Mediterranean diet and metabolic syndrome in an urban population: the Athens Study.

BACKGROUND: Previous studies demonstrated the beneficial impact of the Mediterranean diet (MedDiet) on metabolic syndrome (MetS). The aim of this study was to retrospectively investigate the association between MedDiet and MetS in a representative sample of the Athenian population in the early 1980s, when MetS had not been established as an entity yet. METHODS: In a cross-sectional epidemiologic survey of cardiovascular disease (CVD), 2,074 randomly selected adults were examined: 900 men and 1,174 women (age, 46.9 ± 14.9 years). MetS was defined according to criteria of the National Cholesterol Education Program-Adult Treatment Panel III. A validated questionnaire concerning nutrition habits was administered, and MedDiet was assessed according to guidelines of the Division of Nutrition/Epidemiology, Athens University Medical School. RESULTS: Overall, 1,023 participants (49.3%) followed MedDiet (47.3% men, 52.0% women, P = .033) with similar rates across age groups (P = .337). MetS was diagnosed in 24.0% of those following MedDiet, compared with 27.9% of those not following it (P = .041). Participants with CVD or diabetes mellitus were less likely to follow MedDiet (43% vs 50%, P = .009). Multivariate analysis revealed that MedDiet is associated with a 20% reduction in MetS (odds ratio = 0.80, 95% confidence interval = 0.65-0.98), after adjustment for age, gender, smoking, light physical activity, serum levels of low-density lipoprotein cholesterol and γ-glutamyl transferase, diabetes mellitus, CVD, family history of hypertension, and/or hyperlipidemia. CONCLUSIONS: Results indicate that adherence to MedDiet may attenuate the prevalence of MetS and, consequently, the increasing burden of diabetes mellitus and CVD, especially in urban populations.

Plasma brain natriuretic peptide: a biochemical marker of effective blood pressure management?

OBJECTIVE: To investigate plasma brain natriuretic peptide (BNP) concentrations in association with blood pressure (BP) at baseline and after antihypertensive drug treatment. PATIENTS AND METHODS: We prospectively examined 186 individuals with newly diagnosed essential hypertension without target organ damage, whose mean age was 48.7 +/- 10.9 years. Treatment initiation began with irbesartan 150 mg/day and was doubled at 4 weeks in cases of inadequate BP control. If indicated, at 8-week-follow-up hydrochlorothiazide 12.5 mg alone or with amlodipine 5-10 mg was added. BNP levels were measured at baseline and after 3 months of antihypertensive treatment. RESULTS: At baseline plasma BNP levels were found to be related to systolic BP (r = 0.27, P < 0.001), independent of age, sex, smoking status, BMI and left ventricular mass index estimated by echocardiography (beta = 11.81, SE = 3.82, P = 0.002). Additionally, higher BNP concentrations were observed in patients with stage 2 hypertension compared with those with stage 1 (median 38.9 vs. 29.9 pg/ml, P = 0.022). Multivariate analysis showed a positive association between BNP and systolic BP variability (beta = 0.03, SE = 0.01, P = 0.034). At follow-up, 64.7% of the participants who had achieved BP control showed decreased BNP levels in contrast to those with poor BP control (median change -14.5 vs. -1.3 and median range from -34.4 to -4.4 vs. -9.6 to 10.9, respectively, P < 0.001). CONCLUSION: In this hypertensive population, increased BNP concentrations are associated with higher BP levels and systolic BP variability. The fall of BNP observed in those who achieved BP control indicates that BNP could be used as a biochemical marker of effective BP control and target organ protection.

Metabolic syndrome and incident cardiovascular morbidity and mortality in a Mediterranean hypertensive population.

BACKGROUND: Although the metabolic syndrome (MetS) is associated with adverse cardiovascular disease (CVD) risk in the general population, it is not clear whether its existence is independently associated with CVD in hypertensives. We investigated the presence of MetS in subjects with hypertension and its impact on the incidence of CVD. METHODS: We prospectively investigated 1007 hypertensive individuals. The MetS was assessed using the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. The incidence of fatal and nonfatal cardiovascular events was ascertained during a median follow-up period of 2.1 years. RESULTS: The prevalence of MetS was 42.1% (39.0% in men and 44.7% in women). In addition to hypertension, four MetS components were present in 3.6% of the individuals, three in 13.7%, two in 24.8%, and only one in 33.7%. The incidence of cardiac, cerebrovascular, and total cardiovascular events/1000 person-years was higher among MetS subjects than among those without (31.0% v 21.3%, P = .050, 25.5% v 13.7%, P = .045, and 55.4% v 35.8% P = .009, respectively). After adjustment, MetS subjects had higher risk for cardiac, cerebrovascular, and total cardiovascular events (by 72%, 90%, and 75%, respectively). Hypertensive subjects with three or more components of MetS had threefold higher risk for cardiac events, 2.59 for cerebrovascular, and 2.26 for total cardiovascular events compared with those with no other component. CONCLUSIONS: The MetS is a significant predictor of cardiovascular morbidity and mortality. The clustering of three or more components of the syndrome in addition to hypertension recognizes a population of even higher cardiovascular risk independently of other traditional risk factors.

Insulin resistance and blood pressure circadian variation in an obese hypertensive population.

Insulin resistance (IR) is related to arterial hypertension and target organ damage. Hypertensive individuals exhibiting a diminished nocturnal blood pressure (BP) reduction (non-dippers) have an increased incidence of cardiovascular events. The association, however, of IR with BP circadian variation has not been evaluated so far. Therefore, this study examined 226 (116 male and 110 female) overweight and obese subjects (BMI > 27kg/m2) with newly diagnosed essential hypertension who underwent clinical and laboratory evaluation, including an oral glucose tolerance test and ambulatory BP measurement (ABPM). IR was estimated using the homeostasis model assessment (HOMA-IR). The population was grouped according to HOMA-IR values > 2.75 (insulin resistance type) or < 2.75 (insulin sensitive type). Results. No significant differences were observed between dippers (n = 137) and non-dippers (n = 89) with respect to age, gender, BMI, serum cholesterol, triglycerides, LDL-C, and HDL-C levels, nor smoking habits. The proportion of IR subjects among dippers (59.1%) and non-dippers (56.7%) was similar (p = 0.833). Moreover, no significant association was found when the HOMA-IR was examined as a continuous component (p = 0.96). Conclusions. Insulin resistance is not associated with nocturnal blood pressure reduction in obese hypertensives. This may be explained by the notion that insulin secretion does not follow a circadian mode of variation.

Intermediate postchallenge hyperglycemia in overweight and obese subjects: a new marker of impaired glucose regulation?

The objective of this study was to compare subjects with intermediate postchallenge hyperglycemia (INPH) to those with normal glycemic status, impaired fasting glucose (IFG), and/or impaired glucose tolerance (IGT), as well as type 2 diabetes mellitus. Furthermore, the authors evaluated the impact of INPH on target organ damage. In total, 487 overweight and obese adults (BMI > or =27 kg/m(2)), 252 men and 235 women, mean age 52.9 +/-10.2 years, were studied. All participants underwent a clinical and laboratory evaluation, as well as an oral glucose tolerance test (OGTT). They were also investigated by echocardiography, carotid ultrasonography, and pulse wave analysis. Overall, 302 (62%) subjects had normal glycemic status, 64 (13.1%) had IFG and/or IGT, 95 (19.5%) had type 2 diabetes mellitus, and 26 (5.4%) had INPH. Individuals with INPH had an increased index of insulin resistance (higher homeostasis model assessment-insulinogenic index [HOMA-IR], p<0.0001), impaired insulin secretion (lower insulinogenic index, p<0.0001), and higher glycosylated hemoglobin (HbA(1c)) levels (p<0.0001) in comparison with the normoglycemic subjects, but not to those with IFG and/or IGT or diabetes (p = 0.6). No difference was observed concerning the risk factors studied, left ventricular mass and vascular remodeling, among subjects with INPH, IFG and/or IGT, and diabetes. However, individuals with INPH had a higher proportion of echolucent carotid artery plaques in comparison with the normoglycemic subjects (p = 0.04) and those with IFG and/or IGT (p = 0.01). Intermediate postchallenge hyperglycemia seems to represent a new category of glucose metabolism disturbances with increased atherogenic impact. Therefore, evaluating intermediate glucose levels in an OGTT could contribute to better identify overweight individuals at risk of developing diabetes mellitus and cardiovascular events.

Increased plasma plasminogen activator inhibitor-1 levels: a possible marker of hypertensive target organ damage.

High plasma plasminogen-activator inhibitor-1 (PAI-1) concentrations have been reported in coronary artery disease and stroke. We therefore, prospectively studied the association of PAI-1 with early target organ damage in patients with arterial hypertension has not been clearly established. We therefore investigated 136 subjects, 64 males and 72 females, mean age 50.0 +/- 12.3 years, with newly diagnosed essential hypertension who were free of cardiovascular events and were not receiving any antihypertensive medication. Plasma PAI-1 levels were measured by an ELISA method (STAGO). The study population was divided into two groups, group A with PAI-1 levels below 40 ng/mL and group B with more than 40 ng/mL. The left ventricular mass was calculated according to the formula of Devereux and was normalized by the individual's body surface area (LVM/BSA). Carotid intima-media thickness (IMT) was determined by ultrasonography. Microalbuminuria was assessed by an immunoturbidimetric method (SERA-PAK). Group A consisted of 89 individuals with hypertension (65.4%), 41 males and 48 females and group B of 47 individuals with hypertension (34.6%), 21 males and 26 females. Individuals in group B exhibited significantly higher LVM/BSA than individuals in group A (155.9 +/- 23.1 g/m2 vs. 129.7 +/- 32.2g/m2, respectively, p = 0.004) and increased IMT (0.97 +/- 0.20mm vs. 0.87 +/- 0.21 mm, respectively, p < 0.001). Microalbumin excretion rate was greater in group B than group A (70.9 +/- 84.4 mg/24 hrs vs. 20.9 +/- 45.1 mg/24 hrs, respectively, p = 0.002). In conclusion, elevated PAI-1 levels are associated with target organ damage in subjects with newly diagnosed arterial hypertension. Thus, it can be postulated that this fibrinolytic inhibitor may characterize hypertensives in the early stages of the atherothrombotic process.