Effect of Metabolic Syndrome Score, Metabolic Syndrome, and Its Individual Components on the Prevalence and Severity of Angiographic Coronary Artery Disease.

BACKGROUND: The clinical significance of metabolic syndrome (MS) score, MS, and its individual components with respect to risk prediction of coronary artery disease (CAD) remains unclear. The objective of this study was to investigate whether and to what extent MS score, MS, and its individual components were related to the risk of CAD. METHODS: Among 1191 participants who underwent coronary angiography for the confirmation of suspected myocardial ischemia, 858 were included in this study according to the inclusion criteria from September 2010 to June 2013. MS was diagnosed with the 2005 National Cholesterol Education Program Adult Treatment Panel III criteria. The severity of coronary atherosclerosis was assessed by Gensini score. RESULTS: The results showed that the age- and sex-adjusted odds ratios (OR s) for CAD were as follows: MS score, 1.327; MS, 2.013; elevated waist circumference, 1.447; reduced high-density lipoprotein cholesterol, 1.654; and elevated fasting glucose, 1.782; all P < 0.05; whereas for elevated triglycerides, 1.324, and elevated blood pressure, 1.342, both P > 0.05. After multivariate adjustment, results showed that only MS and elevated fasting glucose were significantly associated with CAD (OR, 1.628, 95% confidence interval [CI], 1.151-2.305, P = 0.006 for elevated fasting glucose, and OR, 1.631, 95% CI, 1.208-2.203, P = 0.001 for MS). The study showed that only MS score and elevated fasting glucose were significantly associated with Gensini score (standardized coefficient, 0.101, P = 0.031 for elevated fasting glucose and standardized coefficient, 0.103, P = 0.009 for MS score). CONCLUSIONS: The present study demonstrated that MS score, MS, and its individual components might have different contributions to CAD prevalence and severity. MS and elevated fasting glucose were independent risk factors for the prevalence of angiographic CAD whereas MS score and elevated fasting glucose were significantly associated with the severity of CAD.

Fasting plasma glucose correlates with angiographic coronary artery disease prevalence and severity in Chinese patients without known diabetes.

Type 2 diabetes mellitus is a risk factor for coronary artery disease (CAD). While there is a clear association of fasting plasma glucose (FPG) with microvascular complications, the risk for CAD conferred by FPG is relatively less clear. Therefore, we investigate the association between different FPG and the prevalence and severity of angiographic CAD in high-risk Chinese patients without known diabetes. Among 1,419 subjects who were to undergo coronary angiography for the confirmation of suspected myocardial ischemia, 906 subjects without known diabetes were included in this study and categorized into four groups according to the level of FPG: group 1, ≤5.5 mmol/l; group 2, 5.6-6.0 mmol/l; group 3, 6.1-6.9 mmol/l; and group 4, ≥7.0 mmol/l. Significant angiographic CAD was defined as ≥50 % lumen diameter reduction in at least one major coronary artery in a given subject. The severity and extent of coronary atherosclerosis were defined as the number of diseased vessels, the proportion of totally occluded vessel and the Gensini score. Associations between FPG and the prevalence and severity of CAD were assessed by logistic and linear stepwise regression analyses. The angiographic CAD prevalence, the number of diseased vessels, the totally occluded vessel, and the Gensini score increased corresponding to increasing FPG levels from ≤5.5 mmol/l to 5.6-6.0 mmol/l to 6.1-6.9 mmol/l to ≥7.0 mmol/l (P < 0.05). The FPG had significant association with angiographic CAD (adjusted OR, 1.53; 95 % CI, 1.19-1.98; P = 0.001) and the Gensini score (standardized regression coefficient = 0.172, P = 0.011). Compared with group 1, group 2, 3 and 4 demonstrated significantly higher CAD prevalence after adjustment (adjusted OR, 1.61 [1.16-2.19]; P = 0.015 for group 2; 1.49 [1.11-2.59]; P = 0.027 for group 3; and 4.19 [2.85-6.16]; P = 0.024 for group 4, respectively). FPG group was also significantly associated with the Gensini score (Standardized coefficients, 0.185; P = 0.007, respectively). FPG was an independent risk factor for the prevalence and severity of significant angiographic CAD in our study population. The severity of angiographic CAD increased along with the increasing FPG levels even in prediabetic state.

Association of the adiponectin gene rs1501299 G>T variant, serum adiponectin levels, and the risk of coronary artery disease in a Chinese population.

BACKGROUND: The present study aimed to investigate whether the single nucleotide polymorphism (SNP) 276G>T (rs1501299) of the adiponectin (ADIPOQ) gene was associated with the risk of coronary artery disease (CAD) and serum adiponectin levels in a Chinese population. METHODS: The rs1501299 polymorphism of the ADIPOQ gene was genotyped in 438 subjects with angiographically diagnosed CAD and 443 controls. Levels of serum adiponectin were determined in 152 CAD subjects and 155 controls. RESULTS: The CAD subjects had GT and TT genotypes more frequently, and had GG genotype less frequently than the controls. The OR increased and was significant after adjustment for known CAD risk factors. Significant difference was also observed with T allele being more frequent among the CAD subjects. The T allele at the rs1501299 polymorphism was associated with a higher risk of CAD. The mean adiponectin levels of CAD patients were lower than control subjects. No significant correlation was seen of different genotypes with serum adiponectin levels. CONCLUSIONS: The adiponectin rs1501299 G>T variant was positively related with an increased risk of CAD, and the CAD patients had lower adiponectin levels which were not affected by the different genotypes of rs1501299 in the present study.

The comparison of coronary angiographic profiles between diabetic and nondiabetic patients with coronary artery disease in a Chinese population.

BACKGROUND: It is well known that diabetes mellitus (DM) is a crucial risk factor for coronary artery disease (CAD). The present study aimed to investigate angiographic profiles of the coronary arteries in diabetic CAD patients in comparison with nondiabetics. METHODS: A total of 546 Chinese patients were angiographically documented for CAD, 375 of whom were diabetics and 171 were nondiabetics according to the WHO diabetes criteria (1999). The patients in these two groups were matched for age, sex, and body mass index (BMI). The 75 g oral glucose tolerance test (OGTT) was performed in all patients, for whom blood glucose, insulin, glycosylated hemoglobin (HbA1c), triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), apolipoprotein A (ApoA), apolipoprotein B (ApoB), and lipoprotein(a) [Lp(a)] were measured. Insulin resistance (Homa-IR) and insulin secretion index (Homa-IS) were determined by the HOMA model. The clinical features and the data from selective coronary angiographies were compared between the diabetic and nondiabetic CAD patients. RESULTS: Diabetic CAD patients had significantly higher waist to hip ratio (WHR) (p=0.016), fasting plasma glucose (FPG), 2h plasma glucose (2hPG), glycosylated hemoglobin (HbA1c) (p<0.001), insulin resistance index (Homa-IR) (p=0.001), and apolipoprotein A (ApoA) (p=0.008), with a significantly lower insulin secretion index (Homa-IS) level (p<0.001). Diabetic patients had one-vessel disease less frequently (28.8% vs 46.2%, p<0.001), and three-vessel disease more frequently (35.2% vs 24.0%, p=0.009), and they also had significantly higher cumulative coronary atherosclerosis score (CAS) (p=0.003). The right coronary artery was significantly more frequently involved in diabetics (66.4% vs 52.6%, p=0.002), with a clearly higher CAS at the same time (p=0.002). CONCLUSIONS: Diabetics were presented with more severe and diffuse angiographically documented coronary artery disease compared to nondiabetics. The right coronary artery was significantly more frequently involved in the diabetics. Duration of CAD, Homa-IR, and diabetes mellitus were the independent risk factors for CAD found in the present study, while ApoA was the protective one.

High sensitive C-reactive protein, adiponectin, and urine albumin excretion rate in Chinese coronary artery disease patients with different glucose tolerance status.

BACKGROUND: Serum high sensitive C-reactive protein (hs-CRP), adiponectin levels and urine albumin excretion rate (UAER) are probably associated with inflammation and atherosclerosis. The aim of this study was to determine the three markers in coronary artery disease (CAD) subjects with different glucose tolerance status in a Chinese population and further explore the levels of the three markers in these subjects and the possible association of these markers with CAD risk factors and the severity of CAD as well. METHODS: A total of 242 subjects with angiographically documented CAD were recruited, and then assigned to three groups: the normal glucose tolerance (NGT) + CAD group, including 100 CAD patients with NGT; the impaired glucose tolerance (IGT) + CAD group, 40 CAD patients with IGT; the type 2 diabetes mellitus (T2DM) + CAD group, 102 CAD patients with T2DM. Serum hs-CRP, adiponectin levels as well as UAER were measured in all subjects. RESULTS: Serum hs-CRP levels were increased in the T2DM + CAD group compared with the NGT + CAD group (4.71 +/- 2.59) vs (3.60 +/- 2.46) mg/L, P = 0.037. Serum adiponectin levels were gradually decreased from the NGT + CAD to IGT + CAD to T2DM + CAD groups, (5.99 +/- 1.84), (5.82 +/- 1.72) and (4.65 +/- 1.71) mg/L, P = 0.002 and 0.040 for NGT + CAD and IGT + CAD groups vs T2DM + CAD group, respectively. While the UAER was gradually increased from the NGT + CAD to IGT + CAD to T2DM + CAD groups, (6.42 +/- 2.51), (6.89 +/- 2.94) and (15.03 +/- 4.22) microg/min (P < 0.001) for NGT + CAD and IGT + CAD groups vs T2DM + CAD group. Multiple linear stepwise regression analysis showed that waist-hip ratio (WHR) and low density lipoprotein cholesterol (LDL-C) were the significant determinants of serum hs-CRP levels; triglyceride (TG), high density lipoprotein cholesterol (HDL-C), age, WHR, T2DM, 2-hour serum insulin (2hINS), sex, and apolipoprotein B were the significant determinants of serum adiponectin levels; and systolic blood pressure (SBP), T2DM, and hemoglobin A1c (HbA1c) were the significant determinants of UAER in all subjects (R(2) = 0.070, 0.352, and 0.214, respectively). However, no significant correlation was seen for hs-CRP, adiponectin and UAER with the severity of CAD. Hs-CRP levels were significantly correlated with UAER. CONCLUSIONS: There was a trend of increased serum hs-CRP levels from the NGT + CAD to IGT + CAD to T2DM + CAD groups, though it only showed significance in the T2DM + CAD group compared with the NGT + CAD group. Serum adiponectin levels were decreased and UAER was increased from the NGT + CAD to IGT + CAD to T2DM + CAD groups. Increased UAER and serum hs-CRP, and decreased adiponectin levels were associated with traditional CAD risk factors but failed to be correlated with the severity of CAD. Hs-CRP levels were significantly correlated with UAER.

Characteristics of the populations defined by different criteria of the metabolism syndrome / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the characteristics of over weight and obesity subjects defined by three criteria: World Health Organization (WHO) in 1999, the National Cholesterol Education Program Adult Treatment Panel Nll (NCEP-ATP II ) in 2001, and the International Diabetes Federation (IDF) in 2005.</p><p><b>METHODS</b>Medical history collection, physical examination, oral glucose tolerance test ( OGTT) , and frequently sampled intravenous glucose tolerance test (FSIGTT) were performed in 371 subjects with body mass index (BMI)> or =23 kg/m(2). Fasting blood samples were taken to test lipid profiles, urea acid level and so on. Data was analyzed including comparison and relationship statistics.</p><p><b>RESULTS</b>Data from FSIGTT showed that insulin resistance existed in all over weight and obesity subjects. The relationship between waist and sensitivity index (SI) was superior than that between BMI and SI ( r = - 0. 198 and r = - 0. 194, P < 0. 001). Totally 107 subjects (28. 8%) did not meet any definitions, 187 (50. 4%) met ATP definition, 98 (26. 4%) met WHO definition, and 234 (63. 1% ) met IDF definition. ATP and IDF definitions had the highest coincidence rate (70. 3% ) , and subjects in these two groups almost had basically the same manifestations. The age of onset in WHO group was higher than those in other two groups. Meanwhile, subjects in the WHO group was characterized by lower BMI, higher hyperlipidemia, and significantly increased fasting and postprandial blood glucose level. The MS component scores were positively correlated with age, BMI, waist, and waist-to-hip ratio (WHR) , and were negatively correlated with SI. However, no correlation was found between MS component scores and gender, fat% , or acute insulin response to glucose index.</p><p><b>CONCLUSIONS</b>Some of over weight and obesity subjects only have insulin resistance and have no metabolism syndrome. The group defined by IDF criteria of the metabolic syndrome (MS) has the highest incidence rate. Limited by the requirements of insulin resistance evaluation, the definition proposed by WHO is somewhat unfeasible for practices. ATP definition may be replaced by IDF definition, because the populations defined by ATP definition is covered by the latter. Meanwhile, the abnormalities of fat mass distribution in the body ( i. e. , central obesity) , rather than its contents, may exacerbate the occurrence of MS, as well as the development of insulin resistance.</p>