Cardiometabolic determinants of mortality in a geriatric population: Is there a “reverse metabolic syndrome”?

Vischer, Ulrich M.; Safar, Michel E.; Safar, Hélène; Iaria, P.; Dudal, K. Le; Henry, Olivier; Herrmann, Françoís; Ducimetière, Pierre; Blacher, Jacques

doi:10.1016/j.diabet.2008.08.006

Cited by 85 publications

(53 citation statements)

References 34 publications

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“…In older persons, a so-called 'reverse metabolic syndrome' is present where low BMI, low diastolic blood pressure, and low TC predict mortality. However, a low HDL remains a risk factor for mortality even in older persons (34), especially for cardiovascular mortality (35). Sattar et al (36) found that the presence of metabolic syndrome in older persons is associated with type 2 diabetes but not with cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

Thyroid function and the metabolic syndrome in older persons: a population-based study

Heima

Eekhoff

Oosterwerff

et al. 2013

European Journal of Endocrinology

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Background: Studies suggest an association between a high TSH and (individual components of) the metabolic syndrome. Only a few studies have been performed in the general older population. Objective: This study investigates the association between serum TSH and the metabolic syndrome in a representative sample of older persons in The Netherlands. Design and patients: Data of the Longitudinal Aging Study Amsterdam were used, which is an ongoing cohort study in a representative sample of Dutch older persons. A total of 1187 subjects (590 men and 597 women) between the ages of 65 and 88 years participated in the study. Measurements: Metabolic syndrome (US National Cholesterol Education Program definition) and its individual components were assessed, as well as serum TSH levels. Results: Among the participants, the prevalence of the metabolic syndrome was 34.2%. The mean serum TSH was 1.9 mU/l. Subjects in the upper quartile with a serum TSH level above 2.28 mU/l (odds ratio (OR)Z1.68; 95% confidence interval (CI) 1.19-2.37) had a significantly increased prevalence of metabolic syndrome compared with subjects in the lowest quartile with a serum TSH below 1.04 mU/l. After adjustment for confounders, age, sex, alcohol use, total physical activity, and smoking, the OR was 1.62 (95% CI 1.15-2.32). Conclusions: Subjects with a serum TSH in the upper quartile have a higher prevalence of metabolic syndrome as compared with subjects with a serum TSH in the lowest quartile.

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Section: Discussionmentioning

confidence: 99%

Thyroid function and the metabolic syndrome in older persons: a population-based study

Heima

Eekhoff

Oosterwerff

et al. 2013

European Journal of Endocrinology

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“…The PROTEGER Study has been described in detail elsewhere; [17][18][19] briefly, the study cohort was then composed of 331 subjects (86 men and 245 women) with mean age ( ± s.d.) of 85 ± 7 years.…”

Section: Study Cohortmentioning

confidence: 99%

Aortic stiffness, inflammation, denutrition and prognosis in the oldest people

et al. 2011

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Observational studies have shown that some of the classic CV risk factors, namely hypertension or hypercholesterolemia, become nebulous, or even act in the reverse direction, in the oldest people. We investigated whether in the elderly, increased aortic stiffness was associated with higher mortality risk, before and after adjustments on common geriatric confounders. In a cohort of 331 (86 men) subjects aged 470 years (mean age ( ± s.d.): 85 ± 7 years), aortic stiffness was assessed by carotid-femoral pulse wave velocity (PWV). Classical CV risk factors were determined simultaneously, in association with inflammation and denutrition parameters. One hundred and ten subjects died during a 2-year follow-up period. In crude analysis, a positive non-significant trend was observed between PWV and mortality risk. Multivariate Cox regression analysis showed that five parameters entered the prediction model: two were positively related to mortality risk, PWV (P ¼ 0.008) and orosomucoide (P ¼ 0.045), and three were related negatively, total cholesterol (P ¼ 0.006), albumin (P ¼ 0.026) and body weight (P ¼ 0.035). Interaction analysis revealed that the effect of PWV on mortality was increased in the presence of renal dysfunction and increased inflammation. In conclusion, although marginally significant in crude analysis, PWV is a powerful determinant of prognosis in the oldest people taking into account inflammation and denutrition.

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“…1 Diabetes and/or insulin resistance, overweightness, arterial hypertension, cigarette smoking, and dyslipidemia are the most established risk factors for cardiovascular disease; nonetheless, malnutrition and/or chronic disorders along with low BMI, low diastolic blood pressure (BP), low total and HDL cholesterol, and high insulin sensitivity can predict cardiovascular mortality. 2,3 Hypoalbuminemia is associated with chronic renal and vascular disease, even dissociating this effect from protein malnutrition; it is a composite marker that reflects malnutrition as well as increased acute-phase inflammation, that is, it is also a negative acute-phase reactant. 4 Traditional risk factors for hypertension 5 may have less importance in drug-treated hypertensive patients in comparison with untreated hypertensive patients, 6 and there are reasons for investigating different lifestyle and nutritional aspects.…”

Section: Introductionmentioning

confidence: 99%

Coffee, nutritional status, and renal artery resistive index

et al. 2010

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Background: The relationship between nutrition and atherosclerosis is known, even dissociated from protein malnutrition. Cardiovascular impact of several nutrients is known; among them the action of coffee is still debated and cardiovascular effect of caffeine has been investigated without definite results. Objective: The aim of this study is to investigate whether coffee habits, and/or quantity of coffee consumption, have any relationship with renal resistive index (RRI), a hallmark of arterial stiffness (AS). The relationship of AS with nutritional status assessed by body composition and serum albumin, insulin resistance (assessed by HOMA), and renal function assessed by glomerular filtration rate (GFR) is concurrently investigated. Methods: This study was done with 221 consecutive patients, without diabetes, cancer, liver, renal, and heart disease, referred for clinical noninvasive assessment and nutritional counseling: 124 essential hypertensive and 97 nonhypertensive patients were eligible. Personalized Mediterranean diet, physical activity increase, and smoking withdrawal counseling were provided. Results: By multiple linear regression, fat-free mass (FFM), HOMA (positive relationship), and number of cups of coffee/day (negative relationship) account for 17.2% of the variance to RRI. By odds ratios lower risk to increased RRI is associated with higher serum albumin, higher hemoglobin, and FFM; greater risk is associated with hypertension, insulin resistance (HOMA ≥ 3.0), and renal insufficiency (GFR ≤ 90); coffee, assessed by number of cups/day, reduces risk. Conclusion: Coffee use is inversely associated with RRI. Habitual coffee users have risk protection to higher RRI; lower serum albumin, insulin resistance, and renal insufficiency are associated with greater RRI.

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Cardiometabolic determinants of mortality in a geriatric population: Is there a “reverse metabolic syndrome”?

Cited by 85 publications

References 34 publications

Thyroid function and the metabolic syndrome in older persons: a population-based study

Thyroid function and the metabolic syndrome in older persons: a population-based study

Aortic stiffness, inflammation, denutrition and prognosis in the oldest people

Coffee, nutritional status, and renal artery resistive index

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