MetS Group Research Articles

Impact of pemafibrate on lipid profile and insulin resistance in hypertriglyceridemic patients with coronary artery disease and metabolic syndrome.

This study examined the effects of pemafibrate, a selective peroxisome proliferator-activated receptor α agonist, on the serum biochemical parameters of male patients with coronary artery disease and metabolic syndrome (MetS). This was a post hoc analysis of a randomized, crossover study that treated hypertriglyceridemia with pemafibrate or bezafibrate for 24weeks, followed by a crossover of another 24 weeks. Of the 60 patients enrolled in the study, 55 were male. Forty-one of 55 male patients were found to have MetS. In this sub-analysis, male patients with MetS (MetS group, n = 41) and those without MetS (non-MetS group, n = 14) were compared. The primary endpoint was a change in fasting serum triglyceride (TG) levels during pemafibrate therapy, and the secondary endpoints were changes in insulin resistance-related markers and liver function parameters. Serum TG levels significantly decreased (MetS group, from 266.6 to 148.0mg/dL, p < 0.001; non-MetS group, from 203.9 to 97.6mg/dL, p < 0.001); however, a percent change (%Change) was not significantly different between the groups (- 44.1% vs. - 51.6%, p = 0.084). Serum insulin levels and homeostasis model assessment of insulin resistance significantly decreased in the MetS group but not in the non-MetS group. %Change in liver enzyme levels was markedly decreased in the MetS group compared with that in the non-MetS group (alanine aminotransferase, - 25.1% vs. - 11.3%, p = 0.027; gamma-glutamyl transferase, - 45.8% vs. - 36.2%, p = 0.020). In conclusion, pemafibrate can effectively decrease TG levels in patients with MetS, and it may be a more efficient drug for improving insulin resistance and liver function in such patients.

The Influence of Metabolic Syndrome on Potential Aging Biomarkers in Participants with Metabolic Syndrome Compared to Healthy Controls.

Biological aging is a physiological process that can be altered by various factors. The presence of a chronic metabolic disease can accelerate aging and increase the risk of further chronic diseases. The aim of the study was to determine whether the presence of metabolic syndrome (MetS) affects levels of markers that are associated with, among other things, aging. A total of 169 subjects (58 with MetS, and 111 without metabolic syndrome, i.e., non-MetS) participated in the study. Levels of telomerase, GDF11/15, sirtuin 1, follistatin, NLRP3, AGEs, klotho, DNA/RNA damage, NAD+, vitamin D, and blood lipids were assessed from blood samples using specific enzyme-linked immunosorbent assay (ELISA) kits. Telomerase (p < 0.01), DNA/RNA damage (p < 0.006) and GDF15 (p < 0.02) were higher in MetS group compared to non-MetS group. Only vitamin D levels were higher in the non-MetS group (p < 0.0002). Differences between MetS and non-MetS persons were also detected in groups divided according to age: in under 35-year-olds and those aged 35-50 years. Our results show that people with MetS compared to those without MetS have higher levels of some of the measured markers of biological aging. Thus, the presence of MetS may accelerate biological aging, which may be associated with an increased risk of chronic comorbidities that accompany MetS (cardiovascular, inflammatory, autoimmune, neurodegenerative, metabolic, or cancer diseases) and risk of premature death from all causes.

A Comparative Study Between The Levels of Adropin in Iraqi Women with Metabolic Syndrome and Diabetes

By measuring Adropin, fasting blood glucose (FBG), cholesterol, high-density lipoprotein (HDL), triglycerides (TG), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) in the sera of Iraqi patients with MetS and type 2 diabetes mellitus (T2DM), the current study was designed to compare some crucial markers in metabolic syndrome (MetS) sera and diabetic patients (T2DM) with control. Twenty female subjects were divided into three groups: group I=40 with MetS and group II=40 with T2DM, and 40 healthy subjects were employed as a control group. Compared to the control group, Adropin levels in the Mets group and T2DM group decreased significantly (p &lt; 0.05). In contrast, none of the patient groups (MetS and T2DM) showed any change compared to themselves. In conclusion, according to the present data, higher levels of FBG, lipid profile, and increased blood pressure (BP) were found in patients with MetS and T2DM. A drop in level could be considered a novel indicator of MetS and T2DM. Compared to T2DM patients, Adropin levels are thought to have a more sensitive diagnostic function than those with MetS and newly diagnosed DM.

Complete blood count inflammation derived indexes as predictors of metabolic syndrome in type 2 diabetes mellitus.

Metabolic syndrome (MetS) is a group of comorbidities related to regulating hyperglycemia and acute cardiovascular incidents and complications. With the increasing prevalence in individuals with type 2 diabetes mellitus (T2DM), MetS represents an increasing public health problem and clinical challenge, and early diagnosis is necessary to avoid the accelerated development of diabetic complications. To investigate the role of Complete Blood Count-derived Inflammation Indexes (CBCIIs) in predicting MetS in T2DM individuals. The study was designed as a two-year prospective study and included 80 T2DM individuals divided into MetS and non-MetS groups based on MetS development over two years. The sera samples were analyzed for complete blood count parameters and C-reactive protein (CRP). Based on the laboratory test results, 13 CBCIIs were calculated and analyzed. The receiver operating characteristic (ROC) curve and their corresponding areas under the curve (AUC) were used to determine prognostic accuracy. There were significant differences between T2DM participants with Mets and those without MetS concerning Neutrophil to Platelet Ratio (NPR) values (p< 0.001), Neutrophil to Lymphocyte and Platelet Ratio (NLPR) (p< 0.001), Platelet to Lymphocyte Ratio (PLR) (p< 0.001), Lymphocyte to C-reactive protein Ratio (LCR) (p< 0.001), C-reactive protein to Lymphocyte Ratio (CRP/Ly) (p< 0.001), Systemic immune inflammation index (SII) (< 0.001), and Aggregate Index of Systemic Inflammation (AISI) (p= 0.005). The results of ROC curve analysis have shown that the LCR (AUC of 0.907), CRP/Ly (AUC of 0.907) can serve as excellent predictors, but NPR (AUC of 0.734), NLRP (AUC of 0.755), PLR (AUC of 0.823), SII (AUC of 0.745), and AISI (AUC of 0.688) as good predictors of MetS in T2 DM individuals. This study confirms the reliability of the CBCIIs as novel, simple, low cost and valuable predictors of MetS developing in T2DM.

Lean Metabolic Syndrome vis-à-vis Obese Metabolic Syndrome: Observations from an Eastern Indian Tertiary Set-up

Background: Metabolic syndrome (MetS) in obese is a fairly common entity. However, excluding the waist circumference (WC) criteria, other components of the MetS are also seen in lean or nonobese people. Our study aimed to determine the prevalence of lean MetS among newly diagnosed MetS cases and compare the biochemical parameters and insulin resistance in lean versus overweight/obese MetS. Methods: A cross-sectional, observational study was conducted over 12 months and included adult patients of either sex, newly diagnosed with MetS. Fever cases, infections such as tuberculosis/HIV/chronic infectious disease, chronic inflammatory diseases, those having endocrine causes of obesity such as Cushing syndrome, known cases of ischemic heart disease, and those on antiobesity medications were excluded. Diagnosed MetS patients were categorized as lean or obese based on the standard criteria. A convenient sample of 50 was considered for either group (lean MetS vs. obese MetS). Included patients were investigated for lipid, liver, glycemic, and insulin resistance profiles. Other parameters included serum uric acid, thyroid function, whole abdomen ultrasound, electrocardiography, two-dimensional echocardiography (ECHO), fibroscan, and polysomnography for obstructive sleep apnea (OSA). Results: The prevalence of lean MetS was 9.87%. Variables such as body mass index, WC, low-density lipoprotein, and systolic blood pressure were significantly higher in the obese MetS in comparison to the lean MetS group. Fasting insulin was also significantly higher in the obese MetS compared to lean MetS. Biochemical measures such as aspartate aminotransferase and alanine transferase were significantly higher for the obese MetS, while the change was nonsignificant for other biochemical measures. Except for complications such as polycystic ovary syndrome, acanthoses nigricans, and gallstones which were significantly higher in the obese MetS group, the rest of the complications were similar in both groups. Conclusion: MetS among nonobese or lean subjects differs in certain aspects from those with obesity. As lean MetS is an emerging entity, clinicians must be aware of it to avoid morbidity.

Sex- and Age-Specific Associations Between Metabolic Syndrome and Future Functional Disability in the Japanese Older Population.

Whether the association between metabolic syndrome (MetS) and functional disability differs depending on sex or age remains unknown. To determine the association between MetS and functional disability in older people separately by sex and age groups. A total of 11 083 participants (4407 men and 6676 women) aged 65 years or over without functional disability were enrolled. MetS was defined according to the revised NCEP ATP III guidelines. Functional disability was defined by a new certification in the long-term care insurance in Japan. Cox proportional hazards models were used to assess the risk of functional disability with adjustment for possible confounding factors. Over the mean observation period of 10.5 years, 1282 men and 2162 women experienced functional disability. For those aged 65 to 74 years, HRs (95% CIs) for functional disability in the MetS group were 1.33 (1.07-1.66) in men and 1.15 (1.000-1.32) in women. For those aged 75 years or older, there was no significant association in men or women. In subjects with a severe care need level, there was a marginal significant association in men aged 65 to 74 years. Among the MetS components that independently increased the risk of functional disability were glucose intolerance and elevated blood pressure (men and women aged 65-74 years), obesity (women aged 65-74 years), and glucose intolerance (women aged 75 years or older). MetS contributed to an increase in a high risk of future functional disability among individuals aged 65 to 74 years. In this age group, improvement of lifestyle, health promotion and interventions for MetS from middle age may prevent future functional disability.

Contributing role of metabolic genes APOE, FTO, and LPL in the development of atrial fibrillation: insights from a case-control study.

The aim of the study was to examine the expression profile of genes (APOE, FTO, and LPL) associated with metabolic syndrome (MetS) in subjects with concomitant atrial fibrillation (AF). A total of 690 subjects were categorized into control, AF without MetS, and AF with MetS. The expression profiles of the APOE, FTO, and LPL genes were decreased in AF subjects and AF subjects with MetS as compared to the controls. In AF without the MetS group, an inverse relationship was found between the expression of the LPL gene with body mass index (BMI) and a positive relationship with creatine kinase-MB, whereas expression of the FTO gene was inversely associated with fasting blood glucose and positively with cardiac troponin I in AF suffering from MetS. Expression of the LPL gene was directly linked with systolic blood pressure (SBP) and high-density lipoprotein-cholesterol (HDL-C), whereas an inverse correlation with heart rate and expression of the FTO gene in AF with MetS were shown. The expression of the LPL gene was inversely related to BMI in subjects with AF. The expression of the LPL gene was positively correlated with SBP and HDL-C and negatively correlated with heart rate, while the expression of the FTO gene was an important predictor of AF with MetS. The decreased expression of APOE, FTO, and LPL genes in AF with and without MetS indicates their potential contributing role in the pathogenesis of AF.

Does metabolic syndrome increase contrast-induced nephropathy in patients with normal renal function?

Contrast-induced nephropathy (CIN) is associated with increased mortality and morbidity in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention. This study aimed to compare the incidence of CIN in two groups of patients with and without metabolic syndrome (Mets) with baseline normal renal function. In this case - control study, 260 patient candidates for CAG, 130 patients with Mets and 130 patients without Mets participated, and their serum creatinine (Cr) level before and the 48 and 72 h after the angiography was measured. The incidence of CIN was compared in two groups. Two-way analysis of variance with repeated measures and univariate and multivariate logistic regression models. The results showed a higher chance of being Mets with raising in triglyceride (adjusted odds ratio = 1.05, 95% confidence interval = (1.03-1.06), P < 0.001), Fasting blood glucose (1.010 [1.001-1.019], P = 0.025), and diastolic blood pressure (1.07 [1.07-1.20], P < 0.001), but declining in high-density lipoprotein-cholesterol (HDL-C) (0.91 [0.85-0.98], P = 0.008). Furthermore, blood urea nitrogen (BUN) and Cr level was raised in 48 and 72 h after contrast injection in both groups (All P < 0.001). Furthermore, in 48 h (3.11 [1.12-9.93], P = 0.016) and 72 h (2.82 [1.07-8.28], P = 0.021) after injection, a total of 25 patients had an increased Cr level and a significant difference between Mets and without Mets groups. The developing Mets had a significant association with the increased risk of AKI, which increased the chance of developing nephropathy (7.14 [2.27-22.5], P = 0.001). Mets, together with other risk factors, increased the overall risk of CIN development. Therefore, the incidence of CIN in patients Mets is significantly higher than that of patients without Mets, indicating a more important CIN risk factor.

The impact of metabolic syndrome on clinical outcomes following total knee arthroplasty in osteoarthritis patients.

Metabolic syndrome (MetS) is a combination of interconnected conditions, including insulin resistance, abdominal obesity, high blood pressure, and abnormal blood lipid levels. The objective of this research was to investigate the impact of MetS on the quality of life and clinical outcomes following total knee arthroplasty (TKA) in patients with osteoarthritis (OA). A retrospective descriptive study was conducted to enroll OA patients who underwent primary TKA at Zhongda Hospital, Southeast University from January 2015 to August 2019. A total of 83 OA patients who did and 144 (MetS group) who did not have MetS (non-MetS group) were included. An analysis was conducted on the patient's clinical data. The two groups had similar results in terms of lengths of stay (P=0.93), hospital costs (P=0.24), and overall complication rates (P=0.99). There was no significant difference in the average erythrocyte sedimentation rate and C-reactive protein levels between the groups. However, the MetS group exhibited notably lower Hospital for Special Surgery knee scores and Short Form [36] health survey (SF-36) scores compared to the non-MetS group (both P>0.05) during the one-year follow-up period. OA patients who have MetS had significantly worse knee joint function and quality of life after TKA. There are certain constraints in the current research. First, it belongs to a single-center retrospective study. Further study will be necessary to determine the generality of this conclusion. Second, this study is retrospective, and the number of patients included is not large. Third, due to the diverse clinical groups in our hospital, it is challenging to comprehensively document all the clinical data of the patients involved in this study. Forth, this study did not compare the preoperative differences between the two groups, as well as analyze the postoperative improvement changes in depth. We will compare the preoperative and postoperative differences between the two groups in more depth in future large sample studies.

Effect of metabolic syndrome on testosterone levels in patients with metastatic prostate cancer: a real-world retrospective study.

Metabolic syndrome (MetS) has been shown to have a negative impact on prostate cancer (PCa). However, there is limited research on the effects of MetS on testosterone levels in metastatic prostate cancer (mPCa). This study aims to investigate the influence of MetS, its individual components, and composite metabolic score on the prognosis of mPCa patients, as well as the impact on testosterone levels. Additionally, it seeks to identify MetS-related risk factors that could impact the time of decline in testosterone levels among mPCa patients. A total of 212 patients with mPCa were included in the study. The study included 94 patients in the Non-MetS group and 118 patients in the combined MetS group. To analyze the relationship between MetS and testosterone levels in patients with mPCa. Additionally, the study aimed to identify independent risk factors that affect the time for testosterone levels decline through multifactor logistic regression analysis. Survival curves were plotted by the Kaplan-Meier method. Compared to the Non-MetS group, the combined MetS group had a higher proportion of patients with high tumor burden, T stage ≥ 4, and Gleason score ≥ 8 points (P < 0.05). Patients in the combined MetS group also had higher lowest testosterone values and it took longer for their testosterone to reach the lowest level (P < 0.05). The median progression-free survival (PFS) time for patients in the Non-MetS group was 21 months, while for those in the combined MetS group it was 18 months (P = 0.001). Additionally, the median overall survival (OS) time for the Non-MetS group was 62 months, whereas for the combined MetS group it was 38 months (P < 0.001). The median PFS for patients with a composite metabolic score of 0-2 points was 21 months, 3 points was 18 months, and 4-5 points was 15 months (P = 0.002). The median OS was 62 months, 42 months, and 29 months respectively (P < 0.001). MetS was found to be an independent risk factor for testosterone levels falling to the lowest value for more than 6 months. The risk of testosterone levels falling to the lowest value for more than 6 months in patients with MetS was 2.157 times higher than that of patients with Non-MetS group (P = 0.031). Patients with hyperglycemia had a significantly higher lowest values of testosterone (P = 0.015). Additionally, patients with a BMI ≥ 25 kg/m2 exhibited lower initial testosterone levels (P = 0.007). Furthermore, patients with TG ≥ 1.7 mmol/L experienced a longer time for testosterone levels to drop to the nadir (P = 0.023). The lowest value of testosterone in the group with a composite metabolic score of 3 or 4-5 was higher than that in the 0-2 group, and the time required for testosterone levels to decrease to the lowest value was also longer (P < 0.05). When monitoring testosterone levels in mPCa patients, it is important to consider the impact of MetS and its components, and make timely adjustments to individualized treatment strategies.

Serum CCDC25 Levels as a Potential Marker for Metabolic Syndrome.

Metabolic syndrome (MetS) stands as a significant risk for developing various severe health problems. Therefore, the discovery of biomarkers capable of predicting the progression of metabolic conditions is crucial for improving overall health outcomes. Recently, we reported that coiled-coil domain containing 25 (CCDC25) might be associated with key proteins involved in metabolic pathways, by bioinformatics analysis. Thus, we assumed that serum CCDC25 levels might have an association with MetS status. In this study, based on the modified National Cholesterol Education Program-Adult Treatment Panel III (modified NCEP-ATP III) criteria, the participants who had three or more of abnormal criteria were defined as MetS, and those who had 1 or 2 abnormal criteria as pre-MetS groups; those who had no abnormal criteria were classified as the healthy control (HC) group. Serum CCDC25 levels were measured using the dot blot assay. The results showed that serum CCDC25 levels of the MetS group (0.072±0.026 ng/μl) were significantly higher (p<0.001) than that of pre-MetS (0.031±0.011 ng/μl) or HC groups (0.018±0.007 ng/μl). We can discern a consistent trend indicating that serum CCDC25 level is well correlated with the number of abnormal criteria of MetS of each participant. Although serum CCDC25 levels correlated with the distribution of all 5 MetS criteria, the highest correlation was seen in serum CCDC25 levels and triglyceride (TG) levels, with r=0.563, followed by systolic blood pressure (SBP) levels (r=0.557) and high-density lipoprotein-cholesterol (HDL-C) levels (r=-0.545). CCDC25 showed correlations with all MetS parameters, particularly with TG, SBP, and HDL-C. This prompts speculation that heightened CCDC25 levels may indicate the development and/or progression of those MetS-associated diseases.

Prevalence of metabolic syndrome in East Azerbaijan-Iran and its determinants factors.

Metabolic syndrome (MetS) is a prevalent metabolic disorder with increasing prevalence attributed to extended life expectancy. This study aims to investigate MetS prevalence and its determinants in the East-Azerbaijan population. Conducted as a cross-sectional study within the East Azerbaijan region, this research is based on a major Lifestyle Promotion Project. The study encompasses 700 participants aged 15 to 65 years, representing the general population and selected using probability proportional to size multistage stratified cluster sampling. MetS diagnoses were conducted using the adult Panel III criteria. Data on socio-demographics, smoking status, and physical activity levels were collected through questionnaires. Among participants, the mean age was 42.4±12.38 years, and the mean body mass index was 27.69±4.94 kg/m2. The MetS group exhibited higher mean age and body mass index compared to the non-MetS group (P<0.001). The prevalence of MetS in the population was 34.2%, with higher rates in females (37.1%) compared to males (30.5%), though this difference wasn't statistically significant (P=0.11). Notably, a substantial distinction was observed between the two groups regarding education levels (P<0.001). The study reveals a significant association between increasing age and higher prevalence of MetS. Furthermore, lower educational levels were linked to an elevated prevalence of MetS. While other socio-demographic factors didn't demonstrate statistically significant relationships, these findings emphasize the importance of targeted interventions and education in mitigating MetS risks.

Prevalence of, risk factors for, and target organ damage from metabolic syndrome among people living with HIV on ART: A cross-sectional analysis in Chongqing, China.

The incidence of metabolic syndrome (MetS) in people living with HIV is significantly higher than in people without HIV. MetS is not only a major driver of cardiovascular disease (CVD) but is also closely related to the development of chronic kidney disease (CKD). The aim of this study was to investigate the prevalence of and risk factors for MetS and to further understand the degree of damage to target organs. This was a cross-sectional descriptive study conducted at Chongqing Public Health Medical Center, China. Information was collected via questionnaire survey, physical examination, and laboratory tests. We used the China Diabetes Society guidelines to define MetS. Pooled cohort equations were calculated to compare CVD risk in the next 10 years in people living with HIV aged ≥40 years with or without MetS. We used Student's t-test, the chi-squared test, Fisher's exact test, binary logistic regression, and multiple linear regression in the statistical analysis. The study included 979 people living with HIV, including 13 who have experienced CVD, receiving antiretroviral therapy (ART). The median age was 43.0 years, 20.9% were female, and the median ART time was 45.0 months. The prevalence of MetS was 33.9%. The components of MetS criteria were hyperglycaemia (50.4%), hypertriglyceridaemia (48.4%), hypertension (46.8%), low concentrations of high-density lipoprotein cholesterol (28.2%), and abdominal obesity (25.0%). Higher body mass index (odds ratio [OR] 1.266; 95% confidence interval [CI] 1.203-1.333), higher total cholesterol (OR 1.267; 95% CI 1.011-1.588), high alcohol consumption (OR 1.973; 95% CI 1.009-3.859), and family history of diabetes (OR 1.726; 95% CI 1.075-2.770) were independent risk factors for MetS. Compared with the non-MetS group, the MetS group had a higher rate of urine albumin (23.8% vs 14.8%, p = 0.001), and the estimated glomerular filtration rate <90 mL/min/1.73 m2 (18.37% vs. 12.8%, p = 0.020) and β2-microglobin (p = 0.004) increased more markedly in the MetS group. Regarding the risk of developing CVD events in the next 10 years, 38.5% of those in the MetS group were at high or very high risk, which was significantly higher than in the non-MetS group (p < 0.001). In addition, age (p < 0.001) and sex (p = 0.002) are independent risk factors for developing CVD events in the next 10 years. The prevalence of MetS in people living with HIV on ART is high in Chongqing, China. Risk factors for the development of MetS are high alcohol consumption, family history of diabetes, higher body mass index, and higher total cholesterol levels. In addition, MetS is associated with a risk of CKD and the incidence of 10-year CVD.

Detection of early heart failure with preserved ejection fraction in metabolic syndrome patients detected as part of a national screening program in middle aged subjects

Background: We wished to investigate if community detected Metabolic Syndrome (MetS) is associated with the burden of incipient heart failure with preserved ejection fraction (HFpEF) in the community. Methods and Results: We prospectively studied 148 consecutive MetS patients identified from the Lithuanian High Cardiovascular Risk primary prevention program and investigated them further for unknown HFpEF through cardiopulmonary stress testing as well as assessment of brain natriuretic peptide (BNP) levels and of arterial stiffness. Subjects with a peak oxygen consumption value lower than 90% of predicted and/or BNP≥35 ng/L were categorized as having early phase HFpEF. For comparison of this early phase HFpEF with others already clinically diagnosed with HFpEF, patients with both established HFpEF and MetS were selected retrospectively from patients attending our cardiopulmonary stress testing laboratory (n=38). Two thirds of the screening program derived MetS population (n=96) demonstrated a reduced exercise capacity and/or an elevated BNP, indicating signs of early HFpEF. Both the clinically diagnosed HFpEF and the screening program detected MetS group with early HFpEF demonstrated similarly decreased exercise tolerance evaluated by peak oxygen uptake (79.8±22.1% vs 82.7±14.0%, p&gt;0.05). Analysis of arterial markers in the screening program group revealed statistically significant differences of augmentation index values between groups with and without signs of early HFpEF (p=0.016).Conclusions: A considerable proportion of patients having MetS may be diagnosed with previously undetected early stage HFpEF. The use of objective parameters of exercise capacity and neurohormonal activation might be effectively used for the early detection of HFpEF. Also, early HFpEF in this setting is found to be associated with increased arterial stiffness.

Detection of early heart failure with preserved ejection fraction in metabolic syndrome patients detected as part of a national screening program in middle aged subjects

Background: We wished to investigate if community detected Metabolic Syndrome (MetS) is associated with the burden of incipient heart failure with preserved ejection fraction (HFpEF) in the community. Methods and Results: We prospectively studied 148 consecutive MetS patients identified from the Lithuanian High Cardiovascular Risk primary prevention program and investigated them further for unknown HFpEF through cardiopulmonary stress testing as well as assessment of brain natriuretic peptide (BNP) levels and of arterial stiffness. Subjects with a peak oxygen consumption value lower than 90% of predicted and/or BNP≥35 ng/L were categorized as having early phase HFpEF. For comparison of this early phase HFpEF with others already clinically diagnosed with HFpEF, patients with both established HFpEF and MetS were selected retrospectively from patients attending our cardiopulmonary stress testing laboratory (n=38). Two thirds of the screening program derived MetS population (n=96) demonstrated a reduced exercise capacity and/or an elevated BNP, indicating signs of early HFpEF. Both the clinically diagnosed HFpEF and the screening program detected MetS group with early HFpEF demonstrated similarly decreased exercise tolerance evaluated by peak oxygen uptake (79.8±22.1% vs 82.7±14.0%, p&gt;0.05). Analysis of arterial markers in the screening program group revealed statistically significant differences of augmentation index values between groups with and without signs of early HFpEF (p=0.016).Conclusions: A considerable proportion of patients having MetS may be diagnosed with previously undetected early stage HFpEF. The use of objective parameters of exercise capacity and neurohormonal activation might be effectively used for the early detection of HFpEF. Also, early HFpEF in this setting is found to be associated with increased arterial stiffness.

Detection of early heart failure with preserved ejection fraction in metabolic syndrome patients detected as part of a national screening program in middle aged subjects

Background: We wished to investigate if community detected Metabolic Syndrome (MetS) is associated with the burden of incipient heart failure with preserved ejection fraction (HFpEF) in the community. Methods and Results: We prospectively studied 148 consecutive MetS patients identified from the Lithuanian High Cardiovascular Risk primary prevention program and investigated them further for unknown HFpEF through cardiopulmonary stress testing as well as assessment of brain natriuretic peptide (BNP) levels and of arterial stiffness. Subjects with a peak oxygen consumption value lower than 90% of predicted and/or BNP≥35 ng/L were categorized as having early phase HFpEF. For comparison of this early phase HFpEF with others already clinically diagnosed with HFpEF, patients with both established HFpEF and MetS were selected retrospectively from patients attending our cardiopulmonary stress testing laboratory (n=38). Two thirds of the screening program derived MetS population (n=96) demonstrated a reduced exercise capacity and/or an elevated BNP, indicating signs of early HFpEF. Both the clinically diagnosed HFpEF and the screening program detected MetS group with early HFpEF demonstrated similarly decreased exercise tolerance evaluated by peak oxygen uptake (79.8±22.1% vs 82.7±14.0%, p&gt;0.05). Analysis of arterial markers in the screening program group revealed statistically significant differences of augmentation index values between groups with and without signs of early HFpEF (p=0.016).Conclusions: A considerable proportion of patients having MetS may be diagnosed with previously undetected early stage HFpEF. The use of objective parameters of exercise capacity and neurohormonal activation might be effectively used for the early detection of HFpEF. Also, early HFpEF in this setting is found to be associated with increased arterial stiffness.

METABOLIC SYNDROME, LIFESTYLE FACTORS, AND SLEEP-DISORDERED BREATHING IN US HISPANICS: IMPLICATIONS FOR MID LIFE

Abstract US Hispanics/Latinos are disproportionately susceptible to metabolic syndrome (MetS), attributed in part to health and lifestyle factors such as low physical activity levels, diet quality, alcohol use, tobacco use, and sleep-disordered breathing. The risk of MetS and MetS-related complications increases with age. We examined the relationships between select health and lifestyle factors and MetS among Hispanic gender-heritage subgroups and determined whether gender and heritage moderate those relationships. Participants included 14,155 Hispanic Americans aged 18–76 (59% women, mean age 45.92 ± 13.97) from seven heritage subgroups. This secondary analysis of cross-sectional data from the observational Hispanic Community Health Study / Study of Latinos dataset used multinomial logistic regression and Hayes’ PROCESS macro to test these relationships; the dependent variable, MetS, included four categories delineating MetS and related medication use. Results include low physical activity (p&amp;lt; .001) and sleep-disordered breathing (p&amp;lt; .001) were associated with the MetS with medication use group. High alcohol use decreased the probability of being in this group (p&amp;lt; .001). Cigarette pack years were not significantly associated with MetS outcomes. Gender moderated the association between MetS and diet quality (p&amp;lt; .001), alcohol use (p&amp;lt; .001), cigarette pack-years (p&amp;lt; .001), and sleep-disordered breathing (p&amp;lt; .001). Low physical activity and sleep-disordered breathing was significantly associated with MetS group membership, whereas low and high alcohol use were associated with decreased MetS risk. Gender-heritage differences were prominent in each of the study variables. Midlife may be an important target for prevention and intervention; other considerations for aging will be discussed.

Association of adiponectin gene expression with atrial fibrillation in a Pakistani populace

Adiponectin, an adipocytokine produced and secreted by adipose tissue, has anti-diabetic, anti-atherogenic, and anti-inflammatory properties. This case-control study was aimed to assess the expression and serum levels of adiponectin in subject suffereing from atrial fibrillation (AF). The study's subjects (n = 690) were enrolled from the Punjab Institute of Cardiology, Lahore and were grouped into control, AF without Metabolic syndrome (MetS), and AF with MetS groups. Along with the collection of demographic data, an analysis of adiponectin and biochemical parameters were performed. A highly significant difference in serum levels of adiponectin was observed among the control, AF without MetS, and AF with MetS groups (61.61 ± 45.30 ng/ml, 37.20 ± 19.46 ng/ml, 63.78 ± 61.69 ng/ml). The expression analysis of adiponectin was decreased (n-fold = ̴ 0.30) in AF without MetS group as compared to control group (n-fold = ~ 1.16) but increased in AF with MetS group (n-fold = ̴ 6.26). The correlation analysis revealed a highly significant positive relationship between the expression of the adiponectin gene with waist-to-hip ratio (WHR) in AF without MetS group. Whereas, serum adiponectin was negatively related to serum triglycerides (TG) in AF with MetS group. In multiple regression analysis using adiponectin expression as the dependent variable, WHR was a determinant in AF without MetS. Whereas, when serum adiponectin was used as the dependent variable, serum TG was the determinant in group AF with MetS. The present study implicates that decreased expression and serum levels of adiponectin were associated with the development of AF in which WHR and serum TG also contributed towards the onset of atrial fibrillation.

Modifications of long-term heart rate variability produced in an experimental model of diet-induced metabolic syndrome.

Metabolic syndrome (MetS) has been linked to a higher prevalence of cardiac arrhythmias, the most frequent being atrial fibrillation, but the mechanisms are not well understood. One possible underlying mechanism may be an abnormal modulation of autonomic nervous system activity, which can be quantified by analysing heart rate variability (HRV). Our aim was to investigate the modifications of long-term HRV in an experimental model of diet-induced MetS to identify the early changes in HRV and the link between autonomic dysregulation and MetS components. NZW rabbits were randomly assigned to control (n = 10) or MetS (n = 10) groups, fed 28 weeks with high-fat, high-sucrose diet. 24-hour recordings were used to analyse HRV at week 28 using time-domain, frequency-domain and nonlinear analyses. Time-domain analysis showed a decrease in RR interval and triangular index (Ti). In the frequency domain, we found a decrease in the low frequency band. Nonlinear analyses showed a decrease in DFA-α1 and DFA-α2 (detrended fluctuations analysis) and maximum multiscale entropy. The strongest association between HRV parameters and markers of MetS was found between Ti and mean arterial pressure, and Ti and left atrial diameter, which could point towards the initial changes induced by the autonomic imbalance in MetS.

Metabolic syndrome is linked to the incidence of pancreatic cancer

Although previous studies have showed that metabolic syndrome is one of the contributors of pancreatic cancer, there is no clear consensus that early stages of metabolic syndrome are linked to increased incidence of pancreatic cancer. Therefore, we confirmed the linkage between metabolic syndrome and pancreatic cancer, and shown that even early stage of metabolic syndrome is linked to pancreatic cancer in the retrospective observational study. We recruited approximately 4.6 million Japanese in 2005 and followed up these subjects for more than 10 years. At the time of the enrollment, after obtaining clinical data with prescribed drugs and examining the presence or absence of metabolic syndrome (MetS), we followed up on these subjects with and without MetS to examine the incidence of pancreatic cancer. The modified criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII) were used to define MetS. During the 40.7-month average follow-up period for 2,707,296 subjects with complete data for identifying MetS and important risk factors without pancreatic cancer before the enrollment, 87,857 suffered from pancreatic cancer. Pancreatic cancers occurred in 16,154 of 331,229 subjects (4.9%) in the MetS group and 71,703 of 2,376,067 patients (3.0%) in the non-MetS group (hazard ratio (HR), 1.37; 95% confidence interval [CI], 1.34-1.39; p<0.0001 after the adjustment with age, smoking and sex). As the number of the constituent factors of MetS increased from one to five, the incidence of pancreatic cancer correspondingly increased (HR: 1.11, 1.23, 1.42, 1.66 and 2.03 using Cox proportional hazard models, p<0.0001 each). When we defined MetS using the Japanese criteria, the results are in accord with the results using NCEP/ATPIII. Especially pre-metabolic syndrome (pre-MetS) in the Japanese criteria was tightly linked to the incidence of pancreatic cancers. MetS is confirmed to be linked to pancreatic cancer. Although we cannot conclude causality. We also demonstrated the link between pre-MetS and pancreatic cancer. The sponsors of the study were Japanese Heart Foundation and Japan Cardiovascular Research Foundation. This is also partially supported by Grants-in-Aid from the Ministry of Education, Culture, Sports, Science and Technology of Japan; and Grants-in-Aid from the Japan Agency for Medical Research and Development.