Diabetes mellitus is associated with early chronic venous disorder of the lower extremities in Chinese patients with cardiometabolic risk factors.

BACKGROUND: Metabolic syndrome has received great attention because it poses a potential cardiovascular hazard, which increases the risk of lower extremity atherosclerosis. However, the relationship between the components of metabolic syndrome and the onset of chronic venous disorder of the lower extremities remains unexplained. METHODS: This study investigated the characteristics of cardiometabolic risk factors of early chronic venous disorder of the lower extremities in subjects with cardiometabolic risk. The characteristics of risk factors and diabetes-related complications in diabetic patients with early chronic venous disorder of the lower extremities were also investigated. In addition, the association between early chronic venous disorder and atherosclerosis of the lower extremities was analysed. The study examined 782 subjects with cardiometabolic risk factors, including obesity, hypertension, diabetes mellitus and dyslipidaemia. Lower extremity venous function was measured by digital photoplethysmography. RESULTS: Women had a higher prevalence of early chronic venous disorder than did men (p < 0.01). Male subjects with early chronic venous disorder had a higher systolic blood pressure than those with normal venous function (p < 0.01), and female subjects with early chronic venous disorder had a higher fasting plasma glucose level than did controls (p < 0.05). The prevalence of diabetes mellitus is also significantly higher in female patients with early chronic venous disorder (p = 0.000). Diabetic patients with early chronic venous disorder not only had higher fasting plasma glucose and total cholesterol levels but also had more serious macrovascular complications than the control group. The independent risk factors of early chronic venous disorder in female subjects with cardiometabolic risks were age and fasting plasma glucose in men it was only age Women face a two times greater risk than men. The independent risk factors of early chronic venous disorder in diabetic patients were age, gender, HbA1c and triglyceride levels Women had an almost 12 times greater risk of early chronic venous disorder than men. Among the diabetic patients, the prevalence of early chronic venous disorder did not differ by ankle-brachial index. CONCLUSION: Female subjects with cardiometabolic risk factors or female diabetic patients face a greater risk of early chronic venous disorder than do male subjects. Diabetic patients with early chronic venous disorder had more serious macrovascular complications than did the controls, and the early venous function was found to be correlated with the blood glucose level and triglyceride status.

[Evaluation of visceral adipose in abdominal obesity and its clinical application].

OBJECTIVE: To compare the values of measurements of obesity, including body mass index(BMI), waist circumference (WC), waist-to-hip ratio (WHR), bioelectrical impedance analyzer(BIA) (fat mass and FAT%), ultrasonography (US) (subcutaneous fat distance and intraabdominal fat distance), and computed tomography (CT) in predicting the quantification of visceral adipose in abdominal obesity, and to evaluate the best cut-off point, sensitivity and specificity of these methods. METHODS: 4,301 inpatients with hypertension, 2,155 males and 2,146 females, aged (56.4 +/- 13.8) (11 - 89), all with at least 1 risk factor of cardiovascular diseases, underwent simple body fat measurement. 3458 received BIA, 2,553 received B mode ultrasonography, 1039 underwent CT examination, and 659 received all kinds of examination. Abdominal visceral adipose area (VA) measured with CT >or= 100 cm(2) was the diagnostic criteria of visceral fat obesity (VFO). Receiver operating characteristic (ROC) curve was used to analyze the body fat indexes to determine the best cut-off point. RESULTS: (1) It was accurate for WC, fat mass, BMI, intraabdominal fat distance, FAT%, and WHR were all accurate in diagnosis of VFO with the values of area under ROC of 0.730 - 0.867. WC was the most effective measurement. (2) The best cut-off points of these methods in predicting abdominal visceral obesity in males and females were as follows: WC: 89.5 cm and 85.5 cm for WC. 25 kg/m(2) and 26 kg/m(2) for BMI, 0.97 and 0.95 for WHR, 29% and 38% for fat composition, 18.6 kg, and 20.4 kg for fat mass, and 38.5 mm and 34.7 mm for intraabdominal fat distance. CONCLUSIONS: WC, fat mass, BMI, intraabdominal fat distance, simple fat parameters, and WHR all can predict visceral adipose in abdominal obesity, in which WC is the best. For a given WC, the type of obesity can be determined by BIA and US.

[Relationship of different types of abdominal obesity to risk of metabolic syndrome].

OBJECTIVE: To explore the relationship of different types of abdominal obesity to risk of metabolic syndrome (MS). METHODS: Visceral fat area (VA) and substantial fat area (SA) were assessed by CT in 846 patients, 470 males and 376 females, aged 55 +/- 12, who suffered from at least one cardiometabolic risk factor and divided into 4 groups according to their VA and waist circumference (WC): non-obesity, masked visceral fat obesity (VFO), pseudo-VFO, and VFO groups. Blood pressure, fasting blood glucose, fasting serum insulin, and lipid profile were also measured. The MS risks of different types of abdominal obesity were compared. RESULTS: The prevalence rate of masked VFO of males was 10.9% (51/470), significantly higher than that of female (4.8%, 18/376). The prevalence rate of MS of the male patients with masked VFO was 43.1%, significantly higher than that of those in non-obesity group (25.0%), and lower than those of the males in the pseudo-VFO group (78.7%) and in the VFO group (88.6%), whereas the MS prevalence rate of the males in the pseudo-VFO group was significantly higher than those in the non-obesity and masked VFO groups. On the other hand, the MS prevalence rate of the female patients with masked VFO was 33.3%, not significantly different from that of the female patients in the non-obesity group (31.2%), but significantly lower than those of the pseudo-VFO and VFO groups (78.7% and 90.9% respectively). The MS prevalence rate of the female pseudo-VFO patients was also significantly higher than those in the non-obesity and masked VFO groups. Logistic regression analysis showed that WC and VA were independent risk factors for MS [OR (95% CI) = 1.13 (1.10-1.17), 1.01 (1.01-1.02), respectively, P < 0.01). CONCLUSION: Different types of abdominal obesity have important impacts on the risk of metabolic syndrome. Masked VFO, even though with normal WC, and pseudo-VFO have considerably higher cardiometabolic risks.

[Relationship between abdominal obesity and left ventricular weight/function].

OBJECTIVE: To observe the relationship between abdominal obesity and left ventricular weight/function. METHODS: A total of 495 patients [265 males, mean age (55 +/- 12) years] with hypertension (139), diabetes (65), metabolic syndrome (285), diabetes complicated with hypertension (11) were enrolled in this study. Visceral adipose area (VA), the subcutaneous adipose (SA), the total abdominal adipose (TA) were measured by computerized tomography (CT) and left ventricular weight and function were obtained by echocardiography. Patients were divided into three groups according to the VA (I. VA<75 cm(2), n=173, II. VA>75 and < 110 cm(2), n=153, III. VA >or= 110 cm(2), n=169). RESULTS: Left ventricular mass (LVM) and LVM index (LVMI) increased and LVEF and E/A decreased in proportion to increasing VA. Left ventricular hypertrophy (LVH) rate was significantly higher in group II and III compared to group I and LVEF was significantly reduced in group III compared to group I and II. There are significant correlation between LVMI and VA, SA, TA as well as between LVEF and VA after adjusting gender, age and blood pressure. Logistic regression analysis showed that VA is an independent predictor for LVH. CONCLUSION: The abdominal adipose accumulation is closely related to the left ventricular weight and function.

Activation of transient receptor potential vanilloid type-1 channel prevents adipogenesis and obesity.

We tested the hypothesis that activation of transient receptor potential vanilloid type-1 (TRPV1) by capsaicin prevents adipogenesis. TRPV1 channels in 3T3-L1-preadipocytes and visceral adipose tissue from mice and humans were detected by immunoblotting and quantitative real-time RT-PCR. The effect of TRPV1 on cytosolic calcium was determined fluorometrically in 3T3-L1-preadipocytes and in human visceral fat tissue. Adipogenesis in stimulated 3T3-L1-preadipocytes was determined by oil red O-staining of intracellular lipid droplets, triglyceride levels, expression of peroxisome proliferator-activated receptor-gamma, and expression of fatty acid synthase. Long-term feeding experiments were undertaken in wild-type mice and TRPV1 knockout mice. We detected TRPV1 channels in 3T3-L1-preadipocytes and visceral adipose tissue from mice and humans. In vitro, the TRPV1 agonist capsaicin dose-dependently induced calcium influx and prevented the adipogenesis in stimulated 3T3-L1-preadipocytes. RNA interference knockdown of TRPV1 in 3T3-L1-preadipocytes attenuated capsaicin-induced calcium influx, and adipogenesis in stimulated 3T3-L1-preadipocytes was no longer prevented. During regular adipogenesis TRPV1 channels were downregulated which was accompanied by a significant and time-dependent reduction of calcium influx. Compared with lean counterparts in visceral adipose tissue from obese db/db and ob/ob mice, and from obese human male subjects we observed a reduced TRVP1 expression. The reduced TRPV1 expression in visceral adipose tissue from obese humans was accompanied by reduced capsaicin-induced calcium influx. The oral administration of capsaicin for 120 days prevented obesity in male wild type mice but not in TRPV1 knockout mice assigned to high fat diet. We conclude that the activation of TRPV1 channels by capsaicin prevented adipogenesis and obesity.

Exercise reduces adipose tissue via cannabinoid receptor type 1 which is regulated by peroxisome proliferator-activated receptor-delta.

Obesity is one major cardiovascular risk factor. We tested effects of endurance exercise on cannabinoid receptor type 1 (CB1) and peroxisome proliferator-activated receptor-delta (PPAR-delta)-dependent pathways in adipose tissue. Male Wistar rats were randomly assigned to standard laboratory chow or a high-fat diet without and with regular endurance exercise. Exercise in rats on high-fat diet significantly reduced visceral fat mass, blood pressure, and adipocyte size (each p<0.05). Adipocyte hypertrophy induced by high-fat diet was accompanied by increased CB1 expression in adipose tissue, whereas exercise significantly reduced CB1 expression (each p<0.05). CB1 receptor expression and adipocyte differentiation were directly regulated by PPAR-delta. Adipocyte hypertrophy induced by high-fat diet was accompanied by reduced PPAR-delta. Furthermore, selective silencing of PPAR-delta by RNA interference in 3T3-L1-preadipocyte cells significantly increased CB1 expression from 1.00+/-0.06 (n=3) to 1.91+/-0.06 (n=3; p<0.01) and increased adipocyte differentiation, whereas adenovirus-mediated overexpression of PPAR-delta significantly reduced CB1 expression to 0.39+/-0.03 (n=3; p<0.01) and reduced adipocyte differentiation. In the presence of the CB1 antagonist rimonabant adipocyte differentiation in stimulated 3T3 L1 preadipocyte cells was significantly reduced. The study indicates that high-fat diet-induced hypertrophy of adipocytes is associated with increased CB1 receptor expression which is directly regulated by PPAR-delta. Both CB1 and PPAR-delta are intimately involved in therapeutic interventions against a most important cardiovascular risk factor.

[PPARdelta + 294T/C gene polymorphism related to plasma lipid, obesity and left ventricular hypertrophy in subjects with metabolic syndrome].

OBJECTIVE: To investigate the relationship between PPARdelta + 294T/C gene polymorphism and lipid profile, obesity and left ventricular hypertrophy (LVH) in patients with metabolic syndrome (MS). METHODS: This study was conducted in 300 patients with MS and 174 patients with essential hypertension (EH) and 143 patients with type 2 diabetes mellitus (T2DM). MS was diagnosed according to 1999 WHO criteria. Fasting insulin (FINS), fasting blood glucose (FBG), plasma lipids levels were measured, LVH was examined by Doppler echocardiography. The PPARdelta + 294T/C gene polymorphism were analyzed using polymerase chain reaction and subsequently digested by BSLI restriction endonuclease. RESULTS: The frequencies of the PPARdelta + 294T/C genotypes were not different among three groups. Compared with T2DM and EH, MS patients had significantly higher body mass index (BMI), plasma total cholesterol, TG and LDL-C levels (P < 0.01 or P < 0.05). LVM, LVMI and incidence rate of LVH were significantly higher in MS and EH patients than that in T2DM (P < 0.01). MS patients with CC genotype had significantly higher total cholesterol and LDL-C levels than those with TT and TC genotypes (total cholesterol in CC genotype: 6.13 +/- 1.86 mmol/L vs in TC genotype: 5.14 +/- 1.10 mmol/L, P < 0.05, and CC genotype: 6.13 +/- 1.86 mmol/L vs TT genotype: 4.99 +/- 1.42 mmol/L, P < 0.01; LDL-C in CC genotype: 3.82 +/- 1.52 mmol/L vs in TC genotype: 3.14 +/- 0.88 mmol/L, P < 0.05, and in CC genotype: 3.82 +/- 1.52 mmol/L vs in TT genotype: 2.90 +/- 0.87 mmol/L, P < 0.01). BMI and LVMI in MS patients with C allele carriers (CC + TC) were significantly higher than that of TT genotype (LVMI in CC + TC: 46 +/- 10 g/m(2.7) vs in TT: 44 +/- 10 g/m(2.7); BMI in CC + TC: 26 +/- 3 kg/m(2) vs in TT: 25 +/- 3 kg/m(2), P < 0.05). CONCLUSIONS: It is indicated that PPARdelta + 294T/C gene polymorphism in subjects with MS may be involved in the occurrence of obesity and dyslipidemia. MS patients with C allele had a predominant LVH than subjects with TT genotype.

[Peroxisome proliferator-activated receptor gamma C-161T polymorphism and carotid artery atherosclerosis in metabolic syndrome].

OBJECTIVE: To assess the relationship between PPAR gamma C161-T polymorphism and Carotid Atherosclerosis in metabolic Syndrome (MS). METHODS: Polymerase chain reaction-restricted fragments length polymorphism was used to study the distribution of the PPAR gamma C161-T polymorphism in 248 metabolism syndrome, 163 essential hypertension (EH) and 115 type 2 diabetes mellitus (DM) patients and 121 normal controls. Fasting insulin (FINS), fasting blood glucose (FBG), uric Acid (UA), plasma lipids and ultrasonography for carotid artery were examined. RESULTS: Waistline and BMI were significantly higher in MS compared with those in control, EH and DM (P < 0.01). systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) were markedly higher in MS and EH compared with those in DM and control (P < 0.01). The frequencies of the CC, CT and TT were 74.6%, 21.8% and 3.6% in MS respectively, The frequencies of the CC was significantly higher in MS compared with that in control, but T allele carrier (CT + TT) was significantly lower compared with control, DM and EH (P < 0.05 or P < 0.01). In MS, CC genotype had significantly increased the intima-media thickness (IMT) of common carotid artery and plaque index compared with CT + TT (IMT: 0.84 mm +/- 0.3 mm vs 0.66 mm +/- 0.19 mm; plaque index: 2.19 +/- 1.21 vs 1.66 +/- 1.36, P < 0.05), CC genotype had significantly increased plaque index compared with CT + TT in EH and DM (plaque index: EH: 1.55 +/- 1.23 vs 1.29 +/- 0.92; DM: 1.57 +/- 1.2 vs 1.18 +/- 0.85, P < 0.05); CC genotype had significantly higher SBP compared with CT + TT in EH (P < 0.05), CC genotype had significantly increased plaque index in MS than that in DM and EH (P < 0.01), CC genotype had significantly increased IMT in MS compared with DM. CC genotype had significantly higher SBP and PP compared with CT + TT in MS (SBP: 155 mm Hg +/- 23 mm Hg vs 145 mm Hg +/- 21 mm Hg; PP: 69 mm Hg +/- 8 mm Hg vs 58 mm Hg +/- 8 mm Hg, 1 mm Hg = 0.133 kPa, P < 0.05). CONCLUSION: In MS, CC genotype was prone to lesion of carotid artery, but CT + TT may reduce lesion of carotid artery, which implicates that PPAR gamma C161-T may play a important role in carotid artery arteriosclerosis.