scholarly journals Pharmacological Approaches to Controlling Cardiometabolic Risk in Women with PCOS

2020 ◽  
Vol 21 (24) ◽  
pp. 9554
Author(s):  
Andrea Cignarella ◽  
Roberto Mioni ◽  
Chiara Sabbadin ◽  
Francesca Dassie ◽  
Matteo Parolin ◽  
...  
Keyword(s):  
Cardiometabolic Risk ◽  
Polycystic Ovary ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Later Life ◽  
Term Treatment ◽  
Hypoglycemic Agents ◽  
Short Term Treatment ◽  
Aldosterone Antagonists ◽  
Increased Risk

Polycystic ovary syndrome (PCOS) is characterized by elevated androgen production and subclinical changes in cardiovascular and metabolic risk markers. Total cholesterol, high-density lipoprotein (HDL) cholesterol, fasting glucose, and fasting insulin appear to increase specifically in PCOS compared with fertile women. PCOS also confers an increased risk of cardiometabolic disease in later life. Novel biomarkers such as serum’s cholesterol efflux capacity and blood-derived macrophage activation profile may assist in more accurately defining the cardiometabolic risk profile in these women. Aldosterone antagonists, androgen receptor antagonists, 5α-reductase inhibitors, and synthetic progestogens are used to reduce hyperandrogenism. Because increased insulin secretion enhances ovarian androgen production, short-term treatment with metformin and other hypoglycemic agents results in significant weight loss, favorable metabolic changes, and testosterone reduction. The naturally occurring inositols display insulin-sensitizing effects and may be also used in this context because of their safety profile. Combined oral contraceptives represent the drug of choice for correction of androgen-related symptoms. Overall, PCOS management remains focused on specific targets including assessment and treatment of cardiometabolic risk, according to disease phenotypes. While new options are adding to established therapeutic approaches, a sometimes difficult balance between efficacy and safety of available medications has to be found in individual women.

scholarly journals Effect of Dietary Carbohydrate Type on Serum Cardiometabolic Risk Indicators and Adipose Tissue Inflammatory Markers

2018 ◽  
Vol 103 (9) ◽  
pp. 3430-3438 ◽  
Author(s):  
Huicui Meng ◽  
Nirupa R Matthan ◽  
Susan K Fried ◽  
Silvia Berciano ◽  
Maura E Walker ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Cholesterol Efflux ◽  
Cardiometabolic Risk ◽  
Ex Vivo ◽  
Inflammatory Marker ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Risk Indicators ◽  
Dietary Carbohydrate ◽  
Fasting Serum

Abstract Context and Objective Direct comparisons between types of dietary carbohydrate in terms of cardiometabolic risk indicators are limited. This study was designed to compare the effects of an isocaloric exchange of simple, refined, and unrefined carbohydrates on serum cardiometabolic risk indicators, adipose tissue inflammatory markers, and peripheral blood mononuclear cell (PBMC) fractional cholesterol efflux. Design, Participants, and Measures Participants [postmenopausal women and men (N = 11), 65 ± 8 years, body mass index 29.8 ± 3.2 kg/m2, low-density lipoprotein (LDL) cholesterol ≥2.6 mmol/L] were provided with diets (60% energy from total carbohydrate, 15% from protein, 25% from fat) for 4.5 weeks in a randomized crossover design, with 2-week washout periods. The variable component was an isocaloric exchange of simple, refined, or unrefined carbohydrate–containing foods. Serum lipoprotein, glucose, insulin, and inflammatory marker concentrations were measured. Abdominal subcutaneous adipose tissue was aspirated to assess macrophage and inflammatory marker gene expression and ex vivo cytokine secretion, and PBMCs were isolated to assess ex vivo fractional cholesterol efflux. Results Fasting serum LDL and non–high-density lipoprotein (HDL) cholesterol concentrations were higher after the refined compared with simple or unrefined carbohydrate–enriched diets (P < 0.01). Other serum measures, ex vivo fractional cholesterol efflux and adipose tissue gene expression and ex vivo cytokine secretion, were similar between diets. Conclusions Diets enriched in refined compared with simple or unrefined carbohydrate resulted in higher fasting serum LDL and non-HDL cholesterol concentrations but had little effect on other cardiometabolic risk indicators. This small study raises the intriguing possibility that refined carbohydrate may have unique adverse effects on cardiometabolic risk indicators distinct from simple and unrefined carbohydrate.

Association Between the Non-HDL-Cholesterol-to-HDL-Cholesterol Ratio and 28-Day Mortality in Septic Patients: A Cohort Study Based on the eICU Collaborative Research Database

2021 ◽  
Author(s):  
Le Chang ◽  
Xinglin Chen ◽  
Cheng Lian
Keyword(s):  
Cohort Study ◽  
High Density Lipoprotein ◽  
High Density Lipoprotein Cholesterol ◽  
Collaborative Research ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Lipoprotein Cholesterol ◽  
Research Database ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background: Dyslipidemia contributes to the development and progression of cardiovascular disease. However, the potential association between non-high-density lipoprotein-cholesterol-to-high-density lipoprotein-cholesterol (nonHDLc/HDLc) ratio and mortality in septic patients is unclear.Methods: This was a retrospective cohort study of patients with sepsis in the eICU Collaborative Research Database (eICU-CRD) from 208 distinct ICUs across the United States between 2014 and 2015. All-cause mortality within 28-days after ICU admission. A multivariable logistic regression model was used to estimate the risk of death.Result: Of the 724 patients with a median age of 68 years, 43 (5.94%) died within 28 days after ICU admission. The association between the nonHDLc/HDLc ratio and the risk of all cause mortality was J shaped, and a high level was associated with increased risk of all cause mortality. The mortality rate increased when the nonHDLc/HDLc ratio higher than the turning point (≥3.41) with an adjusted odds ratio (OR) of 1.34 (95% CI: 1.07–1.67, P=0.010) for every 1 increment of nonHDLc/HDLc ratio. With the per-SD increase in the nonHDLc/HDLc ratio, the OR of mortality was 1.79 (95% CI: 1.15–2.80, P=0.010) when the nonHDLc/HDLc ratio was ≥3.41. The trend of sensitivity analysis was consistent with the main analysis.Conclusion: For patients with sepsis, the association between the nonHDLc/HDLc ratio and the 28-day mortality risk was J shaped. A higher level of nonHDLc/HDLc ratio was associated with an increased risk of 28-day mortality. These findings need to be confirmed in other studies.

Elevated apolipoprotein A1 and HDL cholesterol associated with age-related macular degeneration: two population cohorts

2021 ◽  
Author(s):  
Liv Tybjærg Nordestgaard ◽  
Anne Tybjærg-Hansen ◽  
Ruth Frikke-Schmidt ◽  
Børge Grønne Nordestgaard
Keyword(s):  
Macular Degeneration ◽  
Ldl Cholesterol ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Age Related Macular Degeneration ◽  
Apolipoprotein A1 ◽  
Age Related ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Plasma Apolipoprotein

Abstract Context To enable prevention and treatment of age-related macular degeneration(AMD), understanding risk factors for AMD is important. Objective We tested the hypotheses that elevated plasma apolipoprotein A1 and high-density lipoprotein(HDL) cholesterol, and low levels of low-density lipoprotein(LDL) cholesterol, are associated with increased risk of AMD. Design and Setting From the Danish general population, we studied 106,703 and 16,032 individuals in the Copenhagen General Population Study(CGPS) and the Copenhagen City Heart Study(CCHS) with median follow-up of respectively 9 and 32 years. Main Outcome Measures 1,787 AMD in CGPS and 206 in CCHS. Results Higher concentrations of plasma apolipoprotein A1 and HDL cholesterol, and lower concentrations of LDL cholesterol, were associated with higher risk of AMD in CGPS. After multifactorial adjustment, individuals in the highest versus lowest quartile of plasma apolipoprotein A1 and HDL cholesterol had hazard ratios for AMD of 1.40(95%CI:1.20-1.63) and 1.22(1.03-1.45). Corresponding hazard ratios for individuals in the lowest versus highest quartile of LDL cholesterol were 1.18(1.02-1.37). Per 100 mg/dL higher plasma apolipoprotein A1, 1 mmol/L(39 mg/dL) higher HDL, and 1 mmol/L(39mmol/L) lower LDL cholesterol, the hazard ratios for AMD were 1.53(1.31-1.80), 1.19(1.07-1.32), and 1.05(1.00-1.11), respectively, with similar results across strata of different risk factors. Higher concentrations of HDL cholesterol were also associated with higher risk of AMD in the CCHS. Conclusion Elevated plasma apolipoprotein A1 and HDL cholesterol, and lower LDL cholesterol, are associated with increased risk of age-related macular degeneration.

scholarly journals Adverse differences in cardiometabolic risk factor levels between individuals with pre-diabetes and normal glucose metabolism are more pronounced in women than in men: the Maastricht Study

2019 ◽  
Vol 7 (1) ◽  
pp. e000787 ◽  
Author(s):  
Rianneke de Ritter ◽  
Simone J S Sep ◽  
Carla J H van der Kallen ◽  
Miranda T Schram ◽  
Annemarie Koster ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Pressure Difference ◽  
Cardiometabolic Risk ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Cardiometabolic Risk Factors ◽  
Blood Pressure Difference

ObjectiveTo investigate whether adverse differences in levels of cardiovascular risk factors in women than men, already established when comparing individuals with and without diabetes, are also present before type 2 diabetes onset.Research design and methodsIn a population-based cohort study of individuals aged 40-75 years (n=3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated associations with cardiometabolic and lifestyle risk factors of (1) pre-diabetes and type 2 diabetes (reference category: normal glucose metabolism) and (2) among non-diabetic individuals, of continuous levels of hemoglobin A1c (HbA1c). Age-adjusted sex differences were analyzed using linear and logistic regression models with sex interaction terms.ResultsIn pre-diabetes, adverse differences in cardiometabolic risk factors were greater in women than men for systolic blood pressure (difference, 3.02 mm Hg; 95% CI:−0.26 to 6.30), high-density lipoprotein (HDL) cholesterol (difference, −0.10 mmol/L; 95% CI: −0.18 to −0.02), total-to-HDL cholesterol ratio (difference, 0.22; 95% CI: −0.01 to 0.44), triglycerides (ratio: 1.11; 95% CI: 1.01 to 1.22), and inflammation markers Z-score (ratio: 1.18; 95% CI: 0.98 to 1.41). In type 2 diabetes, these sex differences were similar in direction, and of greater magnitude. Additionally, HbA1c among non-diabetic individuals was more strongly associated with several cardiometabolic risk factors in women than men: per one per cent point increase, systolic blood pressure (difference, 3.58 mm Hg; 95% CI: −0.03 to 7.19), diastolic blood pressure (difference, 2.10 mm Hg; 95% CI: −0.02 to 4.23), HDL cholesterol (difference, −0.09 mmol/L; 95% CI: −0.19 to 0.00), and low-density lipoprotein cholesterol (difference, 0.26 mmol/L; 95% CI: 0.05 to 0.47). With regard to lifestyle risk factors, no consistent pattern was observed.ConclusionOur results are consistent with the concept that the more adverse changes in cardiometabolic risk factors in women (than men) arise as a continuous process before the onset of type 2 diabetes.

scholarly journals Association of Free Sugars Intake with Cardiometabolic Risk Factors among Japanese Adults: The 2016 National Health and Nutrition Survey, Japan

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3624
Author(s):  
Aya Fujiwara ◽  
Emiko Okada ◽  
Chika Okada ◽  
Mai Matsumoto ◽  
Hidemi Takimoto
Keyword(s):  
Risk Factors ◽  
Cholesterol Level ◽  
Cardiometabolic Risk ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Cardiometabolic Risk Factors ◽  
Nutrition Survey ◽  
Free Sugars ◽  
Health And Nutrition ◽  
Japanese Adults

The relationship between free sugars intake and cardiometabolic risk factors is unclear in Japanese adults. This cross-sectional study aimed to investigate this association using data from the 2016 National Health and Nutrition Survey, Japan. The percentage of energy intake from free sugars was estimated based on the 1-day weighed dietary record data of Japanese men (n = 4071) and women (n = 5794) aged ≥ 20 years. Associations between free sugars intake and cardiometabolic risk factors, including body mass index (BMI), waist circumference (WC), systolic and diastolic blood pressures, glycated haemoglobin (HbA1c) level and levels of serum total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol, were investigated using linear regression and Dunnett’s test, with the lowest category of quartiles as a reference. After adjustment for potential confounding factors, free sugars intake was inversely associated with blood pressures (men only) and HDL-cholesterol level (both sexes) and positively associated with total-cholesterol level (women only) and LDL-cholesterol level (both sexes), whereas no association was observed for BMI, WC, and HbA1c level. This study identified both positive and inverse associations of free sugars intake with cardiometabolic risk factors in Japanese adults.

scholarly journals Developmental origin of polycystic ovary syndrome - a hypothesis

2002 ◽  
Vol 174 (1) ◽  
pp. 1-5 ◽  
Author(s):  
DH Abbott ◽  
DA Dumesic ◽  
S Franks
Keyword(s):  
Insulin Resistance ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Regulatory Region ◽  
Later Life ◽  
Ovary Syndrome ◽  
Increased Risk ◽  
Genetically Determined ◽  
Lh Secretion

Polycystic ovary syndrome (PCOS) is a common but complex endocrine disorder and is a major cause of anovulation and consequent subfertility. It is also associated with a metabolic disturbance, characterized by hyperinsulinaemia and insulin resistance that carries an increased risk of type 2 diabetes in later life. Despite its prevalence little is known about its aetiology, but there is increasing evidence for an important genetic involvement. On the basis of experimental observations in the prenatally androgenized sheep and rhesus monkey, and supported by data from human studies, we propose that the clinical and biochemical features of PCOS can arise as a consequence of genetically determined hypersecretion of androgens by the ovary during, or very likely long before, puberty. The resulting hyperandrogenism results in 'programming' of the hypothalamic-pituitary unit to favour excess LH secretion, and encourages preferential abdominal adiposity that predisposes to insulin resistance. The severity of hyperinsulinaemia and insulin resistance (which has a profound influence on the phenotype of PCOS) is further influenced by both genetic factors (such as polymorphism in the insulin gene regulatory region) and environmental factors, notably obesity. This hypothesis therefore suggests a unifying, 'linear' model to explain the aetiology of the heterogeneous phenotype.

scholarly journals A More Atherogenic Serum Lipoprotein Profile Is Present in Women with Polycystic Ovary Syndrome: A Case-Control Study

2008 ◽  
Vol 93 (2) ◽  
pp. 470-476 ◽  
Author(s):  
Olivier Valkenburg ◽  
Regine P. M. Steegers-Theunissen ◽  
Huberdina P. M. Smedts ◽  
Geesje M. Dallinga-Thie ◽  
Bart C. J. M. Fauser ◽  
...  
Keyword(s):  
Lipid Profile ◽  
Ldl Cholesterol ◽  
Case Control Study ◽  
Polycystic Ovary ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Ovary Syndrome ◽  
Atherogenic Lipid Profile ◽  
Control Study ◽  
Atherogenic Lipid

Abstract Context: Polycystic ovary syndrome (PCOS) is associated with a higher frequency of cardiovascular risk factors. Apolipoprotein (apo) A-I and apoB are potent markers for cardiovascular risk. Data on apo levels in women with PCOS are scarce and contradictory. Objective: Our objective was to identify changes in lipid metabolism in women with PCOS, and the relative impact of obesity, insulin resistance, and hyperandrogenism on lipid parameters. Design: This was a case-control study. Setting: The study was performed at a single referral center. Subjects: PCOS was diagnosed according to the 2003 Rotterdam criteria. Healthy mothers with regular menstrual cycles served as controls. Main Outcome Parameters: Fasting insulin, triglycerides (TGs), cholesterol, high-density lipoprotein (HDL)-cholesterol, apoA-I, and apoB were determined. Low-density lipoprotein (LDL)-cholesterol was calculated using the Friedewald formula. Results: We included 557 women with PCOS and 295 controls. After correction for age and body mass index, PCOS women had higher median levels of insulin (10.1 vs. 6.9 mU/liter), TGs (95 vs. 81 mg/dl), cholesterol (196 vs. 178 mg/dl), and LDL-cholesterol (125 vs. 106 mg/dl) in combination with lower levels of HDL-cholesterol (46 vs. 55 mg/dl) and apoA-I (118 vs. 146 mg/dl) compared with controls (all P values ≤ 0.01). apoB levels were similar in cases and controls. Free androgen index, body mass index, SHBG, and estradiol were independent predictors of apoA-I levels in women with PCOS. Conclusions: PCOS is associated with a more pronounced atherogenic lipid profile. Furthermore, obesity and hyperandrogenism contribute to an adverse lipid profile. Finally, PCOS seems to constitute an additional risk factor for an atherogenic lipid profile.

scholarly journals Association of Metabolic Factors with Essential Hypertension

2011 ◽  
Vol 24 (1) ◽  
pp. 21-25
Author(s):  
N Rahman Khandaker ◽  
Akhtaruzzaman ◽  
K Rahat Mahfuz ◽  
AR Khandakar ◽  
MMR Khan ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Waist Circumference ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Metabolic Factors ◽  
College Hospital ◽  
High Waist Circumference ◽  
Increased Risk ◽  
Low Hdl

Background-Metabolic syndrome is a risk factor for cardiovascular disease, so it should call attention. South Asian person has preponderance to it. Objectives-The proper findings of metabolic syndrome are a key to prevent cardiovascular disease. Hypertension is a component of metabolic syndrome with which patients are at increased risk for cardiovascular disease. Methods-This study was carried out in cardiology outdoor of Shaheed Suhrawardy medical college hospital, Dhaka. A total of 322 patients were enrolled from January 2008 to December 2010. Metabolic syndrome was defined as three of the followings: (a) Abnormal fasting serum level of glucose (≥110 mg/dl or 6.1 mmol/L), ( b) abdominal obesity (waist circumference >102 cm in men and >88 cm in women), (c) Triglycerides (≥150 mg/dl), (d) High density lipoprotein cholesterol (<40 mg/dl in men and <50 mg/dl in woman), (e) Hypertension, which was common in all patients. Results- Among hypertensive’s patients 31.8% had hyperglycemia, 37.9% had high waist circumference, 69.8% had low HDL cholesterol and 54.3% high triglycerides. As per definition of NCEP-ATP-III, metabolic syndrome had been detected in 17% of male, 37% of female and 27% of the total population. Conclusion- Metabolic factors are a common association in hypertensive cases. These patients are at increased risk of coronary and cerebro-vascular disease and require more vigorous prevention. Furthermore in all hypertensive patients metabolic screening is recommended. TAJ 2011; 24(1): 21-25

Abundance of undiagnosed cardiometabolic risk within the population of a long-stay prison in the UK

2020 ◽  
Author(s):  
Benjamin J Gray ◽  
Christie Craddock ◽  
Zoe Couzens ◽  
Evie Bain ◽  
Gareth J Dunseath ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiometabolic Risk ◽  
Hdl Cholesterol ◽  
Cardiometabolic Risk Factors ◽  
Risk Assessments ◽  
Public Health Issue ◽  
Clinical Markers ◽  
Screening Guidelines ◽  
Increased Risk ◽  
Low Hdl

Abstract Background The health of people in prisons is a public health issue. It is well known that those in prison experience poorer health outcomes than those in the general community. One such example is the burden of non-communicable diseases, more specifically cardiovascular disease (CVD), stroke and type 2 diabetes (T2DM). However, there is limited evidence research on the extent of cardiometabolic risk factors in the prison environment in Wales, the wider UK or globally. Methods Risk assessments were performed on a representative sample of 299 men at HMP Parc, Bridgend. The risk assessments were 30 min in duration and men aged 25–84 years old and free from pre-existing CVD and T2DM were eligible. During the risk assessment, a number of demographic, anthropometric and clinical markers were obtained. The 10-year risk of CVD and T2DM was predicted using the QRISK2 algorithm and Diabetes UK Risk Score, respectively. Results The majority of the men was found to be either overweight (43.5%) or obese (37.5%) and/or demonstrated evidence of central obesity (40.1%). Cardiometabolic risk factors including systolic hypertension (25.1%), high cholesterol (29.8%), low HDL cholesterol (56.2%) and elevated total cholesterol: HDL ratios (23.1%) were observed in a considerable number of men. Ultimately, 15.4% were calculated at increased risk of CVD, and 31.8% predicted at moderate or high risk of T2DM. Conclusions Overall, a substantial prevalence of previously undiagnosed cardiometabolic risk factors was observed and men in prison are at elevated risk of cardiometabolic disease at a younger age than current screening guidelines.

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