Usefulness of triglycerides-to-high-density lipoprotein cholesterol ratio for predicting the first coronary event in men.

Overweight and obesity potentiate the development of cardiovascular risk factors but many doubts have arisen recently regarding their role in coronary events. We evaluated the predictive value of a surrogate maker of insulin resistance, the ratio of triglyceride (TG) to high-density lipoprotein (HDL), for the incidence of a first coronary event in men workers according to body mass index (BMI). We designed a case-control study of active subjects collected from a single factory through their annual health examination and medical reports. Case subjects included those with myocardial infarction, unstable angina pectoris, or subclinical myocardial ischemia detected through electrocardiographic abnormalities. The sample was constituted by 208 case and 2,080 control subjects (mean age 49.9 years, 49.6 to 50.2). General characteristics of case and control subjects were well matched. The TG/HDL ratio was significantly higher in case subjects compared to controls. Stratification of the sample revealed an increasing prevalence of case subjects and mean TG/HDL in each category of BMI. Multivariable analysis, adjusted by smoking, demonstrated that TG/HDL increased 50% the risk of a first coronary event (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.26 to 1.71), whereas low-density lipoprotein cholesterol values indicated a more moderate increased risk (OR 1.01, 95% CI 1.005 to 1.012); metabolic syndrome (OR 1.76, 95% CI 0.94 to 3.30) and hypertension (OR 1.50, 95% CI 0.81 to 2.79) did not reach statistical significance. The TG/HDL ratio was associated with a first coronary event in all categories of BMI. In conclusion, the TG/HDL ratio has a high predictive value of a first coronary event regardless of BMI.

Gender differences in obesity related cardiovascular risk factors in Spain.

BACKGROUND: Obesity and overweight are increasing progressively leading to an increase in cardiovascular risk factors and cardiovascular events. METHODS: The MESYAS Registry (Metabolic Syndrome in Active Subjects) recruited active workers from their annual health examinations in Spain through 2003. Body mass index was used to diagnose overweight and obesity. Metabolic syndrome (MS) and risk factors were assessed according to the ATP-III definitions. RESULTS: 19,041 subjects were included (80% males), mean age 42.2 (10.7). The prevalence of overweight was 44.6% (44.0-45.2), obesity 17.3% (17.0-17.5) and MS 12.0% (11.8-12.2). Women had lower prevalence of all cardiovascular risk factors. Multivariate analysis showed independent associations between overweight (OR: 2.4; 95% CI 2.2-2.6) or obesity (OR: 5.3; 95% CI 4.7-5.9) and any other two MS criteria. Overweight and obesity were independently associated with all cardiovascular risk factors, except low high-density lipoproteins in women. Significantly higher association was found in women between obesity and diabetes (OR: 13.6; 95% CI 3.8-48.6), MS (OR: 10.6; 7.6-14.8), hypertriglyceridemia (OR: 8.6; 95% CI 5.6-13.1), and impaired fasting glucose (OR: 3.7; 95% CI 2.7-5.3). CONCLUSIONS: Overweight and obesity are strongly related to classical cardiovascular risk factors, atherogenic dyslipidaemia and MS. Obesity has higher association to insulin-resistance related risk factors in women.

Comparison of serum lipid values in subjects with and without the metabolic syndrome.

Insulin resistance is supposed to be the basis of metabolic syndrome (MS), although it is difficult to measure. The ratio of triglyceride (TG) to high-density lipoprotein (HDL) has been proposed as a surrogate marker of insulin resistance in overweight subjects. The aim of the present study was to assess the accuracy of the TG/HDL ratio for the diagnosis of MS. Data of 18,778 active workers (77.6% men) enrolled in 3 insurance companies in Spain were collected from their annual health examinations. Mean age was 42.2 +/- 10.7 years. MS was assessed according to modified Adult Treatment Panel III criteria. Prevalences of MS were 18.8% in men and 6.1% in women. Mean value of the TG/HDL ratio was 2.50 +/- 2.2 and increased in parallel to the number of MS components present. Subjects with MS had a ratio that was 2 times higher compared with those without (5.10 vs 2.03, p <0.001). Receiver operating characteristic curves were performed to assess the capability of the TG/HDL ratio to contribute to a diagnosis of MS and 80% sensitivity and 78% specificity were obtained for values >2.75 in men and >1.65 in women. In conclusion, the TG/HDL ratio is a feasible and accurate measurement for assessment of MS in healthy subjects. We propose cut-off values of 2.75 for men and 1.65 for women for a diagnosis of MS.

Prehypertension is associated with insulin resistance state and not with an initial renal function impairment. A Metabolic Syndrome in Active Subjects in Spain (MESYAS) Registry substudy.

BACKGROUND: The aim of this study was to assess the prevalence of metabolic syndrome (MS) and other surrogate markers of insulin resistance, and whether these markers are better for defining the prehypertensive state than is renal dysfunction. METHODS: Data from 19,041 healthy active workers, mean age 42.2 (10.7) years, from three health insurance companies, were prospectively collected. Presence of MS, assessed according to the modified criteria of the National Cholesterol Education Program Third Adult Treatment Panel, and the ratio of triglycerides to high-density lipoprotein were considered as surrogate markers of insulin resistance. Renal function was assessed by the Modification of Diet in Renal Disease Study equation. Blood pressure was classified as normotension (NT), prehypertension (PHT), or hypertension (HT) according to the guidelines of the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. RESULTS: The global presence of MS was 11.8% The higher prevalence was found in subjects with hypertension (30%), followed by those with PHT (9.6%). The prevalence in normotensive subjects was very low (0.9%). The presence of MS and hypertension increased in parallel with age. Metabolic syndrome (odds ratio [OR] 4.3), obesity (OR 2.2), overweight (OR 1.7), impaired fasting glucose (OR 1.3), and elevated triglycerides to HDL ratio (OR 1.2), but no degree of renal dysfunction, were independent risk factors for the progression from NT to PHT. CONCLUSIONS: Prehypertension is associated with markers of insulin resistance, assessed by the presence of MS and other surrogate markers, and not with an initial renal dysfunction. In this study, MS was found to be present in almost one third of hypertensive but asymptomatic and otherwise healthy workers.

[Cardiovascular risk factors and metabolic syndrome associated with subclinical renal failure]. / Factores de riesgo cardiovascular y síndrome metabólico asociados a la disfunción renal subclínica: subanálisis del Registro MESYAS.

BACKGROUND AND OBJECTIVE: The objectives of this study were to describe the prevalence of subclinical renal dysfunction, assessed by glomerular filtration rate (GFR), and identify the associated cardiovascular risk factors in active working subjects of Spain. SUBJECTS AND METHOD: Data were collected in 11,582 active healthy workers (78.5% males), mean age (standard deviation) 40.2 (10.7) years, in their annual health examinations. Renal function was assessed by the GFR estimated by 3 methods: the abbreviated equation of Modification of Diet in Renal Disease (MDRD) study, the Cockroft-Gault (CG) equation and the weight/creatinine ratio. The assessment of the metabolic syndrome was done according to the modified Adult Treatment Panel III criteria. RESULTS: The 3 equations used for the estimation of GFR showed different values. GFR mean values were highest with the CG method (99.0 [25.0]) ml/min/1.73 m2, followed by the results of the MDRD and weigh/creatinine ratio (90.2 [18.5] ml/min/1.73 m2 and 81.2 [18.3] ml/min/1.73 m2, respectively). The prevalence of mild renal dysfunction (GFR: 60-89 ml/min/1.73 m2) ranged between 35.7% and 50.8% depending on the method applied, and the presence of moderate-severe (GFR < 60 ml/min/1.73 m2) ranged between 1.2% and 2.6%. All cardiovascular risk factors were more prevalent in the categories of worst renal function. Multivariant regression analysis showed that hypertriglyceridemia (odds ratio [OR] = 1.2), metabolic syndrome (OR = 1.2), overweight (OR = 1.2) and hypercholesterolemia (OR = 1.5) were associated independently with mild renal dysfunction. Hypercholesterolemia (OR = 1.6), hypertension (OR = 1.6), low HDL (OR = 2.4), and diabetes mellitus (OR = 3.2) were associated with moderate-severe renal dysfunction. CONCLUSIONS: Renal subclinical dysfunction is highly prevalent and is independently associated with classical cardiovascular risk factors and metabolic syndrome.

Factores de riesgo cardiovascular y síndrome metabólico asociados a la disfunción renal subclínica: subanálisis del Registro MESYAS / Cardiovascular risk factors and metabolic syndrome associated with subclinical renal failure

Fundamento y objetivo: Describir la prevalencia de la disfunción renal subclínica, valorada mediante el filtrado glomerular (FG), e identificar a qué factores de riesgo cardiovascular se asocia en una población laboral activa española. Sujetos y método: Se recogieron los datos de 11.582 trabajadores activos (un 78,5% varones), con una edad media (desviación estándar) de 40,2 (10,7) años, mediante las revisiones anuales de las mutuas laborales. La función renal se clasificó según el FG, valorado mediante la fórmula abreviada del estudio Modification of Diet in Renal Disease (MDRD), la fórmula Cockroft-Gault (CG) y el cociente peso/creatinina. El diagnóstico del síndrome metabólico se realizó mediante los criterios del Adult Treatment Panel III modificados. Resultados: Las 3 fórmulas de estimación del FG aportan valores diferentes. Los valores medios de FG fueron mayores con la fórmula CG (99,0 [25,0]) ml/min/1,73 m2, seguidos de los obtenidos por la fórmula MDRD (90,2 [18,5]) ml/min/1,73 m2 y la fórmula peso/creatinina (81,2 [18,3]) ml/min/1,73 m2. La prevalencia de disfunción renal leve (FG: 60-89 ml/min/1,73 m2) varió entre el 35,7 y el 50,8% en función de la ecuación empleada, y moderada-grave (FG < 60 ml/min/1,73 m2) entre un 1,2 y un 2,6%. Todos los factores de riesgo cardiovascular fueron más prevalentes en las categorías de mayor disfunción renal. El análisis de regresión multivariante muestra que la hipertrigliceridemia (odds ratio [OR] = 1,2), el síndrome metabólico (OR = 1,2), el sobrepeso OR = 1,2) y la hipercolesterolemia (OR = 1,5) se asocian independientemente a la disfunción renal leve. La hipercolesterolemia (OR = 1,6), la hipertensión (OR = 1,6), una concentración baja de colesterol unido a lipoproteínas de alta densidad (OR = 2,4) y la diabetes mellitus (OR = 3,2) se asocian con la disfunción renal moderada-grave. Conclusiones: La disfunción renal subclínica es muy prevalente y se asocia independientemente a los factores de riesgo cardiovascular clásicos y el síndrome metabólico

Background and objective: The objectives of this study were to describe the prevalence of subclinical renal dysfunction, assessed by glomerular filtration rate (GFR), and identify the associated cardiovascular risk factors in active working subjects of Spain. Subjects and method: Data were collected in 11,582 active healthy workers (78.5% males), mean age (standard deviation) 40.2 (10.7) years, in their annual health examinations. Renal function was assessed by the GFR estimated by 3 methods: the abbreviated equation of Modification of Diet in Renal Disease (MDRD) study, the Cockroft-Gault (CG) equation and the weight/creatinine ratio. The assessment of the metabolic syndrome was done according to the modified Adult Treatment Panel III criteria. Results: The 3 equations used for the estimation of GFR showed different values. GFR mean values were highest with the CG method (99.0 [25.0]) ml/min/1.73 m2, followed by the results of the MDRD and weigh/creatinine ratio (90.2 [18.5] ml/min/1.73 m2 and 81.2 [18.3] ml/min/1.73 m2, respectively). The prevalence of mild renal dysfunction (GFR: 60-89 ml/min/1.73 m2) ranged between 35.7% and 50.8% depending on the method applied, and the presence of moderate-severe (GFR < 60 ml/min/1.73 m2) ranged between 1.2% and 2.6%. All cardiovascular risk factors were more prevalent in the categories of worst renal function. Multivariant regression analysis showed that hypertriglyceridemia (odds ratio [OR] = 1.2), metabolic syndrome (OR = 1.2), overweight (OR = 1.2) and hypercholesterolemia (OR = 1.5) were associated independently with mild renal dysfunction. Hypercholesterolemia (OR = 1.6), hypertension (OR = 1.6), low HDL (OR = 2.4), and diabetes mellitus (OR = 3.2) were associated with moderate-severe renal dysfunction. Conclusions: Renal subclinical dysfunction is highly prevalent and is independently associated with classical cardiovascular risk factors and metabolic syndrome

[Prevalence of metabolic syndrome in the Spanish working population: MESYAS registry]. / Prevalencia del síndrome metabólico en población laboral española: registro MESYAS.

INTRODUCTION AND OBJECTIVES: To assess the prevalence of metabolic syndrome in the active Spanish working population and to describe differences related to work type. SUBJECTS AND METHOD: Data were collected on 7256 individuals [82.4% male; mean age (SD), 45.4 (9.8) years] actively employed in a large car factory and a department store. Metabolic syndrome was diagnosed according to modified ATP-III criteria (using body mass index instead of waist circumference). RESULTS: Overall, the prevalence of metabolic syndrome was 10.2%. When data were adjusted to match the age and gender of the general population (age range, 20-60 years), the prevalence was 5.8% (95% CI, 4.1%-7.6%). Moreover, it was significantly higher in men than women, at 8.7% (95% CI, 7.3%-10.0%) vs 3.0% (95% CI, 0.8%-5.1%), respectively. All the components of the metabolic syndrome were significantly more common in males, except a low HDL-cholesterol level. Prevalence increased with age and male gender (OR=1.7), obesity (OR=9.6), hypertension (OR=3.4), and diabetes (OR=15.4). The prevalence was highest in manual workers (11.8%), and lower in office workers (9.3%) and managers (7.7%), which indicates an inverse relationship with social class. The likelihood of presenting with metabolic syndrome, irrespective of age or gender, was highest in manual workers (OR=1.3). This phenomenon seemed to depend on the serum triglyceride level. CONCLUSIONS: One in ten active workers had metabolic syndrome. The prevalence rose with age, male gender, and blood pressure, and was greatly increased by obesity and diabetes. Manual workers had the highest prevalence, whereas managers had a more favorable profile.

Prevalencia del síndrome metabólico en población laboral española: registro MESYAS / Prevalence of metabolic syndrome in the spanish working population: MESYAS registry

Introducción y objetivos. Estudiar la prevalencia del síndrome metabólico (SM) en la población laboral activa española y analizar sus diferencias según las categorías laborales. Sujetos y método. Se recogieron los datos de 7.256 trabajadores activos (un 82,4% varones), con una edad media de 45,4 ± 9,8 años, empleados en una factoría de coches y unos grandes almacenes. El diagnóstico del SM se realizó mediante los criterios modificados del ATP-III (se utilizó el índice de masa corporal en lugar del perímetro abdominal). Resultados. La prevalencia bruta del SM fue del 10,2%. Ajustada por edad y sexo en una población plana (20-60 años) fue del 5,8% (intervalo de confianza [IC] del 95%, 4,1-7,6%), significativamente más alta en varones que en mujeres (el 8,7%; IC del 95%, 7,3-10,0 frente al 3,0%; IC del 95%, 0,8-5,1). Todos los componentes del SM fueron significativamente más prevalentes en varones, excepto las concentraciones de lipoproteínas de alta densidad, que fueron más bajas. La prevalencia aumentó con la edad y el sexo masculino (odds ratio [OR] = 1,7), la obesidad (OR = 9,6), la hipertensión (OR = 3,4) y la diabetes (OR = 15,4). Los trabajadores manuales presentaron la mayor prevalencia de SM (11,8%), seguidos por los trabajadores de oficina (9,3%) y los directivos (7,7%) (gradiente social inverso). Los trabajadores manuales tienen un riesgo superior de presentar SM, con independencia de la edad y el sexo (OR = 1,3); este efecto parece depender de las concentraciones de triglicéridos. Conclusiones. Uno de cada 10 trabajadores activos tiene SM; la prevalencia aumenta con la edad y el sexo masculino. La obesidad y la diabetes suponen gran incremento de la prevalencia. Los trabajadores manuales son el colectivo con mayor prevalencia

Introduction and objectives. To assess the prevalence of metabolic syndrome in the active Spanish working population and to describe differences related to work type. Subjects and method. Data were collected on 7256 individuals [82.4% male; mean age (SD), 45.4 (9.8) years] actively employed in a large car factory and a department store. Metabolic syndrome was diagnosed according to modified ATP-III criteria (using body mass index instead of waist circumference). Results. Overall, the prevalence of metabolic syndrome was 10.2%. When data were adjusted to match the age and gender of the general population (age range, 20-60 years), the prevalence was 5.8% (95% CI, 4.1%-7.6%). Moreover, it was significantly higher in men than women, at 8.7% (95% CI, 7.3%-10.0%) vs 3.0% (95% CI, 0.8%-5.1%), respectively. All the components of the metabolic syndrome were significantly more common in males, except a low HDL-cholesterol level. Prevalence increased with age and male gender (OR=1.7), obesity (OR=9.6), hypertension (OR=3.4), and diabetes (OR=15.4). The prevalence was highest in manual workers (11.8%), and lower in office workers (9.3%) and managers (7.7%), which indicates an inverse relationship with social class. The likelihood of presenting with metabolic syndrome, irrespective of age or gender, was highest in manual workers (OR=1.3). This phenomenon seemed to depend on the serum triglyceride level. Conclusions. One in ten active workers had metabolic syndrome. The prevalence rose with age, male gender, and blood pressure, and was greatly increased by obesity and diabetes. Manual workers had the highest prevalence, whereas managers had a more favorable profile

Temas de actualidad en cardiología preventiva: el síndrome metabólico / Current Topics in Cardiovascular Prevention: the Metabolic Syndrome

Se citan los principales ensayos clínicos en prevención cardiovascular concluidos en el último año. Se revisan el concepto y la fisiopatología del síndrome metabólico, su prevalencia en nuestro medio, los medios diagnósticos más adecuados y la necesidad de establecer medidas preventivas (AU)

This paper refers to the main clinical trials in cardiovascular prevention in the previous year. Further, it reviews the concept and pathophysiology of metabolic syndrome, its prevalence in our setting, the most appropriate diagnosis and the need to establish preventive measures (AU)