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Inflammation, the metabolic syndrome, and risk of coronary heart disease in women and men

Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
Atherosclerosis (Impact Factor: 3.97). 04/2008; 197(1):392-9. DOI: 10.1016/j.atherosclerosis.2007.06.022
Source: PubMed

ABSTRACT This study examined whether inflammation adds to the prediction of coronary heart disease (CHD) beyond metabolic syndrome (MetS), and whether these associations differ between sexes.
Among 30,111 women from the Nurses' Health Study and 16,695 men from the Health Professionals Follow-up Study without prior cardiovascular disease, 249 women and 266 men developed non-fatal myocardial infarction or fatal CHD during 8 and 6 years of follow-up, respectively. Controls were selected 2:1 within each cohort matched on age, smoking, and date of blood draw. Subjects with MetS had a significantly increased relative risk (RR) of CHD compared to individuals without MetS, and this RR was significantly higher in women (3.01; 95%-CI 1.98-4.57) than in men (1.62; 95%-CI 1.13-2.33; p interaction=0.03). Adjustment for most inflammatory markers did not substantially attenuate the risk estimates, although the association was no longer significant in men after adjustment for CRP. Vice versa, associations of inflammatory markers with CHD risk among women were no longer significant after further adjustment for MetS. Among men, CRP and sICAM remained significant predictors of CHD independent of MetS.
MetS is a stronger predictor of CHD in women than in men. Most inflammatory markers did not add appreciable information beyond MetS to predict CHD; only CRP and sICAM remained independently predictive of CHD among men. The basis for these sex-based differences warrants further study.

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    • "Finally, it can be considered that oxidative stress is one of the key factors explaining some of the pathophysiological mechanisms associated with inflammatory conditions such as CVD and periodontitis [39] [40], as lipid peroxidation is one of its most well known effects. In fact, increased lipid peroxidation has been observed in periodontitis [8], and it is accepted that lipid peroxidation indirectly reflects intracellular ROS generation. It is interesting to note that superoxide plays a major role in the release of cytokines (for example, TNF-α, IL-1β, and IL-6) [41], which are involved in the pathogenesis of periodontal disease and CVD [7] and this is also induced by P. gingivalis LPS treatment. "
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    • "Finally, it can be considered that oxidative stress is one of the key factors explaining some of the pathophysiological mechanisms associated with inflammatory conditions such as CVD and periodontitis [39] [40], as lipid peroxidation is one of its most well known effects. In fact, increased lipid peroxidation has been observed in periodontitis [8], and it is accepted that lipid peroxidation indirectly reflects intracellular ROS generation. It is interesting to note that superoxide plays a major role in the release of cytokines (for example, TNF-α, IL-1β, and IL-6) [41], which are involved in the pathogenesis of periodontal disease and CVD [7] and this is also induced by P. gingivalis LPS treatment. "
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    • "Importantly, the prevalence of MetS has increased significantly over the past two decades, and this increase is strongly associated with the global epidemic of obesity and diabetes [4] [5] [6]. A chronic inflammatory state associated with impaired nitric oxide formation and endothelial dysfunction has been described in patients with MetS, thus leading to the development of atherosclerosis in these patients [7] [8] [9] [10] [11]. Increased concentrations of pro-inflammatory mediators and growth factors also play a major role in the atherosclerotic process and may lead to clinical events [12]. "
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