Metabolic syndrome and 10-year cardiovascular disease incidence: The ATTICA study.

AIMS: To evaluate the influence of metabolic syndrome (MetS) as well as inflammatory and renal markers on cardiovascular disease (CVD) incidence. METHODS AND RESULTS: During 2001-2002, 1514 men and 1528 women (>18 y) without any clinical evidence of CVD or any other chronic disease, at baseline, living in greater Athens area, Greece, were enrolled. In 2011-2012, the 10-year follow-up was performed in 2583 participants (15% of the participants were lost to follow-up). Incidence of fatal or non-fatal CVD was defined according to WHO-ICD-10 criteria. MetS was defined using three definitions, provided by the National Cholesterol Education Program Adult Treatment panel III (revised NCEP ATP III), the International Diabetes Federation (IDF) or the Harmonized definition. Furthermore, the contributory predictive role of C-reactive protein (CRP), inteleukin-6, uric acid and estimated glomerular filtration rate in the aforementioned models was evaluated. History of MetS-NCEP was positively associated with CVD, adjusting for potential confounding factors (OR:1.83, 95%CI:1.24-2.72). Not statistically significant associations with CVD incidence were observed when using the IDF or the Harmonized definition. Additionally, none of the added inflammatory and renal function markers mediated the influence of MetS on CVD incidence (all p's from Sobel test >0.40). C-statistic values for the MetS definitions used exceeded 0.789 (CI:0.751-0.827), indicating fair-to-good predictive probability of the models. CONCLUSION: Results of the present work revealed the negative impact of MetS-NCEP, but not of the other MetS definitions, on CVD incidence, a key-point that may help in better understanding the role of IDF and Harmonized MetS definitions on CVD.

The evaluation of inflammatory and oxidative stress biomarkers on coffee-diabetes association: results from the 10-year follow-up of the ATTICA Study (2002-2012).

BACKGROUND/OBJECTIVES: The purpose of this work was to investigate the association between coffee drinking and diabetes development and potential mediation by oxidative stress and inflammatory biomarkers. SUBJECTS/METHODS: In 2001-2002, a random sample of 1514 men (18-87 years old) and 1528 women (18-89 years old) were selected to participate in the ATTICA study (Athens metropolitan area, Greece). A validated food-frequency questionnaire was used to assess coffee drinking (abstention, casual, habitual) and other lifestyle and dietary factors. Evaluation of oxidative stress and inflammatory markers was also performed. During 2011-2012, the 10-year follow-up of the ATTICA study was carried out. The outcome of interest in this work was incidence of type 2 diabetes, defined according to American Diabetes Association criteria. RESULTS: During follow-up, 191 incident cases of diabetes were documented (incidence 13.4% in men and 12.4% in women). After various adjustments, individuals who consumed ⩾250 ml of coffee (≈1.5cup) had 54% lower odds of developing diabetes (95% confidence interval: 0.24, 0.90), as compared with abstainers. A dose-response linear trend between coffee drinking and diabetes incidence was also observed (P for trend=0.017). When controlling for several oxidative stress and inflammatory biomarkers, the inverse association between habitual coffee drinking and diabetes was found to be mediated by serum amyloid-A levels. CONCLUSIONS: This work highlights the significance of long-term habitual coffee drinking against diabetes onset. The anti-inflammatory effect of several coffee components may be responsible for this protection.

Morphometric analysis of endometrial adenocarcinoma: 1. Does architectural dedifferentiation accompany deep invasion by endometrial adenocarcinoma?

Important prognostic factors for endometrial adenocarcinoma include histologic differentiation, depth of myometrial invasion, and clinical stage. Deep myometrial penetration is more commonly observed with poorly differentiated carcinomas, but it is unknown if these tumors are poorly differentiated de novo, or if selection toward more aggressive, less differentiated cells occurs during invasion. To study this question, we performed a morphometric analysis to quantitate the amount of glandular differentiation in superficial portions of 22 endometrial carcinomas for comparison with deep portions of the same neoplasm. Point counting of randomly selected fields was performed on histologic sections of hysterectomy specimens of 22 women with stage I endometrial adenocarcinoma. The components enumerated were tumor cells participating in gland formation (DI), non-gland-forming tumor cells (UI), tumor gland lumens (LUM), inflammatory cells (IC), and stroma (endometrium or myometrium) (ST). Slides of tumors were divided into superficial, middle, and deep thirds. No statistically significant differences were seen between superficial and deep thirds (UI: 45% vs. 43%; DI: 33% vs. 32%; LUM: 22% vs. 24%; IC: 3% vs. 3% of points counted, p greater than .1, paired t-test). The density of tumor cells relative to stroma was greater in the superficial region (55% vs. 41%, p less than .001, paired t-test). Additionally, field-to-field heterogeneity was examined by four methods. No relationship between increased heterogeneity and poor prognosis was identified. These findings do not support the concept that invasion by endometrial adenocarcinoma is accompanied by architectural dedifferentiation.

Morphometric analysis of endometrial adenocarcinoma: 2. A comparison of architectural differentiation determined morphometrically with subjective grading.

Architectural differentiation is the primary criterion used in the grading of endometrial adenocarcinomas. However, there is little evidence supporting the accuracy of pathologists' assignment of histologic grade, and few studies on the value of architectural morphometry in predicting prognosis for endometrial adenocarcinoma. We have thus investigated whether a pathologist's estimate of percentage of tumor in solid array correlated with the volume fraction of tumors composed of cells not participating in gland formation determined morphometrically. Additionally, we conducted this morphometric study of 31 cases of Stage I endometrial cancer to determine the relationship between a variety of objective measurements of architectural arrangement and prognosis. We found that a pathologist can accurately estimate the proportion of endometrial tumors arranged in solid or glandular fashion. In this limited study, morphometric assessment of the proportion of differentiated or undifferentiated cells or lumens did not improve the accuracy of prediction of outcome beyond conventional architectural grading. Further, we reaffirm that estimation of architectural arrangement coupled with measurement of the depth of penetration provides a good index of the probability of survival.