Early and Menopausal Weight Gain and its Relationship with the Development of Diabetes and Hypertension.

Background: Previous research has revealed a clear relationship between weight gain of persons and their metabolic diseases developing later. These studies have covered only short periods lasting 4-8 years.Our goal was to collect decades' old and often life-long anthropometric data and correlate the figures with the presence of hypertension and diabetes or both. Methods: A retrospective international study was planned and organized to compare self-recorded data of lifelong weight gain among 60-70-year-old patients, analyze their correlation with metabolic diseases they developed, with special attention to women's weight gain around pregnancy, delivery and menopause in primary care settings in Germany, Hungary, Italy, Slovakia and the Ukraine. Results: Of the recruited 815 participants, 319 men and 496 women presented all the required data. Diabetics of both genders had the highest baseline weight at 20 years of age. The weight and BMI of the whole study population increased steadily until their seventies, but to a lesser extent after their fifties. Compared to the control group, changes over decades were the greatest among diabetics and also greater among patients with hypertension. Weight increase in the first decades (20-30-year-old men and 30-40-year-old women) was a significant risk factor for the development of diabetes (OR=1.044; p=0.002; 95% CI: 1.01-1.07). Among patients with diabetes and hypertension, both diagnoses were set up earlier than among those with a single morbidity.Among females, weight increase around pregnancy and menopause correlated significantly with higher odds for the diagnoses of diabetes and/or hypertension, irrespective of the number of children. Conclusions: During their decade-long relationship with their patients, family physicians are expected to identify the higher weight gain of their patients, especially among younger generation and intervene, if necessary.

Polycystic ovary syndrome has no independent effect on vascular, inflammatory or thrombotic markers when matched for obesity.

INTRODUCTION: Previous studies investigating cardiovascular (CV) risk in obese women with polycystic ovary syndrome (PCOS) have been potentially confounded by not adequately accounting for body weight. OBJECTIVE: To assess if PCOS increases CV risk independently in young obese women by examining carotid intima-media wall thickness (cIMT) and platelet function. DESIGN: A case-control study comparing women with PCOS (n = 21) to age (32·8 ± 7·2 vs 33·5 ± 6·7 years), and weight (100·9 ± 16·7 vs 99·3 ± 14·7 kg)-matched controls (n = 19). Platelet function was examined by flow cytometry, clot structure and fibrinolysis by turbidimetric assays and endothelial function by ELISA and post ischaemic reactive hyperaemia. RESULTS: The PCOS group had higher testosterone 1·2 ± 0·3 vs 0·9 ± 0·3 nmol/l (P = 0·01), HOMA-IR 2·5 ± 1·7 vs 1·7 ± 1·0 (P = 0·08), impaired glucose regulation 33·3% vs 5·3% (P = 0·02), and urinary isoprostane 16·0 ± 4·4 vs 11·8 ± 7·1 ng/ml (P = 0·04) compared to controls. Mean cIMT 0·5 ± 0·05 vs 0·48 ± 0·06 mm (P = 0·36), and basal platelet surface expression (percentage of positive cells) of P-selectin 0·52 ± 0·3 vs 0·43 ± 0·23 (P = 0·40) and fibrinogen binding 0·97 ± 0·4 vs 0·83 ± 0·3 (P = 0·48) did not significantly differ between the PCOS and control groups respectively. Furthermore, platelets sensitivity to stimulation with adenosine-5'-diphosphate or inhibition with prostacyclin, clot structure and fibrinolytic efficiency ex vivo, endothelial reactive hyperaemic index (RHI), inflammation (hsCRP) and adhesion markers (sE-selectin, sP-selectin, sVCAM-1 and sICAM-1) were not significantly different between the two groups. CONCLUSIONS: PCOS appeared not to independently increase atherothrombotic risk when matched for obesity. It is likely that any excess CV risk in young obese women with PCOS can either be attributed to obesity or is not yet apparent at this early stage of the condition.

Plaque volume derived from three-dimensional reconstruction of coronary angiography predicts the fractional flow reserve.

OBJECTIVES: To compare the data calculated from the three dimensional (3D) reconstruction of a coronary stenosis with the fractional flow reserve (FFR) values measured on the same coronary segment. METHODS: Multiple projections of 22 patients (7 female, 15 male, age: 61 ± 9.73 years) were evaluated by the IC30 software of the Axiom Artis X-ray machine. 3D reconstruction was successfully carried out on 23 coronary arteries (14 LAD, 4 CX and 5 RCA). RESULTS: Regression analysis demonstrated significant relationship between the cross-sectional area percentage stenosis (AS) calculated based on the 3D measurement and the FFR (r: -0.566, p: 0.008), as well as between the 3D derived plaque volume (PV) and the FFR (r: -0.501, p: 0.018). On the other hand, the diameter stenosis (DS) and the minimal lumen diameter (MLD) did not correlate with the FFR values. According to the Receiver Operating Characteristic (ROC) analysis the rank of the areas under the ROC curves (AUC) was the following: 1. PV (0.76), 2. AS (0.74), 3. DS (0.62), 4. MLA (0.55), and 5. MLD (0.51). The difference between the AUC of the PV and MLA was found to be significant (p=0.02). The best agreement with the FFR was found when the PV was >44% (sensitivity 66.67%, specificity 82.35%) and the 3D AS was >60% (sensitivity 100%, specificity 47%). CONCLUSION: Besides the 3D AS the calculated PV characterizing the entire lesion is also an important predictor of the flow consequence of the stenosis.