The relative risk of cardiovascular death among racial and ethnic minorities with metabolic syndrome: Data from the NHANES-II mortality follow-up

Charles R. Drew University of Medicine and Science, Clinical Research Center, Los Angeles, CA 90059, USA.
Journal of the National Medical Association (Impact Factor: 0.96). 06/2008; 100(5):565-71.
Source: PubMed


The tendency for selected cardiovascular disease (CVD) risk factors to occur in clusters has led to the description of metabolic syndrome (MetS). The relative impact of the individual risk factor on the overall relative risk (RR) for cardiovascular death from metabolic syndrome is not well established and may differ across the different racial/ethnic groups. Using data from the National Health and Nutrition Examination Survey (NHANES II) mortality follow-up (NH2MS), we determined the prevalence and RR of cardiovascular death for individual components in the overall population and across racial and ethnic groups. The prevalence of MetS components varied significantly across gender and racial/ethnic groupings. The RR for CVD also varies for the number and different components of MetS. The adjusted RR for cardiovascular death was highest with diabetes (3.23; 95% CI: 2.70-3.88), elevated blood pressure (2.28; 95% CI: 1.94-2.67) and high triglycerides (1.63; 95% CI: 1.34-2.00). Although the RR for cardiovascular death differs significantly for some of the different components, the overall findings were similar across racial/ethnic groups. The two components that confer the highest risks for death are more prevalent in African Americans. We concluded that the RR of cardiovascular death associated with the diagnosis of MetS varies depending on the number and components used to establish the diagnosis of MetS and the racial/ethnic characteristic of the participants.

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    • "Overall body composition appears to differ between AA and CA [31], in addition to WC. e debate on whether WC cutoffs should be based on the relationship between WC and BMI or WC and visceral adipose tissue (WC-VAT) presents another challenge [32]. In particular, AAs have comparable or slightly higher WC than CAs [33] [34]. However, WC does appear to be a superior predictor of mortality risk, regardless of ethnicity [35]. "
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    ABSTRACT: Although progress has been made to understand the association between physiological and lifestyle behaviors with regard to obesity, ethnic differences in markers of obesity and pathways towards obesity remain somewhat unexplained. However, obesity remains a serious growing concern. This paper highlights ethnic differences in African Americans and Caucasians that may contribute to the higher prevalence of obesity among African Americans. Understanding ethnic differences in metabolic syndrome criteria, functioning of the hypothalamic pituitary adrenal axis, variations in glucocorticoid sensitivity and insulin resistance, and physical activity and cardiovascular fitness levels may help to inform practical clinical and public health interventions and reduce obesity disparities.
    01/2013; 2013(5):314295. DOI:10.1155/2013/314295
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    • "Metabolic syndrome (MS), a clustering of abdominal obesity, dyslipidemia , hypertension, insulin resistance, and hyperglycemia [1], is a growing health issue that strongly correlates with the increased risk of type 2 diabetes [2] [3] cardiovascular disease [4] [5] and premature death [6]. It has become a global health problem and a substantional economic burden in both developing and developed countries [7] [8]. "
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    ABSTRACT: C-reactive protein (CRP) is an independent risk factor of diabetes and cardiovascular disease and it is proposed as a component of metabolic syndrome (MS). This study was undertaken to investigate the relationship between CRP and various characteristics of the MS in a sample of the Tunisian population One hundred and forty nine patients with MS and 152 controls, aged 35-70 years were recruited. Waist circumference (WC), blood pressure, HDL-cholesterol (HDL-C), triglycerides (TG), glucose, insulin and CRP were measured. Insulin resistance was assessed by homeostasis model assessment of insulin resistance (HOMA-IR). MS was defined by NCEP-ATPIII report CRP levels were significantly higher in MS group (4.41±3.73 mg/L vs. 2.68±2.59 mg/L, p<0.001) compared to without MS group. For both sexes, CRP increased as the number of MS components increased (p=0.015 for men and p<0.001) after adjustment for age, smoking, alcohol intake and, for women, menopause. There were statistically significant positive correlations for log CRP with WC, log TG, and log HOMA-IR in both sexes adjusted for confounding factors listed above. A significant negative correlation was found between HDL-C and log CRP only in women. In both sexes, WC was identified, by multiple linear regression models, as significant independent predictor of CRP level variability. HDL-C showed also a significant contribution only in women The present study provides evidence that CRP levels are elevated in MS subjects. In addition, WC and HDL-C are significant predictors of the CRP elevation.
    European Journal of Internal Medicine 01/2012; 23(1):e5-9. DOI:10.1016/j.ejim.2011.10.011 · 2.89 Impact Factor
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    • "The middle-aged adults having one or two MetS components had respectively 2.8-fold and 7.3-fold increased risks for developing MetS within five years, versus the adults having zero MetS component count (Table 4). Some cardiovascular disease (CVD)-related surveillance studies had similar findings: the MetS component count has been associated with CVD occurrence[20], mortalities[21] and important surrogate markers[22]. Furthermore, Schultz and Edington demonstrated that changes in MetS component count were significantly related to the medical costs for workforces[23]. "
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    ABSTRACT: Metabolic syndrome (MetS) management programs conventionally focus on the adults having MetS. However, risk assessment for MetS development is also important for many adults potentially at risk but do not yet fulfill MetS criteria at screening. Therefore, we conducted this follow-up study to explore whether initial screening records can be efficiently applied on the prediction of the MetS occurrence in healthy middle-aged employees. Utilizing health examination data, a five-year follow-up observational study was conducted for 1384 middle-aged Taiwanese employees not fulfilling MetS criteria. Data analyzed included: gender, age, MetS components, uric acid, insulin, liver enzymes, sonographic fatty liver, hepatovirus infections and lifestyle factors. Multivariate logistic regression was used to estimate the adjusted odds ratios (OR) and 95% confidence interval (CI) of risk for MetS development. The synergistic index (SI) values and their confidence intervals of risk factor combinations were calculated; and were used to estimate the interacting effects of coupling MetS components on MetS development. Within five years, 13% (175 out of 1384) participants fulfilled MetS criteria. The ORs for MetS development among adults initially having one or two MetS components were 2.8 and 7.3, respectively (both p < 0.01), versus the adults having zero MetS component count at screening. Central obesity carried an OR of 7.5 (p < 0.01), which far exceeded other risk factors (all ORs < 2.7). Synergistic effects on MetS development existed between coupling MetS components: 1. High blood pressure plus low-HDL demonstrated an OR of 11.7 (p < 0.01) for MetS development and an SI of 4.7 (95% CI, 2.1-10.9). 2. High blood pressure plus hyperglycemia had an OR of 7.9 (p < 0.01), and an SI of 2.7 (95% CI, 1.2-6.4). MetS component count and combination can be used in predicting MetS development for participants potentially at risk. Worksite MetS screening programs simultaneously allow for finding out cases and for assessing risk of MetS development.
    BMC Public Health 12/2010; 10:747. DOI:10.1186/1471-2458-10-747 · 2.26 Impact Factor
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