Hypertriglyceridemic waist phenotype and abnormal glucose metabolism: a system review and meta-analysis.

OBJECTIVE: This study was to perform a meta-analysis to assess the relationship between hypertriglyceridemic-waist (HTW) phenotype and abnormal glucose metabolism. METHODS: The data sources were PubMed and EMBASE up to June 2018. Studies providing the relationship between HTW phenotype and abnormal glucose metabolism were included. RESULTS: In total, 48 eligible studies that evaluated 2,42,879 subjects were included in the meta-analysis. In the general population, the pooled odds ratios (ORs) for elevated blood glucose and diabetes related to HTW phenotype was 2.32 (95% confidence interval (CI): 1.98-2.71) and 2.69 (95% CI: 2.40-3.01), respectively. In cohort studies, the pooled OR for diabetes related to HTW phenotype was 2.89 (95% CI: 1.97-4.25) in subjects without diabetes. The levels of homeostasis model assessment of insulin resistance (HOMA-IR) in the HTW population were increased with values of mean differences (MD) 1.12 (95% CI: 0.81-1.43. P < 0.00001, I2 = 99%) in the general population and 0.89 (95% CI: 0.75-1.04, P < 0.00001, I2 = 67%) in subjects without diabetes. CONCLUSION: HTW phenotype was closely associated with increased risk of abnormal glucose metabolism. There was also a significant correlation between HTW phenotype and insulin resistance.

Hypertriglyceridemic Waist: A Simple Marker of High-Risk Atherosclerosis Features Associated With Excess Visceral Adiposity/Ectopic Fat.

BACKGROUND: Subclinical atherosclerosis identification remains challenging; abdominal visceral adiposity may improve risk stratification beyond traditional cardiovascular risk factors. Hypertriglyceridemic waist, a visceral adiposity marker combining elevated triglycerides (≥2 mmol/L) and waist circumference (≥90 cm), has been related to carotid atherosclerosis, although associations with high-risk features, including lipid-rich necrotic core (LRNC), remain unknown. We tested the hypothesis that hypertriglyceridemic waist is an independent marker of high-risk atherosclerosis features. METHODS AND RESULTS: In this cross-sectional study including 467 white men (mean age, 45.9±14.8 years; range 19.4-77.6 years), carotid atherosclerosis characteristics were examined by magnetic resonance imaging and associations with hypertriglyceridemic waist and benefits beyond Framingham Risk Score (FRS) and Pathobiological Determinants of Atherosclerosis in Youth (PDAY) were determined. Subclinical carotid atherosclerosis was present in 61.9% of participants, whereas 50.1% had LRNC. Hypertriglyceridemic waist was associated with carotid maximum wall thickness (P=0.014), wall volume (P=0.025), normalized wall index (P=0.004), and Carotid Atherosclerosis Score (derived from wall thickness and LRNC; P=0.049). Hypertriglyceridemic waist was associated with carotid LRNC volume beyond FRS (P=0.037) or PDAY (P=0.015), contrary to waist circumference alone (both P>0.05). Although 69.7% and 62.0% of participants with carotid atherosclerosis and/or LRNC were not high-risk by FRS or PDAY, respectively, hypertriglyceridemic waist correctly reclassified 9.7% and 4.5% of them, respectively. Combining hypertriglyceridemic waist with FRS (net reclassification improvement=0.17; P<0.001) or PDAY (net reclassification improvement=0.05; P=0.003) was superior to each score alone in identifying individuals with carotid atherosclerosis and/or LRNC. CONCLUSIONS: Hypertriglyceridemic waist is an independent marker of carotid high-risk atherosclerosis features in men, improving on FRS and PDAY risk score.

HYPERTRIGLYCERIDEMIC WAIST PHENOTYPE AND CARDIOMETABOLIC ALTERATIONS IN BRAZILIAN ADULTS.

AIMS: the present study aims to evaluate the prevalence of cardiometabolic changes according to the hypertriglyceridemic waist (HW) phenotype in Brazilian adults. METHODS: it is a population based transversal study with 976 adults (n = 533 women) 20-59 years old. Phenotype was defined by triglycerides concentration (TGL) ≥ 150 mg/dl and waist circumference (WC) ≥80 cm in females and ≥ 90 cm in males. All the analyses were adjusted according to the study design and pondered by gender, age and schooling. A descriptive analysis was performed through averages and ratios; their respective confidence intervals were herein presented (CI 95%). The prevalence of cardiometabolic changes due to the presence of HW and to gender was calculated and compared by means of Pearson's chi-square test. Statistic significance level was 0.05. The probability of coronary event risk was estimated in 10 years and calculated from Framinghan score, using Kernel density graph. RESULTS: no difference in phenotype prevalence between genders was observed. Higher averages in all the cardiometabolic risk factors analyzed and higher probability of evolving to a cardiovascular event in 10 years were observed in individuals with the HW phenotype. Lower HDL values were only verified in this group. CONCLUSION: the HW phenotype is an important cardiovascular risk sign and allows the premature identification of individuals with higher risk, so that its use in clinical practice must be encouraged, mainly because it is a simple low cost asset.

Objetivos: evaluar la prevalencia de alteraciones cardiometabolicas segun el fenotipo cintura hipertrigliceridemica (CH) en adultos brasilenos. Métodos: estudio transversal, de base poblacional, con 976 (n = 533 mujeres) individuos de 20 a 59 anos. El CH fue definido por un aumento en las concentraciones de trigliceridos y en la circunferencia de la cintura (CC). Todos los analisis fueron ajustados por el efecto del diseno del estudio y ponderados por genero, edad y escolaridad. Fue realizado un análisis descriptivo de promedio y presentados sus respectivos intervalos de confianza (IC 95%). La prevalencia de las alteraciones cardiometabolicas segun la presencia o no del fenotipo CH y segun el sexo fue calculada y comparada a traves del test chi-cuadrado de Pearson. El nivel de significancia estadistica adoptado fue de 0,05. Se estimo la probabilidad de riesgo de evento coronario en 10 anos, a partir del score de Framinghan a traves del grafico de densidad de Kernel. Resultados: la prevalencia del fenotipo CH en la muestra fue de 17,32% (IC 95% 13,54-21,89), no se observo diferencia entre sexos. Se observaron mayores promedios para todos los factores de riesgo cardiometabolico analizados en aquellos con CH. Solo Se verificaron menores valores medianos para el HDL en este grupo. Los individuos con CH presentaban mayor probabilidad de evolucionar hacia un evento cardiovascular en 10 anos que aquellos sin el fenotipo. Conclusión: el fenotipo CH constituye un importante marcador precoz del riesgo cardiovascular. Su utilizacion en la practica clinica debe ser incentivada, ya que se trata de una herramienta sencilla y de bajo coste.

[METABOLIC SYNDROME IN PATIENTS WITH CLINICAL PHENOTYPE "HYPERTRIGLYCERIDEMIC WAIST"]. / SINDROME METABÓLICO EN PACIENTES CON FENOTIPO CLÍNICO DE "CINTURA HIPERTRIGLICERIDÉMICA".

INTRODUCTION: hypertriglyceridemic waist phenotype has been associated with metabolic syndrome. OBJETIVES: in the present work has been raised to study the relationship between hypertriglyceridemic waist phenotype and metabolic syndrome as well as other metabolic risk factors. And finally, assess whether it is associated with an increased cardiovascular risk. METHODS: this study was conducted recruiting patients in a national registry of hypertriglyceridemia of the Spanish Society of Artherosclerosis. The total number of patients included in the present study was 1 369. The criteria used to define the increased waist perimeter and metabolic syndrome were based on those established by the ATPIII or IDF, respectively. RESULTS: hypertriglyceridemic waist prevalence in patients with hypertriglyceridemia was near to 50% and 80% using ATPII and IDF anthropometric criteria, respectively. The prevalence of metabolic syndrome in these patients was close to 97% (ATPIII criteria) and 63% (IDF criteria). Also was significantly higher prevalence of hypertension and diabetes mellitus type 2. However, the association with cardiovascular disease does not depend on the existence of hypertriglyceridemic waist phenotype, but the existence (or not) of metabolic syndrome. CONCLUSIONS: the CHTG can be used in clinical practice routine as a marker of metabolic alterations.

Introducción: el fenotipo de cintura hipertrigliceridémica se ha asociado con la presencia de síndrome metabólico. Objetivo: en el presente estudio se ha planteado estudiar la relación entre el fenotipo de cintura hipertrigliceridémica y el síndrome metabólico, así como otros factores de riesgo metabólicos. Y, finalmente, valorar si se asocia a un incremento del riesgo cardiovascular. Métodos: este estudio se ha realizado reclutando a los pacientes incluidos en un registro nacional de hipertrigliceridemias de la Sociedad Española de Arteriosclerosis. El total de pacientes evaluables para el presente estudio ha sido de 1.369. Los criterios empleados para definir el aumento de perímetro y para el síndrome metabólico fueron en base a los establecidos por la ATPIII o por la IDF, respectivamente. Resultados: la prevalencia de cintura hipertrigliceridémica en los pacientes con hipertrigliceridemia resultó casi del 50 % y 80 % empleándose criterios antropométricos de ATPIII y de IDF, respectivamente. La prevalencia de síndrome metabólico en estos pacientes estuvo próxima al 97% (criterios ATPIII) y al 63% (criterios IDF). Asimismo, resultó significativamente elevada la prevalencia de hipertensión arterial y de diabetes mellitus tipo 2. Sin embargo, la asociación con la enfermedad cardiovascular no dependía de la existencia del fenotipo de cintura hipertrigliceridémica, sino de la existencia (o no) de síndrome metabólico. Conclusiones: la CHTG puede ser utilizada en la práctica clínica habitual como un marcador de alteraciones metabólicas.

Increased association of coronary artery calcification in apparently healthy Korean adults with hypertriglyceridemic waist phenotype: The Kangbuk Samsung Health Study.

BACKGROUND: Hypertriglyceridemic waist phenotype is a simple screening parameter to identify people at increased risk for cardiovascular disease. We evaluated whether hypertriglyceridemic waist (HTGW) phenotype increases the risk for coronary artery calcification (CAC) in apparently healthy Korean adults. METHODS: A total of 32,186 participants (mean age 41.3, 80.2% men) in a health screening program, in whom the coronary artery calcium score (CACS) was measured, were analyzed. Subjects were divided into four groups: 1) normal waist circumference (WC)-normal triglyceride (TG) (NWNT), 2) normal WC-high TG (NWHT), 3) enlarged WC-normal TG (EWNT), and 4) enlarged WC-high TG (EWHT). Enlarged WC was defined as WC ≥ 90 cm for men and ≥ 85 cm for women; high serum TG was defined as TG ≥ 150 mg/dL. The presence of CAC was defined by CACS >0, and CACS was analyzed in a logarithmized form of CACS plus 1 {ln(CACS+1)}. RESULTS: A total of 14.9% of the participants had CAC. The EWHT group showed the highest mean value for ln(CACS+1) among the four groups. The EWHT group showed the highest odds ratio for CAC, with NWHT group the second, and with EWNT group the third compared with the NWNT group after adjusting for confounding variables (1.579, 1.302, and 1.266 vs. NWNT). CONCLUSIONS: The EWHT group showed the highest association for CAC, suggesting this HTGW phenotype as a useful marker for the detection of subjects with high cardiometabolic risk in healthy Korean adults.