Metabolic syndrome does not improve the prediction of 5-year cardiovascular disease and total mortality over standard risk markers. Prospective population based study.

Metabolic syndrome (MS) is widely believed to be an important risk factor for cardiovascular disease (CVD). We assessed whether a model based on MS improved prediction of CVD and total mortality over the Framingham's general CVD system (FRS) and whether MS was better than its individual components. Prospective cohort study of 855 participants randomly selected from the general population. Cox proportional hazards models were used to estimate the hazard ratios selecting a composite endpoint of CVD and total mortality. The performance of the FRS was compared with that of 4 MS-based models that differed in their use of individual components of MS as well as in the use of optimized cut-points of MS. The assessment included metrics of discrimination, calibration, and risk reclassification. Of all the models, only the model containing the 5 optimized components of MS improved model fit (deviance 10.7, P = 0.005), discrimination (difference of areas under the receiving operating curves 0.018), and risk reclassification in participants without events (net reclassification index 5.97, P = 0.01). The addition of optimized waist circumference to the FRS model improved the performance more than any other MS-based model. Every model containing the dichotomous definition of MS failed to improve model fit, discrimination, and risk reclassification. MS did not contribute predictive information over the FRS for the 5-year risk of CVD and total mortality. Some individual components of MS, in particular waist circumference, might play a role as part of the FRS provided their cut-off points are optimized.

Nonalcoholic fatty liver disease is associated with blood pressure in hypertensive and nonhypertensive individuals from the general population with normal levels of alanine aminotransferase.

OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) has been associated with hypertension in specific population groups and in cases with elevated levels of alanine aminotransferase (ALT). This study aimed to determine the strength of the association between NAFLD with prevalent hypertension and with high-normal blood pressure (BP) in nonhypertensive individuals from the general population regardless of ALT levels. METHODS: The observational study included 454 participants selected randomly from the general population aged 50-75 years old. Adjusted odds ratios and 95% confidence intervals (CIs) of NAFLD with hypertension were calculated by binary multivariate regression analysis controlling for traditional risk factors and ALT levels. Similar calculations were performed to assess the independent association of NAFLD with high-normal systolic (130-139 mmHg) and diastolic (85-89 mmHg) BP in the subgroup of nonhypertensive participants. RESULTS: The prevalence of NAFLD was 38.5% (95% CI, 34.0-43.0) in the entire sample and 49.5% (95% CI, 44.9-54.1) in hypertensive participants. The percentage of cases with hypertension was 21.2% greater in individuals with NAFLD than those without NAFLD (95% CI, 11.8-30.6, P<0.0005). NAFLD was independently associated with prevalent hypertension with an adjusted odds ratio of 1.71 (95% CI, 1.10-2.65, P=0.017). Among nonhypertensive participants, NAFLD was also independently associated with high-normal systolic BP (adjusted odds ratio 2.13, 95% CI, 1.08-4.20, P=0.029) but not with high-normal diastolic BP. CONCLUSION: In middle-aged and old adults from the general population, NAFLD is associated with an independent risk of identifying hypertension and high-normal systolic BP. Detection of NAFLD, even with normal ALT levels, should serve as an opportunity to identify metabolic and BP abnormalities and intensify lifestyle modification.

Comparison of the MDRD and the CKD-EPI equations to estimate the glomerular filtration rate in the general population

Background and objective: The Chronic Kidney Disease Epidemiology Collaboration (CDK-EPI) equation has been proposed as a replacement for the Modification of Diet in Renal Disease (MDRD) equation to estimate the glomerular filtration rate, but this equation has not yet been evaluated in the general population. Patients and methods: Cross-sectional analysis of a random sample of 858 participants from the general population aged 50–75 years without known kidney disease. The prevalence of low eGFR (<60mL/min/1.73m2) was assessed with the MDRD and the CKD-EPI equations in the overall sample and in normoalbuminuric individuals. Results: With the MDRD equation the median eGFRs (interquartile range) in men/women were 63.3(12.2)/56.7(9.4) mL/min/1.73m2, and with the CKD-EPI equation 66.6(14.2)/61.3(11.6) mL/min/1.73m2. The prevalence of low eGFR in men/women was 35.2%/68.5% and 25.1%/45.7% with the MDRD and the CKD-EPI equations, respectively. Normoalbuminuric women without risk factors for CKD experience the most pronounced reduction in the number of cases with low eGFR with the CKD-EPI equation. The prevalence of renal impairment in this subgroup still remained even greater than that in men with diabetes, hypertension, or cardiovascular disease. Conclusions: Compared with the MDRD, the CKD-EPI equation generates a substantial reduction in the prevalence of renal impairment in subjects with diabetes, hypertension, cardiovascular disease, and in subjects without risk factors. The prevalence of renal impairment in normoalbuminuric females may be still overestimated with the CKD-EPI equation (AU)

Fundamento y objetivo: La ecuación Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) ha sido propuesta para sustituir a la actualmente recomendada Modification of Diet in Renal Disease (MDRD) para el cálculo de la tasa de filtrado glomerular (TFG), si bien no ha sido aún evaluada en la población general. Pacientes y Método: Estudio transversal de una muestra aleatoria de 858 individuos de la población general con edades entre 50–75 años sin enfermedad renal conocida. Comparación de la prevalencia de una TFG<60ml/min/1,73m2 calculada con las ecuaciones MDRD y CKD-EPI en toda la muestra y en el subgrupo de individuos normoalbuminúricos (cociente albúmina/creatinina<30mg/g). Resultados: Con la ecuación MDRD la mediana de la TFG (rango intercuartílico) en varones/mujeres fue de 63,3 (12,2)/56,7 (9,4) ml/min/1,73m2, y con la ecuación CKD-EPI 66,6 (14,2)/61,3 (11,6)ml/min/1,73m2, respectivamente. La prevalencia de una TFG baja en varones/mujeres fue del 35,2–68,5%, y del 25,1–45,7% con las ecuaciones MDRD y CKD-EPI, respectivamente. El grupo de mujeres normoalbuminúricas sin factores de riesgo para enfermedad renal crónica presentó la mayor reducción en la prevalencia de una TFG baja con la ecuación CKD-EPI. Sin embargo, la prevalencia en este grupo se mantuvo incluso más elevada que en el de los varones con diabetes, hipertensión o enfermedad cardiovascular. Conclusiones: Comparada con la ecuación MDRD, la ecuación CKD-EPI produce una importante reducción en la prevalencia de insuficiencia renal en individuos con diabetes, hipertensión, enfermedad cardiovascular, y en individuos sin factores de riesgo. La prevalencia de insuficiencia renal en mujeres normoalbuminúricas calculada con la ecuación CKD-EPI puede estar aún sobreestimada (AU)

Comparison of the MDRD and the CKD-EPI equations to estimate the glomerular filtration rate in the general population.

BACKGROUND AND OBJECTIVE: The Chronic Kidney Disease Epidemiology Collaboration (CDK-EPI) equation has been proposed as a replacement for the Modification of Diet in Renal Disease (MDRD) equation to estimate the glomerular filtration rate, but this equation has not yet been evaluated in the general population. PATIENTS AND METHODS: Cross-sectional analysis of a random sample of 858 participants from the general population aged 50-75 years without known kidney disease. The prevalence of low eGFR (< 60 mL/min/1.73 m(2)) was assessed with the MDRD and the CKD-EPI equations in the overall sample and in normoalbuminuric individuals. RESULTS: With the MDRD equation the median eGFRs (interquartile range) in men/women were 63.3(12.2)/56.7(9.4)mL/min/1.73 m(2), and with the CKD-EPI equation 66.6(14.2)/61.3(11.6) mL/min/1.73 m(2). The prevalence of low eGFR in men/women was 35.2%/68.5% and 25.1%/45.7% with the MDRD and the CKD-EPI equations, respectively. Normoalbuminuric women without risk factors for CKD experienced the most pronounced reduction in the number of cases with low eGFR with the CKD-EPI equation. The prevalence of renal impairment in this subgroup still remained even greater than that in men with diabetes, hypertension, or cardiovascular disease. CONCLUSIONS: Compared with the MDRD, the CKD-EPI equation generates a substantial reduction in the prevalence of renal impairment in subjects with diabetes, hypertension, cardiovascular disease, and in subjects without risk factors. The prevalence of renal impairment in normoalbuminuric females may be still overestimated with the CKD-EPI equation.

[Prevalence of obesity, diabetes, hypertension, hypercholesterolemia and metabolic syndrome in over 50-year-olds in Sanlúcar de Barrameda, Spain]. / Prevalencia de obesidad, diabetes, hipertensión, hipercolesterolemia y síndrome metabólico en adultos mayores de 50 años de Sanlúcar de Barrameda.

INTRODUCTION AND OBJECTIVES: The Spanish province of Cádiz has some of the poorest socioeconomic conditions and the highest cardiovascular morbidity and mortality rates in the country. The aim of this study was to investigate the prevalence of cardiovascular risk factors in the adult population of the city of Sanlúcar de Barrameda in Cádiz. METHODS: This cross-sectional population-based study involved 858 randomly selected individuals aged 50-75 years. Age- and sex-adjusted prevalences of the main cardiovascular risk factors were obtained. RESULTS: The mean age of the study population was 61.5 years and 53.6% were women. Overall, 46% of men and 61.7% of women were illiterate; 23.7% and 7.9%, respectively, were current smokers; 30.9% and 44.8% had a sedentary lifestyle; 54% and 55.9% were obese; 29.4% and 26.1% had diabetes; 45% and 52.4% had hypertension; 40.9% and 45.1% had hypercholesterolemia; and 58.8% and 57% had metabolic syndrome as defined by NCEP/ATP-III criteria. The prevalence of all cardiovascular risk factors, except smoking, increased with age. Significant inverse associations were observed between educational level and obesity in men and between educational level and diabetes and metabolic syndrome in women. CONCLUSIONS: The prevalence of cardiovascular risk factors in individuals aged 50-75 years in Sanlúcar de Barrameda was extremely high. The prevalences of obesity, diabetes and metabolic syndrome were among the highest ever reported in Spain. A very low educational level may underlie these adverse findings.

Prevalencia de obesidad, diabetes, hipertensión, hipercolesterolemia y síndrome metabólico en adultos mayores de 50 años de Sanlúcar de Barrameda / Prevalence of obesity, diabetes, hypertension, hypercholesterolemia and metabolic syndrome in over 50-year-olds in Sanlúcar de Barrameda, Spain

Introducción y objetivos. Cádiz es una de las provincias con los marcadores socioeconómicos más desfavorables y la mayor morbimortalidad cardiovascular de España. Se estudia la prevalencia de los factores de riesgo cardiovascular en la población adulta de Sanlúcar de Barrameda. Métodos. Estudio poblacional con selección aleatoria de una muestra representativa constituida por 858 individuos con edades entre 50 y 75 años. Descripción de la prevalencia de los factores de riesgo cardiovascular principales ajustada por edad y sexo. Resultados. La media de edad de los pacientes era 61,5 años, con un 53,6% de mujeres. La prevalencia de sujetos sin estudios en varones y mujeres fue del 46 y el 61,7%; de tabaquismo activo, el 23,7 y el 7,9%; de sedentarismo, el 30,9 y el 44,8%; de obesidad, el 54 y el 55,9%; de diabetes, el 29,4 y el 26,1%; de hipertensión, el 45 y el 52,4%; de hipercolesterolemia, el 40,9 y el 45,1%, y de síndrome metabólico (NCEP/ATP-III), el 58,8 y el 57%. Con excepción del tabaquismo, la prevalencia de todos los factores de riesgo aumentó con la edad. Se aprecia una asociación significativa e inversa del nivel de estudios con la obesidad en varones, y con la diabetes y el síndrome metabólico en mujeres. Conclusiones. La prevalencia de los factores de riesgo cardiovascular en adultos de 50 a 75 años de Sanlúcar de Barrameda es extraordinariamente elevada. Las prevalencias de obesidad, diabetes y síndrome metabólico se encuentran entre las más elevadas de las que se ha comunicado hasta el momento en España. Un nivel de estudios muy bajo puede estar en relación con un perfil de riesgo tan elevado (AU)

Introduction and objectives. The Spanish province of Cadiz has some of the poorest socioeconomic conditions and the highest cardiovascular morbidity and mortality rates in the country. The aim of this study was to investigate the prevalence of cardiovascular risk factors in the adult population of the city of Sanlucar de Barrameda in Cadiz. Methods. This cross-sectional population-based study involved 858 randomly selected individuals aged 50-75 years. Age- and sex-adjusted prevalences of the main cardiovascular risk factors were obtained. Results. The mean age of the study population was 61.5 years and 53.6% were women. Overall, 46% of men and 61.7% of women were illiterate; 23.7% and 7.9%, respectively, were current smokers; 30.9% and 44.8% had a sedentary lifestyle; 54% and 55.9% were obese; 29.4% and 26.1% had diabetes; 45% and 52.4% had hypertension; 40.9% and 45.1% had hypercholesterolemia; and 58.8% and 57% had metabolic syndrome as defined by NCEP/ATP-III criteria. The prevalence of all cardiovascular risk factors, except smoking, increased with age. Significant inverse associations were observed between educational level and obesity in men and between educational level and diabetes and metabolic syndrome in women. Conclusions. The prevalence of cardiovascular risk factors in individuals aged 50-75 years in Sanlucar de Barrameda was extremely high. The prevalences of obesity, diabetes, and metabolic syndrome were among the highest ever reported in Spain. A very low educational level may underlie these adverse findings (AU)

Does diagnosis of metabolic syndrome predict the likelihood of peripheral arterial disease as defined by a low ankle-brachial index?

BACKGROUND: There is limited information about whether a diagnosis of metabolic syndrome (MS) predicts peripheral arterial disease independently of diabetes. This study assessed whether MS adds prognostic information beyond that relating to diabetes in the identification of a low ankle-brachial index (ABI). DESIGN: Cross-sectional population-based study of people aged 50-75 years. METHODS: Eight hundred and fifty-eight participants were randomly selected. The likelihood of low ABI (<0.90) was calculated according to MS status before and after excluding diabetes. The National Cholesterol Education Panel and the International Diabetes Federation (IDF) definitions of MS were used. RESULTS: The prevalence of National Cholesterol Education Panel-defined and IDF-defined MS, and low ABI was 57.8, 61.1 and 7.5%, respectively. When there were participants with three or more criteria for MS, participants with only three criteria, and participants with four or five criteria were compared with participants without MS, the odds ratio for low ABI was 1.89 (95% confidence interval, 1.08-3.30), 1.34 (0.70-2.60) and 2.70 (1.45-5.03), respectively. The association of MS and low ABI lost statistical significance after excluding diabetes. No difference was observed using the IDF definition of MS. CONCLUSION: Screening of participants with MS does not improve the identification of abnormal ABI provided by diabetes.

[Serum urate levels and urinary uric acid excretion in subjects with metabolic syndrome]. / Concentraciones séricas de uratos y excreción urinaria de ácido úrico en individuos con síndrome metabólico.

BACKGROUND AND OBJECTIVES: Hyperuricemia is considered a feature of the metabolic syndrome (MS) despite serum uric acid (SUA) is not considered a diagnostic criterion. The main physiopathological disturbance leading to the increased SUA is not completely understood. PATIENTS AND METHOD: Descriptive study without drug intervention including 141 subjects (NCEP-ATPIII: 105 with MS and 36 without MS). Serum UA levels were compared in subjects with and without MS. The mechanism of the rise in SUA levels was assessed (overproduction or decreased renal excretion). The relation of SUA levels to the HOMA index was also evaluated. RESULTS: Subjects with MS showed significantly higher SUA levels (5.6 [1.6] vs 4.6 [1.7] mg/dl, p = 0.002), and lower urinary UA excretion than subjects without MS (UA clearance 3.60 [2.41] vs 4.65 [3.04] ml/min/m2, p = 0.049; excreted fraction of filtered UA 7.15 [4.72] vs 9.81 [6.78%], p = 0.045). Sex (male 6.1 [1.6] vs female 4.9 [1.6] mg/dl, p < 0.001), alcohol intake (drinkers 6.1 [1.8] vs non-drinkers 5.2 [1.6] mg/dl, p < 0.01), and MS (present 5.6 [1.6] absent 4.6 [1.7] mg/dl, p < 0.002), were significantly associated with SUA. In the multiple regression analysis, sex and MS were independently associated with SUA. CONCLUSIONS: This study demonstrates significantly higher SUA levels in subjects with MS. A decreased urinary UA excretion, instead of urate overproduction, was the leading mechanism to explain high SUA. Serum UA levels were not associated with the HOMA index.

Concentraciones séricas de uratos y excreción urinaria de ácido úrico en individuos con síndrome metabólico / Serum urate levels and urinary uric acid excretion in subjects with metabolic syndrome

Fundamento y objetivos: La hiperuricemia es una de las alteraciones características del síndrome metabólico (SM), aunque no incluida como criterio diagnóstico. No se conoce con exactitud el mecanismo que causa la elevación del urato sérico en el SM. Pacientes y método: Estudio transversal, sin intervención farmacológica, sobre 141 individuos (National Cholesterol Education Program Adult Treatment Panel III: 105 con SM y 36 sin SM). Se comparan los valores de urato sérico entre individuos con y sin SM, y se analiza si la elevación del urato sérico se asocia a infraexcreción renal o sobreproducción. Se determina la asociación del urato sérico a índice HOMA. Resultados: El grupo con SM presentó valores de urato sérico significativamente más elevados (media [DE] 5,6 [1,6] frente a 4,6 [1,7] mg/dl, p = 0,002), y menor excreción urinaria (aclaramiento de ácido úrico 3,60 [2,41] frente a 4,65 [3,04] ml/min/m2, p = 0,049; fracción excretada del ácido úrico filtrado 7,15 [4,72] frente a 9,81 [6,78]%, p = 0,045). Las variables asociadas con los valores de urato sérico fueron el sexo (media de urato sérico en varón 6,1 [1,6] frente a mujer 4,9 [1,6] mg/dl, p < 0,001), el alcohol (bebedores 6,1 [1,8] frente a no bebedores 5,2 [1,6] mg/dl, p < 0,01), y el SM (presente 5,6 [1,6] frente a ausente 4,6 [1,7] mg/dl, p < 0,002). En el análisis multivariante, sólo el sexo y el SM se asociaron independientemente con los valores de urato sérico. Conclusiones: El presente estudio muestra unos valores de urato sérico significativamente más elevados entre individuos con SM, relacionado a su vez con una infraexcreción renal de uratos. No se observó asociación significativa de los valores de urato sérico con el índice HOMA

Background and objectives: Hyperuricemia is considered a feature of the metabolic syndrome (MS) despite serum uric acid (SUA) is not considered a diagnostic criterion. The main physiopathological disturbance leading to the increased SUA is not completely understood. Patients and method: Descriptive study without drug intervention including 141 subjects (NCEP-ATPIII: 105 with MS and 36 without MS). Serum UA levels were compared in subjects with and without MS. The mechanism of the rise in SUA levels was assessed (overproduction or decreased renal excretion). The relation of SUA levels to the HOMA index was also evaluated. Results: Subjects with MS showed significantly higher SUA levels (5.6 [1.6] vs 4.6 [1.7] mg/dl, p = 0.002), and lower urinary UA excretion than subjects without MS (UA clearance 3.60 [2.41] vs 4.65 [3.04] ml/min/m2, p = 0.049; excreted fraction of filtered UA 7.15 [4.72] vs 9.81 [6.78%], p = 0.045). Sex (male 6.1 [1.6] vs female 4.9 [1.6] mg/dl, p < 0.001), alcohol intake (drinkers 6.1 [1.8] vs non-drinkers 5.2 [1.6] mg/dl, p < 0.01), and MS (present 5.6 [1.6] absent 4.6 [1.7] mg/dl, p < 0.002), were significantly associated with SUA. In the multiple regression analysis, sex and MS were independently associated with SUA. Conclusions: This study demonstrates significantly higher SUA levels in subjects with MS. A decreased urinary UA excretion, instead of urate overproduction, was the leading mechanism to explain high SUA. Serum UA levels were not associated with the HOMA index