Central obesity markers, but not BMI, are associated with cardiovascular risk in type 2 diabetic patients: results from the ADVANCE study
Sébastien CzernichowRobert HuxleyAndré Pascal KengneBastiaan E. de GalanAvinesh PillaiSophia ZoungasG. David BattyMichel MarreBruce NealJohn Chalmers
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Human physiology
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BMI is a proxy measure for adiposity in population-based studies and it is well established that increasing body fat is strongly associated with component features of the metabolic syndrome (MetS), such as dyslipidaemia (low high density lipoprotein cholesterol (HDL-C) and high triglyceride concentrations, increased glucose concentrations, high blood pressure, hypertension, and type 2 diabetes. Whether any or all of these components of the MetS account for relationships between body fatness and all cause mortality is uncertain, but we have recently shown in a large Korean cohort that co-existing cardiovascular disease (CVD), diabetes or hypertension explained much of the increased risk of CVD mortality in obese individuals. Recently, the concept of metabolically healthy obesity (MHO) has been used to try and help explain the ‘obesity paradox’, where there is decreased mortality in some people with obesity. Additionally, whether any association between underweight and increased all cause mortality is due to the presence of pre-existing cardiovascular and metabolic disease states (or risk factors) is not fully understood. Therefore, i will discuss whether BMI was associated with mortality outcomes after subjects with established risk factors and diseases such as diabetes, cardiovascular disease, hypertension and features of the MetS had been excluded.
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OBJECTIVE To quantify the role of BMI and metabolic dysfunction in the risk of development of type 2 diabetes in patients at high risk or with manifest vascular disease. RESEARCH DESIGN AND METHODS A total of 6,997 patients participating in the prospective Secondary Manifestations of ARTerial disease (SMART) cohort study were classified according to BMI and metabolic dysfunction, defined as three or more of the modified National Cholesterol Education Program (NCEP) metabolic syndrome criteria (waist circumference replaced by hs-CRP ≥2 mg/L). Risk of type 2 diabetes (assessed with biannually questionnaires) was estimated with Cox proportional hazards analysis. RESULTS During a median follow-up of 6.0 years (interquartile range 3.1–9.1 years), 519 patients developed type 2 diabetes (incidence rate 12/1,000 person-years). In the absence of metabolic dysfunction (≤2 NCEP criteria), adiposity increased the risk of type 2 diabetes compared with normal-weight patients (HR 2.5 [95% CI 1.5–4.2] for overweight and HR 4.3 [95% CI 2.2–8.6] for obese patients). In the presence of metabolic dysfunction (≥3 NCEP criteria), an increased risk of type 2 diabetes was observed in patients with normal weight (HR 4.7 [95% CI 2.8–7.8]), overweight (HR 8.5 [95% CI 5.5–13.4]), and obesity (HR 16.3 [95% CI 10.4–25.6]) compared with normal-weight patients without metabolic dysfunction. CONCLUSIONS Adiposity, even in the absence of metabolic dysfunction, is a risk factor for type 2 diabetes. Moreover, presence of metabolic dysfunction increases the risk of type 2 diabetes in all BMI categories. This supports the assessment of adiposity and metabolic dysfunction in patients with vascular disease or at high risk for cardiovascular events.
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Obesity is a major public health problem increasing risk for hypertension, diabetes mellitus, cardiovascular diseases, heart failure, stroke, left atrial enlargement and obstructive sleep apnoea. Conventionally, body mass index (BMI) is used in many studies to diagnose and classify obesity. However, epidemiological studies have shown that waist:hip ratio is a better predictor for myocardial infarction and sudden cardiac death compared with BMI. Nevertheless, some subjects who have ‘healthy obese phenotype’ have a benign cardiometabolic profile due to greater deposition of the fat tissue in the subcutaneous area rather than in the visceral area. Large clinical studies have confirmed ‘obesity survival paradox’ in patients with coronary artery disease and heart failure. ‘Sexual dimorphism’ is another interesting issue about obesity survival paradox that gender should be considered as an important confounding factor when investigating the correlation of obesity with cardiovascular diseases.1 ,2 These findings suggest that metabolic effects of adipose tissue may be different between males and females. It is well known that body fat mass is greater in females and the regional distribution …
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Objectives To evaluate: 1) the metabolic profile and cardiometabolic risk in overweight/obese children at first assessment, stratifying patients according to severity of overweight and age; 2) to investigate the relationship between family history for obesity and cardiometabolic diseases and severity of childhood obesity . Methods In this cross-sectional, retrospective, observational study, 260 children (139 female), aged between 2.4 and 17.2 years, with overweight and obesity were recruited. Data regarding family history for obesity and cardiometabolic diseases were collected. Each patient underwent clinical and auxological examination and fasting blood sampling for metabolic profile. HOMA-IR, triglyceride-to-HDL-cholesterol-ratio and atherogenic index of plasma were calculated. To evaluate the severity of obesity, children were divided into two groups for BMI SD ≤ 2.5 and BMI SD >2.5. Moreover, study population was analyzed dividing it into three groups based on chronological age of patient (11 years). Results BMI SD was negatively correlated with chronological age (p2.5) were younger (p<0.005), mostly pre-pubertal, presented a significantly higher HOMA-IR (p=0.04), and had a significantly higher prevalence of family history for arterial hypertension, type 2 diabetes mellitus and coronary heart disease than the other group. Conclusions 1) Family history of obesity and cardiometabolic diseases are important risk factors for precocious obesity onset in childhood and are related to the severity of obesity. 2) Metabolic profile, especially HOMA-IR, is altered even among the youngest obese children at first evaluation; 3) stratification of obesity severity, using BMI SD, is effective to estimate the cardiometabolic risk of patients.
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Impaired fasting glucose
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Objective To investigate the factors affecting the clustering of cardiovascular risk factors in Chinese patients with diabetes. Methods Six hundred and fifty four patients with diabetes were examined comprehensively for diabetes complications and cardiovascular risk factors in a metropolitan hospital in Beijing, China. Insulin resistance and secretion were also evaluated by measurement of glucose and insulin levels before and 2h after a meal. Results were analyzed according to patient groups stratified by the number of cardiovascular risk factors coexisting with diabetes. Results Cardiovascular risk factors were common in Chinese diabetic patients. Clustering of three or more of these factors with diabetes occurred greater than that by random one factor alone and was associated with postprandial hyperinsulinemia. Patients with more risk factors were more prone to macrovascular events. Using the commonly adopted lower threshold for diagnosing obesity and central obesity in women, there were more females with multiple risk factors. But the difference disappeared if the same criteria were used for males and females. Even in the presence of diabetes, cardiovascular risk factors were inadequately controlled in most patients. Conclusion The concurrence of diabetes and other cardiovascular risk factors which constitute the metabolic syndrome is a common phenomenon in urban Chinese diabetic patients. It is possibly associated with hyperinsulinemia and gender.
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Obesity is an independent predictor of risk factors and morbidity of obesity related diseases such as type 2 diabetes, hypertension, dyslipidaemia and cardiovascular diseases. Waist circumference is a valuable additional alternative method in identifying individuals at increased risk and it is an approximate index of intra-abdominal fat mass. In this study we followed the evolution of weight status of diabetics with or without chronic complications associated, to see if there is any link between obesity and chronic complications. The present study is realized between 2010 2011, on a number of 255 diabetics with and without diabetic cardiomyopathy or diabetic kidney disease.We followed index body mass and waist circumference and we note that there were significant differences between the 4 groups in terms of the evolution of weight status, most changes were observed at patients with diabetic cardiomiopathy and diabetic kidney disease.
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1003 PURPOSE: To examine the relationship between cardiovascular (CVD) fitness and CVD risk among obese individuals with type 2 diabetes. METHODS: Maximal exercise stress testing (EST) (Bruce protocol) was conducted among 39 individuals with type 2 diabetes. These individuals were not using insulin and had not previously been diagnosed with vascular disease. EST duration was the measure of CVD fitness. CVD risk was estimated from the CVD Life Expectancy Model which calculates the eight-year mortality risk based on the levels of independent risk vascular risk factors such as age, blood pressure, and blood lipid levels. RESULTS: Mean age was 51 ± 8 years and 51% were women. Average duration of diabetes was 3.7 ± 3.8 years. Mean body mass index (BMI) was 37.6 + 7.4 kg/m2. Mean EST duration was 7.4 ± 2.0 minutes and mean CVD risk was 9.8 ± 7.2%. In a linear regression model corrected for BMI with CVD risk as the dependent variable, EST duration was negatively-associated with CVD risk. A one-minute increase in EST duration was associated with a one percent reduction in 8-year mortality risk as predicted by the CVD life expectancy model (p = 0.04). A second regression model that examined the determinants of EST duration indicated that being a woman and having a larger abdominal circumference were associated with shorter EST duration. CONCLUSIONS: Among women free of symptomatic vascular disease at baseline, 20-year follow-up of the Lipid Research Clinics Prevalence Study has demonstrated that low exercise capacity is independently associated with all-cause and CVD mortality. Our results indicate that among obese type 2 diabetes patients without diagnosed vascular disease, there is a significant relationship between CVD fitness (EST duration) and CVD risk. These findings underscore the importance of improving and maintaining exercise capacity, not only as a means of maintaining weight loss, but more importantly as a means of reducing CVD risk. Individuals described in the present study are in fact enrolled in a supervised exercise trial being conducted at the Cardiovascular Health Improvement Program (CHIP), the primary site of cardiovascular rehabilitation for the McGill teaching hospitals. The impact of supervised exercise on CVD fitness, CVD risk, weight reduction, and glycemic control will be assessed. Funding sources: Canadian Institutes of Health Research-Institute of Nutrition, Diabetes, and Metabolism and the MUHC Research Institute.
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Pregeriatric type 2 diabetic subjects were enrolled to identify the various risk factors for cardiovascular diseas-es. The risk factors analysis on 120 diabetic subjects showed a high prevalence of overweight, obesity, abdo-minal obesity, hypertension and metabolic syndrome. Poor metabolic control as evident from HbA1c was seen in 60% of the diabetic subjects. Dyslipidemia was a common feature. Majority of the subjects had 4-8 risk fac-tors and the most prominent risk factors were overweight/obesity, abdominal obesity, hypertension and low HDL-C levels. The multiple risk factor scenario highlights the need to improve the lifestyle patterns of the pop-ulation to reduce the risk of cardiovascular diseases.
Keywords: Diabetes mellitus; risk factors; cardiovascular diseases
Abdominal obesity
Dyslipidemia
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