MetSyn Components Research Articles

Circulating oxidized LDL predicts future metabolic syndrome independent of lipid levels in the CARDIA study

Experimental data suggest that oxidized LDL (oxLDL) is associated with the metabolic syndrome (MetSyn). However, this hypothesis has not been tested in man. To establish its relation with MetSyn, plasma oxLDL was measured with a competition monoclonal antibody based ELISA in 2823 Black and White participants in year 15 of the U.S. Coronary Artery Risk Development in Adults (CARDIA) study. Prevalence of MetSyn, following the Adult Treatment Panel III of the National Cholesterol Education Program, was 14.6% at year 15. The cross-sectional odds ratio for MetSyn in highest vs. lowest quintile of oxLDL was over 10, adjusted for age, gender, race, study center, cigarette smoking, BMI, physical activity, and LDL-cholesterol; little changed by further adjustment for C-reactive protein, and adiponectin. Cumulative 5-year MetSyn incidence was 13.3% (n = 254) in 1,909 participants free of MetSyn at year 15. The fully adjusted incidence OR in the highest vs. lowest quintile of oxLDL was 4.4 (95% CI 2.4–8.2). The incidence odds ratios for dichotomous MetSyn components in highest vs. lowest oxLDL quintile were 2.2 for abdominal obesity, 2.4 for triglycerides, and 2.5 for fasting glucose. Although oxLDL showed a graded relation to diabetes cross-sectionally, prediction of future diabetes was not significant. In conclusion, higher concentrations of oxLDL relate to concurrent presence of MetSyn and indicate a greater disposition to future MetSyn, especially abdominal obesity, hypertriglycemia, and glycemia.

Increased Small Low-Density Lipoprotein Particle Number

Levels of LDL cholesterol (LDL-C) are frequently not elevated in individuals with the metabolic syndrome (MetSyn). However, the atherogenic potential of LDL may depend on the number and size of LDL particles in addition to the cholesterol content of LDL. We examined the sex-specific cross-sectional relations of small LDL particle number (determined by nuclear magnetic resonance spectroscopy) to the presence of MetSyn and its components in 2993 Framingham Heart Study participants (mean age, 51 years; 53% women) without cardiovascular disease (CVD) and the relations of small LDL particle number to CVD incidence in people with MetSyn. The MetSyn (> or =3 of 5 traits as defined by the National Cholesterol Education Adult Treatment Panel III) was present in 27% of men and 17% of women. In both sexes, small LDL particle number increased from 0 to 5 MetSyn traits, a pattern partly accounted for by strong correlations between small LDL particle number and serum triglycerides (r=0.61, P<0.0001) and HDL-C (r=-0.55, P<0.0001). Compared with participants without the MetSyn, those with the MetSyn had a higher CVD event rate. However, among participants with the MetSyn, CVD rates were similar for groups with an elevated versus a lower number of small LDL particles (defined by the sex-specific median). Small LDL particle number is elevated in the MetSyn, increases with the number of MetSyn components, and most prominently is correlated with triglycerides and HDL-C. Whereas increased small LDL particle number identified the MetSyn with high sensitivity, a higher small LDL particle number was not associated with greater CVD event rates in people with the MetSyn.

The ORlistat and CArdiovascular risk profile in patients with metabolic syndrome and type 2 DIAbetes (ORliCARDIA) study

SUMMARYBackground: Metabolic syndrome (MetSyn) is associated with a marked increase in the risk of cardiovascular disease, especially in patients with type 2 diabetes mellitus (DM).Aim: To investigate the effect of orlistat plus hypocaloric diet (HCD) vs HCD alone on the cardiovascular risk profile in patients with both MetSyn (National Cholesterol Educational Program – NCEP – Adult Treatment Panel III definition) and type 2 DM.Methods: This was a prospective, multicentre, open-label, randomized, controlled study. One hundred and twenty-six patients, free of cardiovascular disease at baseline, were included in the final analysis. Ninety-four (73%) patients were treated with orlistat (360 mg/day) and HCD for a 6-month period, while 34 (27%) were on HCD alone. Analysis of covariance was used to assess differences between the treatment groups over time.Main outcome measures: Components of the MetSyn criteria assessed were: waist circumference; systolic and diastolic blood pressure; fasting glucose, triglycerides; high-density lipoprotein cholesterol (HDL-C) plus body mass index; glycosylated haemoglobin (HbA1C); homeostasis model for assessment of insulin resistance (HOMA) index; and total and low-density lipoprotein cholesterol (LDL-C).Results: By protocol, all patients had MetSyn at baseline. After a 6 month treatment period there were significant differences between the orlistat plus HCD vs the HCD-alone groups in body weight ( p = 0.0001), waist circumference ( p < 0.0001), fasting glucose ( p < 0.0001), HbA1C ( p < 0.0001), systolic blood pressure ( p = 0.024), total cholesterol ( p < 0.0001), LDL-C ( p = 0.034), and HOMA index ( p = 0.022), while there were no significant differences in triglycerides and HDL-C. Orlistat was well tolerated. By the end of the study, 65% of the patients on orlistat plus HCD were still meeting the MetSyn criteria and 41% had four to five MetSyn components vs 91% ( p < 0.0001) and 53% ( p = 0.017), respectively, of those on HCD alone.Conclusions: Orlistat plus HCD favourably modified several cardiovascular risk factors in patients with both MetSyn and type 2 DM. These effects might partly offset the excess cardiovascular risk and improve outcome in this patient population.