicare database. Preexisting MS was identified using ICD-9/10 codes in claims from at least 12 months before MDS diagnosis. MS was defined as the presence of 3 or more of the 5 MS components. MDS histologic risk was defined based on ICD-O-3 morphology codes. Transfusion dependence, defined as 2 or more transfusions within 8 weeks of MDS diagnosis date, and therapy with hypomethylating agents (HMA), lenalidomide and erythropoietin stimulating agents (ESA) were defined from HCPCS codes and prescription records. Other variables defined included age, sex, race/ethnicity, rurality (using RUCC codes), marital status, and socioeconomic status [SES] (using the Yost index). Descriptive statistics were used to define the frequency of MS and its components. MDS outcomes of interest were transformation to acute myeloid leukemia (AML), defined from ICD-9/10 codes for AML, and overall survival (OS), defined as the time between MDS diagnosis and death from any cause. Cox proportional hazards regression was used to determine the association between MS and AML transformation and OS, through adjusted hazard ratios (HR). Results: A total of 15,227 cases diagnosed with MDS between 2007 and 2017 were analyzed, including 3,402 (22.3%) with baseline MS. High BP was present in 72.2%, HyperTG in 47.8%, dysglycemia in 35.5%, central obesity in 4.6% and 0.5% had low HDL cholesterol. The prevalence of MS and the distribution of its components did not significantly differ based on MDS histologic risk (Table 1). The prevalence of hyperTG was notably higher in patients with MDS, especially in the high histologic risk category (50.4%). Compared to other MDS patients, those with preexisting MS were predominantly male (55.5% vs 53.3%, p=0.03) of non-White race (6.7% vs 4.8% non-Hispanic Black, p&amp;lt;0.01, and 2.1% vs 1.5% Hispanic, p&amp;lt;0.01), from urban/metropolitan areas (87.7% vs 86%, p=0.01) and lower SES quintiles 1 and 2 (34.2% vs 31.5%, p&amp;lt;0.01). In a model adjusting for age, sex, race/ethnicity, rurality, marital status, SES, MDS risk, transfusion dependence and MDS therapies (HMA, lenalidomide and ESA), baseline MS at the time of MDS diagnosis was not associated with a significant effect on the risk of AML transformation (HR=1.0, 95%CI 0.9-1.2) or the risk of death from any cause (HR=1.0, 95%CI 0.9-1.1) (Table 2). In models assessing the effect of MS subcomponents on MDS outcomes, high BP (HR=1.0, 95CI% 1.0-1.1) and obesity (HR=1.1, 95CI% 1.0-1.2) were associated with an increased risk of mortality. Obesity was also associated with an increased risk of transformation to AML (HR=1.3, 95CI% 1.0-1.6). Conclusions: The overall prevalence of MS among patients with MDS appears similar to that reported in the general population and does not differ based on the histologic risk category. The observed prevalence of HyperTG was higher than expected, particularly in high-risk MDS patients. Older males of non-White race from urban/metropolitan areas of lower SES are more likely affected across all groups. Though preexisting MS is present in an important proportion of MDS patients, it was not significantly associated with an increased risk of mortality or AML transformation after adjusting for confounders. Obesity was associated with higher mortality and linked to increased transformation to AML. Given recent data suggesting that statins may improve survival and decrease AML transformation in MDS, future studies should investigate the potential association between other metabolic parameters and MDS outcomes.

Top five considerations for improving outcomes in black patients with heart failure: A guide for primary care clinicians

Black patients develop heart failure at younger ages and have worse outcomes such as higher mortality rates compared to other racial and ethnic groups in the United States. Despite significant recent improvements in heart failure medical therapy, these worse outcomes have persisted. Multiple reasons have been provided to explain the situation, including but not limited to higher baseline cluster of cardiovascular risk factors amongst Black patients, inadequate use of heart failure guideline directed medical therapy and delayed referral for advanced heart failure therapies and interventions. Strategic interventions considering social and structural determinants of health, addressing structural inequalities/ bias, implementation of quality improvement programs, early diagnosis and prevention are critically needed to bridge the racial/ ethnic disparities gap and improve longevity of Black patients with heart failure. In this review, we propose evidence-based solutions that provide a framework for the primary care physician addressing these challenges to engender equity in treatment allocation and improve outcomes for all patients with heart failure.

Association of metabolic syndrome and chronic kidney disease.

The prevalence of kidney disease is increasing rapidly worldwide, reflecting rising rates of obesity, diabetes, and associated metabolic syndrome (MetS). Chronic kidney disease and related comorbidities such as obesity, diabetes, and hypertension place a significant financial burden on healthcare systems. Despite the widespread use of RAAS inhibitors, intensive blood pressure and glycemic control, and newer therapeutic options consisting of sodium/glucose cotransporter-2 (SGLT-2) inhibitors or glucagon-like peptide-1 (GLP-1) receptor agonists, a significant risk of progression to end-stage renal disease remains in the high-risk obese and diabetic population. The MetS is a cluster of cardiovascular risk factors that adversely affect the development and progression of chronic kidney failure. According to the criteria of the World Health Organization, it is defined by visceral adiposity, impaired glucose tolerance or insulin resistance, atherogenic dyslipidemia, raised blood pressure, and microalbuminuria with a albumin-to-creatinine ratio ≥30 mg/g. At molecular level MetS is marked by a proinflammatory state and increased oxidative stress leading to various pathophysiological changes causing endothelial dysfunction and a hypercoagulable state. Because the kidney is a highly vascularized organ, it is especially susceptible for those microvascular changes. Therefore, the MetS and its individual components are associated with the premature development, acceleration, and progression of chronic kidney disease. Therefore, it is becoming increasingly important to elucidate the underlying mechanisms of MetS-associated chronic kidney disease in order to develop new strategies for preventing and slowing the progression of renal disease. In this review, we will elucidate (i) the renal structural, hemodynamic, and metabolic changes that occur in obesity and obesity-related kidney injury; (ii) the clinicopathological characteristics of obesity-related kidney injury, primarily focusing on obesity-associated glomerulopathy; (iii) the potential additional factors or predisposing factors that may turn patients more susceptible to renal structural or functional compensatory failure and subsequent injury.

Association between clustering of cardiovascular risk factors and left ventricular geometric remodeling in Chinese children.

Several cardiovascular (CV) risk factors are reported to be associated with abnormal cardiac structure in children and adults. However, no study has assessed the association between clustering of multiple CV risk factors and left ventricular geometric (LVG) remodeling. We examined the association between clustering of CV risk factors and LVG remodeling among Chinese children. This cross-sectional study included 1,406 children aged 6-11 years. Clustering of CV risk factors was quantified as the sum of the number of five CV risk factors (abdominal obesity, elevated blood pressure, high fasting blood glucose, high triglycerides and low high-density lipoprotein cholesterol). Based on left ventricular mass index and relative wall thickness (RWT), left ventricular hypertrophy (LVH), high RWT and LVG remodeling [concentric remodeling (CR), eccentric hypertrophy (EH) and concentric hypertrophy (CH)] were defined. Compared to participants without CV risk factor, those with 1, 2 and ≥3 risk factors were at increased risk of LVH [ORs (95% CIs): 3.49 (2.19-5.56), 5.53 (3.20-9.55), and 19.19 (9.67-38.08), respectively]; corresponding values for high RWT were 2.47 (1.63-3.74), 3.76 (2.25-6.27), and 5.47 (2.65-11.28). Similar associations between clustering of CV risk factors and LVG remodeling were found [CR: 1.71 (1.06-2.76), 2.83 (1.54-5.18), and 3.82 (1.37-10.62); EH: 2.42 (1.42-4.11), 4.23 (2.24-7.96), and 16.86 (7.70-36.92); CH: 14.92 (4.41-50.47), 23.15 (6.32-84.83), and 71.19 (17.09-296.56)]. CV risk factors in isolation and combination were associated with an increased risk of LVH, high RWT and LVG remodeling among children, emphasizing the need to consider multiple risk factors when assessing the risk of cardiac outcomes.

Associations of cardiovascular risk factors and lifestyle behaviors with neurodegenerative disease: a Mendelian randomization study

Previous observational studies reported that midlife clustering of cardiovascular risk factors and lifestyle behaviors were associated with neurodegenerative disease; however, these findings might be biased by confounding and reverse causality. This study aimed to investigate the causal associations of cardiovascular risk factors and lifestyle behaviors with neurodegenerative disease, using the two-sample Mendelian randomization design. Genetic variants for the modifiable risk factors and neurodegenerative disease were extracted from large-scale genome-wide association studies. The inverse-variance weighted method was used as the main analysis method, and MR-Egger regression and leave-one-out analyses were performed to identify potential violations. Genetically predicted diastolic blood pressure (DBP: OR per 1 mmHg, 0.990 [0.979–1.000]), body mass index (BMI: OR per 1 SD, 0.880 [0.825–0.939]), and educational level (OR per 1 SD, 0.698 [0.602–0.810]) were associated with lower risk of late-onset Alzheimer’s disease (LOAD), while genetically predicted low-density lipoprotein (LDL: OR per 1 SD, 1.302 [1.066–1.590]) might increase LOAD risk. Genetically predicted exposures (including LDL and BMI) applied to familial AD showed the same effect. The association of LDL was also found with Amyotrophic lateral sclerosis (ALS) (LDL: OR per 1 SD, 1.180 [1.080–1.289]). This MR analysis showed that LDL, BMI, BP, and educational level were causally related to AD; a significant association between LDL and ALS risk, as well as the potential effect of sleep duration on PD risk, were also revealed. Targeting these modifiable factors was a promising strategy of neurodegenerative disease prevention.