Impact of the metabolic syndrome on the predictive values of new risk markers in the general population

Abstract

Although the metabolic syndrome (MetS) is positively associated with high-sensitivity C-reactive protein (hsCRP), negatively associated with N-terminal probrain natriuretic peptide (Nt-proBNP) and inconsequently related to urine albumin/creatinine ratio (UACR) they are all associated with cardiovascular events. Therefore, we wanted to determine the influence of MetS on the predictive values of UACR, hsCRP and Nt-proBNP. On the basis of the definition of MetS by the International Diabetes Federation, a Danish population sample of 1983 apparently healthy subjects was divided into three groups: 530 subjects without any elements of MetS, 1093 subjects with some elements of MetS and 360 subjects with MetS. During the following 9.5 years the composite end point of cardiovascular death, nonfatal myocardial infarction or stroke (composite cardiovascular end point, CEP) occurred in 204 subjects. In Cox-regression analyses adjusting for age, gender and smoking, all three cardiovascular risk markers predicted CEP independently of MetS. Despite no significant interaction with MetS, high log(hsCRP) was associated with CEP primarily in subjects without any elements of MetS (hazard ratio (HR) ¼ 4.5 (1.5-14.0), Po0.01), log(NtproBNP) primarily in subjects with some elements of MetS (HR ¼ 3.0 (1.6-5.6), Po0.01), and logUACR independently of elements of MetS. Pre-specified genderadjusted (men/women) cutoff values of hsCRPX6.0/ 7.3 mg l À1 predicted CEP in subjects without elements of MetS with positive and predictive values of 11.5 and 98%, respectively. UACRX0.73/1.06 mg mmol À1 predicted CEP in subjects with MetS with positive and predictive values of 23.5 and 93%, respectively. In apparently healthy subjects, high hsCRP was associated with CEP primarily in subjects without MetS, high Nt-proBNP in subjects with elements of MetS and UACR independently of MetS.

Failed Recovery of Glycemic Control and Myofibrillar Protein Synthesis With 2 wk of Physical Inactivity in Overweight, Prediabetic Older Adults

“…The detrimental impact of an abrupt period of physical inactivity on glycemic control and integrated rates of MPS was associated with elevated concentrations of inflammatory markers. Our study represents a relevant clinical observation showing that prediabetic older persons are susceptible to inactivityinduced worsening of an insulin-resistant phenotype, as is observed in healthy older and younger persons (14)(15)(16)(17). Uniquely, we show that the reversal of this phenotype, which occurs in younger adults (14), is impaired on return to normal activity in our population.…”

“…For instance, hospitalized elderly individuals take only ~650-1,000 steps•d −1 (12) as do older persons convalescing from illness or surgery (13). Studies have shown that such periods of acute inactivity result in the onset of insulin resistance in younger adults (14)(15)(16)(17) but that younger persons recover with a return to daily ambulation (14). To our knowledge, only two studies (18,19) have examined how physical inactivity (daily step reduction [SR]) mimicking hospitalization (12), affects muscle metabolic function in older adults.…”

Omega-3 index and prognosis in acute coronary chest pain patients with a low dietary intake of omega-3

“…Nonetheless, based on previous studies (18,19,76) addressing hsCRP, this biomarker has been considered for adoption into risk assessment algorithms (77). Recently conducted studies have, however, shown that the predictivity of hsCRP is attenuated when tested in a multivariable model in the general population (78), and together with natriuretic peptides in patients with known CAD (79)(80)(81)(82). In our study, hsCRP appears to be a potential predictor for all-cause mortality, also when adjusted for BNP, but does not reflect cardiac strength of our study is the absence of patients lost to follow-up; in fact, there were only four patients with no measurements available for hsCRP.…”