US National Cholesterol Education Program Research Articles

Prevalence of Metabolic Syndrome in Primary Health Care, Riyadh, Saudi Arabia

Background: Metabolic Syndrome (MS) is identified as a cluster of risk factors that significantly increase the risk of diabetes, cardiovascular disease, and stroke. It is characterized by obesity, hyperglycemia, dyslipidemia, and hypertension. Multiple definitions and criteria of MS exist. The most widely used set of criteria are the US National Cholesterol Education Program (NCEP) ATP III and the International Diabetes Federation (IDF), both of which are used in this study. Due to different defining criteria and population demographics, the prevalence of MS varies widely across countries, regions, and continents.Objective: This study investigates the prevalence and risk factors of metabolic syndrome among primary healthcare attendees in Riyadh, Saudi Arabia.Methods: A cross-sectional study was conducted over 12 months at the Prince Sultan Military Medical City (PSMMC) Wazzarat Center in Riyadh, Saudi Arabia, involving 262 participants. The study aimed to determine the prevalence and predictors of MS among primary healthcare attendees using ATP III and IDF criteria. Participants were assessed for sociodemographic features, comorbidities, vital signs, and laboratory data related to MS. Statistical analysis utilized R v 4.3 for descriptive statistics, Pearson correlation, Chi-square tests for categorical variables, and the Mann-Whitney test for continuous variables.Results: Among the study participants, 20.2% met the criteria for MS according to ATP III, and 19.9% according to IDF criteria, with a strong concordance between the two (Kappa statistic = 0.92, P < 0.001). The median age of individuals with MS was significantly higher (45 years) than those without (35 years, P < 0.001). Significant predictors included age, with BMI and fasting blood glucose showing a strong positive correlation (r > 0.5, P < 0.001). Notably, 60.7% of the cohort were medically free from conditions contributing to MS.Conclusion: The prevalence of MS among primary healthcare attendees in Riyadh, as defined by ATP III and IDF criteria, underscores the importance of age and lifestyle factors as predictors. The findings advocate for targeted preventive strategies focusing on lifestyle modifications to mitigate the risk of MS. Further research is suggested to explore the long-term impact of these interventions.

Reduction of prevalence of patients meeting the criteria for metabolic syndrome with tirzepatide: a post hoc analysis from the SURPASS Clinical Trial Program

BackgroundMetabolic syndrome is characterized as the co-occurrence of interrelated cardiovascular risk factors, including insulin resistance, hyperinsulinemia, abdominal obesity, dyslipidemia and hypertension. Once weekly tirzepatide is approved in the US and EU for the treatment of type 2 diabetes (T2D) and obesity. In the SURPASS clinical trial program for T2D, tirzepatide demonstrated greater improvements in glycemic control, body weight reduction and other cardiometabolic risk factors versus placebo, subcutaneous semaglutide 1 mg, insulin degludec, and insulin glargine. This post hoc analysis assessed the effect of tirzepatide use on the prevalence of patients meeting the criteria for metabolic syndrome across SURPASS 1–5.MethodsMetabolic syndrome was defined as having ≥ 3 of 5 criteria according to the US National Cholesterol Education Program: Adult Treatment Panel III. Analyses were based on on-treatment data at the primary endpoint from patients adherent to treatment (taking ≥ 75% study drug). A logistic regression model with metabolic syndrome status as the response variable, metabolic syndrome status at the baseline visit as an adjustment, and randomized treatment as fixed explanatory effect was used. The effect of tirzepatide use on the prevalence of patients meeting the criteria for metabolic syndrome by categorical weight loss, background medication and gender were assessed.ResultsIn SURPASS, the prevalence of patients meeting the criteria for metabolic syndrome at baseline was 67–88% across treatment groups with reductions at the primary endpoint to 38–64% with tirzepatide versus 64–82% with comparators. Reductions in the prevalence of patients meeting the criteria for metabolic syndrome was significantly greater with all tirzepatide doses versus placebo, semaglutide 1 mg, insulin glargine, and insulin degludec (p < 0.001). Individual components of metabolic syndrome were also reduced to a greater extent with tirzepatide vs comparators. Greater reductions in body weight were associated with greater reductions in the prevalence of patients meeting the criteria for metabolic syndrome and its individual components. Background SGLT2i or sulfonylurea use or gender did not impact the change in prevalence of patients meeting the criteria for metabolic syndrome.ConclusionsIn this post hoc analysis, tirzepatide at all doses studied was associated with a greater reduction in the prevalence of patients meeting the criteria for metabolic syndrome compared to placebo, semaglutide 1 mg, insulin degludec, and insulin glargine. Although more evidence is needed, these data would support greater potential improvement in cardiovascular risk factor profile with tirzepatide treatment in people across the continuum of T2D.

Elettaria Cardamomum and Vitamin B-3: Novel Considerations in Therapeutics

An important motive for preventive paediatric cardiology is the fact that vascular atherosclerotic lesions may develop in early life. A high risk strategy has been advocated to identify children with hypercholesterolaemia both in the United States (US National Cholesterol Education Program for Children and Adolescents, NCEP-Peds) and European countries including Sweden. The major indicators for lipoprotein screening are a family history of premature CAD and/or a parental serum cholesterol concentration 6.20 mmol/l or greater. A major problem is that the parents are usually quite young and that many children live in one parent households. With coronary artery disease, plaque first grows within the walls of the coronary arteries until the blood flow to the heart’s muscle is limited. View an illustration of coronary arteries. This is also called ischemia. It may be chronic, narrowing of the coronary artery over time and limiting of the blood supply to part of the muscle. Or it can be acute, resulting from a sudden rupture of a plaque and formation of a thrombus or blood clot. The traditional risk factors for coronary artery disease are high LDL cholesterol, low HDL cholesterol, high blood pressure, family history, diabetes, smoking, being post-menopausal for women and being older than 45 for men, according to Fisher. Obesity may also be a risk factor. In this work we compared hypolipidemic effects of Niacin with Cardamom. Seventy five hyperlipidemic patients were selected for research work. They were divided in three groups. Group-I was on placebo, group-II was given 1.5 grams Niacin, and group-III was advised to use powdered Cardamom thrice daily for the period of two months. Their lipid profile was measured at start of research and then on day-60. After two months therapy group-II reduced total cholesterol 30.8 mg/dl and LDL cholesterol 12.1 mg/dl and increased HDL cholesterol 5.6 mg/dl. In group-III Cardamom decreased total cholesterol 7.2 mg/dl and LDL cholesterol 8.8 mg/dl. HDL cholesterol in this group increased 4.9 mg/dl. When results were compiled and analyzed biostatistically, these changes were significant. We conclude from the research work that Niacin has more effects on total cholesterol but effects of both drugs on LDL cholesterol reduction was almost same. KW: serum fats, heart, oxidative stress, heart, prevention, niacin, green illaichi.

Benign prostatic hyperplasia and metabolic syndrome; prevalence and association: a cross-sectional study in Syria

BackgroundBenign Prostatic Hyperplasia (BPH) is considered the most common cause of lower urinary tract symptoms in men aged 40 years and older. BPH is related to sex steroids, but there are increasing studies investigating the relationship between the urinary symptoms and the metabolic syndrome. They still have inconsistent results; some reported a significant positive association, while others found no significant association. In this study, we aim to assess the prevalence rate of metabolic syndrome in BPH patients and whether there is an association between symptoms linked to BPH and metabolic syndrome in the Syrian community.MethodsThe participants of this observational cross-sectional study were benign prostatic hyperplasia patients aged 40-year-old and older from Homs, Syria. An interview questionnaire was performed to collect data from all patients who visited the urology clinic of Homs Military Hospital in the period of January 10 to March 10, 2023. We used the International Prostate Symptom Score (IPSS) to assess the urinary symptoms, and we used the US National Cholesterol Education Program Adult Treatment Panel (NCEP ATPIII) criteria to define the metabolic syndrome.ResultsThe final sample size was 426 patients. The overall prevalence of metabolic syndrome was 46.2%. Patients with metabolic syndrome had higher International Prostate Symptom Score compared to patients without metabolic syndrome (21 vs. 18, P < 0.001), and 59.3% of patients with metabolic syndrome suffered from severe symptoms compared to 36.2% of patients without metabolic syndrome who suffered from severe lower urinary tract symptoms (P < 0.001). There was a positive association between (waist circumference, diabetes, triglycerides) (P < 0.001), HDL (P = 0.014) and higher International Prostate Symptom Score. However, there was no statistically significant association between blood pressure and International Prostate Symptom Score (P = 0.879).ConclusionOur results showed that patients with metabolic syndrome had a higher International Prostate Symptom Score. This idea should be used to design a new benign prostatic hyperplasia/lower urinary tract symptoms treatment.

Effects of therapeutic lifestyle change diets on blood lipids, lipoproteins, glycemic parameters, and blood pressure: a systematic review and meta-analysis of clinical trials.

Cardiovascular disease is the leading cause of death worldwide. Low-calorie, low-fat therapeutic diets (TDs) developed by the US National Cholesterol Education Program, ie, the Step I and II diets and the therapeutic lifestyle changes diet, are approximately similar and are the initial therapeutic interventional approaches for lifestyle modification. This systematic review with meta-analysis was undertaken to evaluate the effects of TDs diet on blood lipids, apolipoprotein A-1, apolipoprotein B, blood pressure, fasting blood glucose, and insulin. A comprehensive search of the PubMed/MEDLINE, Web of Science, Scopus, and Google Scholar databases until October 2022 was performed to identify clinical trials investigating the effects of TDs on the aforementioned parameters. One investigator screened the records and extracted data, and another reviewed the extracted data. A total of 910 records were retrieved. After records were screened for eligibility, 34 clinical trials met the inclusion criteria. The pooled analysis from the random-effects model revealed a significant reduction in total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoprotein A-1, and apolipoprotein B in the TD intervention group vs the control group. The overall effects of TDs on fasting blood glucose, insulin, and blood pressure were not significant, but the results of subgroup analysis revealed a significant reduction in fasting blood glucose with the Step II diet and an intervention duration of more than 24 weeks. For blood pressure, the Step I diet and an intervention duration of more than 24 weeks resulted in significant reduction. There was no evidence of publication bias, but strong heterogeneity was observed. Therapeutic diets have promising effects on lipid profile parameters, glycemic indexes, and blood pressure, which can promote cardiovascular health. PROSPERO registration no. CRD42021259355.

Prevalence of metabolic syndrome in patients attending general practice outpatient department at a community hospital

Background: Metabolic syndrome, a cluster of metabolic abnormalities which bears increased risk for cardiovascular diseases and diabetes mellitus, requires early screening, diagnosis, and timely intervention. Prevalence varies with age, gender, degree of obesity, and increased propensity for type 2 diabetes mellitus. Objectives: To find out the prevalence of metabolic syndrome among individuals with hypertension and/or diabetes seeking medical evaluation in general practice outpatient department of Kathmandu Medical College Community Hospital. Methods: This cross-sectional analytical study was conducted among 100 participants collected by convenience sampling at general practice outpatient department of Kathmandu Medical College Community Hospital, Duwakot, Bhaktapur, Nepal. Physical examination was done and investigations were sent. Metabolic Syndrome was diagnosed using US National Cholesterol Education Program Adult Treatment Panel. Data collection was done from 2019 July to 2019 December. Study population was patients with either hypertension and/or diabetes seeking medical evaluation, age of 18 years or above, both genders, no known comorbidity other than those under medication for hypertension and diabetes. Data analysis was done with SPSS v.16 and two-sample t-test or Chi-square test applied as appropriate. A p-value &lt;0.05 taken as statistically significant. Results: Out of 100 individuals, 73 were found having metabolic syndrome. It was more common among male (38, 52.1%), obese people of age 40-59 years (42, 57%), and among patients with high body mass index (26.93±2.74). Conclusion: The prevalence of metabolic syndrome was found significantly high among patients with hypertension or diabetes. Therefore, it is important to diagnose this condition on time to prevent subsequent complications.

The prevalence and characteristics of metabolic syndrome according to different definitions in China: a nationwide cross-sectional study, 2012–2015

BackgroundMetabolic syndrome (MetS) is characterized by a cluster of signs of metabolic disturbance and has caused a huge burden on the health system. The study aims to explore the prevalence and characteristics of MetS defined by different criteria in the Chinese population.MethodsUsing the data of the China Hypertension Survey (CHS), a nationally representative cross-sectional study from October 2012 to December 2015, a total of 28,717 participants aged 35 years and above were included in the analysis. The MetS definitions of the International Diabetes Federation (IDF), the updated US National Cholesterol Education Program Adult Treatment Panel III (the revised ATP III), and the Joint Committee for Developing Chinese Guidelines (JCDCG) on Prevention and Treatment of Dyslipidemia in Adults were used. Multivariable logistic regression was used to identify factors associated with MetS.ResultsThe prevalence of MetS diagnosed according to the definitions of IDF, the revised ATP III, and JCCDS was 26.4%, 32.3%, and 21.5%, respectively. The MetS prevalence in men was lower than in women by IDF definition (22.2% vs. 30.3%) and by the revised ATP III definition (29.2% vs. 35.4%), but the opposite was true by JCDCG (24.4%vs 18.5%) definition. The consistency between the three definitions for men and the revised ATP III definition and IDF definition for women was relatively good, with kappa values ranging from 0.77 to 0.89, but the consistency between the JCDCG definition and IDF definition (kappa = 0.58) and revised ATP III definition (kappa = 0.58) was poor. Multivariable logistic regression showed that although the impact and correlation intensity varied with gender and definition, area, age, education, smoking, alcohol use, and family history of cardiovascular disease were factors related to MetS.ConclusionsThe prevalence and characteristics of the MetS vary with the definition used in the Chinese population. The three MetS definitions are more consistent in men but relatively poor in women. On the other hand, even if estimated according to the definition of the lowest prevalence, MetS is common in China.

Prevalence of Prehypertension and Associated Cardiovascular Risk Profiles among Adults in Peru: Findings from a Nationwide Population-Based Study.

Prehypertension is a clinical condition that increases the risk of hypertension and cardiovascular disease. In South American countries, prehypertension affects almost one-third of the population. The aim of the present study was to determine the association between prehypertension and the main cardiometabolic risk factors according to the US National Cholesterol Education Program Adult Treatment Panel III by sex in the Peruvian population. A total of 863 participants surveyed were included in the study. A total of 21.1% had prehypertension, 14.4% of whom were female, and 30.5% were male. Women belonging to the age group 50–59 years, having abdominal obesity and being a current smoker, were more likely to have prehypertension, while the likelihood of having prehypertension increased in men with abdominal obesity. Three out of 10 men and one out of 10 women in Peru have prehypertension. In women, being 50 to 59 years of age, having abdominal obesity, and being a current smoker, increased the probability of having prehypertension, whereas, in men, only abdominal obesity was found to be associated with prehypertension. Our findings will allow the development of prevention strategies focused on the appropriate diagnosis of prehypertension and cardiometabolic risk factors according to sex.

Improving Cholesterol Screening in Children—Is Educating Primary Care Providers Enough?

In this volume of The Journal, Soukup et al1 published their assessment of cholesterol-screening practices among pediatric primary care providers (PCPs) and explored barriers and facilitators to successful implementation. It should be noted that recommendations for cholesterol screening are not new. As early as 1992, the US National Cholesterol Education Program advocated cholesterol screening,2 and by 1998, the World Health Organization recognized hypercholesterolemia as a worldwide public health priority.

Role of interleukin-6 and insulin resistance as screening markers for metabolic syndrome in patients of chronic obstructive pulmonary disease. A hospital-based cross-sectional study.

Chronic obstructive pulmonary disease (COPD) is usually associated with various extra-pulmonary manifestations. Metabolic syndrome (MetS) is one such entity that has been scarcely studied in Indian patients. The availability of a good screening marker may help in the timely detection of this co-morbidity in COPD patients. We conducted a cross-sectional study to evaluate the prevalence of MetS among COPD patients and the role of Interleukin-6 and insulin resistance (as measured by HOMA-IR) as screening markers for MetS in COPD. One hundred stable COPD patients were evaluated for MetS using US National Cholesterol Education Program Adult Treatment Panel III (2005) guidelines. Interleukin-6 and HOMA-IR (for insulin resistance) were measured and compared between COPD patients with and without MetS. ROC analysis was done to find both the molecules' best cut-off value and sensitivity and specificity in detecting MetS. In the results, the mean age of the study cohort was 59.9±8.7yrs (males=93). Forty-five COPD patients (45%) fulfilled the criteria for MetS. Patients with MetS were comparatively younger (57.9+9.5 v/s 61.6+7.8 years; p=0.037) but had a longer duration of preceding COPD (9.9±2.8 v/s 6.0±2.2 years; p<0.001) as compared to those without MetS. Both IL-6 and HOMA index were statistically higher (p<0.05) in COPD-MetS patients compared to the other group. A cutoff value of 36.3 pg/ml for IL-6 and 1.61 for HOMA index, IL-6 and HOMA-IR had sensitivity of 91.1% and 82.2%, respectively in detecting MetS among COPD patients. To conclude, metabolic syndrome is common comorbidity seen in COPD patients. Interleukin-6 has a better sensitivity than HOMA-IR in screening MetS among COPD patients.

Common Illnesses and Their Therapy in Medicine

An important motive for preventive paediatric cardiology is the fact that vascular atherosclerotic lesions may develop in early life. A high risk strategy has been advocated to identify children with hypercholesterolaemia both in the United States (US National Cholesterol Education Program for Children and Adolescents, NCEP-Peds) and European countries including Sweden. The major indicators for lipoprotein screening are a family history of premature CAD and/or a parental serum cholesterol concentration 6.20 mmol/l or greater. A major problem is that the parents are usually quite young and that many children live in one parent households. With coronary artery disease, plaque first grows within the walls of the coronary arteries until the blood flow to the heart’s muscle is limited. View an illustration of coronary arteries. This is also called ischemia. It may be chronic, narrowing of the coronary artery over time and limiting of the blood supply to part of the muscle. Or it can be acute, resulting from a sudden rupture of a plaque and formation of a thrombus or blood clot. The traditional risk factors for coronary artery disease are high LDL cholesterol, low HDL cholesterol, high blood pressure, family history, diabetes, smoking, being post-menopausal for women and being older than 45 for men, according to Fisher. Obesity may also be a risk factor. In this work we compared hypolipidemic effects of Niacin with Cardamom. Seventy five hyperlipidemic patients were selected for research work. They were divided in three groups. Group-I was on placebo, group-II was given 1.5 grams Niacin, and group-III was advised to use powdered Cardamom thrice daily for the period of two months. Their lipid profile was measured at start of research and then on day-60. After two months therapy group-II reduced total cholesterol 30.8 mg/dl and LDL cholesterol 12.1 mg/dl and increased HDL cholesterol 5.6 mg/dl. In group-III Cardamom decreased total cholesterol 7.2 mg/dl and LDL cholesterol 8.8 mg/dl. HDL cholesterol in this group increased 4.9 mg/dl. When results were compiled and analyzed biostatistically, these changes were significant. We conclude from the research work that Niacin has more effects on total cholesterol but effects of both drugs on LDL cholesterol reduction was almost same.

The Association between Circulating Inflammatory Markers and Metabolic Syndrome: A General Population Study

INTRODUCTIONChronic inflammation has recently been proposed as the driving force for the development of the Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs). Chronic inflammation is associated with various metabolic disturbances and may also contribute to the massive comorbidity burden in MPNs, which include e.g. inflammatory bowel diseases (Crohn's disease and ulcerative colitis) and polymyalgia rheumatica. Accordingly, MPNs have also been described as “inflammatory diseases”. The metabolic syndrome has so far not been shown to be prevalent in patients with MPNs although the chronic inflammatory state might induce insulin resistance as in other chronic inflammatory diseases. If MPNs indeed are preceded by a chronic inflammatory drive eliciting persistent leukocytosis, monocytosis and thrombocytosis, and ultimately clonal myeloproliferation it is intriguing to consider if MPNs and metabolic syndrome share common pathways. If so, an MPN-phenotype might be expected to be associated with metabolic syndrome in the background population. Therefore, in this study, we tested the association between circulating inflammatory markers (CIMs), a phenotypical presentation of MPNs (e.g. erythrocytosis, leukocytosis, and thrombocytosis), and the metabolic syndrome in a general population study.METHODSData sourcesIn this cross-sectional study, we used data from 20,872 individuals from the Danish General Suburban Population Study (GESUS). Individuals were invited between January 2010 and October 2013 and data were collected through questionnaires, health examinations, and biochemical measurements.AnalysesWe analyzed eight CIMs (leukocytes, neutrophils, monocytes, thrombocytes, erythrocytes, hematocrit, hemoglobin, and high-sensitive CRP) and their linear association with indicators of the metabolic syndrome (according to a modified version of the US National Cholesterol Education Program Adult Treatment Panel III): HbA1c, non-fasting plasma glucose, body mass index, blood pressure, cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides. With logistic regression, we calculated odds ratios (ORs) of metabolic syndrome in individuals with increased levels of CIMs compared to individuals with normal levels based on current Danish reference ranges.RESULTSIn general, there was a positive correlation between most CIMs and indicators of the metabolic syndrome both in the age-sex-adjusted and multivariable linear regression analyses. In the age-sex-adjusted logistic regression analyses, increased levels of all CIMs were associated with increased prevalence of dyslipidemia (OR: 1.4-2.2), hypertension (OR: 1.3-3.1), diabetes mellitus (OR: 1.5-3.4), obesity (1.4-4.6), and the metabolic syndrome (OR: 1.4-2.8). However, neutrophils and thrombocytes were not significant when it came to hypertension and diabetes mellitus, respectively (Table 1).DISCUSSION & CONCLUSIONIn this study we examined the association between different CIMs and a wide variety of metabolic changes. To our knowledge it is the first comprehensive epidemiological study linking the phenotypical presentation of MPNs in a general population of more than 20.000 individuals with a broad spectrum of metabolic disturbances.With chronic inflammation being proposed as a trigger and consequence of both MPNs and metabolic syndrome and considering the results in the present study it is intriguing to postulate chronic inflammation as the common denominator in both metabolic syndrome leading to MPNs and MPNs leading to metabolic syndrome(Figure 1). It is of great clinical interest to investigate if an increased risk of metabolic syndrome exists in e.g. a cohort of MPN patients and whether people with incident metabolic syndrome have increased risk of MPNs and second cancer.An increased prevalence of a wide variety of metabolic disturbances following increased CIMs could potentially, if similar results are found in the MPN population, support a future change in the MPN-risk stratification. Amongst the tested CIMs only thrombocytes (> 1500 Mia/L) are currently used as a risk factor.In conclusion, elevated levels of CIMs were associated with an increased prevalence of metabolic disturbances. Our results substantiate the need for similar studies in MPN patients, being characterized by chronic inflammation and elevated cell counts. [Display omitted] DisclosuresHasselbalch:Novartis: Research Funding.

The Association of Dietary Cholesterol and Fatty Acids with Dyslipidemia in Chinese Metropolitan Men and Women.

Background: The associations between dietary cholesterol and fatty acids and serum lipids are controversial. This study is to examine the association of dietary cholesterol and fatty acids with serum lipids and dyslipidemia in Chinese metropolitan male and female adults. Methods: 3850 participants in the Shanghai Diet and Health Survey were investigated during the period 2012–2013. Information was obtained on dietary intake, anthropometric and blood laboratory measurements. Dyslipidemia was determined by US National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III). Results: Dietary cholesterol was in line with serum TC, LDL-C and the LDL-C to HDL-C ratio in general and the partial correlation coefficients were 0.64 (95% CI: 0.13–1.15, p = 0.015), 0.73 (95% CI: 0.21–1.24, p = 0.006) and 0.01 (95% CI: 0.00–0.02, p = 0.018), respectively. The partial correlation coefficients were greater in women. Dietary fatty acids were not associated with serum lipids. The highest quintile of dietary cholesterol intake (≥538.0 mg/day) was associated with an approximate 1.6-fold risk for high TC and high HDL-C compared with the lowest quintile (<193.1 mg/day) generally. Conclusions: Dietary cholesterol was associated with serum cholesterol in Chinese metropolitan adults and a higher risk of dyslipidemia was observed at a high level of dietary cholesterol intake. Whether there should be an upper limit on dietary cholesterol in the Chinese population warrants further study.

Markers of metabolic endotoxemia as related to metabolic syndrome in an elderly male population at high cardiovascular risk: a cross-sectional study

BackgroundMetabolic syndrome (MetS) is a cluster of conditions that conjoined represents a 1.5–2.5 fold increased risk of developing cardiovascular disease (CVD). Recent studies have reported that gut dysbiosis and leakage of bacterial components, may contribute to the metabolic disturbances and systemic inflammation observed in subjects with MetS. Chronic exposure to lipopolysaccharide (LPS) has been shown to induce features of MetS in experimental studies. LPS interacts with the innate immune system, facilitated through LPS-binding protein (LBP) and the co-receptor CD14, both regarded as markers of gut leakage.PurposeWe investigated whether circulating levels of LBP and sCD14 are associated with the presence of MetS and its components, and further any association with systemic inflammation.MethodsWe examined 482 men, aged between 65 and 75 years, all at high CVD risk. MetS criteria’s according to the US National Cholesterol Education Program Adult Treatment Panel III were met in 182 subjects (38%).ResultsLevels of LBP and sCD14 did not differ between individuals with and without MetS. However, a trend towards increased risk of MetS through quartiles of LBP was observed (p = 0.05). Individuals in the highest quartile (Q4), had an increased risk of MetS (OR = 1.76, 95% CI (1.04–3.00), compared to the lowest quartile (Q1) (p = 0.04). With regard to the separate constituents of MetS, patients who met the waist circumference criterion had significant higher concentration of LBP compared to those who did not (p = 0.04). We also found a weak, but significant correlation between LBP and waist circumference (r = 0.10, p = 0.03). Moderate, yet significant correlations were observed between both LBP and sCD14 and several markers of systemic inflammation (r = 0.1–0.23; p < 0.001–0.04).ConclusionThe trend for increased prevalence of MetS observed with increasing quartiles of LBP seems to be mainly driven by central obesity in our male cohort. The associations between LBP, sCD14 and systemic inflammation, indicate a potential role of the innate immune system in MetS.Trial registration CLINICALTRIALS.GOV, NCT00764010. Registered 01 October 2008—retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT00764010?term=NCT00764010&rank=1

Lipid profile and dyslipidemia among school-age children in urban Ghana

BackgroundDyslipidemia during childhood has been associated with higher risk of atherosclerosis later in life. Information on the lipid profile of Ghanaian children is scarce. The aim of this study was to assess the lipid profiles of school children between the ages of 9–15 years, living in urban Ghana.MethodsA total of 802 randomly selected school-age children participated in the Ghana School Survey implemented in Kumasi and Accra, Ghana. A structured questionnaire was used to collect information on child and maternal socio-demographic characteristics (including age, education, and occupation), 7-day food frequency, home and school activity, as well as measurement of weight and standing height. Weight, height, and age data were converted into BMI-for-age indices to determine weight status. Finger-prick fasting blood samples were taken from the school-age children. Total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) cholesterol levels were determined using the CardioChek® PA Test System. Reference lipid levels based on the US National Cholesterol Education Program 2001 guidelines were used to determine the proportion of children with dyslipidemia.ResultsThe mean TC, LDL-C, HDL-C, and TG levels were 149.0 ± 57.0 mg/dl, 80.1 ± 38.6 mg/dl, 53.5 ± 19.4 mg/dl, and 71.4 ± 54.7 mg/dl, respectively. Mean TC/HDL-C ratio was 3.0 ± 1.0. The proportion of children with abnormal values were 12.1% for TC, 4.5% for TG, 28.4% for HDL-C, 9.2% for LDL-C, and 6.6% for TC/HDL-C ratio. The levels of dyslipidemia (HDL, LDL, and TC/HDL-C ratio) were higher among overweight/obese compared to normal-weight children. More frequent fruit consumption was also linked with lower LDL-C (p = 0.020) while watching television (TV) in the mornings was linked with both higher TC (p = 0.011) and TG (p = 0.006).ConclusionsMajority of urban-dwelling Ghanaian school children had normal lipid profiles. However, the higher levels of dyslipidemia observed among overweight and obese children suggest the need for population level physical activity and dietary interventions among children to reduce risk of cardiovascular diseases in adult life.

S.27.04 - Adult hippocampal neurogenesis determines vulnerability and resilience to stress-induced psychiatric disorders

The association between the metabolic syndrome (MetS) and adverse outcomes in older adults may be explained by other health conditions. This study examined the role of frailty in explaining the association between MetS and mortality, independent of comorbidity. Data were used from 1247 men and women aged ≥ 65 years of the Longitudinal Aging Study Amsterdam. MetS was assessed using the definition of the US National Cholesterol Education Program. Frailty was measured by the frailty phenotype. Mortality was monitored from 1995 until 2015. Associations of MetS with 19-year all-cause mortality were assessed using Cox proportional hazard models. MetS was present in 37% of the participants. In a model adjusted for age, sex and educational level hazard ratios of mortality were significantly higher in people with MetS (HR = 1.23, 95% CI = 1.08–1.40). After adjusting for frailty the association of MetS with mortality reduced, but remained statistically significant (HR = 1.15, 95% CI = 1.01–1.31). The presence of chronic diseases (cardiovascular diseases and diabetes) explained a larger part of the relationship between MetS and mortality (HR = 1.12, 95% CI = 0.98–1.28). These results show that physical frailty has a smaller contribution to the explanation of the association between MetS and 19-year all-cause mortality than the presence of chronic diseases.

The role of frailty in explaining the association between the metabolic syndrome and mortality in older adults

The association between the metabolic syndrome (MetS) and adverse outcomes in older adults may be explained by other health conditions. This study examined the role of frailty in explaining the association between MetS and mortality, independent of comorbidity. Data were used from 1247 men and women aged ≥65years of the Longitudinal Aging Study Amsterdam. MetS was assessed using the definition of the US National Cholesterol Education Program. Frailty was measured by the frailty phenotype. Mortality was monitored from 1995 until 2015. Associations of MetS with 19-year all-cause mortality were assessed using Cox proportional hazard models. MetS was present in 37% of the participants. In a model adjusted for age, sex and educational level hazard ratios of mortality were significantly higher in people with MetS (HR=1.23, 95% CI=1.08–1.40). After adjusting for frailty the association of MetS with mortality reduced, but remained statistically significant (HR=1.15, 95% CI=1.01–1.31). The presence of chronic diseases (cardiovascular diseases and diabetes) explained a larger part of the relationship between MetS and mortality (HR=1.12, 95% CI=0.98–1.28). These results show that physical frailty has a smaller contribution to the explanation of the association between MetS and 19-year all-cause mortality than the presence of chronic diseases.

Physical activity disparities by socioeconomic status among metabolic syndrome patients: The Fifth Korea National Health and Nutrition Examination Survey.

Physical activity plays an important role in preventing further progression of metabolic syndrome conditions to cardiovascular disease and type-2 diabetes. This study investigated physical activity disparities by socioeconomic status among metabolic syndrome patients. The fifth Korea National Health and Nutrition Examination Survey (2010–2012) data were analyzed (n=19,831). A revised definition of the US National Cholesterol Education Program Adult Treatment Panel III was used for screening metabolic syndrome patients. Using International Physical Activity Questionnaire, physical activity adherence was defined as participating in 150+ minutes of moderate-intensity physical activity, 75+ minutes of vigorous-intensity physical activity, or an equivalent combination of moderate-to vigorous-intensity physical activity per week. Socioeconomic status was measured by level of education and house-hold income. Among metabolic syndrome patients, physical activity adherence rate of first (lowest), second, third, and fourth quartile house-hold income group were 28.31% (95% confidence interval [CI], 26.14–30.28%), 34.68% (95% CI, 32.71–36.70), 37.44% (95% CI, 35.66–39.25), and 43.79% (95% CI, 41.85–45.75). Physical activity adherence rate of groups with elementary or lower, middle-school, high-school, and college or higher education degree were 25.17% (95% CI, 22.95–27.54), 38.2% (95% CI, 35.13–41.00), 39.60% (95% CI, 38.24–41.77), and 36.89% (95% CI, 35.77–38.03), respectively. This study found that physical activity adherence rate was lower in socioeconomically disadvantaged metabolic syndrome patients, which may aggravate health inequity status of Korean society.

Suboptimal Control of Lipid Levels: Results from 29 Countries Participating in the Centralized Pan-Regional Surveys on the Undertreatment of Hypercholesterolaemia (CEPHEUS).

Five multicentre, cross-sectional Centralized Pan-Regional Surveys on the Undertreatment of Hypercholesterolaemia (CEPHEUS) were conducted in 29 countries across Asia, Western Europe, Eastern Europe, the Middle East, and Africa. The surveys assessed the current use and efficacy of lipid-lowering drugs (LLDs) worldwide and identified possible patient and physician characteristics associated with failure to attain low-density lipoprotein cholesterol (LDL-C) goals. The aim of this analysis was to consolidate the global results from these surveys. The surveys involved patients aged ≥18 years who had been prescribed LLDs for at least 3 months without dose changes for at least 6 weeks. A single visit was scheduled for data collection, including fasting plasma lipid and glucose levels. Cardiovascular risk profile and LDL-C goal attainment were assessed according to the 2004 updated US National Cholesterol Education Program Adult Treatment Panel III guidelines. In total, 35 121 patients (mean age: 60.4 years) were included, and 90.3% had been prescribed statin monotherapy. Overall, only 49.4% of patients reached their recommended LDL-C level. LDL-C goals were attained in 54.8% (5084/9273) and 22.8% (3287/14 429) of patients were at high and very high cardiovascular risk, respectively. Factors associated with an increased likelihood of LDL-C goal attainment were lower baseline cardiovascular risk; presence of diabetes mellitus, hypertension, or history of cardiovascular disease; and treatment with simvastatin, atorvastatin, or rosuvastatin (vs. all other LLDs). LDL-C goal attainment in patients taking LLDs is suboptimal worldwide, particularly in patients at high and very high cardiovascular risk.

Prevalence of metabolic syndrome among postmenopausal women in Montenegro: Relation to hyperuricemia

Aim: The data regarding the prevalence of metabolic syndrome (MetS) among postmenopausal women in Montenegro is limited. Therefore, the aim of this study was to evaluate this prevalence and to examine its association with serum uric acid level, an established cardiometabolic risk factor. Methods: A total of 242 postmenopausal women (aging 43-68) were included. Fasting glucose, lipid parameters, and uric acid were determined with the standard procedure. Blood pressure and anthropometric parameters were obtained. MetS was diagnosed according to the modified US National Cholesterol Education Program Adult Treatment Panel III guidelines. Results: The prevalence of MetS in postmenopausal women was 42.1%. The most prevalent component was abdominal obesity (65.3%), following by hypertension (systolic blood pressure and diastolic blood pressure accounting for 54.1% and 49.2% respectively), hyperglycemia (40.5%), and dyslipidemia (high triglycerides and low HDL-c level accounting for 30.2% and 25.2% respectively). Uric acid levels were significantly higher in postmenopausal women with MetS than in those without MetS (P<0.001). Moreover, a significantly higher number of patients with MetS as compared to subjects without diagnosed MetS across uric acid tertiles was found (χ2=27.02, P<0.001). Conclusion: MetS is highly prevalent among postmenopausal women in Montenegro and correlated with higher uric acid level. Abdominal obesity is the most prevalent feature of the syndrome. This suggests the importance of reducing obesity and lowering uric acid level in prevention of cardiometabolic diseases.