Gender differences in the prevalence and determinants of the metabolic syndrome in screened subjects at risk for coronary heart disease.

BACKGROUND: The metabolic syndrome is prevalent among individuals with coronary heart disease (CHD) risk factors. This study's goal was to compare gender differences in the prevalence and determinants of the metabolic syndrome in subjects who were re-examined after a cardiovascular risk factor screening program. METHODS: In a population-based cross-sectional study of 14,811 screened men and women aged 30, 40, 45, and 59 to 60 years, 1,491 subjects in the predetermined risk categories of high glucose (n = 64, 69% male), cholesterol (n = 496, 66.3% male), and blood pressure (n = 362, 63.5% male) or Framingham risk score (n = 253, 93.7% male) or low HDL cholesterol (n = 316, 79.1% male) underwent further examination. RESULTS: The metabolic syndrome was more prevalent among women than among men in the same risk categories with the exception of the blood pressure category. Women with the metabolic syndrome had a higher BMI and C reactive protein (CRP) levels, and were more likely to meet the waist circumference criterion than men (92% versus 70%; P < 0.0001). In multivariate analysis, BMI (odds ration(OR) 25.8, 95% CI 14.3-46.3 for >/=30 kg/m(2) versus < 25 kg/m(2)), CRP (OR 1.9, 95% CI 1.3-2.7 for the highest versus the lowest tertile) and female gender (OR 1.7, 95% CI 1.2-2.3 versus male) were associated with the metabolic syndrome after adjustment for age, physical activity, smoking, and family history of premature cardiovascular disease. CONCLUSION: The metabolic syndrome was more prevalent and more strongly characterized by obesity and low grade inflammation in women than men. These findings underscore the need to study gender-specific approaches to screen for CHD risk.

Characterization of 4-hydroxyphenylacetate 3-hydroxylase (HpaB) of Escherichia coli as a reduced flavin adenine dinucleotide-utilizing monooxygenase.

4-Hydroxyphenylacetate 3-hydroxylase (HpaB and HpaC) of Escherichia coli W has been reported as a two-component flavin adenine dinucleotide (FAD)-dependent monooxygenase that attacks a broad spectrum of phenolic compounds. However, the function of each component in catalysis is unclear. The large component (HpaB) was demonstrated here to be a reduced FAD (FADH(2))-utilizing monooxygenase. When an E. coli flavin reductase (Fre) having no apparent homology with HpaC was used to generate FADH(2) in vitro, HpaB was able to use FADH(2) and O(2) for the oxidation of 4-hydroxyphenylacetate. HpaB also used chemically produced FADH(2) for 4-hydroxyphenylacetate oxidation, further demonstrating that HpaB is an FADH(2)-utilizing monooxygenase. FADH(2) generated by Fre was rapidly oxidized by O(2) to form H(2)O(2) in the absence of HpaB. When HpaB was included in the reaction mixture without 4-hydroxyphenylacetate, HpaB bound FADH(2) and transitorily protected it from rapid autoxidation by O(2). When 4-hydroxyphenylacetate was also present, HpaB effectively competed with O(2) for FADH(2) utilization, leading to 4-hydroxyphenylacetate oxidation. With sufficient amounts of HpaB in the reaction mixture, FADH(2) produced by Fre was mainly used by HpaB for the oxidation of 4-hydroxyphenylacetate. At low HpaB concentrations, most FADH(2) was autoxidized by O(2), causing uncoupling. However, the coupling of the two enzymes' activities was increased by lowering FAD concentrations in the reaction mixture. A database search revealed that HpaB had sequence similarities to several proteins and gene products involved in biosynthesis and biodegradation in both bacteria and archaea. This is the first report of an FADH(2)-utilizing monooxygenase that uses FADH(2) as a substrate rather than as a cofactor.

White coat hypertension in a general practice. Prevalence, cardiovascular risk factors and clinical implications.

OBJECTIVE: To examine the prevalence of white coat hypertension (WCH) and white coat effect (WCE) in a general practice. Background and biochemical characteristics, triglycerides, total cholesterol, HDL cholesterol, fasting blood glucose, microalbuminuria, ECG, smoking habits, height and weight of patients with white coat hypertension were compared to patients with sustained hypertension. DESIGN: Blood pressure measurements among mild hypertensives in clinic visits by doctor and at home by the patients. SETTING: A primary health centre in Oslo, Norway. SUBJECTS: Sixty-eight patients with mild hypertension (41 females and 27 males) aged 20-75 years. MAIN OUTCOME MEASURES: Patients had their blood pressure measured in clinic visits by general practitioners and by themselves at home to study the prevalence of WCH and the WCE. WCH was defined as a consistently increased blood pressure in the clinic and a normal home-measured blood pressure. WCE was defined as a difference in mean systolic blood pressure measured by physician and patients of 10 mmHg, or more. An individual risk score for myocardial infarction was calculated. Subjects with and without WCH/WCE were compared in relation to background characteristics and biochemical differences. RESULTS: Fourteen patients (21%) were found with WCH, while 25 (37%) had WCE. Patients with WCH differed significantly from hypertensives in age, total cholesterol, and heart rate. In multivariate analysis, increasing age and heart rate were significant negative predictors for WHC. CONCLUSION: WCH may be a significant clinical challenge in general practice, especially among younger patients.

[Home blood pressure measurement in general practice patients]. / Hjemmemåling av blodtrykk hos pasienter i allmennpraksis.

In 68 consecutive patients with mild hypertension, blood pressure was measured by general practitioners during visits to the clinic, by nurse and by the patients at home. Mean age was 50 years (SD: 11) for both genders and 60% were women. Blood pressure and heart rate were significantly higher when measured by physicians than by nurse and patient (p < 0.01). During the study period of six weeks a significant decrease in blood pressures was registered by both physicians and patients. The study demonstrates the feasibility of home blood pressure monitoring as a part of the practice to diagnose hypertension in general practice.

Effect of angiotensin II receptor blockade on fibrinolysis during acute hyperinsulinemia in patients with essential hypertension.

We performed the present study to investigate indirectly the in vivo effects of angiotensin II on fibrinolysis and catecholamines by treatment with losartan, a selective angiotensin II type 1 receptor antagonist. The effects were evaluated in basal conditions as well as in two different models of acute hyperinsulinemia physiologically induced by oral glucose ingestion and by a euglycemic glucose clamp technique. Twenty subjects with moderate hypertension were included in a randomized, double-blind, placebo-controlled crossover study of 4-week treatment periods. Plasma levels of catecholamines, tissue plasminogen activator activity and antigen, and plasminogen activator inhibitor type 1 activity and antigen were unchanged in the basal state after 4 weeks of treatment. During both models of hyperinsulinemia, plasminogen activator inhibitor activity and antigen decreased significantly (both P<.001), and tissue plasminogen activator activity increased significantly (P<.Ol). Norepinephrine did not change during any of the procedures, whereas epinephrine increased significantly after 3 hours of the oral glucose tolerance test. Changes from baseline did not differ between the treatment and placebo regimens during the hyperinsulinemic procedures with regard to either of the fibrinolytic variables or the catecholamines. In conclusion, we could not demonstrate any effects of 4 weeks of treatment with losartan on plasma levels of fibrinolytic variables or catecholamines either in basal conditions or during acute hyperinsulinemia. However, the present findings do not preclude more direct effects of angiotensin II or involvement of other receptor subtypes on fibrinolysis.

Gender differences in negative affect and well-being: the case for emotional intensity.

Affect intensity (AI) may reconcile 2 seemingly paradoxical findings: Women report more negative affect than men but equal happiness as men. AI describes people's varying response intensity to identical emotional stimuli. A college sample of 66 women and 34 men was assessed on both positive and negative affect using 4 measurement methods: self-report, peer report, daily report, and memory performance. A principal-components analysis revealed an affect balance component and an AI component. Multimeasure affect balance and AI scores were created, and t tests were computed that showed women to be as happy as and more intense than men. Gender accounted for less than 1% of the variance in happiness but over 13% in AI. Thus, depression findings of more negative affect in women do not conflict with well-being findings of equal happiness across gender. Generally, women's more intense positive emotions balance their higher negative affect.

Further validation of the Satisfaction with Life Scale: evidence for the cross-method convergence of well-being measures.

The structure of subjective well-being has been conceptualized as consisting of two major components: the emotional or affective component and the judgmental or cognitive component (Diener, 1984; Veenhoven, 1984). The judgmental component has also been conceptualized as life satisfaction (Andrews & Withey, 1976). Although the affective component of subjective well-being has received considerable attention from researchers, the judgmental component has been relatively neglected. The Satisfaction With Life Scale (SWLS; Diener, Emmons, Larsen, & Griffin, 1985) was developed as a measure of the judgmental component of subjective well-being (SWB). Two studied designed to validate further the SWLS are reported. Peer reports, a memory measure, and clinical ratings are used as external criteria for validation. Evidence for the reliability and predictive validity of the SWLS is presented, and its performance is compared to other related scales. The SWLS is shown to be a valid and reliable measure of life satisfaction, suited for use with a wide range of age groups and applications, which makes possible the savings of interview time and resources compared to many measures of life satisfaction. In addition, the high convergence of self- and peer-reported measures of subjective well-being and life satisfaction provide strong evidence that subjective well-being is a relatively global and stable phenomenon, not simply a momentary judgment based on fleeting influences.