Syndrome In Older Men Research Articles

Takotsubo Syndrome in Older Men - Clinical Characteristics Differ by Sex and Age.

Background: Takotsubo syndrome (TTS) in male patients is under-studied, particularly in the older population. Methods and Results: From 226 patients with TTS, 44 older male patients (prevalence rate: 19.5%, age: median 77 years) were compared with 182 older female patients (prevalence rate: 80.5%, age: median 80 years). Emotional triggers of TTS were less frequent (2% vs. 19%; P=0.007), whereas physical triggers were more frequent (75% vs. 58%; P=0.040) in older men than in women. Among physical triggers, serious respiratory infection was more common in older men than in women. As initial clues to the diagnosis, ECG T-wave inversion was more frequent (48% vs. 29%; P=0.018) and chest pain and/or dyspnea were less common (23% vs. 38%; P=0.050) in older men than in women. In total, 14 patients (6%) had cardiogenic shock and 41 (18%) had severe heart failure as complications, although there were no significant differences in the frequency of these complications between older men and women. Although cardiac death occurred in 3 female patients (1%) and noncardiac death in 3 male and 5 female patients (4%), there were no significant differences in death rate between older men and women. Conclusions: Emotional triggers of TTS were extremely infrequent whereas physical triggers were common in older men. Although severe heart failure was common, there were no significant differences in the frequency of complications and in-hospital deaths between older men and women.

Multiplatform metabolomics for an integrative exploration of metabolic syndrome in older men.

BackgroundMetabolic syndrome (MetS), a cluster of factors associated with risks of developing cardiovascular diseases, is a public health concern because of its growing prevalence. Considering the combination of concomitant components, their development and severity, MetS phenotypes are largely heterogeneous, inducing disparity in diagnosis.MethodsA case/control study was designed within the NuAge longitudinal cohort on aging. From a 3-year follow-up of 123 stable individuals, we present a deep phenotyping approach based on a multiplatform metabolomics and lipidomics untargeted strategy to better characterize metabolic perturbations in MetS and define a comprehensive MetS signature stable over time in older men.FindingsWe characterize significant changes associated with MetS, involving modulations of 476 metabolites and lipids, and representing 16% of the detected serum metabolome/lipidome. These results revealed a systemic alteration of metabolism, involving various metabolic pathways (urea cycle, amino-acid, sphingo- and glycerophospholipid, and sugar metabolisms…) not only intrinsically interrelated, but also reflecting environmental factors (nutrition, microbiota, physical activity…).InterpretationThese findings allowed identifying a comprehensive MetS signature, reduced to 26 metabolites for future translation into clinical applications for better diagnosing MetS.

Obesity and the metabolic syndrome in older men

Obesity and the metabolic syndrome in older men

High serum oxytocin is associated with metabolic syndrome in older men – The MINOS study

AimOxytocin regulates food intake, carbohydrate and lipid metabolism, and urinary sodium excretion. We assessed the association between serum oxytocin levels and presence of metabolic syndrome (MetS) in older men. MethodsCross-sectional study was performed in 540 volunteer men aged 50–85yrs from the MINOS cohort. Oxytocin was measured in fasting serum by radioimmunoassay (Oxytocin RIA, Phoenix Pharmaceuticals). MetS was diagnosed using the harmonized definition. ResultsSerum oxytocin was higher in 166 men with MetS vs. controls (p<0.005). After adjustment for confounders including leptin, higher oxytocin was associated with higher odds of MetS (OR=1.38 per SD, 95%CI: 1.10–1.71, p<0.005). Men with serum oxytocin >0.74pg/mL (median) had higher odds of MetS vs. men with oxytocin ⩽0.74pg/mL (OR=2.06, 95%CI: 1.33–3.18, p<0.005). Higher oxytocin levels and low testosterone levels (total or free) were significantly associated with higher odds of MetS jointly and independently of each other. Men having oxytocin >0.74pg/mL and total testosterone <300ng/dL (<10.4nmol/L) had higher odds of MetS vs. men without these characteristics (OR=3.95, 95%CI: 1.65–9.46, p<0.005). Men having 25-hydroxycholecalciferol levels <30ng/mL and oxytocin >0.74pg/mL had higher odds of MetS vs. men without these characteristics (OR=2.86, 95%CI: 1.47–5.58, p<0.01). Men having oxytocin >0.74pg/mL and osteocalcin levels <14.6ng/mL (lowest quartile) had higher odds of MetS vs. men without these characteristics (OR=4.12, 95%CI: 2.07–8.20, p<0.001). ConclusionIn older men, higher serum oxytocin levels are associated with higher odds of MetS regardless of potential confounders.

Associations between circulating reproductive hormones and SHBG and prevalent and incident metabolic syndrome in community-dwelling older men: the Concord Health and Ageing in Men Project.

The causal relationship between metabolic syndrome and reproductive hormones is unclear. This study sought to examine the cross-sectional, longitudinal, and predictive associations between reproductive hormones and SHBG and metabolic syndrome in older men. Men ages 70 years and older from the Concord Health and Ageing in Men Project study (n = 1705) were assessed at baseline and 2-year follow-up. At baseline, T, dihydrotestosterone (DHT), estradiol, and estrone were measured by liquid chromatography-tandem mass spectrometry, and SHBG, LH, and FSH by immunoassay. Metabolic syndrome was defined using the P National Cholesterol Education Program (NCEP) Adult Treatment Panel III criteria. In cross-sectional data, significant associations between each of T, SHBG, DHT, and calculated free testosterone (cFT) with the metabolic syndrome remained significant after multivariate adjustment. In longitudinal analyses, however, only lower SHBG was significantly associated with incident metabolic syndrome over the 2-year follow-up (P for linear trend = .04). Although low serum T, DHT, SHBG, and cFT were associated cross-sectionally with metabolic syndrome among community-dwelling older men, over a 2-year follow-up period only SHBG remained significant after multivariate adjustment. This suggests that lowered circulating androgens (T and DHT) may be biomarkers rather than causally related to incident metabolic syndrome.

Adiposity measurements in association with metabolic syndrome in older men have different clinical implications

Obesity is a major public health problem, and measuring adiposity accurately and predicting its future comorbidities are important issues. Therefore, we hypothesized that 4 adiposity measurements, body mass index (BMI), waist circumference (WC), waist-to-height ratio, and body fat percentage, have different physiological meanings and distinct associations with adverse health consequences. This study aimed to investigate the relationship of these 4 measurements with metabolic syndrome (MetS) components and identify the most associated factor for MetS occurrence in older, non-medicated men. Cross-sectional data from 3004 men, all 65 years of age and older, were analyzed. The correlation and association between adiposity measurements and MetS components were evaluated by Pearson correlation and multiple linear regression. Based on multivariate logistic regression, BMI and WC were significantly associated with MetS and were selected to build a combined model of receiver operating characteristic curves to increase the diagnosis accuracy for MetS. The results show that BMI is independently associated with systolic and diastolic blood pressure; WC and body fat percentage are associated with fasting plasma glucose and log transformation of triglyceride; BMI and WC are negatively associated with high-density lipoprotein cholesterol (HDL-C); and WC is a better discriminate for MetS than BMI, although the combined model (WC + BMI) is not significantly better than WC alone. Based on these results, we conclude that the 4 adiposity measurements have different clinical implications. Thus, in older men, BMI is an important determinant for blood pressure and HDL-C. Waist circumference is associated with the risk of fasting plasma glucose, HDL-C, triglyceride, and MetS occurrence. The combined model did not increase the diagnosis accuracy.

Increased incidence of metabolic syndrome in older men with high normotension

Introduction: Hypertension and prehypertension are correlated with future cardiovascular disease (CVD) and diabetes. Whether these harmful effects of the blood pressure (BP) could be found in normotensive is of interest. Methods: In this cross-sectional study, totally 2388 normotensive older men aged 65–80 years undergoing routine health examinations were enrolled. To eliminate the influence of age on BP, subjects were initially grouped in each age stratum. Then in each age-stratum, subjects were further grouped into low, middle and high-tertile systolic BP (SBP) subgroups. Finally, all the low-tertile subgroups in each age stratum were gathered to form Group-1. Similarly, Group-2 (middle-tertile) and Group-3 (high-tertile) were also created. Metabolic syndrome (MetS) was regarded as having risks for future CVD and diabetes. Results: Age, waist circumstance (WC), fasting plasma glucose (FPG) and log triglyceride (TG) were independently and significantly correlated with SBP by multiple linear regression analysis. On the other hand, logistic regression showed that Group-3 had significant higher odds ratios (ORs) for having abnormal WC, FPG and TG. In addition, Group-3 presented a 1.55–fold OR (p < 0.001) for having MetS than Group-1. Conclusions: In normotensive older men, the risk for having MetS was significantly associated with higher SBP. Primary prevention of hypertension should be stressed.

Changes in Reproductive Hormone Concentrations Predict the Prevalence and Progression of the Frailty Syndrome in Older Men: The Concord Health and Ageing in Men Project

Frailty, a syndrome of multiple morbidity, weakness, and immobility in aging, is an increasingly urgent threat to public health. Single measures of low serum androgen have been associated with frailty in men, but the contributory role of hormonal changes with time is unassessed. The objective of the study was to examine, using longitudinal measurements, the relations of serum androgens, estrogens, gonadotropins, and SHBG to the prevalence and progression of frailty in older men. Concord Health and Ageing in Men Project is an observational cohort study of 1705 men (aged 70 yr or older) living in the suburb of Concord, Sydney, Australia. Measurements were obtained at baseline (2005-2007) and 2-yr follow-up (2007-2009). Testosterone (T), dihydrotestosterone, estradiol, and estrone were obtained by liquid chromatography-tandem mass spectrometry, whereas SHBG, LH, and FSH were measured by immunoassay. Subjects from the general community were sampled. A total of 1645 subjects constituting a representative sample of community-dwelling men aged 70 yr old or older participated in the study. The frailty syndrome was measured according to the Cardiovascular Health Study (CHS) and Study of Osteoporotic Fractures (SOF) indices. Androgens and estrogens showed significant age-adjusted associations with concurrent frailty. Subjects in the lowest T quintile had 2.2-fold odds of exhibiting greater CHS frailty as compared with the highest T quintile (P < 0.001); results for dihydrotestosterone, estradiol, estrone, and calculated free T were similar, and were unchanged when the SOF frailty index was substituted for the CHS frailty index. A 1 sd, 2-yr decrease in T, calculated free T, or LH was associated with a 1.2- to 1.3-fold increase in the odds of progression (increase in severity) of frailty. The control for comorbid medical conditions did not affect results. Age-related changes in blood androgens and estrogens may contribute to the development or progression of frailty in men.

Associations Between Television Viewing Time and Overall Sitting Time with the Metabolic Syndrome in Older Men and Women: The Australian Diabetes Obesity and Lifestyle Study

To examine associations between self-reported television (TV) viewing time and overall sitting time with the metabolic syndrome and its components. Cross-sectional. Population-based sample of older men and women living in Australia. One thousand nine hundred fifty-eight participants from the Australian Diabetes, Obesity and Lifestyle (AusDiab) study (aged ≥ 60, mean age 69, 54% women). Self-reported television viewing time and overall sitting time were collected using an interviewer-administered questionnaire. The metabolic syndrome was defined according to the revised International Diabetes Federation criteria. Compared with those in the lowest quartile, the odds ratios (ORs) of the metabolic syndrome in the highest quartile of television viewing time were 1.42 (95% confidence interval (CI)=0.93-2.15) for men and 1.42 (95% CI=1.01-2.01) for women and in the highest quartile of overall sitting time were 1.57 (95% CI=1.02-2.41) for men and 1.56 (95% CI=1.09-2.24) for women. Television viewing time was associated with lower high-density lipoprotein cholesterol (HDL-C) levels and glucose intolerance in women. Overall sitting time was detrimentally associated with greater risk of high triglyceride levels in men and women, abdominal obesity in women, and low HDL-C levels in men. All models were adjusted for age, education, physical activity, self-rated health, employment, diet, smoking, and alcohol intake and for hormone replacement therapy and estrogen use in women. For older adults, high levels of sedentary behavior were associated with greater prevalence of the metabolic syndrome; reducing prolonged overall sitting time may be a feasible way to improve metabolic health.

Reduced serum total osteocalcin is associated with metabolic syndrome in older men via waist circumference, hyperglycemia, and triglyceride levels

In the above article published in the European Journal of Endocrinology (2010) 163 265–272, the authors apologise for an error and clarify that total osteocalcin was measured in aliquots of plasma and not in serum as stated. The authors opine that as the assay is appropriate for either serum or plasma, it is not likely to have influenced the results.

Reduced serum total osteocalcin is associated with metabolic syndrome in older men via waist circumference, hyperglycemia, and triglyceride levels

Bone-derived undercarboxylated osteocalcin regulates insulin secretion and sensitivity in mice, and reduced serum total osteocalcin (TOC) is associated with diabetes in humans. However, the relationship between TOC levels and other cardiovascular risk factors is uncertain. We sought to determine whether serum TOC is associated with metabolic syndrome and its components in older men. Cross-sectional analysis from a population-based cohort of men aged >or=70 years. Early morning sera were assayed for TOC. Insulin resistance was estimated using a homeostatic model (HOMA2-IR). Metabolic syndrome was defined according to NCEP-ATPIII criteria. TOC was assayed in 4047 men. Men who were not fasting and reported having bone fractures, Paget's disease, or bisphosphonate, glucocorticoid, or warfarin use were excluded, leaving 2765 men with metabolic syndrome present in 797 (28.8%). TOC was inversely associated with waist circumference, glucose, and triglyceride levels and HOMA2-IR (all P<0.001), and was lower in men with metabolic syndrome (mean+/-S.E.M.: 20.1+/-0.4 vs 21.4+/-0.2 microg/l, P=0.002). In multivariate analysis, men with TOC of 13.25-16.55 and <13.25 microg/l had 1.5- to 2-fold increased risk of metabolic syndrome compared with men with levels >or=30 microg/l. TOC remained associated with metabolic syndrome after adjustment for individual components, but not after adjusting for both waist circumference and glucose. Increased waist circumference, reduced TOC, elevated glucose, and triglyceride levels are inter-related in aging men. Osteocalcin may lie in the causal pathway between central adiposity and insulin resistance. Further research is required to evaluate whether interventions which raise osteocalcin levels might decrease cardiovascular risk.

Cardiorespiratory Fitness and Metabolic Syndrome in Older Men and Women

OBJECTIVEWe studied the association of maximum oxygen uptake (Vo2max) with the development and resolution of metabolic syndrome (MetS) for 2 years in older individuals.RESEARCH DESIGN AND METHODSSubjects were a population sample of 1,226 men and women aged 57–78 years. We assessed Vo2max directly by respiratory gas analysis during maximum exercise testing and used dichotomous and continuous variables for MetS.RESULTSOne SD increase in baseline Vo2max associated with 44% (95% CI 24–58) decreased risk of developing MetS. Individuals in the highest third of baseline Vo2max were 68% (37–84) less likely to develop MetS than those in the lowest third. One SD increase in Vo2max increased the likelihood to resolve MetS 1.8 (1.2–2.8) times. Individuals in the highest Vo2max third were 3.9 (1.5–9.9) times more likely to resolve MetS than those in the lowest third.CONCLUSIONSHigher levels of cardiorespiratory fitness protect against MetS and may resolve it in older individuals.

IGF1 and its binding proteins 3 and 1 are differentially associated with metabolic syndrome in older men

Circulating IGF1 declines with age, and reduced circulating IGF1 is associated with increased cardiovascular mortality in some but not all studies. The relationship between IGF-binding proteins 3 and 1 (IGFBP3 and IGFBP1) with risk of cardiovascular disease remains unclear. We sought to examine associations between IGF1, IGFBP3 and IGFBP1 with metabolic syndrome in older men. Cross-sectional analysis of 3980 community-dwelling men aged >or=70 years. Methods Morning plasma levels of IGF1, IGFBP3 and IGFBP1 were assayed. Metabolic syndrome was defined according to National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) criteria. For IGF1 and IGFBP3, there was a U-shaped relationship, with middle quintiles possessing the lowest odds ratios (OR) for metabolic syndrome (reference Q1, Q3 IGF1: OR 0.74, 95% confidence intervals 0.57-0.96, Q3 IGFBP3: OR 0.67, 0.51-0.87). Increasing IGFBP1 was associated with reduced risk of metabolic syndrome with a dose-response gradient (reference Q1, OR for Q2 to Q5 IGFBP1: 0.56, 0.33, 0.22 and 0.12 respectively, P<0.001). IGF1 was associated with two, IGFBP1 with four and IGFBP3 with all five components of the metabolic syndrome. The ratio of IGF1/IGFBP3 was not associated with metabolic syndrome. In older men, both lower and higher IGF1 and IGFBP3 levels may be metabolically unfavourable. IGFBP1, as a marker of insulin sensitivity, is relevant in the assessment of metabolic syndrome, while the IGF1/IGFBP3 ratio is less informative. Longitudinal follow-up of this cohort would be needed to determine whether these distributions of IGF1, IGFBP3 and IGFBP1 predict incidence of cardiovascular events during male ageing.

Lower sex hormone-binding globulin is more strongly associated with metabolic syndrome than lower total testosterone in older men: the Health in Men Study

Reduced circulating testosterone and sex hormone-binding globulin (SHBG) are implicated as risk factors for metabolic syndrome. As SHBG increases with age while testosterone declines, we examined the relative contributions of SHBG and testosterone to the risk of metabolic syndrome in older men. We conducted a cross-sectional study of 2502 community-dwelling men aged > or = 70 years without known diabetes. Metabolic syndrome was defined using the National Cholesterol Education Program-Third Adult Treatment Panel (NCEP-ATPIII) criteria. Early morning fasting sera were assayed for total testosterone, SHBG and LH. Free testosterone was calculated using mass action equations. There were 602 men with metabolic syndrome (24.1%). The risk of metabolic syndrome increased for total testosterone < 20 nmol/l, SHBG < 50 nmol/l and free testosterone < 300 pmol/l. In univariate analyses SHBG was associated with all five components of metabolic syndrome, total testosterone was associated with all except hypertension, and free testosterone was associated only with waist circumference and triglycerides. In multivariate analysis, both total testosterone and especially SHBG remained associated with metabolic syndrome, with odds ratios of 1.34 (95% confidence interval (CI): 1.18-1.52) and 1.77 (95% CI: 1.53-2.06) respectively. Men with hypogonadotrophic hypogonadism (total testosterone < 8 nmol/l, LH < or = 12 IU/l) had the highest prevalence of metabolic syndrome (53%, P<0.001). Lower SHBG is more strongly associated with metabolic syndrome than lower total testosterone in community-dwelling older men. SHBG may be the primary driver of these relationships, possibly reflecting its relationship with insulin sensitivity. Further studies should examine whether measures that raise SHBG protect against the development of metabolic syndrome in older men.

Cardiorespiratory Fitness as a Feature of Metabolic Syndrome in Older Men and Women

OBJECTIVE—We studied the associations of cardiorespiratory fitness with metabolic syndrome in older men and women, because such data are limited in representative population samples. RESEARCH DESIGN AND METHODS—We studied a population sample of 671 men and 676 women aged 57–79 years at baseline of a randomized controlled intervention study. We assessed maximal oxygen uptake (Vo2max) by respiratory gas analysis during a maximal bicycle exercise test. RESULTS—Vo2max had a strong, inverse, and graded association with the risk of having metabolic syndrome as defined by the National Cholesterol Education Program criteria. Men and women in the lowest third of Vo2max had 10.2- and 10.8-fold higher risks and those in the middle third had 2.9- and 4.7-fold higher risks (P &amp;lt; 0.001 all) of metabolic syndrome than those with the highest Vo2max after multivariable adjustments. Factor analysis generated a principal factor that was strongly loaded by the main components of metabolic syndrome and Vo2max (−0.68 in men and −0.70 in women). CONCLUSIONS—Low cardiorespiratory fitness is associated with metabolic syndrome in older men and women. Our findings suggest that low cardiorespiratory fitness could be considered a feature of metabolic syndrome.

Benchmarks for the Assessment of Novel Cardiovascular Biomarkers

The investigation of novel circulating serum and plasma biomarkers in patients with cardiovascular disease has been accelerating at a remarkable pace. For example, a Medline search that uses the terms “biomarkers” and “acute coronary syndromes” (ACS) reveals an approximate tripling in the number of published reports during the 2-year interval from 2003 to 2004 compared with the period from 2001 to 2002, and this number more than doubled from 2005 to 2006. Although this expanding body of research has established firm evidence for the value of biomarkers, such as for diagnosis and risk assessment among patients with suspected ACS,1 it has also deluged the clinical and research communities with candidate biomarkers, very few of which are likely to survive the test of time as useful clinical tools.2,3 It is thus increasingly important for researchers, manufacturers, regulators, and clinicians to critically appraise the value of new biomarkers as they emerge as candidates for further investigation and possible clinical application. The superb report by Wollert and colleagues4 in the present issue of Circulation on growth differentiation factor-15 (GDF-15) as a biomarker for prognostic assessment in ACS provides an opportunity to outline a basic set of benchmarks against which new markers can be evaluated. Article p 962 Assessment of the clinical potential of a novel biomarker5 may be structured around 3 fundamental questions (Figure): (1) Can the clinician measure it? (2) Does it add new information? (3) Does it help the clinician to manage patients? A, Criteria for assessment of novel cardiovascular biomarkers for clinical use. Statements in bold font are given the highest priority. B, Clinical applications of cardiovascular biomarkers. To be clinically useful, analytical methods must be available that allow reliable measurement, optimally with capability for high throughput tests, prompt turnaround time, and reasonable cost. Evaluation of …

Modifiable Lifestyle Factors and the Metabolic Syndrome in Older Men: Effects of Lifestyle Changes

To examine the influence of lifestyle factors and changes in these factors on risk of the metabolic syndrome in elderly men. Cross-sectional and longitudinal analyses of cohort study. General practices in 24 British towns. Three thousand fifty-one men aged 60 to 79 with no diabetes mellitus or diagnosis of coronary heart disease. Lifestyle factors (smoking, physical activity, alcohol intake, body weight, dietary fat and carbohydrate intake) including recent changes in the previous 3 years (physical activity and body weight); metabolic syndrome. After adjustment for each of the other modifiable lifestyle factors, overweight/obesity and physical inactivity were associated with a significantly higher risk of the metabolic syndrome, as were cigarette smoking and a high-carbohydrate diet (>57% of energy). Alcohol intake and dietary fat intake were not related to the metabolic syndrome. Long-term ex-smokers showed similar risk to never smokers. Taking up physical activity and losing weight in the previous 3 years were associated with a reduction in risk of the metabolic syndrome. Overweight/obesity, physical inactivity, a high-carbohydrate diet, and cigarette smoking are associated with higher risk of the metabolic syndrome in elderly men. Modification of lifestyle factors, even later in life, has considerable potential for primary prevention of the metabolic syndrome.

Coping, Affect, and the Metabolic Syndrome in Older Men: How Does Coping Get Under the Skin?

The metabolic syndrome is a complex construct with interrelated factors of obesity, blood pressure, lipids, and glucose. It is a risk factor for a number of chronic diseases in late life. This study tested a model in which the relationship between stress and the metabolic syndrome was mediated by appraisal, coping, and affect. Data were collected from 518 male participants in the Normative Aging Study (X(age) = 68.17 years). The model was partially confirmed. Relationships among stress, appraisal, coping, and affect were valenced along positive and negative pathways. However, affect was not directly related to the metabolic syndrome. The metabolic syndrome was related to positive coping as operationalized by self-regulatory strategies. The results of this study suggest that the influence of coping on physical health may occur through emotional regulation.

Modifiable lifestyle factors and the metabolic syndrome in older men: effects of lifestyle changes

Modifiable lifestyle factors and the metabolic syndrome in older men: effects of lifestyle changes

Obesity, Regional Body Fat Distribution, and the Metabolic Syndrome in Older Men and Women

Obesity, Regional Body Fat Distribution, and the Metabolic Syndrome in Older Men and Women