Clustering Of Cardiovascular Risk Factors Research Articles

Assessment of incidence rate and prognosis of metabolic syndrome among acute myocardial infarction: a longitudinal study

Background: The Metabolic Syndrome (METS) is a specific clustering of cardiovascular risk factors in the same person (abdominal obesity, atherogenic dyslipidemia, elevated Blood Pressure (BP), Insulin Resistance (IR), and a proinflammatory state. A recent review of insulin resistance syndrome revealed a rapid escalation of this syndrome among Indians and the prevalence of predominant component of METS varies from region to region. Hence the present study was undertaken to assess the incidence of Metabolic Syndrome and prognosis of metabolic syndrome among acute myocardial infarction patients.Methods: A longitudinal study was carried among Acute myocardial infarction patients, who were admitted to ICCU of Shri. B. M. Patil Hospital and Research Centre, Bijapur during November 2009 to March 2011. Sample size was calculated using the formula: n=4pq/L2. Sample size required was 92. Descriptive statistics and Inferential statistics were used to analyse the results.Results: The incidence rate of METS among AMI in our study was 48.7%. The complications were more common in METS group compared to those without METS groups. Recovery was better among those without METS group. There was a statistically significant association between complications and status of METS. The past history of DM was more common in METS. Hyperglycemia among the components of METS has strongest association with the outcome of death in patients of AMI.Conclusions: The metabolic syndrome is a highly prevalent condition among the patients with acute myocardial infarction and has detrimental impact on outcome Metabolic syndrome is also associated with a higher risk of severe heart failure and death.

Clusters of Cardiovascular Risk Factors and Their Impact on the 20-Year Cardiovascular Risk in a General Population.

Clustering of cardiovascular risk factors (CVRFs) is extraordinarily common and is associated with an increased risk of cardiovascular disease (CVD). However, the particular impact of the sum of CVRFs on cardiovascular morbidity and mortality has not been sufficiently explored in Europe. The aim of this study was to analyze the differences in survival-free probability of CVD in relation to the number of CVRFs in a Spanish population. A prospective cohort study was conducted from 1992 to 2016 in a Spanish population that included 1144 subjects with no history of CVD (mean age, 46.7 years) drawn from the general population. We calculated the number of CVRFs for each subject (male sex, smoking, diabetes, hypertension, dyslipidemia, obesity, and left ventricular hypertrophy). Cardiovascular morbidity and mortality records were collected, and survival analysis was applied (competing risk models). There were 196 cardiovascular events (17.1%). The differences in total survival-free probability of cardiovascular morbidity and mortality of the different values of the sum of CVRFs were significant, increasing the risk of CVD (hazard ratio, 1.30; 95% confidence interval, 1.13-1.50) per each additional risk factor. Differences in survival-free probability of CVD in relation to the number of CVRFs present were statistically significant. Further studies are needed to corroborate our results.

Association of physical activity and sedentary behavior at school with cardiovascular risk factors in adolescents

Abstract The association of moderate to vigorous physical activity and sedentary behavior performed in the school context with cardiovascular risk factors is unclear. Thus, the purpose of this study was to evaluate whether MVPA and SB during school time are associated with single and clustered cardiovascular risk factors in 10- to 16-year-old school students. This study used the baseline data from a non-randomized controlled clinical trial (“MEXA-SE”) conducted on 6th to 9th-grade students from schools in Florianopolis, Brazil. Skinfolds, resting blood pressure, 20-m shuttle-run test, fasting glucose, triglycerides, total cholesterol, high-density lipoprotein cholesterol, and white blood cell counts were obtained. MVPA and SB were objectively measured with accelerometers. A minimum of 180 minutes was considered valid school-time for analysis. Multiple linear regression adjusted for age, sex and habitual physical activity was used. School-time MVPA was positively associated with the peak VO2 (β = 0.17 ml.kg.min-1), and inversely associated with sum of four skinfolds (β = -0.96 mm), diastolic blood pressure (β = -0.36 mmHg), systolic blood pressure (β = -0.301 mmHg); triglycerides (β = -1.49 mg.dL-1), and clustered cardiovascular risk factors (β = -0.123). School-time SB was positively associated with clustered cardiovascular risk factors (β = 0.033). In conclusion, independently of habitual physical activity level, school-time MVPA and a lower time in SB were associated to single and clustered cardiovascular risk factors. Thus, the promotion of strategies aimed increase MVPA and reduce SB at school may prevent the onset and early accumulation of cardiovascular risk factors in adolescence.

Non-HDL cholesterol is better than LDL-c at predicting atherosclerotic cardiovascular disease risk factors clustering, even in subjects with near-to-normal triglycerides: A report from a Venezuelan population

Background: Non-high density lipoprotein cholesterol (non-HDL-c) has emerged as an important tool in primary prevention of atherosclerotic cardiovascular disease (ASCVD), especially among those at high risk. The main objective of this study was to evaluate the predictive value of non-HDL-c for the coexistence aggregation of multiple ASCVD risk factors and compare this with LDL-c in general subjects with normal or near normal triglycerides from Maracaibo city in Venezuela. Methods: This is a descriptive, cross-sectional study with a randomized multistage sampling. 2026 subjects were selected for this study, all were adults ≥18 years old of both genders and inhabitants of Maracaibo city, Venezuela. A complete history and physical medical assessment was performed. A multivariate logistic regression model was used to determine the odds ratio (CI95%) for the coexistence of multiple risk factors for ASCVD. Results: The median (p25-p75) of non-HDL-c was 143 mg/dL (114-174 mg/dL). 52.1% (n=1056) of the sample were women, with a median of 144 mg/dL (115-174 mg/dL) among women and 143 mg/dL (114-17 4mg/dL) among men; p=0.740. Individuals ≥50 years old, smokers, those with hypertension, obesity, diabetes, high waist circumference and elevated hs-C Reactive Protein, all had higher levels of non-HDL-c. A lower median was observed among those <30 years of age with elevated physical activity levels in their leisure time. Non-HDL-c between 130-159 mg/dL (OR=2.44; CI 95%=1.48-4.02; p<0.001) and ≥160 mg/dL (OR=3.28; CI 95%=1.72-6.23; p<0.001) was associated with greater risk of coexistent multiple risk factors for ASCVD, albeit LDL-c was not significant in the multivariate model. Conclusions: Elevated non-HDL-c was associated with conglomeration of multiple risk factors for ASCVD. This suggests evaluation of non-HDL-c may be of better utility in primary care for early identification of subjects for high risk of ASCVD. Future research might focus on the influence of non-HDL-c in cardiovascular mortality.

Association of Risk Factors with Coronary Angiographic Findings of Female Patients with Acute Myocardial Infarction at a Tertiary Hospital of Bangladesh

Background: Coronary artery disease (CAD) is the leading cause of mortality and morbidity of women in developed and developing country. Although women in low and middle income countries have worse situation they are least studied. Cardiovascular risk factors assessment and their correlation with angiographic severity in female patients is essential to take preventive strategy and timely intervention.
 Aim: The aim of this study was to evaluate the major risk factors of coronary artery disease and to study the relation of those cardiovascular risk factors with coronary angiographic findings in female patients with AMI .
 Methods: This was a cross-sectional observational study carried out in the department of Cardiology, Chittagong Medical College Hospital (CMCH) from January 2017 to December 2017. One hundred and fifty consecutive female patients diagnosed as acute myocardial infarction (AMI) who subsequently underwent coronary angiography (CAG) during the study period were included in the study. Data regarding demographic, clinical & laboratory features were recorded. Severity of CAG findings was assessed by Gensini score.
 Results: The mean age of the study population was 53.19(±10.71) years. Hypertension was the commonest cardiovascular risk factor (78%) in this study followed by obesity (68%), dyslipidaemia (62%) and diabetes mellitus (57.3%). About 80% patients had clustering of ≥3 risk factors. Proportion of patients having STsegment elevation myocardial infarction (STEMI) and non ST-segment elevation myocardial infarction (NSTEMI) were 47% and 53% respectively. Thrombolytic was the most frequently used treatment modality for the management of STEMI patients. Double Vessel Disease, type B lesion with Gensini score ≥20 were the most common CAG findings. Triple vessel disease and severe CAD (Gensini score ≥20) were more in women with three or more risk factors. A significant (p<0.05) linear correlation was found between Gensini score and age, triglyceride level and total cholesterol level. Other factors, including, obesity, family history, hypertension, diabetes mellitus, menopausal status were found to be more prevalent among severe coronary artery disease on CAG but the differences were not statistically significant (p>0.05).
 Conclusion: The present study showed a significant relation of having multiple cardiovascular risk factors with developing more aggressive angiographic findings. It also revealed that Bangladeshi female patients of AMI had clusters of cardiovascular risk factors and presence of multiple risk factors is a predictor of severe coronary artery disease.
 Bangladesh Heart Journal 2019; 34(2) : 100-110

Potential Role of New Anthropometric Parameters in Childhood Obesity with or Without Metabolic Syndrome.

BACKGROUND:Obese children and adolescents are more prone to have metabolic syndrome (MS).MS is a cluster of cardiovascular risk factors associated with insulin resistance. Body round index [BRI], visceral adiposity index [VAI] and a body shape index [ABSI] are among the new obesity anthropometric parameters.AIM:To evaluate the new markers for obesity in children and their possible association with other laboratory and clinical variables of MS.METHODS:Eighty nine obese children and 40 controls aged 10-18 years were recruited. Full history taking, thorough clinical examination, anthropometric and biochemical features were performed in the studied groups. Subcutaneous fat thickness (SFT) and visceral fat thickness (VFT) were estimated by ultrasonography.RESULTS:Obese children, exhibited significantly higher values in all anthropometric measurements (P < 0.001). Diastolic and systolic blood pressure were significantly higher (P < 0.001) in the obese group. ABSI, BRI and VAI have been found to be significantly higher in obese subjects (P < 0.001), with no significant gender difference. BMI, WHtR, WC/HR, SBP, DBP, subcutaneous fat thickness and visceral fat thickness, Liver Span, ABSI, BRI, VAI and HOMA_IR were significantly higher among children with MS than those without MS. Positive significant correlations of VAI with BMI, WC/Ht, WC/Hip, SBP, DBP, SFT, VFT, Liver size and HOMA-IR (r = 0.384, 0.239, 0.268, 0.329, 0.516, 0.320, 0.254, 0.251, and 0.278 respectively) are shown. The area under the ROC curve (AUC) of BMI, VAI, ABSI, BRI for predicting MS was 0.802 (0.701-0.902), 0.737 (0.33-0.841), 0.737 (0.620-0.855), 0.816 (0.698-0.934).CONCLUSION:We suggest using the VAI and WHtR indexes, as they are better predictor of MS.

Physical activity is associated with better global cognition and frontal function in overweight/obese older adults with metabolic syndrome

BackgroundThere is epidemiological evidence of an association between the metabolic syndrome (MetS), a cluster of cardiovascular risk factors related to central adiposity and insulin resistance, and cognitive impairment and dementia. On the other hand, there is evidence for a beneficial effect of physical activity on cognitive outcomes in older adult populations. In a cross-sectional study, we evaluated the relationship between aerobic physical activity and cognition in a cohort of overweight/obese older adults with MetS at risk for dementia. Cognitive function was assessed in a subsample of 82 subjects (men 55–75 y; women 60–75 y), with MetS and a BMI ≥27 to < 40 kg/m2 enrolled in the PREDIMED-PLUS study, a trial of diet and exercise in individuals with MetS with outcomes of cardiovascular prevention. Domain Z scores were calculated for the different cognitive domains. Aerobic physical activity was determined with the Rapid Assessment of Physical Activity questionnaire.ResultsAdjusted covariance analyses revealed that, compared to sedentary participants, those physically active obtained higher scores in mean global cognitive scores, with mean adjusted difference 0.254 (95% CI 0.032 to 0.477, p = 0.026) and frontal composites, with mean adjusted difference 0.375 (95% CI 0.110 to 0.639, p = 0.006).ConclusionsOur findings indicate that aerobic physical activity is associated with better global cognition and frontal function in overweight/obese older individuals with MetS, suggesting that physical activity could be a therapeutic strategy to reduce the risk of developing cognitive impairment or dementia in this population.

Kidney and liver are the main organs of expression of a key metabolic enzyme alanine:glyoxylate aminotransferase 2 in humans

BackgroundThe metabolic syndrome is a cluster of cardiovascular risk factors and is highly predictive for development of cardiovascular diseases. An association between elevated plasma levels of the endogenous inhibitor of nitric oxide synthases asymmetric dimethylarginine (ADMA) and risk of cardiovascular diseases has been demonstrated in numerous epidemiological studies. ADMA can be catabolized by dimethylarginine dimethylaminohydrolase (DDAH) or metabolized through a much less understood alternative pathway by alanine:glyoxylate aminotransferase 2 (AGXT2) with the formation of α-keto-δ-(N,N-dimethylguanidino)valeric acid (ADGV). Previous RT-PCR and Western Blot studies suggested that Agxt2 is expressed in the mouse kidney and liver at comparable levels, while Northern Blot and in-situ RNA-hybridisation experiments demonstrated that the kidney is the main organ of Agxt2 expression in rats. Given this discrepancy, the goal of the current study was to analyse the expression of AGXT2 in human tissues. Material and methodsWe analyzed AGXT2 expression in human tissues from a normal tissue bank by RT-PCR and further validated the results by Western Blot. We also performed immunohistochemical staining for AGXT2 and double fluorescent staining with an anti-AGXT2 antibody and a monoclonal anti-mitochondrial antibody. ResultsWe saw the strongest expression of AGXT2 in the kidney and liver and confirmed this results on protein level. By IHC staining we were able to show that AGXT2 is present in the convoluted tubule in the kidney and in the liver hepatocytes. The double fluorescent staining revealed mitochondrial localization of AGXT2. ConclusionsOur current data suggest that both hepatocytes and kidney tubular epithelial cells are the major sources of AGXT2 in humans. We also demonstrated the mitochondrial localization of human AGXT2 enzyme.

Estimation of apolipoprotein A in early onset ST-segment elevation myocardial infarction.

The role of apolipoprotein A in early onset ST-segment elevation myocardial infarction is not clear. This study sought to assess the apolipoprotein A in cohort of patients diagnosed with early onset acute ST-segment elevation myocardial infarction and to corelate it with major traditional cardiovascular risk factors. A total of 50 such patients and 40 age and sex-matched healthy controls, both aged less than 50 years with their baseline demographic, clinical characteristics and cardiovascular risk factors were studied. Apolipoprotein A was estimated for all enrollees. The mean age of cases was 43.37 ± 5.85 years. The levels of apolipoprotein A among cases were not significantly lower compared to controls (P = 0.52). They were lower among the male, current smokers and the dyslipidemia (P's < 0.05). Considering the apolipoprotein A as the dependent factor, the early onset ST-segment elevation myocardial infarction was associated significantly with the male and the dyslipidemia in linear regression (P < 0.001 and 0.030), respectively. Lower levels of apolipoprotein A are significantly related to conventional risk factors in early onset ST-segment elevation myocardial infarction. This apolipoprotein A that particularly develops in young patients with clustering of traditional cardiovascular risk factors should be targeted. Further studies are warranted to determine the diagnostic and prognostic indicators of this apolipoprotein in ST-segment elevation myocardial infarction.

Clusters of cardiovascular risk factors and its association with muscle strength in adults.

Cardiovascular diseases are the leading cause of death globally. The aim of the study was to investigate the relationship between muscle strength (MS) and clusters of metabolic syndrome (MetS) components in adults. Population-based cross-sectional study comprising 533 adults (45.3±11.1 years) from Florianópolis, Brazil. MS - calculated as the ratio between absolute strength (kgf) and body mass (kg) - was measured by handgrip dynamometry. Data on blood pressure, waist circumference, lipids and blood glucose were used to identify MetS components that were analyzed as individual variables and clusters. Multiple linear regression adjusted was used. Individually, MS was inversely associated with all MetS components (1, 2, 3 and 4 factors, β of at least -0.08 kgf/kg). In addition, MS was negatively associated with number of positive MetS components (1, 2, 3 and 4 factors; β of at least -0.05 kgf/kg). Individually or combined in clusters of two, three and four risk factors (β of at least -0.20 kgf/kg), abdominal obesity was directly associated with lower MS values. All combinations of 3 and 4 MetS components (β of at least -0.13 kgf/kg) were inversely associated with MS. Greater number of individual MetS components were related to lower MS values.

Cluster patterns of behavioural risk factors among children: Longitudinal associations with adult cardio-metabolic risk factors

Much of what is known about childhood clusters of cardiovascular disease behavioural risk factors (RFs) comes from cross-sectional studies, providing little insight into the long-term health impacts of different behavioural cluster profiles. This study aimed to establish the longitudinal relationship between cluster patterns of childhood behavioural RFs and adult cardio-metabolic RFs.Data were from an Australian prospective cohort study of 1265 participants measured in 1985 (ages 9–15 yrs), and in 2004–06 (ages 26–36 yrs). At baseline, children self-reported smoking status, alcohol consumption, physical activity (PA), dietary behaviour and psychological well-being. At follow-up, participants completed questionnaires and attended study clinics where the following component indicators of the metabolic syndrome (MetS) score were measured: waist circumference, blood pressure, fasting blood glucose and lipids. TwoStep cluster analyses were carried out to identify clusters in childhood. Linear regression was used to examine the longitudinal associations between cluster patterns of childhood behavioural RFs and adult cardio-metabolic RFs.Four childhood cluster patterns of behavioural RFs labelled ‘most healthy’, ‘high PA’, ‘most unhealthy’, and ‘breakfast skippers’ were identified. The unhealthier childhood clusters predicted a significantly higher adult MetS score (‘most unhealthy’: β = 0.10, 95%CI = 0.01, 0.19) and adult waist circumference (‘most unhealthy’: β = 2.29, 95%CI = 0.90, 6.67; ‘breakfast skippers’: β = 2.15, 95%CI = 0.30, 4.00). These associations were independent of adult behavioural RFs and socio-economic position.These findings emphasise the impact of multiple childhood behavioural RFs on important adult health outcomes and may be useful for the development of early intervention strategies, where identification of children at higher risk of poorer adult cardio-metabolic health is vital.

Coronary Artery Bypass Grafting in Women 50Years or Younger.

BackgroundPrior research has shown higher mortality in women with severe coronary artery disease compared with men, particularly in younger patients. It is unknown if this could be attributable to an adverse risk factor profile.Methods and ResultsIn a population‐based cohort study, we included all adults ≤50 years of age (932 women and 4514 men) who underwent coronary artery bypass grafting from 1995 to 2013 from the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) register. Following inverse probability of treatment weighting, we investigated differences between women and men. Women had a higher prevalence of cardiovascular risk factors compared with men. There was no difference in early mortality between women and men (unadjusted: 1.3% versus 0.9%; hazard ratio, 1.42; 95% CI, 0.75–2.70; weighted sample: 1.1% versus 1.0%; hazard ratio, 1.10; 95% CI, 0.52–2.30). During a median follow‐up time of 11.8 years, in the unweighted population, the risk of death was greater in women compared with men (hazard ratio, 1.34; 95% CI, 1.13–1.58). However, in the weighted sample, the risk of death was not significantly different in women compared with men (hazard ratio, 1.02; 95% CI, 0.83–1.26).ConclusionsWomen ≤50 years of age had a higher unadjusted risk of death after coronary artery bypass grafting compared with men, but this was explained by a clustering of cardiovascular risk factors. Female sex per se was not associated with increased mortality or major adverse cardiovascular events. Early mortality was not increased in women compared with men, even though younger women in our study had an increased burden of risk factors known to affect early risk.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02276950.

Ethnic disparities in prevalence and clustering of cardiovascular disease risk factors in rural Southwest China

BackgroundThis study examines how prevalence and clustering of cardiovascular disease (CVD) risk factors differ by ethnicity and socioeconomic status (SES) among rural southwest Chinese adults.MethodsA cross-sectional survey of 7027 adults aged ≥35 years of Han and four ethnic minority group descent (Na Xi, Li Shu, Dai, and Jing Po) was used to derive prevalence of tobacco smoking and exposure to secondhand smoke (SHS) as well as alcohol consumption and physical activity data. Anthropometric measurements were also taken, including height, weight, and waist and hip circumference, as well as blood pressure (BP) and fasting blood glucose (FBG) measurements.ResultsCurrent smoking and drinking status were the top two CVD risk factors in the study population. Dai ethnic minority participants had the highest prevalence of hypertension, obesity, and central obesity, whereas Jing Po ethnic minority participants had the highest prevalence of current smoking status, SHS exposure, and current drinking status (P < 0.01). Han participants had the highest prevalence of diabetes and physical inactivity (P < 0.01). 11.1% of all participants did not have any of the studied CVD risk factors, while 68.6% of Han, 60.2% of Na Xi, 50.7% of Li Shu, 82.2% of Dai, and 73.0% of Jing Po participants had clustering of two or more CVD risk factors. Prevalence of CVD risk factor clusters increased with age (P < 0.01). Males and individuals with lower education levels and lower annual household income were more likely to have CVD risk factors than their counterparts (P < 0.01).ConclusionClustering of CVD risk factors is common in rural southwest China. Ethnicity and individual SES significantly impact prevalence of CVD risk factors and their clustering.

Obesity as the Main Risk Factor for Metabolic Syndrome in Children.

Obesity in childhood is the main determinant of whole body reduced insulin sensitivity. This association has been demonstrated in multiple adult and pediatric cohorts. The mechanistic link explaining this association is the pattern of lipid partitioning in the face of excess calories and energy surplus. A tight relation exists between typical lipid deposition patterns, specifically within the skeletal muscle and liver, as well as the intra-abdominal compartment and whole body insulin sensitivity. The impact of lipid deposition within insulin responsive tissues such as the liver and skeletal muscle relates to the ability of fatty acid derivates to inhibit elements of the insulin signal transduction pathway. Strengthening the relation of obesity and reduced insulin sensitivity are the observations that weight gain reduces insulin sensitivity while weight loss increases it. This manifests as the appearance of cardiovascular risk factor clustering with weight gain and its recovery in the face of weight loss. Both obesity per se, via the adipocytokine profile it induces, and low insulin sensitivity, are independent determinants of the adverse metabolic phenotype characteristic of the metabolic syndrome.

Association of cardiovascular risk factor clustering and prehypertension among adults：Results from the China health and retirement longitudinal study baseline

ABSTRACTBackground: Prehypertension is common in China, but its causes and associated factors have not been well studied. This study aimed to examine the age and gender-specific associations between CVD risk factor clustering and prehypertension among adults in China.Methods: This cross-sectional study used data from participants (n = 8735) aged over 45 in the China Health and Retirement Longitudinal Study (CHARLS) Baseline conducted from 2011–2012. The participants’ data were collected using standard questionnaires, anthropometric, and biochemical tests. Logistic regression analyses were used to examine the associations between cardiovascular risk factors, their clustering and prehypertension.Results: Overall, 21.1%, 39.5%, 27.6% and 11.8% participants had 0, 1, 2, ≥ 3 CVD risk factors in prehypertension group, respectively. Diabetes and overweight/obesity were significantly associated with prehypertension (OR, 1.24; 95% confidence interval [CI], 1.06–1.44; OR, 1.55; 95% CI, 1.38–1.75) in the overall population, and diabetes was associated with prehypertension only in men (OR, 1.26; 95% CI, 1.00–1.58) and older adults (OR, 1.32; 95% CI, 1.03–1.69). Moreover, participants with 1, 2 and ≥3 risk factors had increased odds of having prehypertension (OR, 1.29; 95% CI, 1.12–1.49; OR, 1.59; 95% CI, 1.31–1.78; OR, 2.05; 95% CI, 1.66–2.53, respectively) and existed dose-response relationship, regardless of age and gender.Conclusions: This study indicated that CVD risk factor clustering was significantly associated with prehypertension and hypertension. These results provide valuable information for health professionals to better understand the impact of CVD risk factor clustering on prehypertension and hypertension.

CLINICAL AND LABORATORY DIFFERENCES AMONG PATIENTS WITH ESSENTIAL HYPERTENSION AND METABOLIC SYNDROME

Objective: The metabolic syndrome (MetS) is recognized as a cluster of cardiovascular risk factors. However, these individuals are not a homogenous group. We sought to study the differences among patients with essential hypertension and metabolic syndrome. Design and method: We studied 951 [390 (41.0%) were men] hypertensives, who were not under any lipid-lowering agent. Their median age was 58 (range: 16–92) years. The waist circumference and blood pressure were measured. Fasting blood samples were obtained in order to measure glucose, a complete lipid profile, liver and kidney factional tests and uric acid. MetS defined by the Adult Treatment Panel III criteria. Results: Six hundred twenty two out of 951 patients (65.3%) met the criteria for MetS. We divided hypertensives with MetS into two groups according to their serum glucose levels. Four hundred fourteen (66.6%) had serum glucose >100 mg/dl (HG) and the rest 208 (33.4%) <100 mg/dl (LG). HG group was significantly older than LG [60 (16–92) vs 57 (19–82) years; p = 0.001]. There was no statistically significant difference in both sex distribution and smoking status between the two groups. Subjects with high glucose levels (HG) were significantly heavier [body mass index (BMI): 33.4 ± 6.0Kg/m2 vs 32.4 ± 4.9Kg/m2; p = 0.03] with visceral obesity predominates (higher waist circumference: 111.8 ± 16.9 cm vs 105.8 ± 11.3 cm; p < 0.01) when compared with the other group. HG hypertensives had significantly greater pulse pressure (PP) when compared with LG (66.4 ± 17.6mmHg vs 60.2 ± 15.6mmHg; p < 0.001). There was no significant difference either in total and low density cholesterol, or uric acid and creatinine serum levels between the two groups of patients. On the contrary HG hypertensives had significantly elevated both Gamma-Glutamyl Transpeptidase (gGT) (35.2 ± 10.5U/dl vs 28.7 ± 8.6U/dl; p = 0.03) and Alkaline Phospatase (ALP) (86.5 ± 16.3U/dl vs 71.5 ± 13.5U/dl; p < 0.01) than the others. Linear regression analysis revealed that only PP and ALP levels associated independently with HG group of hypertensives. Conclusions: Our results suggest that among hypertensive patients with MetS those with higher serum glucose levels were older and more obese than the others. They had also greater PP and increased both liver obstructive functional tests. While, there were no difference in total and low density cholesterol serum levels.

Identification of Haptoglobin as a Readout of rhGH Therapy in GH Deficiency.

GH deficiency (GHD) is characterized by a cluster of cardiovascular risk factors and subtle inflammation. We aimed to demonstrate, through a proteomic approach, molecules directly modulated by GHD and involved in the inflammatory state. Ten children with isolated GHD were studied before and after 1 year of treatment with rhGH and compared with 14 matched controls. A two-dimensional electrophoresis plasma proteomics analysis was performed at baseline and after GH treatment to identify the top molecules modulated by GH. In vitro studies on human hepatoma (HepG2) cells were performed to validate the data. Twelve of 20 proteomic spots were predicted to be isoforms α and β of haptoglobin (Hp) and confirmed by liquid chromatography tandem mass spectrometry and Western immunoblot analyses. Hp levels were higher in patients with GHD than controls at baseline (P < 0.001) and were reduced following GH treatment (P < 0.01). In HepG2 cells, both GH and IGF-1 were able to downregulate IL-6-induced Hp secretion. Moreover, Hp secretion was restored in pegvisomant-treated HepG2 cells. Hp is a molecule acting in the inflammatory state of GHD and a possible biomarker for GH treatment. Nevertheless, the contribution of other factors and the molecular pathways involved in the GH downregulation of Hp remain to be clearly defined.

Association of a genetic variant in the angiopoietin-like protein 4 gene with metabolic syndrome

BackgroundMetabolic syndrome (MetS) is characterized by a clustering of cardiovascular risk factors that include: abdominal obesity, dyslipidemia, hypertension and glucose intolerance. Angiopoietin-like protein 4 (ANGPTL4) is a circulating peptide that is an inhibitor of lipoprotein lipase, a key enzyme in lipid metabolism. The objective of this study was to investigate the association of ANGPTL4 gene variants (E40K) with fasting serum triglyceride levels and with cardiovascular risk factors, that included the presence of MetS in 817 subjects recruited from the Mashhad stroke and heart Atherosclerosis Disorders (MASHAD) cohort Study.MethodANGPTL4 genotypes were determined using a TaqMan genotyping based real time PCR method. The association of the genetic variant with the risk of metabolic syndrome and its relationship with lipid profile were determined.ResultThe frequency of GG, GA and AA genotypes were 96.9, 2.7 and 0.4% in individuals with MetS, and 78.8, 20.8, 0.4%, in those without MetS. The GA genotype of the rs116843064 polymorphism was associated with a lower risk for MetS (e.g., OR in Codominant genetic model: 0.14, 95% CI: (0.06–0.33), p < 0.0001). Subject with an A allele had a higher risk for MetS (OR: 6.72, 95% CI: (3.05–14.82), p < 0.0001). There was a significant difference in fasted lipid profiles across the genotypes for ANGPTL4. Carriers of the AG genotype had higher levels of serum HDL-cholesterol (HDL-C) and lower TG, compared to the GG homozygotes genotype.ConclusionThe G allele at the rs116843064 polymorphic locus of the ANGPTL4 gene was associated with a lower prevalence of MetS.

Adherence to a priori dietary indexes and baseline prevalence of cardiovascular risk factors in the PREDIMED-Plus randomised trial.

Cardiovascular disease remains the global leading cause of death. We evaluated at baseline the association between the adherence to eight a priori high-quality dietary scores and the prevalence of individual and clustered cardiovascular risk factors (CVRF) in the PREDIMED-Plus cohort. All PREDIMED-Plus participants (6874 men and women aged 55-75years, with overweight/obesity and metabolic syndrome) were assessed. The prevalence of 4 CVRF (hypertension, obesity, diabetes, and dyslipidaemia), using standard diagnoses criteria, were considered as outcomes. The adherence to eight a priori-defined dietary indexes was calculated. Multivariable models were fitted to estimate differences in mean values of factors and prevalence ratios for individual and clustered CVRF. Highest conformity to any dietary pattern did not show inverse associations with hypertension. The modified Mediterranean Diet Score (PR = 0.95; 95% CI 0.90-0.99), Mediterranean Diet Adherence Score (MEDAS) (PR = 0.94; 95% CI 0.89-0.98), the pro-vegetarian dietary pattern (PR = 0.95; 95% CI 0.90-0.99) and the Alternate Healthy Eating Index 2010 (PR = 0.92; 95% CI 0.87-0.96) were inversely associated with prevalence of obesity. We identified significant inverse trend among participants who better adhered to the MEDAS and the Prime Diet Quality Score (PDQS)in the mean number of CVRF across categories of adherence. Better adherence to several high-quality dietary indexes was associated with better blood lipid profiles and anthropometric measures. Highest adherence to dietary quality indexes, especially Mediterranean-style and PDQS scores, showed marginal associations with lower prevalence of individual and clustered CVRF among elderly adults with metabolic syndrome at high risk of cardiovascular disease.

PO-01-049 Testosterone counteracts metabolic syndrome-related changes in skeletal muscle fiber metabolism and improves exercise performance in the rabbit

Lifestyle modifications, including physical exercise (PhyEx) are well-known treatments for metabolic syndrome (MetS), a cluster of metabolic and cardiovascular risk factors often associated to hypogonadism. Given the trophic role of testosterone (T) on skeletal muscle (SkM) mass, this study was aimed at evaluating the effects of T treatment on SkM metabolism and exercise performance in male rabbits with high fat diet (HFD)-induced MetS. HFD rabbits, treated or not with T (HFD+T; 30 mg/kg/week) for 12 weeks were compared to regular diet animals (RD). A subset of each group were exercise-trained on a treadmill for 12 weeks. SkM samples were collected for subsequent analyses. HFD determined an increased gene expression of type-II (fast, glycolytic) and a significant decrease of type-I (slow, oxidative) muscle fiber markers, as compared to RD group. T reverted these effects, also inducing the expression of mitochondrial respiration chain enzymes and normalizing HFD-induced mitochondrial cristae reduction. Fiber typing by PAS-staining in SkM cross-sections confirmed a shift from type-I to type-II fibers in HFD, which was normalized by T. Moreover, T significantly increased the expression of both myogenic and muscle metabolism (insulin-dependent signaling, lipid turnover) markers. Preliminary Results in rabbit SkM satellite cells confirmed the positive effect of T on myogenesis. At the end of the PhyEx protocol, when compared to RD, HFD rabbits showed a significant reduction of both running distance and running time, while T counteracted this effect, also decreasing the lactate production. Muscle histology evidenced a further reduction of type-I fibers in HFD compared to RD and the positive effect of T in maintaining oxidative metabolism, as also demonstrated by mitochondrial ultrastructure analysis.