Education Program Adult Treatment Panel-III Research Articles

Pattern of Metabolic Syndrome in Relation to Gender among Type-II DM Patients in Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia

Background: The co-existence of diabetes and metabolic syndrome (MetS) in individuals potentiate the cardiovascular risk associated with each of these mentioned circumstances. Hence investigating the presence of MetS and its individual components in diabetes mellitus (DM) patients is fundamental in order to minimize the risks of developing cardiovascular related morbidities. Objectives: This study aimed to assess pattern of metabolic syndrome in relation to gender among type-II DM patients in Hawassa University Comprehensive specialized Hospital. Methods: A cross-sectional study was conducted on 270 participants from March to November 2014. Structured questionnaires were used for appropriate data collection; blood glucose and lipid profiles were determined after overnight fasting. In addition, MetS was interpreted according to modified National cholesterol Education Program Adult Treatment Panel-III guideline and finally in all cases, at 95% confidence interval (CI), a P value <0.05 was accepted as statistically significant. Results: The prevalence of MetS was 45.9% and the proportion of MetS was significantly higher in women when compared to men (60.6% vs. 36.7%; p<0.0001), respectively. Elevated TGs was 68.1% and it was found to be the most frequently encountered MetS component followed by Low HDL-c (47%) other than hyperglycemia. Abdominal obesity and low HDL-c were significantly higher in women when compared to men (p<0.0001 for both). In addition, being women [AOR (95%CI): 4.1(1.5-10.9)], overweight [AOR (95%CI): 12(2.3-61.4)], and obesity [AOR (95%CI): 19.8 (3.1-124.7)], were significantly positively associated with MetS. Furthermore duration since the diagnosis of diabetes was also significantly associated with MetS. Conclusions: Applying comprehensive management approach in each abnormal component of MetS is a fundamental in order to minimize cardiovascular risks. In addition, cohort studies should be conducted to address others hidden factors that potentiate MetS.

Metabolic Syndrome After Liver Transplantation: Five-Year Prevalence and Risk Factors

Survival after orthotopic liver transplantation (OLT) has increased over the last decades, focusing on the metabolic complications that contribute to patient morbidity and mortality. The aim of our study was to describe the prevalence of metabolic syndrome (MS), its components, and its associated factors in patients who underwent OLT in a hospital in Spain. From November 2001 to January 2014, we performed 415 transplantations in 386 patients. We analyzed 204 patients with a minimum follow-up of 1 year (77.6% were male and the mean age was 54.2+/−9.5 years). The most frequent etiology was alcohol (41%), followed by hepatitis C virus (29.1%). The indication was decompensated cirrhosis in 51.8% and hepatocellular carcinoma in 34%. According to modified National Cholesterol Education Program–Adult Treatment Panel-III (NCEP-ATP III) criteria, 5 years post-transplantation MS was diagnosed in 38.2% of patients. Significant independent predictors of post-transplantation MS on logistic regression analysis were as follows: pretransplantation obesity (odds ratio [OR], 3.09; P = .056), 1-year post-transplantation obesity (OR, 3.95; P = .009), pretransplantation diabetes (OR, 4.63; P = .001), 1-year post-transplantation diabetes (OR, 3.01; P = .015), 1-year post-transplantation hypertension (OR, 1.85; P = .176), and hypertriglyceridemia at the first year after transplantation (OR, 2.32; P = .063). In our center the prevalence of MS at 5 years after OLT is slightly lower than published. The most important risk factors were obesity and diabetes (both pretransplantation and the first year post-transplantation).

Associations of metabolic syndrome with elevated liver enzymes and C-reactive protein in drug-naive patients with depressive disorders

Background and Aim: Metabolic syndrome (MS) is found to be more prevalent in patients with depression. As there is a lack of Indian data, this study was aimed to assess the prevalence of MS and its association with liver enzymes and C-reactive protein (CRP) in drug-naive patients with depressive disorders. Methods: Prevalence of MS was assessed in 170 patients with depressive disorders and thirty healthy controls using Modified National Cholesterol Education Program Adult Treatment Panel-III criteria. Liver enzymes and CRP were also assessed for patient group. Results: MS prevalence was 25.9% in patients with depression, which was higher than the healthy controls (17.3%). Lower HDL level was the most common abnormality in depression group. Compared to healthy controls, significantly greater proportion of patients with depression had abnormal fasting blood sugar and HDL levels. Besides MS, another 61% fulfilled one or two criteria of MS. Significant predictors of MS were age, duration of psychiatric illness, body mass index, obesity, gamma-glutamyl transferase (GGT), and CRP levels. Conclusions: One-fourth of the depressed patients had MS and another three-fifth of the patients had one or two metabolic abnormalities, and these were associated with greater GGT and CRP levels. Patients with depression should be regularly evaluated and timely treated for cardiovascular risk factors.

Update on the NCEP ATP-III emerging cardiometabolic risk factors.

The intent of this review is to update the science of emerging cardiometabolic risk factors that were listed in the National Cholesterol Education Program (NCEP) Adult Treatment Panel-III (ATP-III) report of 2001 (updated in 2004). At the time these guidelines were published, the evidence was felt to be insufficient to recommend these risk factors for routine screening of cardiovascular disease risk. However, the panel felt that prudent use of these biomarkers for patients at intermediate risk of a major cardiovascular event over the subsequent 10 years might help identify patients who needed more aggressive low density lipoprotein (LDL) or non-high density lipoprotein (HDL) cholesterol lowering therapy. While a number of other emerging risk factors have been identified, this review will be limited to assessing the data and recommendations for the use of apolipoprotein B, lipoprotein (a), homocysteine, pro-thrombotic factors, inflammatory factors, impaired glucose metabolism, and measures of subclinical atherosclerotic cardiovascular disease for further cardiovascular disease risk stratification.

Association of 25-hydroxyvitamin D with Metabolic Syndrome in Patients with Psoriasis: A Case-control Study

Vitamin D deficiency is associated with higher cardiovascular risk and metabolic syndrome (MeS) criteria. The main objective of this study was to analyse the association of 25-hydroxyvitamin D (25-OHD) serum levels with MeS (National Cholesterol Education Program-Adult Treatment Panel-III criteria) in 46 Spanish patients with psoriasis, but without arthritis and systemic treatment, and 46 control subjects, matched by sex and age. The patients with psoriasis showed significantly lower level of 25-OHD than controls (30.5 vs. 38.3 ng/ml; p = 0.0001). Patients with MeS had significantly lower serum levels of 25-OHD than those without MeS (24.1 ± 7.5 vs. 32.8 ± 8.9, p = 0.007), and a negative correlation was found between 25-OHD and waist circumference, diastolic blood pressure, fasting glucose, and triglyceridaemia. In the control group no significant correlation between 25-OHD and MeS was found. Al-though the sample was small, our results suggest a potential protective role for 25-OHD in the metabolic profile of patients with psoriasis without arthritis.

Metabolic Syndrome in Alcohol-dependent Men: A Cross-sectional Study

Background:In the context to mental illness metabolic syndrome (MS) has gained significant attention in the last decade. The present research aimed to study the prevalence of MS and its correlates among the alcohol-dependent men at a deaddiction center in Northern India.Materials and Methods:A cross-sectional analysis was done for consecutive male subjects who met the diagnosis of alcohol-dependence syndrome currently using alcohol according to the International Clinical Diagnostic criteria- tenth revision mental and behavioral disorder- Clinical description and diagnostic guidelines criteria (ICD-10). The subjects were evaluated for alcohol consumption and the components of MS as per the International Diabetic Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel-III (NCEP ATP-III).Results:A total of 200 male subjects were studied: 100 subjects meeting ICD-10 criteria for alcohol dependence currently using alcohol; 50 each of genetically related controls and nongenetically related healthy controls. As per the IDF (with ethnicity specific modifications for waist circumference) and NCEP ATP- III definitions, respectively, MS was found to be less prevalent in alcohol-dependent subjects (27% and 18%) in comparison the healthy controls (30% and 20%).Conclusion:Findings of the study suggest that irrespective of the amount the current alcohol intake is associated with a lower prevalence of MS and a favorable effect on serum high density lipoproteins and waist circumference. However, the cross-sectional nature of our study does not allow any definitive causal inference.

Poor-Quality Sleep Is Associated with Metabolic Syndrome in Korean Adults

Sleep disorder and metabolic syndrome (MetS) are important health-related problems. Recently, sleep duration has decreased among Korean adults. In this study, we examined whether sleep quality is associated with MetS by analyzing 301 subjects, aged 20 years or over, without acute and severe illness who visited three primary care clinics. Sleep duration, sleep quality and the risk of sleep-related breathing disorder (SRBD) were assessed with a standardized sleeping-estimating instrument. MetS was defined according to the modified diagnostic criteria of the National Cholesterol Education Program Adult Treatment Panel-III using the Korean abdominal obesity definition. In the multiple logistic regression analysis, compared with the 7-hour sleep group, the adjusted odds ratios (ORs) of the ≤ 5- and ≥ 9-hour sleep groups for MetS were 4.89 and 5.98, respectively. Compared with the good-sleep quality and low-SRBD risk groups, the adjusted ORs of the poor-quality sleep and high-SRBD risk groups were 3.83 and 1.92, respectively (p < 0.05). In the ≤ 5- and ≥ 9-hour sleep groups, the prevalence of elevated triglyceride and high HOMA-IR was higher (p = 0.069). In the poor-quality sleep group, the prevalence of abdominal obesity, elevated triglyceride, low HDL cholesterol, high fasting insulin and high HOMA-IR were higher. In the high-SRBD risk group, the prevalence of abdominal obesity, obesity and elevated triglyceride were higher (p < 0.05). Overall, the ≤ 5- or ≥ 9-hour sleep duration, poor-quality sleep and high-SRBD risk are related with the high prevalence of MetS, perhaps through elevated insulin-resistance resulting from adiposity.

Metabolic syndrome in human immunodeficiency virus positive patients.

Aims and Objectives:To assess the prevalence of metabolic syndrome (MetS) in human immunodeficiency virus (HIV) positive patients. Prevalence of MetS was compared in patients who were not on highly active antiretroviral therapy (HAART) to patients who were on HAART.Materials and Methods:Seventy HIV positive cases were studied. Pregnant and lactating women, patients on drugs other than HAART known to cause metabolic abnormalities and those having diabetes or hypertension were excluded. Cases were evaluated for MetS by using National Cholesterol Education Program Adult Treatment Panel-III.Results:47 cases were on HAART and 23 cases were not on HAART. Fasting Blood Glucose ≥100 mg/dl was present in 28.6% cases, out of whom 27.7% were on HAART and 30.4% were not on HAART (P = 0.8089). 12.9% cases had BP ≥130/≥85 mm Hg, out of whom 14.9% were on HAART and 8.7% were not on HAART (P = 0.4666). 42.9% cases had TG ≥150 mg/dl, out of whom 44.7% were on HAART and 39.1% were not on HAART (P = 0.6894). HDL cholesterol was low (males <40 mg/dl, females <50 mg/dl) in 50% cases, out of whom 55.3% were on HAART and 39.1% were not on HAART (P = 0.2035).Conclusions:Prevalence of MetS was 20%. Majority of patients had only one component of MetS (32.9%). Low HDL was present in 50%, followed by raised triglycerides in 42.9%. Waist circumference was not increased in any of the patients. There was no statistically significant difference between those on HAART and those not on HAART in distribution of risk factors and individual components of MetS.

Interleukin-6 Receptor Gene 48892 A/C Polymorphism Is Associated with Metabolic Syndrome in Female Taiwanese Adolescents

This study was to evaluate the relationship between the interleukin-6 receptor (IL-6R) 48892 A/C single-nucleotide polymorphism (SNP) (rs8192284) and the metabolic syndrome (MetS) and its components among young adolescents in Taiwan. We enrolled 925 adolescents (451 boys and 474 girls). Modified National Cholesterol Education Program Adult Treatment Panel-III (NCEP ATP-III) criteria were applied to define MetS (with age- and gender-specific 90th percentile cutoff point of variables). Subjects had three or more of the following cardiometabolic abnormalities that occur in MetS: high blood pressure, high fasting glucose, high triglyceride (TG), low high-density lipoprotein cholesterol (HDL-C), and obesity. The characteristics of the MetS components associated with different alleles and genotypes of the IL-6R rs8192284 SNP were compared. Frequencies of alleles and genotypes of the IL-6R 48892 polymorphism were similar in both sexes. Boys with C-alleles had borderline lower TG levels than A-allele carriers (66.0±30.1 vs. 70.3±34.6 mg/dL, p=0.07). However, girls with C-alleles had higher waist circumference (WC) (68.0±7.9 vs. 67.0±7.7 cm) and lower HDL-C levels (50.7±11.1 vs. 52.2±11.7 g/dL) than A-allele carriers (p=0.05). The prevalence of MetS and its components, high WC and low HDL-C level, were higher in female C-allele carriers (all p<0.05) but not in boys. The odds ratios for high WC, low HDL-C levels, and MetS for female C-allele carriers were 1.54 (95% confidence interval [CI]: 1.01-2.34), 1.49 (95% CI: 1.01-2.18), and 2.19-2.39 (95% CI: 1.15-4.51), respectively, when compared with A-allele carriers. The IL-6R 48892 A/C polymorphism is associated with high TG and WC, and low HDL-C levels in adolescents. Additionally, there is a gender difference in the incidence of MetS, indicating a possible gene-gender interaction of the IL-6R 48892 A/C polymorphism in MetS among Taiwanese adolescents.

Prevalence of metabolic syndrome in patients with schizophrenia in India

Prevalence of metabolic syndrome (MS) was estimated in 227 patients with schizophrenia. A total of 43.6% of patients fulfilled International Diabetes Federation (IDF) criteria and 44.5% met modified National Cholesterol Education Program Adult Treatment Panel-III (NCEP ATP- III) criteria of MS. Increased waist circumference was the most common abnormality (64.8%) and high glucose level was the least common (15.9%). In regression analysis, age more than 35 years (OR—3.37), female gender (odds ratios (OR—1.81)), urban locality (OR—2.08), being employed (OR—2.12) and BMI more than 25 (OR—5.64) emerged as significant predictors of MS.

The Role of Cortisol in the Pathogenesis of the Metabolic Syndrome

Corresponding author: In-Kyung Jeong Division of Endocrinology & Metabolism, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul 134-727, Korea E-mail: jik1016@dreamwiz.com Metabolic syndrome (MetS) is a constellation of metabolic derangements that includes insulin resistance, hyperglycemia, hypertension, reduced high density lipoprotein cholesterol (HDL-C), elevated triglycerides, and abdominal obesity. It was originally described by Reaven in 1988 as “syndrome X” or “insulin resistance syndrome” [1]. MetS increases the risk for development of type 2 diabetes mellitus as well as cardiovascular disease [2]. The prevalence of MetS has increased worldwide, with an increase from 19.6% in 1998 to 32.4% in 2009, according to the Korean National Health and Nutrition Examination Survey (NHANES) [3]. In spite of the increasing prevalence of MetS, there are no uniformly accepted diagnostic criteria for MetS. Different organizations have suggested their own criteria. The National Cholesterol Education Program (NCEP) Adult Treatment Panel-III (ATP III) guidelines [4] are the most widely used, and require at least three of the following: 1) central obesity (waist circumference ≥90 cm for Asian men or ≥80 cm for Asian women, 2) triglycerides ≥150 mg/dL, or receiving drug treatment for high triglycerides, 3) HDL-C <40 mg/dL for men or <50 mg/dL for women or receiving drug treatment for low HDL-C, 4) systolic/diastolic blood pressure ≥130/85 mm Hg or receiving drug treatment for high blood pressure, and 5) fasting plasma glucose ≥100 mg/dL or receiving drug treatment for high fasting plasma glucose levels. However, according to the International Diabetes Federation (IDF) criteria [5], abdominal obesity (waist circumference ≥90 cm for Asian men or ≥80 cm for Asian women) is a prerequisite for the diagnosis of MetS, in addition to at least two of the following components: 1) triglycerides ≥150 mg/dL or receiving drug treatment for high triglycerides, 2) HDL-C <40 mg/dL for men or <50 mg/dL for women or receiving drug treatment for low HDL-C, 3) systolic/diastolic blood pressure ≥130/85 mm Hg or receiving drug treatment for high blood pressure, and 4) fasting plasma glucose ≥100 mg/dL or receiving drug treatment for high fasting plasma glucose levels. Yoon et al. [6] compared the two criteria. All MetS patients who met the IDF criteria also met the revised NCEP criteria. Patients who met the NCEP criteria but not the IDF criteria were metabolically obese with normal waist circumferences and significantly worse metabolic profiles than the MetS-free group. This illustrates why the revised NCEP criteria are preferred to the IDF criteria for measuring the prevalence of MetS in Korea. Even though the primary mechanism of MetS is insulin resistance, there is still controversy regarding the pathogenesis of MetS. Because the clinical features of MetS are shared by Cushing’s syndrome (CS), mild hypercortisolism was proposed as one of the pathogenic mechanisms of MetS [7]. Shared features between MetS and CS are abdominal obesity, high triglycerides, low HDL-C, hypertension, and hyperglycemia. Previous studies have evaluated the association between MetS and hypercortisolism by examining fasting plasma cortisol, 24-hour urinary free cortisol, cortisol reactivity to some stimuli, or profiles of cortisol patterns over the day [8-24]. More Editorial Obesity and Metabolic Syndrome

Metabolic syndrome in the Mediterranean region: Current status

Metabolic syndrome (MetS) is a cluster of metabolic abnormalities including abdominal obesity, impaired fasting glucose, hypertension and dyslipidemia. It seems to affect about one-fourth to one-fifth of the Mediterranean population, and its prevalence increases with age, being similar for both sexes and depending on the region and the definition used, with the National Cholesterol Education Program-Adult Treatment Panel-III (NCEP-ATPIII) definition being the most effective in the identification of glucose intolerance and cardiovascular risk. Except for these, MetS is associated with fatty liver disease, some forms of cancer, hypogonadism, and vascular dementia. The Mediterranean diet seems to be an ideal diet in patients with MetS, being rich in fibre, monounsaturated and polyunsaturated fats, and low in animal protein; and decreases the prevalence of MetS and cardiovascular disease risk. Except for weight loss, multifactorial intervention including insulin resistance reduction and normoglycemia, management of dyslipidemia, optimizing blood pressure and administration of low-dose aspirin for patients at high or moderately high cardiovascular disease (CVD) risk are additional targets. The present review provides current understanding about MetS in the Mediterranean region, focusing on its prevalence, clinical significance, and therapeutic strategy.

J-033 THE ASSOCIATION BETWEEN SERUM URIC ACID LEVEL AND METABOLIC SYNDROME

Background Serum uric acid levels have been reported to be associated with a variety of cardiovascular conditions. However, the direct association between uric acid levels and metabolic syndrome remains controversial. Thus, we evaluated the associations of serum uric acid levels and metabolic syndrome in a community-based cohort study in Korea. Methods We performed cross-sectional analysis of baseline data of 889 males and 1491 females (aged 38–87) who participated in baseline examinations of the Korean Genome and Epidemiology Study- Kangwha study. Blood samples were collected after at least 8-hour fast. Uric acid quartiles were defined as follows: <4.8, 4.8–5.6, 5.6–6.5, and ≥6.5 mg/dL for males: and <3.8, 3.8–4.3, 4.3–5.1, and ≥5.1 mg/dL for females. Metabolic syndrome was defined by the criteria proposed by the National Cholesterol Education Program Adult Treatment Panel-III with adjusted cutoffs for waist circumference (>90 cm for males, >80 cm for females). Association between serum uric acid quartiles and metabolic syndrome was assessed using multivariate logistic regression. Results Odds ratio for having metabolic syndrome for the highest versus lowest quartiles of serum uric acid level was 2.67 (95% CI, 1.78–4.00) in males and 3.32 (95% CI, 2.46–4.48) in females. The association remained significant after adjustment for age, sex, smoking, alcohol intake, body mass index, total cholesterol, HDL-cholesterol, HbA1c, albumin, γ-glutamyltransferase, blood urea nitrogen, and C-reactive protein; the corresponding odds ratio was 2.08 (95% CI, 1.21–3.57) in males and 1.68 (95% CI, 1.14–2.49) in females. Conclusion Higher serum uric acid levels are positively associated with the presence of metabolic syndrome in Korean males and females.

Cardiovascular risk factors and recommended lipid goals attainment among patients referred in a tertiary care lipid clinic

Background Many adults are not at recommended lipid levels and the extent of treatment of dyslipidemia remains poor. We investigated the burden of cardiovascular risk and the distance of lipid fractions from the recommended targets by statin therapy and risk status in patients referred to a tertiary care lipid clinic. Methods Assessment of cardiovascular risk factors was performed in 1657 patients, mostly dyslipidemics, referred by family physicians to our Lipid Clinic, 393 patients being under statin therapy. The shortfall of lipid fractions from the National Cholesterol Education Program Adult Treatment Panel-III (NCEP ATP-III) recommended goals was evaluated. Results A high prevalence of cardiovascular risk factors was found. LDL cholesterol target was reached by 20% and 45% of untreated and statin treated patients, whereas non-HDL cholesterol target by 13% and 45% of untreated and statin treated patients, respectively. LDL cholesterol was over the goal by 27% in untreated patients and by 25% in statin treated patients. More than 40% and 65% statin treated patients were taking either a low statin dose or statins with low-to-moderate LDL cholesterol lowering efficacy (< 30%). A decrease in the proportion of patients at target and greater shortfalls from recommended goals were found from low to high risk categories. Conclusion The shortfall in reaching lipid targets, particularly among high risk statin untreated patients, may be partly explained by delayed or even inadequate lipid lowering therapy. Shortfalls in reaching the targets are not necessarily high and might be possibly managed at a primary care level.

Association of the leptin to high-molecular-weight adiponectin ratio with metabolic syndrome

Recent studies have reported that leptin and adiponectin are associated with metabolic syndrome. The leptin/adiponectin ratio has been suggested as an atherosclerotic index. The objective of this study was to compare the degree of association of metabolic syndrome with adiponectin levels, leptin levels, leptin/adiponectin ratio, and leptin/high-molecular-weight (HMW) adiponectin ratio. The study population included 3272 Koreans (men: 1915, women: 1357; age, 30-84 years), who had visited the Health Examination Center. Adipokines were divided into quartiles, and metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel-III (NCEP ATP III). A logistic regression model was fitted to establish the association between adipokines and metabolic syndrome. Adipokines, such as adiponectin, HMW adiponectin, and leptin, were found to be statistically related to metabolic syndrome. Compared to the lowest quartile, the leptin/HMW adiponectin ratio in the highest quartile was associated with a 5-fold increase in the probability of prevalent metabolic syndrome, which was independent of age, smoking status, exercise, low-density lipoprotein (LDL) cholesterol, and body mass index. There was a linear increase in the leptin/HMW adiponectin ratio as the number of metabolic syndrome components increased. The leptin/HMW adiponectin ratio had the highest odds ratio in women. In addition, compared to adiponectin or leptin alone, the AUC of the leptin/adiponectin ratio and leptin/HMW adiponectin ratio was higher for metabolic syndrome. We may suggest that the leptin/HMW adiponectin ratio is not superior to other adipokine markers, but is as effective as the leptin/total adiponectin ratio.

The Cost Effectiveness of Statin Therapies in Spain in 2010, after the Introduction of Generics and Reference Prices

HMG-CoA reductase inhibitors (statins) are the first-line drugs for use in the reduction of low-density lipoprotein cholesterol (LDL-C) levels and prevention of coronary heart disease (CHD) in patients with hypercholesterolemia. Generic statins could change the cost effectiveness of statin therapies in Spain, and more population groups could be included in the recommendations for reduction of cholesterol levels based on cost effectiveness. The objectives of this study were: (i) to assess the cost effectiveness of available statins for the reduction of LDL-C levels in Spain in 2010, after the introduction of generics and reference prices; (ii) to assess the cost effectiveness of combination therapy using a statin plus cholestyramine or ezetimibe; and (iii) to estimate the mean cost per patient to achieve National Cholesterol Education Program (Adult Treatment Panel-III) therapeutic objectives. The following treatments were evaluated: rosuvastatin 5-20 mg/day; atorvastatin, simvastatin, and pravastatin 10-40 mg/day; lovastatin and fluvastatin 20-80 mg/day; and combination therapy with a statin plus either cholestyramine 12-24 g/day or ezetimibe 10 mg/day. The cost effectiveness was evaluated in terms of cost per percentage point reduction in LDL-C, comparing the annual treatment costs with the effectiveness in reducing LDL-C. Treatment costs included those for medications (2010 wholesale prices), control measures, and treatment of adverse drug effects. The effectiveness of statins was estimated by developing a meta-analysis of clinical trials published between 1993 and 2005 that met several inclusion criteria. Average and incremental cost-effectiveness ratios were calculated to assess the efficiency of individual statin and combination therapies in reducing LDL-C levels. The effectiveness in terms of percentage reduction in LDL-C ranged from 19% for pravastatin 10 mg/day to 55% for atorvastatin 80 mg/day. Annual treatment costs ranged from Euro 189.7 for simvastatin 10 mg/day to Euro 759.3 for atorvastatin 80 mg/day. The cost-effectiveness ratios, in terms of cost per percentage point reduction in LDL-C, were: Euro 6 for simvastatin, Euro 10-12 for rosuvastatin, Euro 10 for lovastatin, Euro 13-16 for atorvastatin, Euro 13-14 for fluvastatin, and Euro 14-20 for pravastatin. Rosuvastatin + ezetimibe, simvastatin + ezetimibe, and atorvastatin + ezetimibe were the most cost-effective combination therapies for reducing LDL-C levels. Rosuvastatin was the most cost-effective statin for achieving the LDL-C therapeutic goal in patients at high risk for CHD, with a mean cost per patient of Euro 516. Simvastatin was the most cost-effective statin to achieve the LDL-C goal in patients with moderate or low CHD risk, with a cost per patient of Euro 217 and Euro 190, respectively. Rosuvastatin should be the first-choice agent in patients with high CHD risk, while simvastatin should be the first choice in patients with moderate or low risk. The addition of ezetimibe to rosuvastatin, simvastatin, or atorvastatin should be the preferred combination therapies when greater LDL-C reductions are required. The cost effectiveness of all statin therapies has increased in Spain after the introduction of generic statins and reference prices.

Comparison of four definitions of the metabolic syndrome in a Greek (Mediterranean) population

Background:There is a need to evaluate the prevalence of metabolic syndrome (MetS) diagnosed by the new Joint Interim Societies (JIS) MetS definition. The JIS definition was compared with three previous definitions to assess their ability to predict cardiovascular disease (CVD) risk.Methods:A cross-sectional analysis of a representative sample of Greek adults (n = 9669) was performed to estimate the prevalence of MetS and CVD using the JIS vs. the three older definitions of MetS: the National Cholesterol Education Program-Adult Treatment Panel-III (NCEP-ATP-III), the International Diabetes Federation (IDF) and the American Heart Association/National Heart Lung and Blood Institute (AHA/NHLBI) definitions.Results:The age-adjusted MetS prevalence was 45.7%, 43.4%, 24.5% and 26.3% (ANOVA p < 0.001) with the JIS, IDF, NCEP and AHA/NHLBI definitions. The prevalence of CVD was 11.4% in the whole study population and 17.6%, 18.3%, 23.3%, 22.6% and in subjects with MetS according to the JIS, IDF, NCEP and AHA/NHLBI definitions (ANOVA p < 0.001). The prevalence of CVD was only 10.4% (i.e., lower than in the whole study population) in subjects with MetS according to the JIS but not according to the NCEP-ATP-III and AHA/NHLBI definitions (p < 0.001 vs. subjects with MetS as defined by NCEP-ATP-III or AHA/NHLBI).Conclusions:When diagnosed according to the new JIS definition, the prevalence of MetS was high in a Greek Mediterranean cohort (nearly half of the adult population). The NCEP-ATP-III and AHA/NHLBI definitions were more predictive of CVD risk than the new JIS definition. These findings, though limited by the cross sectional analysis, may have implications regarding the choice of the definition to diagnose MetS.

Reduced factor VII and factor VIII levels and prolonged thrombin-generation times during a healthy diet in middle-aged women with mild to moderate cardiovascular disease risk.

No experimental study has investigated the effect of whole-diet therapies on a wide range of hemostatic parameters, and their relationship with metabolic and inflammatory markers. Such information was sought in middle-aged women with moderate cardiovascular disease (CVD) risk subjected to an integrated healthy diet. Forty-nine premenopausal women were screened for C-reactive protein levels > or =1 mg L(-1) and at least one additional CVD risk factor. Sixteen women (age: 43-54 years) were selected and received a 12-week diet (four phases) integrating National Cholesterol Education Program-Adult Treatment Panel-III recommendations with components of a Mediterranean-style diet. We observed a reduction in body mass index (BMI) (P = 0.001), waist circumference (P = 0.005), total (P = 0.011) and low-density lipoprotein (LDL) cholesterol levels (P = 0.035). Antigen levels of coagulation factor (F)VII (P = 0.003) and FVIII (P = 0.005) were clearly reduced by dietary intervention, which also appeared to decrease circulating tissue factor but not fibrinogen and von Willebrand factor (VWF) antigen levels. Levels of FVIII and tumor necrosis factor-alpha, among the inflammation markers, showed the highest correlation, particularly before the intervention (r = 0.55, P = 0.032). Only this cytokine influenced FVIII variation over time, thus highlighting new relations between coagulation and cellular components of inflammation. The functional effect of diet on coagulation was indicated by markedly prolonged thrombin generation initiation and propagation times (lag time, P = 0.002; time to peak, P = 0.005). The changes observed in coagulation initiation and amplification phases, body composition and lipid profile could translate into a remarkable decrease in the risk for cardiovascular disease. Our observations suggest novel relationships between coagulation and inflammatory components.

Age-specific prevalence of the metabolic syndrome defined by the International Diabetes Federation and the National Cholesterol Education Program: the Norwegian HUNT 2 study

BackgroundThe 2005 International Diabetes Federation (IDF) definition of the metabolic syndrome was designed to be useful worldwide, but to date few prevalence studies have used that definition in European populations. We estimated the age- and sex-stratified prevalence of IDF-defined metabolic syndrome in a county of Norway and compared it with the prevalence estimated using the revised National Cholesterol Education Program-Adult Treatment Panel-III definition (2005 ATP III).MethodsCross-sectional analysis of 10,206 participants aged 20–89 years in the Nord-Trøndelag Health Study 1995–97 (HUNT 2).ResultsPrevalence of IDF-defined metabolic syndrome was 29.6% (95% CI: 28.8 to 30.5), compared to 25.9% (95% CI: 25.0 to 26.7) using the 2005 ATP III criteria. The prevalence of IDF-defined metabolic syndrome increased from 11.0% in the 20–29 years age group to 47.2% in the 80–89 years group in men, and from 9.2% to 64.4% for women in the corresponding age groups. Among men and women aged ≥60 years, the IDF criteria classified 56.7% and 75.0%, respectively, as having central obesity, and 89.3% and 90.9%, respectively, as being hypertensive.ConclusionAccording to both definitions, the prevalence of the metabolic syndrome increased strongly with age. The IDF and the American Heart Association/National Heart, Lung, and Blood Institute guidelines for clinical management of metabolic syndrome would classify a high proportion of elderly Norwegians as in need of overall risk assessment for cardiovascular disease.

Prevalence of vascular disease in metabolic syndrome using three proposed definitions

Background There are a number of definitions available for the diagnosis of the metabolic syndrome (MetS). The MetS-associated increase in cardiovascular disease (CVD) risk may depend on the definition used. Aim To investigate which of the 3 recently proposed definitions of MetS [the National Cholesterol Education Program-Adult Treatment Panel-III (NCEP-ATP-III), the International Diabetes Federation (IDF) and the American Heart Association/National Heart Lung and Blood Institute (AHA/NHLBI)] is related to excessive CVD risk and thus may be more appropriate to implement in clinical practice. Methods A cross-sectional analysis of a representative sample of Greek adults ( n = 9669). Results The age-adjusted CVD prevalence was 11.4% in the whole study population, 23.3% in the NCEP-ATP-III (+) subjects, 22.6% in AHA/NHLBI (+) subjects and 18.3% in IDF (+) subjects [ p < 0.001 for the comparison between the whole study population and all MetS groups and p < 0.0001 for the comparison between IDF (+) and either NCEP-ATP-III (+) or AHA/NHLBI (+) MetS]. However, the CVD prevalence was only 11.2% in the IDF (+) but NCEP-ATP-III (−)/AHA/NHLBI (−) MetS subjects [ p < 0.0001 vs. either NCEP-ATP-III (+) or AHA/NHLBI (+)], which was not different compared with the whole study population. Furthermore, subjects with NCEP ATP III (+) or AHA/NHLBI (+) MetS but not diabetes (DM) had a persistently higher prevalence of CVD compared with the whole study population. However, there was no significant difference regarding CVD prevalence between the whole study population and IDF (+)/DM (−) MetS subjects. Conclusions CVD prevalence was increased in the presence of MetS irrespective of the definition used. However, this increase was more pronounced when the NCEP-ATP-III and AHA/NHLBI criteria were implemented compared with the IDF definition. Furthermore, the IDF definition included a large proportion of subjects who did not have increased CVD prevalence compared with the whole study population. These findings may have implications regarding which definition should we use to diagnose the MetS.