National Cholesterol Education Program Adult Treatment Panel Research Articles

Risk factors and longitudinal changes of dyslipidemia among Chinese people living with HIV receiving antiretroviral therapy

BackgroundAntiretroviral therapy (ART) improved the prognosis of people living with human immunodeficiency virus (HIV) (PLWH). Life-long treatment is required in PLWH and is accompanied by various metabolic abnormalities in the disease course. Data about the epidemiology and the dynamic changes of dyslipidemia in PLWH receiving antiretroviral therapy were scarce in Asian countries. This study aimed to explore the risk factors of dyslipidemia and analyze the longitudinal changes of dyslipidemia among Chinese PLWH receiving HAART.MethodsWe conducted a longitudinal analysis of PLWH enrolled in two large multicenter clinical trials across China, and outpatients followed at the clinic of Peking Union Medical College Hospital. Demographic data and clinical parameters were collected. The risk factors and longitudinal changes in lipid profiles associated with HIV-1 infection were analyzed. The definition of dyslipidemia was made based on the National Cholesterol Education Program, Adult Treatment Panel (NCEP-ATP) III guidelines.ResultsA total of 1542 PLWH were included. The median follow-up was 6 years. At baseline, the concentrations of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were 4.1 ± 0.91 mmol/L, 1.2 (interquartile ranges [IQR] 0.85–1.75) mmol/L, 1.1 ± 0.37 and 2.4 ± 0.76 mmol/L, respectively. The rate of hypercholesterolemia, hyperglyceridemia, high LDL-C, and low HDL-C were 10.18%, 26.39%, 9.08%, and 44.94%, respectively. The overall prevalence of dyslipidemia was 69.3%, which raised to 84.3% after antiretroviral therapy, substantially higher. CD4/CD8 ratio < 0.3 and viral load > 105 copies/mL were risk factors associated with any subtype of dyslipidemia. A negative correlation between CD8+CD38+ percentage and HDL-C concentration was found. The regimens including efavirenz (EFV) and tenofovir (TDF) showed better lipid profiles. Longitudinal analysis revealed that both the level and the percentage of abnormal TG and HDL-C occurred drastic change in the first 6 months after ART initiation (from 4.07 to 4.41, from 1.11 to 1.28mmol/L, from 26.39 to 31.1% and from 44.94 to 29.5%, respectively).ConclusionsThe prevalence of dyslipidemia is high in PLWH and increases after ART, mainly represented as high TG and low HDL-C and associated with advanced stage of HIV-1 infection. The greatest changes in lipids occurred in the early stage after initiating ART therapy. The results suggest that dyslipidemia should be monitored and managed when starting ART.

Association Between Metabolic Syndrome and Mortality: Prospective Cohort Study.

Metabolic syndrome (MetS) is a common metabolic disorder that results from the increasing prevalence of obesity, which has been an increasing concern in recent years. Previous evidence indicated that MetS was associated with mortality; however, different definitions of MetS were used. In 2005, the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III updated the definition of MetS, which has since been widely adopted. Therefore, it is necessary to conduct a novel study among other populations and countries with a larger sample size using the updated definition of MetS and death code to examine the association of MetS with all-cause and cause-specific mortality. We aimed to examine the associations of MetS with all-cause and cause-specific mortality. A total of 36,414 adults were included in this study, using data from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and the continuous NHANES (1999-2014) in the United States. Death outcomes were ascertained by linkage to National Death Index records through December 31, 2015. MetS was defined by the NCEP ATP III-2005 criterion. Complex survey design factors including sample weights, clustering, and stratification were considered for all analyses with instructions for using NHANES data. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for mortality from all causes, heart disease, diabetes, and cancer. We observed 8494 deaths during the 16.71 years of follow-up. Compared with those without MetS, individuals with MetS were associated with a significantly elevated multiadjusted HR of 1.24 (95% CI 1.16-1.33), 1.44 (95% CI 1.25-1.66), and 5.15 (95% CI 3.15-8.43) for all cause, heart diseases, and diabetes mellitus, respectively, whereas no significant association was found for cancer mortality (HR 1.17, 95% CI 0.95-1.43). Our study provides additional evidence that MetS and its components are significantly associated with all-cause, heart disease, and diabetes mortality, but not with cancer mortality. Health care professionals should pay more attention to MetS and its individual component.

Dyslipidemia and its associated factors among adult cardiac patients at Ambo university referral hospital, Oromia region, west Ethiopia

BackgroundCardiovascular disease is a cluster of illnesses that affect the heart and blood vessels. Dyslipidemia is the most common risk factor for cardiovascular disease, causing more than 4 million deaths each year worldwide. However, there is very little evidence concerning the prevalence and pattern of dyslipidemia among cardiac patients in Ethiopia.MethodsHospital-based cross-sectional study was conducted from June to September 2022 at Ambo University referral hospital. Data on socio-demographic, clinical and anthropometric features were collected from adults with cardiac diseases using a convenient sampling technique. Lipid profiles and uric acid were measured from overnight fasting blood. The national cholesterol education program adult treatment panel (NCEP-ATP) III criteria was used to define dyslipidemia.ResultsA total of 269 participants were enrolled and the overall 76.6% [95% confidence interval (CI):72.1–81] of patients had at least one dyslipidemia. The prevalence of total cholesterol (TC) ⩾200 mg/dl, triglyceride (TG), LDL-cholesterol and HDL-cholesterol < 40 mg/dl were 38.9%, 44.6%, 29.4%, and 53.5%, respectively. Age > 54 was associated with TC and TG dyslipidemia, adjusted odds ratio (aOR) and (95% CI) were 2.6(1.4–4.8) and 2.4(1.2–4.7), respectively. While, a family history of heart disease, sedentary lifestyle and obesity were associated with TC dyslipidemia, aOR (95%CI) were 1.9(1.1–3.5), 1.4 (1.4–14.6) and 6.7 (1.4–32.5), respectively. In addition, diabetetes mellitus and abdominal obesity were significantly associated with TG dyslipidemia, aOR (95%CI) were 1.9(1.0–3.6) and 2.6(1.16–5.8), respectively. Moreover, uric acid was positively correlated with TC and TG level.ConclusionsThe results indicate that more than 75% of the cardiac patients had at least one dyslipidemia. This reflects the need for regular monitoring of lipid profiles and intensive counseling in this population to mitigate further cardio-metabolic complications.

Dietary choline and betaine intake, cardio-metabolic risk factors and prevalence of metabolic syndrome among overweight and obese adults

BackgroundCholine is an important metabolite involved in phospholipids synthesis, including serum lipids, and is the immediate precursor of betaine. There are numerous studies with inconsistent results that evaluated the association between dietary choline intakes with cardiovascular risk factors. In addition, the association between dietary betaine and choline intakes with cardio-metabolic risk factors is not well studied. In the current study, our aim was to evaluate dietary choline and betaine intakes in the usual diet of obese individuals and to assess its association with serum lipids, blood pressure and glycemic markers among obese individuals.MethodsWe recruited a total number of 359 obese people aged between 20 and 50 years in the present study. A semi-quantitative food frequency questionnaire (FFQ) was used for dietary assessment; dietary choline and betaine intakes were calculated using the United States Department of Agriculture (USDA) database. National cholesterol education program adult treatment panel (NCEP-ATP)-III criteria was used metabolic syndrome (MetS) definition. Enzymatic methods were used to assess biochemical variables. Body composition was measured with the bioelectrical impedance analysis (BIA) method.ResultsHigher body mass index (BMI), waist to hip ratio (WHR), fat-free mass (FFM) and basal metabolic rate (BMR) were observed in higher tertiles of dietary choline intake (P < 0.01). There was no significant difference in terms of biochemical parameters among different tertiles of dietary choline intake, while systolic blood pressure (SBP) and diastolic blood pressure (DBP) were reduced in higher betaine tertiles (P < 0.05). For total dietary choline and betaine intakes, there was a reduction in DBP and low density lipoprotein (LDL) concentrations (P < 0.05). Also, a non-significant reduction in serum total cholesterol (TC), triglyceride (TG) and MetS prevalence was observed in higher tertiles of dietary choline and betaine intakes. After classification of the study population according to MetS status, there was no significant difference in biochemical variables in subjects with MetS (P > 0.05), while in the non-MetS group, SBP, DBP, TG and insulin levels reduced in higher tertiles of dietary betaine and choline (P > 0.05).ConclusionAccording to our findings, higher dietary intakes of choline and betaine were associated with lower levels of blood pressure and LDL concentrations among obese individuals. Further studies are warranted to confirm the results of the current study.

Metabolic syndrome in a cohort of rheumatoid arthritis patients

Objectives. We aimed to assess the presence of MetS and traditional CV risk factors in a group of RA patients, compared to controls and their possible inter-relation with disease activity variables. Methods. We performed an observational study on 38 consecutive patients diagnosed with RA in Rheumatology Department of the Emergency County Hospital Craiova, based on ACR/EULAR criteria, in a one year interval between 2019-2020, and a control group including 30 subjects. Patients’ data were obtained from each subject according to the study protocol and included demographic, clinical, laboratory parameters. The presence of MetS was assessed according to the National Cholesterol Education Program Adult Treatment Panel (NCPATP) III. Results. Regarding the components of metabolic syndrome, as defined by NCPATP III, the differences established for the RA vs control groups were: increased waist circumference in 21 (52.25%) vs 13 (43.33%) subjects (p=0.002); high triglycerides (or under treatment) in 10 (26.31%) vs 6 (20%) subjects, p=0.004; low HDL cholesterol in 15 (39.47%) vs 7 (23.33%) subjects, p=0.002; high blood pressure (or under treatment) in 25 (65.79%) vs 12 (40%) subjects, p&lt;0.0001; high blood glucose (or under treatment) in 7 (18.42%) vs 8 (26.66%) subjects, p= 0.08. Our data revealed a positive correlation between disease activity index and smoking (r=0.432, p=0.02), as well as between DAS 28-CRP and LDL cholesterol (r=0.454, p=0.004), or triglycerides (r=0.337, p=0.03). We also observed a strong, positive correlation between the presence of MetS and disease activity score (r=0.645, p&lt;0.0001). Conclusions. Metabolic syndrome is associated with a high cardiovascular risk, the main cause of mortality in RA patients. Due to the chronic inflammatory state and the intervention of both traditional and non-traditional cardiovascular risk factors, each patient should undergo periodic evaluations, in order to apply an adequate and early therapeutic intervention and reduce further cardiovascular morbidity and mortality rates.

Cardiometabolic risk factors and metabolic syndrome based on severity of obesity in Korean children and adolescents: data from the Korea National Health and Nutrition Examination Survey 2007-2018.

Data regarding cardiometabolic risk factors (CMRFs) and metabolic syndrome (MetS) by body mass index (BMI) category in Korean youth are sparse. Among the participants of the Korea National Health and Nutrition Examination Survey 2007-2018, 9,984 youth aged 10-18 years were included in the study. Participants were classified into 4 groups based on BMI status: normal weight, overweight, class I, and class II/III obesity. CMRF prevalence, including total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, blood pressure, fasting glucose, glycated hemoglobin, and MetS, were determined using the International Diabetes Federation (IDF) and modified National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) III criteria based on BMI category. The prevalence of overweight, class I, class II, and class III obesity was 9.52%, 7.73%, 2.10%, and 0.32%, respectively. Mean CMRF values increased with BMI, except high-density lipoprotein cholesterol. Age- and sex-adjusted odds ratios (ORs) for prediction of CMRFs also increased with BMI. Adjusted ORs for MetS among overweight, class I, and class II/II obesity were 54.2, 283.3, and 950.3 for IDF criteria and 9.56, 37.9, and 126.8 for NCEP-ATP III criteria, respectively (all p<0.001). Class II and III obesity in Korean children and adolescents was associated with significantly increased CMRF and MetS prevalence. Therefore, it can be useful to measure CMRFs in obese children and adolescents. Further studies are required to establish screening guidelines based on obesity severity.

Association between periodontitis and metabolic syndrome in the Hamburg City Health Study.

Previous studies demonstrated an association between severe chronic periodontitis (CP) and metabolic syndrome (MetS). However, these studies mostly used the outdated National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) III case definition of MetS. Additionally, CP was rarely diagnosed based on a full-mouth examination. Thus, the aim of the current study was to re-evaluate the potential association between CP and MetS in the Hamburg City Health Study (HCHS), a large population-based survey of middle-aged and elderly men and women in Germany, in view of more current definitions of MetS and CP. A cross-sectional study was performed with baseline-data from participants of the HCHS. Periodontitis severity grades were determined in a random sample of 6,209 participants of which 5,456 had sufficient data to call absence or presence of MetS. Variables defining MetS according to the currently valid harmonized definition were determined and a full-mouth examination was performed, including determination of the clinical attachment loss, bleeding on probing, and dental plaque index. CP was classified in three grades of severity (none/mild, moderate, and severe). The Kruskal-Wallis test or the Chi-squared test were used for descriptive statistics and multivariate logistic regression models with and without adjustments for potential confounders (age, sex, smoking, high-sensitivity C-reactive protein [hsCRP], energy intake, and physical activity) were used to test for associations. The prevalence of MetS (39.0%) increased according to the severity grades of periodontitis (none/mild: 33.6%; moderate: 38.7%, and severe: 46.8%). Multivariate logistic regression analyses demonstrated that severe but not moderate CP was associated with MetS after adjusting for age and sex (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.03 to 1.48; P=0.02). However, the association was attenuated after additional adjustment for smoking (OR, 1.19; 95% CI, 0.99 to 1.43; P=0.058) and hsCRP, energy intake, and physical activity (OR, 1.11; 95% CI, 0.91 to 1.36; P=0.294). The use of the more current definitions for MetS and CP confirmed previous observations of an age- and sex-adjusted association between severe CP and MetS. Smoking, high-energy intake, and low physical activity were identified as important lifestyle-related confounders. Abdominal obesity, as indicated by elevated waist circumference, was determined as the most important component of MetS in relationship to CP.

A CROSS -SECTIONAL STUDY OF METABOLIC SYNDROME IN HYPOTHYROID PATIENTS

Hypothyroidism and metabolic syndrome are well-associated risk factors for atherogenic cardiovascular disease. Insulin resistance, being a common pathogenic mechanism in both, can cause a considerable overlap between hypothyroid and metabolic syndrome population. This crosssectional study was intended to assess the thyroid function in patients with metabolic syndrome and to investigate the association between hypothyroidism and metabolic syndrome.One hundred patients with metabolic syndrome as per National Cholesterol Education Program-Adult Treatment Panel (NCEPATP) III criteria and 50 controls (0 out of 5 criteria) attending the internal medicine outpatient clinic were included in the study. Patients were subjected to anthropometry, evaluation of vital parameters, and lipid and thyroid prole, along with other routine laboratory parameters. Students' "t" test, Chi-square test, linear regression, and multiple logistic regression models were used for statistical analysis. P value &lt;0.05 was considered signicant.Body mass index, waist circumference, mean systolic pressure, diastolic pressure, fasting blood sugar, total cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides, and thyroid stimulating hormone (TSH) were signicantly higher, and free triiodothyronine (FT3), free thyroxine (FT4), and high density lipoprotein (HDL) cholesterol were signicantly lower in the study group compared to the control group. In the metabolic syndrome group, 22 had subclinical hypothyroidism (22%), 4 were overtly hypothyroid (4%), and 74 were euthyroid (74%). Subclinical hypothyroidism was signicantly associated with metabolic syndrome group (P = 0.032). There was signicant linear association between TSH levels and total cholesterol, triglycerides, LDL cholesterol, and HDL cholesterol across the metabolic syndrome group in the linear regression model. Multiple logistic regression analysis recognized the association between body mass index with subclinical hypothyroidism (P= 0.006) in the metabolic syndrome group

Healthy Promotion for Fighting Metabolic Syndrome: Insights from Multi-Center HeRO-FiT Cohort.

We know that metabolic syndrome (MS) is a modern cardiovascular (CV) “epidemic”, especially in western populations. MS is indeed strictly related to the risk of developing CV diseases (CVD) and/or diabetes. Therefore, the aim of our multi-center study was to promote a “healthy style” for fighting MS. Each participating center analyzed its own database of outpatients and globally we have pulled out 100 volunteers to participate in the study. Before starting, we collected their written consent. Enrolled subjects have not any history of overt CVD and/or diabetes, but they matched National Cholesterol Education Program/Adult Treatment Panel (NCEP/ATP) criteria for MS. After enrolment (t0), subjects were randomly divided into two homogeneous groups: a) only diet suggestions; b) both diet and exercise prescription. Later, we measured for each subject: blood pressure (BP), heart rate (HR), height, weight, body mass index (BMI), waist circumference (WC), waist hip ratio (WHR), six-minute walking test (WT6M), distance and common blood tests such as fasting plasma glucose, high-density lipoproteins (HDL) and triglycerides (T1 assessments). At six months (T2), the same parameters were measured and then statistical comparisons were performed. Attention to diet caused significant changes only in WC and WHR, whilst a coupling of exercise and diet revealed a statistically significant improvement in HR, BP, BMI, blood samplings and WT6M too. In conclusion, a healthy lifestyle should be more encouraged by physicians and/or collaborators (such as dieticians) operating in preventive settings. Diet and physical activity may be early useful strategies in the “battle” against MS even before any medication choices. Further studies will be necessary in order to better address the topic.

Which obesity index is more compatible in predicting metabolic syndrome? A population based study?

Metabolic syndrome (MS) is a cluster of cardiometabolic factors predisposing to diabetes and cardiovascular disease. The purpose of this study was to compare the different indexes, including the obesity index, the lipid accumulation product index (LAP), and the cardiometabolic index (CMI) to predict the MS. A total of 2708 individuals, aged 35 to 69 years were included came in a community based cross-sectional survey from in Great Tunis. Waist circumferences (WC), body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) were determined. LAP and CMI were calculated. MS was defined using 3 different definitions: the National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP) III, National Heart, Lung and Blood Institute/American Heart Association (NHLBI/AHA), and International Diabetes Federation (IDF). The prevalence of MS is 30.4%, 38.2%, 35.2% from NCEP-ATP, IDF and AHA//NHLBI criteria respectively. CMI showed better area under the curve (AUC) for MS in three different criteria (AUC = 0.873 (NCEP-ATP), AUC = 0.850 (IDF), AUC = 0.858 (AHA//NHLBI)) than the others indexes: LAP, WHtR, WC, BMI and WHR. Even after adjustment of age, gender, current smoking, family history of cardiovascular diseases, educational status, CMI showed better area under the curve (AUC = 0.895 (NCEP-ATP), AUC = 0.879 (IDF) and AUC = 0.891 (AHA//NHLBI). Independent of age and gender, CMI is good predictor factor in the diagnosis of the MS.

Usefulness of waist-to-height ratio in screening incident metabolic syndrome among Japanese community-dwelling elderly individuals.

This study examined a range of anthropometric indices and their relationships with metabolic syndrome (MetS). Despite recommendations that central obesity assessment should be employed as a marker of metabolic health, there is no consensus regarding the protocol for measurement. The present study included 720 men aged 71 ± 8 years and 919 women aged 71 ± 7 years from a rural village. We examined the relationship between anthropometric indices {e.g., body mass index (BMI), waist-to-height ratio (WHtR), waist-to-hip ratio (WHpR)}, and MetS based on the modified criteria of the National Cholesterol Education Program’s Adult Treatment Panel (NCEP-ATP) III report in a cross-sectional (N = 1,639) and cohort (N = 377) data. A receiver operating curve (ROC) analysis was performed to determine the optimal cut-off value and best discriminatory value of each of these anthropometric indices to predict MetS. In the cross-sectional study, WHtR as well as BMI and WHpR showed significantly predictive abilities for MetS in both genders; and WHtR showed the strongest predictive ability for the presence of MetS. Also in the cohort study, WHtR as well as BMI and WHpR showed significantly predictive abilities for incident MetS in both genders, and in men WHtR showed the strongest predictive ability for incident MetS, but in women BMI showed the strongest predictive ability. In the cross-sectional study, the optimal WHtR cutoff values were 0.52 (sensitivity, 71.0%; specificity, 77.9%) for men and 0.53 (sensitivity, 79.8%; specificity, 75.7%) for women. In the cohort study, the optimal WHtR values were 0.50 (sensitivity, 60.7%; specificity, 73.2%) for men and 0.50 (sensitivity, 75.0%; specificity, 56.1%) for women. Increased WHtR was significantly and independently associated with prevalence of MetS in both genders. These results suggest that WHtR is a useful screening tool for determining metabolic risk in Japanese elderly community dwelling individuals.

Serum klotho is inversely associated with metabolic syndrome in chronic kidney disease: results from the KNOW-CKD study

BackgroundMetabolic syndrome (MS) is prevalent in chronic kidney disease (CKD). Klotho, a protein linked to aging, is closely associated with CKD. Each component of MS and klotho has an association. However, little is known about the association between klotho and MS per se. We investigated the association between serum klotho levels and MS using baseline cross-sectional data obtained from a large Korean CKD cohort.MethodsOf the 2238 subjects recruited in the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD) between 2011 and 2016, 484 patients with missing data on serum klotho and extreme klotho values (values lower than the detectable range or > 6000 pg/mL) or with autosomal dominant polycystic kidney disease patients were excluded. The data of the remaining 1754 subjects were included in the present study. MS was defined using the revised National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP) III criteria. Serum klotho levels were measured using an enzyme-linked immunosorbent assay.ResultsMean patient age was 54.9 ± 12.1 years and 1110 (63.3%) were male. The prevalence of MS among all study subjects was 63.7% (n = 1118). The median serum klotho level was 527 pg/mL (interquartile range [IQR]: 418–656 pg/mL). Serum klotho level was significantly lower in MS patients than patients without MS (Median [IQR]; 521 pg/mL [413, 651] vs. 541 pg/mL [427, 676], respectively; P = 0.012). After adjusting for age, sex, estimated glomerular filtration rate, and overt proteinuria, serum klotho was independently associated with MS (adjusted odds ratio [OR], 0.44; 95% confidence interval, 0.23–0.82; P = 0.010). Furthermore, the adjusted OR for MS was found to be significantly increased at serum klotho levels of < 518 pg/mL (receiver operating characteristic curve cut-off value).ConclusionsSerum klotho was inversely associated with the presence of MS in patients with CKD.Trial registrationThis trial was registered on ClinicalTrials.gov on 26 June 2012 (https://clinicaltrials.gov;NCT01630486).

Total bilirubin independently predicts incident metabolic syndrome among community-dwelling women

BackgroundMetabolic syndrome (MetS) is related to the increased risk of major cardiovascular diseases (CVD). The link between high serum total bilirubin (TBL) is cross-sectionally related to MetS and its components. However, whether serum TBL predicts incidence of MetS and its components remains inconclusive. MethodsThe present study included 893 women aged 70 ± 9 years from a rural village. We examined the relationship between serum TBL and MetS based on the modified criteria of the National Cholesterol Education Program's Adult Treatment Panel (NCEP-ATP) III report in a cross-sectional (N = 893) and cohort (N = 288) data. ResultsIn the cross-sectional study, serum TBL (β = 0.536, p < 0.001) as well as age, alcohol consumption, exercise habits, history of CVD, SUA, GGT, and ALT was significantly and dependently associated with number of MetS components, but in the cohort study serum TBL was not associated with number of MetS components. Compared with the 1st tertile of serum TBL (0.20–0.55 mg/dL), multivariate-adjusted odds ratio (95% confidence interval) for the 2nd -3rd tertiles of serum TBL (0.54–2.00 mg/dL) was 0.70 (0.51–0.95) in the cross-sectional study and 0.41 (0.21–0.81) in the cohort study. ConclusionsOur data demonstrated an independently negative association between serum TBL and MetS in Japanese community-dwelling women.

Baseline and changes in serum uric acid independently predict 11-year incidence of metabolic syndrome among community-dwelling women

Metabolic syndrome (MetS) is associated with an increased risk of major cardiovascular events. In women, increased serum uric acid (SUA) levels are associated with MetS and its components. However, whether baseline and changes in SUA predict incidence of MetS and its components remains unclear. The subjects comprised 407 women aged 71±8years from a rural village. We have identified participants who underwent a similar examination 11years ago, and examined the relationship between baseline and changes in SUA, and MetS based on the modified criteria of the National Cholesterol Education Program's Adult Treatment Panel (NCEP-ATP) III report. Of these subjects, 83 (20.4%) women at baseline and 190 (46.7%) women at follow-up had MetS. Multiple linear regression analysis was performed to evaluate the contribution of each confounding factor for MetS; both baseline and changes in SUA as well as history of cardiovascular disease, low-density lipoprotein cholesterol, and estimated glomerular filtration ratio (eGFR) were independently and significantly associated with the number of MetS components during an 11-year follow-up. The adjusted odds ratios (ORs) (95% confidence interval) for incident MetS across tertiles of baseline SUA and changes in SUA were 1.00, 1.47 (0.82-2.65), and 3.11 (1.66-5.83), and 1.00, 1.88 (1.03-3.40), and 2.49 (1.38-4.47), respectively. In addition, the combined effect between increased baseline and changes in SUA was also a significant and independent determinant for the accumulation of MetS components (F=20.29, p<0.001). The ORs for incident MetS were significant only in subjects with age ≥55years, decline in eGFR, and no baseline MetS. These results suggested that combined assessment of baseline and changes in SUA levels provides increased information for incident MetS, independent of other confounding factors in community-dwelling women.

Low Density Lipoprotein Cholesterol (LDL-C) Target Goal Achievement Rate According to Physicians’ Compliance to Established Clinical Guidelines from National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) and American College of Cardiology/American Heart Association (ACC/AHA): Results from Korea Cristar Study

Low Density Lipoprotein Cholesterol (LDL-C) Target Goal Achievement Rate According to Physicians’ Compliance to Established Clinical Guidelines from National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) and American College of Cardiology/American Heart Association (ACC/AHA): Results from Korea Cristar Study

Alanine Aminotransferase and Total Bilirubin Are Synergistically Associated with Metabolic Syndrome Among Middle-Aged and Elderly Japanese Women.

Metabolic syndrome (MetS) is associated with an increased risk of major cardiovascular events. Alanine aminotransferase (ALT) at high levels and total bilirubin (T-BiL) at low levels were oxidative potentials, but it was uncertain whether ALT and T-BiL had an additive interaction for the risk of MetS. From a single community, we recruited 864 women (70 ± 8 years) during their annual health examination. We cross-sectionally investigated whether ALT and T-BiL are associated with MetS and its components based on the modified criteria of the National Cholesterol Education Program's Adult Treatment Panel (NCEP-ATP) III report. Of these subjects, 415 women (48.0%) had MetS. Participants with MetS had a higher ALT and lower T-BiL level than those without MetS. The adjusted-odds ratios (OR) (95% confidence interval [CI]) for MetS across tertiles of ALT and T-BiL were 1.00, 1.19 (0.78-1.81), and 1.86 (1.24-2.80) and 1.00, 0.96 (0.65-1.43), and 0.54 (0.36-0.81), respectively. When ALT and T-BiL were categorized into three binary characteristics by tertiles of ALT and T-BiL, high T-BiL was associated with decreased risk for MetS in a multivariable model (OR: 0.55, 95% CI: 0.37-0.82), especially among those with 1st tertile ALT. Similarly, high ALT was also associated with increased risk for MetS in a multivariate model (OR: 1.81, 95% CI: 1.20-2.71), especially among those with 2nd & 3rd tertiles of T-BiL. In the formal testing of addictive interaction between ALT and T-BiL for MetS, presence of T-BiL <0.72 mg/dL (1st and 2nd tertile) alone was not associated with increased risk of MetS in a multivariate analysis, and presence of ALT ≥16 IU/L (2nd and 3rd tertile) alone was not associated with increased risk of MetS. These results suggested that higher ALT and lower T-BiL levels were synergistically associated with MetS, independent of other confounding factors among Japanese women.

Metabolic Syndrome in Apparently "Healthy" Ghanaian Adults: A Systematic Review and Meta-Analysis.

Background Metabolic syndrome (MetS) is a major public health problem in Sub-Saharan Africa. We systematically reviewed the literature towards estimating the prevalence of MetS among apparently “healthy” Ghanaian adults. Methods We searched PubMed, Web of Science, Scopus, Africa Journals Online, African Index Medicus, and Google scholar as well as the websites of the Ministry of Health and Ghana Health service through September 2016. Only studies conducted among apparently “healthy” (no established disease, e.g., diabetes and hypertension) adults aged ≥ 18 years were considered. Only studies that utilised the National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP), World Health Organization (WHO), or International Diabetes Federation (IDF) classifications for MetS were included. Results Data from nine studies involving 1,559 individuals were pooled. The prevalence of MetS based on NCEP-ATP, WHO, and IDF classifications was 12.4% (95% confidence interval [CI] = 8.3–17.4%), 6.0% (95% CI = 1.4–13.1%), and 21.2% (95% CI = 12.4–30.9), respectively. Prevalence of MetS was higher among women than men. Conclusion Among a population of adult Ghanaians deemed “healthy,” there is a high prevalence of MetS. Preventive measures are required to address the risk components of MetS such as obesity and hypertension which are rapidly rising in Ghana.

Association of neutrophil-lymphocyte ratio with metabolic syndrome and its components in Asian Indians (CURES-143)

BackgroundMetabolic syndrome (MS) is the state of chronic low grade inflammation. This study looks at the relationship of neutrophil-lymphocyte ratio (NLR) in subjects with and without MS in Asian Indians. MethodsStudy subjects (n=754) were recruited from the Chennai Urban Rural Epidemiology Study. MS was defined using the National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) III criteria modified for waist according to World Health Organization Asia Pacific guidelines. A complete hemogram was done in all subjects using a five-part hematology analyzer (model SF-3000; Sysmex, Kobe, Japan). The NLR was calculated as the ratio between counts for neutrophils and total lymphocytes in subjects with (n=422) and without (n332) MS and correlated with number of metabolic abnormalities in those with MS. ResultsSubjects with five metabolic abnormalities had the highest NLR, and with decreasing number of metabolic abnormalities, the NLR decreased linearly (p for trend <0.001). Logistic regression analysis revealed that even after adjusting for age, gender and body mass index, MS was strongly associated with NLR (p<0.001). ConclusionAmong Asian Indians, NLR is correlated with MS and also with the number of metabolic abnormalities.

Apolipoprotein B/Apolipoprotein A1 ratio is associated with sex hormone binding globulin and may be an indicator of metabolic syndrome in PCOS women

Objective To identify significant factors related to the apolipoprotein B/apolipoprotein A1 (apoB/A1) ratio and investigate the association between the apoB/A1 ratio and metabolic syndrome (MS) in polycystic ovary syndrome (PCOS) women. Methods Totally 307 subjects with PCOS were collected and recruited fulfilling the revised 2003 Rotterdam diagnostic criteria. MS was diagnosed by the National Cholesterol Education Program-Adult treatment Panel (NCEP-ATP) III criteria. Results The prevalence of MS in PCOS women was 31.6%, whose average age was 26.2 ± 5.2 years. The apoB/A1 ratio was significantly correlated with age, body mass index (BMI), waist circumference (WC), hip circumference, waist-to-hip ratio, blood pressure, metabolic abnormalities, sex hormone binding globulin (SHBG), and free androgen index. In addition, SHBG had a significant association with all five component risk of MS. The increasing apoB/A1 ratio was associated with the prevalence of MS and was one of the risk factors of MS. Conclusion SHBG was considered as an additional potential factor in predicting the metabolic abnormity in PCOS women. The apoB/A1 ratio is associated with SHBG and might be an indicator of MS in PCOS women.

Prevalence of Metabolic Syndrome and its Related Risk Factors in the City of Oran, Algeria: the ISOR Study.

Aging and lifestyle changes had led to an epidemiological transition, with a significant impact on the incidence of cardiovascular diseases in North Africa. The aim of this study was to determine the prevalence of metabolic syndrome and its associated factors, which were unknown, among an urban population in Algeria. During 2007-2009, 787 individuals aged 30-64 years, randomly selected from the list of insured persons residing in the city of Oran, participated in a clinical, anthropometric and biological survey. Participants were classified according to the National Cholesterol Education Program - Adult Treatment Panel (NCEP-ATP) III definition of metabolic syndrome. The prevalence of metabolic syndrome was 20%, higher in women than men (25.9 vs 13.7%; P<.0001). Among the components of the syndrome, the most common risk factors observed in women were a low high-density lipoprotein (HDL) cholesterol concentration (60.4% vs 44.2% in men) and abdominal obesity (46.8% vs 30.1% in men) whereas men displayed more high blood pressure (42.5% vs 34.8% in women). In men, metabolic syndrome was more frequent in married and highly educated participants. In contrast, women with a high level of education and who had an intermediate level of physical activity seemed to be protected. Metabolic syndrome, prevalent in the urban population of North Algeria, is associated with a high proportion of low HDL-cholesterol and abdominal obesity, especially among women. There is a need for prevention strategies involving promotion of physical activity for the whole population and screening for hypertension among men.