African American Women, Metabolic Syndrome, and National Cholesterol Education Program Criteria

Appel, Susan J.; Floyd, Natalie A.; Giger, Joyce Newman; Weaver, Michael T.; Luo, Huabin; Hannah, Tiffany; Ovalle, Fernando

doi:10.1097/00006199-200509000-00008

Cited by 12 publications

(10 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On a population level, African-American subjects generally have lower triglyceride and higher HDL cholesterol levels than European-American subjects20–22, which may in turn explain some of the frequency difference in prevalence of the MS components between these 2 groups. In European-Americans, the higher prevalence and more common lipid abnormalities may have made the MS as a strong and independent predictor of CAD.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Apolipoprotein B/Apolipoprotein A-I Ratio to Predict Coronary Artery Disease Independent of the Metabolic Syndrome in African Americans

Enkhmaa

Anuurad

Zhang

et al. 2010

The American Journal of Cardiology

View full text Add to dashboard Cite

Studies demonstrate that the apolipoprotein B/apolipoprotein A-I (ApoB/apoA-I) ratio predicts cardiovascular risk better than any of the cholesterol indexes. A number of factors that define the metabolic syndrome (MS) differ across African-American and European-American ethnicities. We assessed relationship of the apoB/apoA-I ratio to MS and coronary artery disease (CAD) in 224 African-Americans and 304 European-Americans. The MS was defined by the revised NCEP-ATP III criteria and CAD was assessed as ≥50% stenosis or a continuous cardiovascular score (0–75). European-Americans had higher apoB/apoA-I ratio compared with African-Americans (1.15 vs. 1.07, P=0.008). The apoB/apoA-I ratio was associated with presence of the MS in both European-Americans (OR=5.9; 95% confidence interval (CI), 2.53–13.57; P<0.001) and African-Americans (OR=8.3; 95% CI, 3.52–19.25; P<0.001), and was higher in subjects with MS compared to those without MS (1.21 vs. 1.04, P<0.001 for European-Americans and 1.20 vs. 0.94, P<0.001 for African-Americans). There was a stepwise increase in the prevalence of MS across apoB/apoA-I ratio tertiles in both ethnic groups (χ2=13.1, P<0.001 for European-Americans and χ2=19.6, P<0.001 for African-Americans). In multiple regression analyses, the apoB/apoA-I ratio independently predicted CAD in African-Americans (β=0.242, P=0.011). The cardiovascular score was significantly increased across apoB/apoA-I ratio tertiles in European-American subjects with MS (P=0.001), whereas this association was seen in African-American subjects without MS (P=0.023). In conclusion, the apoB/apoA-I ratio differed across ethnicities and was associated with presence of the MS in both groups. Among African-Americans, elevated apoB/apoA-I ratio independently predicted higher risk for CAD.

show abstract

Section: Discussionmentioning

confidence: 99%

Usefulness of Apolipoprotein B/Apolipoprotein A-I Ratio to Predict Coronary Artery Disease Independent of the Metabolic Syndrome in African Americans

Enkhmaa

Anuurad

Zhang

et al. 2010

The American Journal of Cardiology

View full text Add to dashboard Cite

show abstract

“…It is now a source of controversy that the NCEP's definition of the metabolic syndrome may not be sensitive enough to sufficiently detect risk associated with insulin resistance in nondiabetics who have normal glucose levels (Reaven, 2004). Consequently, using the NCEP's guidelines for the metabolic syndrome may underestimate the risk in Table 3 certain populations such as African American women who often manifest insulin resistance (Appel, 2004;Appel et al, 2005;Liao et al). However, African American women do not commonly present with hypertriglyceridemia (Metcalf et al, 1998).…”

Section: Discussionmentioning

confidence: 99%

Central Obesity, the Metabolic Syndrome, and Plasminogen Activator Inhibitor‐1 in Young Adults

Appel¹,

Harrell²,

Davenport³

2005

Journal of the American Academy of Nurse Practitioners

Self Cite

View full text Add to dashboard Cite

Purpose To determine the association of central obesity with the components of the metabolic syndrome (i.e., hyperinsulinemia, hypertension, hypertriglyceridemia, low levels of high‐density lipoprotein cholesterol [HDL‐C]) and plasma levels of plasminogen activator inhibitor‐1 (PAI‐1) in young adults. We hypothesized that central obesity as determined by waist circumference would be predictive of components of the metabolic syndrome and of PAI‐1. Data sources Participants in this descriptive study consisted of 85 healthy young adults aged 19–22 years, 62% women who fasted for 12 h prior to data collection in the General Clinical Research Center at a major university hospital medical center in the southeastern United States. Conclusions The majority of the participants had one or more components of the metabolic syndrome (n= 43, 51%). Central obesity was present in 14.1% and was more common in women than men (χ2= 5.11; p= 0.021). Central obesity was significantly and positively correlated with elevated blood pressure (BP) and levels of insulin and PAI‐1 while being negatively correlated with HDL‐C. In multiple regression analyses, diastolic BP, insulin, and HDL‐C were predictors of waist circumference (R2= 0.615). In a separate multiple regression, PAI‐1 was predicted by waist circumference (R2= 0.331). Implications for practice Many otherwise healthy young adults have one or more components of the metabolic syndrome. Assessment and institution of preventative measures for obesity and the components of the metabolic syndrome should begin in childhood. Furthermore, determination of waist circumference especially in young women may aid the practitioner to identify those at risk for the metabolic syndrome earlier in their disease trajectory. Furthermore, insulin resistance is believed to occur initially in the trajectory of the metabolic syndrome, making it a principal contender for suitable interventions to reduce risk for both type 2 diabetes and cardiovascular disease (CVD). Homeostatic model assessment for insulin resistance was used to assess for insulin resistance among the euglycemic participants. Recording the presence of insulin resistance will aid the practitioner in determining if a low‐risk patient is in peril for development of type 2 diabetes and/or CVD. Early cardiovascular risk recognition is vital to clinical practice as it allows more time for the practitioner to counsel patients for the essential planning needed to make lifestyle changes.

show abstract

“…The ATP III definition, however, has been criticized for not including measurement of insulin resistance (i.e., elevated plasma insulin levels or acanthosis nigricans) 39-41,45,58,59. The ATP III definition relies heavily on an abnormal lipid profile to meet the criteria for metabolic syndrome (elevated triglycerides and low HDL-C) 40.…”

Section: Discussionmentioning

confidence: 99%

“…Most investigations of inflammation and fibrinolysis, however, have focused on American and/or European men and have studied women less often, particularly at middle age; further, these studies have not fully considered the impact of insulin resistance or race. In fact, using the ATP III definition17 alone for metabolic syndrome, especially among healthy younger to middle aged African-American women, often results in relatively low risk predictions 29,39-41. This is counterintuitive, since African-American women have some of the highest prevalence rates for many of the cardiometabolic risk factors and suffer from extreme morbidity and mortality in association with obesity, type 2 diabetes, hypertension and CVD.…”

Section: Introductionmentioning

confidence: 99%

Cardiometabolic Risk Among African American Women

Appel

Oster

Floyd

et al. 2009

Journal of Cardiovascular Nursing

Self Cite

View full text Add to dashboard Cite

Objective-To determine the associations of the Homeostatic Model of Assessment-insulin resistance (HOMA -ir ), acanthosis nigricans, high sensitivity C-reactive protein ( hs-CRP), and plasminogen activator inhibitor-1 (PAI-1) with two of the commonly used definitions of the metabolic syndrome (Adult Treatment Panel III {ATP III} and International Diabetes Federation {IDF}) among reproductive age healthy free living African-American women.Methods-A pilot study with a cross-sectional design examined 33 African-American women aged 20 to 46 (mean 31.24, +/-7.25), for the presence of metabolic syndrome determined by ATP III and IDF criteria, insulin resistance (HOMA -ir and/or acanthosis nigricans), degree of inflammation ( hs-CRP) and presence of dysfibrinolysis (PAI-1).Results-HOMA-ir identified insulin resistance in 27 (81.8%) of the women, whereas the presence of acanthosis nigricans indicated that 16 (48 %) of these women manifested insulin resistance. Metabolic syndrome was found in 7 women (21.2 %) by ATP III or 9 (27.3 %) by IDF criteria. Bivariate correlations showed associations between HOMA-ir and waist circumference, body mass index (BMI), acanthosis nigricans, the ATP III and IDF definitions for metabolic syndrome. PAI-1 was significantly correlated with waist circumference, BMI, fasting glucose, HOMA-ir , and ATP III. Both HOMA-ir and PAI-1 were significantly and negatively correlated with HDL-C. hs-CRP was significantly correlated with BMI and 2-hour post glucose.Conclusion-Both dysfibrinolysis (PAI-1 levels) and insulin resistance (HOMA-ir ) when individually regressed on the ATP III definition of metabolic syndrome explained 32 % and 29% of the respective variance. The addition of HOMA-ir measurement may significantly improve early recognition of cardiometabolic risk among reproductive age African-American women who have not yet met the criteria for the ATP III or IDF definitions of the metabolic syndrome. Likewise, acanthosis nigricans is potentially a clinically significant screening tool when used to determine early recognition of insulin resistance and/or cardiometabolic risk among this population.African-American women's risk for CVD is likely underestimated based on the sole use of ATP III criteria for diagnosis of metabolic syndrome. Clinicians should consider a broader definition of risk than that is contained within ATP III. Inclusion of biomarkers of inflammation and dysfibrinolysis along with measures of insulin resistance may add to early detection of NIH Public Access Recommendations from Healthy People 2010 1 emphasize the need to eradicate racial disparities in cardiovascular health. African-American women experience higher age adjusted prevalence rates for obesity, hypertension, coronary heart disease, stroke and type 2 diabetes than compared with any other group of U.S. women. 2-6 However, these disparities are not fully explained by conventional risk factors. Obesity and hyperinsulinemia have been strongly associated with an inflammatory state leading to release of substance...

show abstract

African American Women, Metabolic Syndrome, and National Cholesterol Education Program Criteria

Cited by 12 publications

References 21 publications

Usefulness of Apolipoprotein B/Apolipoprotein A-I Ratio to Predict Coronary Artery Disease Independent of the Metabolic Syndrome in African Americans

Usefulness of Apolipoprotein B/Apolipoprotein A-I Ratio to Predict Coronary Artery Disease Independent of the Metabolic Syndrome in African Americans

Central Obesity, the Metabolic Syndrome, and Plasminogen Activator Inhibitor‐1 in Young Adults

Cardiometabolic Risk Among African American Women

Contact Info

Product

Resources

About