Likelihood Of Coronary Heart Disease Research Articles

Application of machine learning algorithms to construct and validate a prediction model for coronary heart disease risk in patients with periodontitis: a population-based study

BackgroundThe association between periodontitis and cardiovascular disease is increasingly recognized. In this research, a prediction model utilizing machine learning (ML) was created and verified to evaluate the likelihood of coronary heart disease in individuals affected by periodontitis.MethodsWe conducted a comprehensive analysis of data obtained from the National Health and Nutrition Examination Survey (NHANES) database, encompassing the period between 2009 and 2014.This dataset comprised detailed information on a total of 3,245 individuals who had received a confirmed diagnosis of periodontitis. Subsequently, the dataset was randomly partitioned into a training set and a validation set at a ratio of 6:4. As part of this study, we conducted weighted logistic regression analyses, both univariate and multivariate, to identify risk factors that are independent predictors for coronary heart disease in individuals who have periodontitis. Five different machine learning algorithms, namely Logistic Regression (LR), Gradient Boosting Machine (GBM), Support Vector Machine (SVM), K-Nearest Neighbor (KNN), and Classification and Regression Tree (CART), were utilized to develop the model on the training set. The evaluation of the prediction models’ performance was conducted on both the training set and validation set, utilizing metrics including AUC (Area under the receiver operating characteristic curve), Brier score, calibration plot, and decision curve analysis (DCA). Additionally, a graphical representation called a nomogram was created using logistic regression to visually depict the predictive model.ResultsThe factors that were found to independently contribute to the risk, as determined by both univariate and multivariate logistic regression analyses, encompassed age, race, presence of myocardial infarction, chest pain status, utilization of lipid-lowering medications, levels of serum uric acid and serum creatinine. Among the five evaluated machine learning models, the KNN model exhibited exceptional accuracy, achieving an AUC value of 0.977. The calibration plot and brier score illustrated the model's ability to accurately estimate probabilities. Furthermore, the model's clinical applicability was confirmed by DCA.ConclusionOur research showcases the effectiveness of machine learning algorithms in forecasting the likelihood of coronary heart disease in individuals with periodontitis, thereby aiding healthcare professionals in tailoring treatment plans and making well-informed clinical decisions.

Metabolic syndrome in patients with first-ever ischemic stroke: prevalence and association with coronary heart disease

The metabolic syndrome (MetS) has been well linked with coronary heart disease (CHD) in the general population, but studies have rarely explored their association among patients with stroke. We examine prevalence of MetS and its association with CHD in patients with first-ever ischemic stroke. This hospital-based study included 1851 patients with first-ever ischemic stroke (mean age 61.2 years, 36.5% women) who were hospitalized into two university hospitals in Shandong, China (January 2016–February 2017). Data were collected through interviews, physical examinations, and laboratory tests. MetS was defined following the National Cholesterol Education Program (NCEP) criteria, the International Diabetes Federation (IDF) criteria, and the Chinese Diabetes Society (CDS) criteria. CHD was defined following clinical criteria. Data were analyzed using binary logistic regression models. The overall prevalence of MetS was 33.4% by NECP criteria, 47.2% by IDF criteria, and 32.5% by CDS criteria, with the prevalence being decreased with age and higher in women than in men (p < 0.05). High blood pressure, high triglycerides, and low HDL-C were significantly associated with CHD (multi-adjusted odds ratio [OR] range 1.27–1.38, p < 0.05). The multi-adjusted OR of CHD associated with MetS defined by the NECP criteria, IDF criteria, and CDS criteria (vs. no MetS) was 1.27 (95% confidence interval 1.03–1.57), 1.44 (1.18–1.76), and 1.27 (1.03–1.57), respectively. In addition, having 1–2 abnormal components (vs. none) of MetS was associated with CHD (multi-adjusted OR range 1.66–1.72, p < 0.05). MetS affects over one-third of patients with first-ever ischemic stroke. MetS is associated with an increased likelihood of CHD in stroke patients.

Adverse Childhood Experiences and the Risk of Coronary Heart Disease in Adulthood: Examining Potential Psychological, Biological, and Behavioral Mediators in the Whitehall II Cohort Study.

BackgroundThis study investigated potential psycho‐bio‐behavioral mediators of the association between adverse childhood experiences (ACEs) and the risk of coronary heart disease (CHD) in adulthood.Methods and ResultsParticipants were 5610 British civil servants (mean age, 55.5; 28% women) from the Whitehall II cohort study without CHD at baseline in 1997 to 1999 (wave 5) when retrospective data on the number of ACEs were collected via questionnaire (range, 0–8). Potential mediators assessed at wave 5 included depression and anxiety symptoms, health behaviors (smoking, alcohol dependence, sleep, and physical activity), and cardiometabolic dysregulations. New diagnoses of CHD (myocardial infarction, definite angina, coronary artery bypass grafting, or percutaneous transluminal coronary angioplasty) were assessed from wave 6 (2001) to wave 11 (2012–2013). Logistic regressions examined associations between ACEs, potential mediators, and CHD during the follow‐up period. Natural indirect effects were examined using mediation analysis. A total of 566 (10.1%) participants developed CHD during the follow‐up period. ACEs were associated with an increased likelihood of CHD (odds ratio per ACE, 1.09; 95% CI, 1.00–1.19). Controlling for age and sex, mediation analyses revealed an indirect effect of depression symptoms (natural indirect effects, 1.05; 95% CI, 1.03–1.07), anxiety symptoms (natural indirect effects, 1.12; 95% CI, 1.10–1.15), and a greater number of cardiometabolic dysregulations (natural indirect effects, 1.02; 95% CI, 1.01–1.03) in the association between ACEs and incident CHD. Behavioral factors were not statistically significant mediators.ConclusionsDepression symptoms, anxiety symptoms, and cardiometabolic dysregulations partially mediated the association between ACEs and CHD. Regular screening and treatment of symptoms of psychological disorders and cardiometabolic dysregulations may help mitigate the long‐term health burden of ACEs.

Cost-effectiveness of cardiovascular imaging for stable coronary heart disease

ObjectiveTo assess the cost-effectiveness of management strategies for patients presenting with chest pain and suspected coronary heart disease (CHD): (1) cardiovascular magnetic resonance (CMR); (2) myocardial perfusion scintigraphy (MPS); and...

The role of spoken language in cardiovascular health inequalities: a cross-sectional study of people with non-English language preference.

BackgroundSocioeconomic and ethnic factors are established determinants of cardiovascular health inequalities. The role of low proficiency in the majority language as a mediator of these inequalities is uncertain.AimThis study aimed to investigate the association between non-English language preference and cardiovascular health inequalities in a community in London.Design & settingRetrospective, cross-sectional analysis of anonymised patient-level data collected from general practices in Lambeth, south London.MethodCardiovascular disease prevalence, monitoring, and risk-identification data were compared between non-English and English language groups using multiple logistic regression.ResultsOf the total number of patients registered at the 49 participating practices, 302 404 (83%) patients were aged ≥18 years. Preferred language was recorded by 69.4%: English 53.6%, Portuguese 3.2%, Spanish 2.6%, French 1.6%, Polish 1.4%, Somali 0.5%, and others 7.1%; 30.6% had no record of language preference. The non-English language preference group had a greater likelihood of coronary heart disease ([CHD], odds ratio [OR] 1.18, 95% confidence interval [CI] = 1.03 to 1.34); diabetes mellitus ([DM], OR = 1.33, 95% CI = 1.23 to 1.43); obesity (OR = 1.08, 95% CI = 1.04 to 1.13); and smoking (OR = 1.18, 95% CI = 1.14 to 1.21), but no difference in the prevalence of hypertension or stroke. Cardiovascular monitoring was not less intense in this group. Portuguese-speakers (the largest non-English language preference group) had a greater likelihood of hypertension (OR = 1.43, 95% CI = 1.30 to 1.57); DM (OR = 1.74, 95% CI = 1.50 to 2.02); stroke (OR = 1.40, 95% CI = 1.08 to 1.81); obesity (OR = 1.53, 95% CI = 1.36 to 1.73); and smoking (OR = 1.13, 95% CI = 1.02 to 1.25).ConclusionThe non-English language preference group was associated with a greater risk of some aspects of cardiovascular disease than the English language preference group, probably reflecting shared cultural and behavioural risk. Non-English language preference was not associated with lower rates of cardiovascular monitoring, providing some evidence of equitable primary care access in this group.

Is Childhood Socioeconomic Status Related to Coronary Heart Disease? Evidence From the Health and Retirement Study (1992-2012).

Objective: We investigated the association between childhood socioeconomic status (SES) and coronary heart disease (CHD) in older Americans. Method: We used Health and Retirement Study data from 1992 to 2012 to examine a nationally representative sample of Americans aged ≥50 years (N = 30,623). We modeled CHD as a function of childhood and adult SES using maternal and paternal educational level as a proxy for childhood SES. Results: Respondents reporting low childhood SES were significantly more likely to have CHD than respondents reporting high childhood SES. Respondents reporting both low childhood and adult SES were 2.34 times more likely to have CHD than respondents reporting both high childhood and adult SES. People with low childhood SES and high adult SES were 1.60 times more likely than people with high childhood SES and high adult SES to report CHD in the fully adjusted model. High childhood SES and low adult SES increased the likelihood of CHD by 13%, compared with high SES both as a child and adult. Conclusion: Childhood SES is significantly associated with increased risk of CHD in later life among older adult Americans.

Predicting Coronary Heart Disease in Remote Settings: A Prospective, Cross-sectional Observational Study

Coronary heart disease (CHD) places a major burden on the Australian health care system. Determining the likelihood of CHD in a patient presenting with chest pain can be particularly difficult in a remote setting where access to transportation and specialised investigations including myocardial stress studies and coronary angiography can be difficult and delayed. The objective is to develop a predictive model for determining the risk of CHD, including the value of high sensitivity C-reactive protein (hsCRP), in patients presenting with chest pain with a particular emphasis on resources and information likely to be available in a remote primary health care setting. A prospective, cross-sectional observational study of patients with no prior diagnosis of CHD presenting to a specialist chest pain assessment clinic at Cairns Hospital from November 2012 to May 2013. Out of the 163 participants included in the study analyses, a total of 38 were classified as CHD likely (23.3% (95% CI 17.1-30.6)). Logistic regression modelling identified two factors that were independently associated with likely CHD, namely the presence of typical chest pain (OR 83.7 (95% CI 21.7-322.1)) and an abnormal baseline ECG (OR 12.8 (95% CI 1.9-86.0)). In this study, it was demonstrated that the presence of typical chest pain and an abnormal resting ECG, remain the cornerstone of predicting a subsequent diagnosis of CHD. This information is easily accessible in remote primary health care and should be utilised to expedite assessment in patients presenting with symptoms suggestive of CHD.

Serum creatinine is associated with coronary disease risk even in the absence of metabolic disorders

Background. In view of recent evidence that serum creatinine and dysfunctional apolipoprotein (apo)A-I may serve as inflammation mediators in people with enhanced inflammation, we studied whether or not these molecules were interrelated and associated with coronary heart disease (CHD) likelihood even in subjects without metabolic syndrome (MetS) or type-2 diabetes. Methods. Among unselected middle-aged Turkish adults with available serum apo A-I, lipoprotein(a) and creatinine measurements, 697 participants (designated as ‘healthy’) were enrolled, after exclusion of the stated metabolic disorders. CHD was identified in 87 subjects, roughly half during 3.1 years’ follow-up. Results. ‘Healthy’ individuals were overweight and had partly impaired fasting glucose but otherwise normal serum creatinine and other biochemical measurements. Being consistent with lacking anti-inflammatory activity, apoA-I was linearly and positively associated with apoB, in women further with creatinine. Logistic regression analyses showed that, beyond age, not non-HDL-cholesterol, systolic blood pressure and smoking status, but serum creatinine in each sex (OR in men 1.63 [95% CI 1.14; 2.31]) and CRP in women were significantly associated with CHD likelihood. The combined highest and lowest creatinine quartiles in women displayed an OR 2.14 (1.02; 4.51) compared with the intermediate quartiles, after similar adjustments. Conclusion. Elevated creatinine levels within normal range, linked to apoA-I dysfunctionality, are independently associated with CHD likelihood even in non-diabetic subjects without MetS. In such women the lowest creatinine quartile is also linked to CHD risk.

Cost-effectiveness of cardiovascular magnetic resonance in the diagnosis of coronary heart disease: an economic evaluation using data from the CE-MARC study

ObjectiveTo evaluate the cost-effectiveness of diagnostic strategies for coronary heart disease (CHD) derived from the CE-MARC study.DesignCost-effectiveness analysis using a decision analytic model to compare eight strategies for the diagnosis...

A nurse-led rapid access chest pain clinic post NICE guidance: Analysis of audit results

Background: Rapid access chest pain clinics (RACPCs) became an immediate priority following the introduction of the National Service Framework for Coronary Heart Disease (CHD) in 2000, aiming for prompt assessment to determine the likelihood of CHD. The benefits of nurse-led RACPC are well documented throughout the literature. In March 2010, the National Institute for Health and Clinical Excellence (NICE) set out structured evidence-based guidance to support the assessment of chest pain in these clinics, marking a significant movement away from treadmill testing towards clinical assessment and non-invasive functional imaging. Setting: Nurse-led RACPC in a large London teaching hospital. Method: Patients seen in clinic referred via GP fax, from April 2010 to April 2011. Results: 646 patients seen. The largest initial patient referral (42%) was for CT coronary angiography. Final patient diagnosis identified that 350 patients (53%) had non-anginal/non-cardiac chest pain, 153 patients (24%) had non-obstructive disease and 103 patients (16%) had angina. Conclusions: Nurse-led RACPC leads to effective triage and a fast rout to diagnosis of the symptoms of ‘chest pain’. NICE provides clear guidance for these clinics, with a move away from exercise tolerance testing towards clinical assessment and functional imaging. A national annual audit may be required to monitor the clinical effectiveness and cost-effectiveness of this new guidance.

AS-111 Registry of Endovascular Infragenicular Arterial Revascularization

Patients with infrapopliteal arterial disease have a high likelihood of coronary heart disease&multiple co-morbidites. PTA is a minimally invasive procedure, which rarely compromises a later surgical procedure, and at the same time preserves the saphenous vein for future coronary or lower extremity distal bypass surgery . The infrapopliteal PTA is much shorter in time&of lower risk than surgical option. Repeat PTA, unlike repeat surgical bypass operations, can be easily performed in case of restenosis.For all these reasons, many vascular units now consider endovascular treatment as the first treatment option in critical limb ischaemia and reserve surgical revascularization for those where endovascular treatment has failed.

Dual activity of serum lipoprotein-associated phospholipase A2 yielding positive and inverse associations with cardiometabolic risk

The clinical relevance of serum lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) in populations prone to cardiometabolic risk needs exploration. We determined major covariates of Lp-PLA(2) mass, and its associations with cardiometabolic disorders. In 736 Turkish adults, serum total Lp-PLA(2) mass was determined by immunoassay. Its association with cardiometabolic risk was assessed in three categories. In a second sample of 98 subjects, enzyme protein in high-density lipoprotein (HDL) was also assayed after precipitation. Significant inverse correlation existed with high triglyceride/low HDL cholesterol dyslipidemia, waist girth, apolipoprotein C-III, homeostatic model assessment, and linear inverse associations in women with lipoprotein (a) and fibrinogen, suggesting that Lp-PLA(2) mass reflected insulin sensitivity and that HDL bound enzyme mass dominated the associations. Among men, positive linear association with total cholesterol suggested additional association with low-density lipoprotein (LDL)-bound enzyme. High (>450 ng/mL) opposed to low (<210 ng/mL) circulating Lp-PLA(2) mass was associated with prevalent and incident coronary heart disease (CHD) in men. One SD increment in Lp-PLA(2) was associated with a 1.64-fold (95% CI 1.00; 2.70) likelihood of CHD, after adjustment for potential confounders. Furthermore, Lp-PLA(2) categories were significantly, independently and inversely associated in men with diabetes only (OR 0.61) and in women with metabolic syndrome only (OR 0.68), for a 1-SD increment. Serum total Lp-PLA(2) mass may indicate either elevated or diminished cardiometabolic risk, specific for gender, depending on its partitioning in lipoprotein groups.

Hazardous Drinking Is Associated with a Lower Risk of Coronary Heart Disease: Results from a National Representative Sample

This analysis assesses the 12-month prevalence of coronary heart disease (CHD) in individuals according to their category of alcohol use. The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions study (the NESARC, n = 43,093) identified 16,147 abstinent individuals, 15,884 moderate consumers, 9,578 hazardous drinkers-defined as exceeding sex-specific weekly limits established by the World Health Organization, and 1,484 alcohol-dependent subjects. Diagnoses were generated using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version. Both moderate and hazardous drinking were associated with decreased odds of CHD when compared with abstinence, whereas odds of CHD were not significantly different between alcohol-dependent and abstinent participants. A moderate or even a hazardous consumption of alcohol is associated with a decreased likelihood of CHD after controlling for sociodemographic, psychiatric, and addictive risk factors. Our study shows that alcohol may have cardioprotective effects not only in moderate drinkers, but also in individuals with patterns of use traditionally considered as hazardous.

The effect of intimate partner violence and other forms of violence against women on health

There are many studies concerning the health consequences of intimate partner violence (IPV). However, little research has been done on the health consequences of other forms of violence against women (VAW) such as the violence perpetrated by male relatives, friends or strangers. The aims of this paper were: (i) to analyze the prevalence of different forms of VAW perpetrated by males at home, workplace and other social environments in Spain and (ii) to analyze whether IPV and other forms of VAW have a different or similar negative impact on women's health. A sample of 13 094 women interviewed in the Spanish National Health Survey 2006 was included. Outcomes were physical and mental health indicators. Predictor variables were IPV and other VAW forms. Logistic regression models were fitted. The likelihood of coronary heart disease [OR: 5.28 (1.45-19.25)], chronic neck [OR: 2.01 (1.35-2.97)] and back pain [OR: 2.34 (1.53-3.57)] was higher among women who reported IPV than among those who did not. Similar associations were found in the case of women affected by other forms of VAW. Mental health problems, with the exception of psychotropic drug use, were more frequent and more strongly associated with IPV than with other forms of VAW. There are health inequities between battered and non-battered women, which may be related to exposure to not only IPV but also other forms of VAW.

MENTAL DISORDERS THE MISSING PIECE?

Mental disorders remain one of the world's major international public health problems, and mental disorders may also interact with the progress and development of many physical diseases [1]. Mental health status (MHS) plays a central role in influencing the behaviours of individuals, especially those related to physical health [1]. Given this, MHS has the potential to confound observational research studies which seek to understand associations between physical health problems and behaviour factors. Two such health problems are coronary heart disease (CHD) and ischaemic stroke [1,2]. Many cohort studies from the medical epidemiology literature have observed a ‘J-shaped’ association between alcohol consumption and risk of CHD and stroke for middle-aged and older people [3–5]. Non-drinkers appear to have a higher risk of CHD and stroke than regular moderate drinkers. The direct implication is that moderate drinking is cardioprotective, but the veracity of the J-shaped curve is being scrutinized increasingly [e.g. 4]. As well as research concerned with cardiovascular health, studies have emerged recently which show consistently that the prevalence of depression is significantly higher among non-drinkers compared to moderate drinkers [6–8]. It is arguable that adjustment for socio-economic factors may mitigate some MHS effects; however, the large-scale cohort study by Skogen et al. [8] adjusted for confounders typically controlled for in alcohol–CHD studies and the effects of MHS on cardiovascular health remained. Three alternative hypotheses explicate the association observed between mental disorders and alcohol consumption, as follows. Better MHS leads to drinking at moderate levels. Moderate alcohol consumption leads to lower risk of mental disorders (i.e. depression). There is no causal relation between MHS and alcohol consumption, and the association is due to unknown confounding factors. If hypothesis 3 is true, hypotheses 1 and 2 must be rejected and if hypotheses 1 and 2 are true, hypothesis 3 must be rejected. However, hypotheses 1 and 2 are not mutually exclusive. Bringing the observations from the mental health and cardiovascular literature together: if hypothesis 2 is true, then moderate regular alcohol consumption may protect against cardiovascular disease via its positive effect on MHS (i.e. lower risk of depression). Alternatively, the action of drinking and/or the constituents of the beverage (e.g. alcohol) may produce a desirable effect on MHS and thereby a protective effect on CHD. Conversely, if hypothesis 2 is not true, the apparent cardioprotective effect of moderate drinking may be due, in fact, to the better MHS of moderate drinkers. It is not currently possible to determine whether or not this might be the case, as MHS is rarely investigated using reliable psychiatric measurements by cohort studies [2,3,5,9]. It is not feasible to test hypothesis 2 with animal studies; however, it would be useful to test how MHS may change among moderate drinkers who stop drinking or switch to lower-strength alcoholic beverages in a randomized controlled trial. Attempts to test this outside a randomized setting would be prone to bias, as people who cease alcohol consumption often do so because of failing health and/or increasing age [4]. The adjusted likelihood of depression among abstainers compared to moderate drinkers was 38% higher [8]—about 10% higher than the comparative likelihood of CHD among abstainers (1.25) [3]. We argue that a concerted effort to adjust for MHS with reliable, comprehensive measures will bring the apparent association between moderate alcohol consumption and CHD substantially closer to 1. Until such efforts are made, apparent cardioprotective effects of moderate drinking from observational studies will be questionable. Changing MHS over the life-span and its association with drinking behaviours may be key to understanding the true nature of the apparent cardioprotective effects of moderate alcohol consumption on older populations. None.

Antipsychotics May Influence Patients' Risk for Heart Disease

Antipsychotics May Influence Patients' Risk for Heart Disease

Serum folate is associated with coronary heart disease independently of homocysteine in Turkish men

Whether serum homocysteine levels are associated with coronary heart disease (CHD) and the metabolic syndrome (MS) needs investigation in different ethnic groups. These associations and the influence of serum folate and vitamin B(12) thereupon were addressed separately in genders. A random sample of Turkish adults was studied cross-sectionally. Median age of 338 men and 342 women was 55 years. Geometric mean serum homocysteine concentrations were 12.7+/-1.5 micromol/l in men and 9.6+/-1.4 micromol/l in women (p<0.001). Linear regression analysis among 11 variables revealed male sex, reduced estimated glomerular filtration rate (eGFR) and vitamin B(12), (in men) reduced folate as significant independent covariates of higher homocysteine levels. Logistic regression analysis disclosed that (sex-specific) top versus bottom homocysteine tertile was borderline significantly and independently associated with CHD in men and both genders combined, after adjustment for gender, age, smoking status, systolic blood pressure, eGFR, folate and vit B(12). Folate revealed significant inverse association with CHD likelihood in men and combined genders (OR 0.73 for doubling [95%CI 0.56; 0.94]), independently of homocysteine levels and even of presence of type-2 diabetes. Serum vit B(12) concentrations were significantly associated with MS likelihood in women alone after adjustment for sex, age, smoking status, folate and antidiabetic medication. High serum homocysteine and low folate levels are associated in Turkish men independently with CHD, which needs confirmation in a larger sample. In women, vitamin B(12) concentrations are significantly associated with MS likelihood.

The association of periodontal disease, diabetes and cardiovascular disease

Background: Evidence for a link between periodontal disease and several systemic diseases is growing rapidly. Current evidence suggests that periodontitis is associated with an increased likelihood of coronary heart disease and diabetesScope: A consensus group reviewed published data on the contributory role of periodontal disease to overall health. Particular consideration was given to a role for periodontal disease in cardiovascular disease and in diabetesConclusions: Further research is needed to define the population-attributable risk of periodontal disease to cardiovascular diseases and to diabetes control and progression. Br J Diabetes Vasc Dis 2008; 8: 188—189.

Lipoprotein(a) is associated with coronary heart disease independent of metabolic syndrome

To assess (i) the association between lipoprotein(a) [Lp(a)] with the likelihood of coronary heart disease and metabolic syndrome (MS) and (ii) its covariates in Turkish adults. Cross-sectional evaluation of 1309 adults, who had serum Lp(a) determinations by Behring nephelometry, and followed for a mean 1.0 year. MS was defined by ATPIII criteria modified for male abdominal obesity. Mean age of the sample was 56.8+/-11.3 years. After adjustment for sex, age, and smoking status, log-transformed Lp(a) levels were associated significantly with coronary heart disease likelihood in both sexes combined [odds ratio: 1.53 (95% confidence interval: 1.06; 2.20)]. This association persisted after additional adjustment for MS [odds ratio: 1.57 (95% confidence interval: 1.09; 2.26)]. The Lp(a) mid-tertile (5-17 mg/dl), accompanied by significantly lower serum triglycerides than the two remaining tertiles, was inversely associated significantly with MS in either sex; in women, this association was independent of waist circumference. In a linear regression comprising seven variables, excepting total cholesterol, only gamma-glutamyltransferase in women (P=0.002) and waist circumference (P=0.057) in men were inverse covariates of modest magnitude of Lp(a). Coronary heart disease likelihood, significantly associated with Lp(a) concentrations, is independent of MS and insulin resistance. Suggestive evidence was provided that intermediary Lp(a) concentrations, when accompanied by the presence of MS, could accelerate progression of vascular disease, especially in women.

Serum Total and High-Density Lipoprotein Phospholipid Levels in a Population-Based Study and Relationship to Risk of Metabolic Syndrome and Coronary Disease

The aim of study was to investigate the role of serum total (TPL) and high-density lipoprotein phospholipids (HDL-pl) as a risk factor in coronary heart disease (CHD) and metabolic syndrome (MS). In a random sample, total and HDL-pl were measured in 1088 and 642 adults from Turkey, respectively, who have a high prevalence of MS; this was done with an enzymatic method that measures total phosphatidylcholine, sphingomyelin, and lysophosphatidylcholine. Serum TPL and HDL-pl levels were significantly higher in women (TPL, 2.8 mmol/L; HDL-pl, 1.21 mmol/L) than in men. Strong correlations existed between serum TPL levels and non-HDL cholesterol (HDL-C), triglycerides, apolipoprotein (apo) B, complement C3, and gamma-glutamyltransferase. Non-HDL-C, HDL triglyceride, and apo A-I were strongly correlated with HDL-pl. Linear regression analyses revealed HDL-C, apo B, triglycerides, diabetes, and female gender as independent significant determinants of TPL levels in adults. HDL-C and impaired glucose regulation were sole significant variables, together contributing one-quarter of serum HDL-pl. Individuals with MS or diabetes had significantly higher TPL concentrations. The gender- and age-adjusted odds ratio (OR) of TPL for MS was 1.73 (95% confidence interval, 1.35-2.21), whereas the multiadjusted OR of HDL-pl per 1 SD increment corresponded to a significantly reduced independent MS likelihood by 26% in women (and 18% in the entire group). The multiadjusted OR of HDL-pl for CHD in men and women combined was 0.32 (P = .057) corresponding to a reduced CHD likelihood by 32% per 1 SD increment of HDL-pl. Plasma TPL levels point to an adverse relationship to MS, whereas their role in CHD risk needs further investigation. HDL-pls, in contrast, mark substantial protection from MS as well as from CHD.