Individual Cardiometabolic Risk Factors Research Articles

Clinical Implications

HomeHypertensionVol. 61, No. 4Clinical Implications Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBClinical Implications Originally published1 Apr 2013https://doi.org/10.1161/HYP.0b013e31828e0de3Hypertension. 2013;61:745Aldosterone Physiology and Cardiometabolic Risk (page 886)Normal aldosterone regulation is dynamic and responsive. Therefore, single cross-sectional aldosterone measurements capture only a limited range of aldosterone physiology. Quantifying the dynamic nature of aldosterone physiology may improve the understanding of the relationship between aldosterone and cardiometabolic diseases. In this issue of Hypertension, Vaidya et al hypothesized that progressive cardiometabolic abnormalities would predict a blunted dynamic range of aldosterone. Novel indices of aldosterone responses to dietary sodium manipulation were developed, the Sodium-modulated Aldosterone Suppression-Stimulation Index (for serum and SAUSSI for urine), and tested with risk factors in 539 human participants. These indices were calculated as the ratio of aldosterone on a high dietary sodium balance (maximally suppressed aldosterone) to aldosterone on restricted dietary sodium balance (stimulated aldosterone), thereby reflecting the full dynamic range of aldosterone to dietary sodium modulation. Individual cardiometabolic risk factors and components of the metabolic syndrome strongly predicted higher Sodium-modulated Aldosterone Suppression-Stimulation Index and SAUSSI and captured more predictive power than cross-sectional aldosterone measurements alone. These results suggest that abnormal aldosterone physiology, an impaired ability to appropriately stimulate and suppress aldosterone, may contribute to, and result from, progressive cardiometabolic abnormalities.Download figureDownload PowerPointAntihypertensive Therapy and Insulin Action (page 800)Meta-analysis of studies in hypertensive patients using β-blockers and thiazide diuretics indicates that although lowering blood pressure is associated with significantly fewer coronary heart disease events, the benefit is less than that expected from prospective observational data. One explanation is that these older drugs adversely affect cardiovascular risk factors through deleterious effects on insulin action, thereby reducing the impact of blood pressure lowering. This has led to increasing use of newer antihypertensive agents such as angiotensin-converting enzyme inhibitors and calcium channel blockers known to have neutral metabolic effects. Despite this, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), the largest antihypertensive study to date, has shown diuretics to be superior to these newer agents in lowering some cardiovascular outcomes. In this issue of Hypertension, McHenry et al report results from a small study of carefully selected nondiabetic hypertensive patients. In a randomized double-blind crossover protocol, the authors find that sensitive measures of insulin action assessed by the euglycemic hyperinsulinemic clamp technique are no different after treatment with an angiotensin-converting enzyme inhibitor combined with low-dose thiazide compared with an angiotensin-converting enzyme inhibitor alone. These results contrast with the authors’ previous studies in diabetic hypertensive patients, where even low doses of thiazides had a negative impact on glucose metabolism. Overall, the current study is reassuring and should encourage physicians to include low-dose thiazide diuretics in treatment regimens for essential hypertension.Left Ventricular Global Function Index: Predictive Value (page 770)Current indices of left ventricular (LV) function are adequate at reflecting the heart’s actual functional state with respect to the vascular system and the body’s needs. However, they do not take into account how much structural remodeling has occurred and the lifetime evolution of the cardiovascular (CV) system for 1 specific individual. Our intent with proposing this novel approach was to integrate information on ventricular remodeling into the functional capacity of the heart for a given vascular system of an individual.By assessing stroke volume with respect to size of LV cavity and myocardium, the LV global function index combines LV mass, volume, and stroke volume into 1 index. In a multiethnic population free of symptomatic CV disease at baseline, the LV global function index was strongly and consistently associated with adverse CV events during follow-up, whereas LV ejection fraction was not associated with hard CV events beyond heart failure. LV global function index’s predictive power was better and more consistent than LV mass-to-volume ratio and LV ejection fraction and was comparable with indexed LV mass.By conventional indices, the impact of long-standing increased workload, such as hypertension, is manifested on LV structure before LV function. It is, therefore, essential to have a reliable and reproducible assessment of both LV structure as well as LV function in the risk stratification of cardiac patients. Therefore, LV global function index may provide unique information in the CV risk assessment and therapeutic follow-up of hypertensive patients.Download figureDownload PowerPoint Previous Back to top Next FiguresReferencesRelatedDetails April 2013Vol 61, Issue 4 Advertisement Article InformationMetrics © 2013 American Heart Association, Inc.https://doi.org/10.1161/HYP.0b013e31828e0de3 Originally publishedApril 1, 2013 PDF download Advertisement

Cardiometabolic risk factors in Iranians with spinal cord injury: Analysis by injury-related variables

Persons with spinal cord injury (SCI) have a high prevalence of abnormalities in carbohydrate and lipid metabolism. These abnormalities cause adverse coronary heart disease (CHD) in patients with SCI. In this study, we performed a detailed analysis of the level-specific cardiometabolic risk factors in individuals with SCI and analyzed the association of injury level on these risk factors. This was a cross-sectional study of 162 patients with SCI, assessing the prevalence of diabetes mellitus, dyslipidemia, hypertension, obesity, and smoking. Fasting blood sugar (>100) was diagnosed in 27 patients (16.7%). Of the total patients, 36 (22.2%) had a total cholesterol (TC) level of >200. A triglyceride level of >150 was present in 56 patients (34.6%). Hypertension was present in 2.5% of the entire patient group. Body mass index (BMI), TC, and low-density lipoprotein cholesterol (LDL-C) were significantly higher in the paraplegia group than the tetraplegia group (24.44 +/- 4.23 vs 22.65 +/- 4.27, p = 0.01; 185.71 +/- 40.69 vs 163.28 +/- 37.92, p < 0.001; and 102.51 +/- 28.20 vs 89.15 +/- 22.35, p = 0.01, respectively). Patients with paraplegia may have increased hypertension, higher BMI, and increasing levels of serum LDL-C and TC than those with tetraplegia. Conventional risk factors for CHD should be identified and treated in individuals with SCI.

Cardiovascular Reactivity and Cardiometabolic Risk in Adolescents

Cardiovascular reactivity has been examined as a risk marker or factor in the pathogenesis of hypertension or cardiovascular disease, but few have examined the relationship with the metabolic syndrome. We examined whether cardiovascular reactivity to laboratory stress is associated with individual cardiometabolic risk factors and their co-occurrence. A significant positive relationship was hypothesized for both individual and clustered risk factors in their cross-sectional associations with reactivity to multiple stressors. A sample of 144, 15-17-year-old adolescents (74 % boys) largely from ethnic minority groups (54 % Hispanic White, 26 % Black) were identified at annual blood pressure (BP) screening (39 % with elevated BP) at high schools in Miami, Florida, USA. Participants completed the evaluated speaking, mirror star tracing, and cold pressor tasks, as well as cardiometabolic risk factor blood sampling. Participants were classified into metabolic syndrome criterion groups (0, 1, 2, or ≥3 criteria) based on American Heart Association adult criteria. Multiple regression analyses with individual metabolic syndrome variables demonstrated that diastolic (D)BP reactivity during the mirror star tracing task accounted for 1.3 %, 3.8 %, and 5.1 % of the respective variances in casual systolic BP, waist circumference, and triglycerides (ps < 0.05). In multinomial logistic regression models, increased DBP reactivity during mirror star tracing and cold pressor tasks, and decreased HR reactivity during the cold pressor, were associated with greater likelihood of risk factor co-occurrence (ranging from 8.3 % to 15.8 %). Findings indicate that autonomic reactivity to the mirror star tracing and cold pressor tasks, but not the evaluated speaking task, is associated with risk factor co-occurrence, and reactivity may be a clinical prognosticator of cardiometabolic disease risk.

Oral hygiene and cardiometabolic disease risk in the survey of the health of Wisconsin

Poor oral health is an increasingly recognized risk factor for cardiovascular disease (CVD) and type 2 diabetes (T2D), but little is known about the association between toothbrushing or flossing and cardiometabolic disease risk. The purpose of this study was to examine the degree to which an oral hygiene index was associated with CVD and T2D risk scores among disease-free adults in the Survey of the Health of Wisconsin. All variables were measured in 2008-2010 in this cross-sectional design. Based on toothbrushing and flossing frequency, an oral hygiene index (poor, fair, good, excellent) was created as the primary predictor variable. The outcomes, CVD and T2D risk score, were based on previous estimates from large cohort studies. There were 712 and 296 individuals with complete data available for linear regression analyses in the CVD and T2D samples, respectively. After covariate adjustment, the final model indicated that participants in the excellent (β ± SE = -0.019 ± 0.008, P = 0.020) oral hygiene category had a significantly lower CVD risk score as compared to participants in the poor oral hygiene category. Sensitivity analyses indicated that both toothbrushing and flossing were independently associated with CVD risk score, and various modifiable risk factors. Oral hygiene was not significantly associated with T2D risk score. Regular toothbrushing and flossing are associated with a more favorable CVD risk profile, but more experimental research is needed in this area to precisely determine the effects of various oral self-care maintenance behaviors on the control of individual cardiometabolic risk factors. These findings may inform future joint medical-dental initiatives designed to close gaps in the primary prevention of oral and systemic diseases.

Metabolic syndrome in patients attending psychiatric day centres: prevalence and associations

Aims and methodTo ascertain the prevalence of metabolic syndrome in individuals with chronic enduring mental illness attending community psychiatric day centres, and to identify the prevalence of individual cardiometabolic risk factors and the rate of screening for these abnormalities. One hundred participants with chronic enduring mental illness were recruited and investigated using physical assessments and comprehensive laboratory testing.ResultsOf the 100 participants recruited, 55% met the criteria for metabolic syndrome. There were similar prevalence rates between those with psychotic and non-psychotic disorders. Forty-four per cent of the patients had not been screened for metabolic parameters in the previous 12 months, and 43% of these met criteria for metabolic syndrome.Clinical implicationsChronic enduring mental illness is associated with high prevalence rates of metabolic syndrome regardless of diagnosis or use of antipsychotic medication. A substantial proportion of this standard cohort of patients attending day centres carry cardiovascular risk factors that remain unidentified, but should be screened for and intensively managed.

Association between different growth curve definitions of overweight and obesity and cardiometabolic risk in children

Overweight and obesity in young people are assessed by comparing body mass index (BMI) with a reference population. However, two widely used reference standards, the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) growth curves, have different definitions of overweight and obesity, thus affecting estimates of prevalence. We compared the associations between overweight and obesity as defined by each of these curves and the presence of cardiometabolic risk factors. We obtained data from a population-representative study involving 2466 boys and girls aged 9, 13 and 16 years in Quebec, Canada. We calculated BMI percentiles using the CDC and WHO growth curves and compared their abilities to detect unfavourable levels of fasting lipids, glucose and insulin, and systolic and diastolic blood pressure using receiver operating characteristic curves, sensitivity, specificity and kappa coefficients. The z scores for BMI using the WHO growth curves were higher than those using the CDC growth curves (0.35-0.43 v. 0.12-0.28, p < 0.001 for all comparisons). The WHO and CDC growth curves generated virtually identical receiver operating characteristic curves for individual or combined cardiometabolic risk factors. The definitions of overweight and obesity had low sensitivities but adequate specificities for cardiometabolic risk. Obesity as defined by the WHO or CDC growth curves discriminated cardiometabolic risk similarly, but overweight as defined by the WHO curves had marginally higher sensitivities (by 0.6%-8.6%) and lower specificities (by 2.6%-4.2%) than the CDC curves. The WHO growth curves show no significant discriminatory advantage over the CDC growth curves in detecting cardiometabolic abnormalities in children aged 9-16 years.

Salivary uric acid as a noninvasive biomarker of metabolic syndrome

BackgroundElevated serum uric acid is associated with obesity, hypertension and metabolic syndrome. Because a linear relationship exists between serum and salivary uric acid (SUA) concentration, saliva testing may be a useful noninvasive approach for monitoring cardiometabolic risk. The goal of this pilot study was to determine if SUA is increased in patients with metabolic syndrome and to investigate correlations between SUA and individual cardiometabolic risk factors.FindingsVolunteers between the ages of 18 and 65 without conditions known to affect serum uric acid levels were recruited. Height, weight, blood pressure and waist circumference were measured and a full lipid panel along with fasting blood glucose was obtained. Saliva samples were collected and uric acid levels were determined. 78 volunteers, 35% of whom had metabolic syndrome, completed the study. SUA was significantly elevated in patients with metabolic syndrome (p=.002). The incidence of metabolic syndrome in the 4th quartile for SUA was 67% compared to 25% in quartiles1-3 combined. Significant correlations were seen between SUA and systolic blood pressure (r=.440, p=.000), diastolic blood pressure ( r=.304, p=.007), waist circumference (r=.332, p=.003), BMI ( r=.269, p=.018), fasting blood glucose ( r=.341, p=.002), triglycerides (r=.410, p=.000), HDL ( r=.237, p=.036) and the number of cardiometabolic risk factors present (r=0.257, p=.023).ConclusionsThese results suggest that SUA may be a useful biomarker for noninvasive monitoring of cardiometabolic risk. Larger studies are needed to validate this approach.

Vitamin D and Cardiovascular Disease: A Novel Agent for Reducing Cardiovascular Risk?

Vitamin D deficiency is a well-established risk factor for bone disease. Emerging data suggest a pleiotropic role of this agent in a variety of functions in humans. Epidemiological studies indicate an inverse association between vitamin D deficiency and the prevalence of cardiovascular disease (CVD), as well as individual cardiometabolic risk factors, such as hypertension, diabetes, dyslipidemia and the metabolic syndrome. Moreover, vitamin D deficiency has been implicated in the atherosclerotic process. This review considers current data regarding the role of vitamin D deficiency in the development of CVD and addresses the effect of supplementation on cardiovascular outcomes.

Clozapine and Cardiometabolic Health in Chronic Schizophrenia: Correlations and Consequences in a Clinical Context

The aim of this study was to identify the prevalence of metabolic syndrome and its putative precursors in a naturalistic study of non-acute inpatients at a psychiatric hospital. Anthropometric and biochemical data collected from the hospital's annual cardiometabolic survey, along with information about prescribed medications, were used to assess the prevalence and predictors of physical health problems in patients with schizophrenia. Of the 167 patients included in the survey, 52.4% met criteria for metabolic syndrome. A shorter duration of hospital admission and clozapine use were significant predictors of metabolic syndrome. Age, gender, duration of admission and clozapine use were all predictors of individual cardiometabolic risk factors. The findings from this naturalistic study reinforce the high prevalence of physical health problems in patients with schizophrenia and the important influence that psychiatric treatments can have on physical health. The impact of clozapine on cardiometabolic health appears to occur early in the course of treatment and emphasizes the need for proactive monitoring and interventions from the outset of management.

Visceral adiposity and its anatomical distribution as predictors of the metabolic syndrome and cardiometabolic risk factor levels

Background:Despite the recognition that central obesity plays a critical role in chronic disease, few large-scale imaging studies have documented human variation in abdominal adipose tissue patterning. Objective:We aimed to compare the associations between abdominal subcutaneous adipose tissue (ASAT) and visceral abdominal tissue (VAT), which were measured at different locations across the abdomen, and the presence of the metabolic syndrome (MS; National Cholesterol Education Program Adult Treatment Panel III definition) and individual cardiometabolic risk factors. Design:This study included 713 non-Hispanic whites aged 18–86 y, in whom VAT and ASAT were assessed by using multiple-image magnetic resonance imaging. The anatomical position of the magnetic resonance image containing the maximum VAT area for each subject was used as a measure of VAT patterning. Multivariate linear and logistic regression analyses were used to examine the relation of VAT, ASAT, and VAT patterning to cardiometabolic risk. Results:VAT mass was a stronger predictor of the MS than was ASAT mass, but ASAT mass (and other measures of subcutaneous adiposity) had signification interactions with VAT mass, whereby elevated ASAT reduced the probability of MS among men with high VAT (P = 0.0008). There was variation across image locations in the association of VAT area with the MS in men, and magnetic resonance images located 4–8 cm above L4–L5 provided the strongest correlations between VAT area and cardiometabolic risk factors. Subjects whose maximum VAT area was higher in the abdomen had higher LDL-cholesterol concentrations (R2 = 0.07, P < 0.0001), independent of age and adiposity. Conclusion:Further studies are needed to confirm the effects of VAT patterning on cardiometabolic risk.

Prevalence of cardiometabolic risk factors by weight status in a population-based sample of Quebec children and adolescents

There are few data on the prevalence of cardiometabolic risk factors in population-based samples of overweight and obese youth. To compare the prevalence of individual and multiple cardiometabolic risk factors across body mass index (BMI) categories in a population-based sample of youth. In 1999, a school-based survey of a provincially representative sample of youth nine, 13 and 16 years of age was conducted in Quebec (1778 boys, 1835 girls). Overweight was defined as BMI in the 85th percentile or higher and lower than the 95th percentile of the Centers for Disease Control and Prevention 2000 growth charts, and obesity was defined as BMI in the 95th percentile or higher. Levels of total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B, high-density lipoprotein cholesterol, triglycerides, insulin, glucose, C-reactive protein and systolic blood pressure were categorized as desirable, borderline or unfavourable. The proportions of overweight and obese participants were 14% and 10% in boys, and 14% and 7% in girls, respectively. With the exception of total cholesterol and low-density lipoprotein cholesterol in girls, and glucose in both sexes, the prevalence of all investigated risk factors (borderline or unfavourable) was significantly higher among overweight and obese participants. Almost one-third of obese participants had unfavourable levels of at least two of seven risk factors (apolipoprotein B, high-density lipoprotein cholesterol, triglycerides, insulin, glucose, C-reactive protein and systolic blood pressure) compared with 3% of normal weight participants (adjusted OR 15 and 18 in boys and girls, respectively). Thirty-four per cent of obese youth did not have unfavourable levels of any risk factor. There is marked heterogeneity in the association between excess weight and cardiometabolic risk factors. Nonetheless, the present study highlights a high prevalence of multiple risk factors in a population-based sample of overweight and obese youth.