Higher Prevalence Of Central Obesity Research Articles

Prevalence of type 2 diabetes mellitus in elderly in a primary care facility: An ideal facility.

In 2011 census, 5.3% of the Indian population was > 65 years of age. This number has steadily grown over past few years and is steeply growing. Healthcare burden of elderly diabetics is immense and proper diagnosis and treatment alone can prevent further complications. According to the most recent surveillance data in U.S., the prevalence of diabetes among U.S. adults aged ≥65 years varies from 22 to 33%, depending on the diagnostic criteria used. In CSIR-NEERI, India, we have healthcare system wherein a fixed and limited number of patients are treated for their lifetime by qualified practitioners with negligible financial burden of the treatment costs. The patients have regular monthly follow up and hence we diagnose Diabetes and evaluate the control and diagnose micro vascular and macro vascular complications in all patients. We did retrospective analysis of all elderly patients following up in NEERI Hospital to find the exact prevalence of T2DM in elderly. It was observed that from total 585 elderly people, 178 had T2DM (30.42%- Prevalence). The sex ratio of Diabetic males to females was almost equal (1:0.97). Obesity was present in 114 people (64%). High prevalence of hypertension was found in Diabetic elderly population (80%). Comparing our prevalence rates with few other studies, it was found that our prevalence rates are quite high. The contributing factors may be urban living, with high prevalence of central obesity and Asian ethnicity, over and above, data of all patients undergoing treatment is available. We treated all diabetics with persistent values of Systolic BP > 130 mm of Hg and Diastolic values of BP > 80mm of Hg as Hypertensives, in order to achieve reduction in cardiovascular mortality and morbidity. This paper is for awareness of disease burden, in real primary care setup. It is not cross-sectional study but study with 100% inclusion of beneficiaries’. This is real world urban diabetes prevalence, also associated hypertension and central obesity prevalence.

Heterogeneity in sex differences in the metabolic syndrome in Dutch white, Surinamese African and South Asian populations

To determine whether sex differences in the prevalence of the metabolic syndrome and its components differ among different ethnic groups. A random sample of non-institutionalized adults aged 35-60 years in Amsterdam, the Netherlands (white Dutch men n = 242, women n = 244; African-Surinamese men n = 193, women n = 399, Hindustani-Surinamese men n = 149, women n = 186). The metabolic syndrome was defined according to the International Diabetes Federation criteria. In all ethnic groups, the prevalence of central obesity and reduced HDL cholesterol were higher in women than in men, but the prevalence of elevated blood pressure, fasting glucose and triglycerides were lower in women than in men. However, the magnitude of the differences varied. The sex differences in the prevalence of central obesity and reduced HDL cholesterol were particularly larger in ethnic minority groups, especially in African-Surinamese than in white Dutch. After adjustment for education, smoking, alcohol intake and physical activity, the prevalence of the metabolic syndrome was lower in white Dutch women than in white Dutch men (adjusted prevalence ratio 0.70, 95% CI 0.52-0.94). By contrast, the prevalence of the metabolic syndrome was higher in African-Surinamese women than in African-Surinamese men (adjusted prevalence ratio 1.56, 95% CI 1.12-2.18). Among Hindustani-Surinamese, men and women had a similar prevalence of the metabolic syndrome (adjusted prevalence ratio 1.00, 95% CI 0.76-1.31). Our findings suggest different patterns in sex differences in the metabolic syndrome among the ethnic groups. The relatively high prevalence of central obesity in African-Surinamese women may underlie their higher prevalence of the metabolic syndrome. Strategies to improve metabolic profiles among African-Surinamese and white Dutch people need to take sex differences into account.

Free Testosterone Level Correlated with the Metabolic Abnormalities Dependent on Central Obesity in Women with Polycystic Ovary Syndrome

Women with polycystic ovary syndrome (PCOS) have increased risks of developing metabolic abnormalities compared with the women without PCOS. Hyperandrogenemia is one of the most important characteristics of PCOS. However, the correlations between hyperandrogenemia and metabolic disorders are uncertain. To elucidate the relationship between androgen indices and metabolic abnormalities in Chinese women with PCOS. A retrospective analysis of the anthropometric and biochemical records of 408 women with PCOS. The prevalence of metabolic syndrome (MetS) was 15.7% in women with PCOS. No association existed between total testosterone (TT) and metabolic profile. Free testosterone (FT) correlated with most of the metabolic variables by unadjusted correlation analyses. The women with elevated FT levels exhibited more unfavorable metabolic profiles compared with the women with normal FT levels. After adjusting for the confounding factors by multivariate logistic regression analysis, the women with elevated FT levels had higher prevalence of central obesity than the women with normal FT levels (odds ratio [OR] 2.346, p=0.042). Women with reduced sex hormone-binding globulin levels were more likely to have central obesity, overweight, raised fasting glucose, insulin resistance, and raised diastolic blood pressure. Raised dehydroepiandrosterone sulfate (DHEAS) level was associated with a lower probability of having central obesity (OR 0.293, p=0.001) and overweight (OR 0.47, p=0.023). FT has closer association with metabolic parameters than TT. FT can involve in the development of metabolic disorders dependent on central obesity. Raised DHEAS level can reduce the risks of central obesity and overweight.

Prevalence of Obesity, Metabolic Syndrome, Impaired Fasting Glycemia, and Diabetes in Selected Villages of Bali, Indonesia

Aims/Introduction. To know the prevalence of obesity, metabolic syndrome, impaired fasting glycemia and diabetes in the population of Bali. Materials and Methods. A cross-sectional study enrolling 1840 subjects, aged 13-100 years with male-to-female ratio of 972/868, were studied at seven villages across the island of Bali. Results: The prevalence of central obesity was 35% (male, 27.5%; female, 43.4%); metabolic syndrome (MS), 18.2% (male, 16.6%; female, 20.0%); impaired fasting glycemia (IFG), 13.1% (male, 14.3%; female, 12.4%); and diabetes mellitus (DM), 5.9% (male, 6.1%; female, 5.7%). The subjects who had 1, 2, 3, 4, and 5 components of MS were 34.6%, 23.8%, 13.0%, 4.3%, and 0.9% respectively. The population in two tourist areas (Legian and Ubud) had the highest prevalence of central obesity (61.2% and 70.1%), but they did not necessarily have a higher prevalence of DM. The two tourist areas (Legian, 24.1%; and Ubud, 21%) as well as Sangsit village (23.3%) have the highest prevalence of MS. Conclusions. The prevalence of obesity, MS, IFG and DM were comparatively low. Analysis across the villages revealed that higher prevalence of central obesity was not necessarily associated with higher prevalence of DM. There is a need to further study the risk of obesity on MS and DM in tourist areas of Bali.

Fatores associados à obesidade central em adultos de Florianópolis, Santa Catarina: estudo de base populacional

To estimate the prevalence of central obesity and its association with socio-demographic factors and health-related behaviors among adults from Florianópolis, State of Santa Catarina, Southern Brazil. A cross-sectional population-based study was carried out in a sample of 1,720 adults between 20 to 59 years of age, residents in the urban area of the city. The outcome was the central obesity which was defined as a waist-height ratio > 0.50. Unadjusted and adjusted models were performed by using Poisson regression allowing estimation of the Prevalence Ratio (PR). All analyses were stratified by sex. The prevalence of central obesity was 50.5% (95% CI: 46.6-54.4) among men and 38.9% (95% CI 34.4-43.5) among women. In the adjusted analysis, central higher prevalence of obesity was observed in women aged 50 to 59 years and those who were living with a partner; lower prevalences were observed among women with > 12 years of study (PR: 0.63; 95% CI: 0.47-0.85) and among those with higher income (PR: 0.64; 95% CI: 0.47-0.86). Among men, a higher prevalence of central obesity was associated with ages 50 to 59 years and among those who were living with a partner, while a lower prevalence was identified in those in the highest income group. The prevalence of central obesity was high in the population studied. Demographic and socioeconomic factors were strongly associated with central obesity in both sexes. The knowledge of factors associated with central obesity may help the implementation of health interventions in order to prevent this core issue in Public Health.

Prevalence of central obesity in a large sample of adolescents from public schools in Recife, Brazil

To determine the prevalence and association of central obesity (CO) and hypertension and its associations with alcohol intake, smoking and physical activity in adolescents. Cross sectional study in 1,824 students from 29 public schools in Recife. 89.6% were normal weight, 6.7% overweight and 3.7% obese; 77.2% were normotensive, 5.9% prehypertensive and 16.9% hypertensive; CO was 10.2% when the 90th percentile was used as cutoff and 25.2% when the 75th percentile was used. There was a higher likelihood of central obesity among students aged 18 to 20 years, smoking and alcohol intake. The probability of hypertension increases if the subject is male, has a waist circumference (WC) ≥ 90, WC ≥ 75 and does not practice physical activity. A high prevalence of CO and hypertension was found in adolescents. CO was more frequent in students aged 18 to 20 years, smokers and with alcohol intake and hypertension was associated with male, CO and no physical activity.

Introduction on the ATVB Review Series “Nuclear Receptors in Metabolism and Cardiovascular Disease”

Series Editor: Bart Staels Articles in this series: •Staels B. Introduction on the ATVB review series “Nuclear Receptors in Metabolism and Cardiovascular Disease.” Arterioscler Thromb Vasc Biol . 2010;30:1504–1505. •Arnal J-F, Fontaine C, Billon-Gales, Favre J, Laurell H, Lenfant F, Gourdy P. Estrogen receptors and endothelium. Arterioscler Thromb Vasc Biol . 2010;30:1506–1512. •Calkin A, Tontonoz P. Liver X receptor signaling pathways and atherosclerosis. Arterioscler Thromb Vasc Biol . 2010;30:1513–1518. •Hageman J, Herrema H, Groen AK, Kuipers F. A role of the bile salt receptor FXR in atherosclerosis. Arterioscler Thromb Vasc Biol . 2010;30:1519–1528. •Duez H, Staels B. Nuclear receptors linking circadian rhythms and cardiometabolic control. Arterioscler Thromb Vasc Biol . 2010;30:1529–1534. •Zhao Y, Bruemmer D. NR4A orphan nuclear receptors: Transcriptional regulators of gene expression in metabolism and vascular biology. Arterioscler Thromb Vasc Biol . 2010;30:1535–1541. •Huang W, Glass CK. Nuclear receptors and inflammation control: Molecular mechanisms and pathyphysiological relevance. Arterioscler Thromb Vasc Biol . 2010;30:1542–1549. Over the last decades, dramatic changes in lifestyle habits have precipitated a worldwide obesity epidemic. The decrease in exercise and increase in caloric intake results in a higher prevalence of central obesity, which is often accompanied by metabolic derangements, including dyslipidemia and diabetes and, as a consequence, an increased risk for cardiovascular disease. Organisms adapt their metabolism to environmental changes by modulating signaling pathways, including several transcription factor pathways. Although these adaptations are initially meant to maintain physiological homeostasis, chronic overactivation may result in the dysregulation of pathways, leading to insulin resistance, dyslipidemia, inflammatory responses, etc. …

Metabolic syndrome in Mexican adults: results from the National Health and Nutrition Survey 2006

To examine the prevalence of metabolic syndrome (MS) and its associated risk factors in Mexican adults aged 20 years or older, using data derived from the National Health and Nutrition Survey 2006 (ENSANUT 2006). The ENSANUT 2006 was conducted between October 2005 and May 2006. Questionnaires were administered to 45 446 adult subjects aged 20 years or older who were residents from urban and rural areas. Anthropometric and blood pressure measurements were obtained from all subjects and fasting blood specimens were provided by 30% of participants. We randomly selected a sub-sample of 6 613 from which laboratory measurements were carried out for glucose, insulin, triglycerides, total cholesterol and HDL-cholesterol. For this analysis, we included only results from eight or more hours of fasting samples (n=6 021). We used individual weighted factors in the statistical analysis and considered the survey's complex sampling design to obtain variances and confidence intervals. All analyses were done using SPSS 15.0. In accordance with definitions by the National Cholesterol Education Program Adult Treatment Panel III (ATP III), the American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI), and the International Diabetes Federation (IDF), the prevalence of MS in Mexican adults aged 20 years or older was 36.8, 41.6 and 49.8%, respectively. Women were more affected than men due to the higher prevalence of central obesity among females. Prevalence of MS increased with age and was higher among populations living in metropolitan areas, in the west-central region, and those with lower education. Regardless of the MS definition, a large proportion of Mexican adults has the condition, so preventive measures are needed to decrease the prevalence of the MS components in this population. MS can predict type 2 diabetes and cardiovascular disease, two of the main causes of death in the adult population in Mexico. The intentional search of MS components allows stratifying the population according to risk levels. Treatment for each component should be implemented properly to prevent or delay onset of type 2 diabetes and cardiovascular disease.

Glutathione peroxidase 1 Pro198Leu variant contributes to the metabolic syndrome in men in a large Japanese cohort

BackgroundThere has been much interest in the role of free radicals and oxidative stress in the pathogenesis of metabolic syndrome (MetS). Cellular antioxidant enzymes such as glutathione peroxidase 1 (GPX1) play a central role in the control of reactive oxygen species. ObjectiveWe examined whether GPX1 polymorphism (Pro198Leu) is associated with MetS as well as with each component of MetS. DesignThe study was a cross-sectional analysis of randomly selected, community-dwelling Japanese persons aged 40–70 y (1128 M, 1105 F). ResultsThe genotype frequencies for the GPX1 Pro198Leu polymorphism in this cohort were 0.846, 0.151, and 0.003 for CC, CT, and TT, respectively. The CT/TT genotypes had significantly higher waist-hip ratios, triacylglycerol concentrations, homeostasis model assessment for β-cell function, and systolic and diastolic blood pressures in men (P = 0.045, 0.012, 0.011, 0.004, and 0.003, respectively) than did the CC genotype; the CC/TT genotypes also had higher insulin in both sexes (P = 0.019 for men, P = 0.010 for women) and higher body fat mass (P = 0.027) and homeostasis model assessment for insulin resistance (P = 0.008) in women. The CT/TT genotypes showed significant association with higher prevalence of MetS as defined by 2 commonly used criteria in men [odds ratio (OR): 2.02; 95% CI: 1.30, 3.15 by the International Diabetes Federation criteria; OR: 1.49; 95% CI: 1.02, 2.18 by the modified National Cholesterol Education Program criteria) but not in women. The CT/TT genotypes showed a higher prevalence of central obesity (OR: 1.93; 95% CI: 1.31, 2.85) and hypertriglyceridemia (OR: 1.52; 95% CI: 1.08, 2.15) in men but not in women; there were no differences in other components of MetS between the CC and CT/TT genotypes in either sex. ConclusionGPX1 Pro198Leu variants are associated with the prevalence of MetS in Japanese men but not in women.

Foetal nutritional status and cardiovascular risk profile among children

To estimate the impact of foetal nutritional status on cardiovascular risk among children with the Foetal Nutritional Status Index (FNSI), calculated by dividing the child's birth weight (BW, kg) by the mother's height (m2). Cross-sectional survey analysis. A sample of children from the US Third National Health and Nutrition Examination Survey. A total of 3109 children who were 5-11 years of age and had data on BW and mother's height. Non-fasting blood samples were included. Overall, the FNSI was positively associated with BW and negatively associated with mother's height (P<0.0001). Within sex-specific quintiles of FNSI (third quintile as reference) adjusted for potential confounding variables, cardiovascular risk factors tended to be 'higher' in the lower quintiles for males while the opposite was true for females. Multivariate logistic regression analyses indicated that the odds for males in quintile 1 was 2.4 for having a low level of high-density lipoprotein cholesterol (P<0.01) and 2.1 for having a cluster of cardiovascular risk factors (P=0.01); for females, the odds of having a cluster of cardiovascular risk factors was approximately two times higher for those in the first and fifth quintiles, who also had a significantly higher prevalence of central obesity. The FNSI may be a potential proxy indicator of foetal nutritional status and it may be used to test specific hypotheses of whether foetal nutrition restriction or overnutrition programmes future cardiovascular risk.

A Comparison of Two Proposed Definitions for Metabolic Syndrome in the Chinese Adult Population

The metabolic syndrome is a major risk factor for cardiovascular disease (CVD). We estimated the prevalence of the metabolic syndrome using the definitions proposed by the International Diabetes Federation (IDF) and the American Heart Association and the National Heart, Lung, and Blood Institute (revised ATP III), and compared the 2 definitions in the Chinese adult population. We conducted a cross-sectional study among a nationally representative sample of 15,838 Chinese adults ages 35 to 74 years in 2000 to 2001. Waist girth, blood pressure, and blood levels of HDL-cholesterol, triglycerides, and glucose were measured according to standard methods. The overall age-standardized prevalence of the metabolic syndrome by the IDF and revised-ATP III definitions was 16.5% and 23.3%, respectively. The overall agreement of being classified as having or not having the metabolic syndrome was 93.2% for the 2 definitions, with a Kappa coefficient of 0.80. The prevalence significantly increased with age and was higher in women than in men by both definitions (23.3% vs 10.0% for IDF and 29.1% vs 17.7% for revised ATP III). Compared with men, women had a significantly higher prevalence of central obesity (37.6% vs 16.0%) and reduced HDL-cholesterol (46.5% vs 21.9%), whereas men had a significantly higher prevalence of raised blood pressure (44.2% vs 38.0%) compared with women. The metabolic syndrome is very common in China regardless of the definition used. Prevention and treatment of the metabolic syndrome should become a public health priority to reduce the CVD-related burden in China.

Central Obesity Is an Independent Risk Factor for Albuminuria in Nondiabetic South Asian Subjects

South Asians have a high prevalence of central obesity. When the diagnosis of diabetes is made, they have a very high risk of developing renal failure. In the current study, we explored the hypothesis that central obesity is associated with the development of renal injury, before the manifestation of diabetes. We invited first-degree nondiabetic relatives of South Asian type 2 diabetic patients for investigation of microalbuminuria and diabetes. Subjects who used antihypertensive or antidiabetic medication were excluded. We performed a glucose tolerance test according to the classic World Health Organization criteria. A total of 205 subjects were normoglycemic; we excluded 25 subjects because of impaired glucose tolerance, and 30 subjects were excluded because of de novo diabetes. Central obesity was measured by waist-to-hip ratio (WHR). Albuminuria was measured as albumin-to-creatinine ratio (ACR) in the early-morning urine. Central obesity was independently related with albuminuria in the 205 normoglycemic subjects. We found no relation of fasting blood glucose or systolic blood pressure with albuminuria. Multivariate analysis for the presence of increased albuminuria (median ACR >0.31 mg/mmol) showed a relative risk of 4.1 for the highest versus the lowest tertile of WHR (P = 0.002). Central obesity is an early and independent risk factor for increased albuminuria in normoglycemic South Asian subjects. This could explain the high incidence of diabetic renal disease in South Asians, probably by the mechanism of insulin resistance and endothelial dysfunction in the pre-diabetic state.

Impacto del sexo en el síndrome de lipodistrofia en pacientes con infección por el VIH y su asociación con factores de riesgo cardiovascular

To evaluate the influence of sex in human immunodeficiency virus (HIV)-infected patients with lipodystrophy and its association with cardiovascular risk factors. A cross-sectional study was conducted in HIV-infected patients aged 20 or over managed at the outpatient Infectious Disease Unit in 2003. Clinical and epidemiological characteristics of HIV infection, lipodystrophy and cardiovascular risk factors were evaluated. Of the 760 patients included in the study, women comprised 28%. Men with lipodystrophy had a higher prevalence of hypertension, hypercholesterolemia, hypoalphalipoproteinemia and hypertriglyceridemia than those without lipodystrophy. Women with lipodystrophy had a higher prevalence of central obesity and hypertriglyceridemia compared with those without lipodystrophy (22.8 vs. 11.2%, p = 0.000; 20.6 vs. 9.3%, p = 0.001; 39.7 vs. 30%, p = 0.03 y 56.6 vs. 40.9%, p = 0.0001, respectively). The lipoatrophy pattern was predominant in men (24.9 vs. 12.6%, p = 0.0001) and lipoaccumulation forms in women (12.3 vs. 22.6%, p = 0.0001). Furthermore, women were younger, had a higher prevalence of smoking, family history of premature coronary heart disease and central obesity, and a lower prevalence of hypertension and hypoalphalipoproteinemia than men with lipodystrophy (42.1 +/- 8 years vs. 44.8 +/- 9.9 years, p = 0.03; 77.5 vs. 64%, p = 0.04; 22.5 vs. 9%, p = 0.003; 31 vs. 8.5%, p = 0.0001; 9.9 vs. 22.8%, p = 0.01; 25.4 vs. 39.7%, p = 0.03). This study demonstrated that the influence of sex in lipodystrophy in HIV-infected patients affects not only the lipodystrophy pattern, but also the cardiovascular risk profile.

The metabolic syndrome and high C-reactive protein: prevalence and differences by sex in a southern-European population-based cohort

To evaluate the prevalence of the metabolic syndrome (MS) and its components in a population-based cohort, and to analyse the association between gender, environmental conditions, C-reactive protein (CRP), and the syndrome. Out of 1877 subjects aged 45-64, who represented all the patients of six family physicians, representative of the sanitary districts of Asti (north-western Italy), 88% accepted to participate in an interview on personal habits, and several clinical and laboratory measurements. The MS (National Cholesterol Education Program criteria) was present in 24% of males and 22% of females. Males had a significantly higher percentage of hyperglycaemia, hypertension, hypertriglyceridemia, whereas females had a higher prevalence of central obesity and low HDL-cholesterol. In a multiple logistic regression model, the MS was significantly associated with increasing age, BMI, and >30 g/day alcohol intake (OR = 1.42; 95% CI 1.27-1.58), and negatively to higher education level (OR = 0.52; 95% CI 0.28-0.99) and moderate exercise (OR = 0.65; 95% CI 0.57-0.76). CRP levels are highly correlated to BMI and the components of the syndrome. The association between CRP and the MS remains significant in women only, in a multivariate analysis, after multiple adjustments (OR = 1.73; 95% CI 1.42-2.11). Higher CRP levels, correlated to smoking and, inversely, to alcohol intake, identify a further 12% of the cohort at higher cardiovascular risk. The MS affects more than 20% of this middle-aged cohort, but more than 30%, with higher CRP levels are at high cardiovascular risk. Healthier lifestyle habits are inversely associated with the MS and CRP levels, suggesting the need for strategies and their implementation in the general population.

Waist circumference as a measurement of obesity in the Netherlands Antilles; associations with hypertension and diabetes mellitus

To evaluate waist circumference (WC) as a screening tool for obesity in a Caribbean population. To identify risk groups with a high prevalence of (central) obesity in a Caribbean population, and to evaluate associations between (central) obesity and self-reported hypertension and diabetes mellitus. Cross-sectional. Population-based study. A random sample of adults (18 y or older) was selected from the Population Registries of three islands of the Netherlands Antilles. Response was over 80%. Complete data were available for 2025 subjects. A questionnaire and measurements of weight, height, waist and hip. Central obesity indicator (WC > or =102 cm men, > or =88 cm women). WC was positively associated with age (65-74 y vs 18-24 y) in men (OR=7.7, 95% CI 3.4-17.4) and women (OR=6.4, 95% CI 3.2-12.7). Women with a low education had a higher prevalence of central obesity than women with a high education (OR=0.5, 95% CI 0.3-0.7). However, men with a high income had a higher prevalence of a central obesity than men with a low income (OR=1.7, 95% CI=1.1-2.6). WC was the strongest independent obesity indicator associated with self-reported hypertension (OR=1.7, 95% CI 1.4-2.0) and diabetes mellitus (OR=1.6, 95% CI 1.3-1.9). The identified risk groups were women aged 55-74 y, women with a low educational level and men with a high income. WC appears to be the major obesity indicator associated with hypertension and diabetes mellitus. Island Governments of Saba, St Eustatius and Bonaire, the Federal Government of the Netherlands Antilles, Dutch Directorate for Kingdom relationships.

Does syndrome X exist in hypertensive elderly persons with impaired glycemic control?

This report focuses on the glycemic state in relation to insulin and lipid levels of a cohort of elderly hypertensive persons to estimate the prevalence of syndrome X. A cross-sectional study was performed at the University of Tennessee, Memphis, and the General Clinical Research Center (GCRC) on 95 participants in the Trial of Nonpharmacologic Interventions in the Elderly (TONE) study who agreed to participate in an ancillary study. A standard oral glucose tolerance test (OGTT) with insulin and C-peptide levels and a fasting lipid profile were obtained. In this sample of healthy elderly participants with hypertension who were taking an antihypertensive medication, 43 (45.3%) had normal glucose tolerance (NGT), 41 (43.2%) had impaired glucose tolerance (IGT), and 11 (11.6%) had undiagnosed non-insulin-dependent diabetes mellitus (NIDDM). Fasting hyperinsulinemia occurred in only one participant, who was in the IGT group. Hypertriglyceridemia and low high density lipoprotein (HDL) occurred in four persons, none of whom had hyperinsulinemia. Persons in the NIDDM and IGT groups had decreased beta cell function compared to persons in the NGT group, but did not have increased peripheral insulin resistance as estimated from the OGTT data. Our data demonstrated that in this cohort of elderly hypertensive participants with a high prevalence of central obesity, impaired glycemic control was common, but was not associated with fasting hyperinsulinemia or peripheral insulin resistance. Furthermore, we conclude that syndrome X essentially did not occur in these participants and postulate that the primary etiology for their impaired glycemic control is beta cell dysfunction. Further research is needed to elucidate these relationships.

Risk factors in the offspring of women with premature coronary heart disease

Some studies suggest that first-degree relatives of female patients with premature coronary heart disease (CHD) are at greater risk for early disease than if the proband is a male patient. To examine coronary risk factors, related knowledge, attitudes, and beliefs concerning CHD risk, we screened a sample of 87 apparently healthy offspring (56 female subjects and 31 male subjects) of women with documented premature CHD. More than half of the offspring had total and low-density lipoprotein cholesterol levels above the recommended levels for primary prevention, 31% were current smokers, and 56% exercised fewer than three times a week. A high proportion were overweight with a high prevalence of central obesity. A total of 13% had only one major risk factor, a family history of premature CHD, 10% had two risk factors, 23% had three, and 54% had four or more CHD risk factors. When compared with the Framingham cohort, 29% of sons and 30% of daughters exceeded their age- and sex-specific average risk for having CHD in 10 years. Only 28% identified heredity as a major cause of CHD, and 47% perceived their risk for future myocardial infarction as less than or equal to that of others their age. These findings suggest that adult children of women with premature CHD have a high prevalence of modifiable risk factors and do not perceive themselves to be at risk for CHD. (Am Heart J 1998;135:428-34.)

Plasma total homocysteine levels in patients with early-onset coronary heart disease and a low cardiovascular risk profile

Mild hyperhomocysteinemia has been associated with an increased risk to develop premature coronary heart disease. Recently, the homocysteine concentration has been positively correlated with several main cardiovascular risk factors. We addressed the issue as to whether patients with coronary heart disease and a low cardiovascular risk profile also have a higher prevalence of hyperhomocysteinemia than matched controls. Ninety-five patients (aged 50.5 ± 6.6 years) and 34 controls (50.0 ± 6.7 years) less than 60 years of age were selected from a sample of patients after coronary angiography. Subjects with hypertension, diabetes, and moderate or severe hyperlipidemia were excluded. We determined plasma aminothiols (total homocysteine, cysteine, and glutathione), lipoprotein fractions, fibrinogen, and uric acid, the body mass index (weight in kilograms divided by height in meters squared), and the waist to hip ratio. Furthermore, 37 healthy subjects aged 30.8 ± 7.5 years underwent aminothiol determinations. Patients and controls were similar with regard to age and primary cardiovascular risk factors. Total homocysteine concentrations in the patient group (9.2 ± 2.4 μmol/L) were significantly higher than in the healthy subjects (8.0 ± 2.0 μmol/L). However, they did not differ from the levels in the age-matched controls (9.3 ± 3.0 μmol/L). Neither total cysteine nor glutathione concentrations were significantly different between patients and controls. Male patients (n = 85) had higher mean very—low-density lipoprotein (VLDL) triglycerides (1.36 ± 0.90 mmol/L) and lower high-density lipoprotein 3 (HDL 3) cholesterol (0.75 ± 0.21 mmol/L) than male controls (n = 28; 1.01 ± 0.62 and 0.88 ± 0.26 mmol/L, respectively). Female patients did not have any significant differences in lipoprotein concentrations versus the controls. Among further cardiovascular risk factors, we found a higher prevalence of central obesity in male patients. In conclusion, there was not a higher incidence of hyperhomocysteinemia among patients with premature coronary heart disease and a low cardiovascular risk profile. The higher prevalence of hyperhomocysteinemia found in other studies may be related to the primary risk factors seen in these populations, and may therefore be an indicator of the global cardiovascular risk.