The metabolic syndrome and ECG detected left ventricular hypertrophy--influences from IGF-1 and IGF-binding protein-1.

BACKGROUND AND AIMS: The metabolic syndrome (MetS) is associated with an increased risk for left ventricular hypertrophy (LVH) and cardiovascular mortality. The aim of this study was to investigate potential influences from insulin-like growth factor-1 (IGF-1) and IGF binding protein-1 (IGFBP-1) on the relationship between the MetS and LVH, also taking into account the role of physical activity (PA), use of oestrogen and gender. METHODS AND RESULTS: In a population-based cross-sectional study of 60-year-old men (n = 1822) and women (n = 2049) participants underwent physical examination and laboratory tests, including electrocardiography (ECG), and completed an extensive questionnaire. Women showed higher levels of IGFBP-1 than men (37.0 vs. 28.0 µg/l, p < 0.001), and women with LVH had lower levels of IGFBP-1 than women without LVH (31.0 µg/l vs. 37.0 µg/l, p < 0.001). Furthermore, women with low levels of IGFBP-1 had a significantly increased risk of having LVH (crude OR ≈ 2.5). When stratifying for PA and oestrogen, respectively, a weaker association between IGFBP-1 and LVH was demonstrated in physically active men and women, compared to inactive individuals, as well as in women using oestrogen, compared to non-users. CONCLUSION: In a representative sample of 60-year-old Swedish men and women, the main findings were higher levels of IGFBP-1 in women than in men; lower levels of IGFBP-1 in women with LVH, compared to women without LVH; and an increased risk of having LVH in women with low levels of IGFBP-1. The association between IGFBP-1 and LVH was diminished in physically active men and women, as well as in women using oestrogen.

The metabolic syndrome and left ventricular hypertrophy--the influence of gender and physical activity.

AIMS: To investigate associations between the metabolic syndrome (MetS) and left ventricular hypertrophy (LVH) as well as the influence of gender and physical activity (PA) in a population-based cross-sectional study of 60-year-old men (n = 1822) and women (n = 2049). MAJOR FINDINGS: In total, 908 (23.5%) study participants fulfilled the criteria for MetS (54.2% men). Among those, 104 (11.5%) exhibited signs of LVH (60.6% men), compared with 182 (6.1%) among those without MetS (60.4% men). Of the individual factors contained in MetS, hypertension was independently associated with LVH in both men and women (OR = 3.4; 95% CI 2.0-5.8 and 4.4; 2.5-7.8 respectively), whereas waist circumference (OR = 1.6; 95% CI 1.0-2.6), high glucose levels (OR = 1.8; 95% CI 1.1-2.8) and hyperinsulinaemia (OR = 1.7; 95% CI 1.1-2.6) were independently related to risks for LVH exclusively in women. PA did not significantly affect the association. PRINCIPAL CONCLUSION: Participants with MetS were at an increased risk of LVH, independently of PA level. Of the various components in MetS, hypertension was most strongly and independently related to LVH in both men and women. In women, abdominal obesity, high glucose levels and hyperinsulinaemia were independently related to LVH, suggesting a gender differences in the mechanisms behind development of LVH.

Cost-effectiveness of primary prevention of coronary heart disease through risk factor intervention in 60-year-old men from the county of Stockholm--a stochastic model of exercise and dietary advice.

BACKGROUND: Recent screenings show a high prevalence of cardiovascular risk factors in the county of Stockholm. Primary prevention may be a way to lower the risk burden of coronary heart disease, but we must establish that preventive programs are cost-effective. METHODS: Through the use of a stochastic Markov model, which predicts reduction in coronary heart disease events based on risk factor reductions, this study evaluates the results of a previous controlled trial in middle-aged men comparing dietary advice, exercise, and the combination of both applied to an observed cohort of 60-year-old men in the county of Stockholm. RESULTS: The model predicts lower costs and higher effectiveness for dietary advice compared to the alternatives. Assuming a declining effect of the intervention, dietary advice saves 0.0228 life-years compared to no intervention. If no decline is assumed, the corresponding figure is 0.0997 life-years. From the societal perspective, the added costs are 2,892 Swedish Kronor (SEK) and 14,106 SEK for the two modeling assumptions, resulting in a cost-effectiveness of 127,065 SEK per life-year gained (LYG) and 141,555 SEK/LYG. These figures are below what is generally thought of as cost-effective. CONCLUSION: Based on the model, dietary advice appears to be the most cost-effective of the studied interventions.