Relationship Between Hypertriglyceridemic Waist Phenotype and Disposition Index in Chinese Men With Normal Glucose Tolerance.

The relationship between hypertriglyceridemic waist (HTGW) phenotype, insulin sensitivity, and pancreatic ß-cell function remains still unclear in subjects with normal glucose tolerance (NGT). The objective is to detect whether the disposition index (DI) could be used as a predictive indicator of insulin sensitivity and pancreatic ß-cell function in men with HTGW phenotype and NGT. A total of 180 men without diabetes were recruited in this study and underwent an oral glucose tolerance test (OGTT) to calculate DI based on the OGTT. Subjects were put into Group A (normal waist circumference [WC] and triglyceride [TG] concentrations), B (enlarged WC or elevated TG concentrations), and C (HTGW phenotype, both enlarged WC and elevated TG concentrations) (n = 60 for each group) according to WC and TG concentrations. The OGTT plasma glucose concentrations at 0.5 and 1 hr for patients in Groups B and C were higher than those in Group A (both p < .05). Group C patients had significantly lower 1/[fasting insulin] values and DI than those in Group A (p < .05), and the 1/[fasting insulin] values in Group C were significantly lower than those in Group B (p < .05). DI correlated positively with high-density lipoprotein cholesterol (p < .05), which was independently associated with WC (p = .002) and TG (p = .009). The HTGW phenotype is associated with decreased DI among men with NGT, indicating decreased DI is a strong predictor of future impaired glucose tolerance, which can provide guidance and reference for screening patients with potential impaired glucose tolerance in Chinese community population.

Development and validation of a risk score for chest pain with suspected non-ST-segment elevation acute coronary syndrome.

OBJECTIVE: To investigate a new risk score for acute chest pain with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS). METHODS: Patients who suffered from Chest pain and suspected NSTE-ACS were enrolled as subjects. Predictor variables had been analyzed, and a bootstrap technique was used to evaluate the internal validity of the model, and external validation had been assessed for a prospective cohort study. RESULTS: Thousand five hundred and sixty-eight patients had been included in this study. Six predictor variables were found to be significant and were used to develop the model. The C-statistic of the model was 0.83, and internal validation revealed the stability of the model and the absence of over-optimism. Patients were given different triage recommendations, and the risk score was prospectively validated. CONCLUSIONS: A risk score may be a suitable method for assessing the risk of major adverse cardiac events and aiding patient triage in emergency departments among patients with suspected NSTE-ACS.

Performance of Two Novel Obesity Indicators for the Management of Metabolic Syndrome in Young Adults.

Background: Metabolic syndrome (MetS) is a pathophysiological change based on the abnormal metabolism of many substances. The study aims to investigate the performance of visceral adiposity index (VAI) and lipid accumulation product (LAP) of MetS in young adults. Methods: 448 young adults aged between 19 and 24 years old in Qinhuangdao had been included in this cross-sectional study. Receiver operating characteristic (ROC) curve analyses were used to assess the accuracy of these two obesity indicators for MetS. Results: The prevalence of MetS was 2.0%. In male subjects, LAP had the highest area under the ROC curve (AUC) value (AUC = 0.963), followed by VAI (AUC = 0.937). In female subjects, LAP also had the highest AUC value (AUC = 0.931), followed by VAI (AUC = 0.861). No significant difference was found between the two obesity indicators (P > 0.05). Conclusion: The two obesity indicators were valuable for the screening of MetS in young adults, and LAP was the simpler of the two.

A New Risk Score for Patients With Acute Chest Pain and Normal High Sensitivity Troponin.

Objective: To investigate a new risk score for patients who suffered from acute chest pain with normal high-sensitivity troponin I (hs-TnI) levels. Methods: In this study, patients with acute chest pain who were admitted to the emergency department (ED) of our hospital had been recruited. Hs-TnI was measured in serum samples drawn on admission to the ED. The end point was the occurrence of major adverse cardiac events (MACE) within 3 months. Predictor variables were selected by logistic regression analysis, and external validity was assessed in this study. Furthermore, validation was performed in an independent cohort, i.e., 352 patients (validation cohort). Results: A total of 724 patients were included in the derivation cohort. The results showed that four predictor variables were significant in the regression analysis-male, a history of chest pain, 60 years of age or older and with three or more coronary artery disease (CAD) risk factors. A total of 105 patients in the validation cohort had serious adverse cardiac events. The validation cohort showed a homogenous pattern with the derivation cohort when patients were stratified by score. The area under the curve (AUC) of the receiver operating characteristic (ROC) in the derivation cohort was 0.80 (95% CI: 0.76-0.83), while in the validation cohort, it was 0.79 (95% CI: 0.75-0.82). Conclusion: A new risk score was developed for acute chest pain patients without known CAD and ST-segment deviation and with normal hs-TnI and may aid MACE risk assessment and patient triage in the ED.

A modified HEART risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome.

OBJECTIVE: To validate a modified HEART [History, Electrocardiograph (ECG), Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the emergency department (ED). METHODS: This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used. The serum sample of high-sensitivity cardiac Troponin I other than conventional cardiac Troponin I used in the HEART risk score was tested. The modified HEART risk score was calculated. The end point was the occurrence of major adverse cardiac events (MACE) defined as a composite of acute myocardial infarction (AMI), percutaneous intervention (PCI), coronary artery bypass graft (CABG), or all-cause death, within three months after initial presentation. RESULTS: A total of 1,300 patients were enrolled. A total of 606 patients (46.6%) had a MACE within three months: 205 patients (15.8%) were diagnosed with AMI, 465 patients (35.8%) underwent PCI, and 119 patients (9.2%) underwent CABG. There were 10 (0.8%) deaths. A progressive, significant pattern of increasing event rate was observed as the score increased (P < 0.001 by χ (2) for trend). The area under the receiver operating characteristic curve was 0.84. All patients were classified into three groups: low risk (score 0-2), intermediate risk (score 3-4), and high risk (score 5-10). Event rates were 1.1%, 18.5%, and 67.0%, respectively (P < 0.001). CONCLUSIONS: The modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.

Waist-to-height ratio as a screening measure for identifying adolescents with hypertriglyceridemic waist phenotype.

OBJECTIVE: The purpose of the present study was to investigate the relationship between waist-to-height ratio (WHtR) and the hypertriglyceridemic waist (HTGW) phenotype to test the hypothesis that WHtR can identify adolescents at high risk of the HTGW phenotype. METHODS: In 2006, anthropometric measurements were assessed in a cross-sectional population-based study of 3136 Han adolescents aged 13-17 years. Blood samples were collected to measure triacylglycerol concentrations. WHtR was calculated by waist circumference/height. The HTGW phenotype was represented by the simultaneous presence of elevated serum triglycerides and increased waist circumference. The ability of WHtR to accurately define the HTGW phenotype was assessed by area under the curve (AUC). RESULTS: The prevalence of the HTGW phenotype was 3.3% (boys 3.6% vs. girls 2.9%, χ2=1.424, p=0.233). The prevalence of the HTGW phenotype increased with WHtR (p<0.001). The accuracy of WHtR in the identification of the HTGW phenotype (as assessed by AUC) was over 0.85, both in boys and girls (AUC: 0.956 in boys and 0.961 in girls). WHtR cutoff values, chosen to maximize sensitivity plus specificity, for the HTGW phenotype were calculated to be 0.48 in boys and 0.46 in girls. The sensitivities were 98.3% in boys and 97.7% in girls. The specificities were 88.0% in boys and 86.8% in girls. CONCLUSIONS: WHtR is simpler than the HTGW phenotype and does not require blood tests. The prevalence of the HTGW phenotype increased with WHtR. Higher WHtR can identify adolescents with high risk of the HTGW phenotype.