Waist-to-Height Ratio and Cardiovascular Risk Factors among Chinese Adults in Beijing

Objectives

To examine whether waist-to-height ratio (WHtR) performed better than, body mass index (BMI) or waist circumference (WC) in relation to hypertension, diabetes, and dyslipidemia among Chinese adults in Beijing.

Methods

A total of 5720 adults (2371 men and 3349 nonpregnant women) aged 18 to 79 years were selected from the general population in a cross-sectional study. Data from a standardized questionnaire, physical examination, and blood sample were obtained.

Results

The area under curve (AUC) values for WHtR (0.661–0.773) were significantly higher than those for BMI for all outcomes in both sexes, except that WHtR and BMI had similar AUCs for dyslipidemia in men. The AUCs for WHtR were significantly higher than those for WC with respect to hypertension in both sexes, and to diabetes in women. AUCs for the relationships between anthropometric indices and the three outcomes were larger in women than in men, and tended to decrease with age. Optimal cutoffs for WHtR were 0.51–0.53 and 0.48–0.50 in men and women, respectively. With regard to the current Chinese criteria for BMI (≥24 kg/m²), WC (≥90 cm for men, and ≥85 cm for women), and the recommended cutoff of WHtR (≥0.5), WHtR yielded the greatest odds ratio for hypertension and diabetes in both sexes, and dyslipidemia in women. BMI had the highest odds ratio for dyslipidemia in men. The odds ratios of anthropometric indices for hypertension and diabetes, but not for dyslipidemia, were higher in women than in men. The association between anthropometric indices and the three outcomes decreased with age.

Conclusion

WHtR performed better than BMI and WC for the association with hypertension and diabetes. More studies should be conducted to explore the age differences in the relationships between obesity indices and cardiovascular risk factors.     

The Cut-Off Point and Boundary Values of Waist-to-Height Ratio as an Indicator for Cardiovascular Risk Factors in Chinese Adults from the PURE Study

To explore a scientific boundary of WHtR to evaluate central obesity and CVD risk factors in a Chinese adult population. The data are from the Prospective Urban Rural Epidemiology (PURE) China study that was conducted from 2005–2007. The final study sample consisted of 43 841 participants (18 019 men and 25 822 women) aged 35–70 years. According to the group of CVD risk factors proposed by Joint National Committee 7 version and the clustering of risk factors, some diagnosis parameters, such as sensitivity, specificity and receiver operating characteristic (ROC) curve least distance were calculated for hypertension, diabetes, high serum triglyceride (TG), high serum low density lipoprotein cholesterol (LDL-C), low serum high density lipoprotein cholesterol (HDL-C) and clustering of risk factors (number≥2) to evaluate the efficacy at each value of the WHtR cut-off point. The upper boundary value for severity was fixed on the point where the specificity was above 90%. The lower boundary value, which indicated above underweight, was determined by the percentile distribution of WHtR, specifically the 5^th percentile (P₅) for both males and females population. Then, based on convenience and practical use, the optimal boundary values of WHtR for underweight and obvious central obesity were determined. For the whole study population, the optimal WHtR cut-off point for the CVD risk factor cluster was 0.50. The cut-off points for severe central obesity were 0.57 in the whole population. The upper boundary values of WHtR to detect the risk factor cluster with specificity above 90% were 0.55 and 0.58 for men and women, respectively. Additionally, the cut-off points of WHtR for each of four cardiovascular risk factors with specificity above 90% in males ranged from 0.55 to 0.56, whereas in females, it ranged from 0.57 to 0.58. The P₅ of WHtR, which represents the lower boundary values of WHtR that indicates above underweight, was 0.40 in the whole population. WHtR 0.50 was an optimal cut-off point for evaluating CVD risks in Chinese adults of both genders. The optimal boundaries of WHtR were 0.40 and 0.57, indicating low body weight and severe risk for CVD, respectively, in Chinese adults.     

Obesity Indexes and Total Mortality among Elderly Subjects at High Cardiovascular Risk: The PREDIMED Study

Background

Different indexes of regional adiposity have been proposed for identifying persons at higher risk of death. Studies specifically assessing these indexes in large cohorts are scarce. It would also be interesting to know whether a dietary intervention may counterbalance the adverse effects of adiposity on mortality.

Methods

We assessed the association of four different anthropometric indexes (waist-to-height ratio (WHtR), waist circumference (WC), body mass index (BMI) and height) with all-cause mortality in 7447 participants at high cardiovascular risk from the PREDIMED trial. Forty three percent of them were men (55 to 80 years) and 57% were women (60 to 80 years). All of them were initially free of cardiovascular disease. The recruitment took place in 11 recruiting centers between 2003 and 2009.

Results

After adjusting for age, sex, smoking, diabetes, hypertension, intervention group, family history of coronary heart disease, and leisure-time physical activity, WC and WHtR were found to be directly associated with a higher mortality after 4.8 years median follow-up. The multivariable-adjusted HRs for mortality of WHtR (cut-off points: 0.60, 0.65, 0.70) were 1.02 (0.78–1.34), 1.30 (0.97–1.75) and 1.55 (1.06–2.26). When we used WC (cut-off points: 100, 105 and 110 cm), the multivariable adjusted Hazard Ratios (HRs) for mortality were 1.18 (0.88–1.59), 1.02 (0.74–1.41) and 1.57 (1.19–2.08). In all analyses, BMI exhibited weaker associations with mortality than WC or WHtR. The direct association between WHtR and overall mortality was consistent within each of the three intervention arms of the trial.

Conclusions

Our study adds further support to a stronger association of abdominal obesity than BMI with total mortality among elderly subjects at high risk of cardiovascular disease. We did not find evidence to support that the PREDIMED intervention was able to counterbalance the harmful effects of increased adiposity on total mortality.

Trial Registration

Controlled-Trials.com ISRCTN35739639     

Obesity in the Elderly and Its Relationship with Cardiovascular Risk Factors in Taiwan**

Objectives: The obese elderly are at increased risk of mortality, morbidity, and functional disability. In this study, we examined the prevalence of obesity and relationship between various anthropometric indices (AI) and cardiovascular disease (CVD) risk factors in the elderly. Research Methods and Procedures: A stratified multistage clustered sampling scheme was used in the Elderly Nutrition and Health Survey in Taiwan during 1999 to 2000. 2432 non‐institutionalized subjects (age, 72.8 ± 9.4 years; BMI, 23.6 ± 6.4 kg/m²) were recruited. The receiver operating characteristic analysis was used to compare predictive validity of CVD risk factors among various AI, including BMI, waist circumference (WC), and waist‐to‐hip ratio (WHR). Results: The prevalence of obesity was 29.0% in men and 36.8% in women by obesity criteria for Asians (BMI ≥ 25 kg/m²) and 13.3% in men and 21.0% in women by the Taiwanese definition (BMI ≥ 27 kg/m²). Odds ratios of acquiring various CVD risk factors increased significantly with increment of WC, WHR, and BMI. The areas under the curve predicting metabolic syndrome were all <0.8. The cut‐off values of WC corresponding to the highest sensitivity and the highest specificity in predicting various CVD risk factors were 86.2–88.0 cm in men and 82.0–84.0 cm in women, respectively. Discussion: Obesity was prevalent in the Taiwanese elderly. WC was related to CVD risk factors to a greater extent than BMI and WHR. However, none of them alone was a good screening tool for CVD risk factors. Therefore, how to apply AI prudently to screen elderly for CVD risk factors needs further research.     

Conditioning Factors for High Cardiovascular Risk in Patients with Cushing Syndrome

Objective: To characterize the alterations in carbohydrate and lipoprotein metabolism, to evaluate markers of lipoprotein functionality, and to identify the presence of novel atherogenic risk factors in patients with Cushing syndrome (CS) in comparison with sex- and age-matched controls.Methods: In an open, cross-sectional study, 32 nontreated patients with active CS were consecutively recruited from the Endocrinology Service at “José de San Martín” Clinical Hospital, University of Buenos Aires, Argentina, between April 11, 2010 and December 11, 2012. The patients were compared with sex- and age-matched controls.Results: Versus controls, patients with CS presented with excess weight, central obesity, and hypercortisolism. They also exhibited an insulin-resistant state, with high resistin levels (median [interquartile range], 16 [10 to 22] ng/mL versus 6 [5 to 9] ng/mL; P<.0001), a more atherogenic lipoprotein profile, high oxidized low-density lipoprotein levels (oxLDL; mean ± SD, 100 ± 31 U/L versus 75 ± 32 U/L; P<.05) and high sensitive C-reactive protein levels (median [interquartile range], 1.2 [0.6 to 3.1] mg/L versus 0.6 [0.3 to 1.1] mg/L; P<.05), and increased leukocyte count (mean ± SD, 9.5 ± 2.6 × 10³ cells/μL versus 6.5 ± 1.4 × 10³ cells/μL; P<.0001). Multivariate analyses showed that the increase in waist circumference was associated with both the diagnosis of CS and the degree of insulin resistance. Resistin concentration was related to a greater extent to the diagnosis of CS than to homeostasis model assessment–insulin resistance. Triglyceride and oxLDL levels were only significantly associated with the diagnosis of CS.Conclusion: Hypercortisolism is related to the increase observed in triglycerides and oxLDL levels, and, in combination with insulin resistance, acts to increase waist circumference and amplify the inflammatory process, key factors for the development of cardiovascular disease.Abbreviations: apo = apolipoprotein ARE = arylesterase CETP = cholesteryl ester transfer protein CRP = C-reactive protein CS = Cushing syndrome CV = coefficient of variation HDL = high-density lipoprotein HDL-C = high-density-lipoprotein cholesterol HOMA = homeostasis model assessment LDL = low-density lipoprotein LDL-C = low-density-lipoprotein cholesterol Lp-PLA₂ = lipoprotein-associated phospholipase A₂ oxLDL = oxidized LDL PON = paraoxonase TG = triglyceride     

老年患者下肢动脉粥样硬化与心血管疾病的危险因素相关分析

目的:探讨老年患者下肢动脉粥样硬化与心血管疾病危险因素关系,为疾病的预防控制和治疗提供依据。方法:收集从2016年1月到2017年1月在南华大学附属第一医院进行下肢静脉彩色多普勒超声检查的715例住院患者的基本临床数据和检测数据,确诊为下肢动脉粥样硬化的患者215例作为实验组,剩余500例为对照组,比较两组心血管危险因素,并采用Logistics回归分析筛选出下肢动脉粥样硬化的独立危险因素。结果:实验组年龄、存在高血压病史及糖尿病史比例及血清总胆固醇(TC)、甘油三酯(TG)、载脂蛋白B(APO-B)、血清肌酐(Cr)、尿酸(UA)、超敏C-反应蛋白(hs-CRP)、空腹血糖(FBG)、血浆纤维蛋白原(Fib)、收缩压(SBP)、舒张压(SDP)水平均高于对照组(P0.05),而体质量指数(BMI)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白AI(APO-AI)、鞘氨醇1-磷酸(S1P)、清道夫受体(SRB1)水平均低于对照组(P0.05)。多因素Logistics回归分析显示,年龄(OR=1.156)、糖尿病史(OR=2.623)、UA(OR=1.005)、TG(OR=2.345)、FBG(OR=1.066)为下肢动脉粥样硬化的独立危险因素(均P0.05)。结论:心血管的危险因素与下肢动脉粥样硬化有关,其中年龄、糖尿病史、UA、TG、FBG为下肢动脉粥样硬化的独立危险因素,对上述因素进行针对性干预可以有效预防下肢动脉粥样硬化的发生。     

臂踝脉搏波速度与老年心血管病高危因素的相关性研究

目的:探讨臂踝脉搏波速度(brachial-ankle pulse wave velocity,BaPWV)和心血管高危因素的相关性.方法:选取2011年1月～2012年1月在我院体检的居民共122例,根据体检结果分为非糖尿病及高血压组(A组,25例),糖尿病组(为B组,22例),高血压组(C组,46例)和高血压合并糖尿病组(D组,29例).记录各组的年龄、体重指数(BMI)、收缩压(SBP),舒张压(DBP)、心率(HR)、左心房内径(LAD)、左室舒张末期内径(LVIDd)、左室收缩末期内径(LVIDs)、右心室舒张末期内径(IVSd)、肺动脉收缩压(SPAP)和射血分数(EF).并检测肌酐(Scr)、尿酸(UA)、血糖(BG)、总胆固醇(TC)、甘油三酷(TG)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、餐后血糖和糖化血红蛋白(HbA1c)水平.结果:各组之间Scr、UA、BG、TC、LDL、HbA1c、LAD、LVIDd、IVSd、LVIDs、SPAP、IMT、SBP、DBP、EF和BaPWV的差异有统计学意义(P＜0.05或＜0.01),而各组之间年龄、BMI、TG、HDL、餐后血糖、IMT和HR差异无统计学意义(P＞0.05).多元逐步回归分析发现:年龄、BG、TC和SBP是影响BaPWV的独立因素.结论:BaPWV在心血管高危因素患者中显著增加,年龄、BG、TC和SBP与BaPWV呈正相关.     

广东丰顺地区老年高血压患者的危险因素及合并症的特征

目的:分析广东省丰顺地区老年高血压患者的临床特点,为临床治疗该地区老年高血压病提供参考。方法:选取广东省丰顺县人民医院等共3所医院2015年1月至2016年1月收治的老年高血压患者827例,并对所收集的临床资料进行整理,回顾性分析该地区老年人高血压病心脑血管危险因素的分布特征以及其合并症的发生情况。结果:本次纳入研究的827例老年高血压患者中,男性409人,占49.5%,女性418人,占50.5%,平均年龄(75.32±8.74)岁。其中,34.23%存在血脂异常,15.60%有吸烟史,4.47%有高血压家族史,肥胖占2.06%,23.10%合并糖尿病,29.02%合并冠心病,5.20%合并心力衰竭,28.78%合并脑血管疾病,25.83%合并肾功能不全。不同高血压级别合并脑血管病、冠心病、心力衰竭、肾功能不全的发生率存在显著差异(P=0.047,P0.001,P=0.026,P=0.041),而吸烟、血脂异常、肥胖、糖尿病的占比差异无统计学意义(P0.05)。结论:广东省丰顺地区老年高血压患者在心脑血管病危险因素中所占比重最大的是血脂异常,合并冠心病及脑血管疾病比例最大,这可能与血脂异常有着密切的关系。     

Blood Pressure Variability and Cardiovascular Risk in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER)

Variability in blood pressure predicts cardiovascular disease in young- and middle-aged subjects, but relevant data for older individuals are sparse. We analysed data from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) study of 5804 participants aged 70–82 years with a history of, or risk factors for cardiovascular disease. Visit-to-visit variability in blood pressure (standard deviation) was determined using a minimum of five measurements over 1 year; an inception cohort of 4819 subjects had subsequent in-trial 3 years follow-up; longer-term follow-up (mean 7.1 years) was available for 1808 subjects. Higher systolic blood pressure variability independently predicted long-term follow-up vascular and total mortality (hazard ratio per 5 mmHg increase in standard deviation of systolic blood pressure = 1.2, 95% confidence interval 1.1–1.4; hazard ratio 1.1, 95% confidence interval 1.1–1.2, respectively). Variability in diastolic blood pressure associated with increased risk for coronary events (hazard ratio 1.5, 95% confidence interval 1.2–1.8 for each 5 mmHg increase), heart failure hospitalisation (hazard ratio 1.4, 95% confidence interval 1.1–1.8) and vascular (hazard ratio 1.4, 95% confidence interval 1.1–1.7) and total mortality (hazard ratio 1.3, 95% confidence interval 1.1–1.5), all in long-term follow-up. Pulse pressure variability was associated with increased stroke risk (hazard ratio 1.2, 95% confidence interval 1.0–1.4 for each 5 mmHg increase), vascular mortality (hazard ratio 1.2, 95% confidence interval 1.0–1.3) and total mortality (hazard ratio 1.1, 95% confidence interval 1.0–1.2), all in long-term follow-up. All associations were independent of respective mean blood pressure levels, age, gender, in-trial treatment group (pravastatin or placebo) and prior vascular disease and cardiovascular disease risk factors. Our observations suggest variability in diastolic blood pressure is more strongly associated with vascular or total mortality than is systolic pressure variability in older high-risk subjects.     

老年轻度认知障碍患者生活高危因素探讨

目的:探讨生活高危因素对老年轻度认知障碍的影响。方法:应用简明精神状态量表(MMSE)、蒙特利尔认知测验量表(MoCA)、临床痴呆评定量表(CDR)和生活高危因素量表对219例老年人进行调查,分析生活高危因素对老年轻度认知障碍的影响。结果:女性患MCI风险高于男性(P=0.03);文盲组患MCI风险高于小学组,小学组高于初中及以上组(P=0.00);农民组患MCI风险高于工人组,工人组高于管理人员组(P=0.01);农村居民患MCI风险高于城市居民(P=0.01);运动影响MCI发病,不运动组患MCI风险高于运动组(P=0.00),运动频率<4次/周高于运动频率≥4次/周(P=0.00),运动年数≤10年组高于运动>10年组(P=0.01);业余爱好影响MCI发病,无业余爱好组患MCI风险高于有业余爱好组(P=0.00),业余爱好史≤10年组高于业余爱好史>10组(P=0.00)。不同年龄的老年人其MCI发病风险无统计学差异(P>0.05);吸烟、饮酒、喝茶等不同年数及频率的老年人其MCI发病风险无统计学差异(P>0.05);是否午休及不同午休频率和不同每晚睡眠时间的老年人其MCI发病风险无统计学差异(P>0.05)。结论:性别、教育程度、职业、居住地、运动时间及频率、业余爱好时间等因素与老年MCI发病有关。     

老年轻度认知障碍患者生活高危因素探讨

目的：探讨生活高危因素对老年轻度认知障碍的影响。方法：应用简明精神状态量表（MMSE）、蒙特利尔认知测验量表（MoCA）、临床痴呆评定量表（CDR）和生活高危因素量表对219例老年人进行调查,分析生活高危因素对老年轻度认知障碍的影响。结果：女性患MCI风险高于男性（P=0．03）;文盲组患MCI风险高于小学组,小学组高于初中及以上组（P=0．00）;农民组患MCI风险高于工人组,工人组高于管理人员组（P=O．01）;农村居民患MCI风险高于城市居民（P=O．01）;运动影响MCI发病,不运动组患McI风险高于运动组（P=0．00）,运动频率〈4次／周高于运动频率≥4次／周（P=0．00）,运动年数≤10年组高于运动〉10年组（P=O．01）;业余爱好影响MCI发病,无业余爱好组患MCI风险高于有业余爱好组（P=O．00）,业余爱好史≤10年组高于业余爱好史〉10组（P=O.00）。不同年龄的老年人其MCI发病风险无统计学差异（P〉O．05）;吸烟、饮酒、喝茶等不同年数及频率的老年人其MCI发病风险无统计学差异（P〉0．05）;是否午休及不同午休频率和不同每晚睡眠时间的老年人其MCI发病风险无统计学差异俨（〉O．05）。结论：性别、教育程度、职业、居住地、运动时间及频率、业余爱好时问等因素与老年MCI发病有关。     

Waist Circumference and Cardiovascular Risk Factors in Prepubertal Children

Objective: Intra‐abdominal fat has been identified as being the most clinically relevant type of fat in humans. Therefore, an assessment of body‐fat distribution could possibly identify subjects with the highest risk of adverse lipid profile and hypertension. Few data on the relationship between body‐fat distribution and cardiovascular risk factors are available in children, especially before puberty. Research Methods and Procedures: This cross‐sectional study was undertaken to explore the relationship between anthropometric variables, lipid concentrations, and blood pressure (BP) in a sample of 818 prepubertal children (ages 3 to 11 years) and to assess the clinical relevance of waist circumference in identifying prepubertal children with higher cardiovascular risk. Height, weight, triceps and subscapular skinfolds, waist circumference, and BP were measured. Plasma levels for triacylglycerol, total cholesterol, high‐density lipoprotein (HDL) cholesterol, low‐density lipoprotein cholesterol, apolipoprotein A1 (ApoA1), and apolipoprotein B (ApoB) were determined. Results: Females were fatter than males (5.8 [3.5] vs. 4.8 [3.3] kg of fat mass; p < 0.01). Males had higher HDL cholesterol and ApoA1/ApoB plasma concentrations than females (p < 0.001 and p < 0.01, respectively). Waist circumference had a higher correlation with systolic and diastolic BP (r = 0.40 and 0.29, respectively; p < 0.001) than triceps (r = 0.35 and 0.21, respectively; p < 0.001) and subscapular (r = 0.28 and 0.16, respectively; p < 0.001) skinfolds and relative body weight (0.33 and 0.23, respectively; p < 0.001). Multivariate linear model analysis showed that ApoA1/ApoB, HDL cholesterol, total cholesterol/HDL cholesterol, and systolic as well as diastolic BP were significantly associated with waist circumference and triceps and subscapular skinfolds, independently of age, gender, and body mass index. Discussion: Waist circumference as well as subscapular and triceps skinfolds may be helpful parameters in identifying prepubertal children with an adverse blood‐lipids profile and hypertension. However, waist circumference, which is easy to measure and more easily reproducible than skinfolds, may be considered in clinical practice. Children with a waist circumference greater than the 90th percentile are more likely to have multiple risk factors than children with a waist circumference that is less than or equal to the 90th percentile.     

A High Dietary Glycemic Index Increases Total Mortality in a Mediterranean Population at High Cardiovascular Risk

Objective

Different types of carbohydrates have diverse glycemic response, thus glycemic index (GI) and glycemic load (GL) are used to assess this variation. The impact of dietary GI and GL in all-cause mortality is unknown. The objective of this study was to estimate the association between dietary GI and GL and risk of all-cause mortality in the PREDIMED study.

Material and Methods

The PREDIMED study is a randomized nutritional intervention trial for primary cardiovascular prevention based on community-dwelling men and women at high risk of cardiovascular disease. Dietary information was collected at baseline and yearly using a validated 137-item food frequency questionnaire (FFQ). We assigned GI values of each item by a 5-step methodology, using the International Tables of GI and GL Values. Deaths were ascertained through contact with families and general practitioners, review of medical records and consultation of the National Death Index. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HR) and their 95% CI for mortality, according to quartiles of energy-adjusted dietary GI/GL. To assess repeated measures of exposure, we updated GI and GL intakes from the yearly FFQs and used Cox models with time-dependent exposures.

Results

We followed 3,583 non-diabetic subjects (4.7 years of follow-up, 123 deaths). As compared to participants in the lowest quartile of baseline dietary GI, those in the highest quartile showed an increased risk of all-cause mortality [HR = 2.15 (95% CI: 1.15–4.04); P for trend  = 0.012]. In the repeated-measures analyses using as exposure the yearly updated information on GI, we observed a similar association. Dietary GL was associated with all-cause mortality only when subjects were younger than 75 years.

Conclusions

High dietary GI was positively associated with all-cause mortality in elderly population at high cardiovascular risk.     

Comparison of Cardiovascular Risk Factors in Obese Blacks and Whites

Blacks are known to have higher blood pressure levels, a higher prevalence of hypertension, and higher body weights than whites. However, the interrelationships of these and other cardiac risk factors have not been analyzed in an obese population. We compared blood pressure (BP) and lipid levels in 174 obese blacks and 939 obese white patients who were entering a weight loss program; we also assessed the effects of weight loss on these factors. Prevalence of treated hypertension was similar in blacks and whites (28% vs. 25%, respectively). In patients not taking BP medication, black women weighed more (108 kg) than white women (102 kg) and black and white males' weights were similar (135 kg vs. 131 kg). Systolic and diastolic BP were similar in black and white women; black males had similar SBP but a significantly lower DBP than white males (83 mmHg vs. 89 mmHg, respectively). Lipid levels were similar in black and white women except black women had lower triglycerides (1.30 mmol/L) than white women (1.58 mmol/L, p<0.05); and black males compared to white males had significantly lower total cholesterol (4.76 mmol/L vs. 5.56 mmol/L), LDL-cholesterol (3.15 mmol/L vs. 3.52 mmol/L) and triglycerides (1.31 mmol/L vs. 2.17 mmol/L, p<0.05). Adult-onset obesity adversely affected a number of cardiovascular risk factors in whites, but not in blacks. Blacks lost significantly less weight (?13 kg) than whites (?19 kg). However, controlling for the difference in weight loss, blacks sustained comparable improvement in lipids and blood pressure, except for TC/HDL-C (whites improved significantly more, ?0.36 kg/m2, than blacks, 0.03 kg/m2). Thus, the impact of obesity on cardiovascular risk factors seems ameliorated in blacks com-pared to whites.     

Metabolically Healthy Obesity and the Risk of Cardiovascular Disease in the Elderly Population

BackgroundWhether being metabolically healthy obese (MHO)—defined by the presence of obesity in the absence of metabolic syndrome—is associated with subsequent cardiovascular disease (CVD) remains unclear and may depend on the participants’ age. We examined the association of being MHO with CVD risk in the elderly.ConclusionsIn our elderly population, we found that the presence of obesity without metabolic syndrome did not confer a higher CVD risk. However, metabolic syndrome was strongly associated with CVD risk, and was associated with an increased risk in all BMI categories. Therefore, preventive interventions targeting cardiometabolic risk factors could be considered in elderly, regardless of weight status.     

Optimal Waist-to-Height Ratio Values for Cardiometabolic Risk Screening in an Ethnically Diverse Sample of South African Urban and Rural School Boys and Girls

Background

The proposed waist-to-height ratio (WHtR) cut-off of 0.5 is less optimal for cardiometabolic risk screening in children in many settings. The purpose of this study was to determine the optimal WHtR for children from South Africa, and investigate variations by gender, ethnicity and residence in the achieved value.

Methods

Metabolic syndrome (MetS) components were measured in 1272 randomly selected learners, aged 10–16 years, comprising of 446 black Africans, 696 mixed-ancestry and 130 Caucasians. The Youden’s index and the closest-top-left (CTL) point approaches were used to derive WHtR cut-offs for diagnosing any two MetS components, excluding the waist circumference.

Results

The two approaches yielded similar cut-off in girls, 0.465 (sensitivity 50.0, specificity 69.5), but two different values in boys, 0.455 (42.9, 88.4) and 0.425 (60.3, 67.7) based on the Youden’s index and the CTL point, respectively. Furthermore, WHtR cut-off values derived differed substantially amongst the regions and ethnic groups investigated, whereby the highest cut-off was observed in semi-rural and white children, respectively, Youden’s index0.505 (31.6, 87.1) and CTL point 0.475 (44.4, 75.9).

Conclusion

The WHtR cut-off of 0.5 is less accurate for screening cardiovascular risk in South African children. The optimal value in this setting is likely gender and ethnicity-specific and sensitive to urbanization.     

Prognostic Values of Some Cardiovascular Risk Factors in Cosmonauts

A ten-year follow-up study was focused on comparison of risk factors of atherosclerosis and damage to target organs in a group of 40- to 65-year-old cosmonauts and volunteers in the same age range. It was shown that the incidence of supraventricular extrasystoles in the groups increased with aging by 85 and 80%, respectively, inferring the risk of supraventricular tachyarrhythmias. The primary predictors of atherosclerosis and coronary artery disease (CAD) in cosmonauts are decreased endothelium-dependent vasodilation in the right brachial artery, C-reactive protein (hsCRP) level > 2 mg/L, and high atherogenic index. These CAD predictors should be of particular concern during medical screening of candidates for cosmonauts.     

Plasma Lipidomic Profiling of Treated HIV-Positive Individuals and the Implications for Cardiovascular Risk Prediction

Background

The increased risk of coronary artery disease in human immunodeficiency virus (HIV) positive patients is collectively contributed to by the human immunodeficiency virus and antiretroviral-associated dyslipidaemia. In this study, we investigate the characterisation of the plasma lipid profiles of treated HIV patients and the relationship of 316 plasma lipid species across multiple lipid classes with the risk of future cardiovascular events in HIV- positive patients.

Methods

In a retrospective case-control study, we analysed plasma lipid profiles of 113 subjects. Cases (n = 23) were HIV-positive individuals with a stored blood sample available 12 months prior to their diagnosis of coronary artery disease (CAD). They were age and sex matched to HIV-positive individuals without a diagnosis of CAD (n = 45) and with healthy HIV-negative volunteers (n = 45).

Results

Association of plasma lipid species and classes with HIV infection and cardiovascular risk in HIV were determined. In multiple logistic regression, we identified 83 lipids species and 7 lipid classes significantly associated with HIV infection and a further identified 74 lipid species and 8 lipid classes significantly associated with future cardiovascular events in HIV-positive subjects. Risk prediction models incorporating lipid species attained an area under the receiver operator characteristic curve (AUC) of 0.78 (0.775, 0.785)) and outperformed all other tested markers and risk scores in the identification of HIV-positive subjects with increased risk of cardiovascular events.

Conclusions

Our results demonstrate that HIV-positive patients have significant differences in their plasma lipid profiles compared with healthy HIV-negative controls and that numerous lipid species were significantly associated with elevated cardiovascular risk. This suggests a potential novel application for plasma lipids in cardiovascular risk screening of HIV-positive patients.     

Relationship of Neck Circumference to Cardiovascular Risk Factors

Objective: To determine a relationship between neck circumference (NC) and risk factors for coronary heart disease by evaluating the components of the metabolic syndrome. Research Methods and Procedures: The study group included 561 subjects (231 men and 330 women) who had no known major medical conditions and were not receiving any medication therapy. The subjects were those who attended a family health clinic for any reason between 1998 and December 2001. Main indicators studied included NC, waist circumference, waist‐to‐hip ratio, body mass index, blood pressure, and lipoprotein, glucose, and uric acid levels. Results: Pearson's correlation coefficients indicated a significant association between NC and body mass index (men, r = 0.71; women, r = 0.81; each, p < 0.0001), waist circumference (men, r = 0.75; women, r = 0.79; each, p < 0.0001), waist‐to‐hip ratio (men, r = 0.56; women, r = 0.63; each, p < 0.0001), total cholesterol (men, r = 0.50; women, r = 0.66; each, p < 0.0001), low‐density lipoprotein‐cholesterol (men, r = 0.42; women, r = 0.60; each, p < 0.0001), triglycerides (men, r = 0.48; women, r = 0.49; each, p < 0.0001), glucose (men, r = 0.21, p < 0.001; women, r = 0.44; p < 0.0001), uric acid (men, r = 0.50, p < 0.0001; women, r = 0.60, p < 0.001), and systolic (men, r = 0.53; women, r = 0.69; each, p < 0.0001), and diastolic (men, r = 0.55; women, r = 0.65; each, p < 0.0001) blood pressure. Discussion: Higher NC is correlated positively with the factors of the metabolic syndrome; therefore, it is likely to increase the risk of coronary heart disease.