What predicts the occurrence of the metabolic syndrome in a population-based cohort of adult healthy subjects?
ABSTRACT Metabolic syndrome (MS), the concurrence of hyperglycaemia, dyslipidaemia, hypertension and visceral obesity, increases cardiovascular risk and mortality. Predictors of MS were previously evaluated in patients without the full syndrome, but with some of its traits. This might confound the resulting associations.
The relationship between baseline variables and MS development was evaluated in healthy middle-aged subjects without any MS component at baseline, over a 4.5-year follow-up.
From a population-based cohort of 1658 subjects, 241 individuals showed no MS components and 201 (83.4%) of them participated in a follow-up screening. At baseline, patients who developed the MS (n = 28/201; 13.9%) showed significantly higher Homeostasis Model Assessment-Insulin Resistance score (HOMA-IR) and C-reactive protein (CRP) values, and lower exercise level than subjects who did not. In a multiple logistic regression analysis, after multiple adjustments, the only baseline variable significantly (p < 0.01) associated with the MS was CRP (OR = 4.05; 95% CI 2.23-7.38; p < 0.001). Results did not change after adjusting for weight gain. The area under the receiver-operating curve was 0.83 for CRP after multiple adjustments. The optimal cut-off point of baseline CRP values was 2.1 mg/L, with 86% (95% CI 81-90) sensitivity and 75% (69-81) specificity in predicting the MS. Baseline CRP resulted associated with after-study glucose values in a multiple regression model (beta = 0.14; 0.08-0.20; p < 0.001).
Higher baseline CRP values confer a significant increased risk of developing the MS in healthy subjects, independently of weight gain.
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ABSTRACT: Polycystic Ovary Syndrome (PCOS) is a common reproductive endocrine disorder in women that is highly associated with obesity. Whether obesity is intrinsic to the disorder or is a result of different lifestyle and environmental concerns is unclear, however obesity influences the risks of PCOS with respect to fertility complications, pregnancy complications and cardiovascular risk. Polycystic ovary syndrome is known to be associated with insulin resistance in both lean and obese individuals. Insulin resistance in fact is felt to be a key feature in the reproductive and metabolic dysfunction of PCOS. There are numerous studies reporting the benefits of insulin sensitizing therapy, specifically metformin and thiazolidinediones, on the features of PCOS and emerging evidence on the impact of these agents on the risk and management of obesity. Weight loss and maintenance of weight reduction has been seen in women and adolescents treated with metformin therapy. Most studies indicate a synergy of metformin with lifestyle therapy in the general population but there are limited data in PCOS.12/2012; 1(4). DOI:10.1007/s13679-012-0030-y
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ABSTRACT: Congestive heart failure (CHF) is associated with a high readmission rate after diagnosis. We assessed the ability of a comprehensive management program (CMP) for CHF to reduce readmissions with secondary endpoints of improving quality of life, exercise capacity and targeted drug doses. Patients (pts) with: New York Heart Association Class (NYHA) III or IV CHF; left ventricular ejection fraction <40%; and stable outpatient therapy were assigned to a CMP of cardiology assessment intensive education and referral to a tailored exercise program. Forty-two pts (35 M, 7 F, mean age 54 years, S.D. 12 years) were enrolled. Two pts were transplanted, two died during follow-up and two were lost to follow-up. Hospital admissions were reduced by 87.2%, (mean 1.05, S.D. 0.98, admissions per pt to mean 0.08, S.D. 0.28, admissions per pt at 6-month follow-up; P<0.0001). ACE-inhibitor dose increased by 42% (P<0.0008) and beta-blocker dose increased by 61% (P<0.0001). NYHA Class, 6-min walk and quality of life scores all improved significantly (P<0.0001). A CMP improves QOL and exercise capacity as well as substantially reducing hospital admissions in CHF pts. This study validates the benefit of intensive outpatient care of CHF.European Journal of Heart Failure 10/2001; 3(5):619-25. DOI:10.1016/S1071-9164(99)91507-5 · 6.53 Impact Factor
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ABSTRACT: The metabolic syndrome is one of several patterns of risk for atherosclerotic cardiovascular disease. Although the concept of the metabolic syndrome has been known for 2 centuries or more, it is only recently that its individual components have been proposed. Visceral obesity is a central component but other major facets such as hypertension, dyslipidemia, or dysglycemia are often present. These components are well-established cardiovascular risk factors and therefore grouping them under a single entity, namely the metabolic syndrome, has questioned its clinical usefulness and its ability to predict cardiovascular disease. Depending on what criteria are used, the prevalence of this syndrome may be as much as 40% in those aged 60 years and older. Heredity, environmental factors, personal lifestyle habits and behavior, and clinical comorbidities all seem to be associated with the metabolic syndrome. In addition, hypogonadism in men and hypovitaminosis D are age-related issues associated with the metabolic syndrome. In ageing individuals the existence of the metabolic syndrome as a distinct entity is questioned although some studies report an association with diabetes mellitus, physical impairments, and cognitive dysfunction. Further studies that explore these factors over time are needed but for now, treatment remains focused on individual components and not on the syndrome as a whole.Clinics in Geriatric Medicine 05/2010; 26(2):261-74. DOI:10.1016/j.cger.2010.02.011 · 3.19 Impact Factor