Metabolic syndrome in Bantu subjects with type 2 diabetes from sub-Saharan extraction

Dehout, Florence; Haumont, Sophie; Gaham, N.; Amoussou-Guenou, K. Daniel; Hermans, Michel P.

doi:10.1016/j.dsx.2007.11.008

Cited by 27 publications

(18 citation statements)

References 31 publications

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“…n A co-occurrence criterion may underestimate the magnitude of atherogenic dyslipidemia in groups with spontaneously low TG (e.g., African-Americans and sub-Saharan Africans) or with elevated TG levels prior to LLD or i nsulin therapy [81][82][83][84].…”

Section: Box 1 Major Determinants Of Vldl Assembly and Secretion Anmentioning

confidence: 99%

Reducing residual vascular risk in patients with atherogenic dyslipidemia: where do we go from here?

Hermans¹,

Fruchart²

2010

Clinical Lipidology

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Section: Box 1 Major Determinants Of Vldl Assembly and Secretion Anmentioning

confidence: 99%

Reducing residual vascular risk in patients with atherogenic dyslipidemia: where do we go from here?

Hermans¹,

Fruchart²

2010

Clinical Lipidology

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“…Indeed, many studies suggest that HIV itself is an inflammatory and insulin-resistant state which can precipitate overt diabetes mellitus,40 although there has been a case report of a 52-year-old African man whose type 2 diabetes resolved when viral replication was suppressed with protease inhibitor-based ART 41. Advanced HIV disease may be associated with an increase in counter-regulatory hormones whereby excess free fatty acids in the circulation reduce insulin sensitivity, hypercortisolism with further stress response as HIV disease progresses,42 growth hormone,43 high tumor necrosis factor alpha levels,44 interleukin-6,45 and HIV protein Vpr acting as a glucocorticoid agonist 46…”

Section: Discussionmentioning

confidence: 99%

Nadir CD4+, religion, antiretroviral therapy, incidence of type 2 diabetes mellitus, and increasing rates of obesity among black Africans with HIV disease

Ndona

Longo-Mbenza²,

Wumba³

et al. 2012

IJGM

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Background:The purpose of this study was to determine the cross-sectional association between some sociodemographic factors and antiretroviral therapy (ART), as well as the incidence and predictors of type 2 diabetes mellitus among Central Africans with human immunodeficiency virus (HIV) disease.Methods:This study had a cross-sectional design and was a prospective analysis of 102 patients with HIV disease (49 on ART versus 53 not on ART) in Kinshasa, Democratic Republic of Congo, between 2004 and 2008. A Cox regression model was used to assess for any relationship between type 2 diabetes and exposure to combination ART without protease inhibitors, after adjusting for known risk factors for type 2 diabetes, nadir CD4 and CD8 levels, viral load, marital status, and religion.Results:Unexpectedly elevated rates of smoking, excess alcohol intake, and ART-related total, abdominal, and peripheral obesity were observed in our study group of HIV patients. At the end of follow-up, five patients were diagnosed with type 2 diabetes (incidence rate 4.9%, 9.8 per 1000 person-years). Univariate risk factors for type 2 diabetes were male gender (relative risk [RR] 1.1, 95% confidence interval [CI] 1.01–1.4; P = 0.019), traditional religion versus new charismatic religion (RR 1.1, 95% CI 1.01–1.3; P = 0.046), exposure to ART (RR 1.1, 95% CI 1.002–1.3; P = 0.034), and single status (RR 6.2, 95% CI 1.5–15; P = 0.047). In multivariate analysis, strong significant independent predictors of type 2 diabetes were belonging to a traditional religion (HR 2.1, 95% CI 1.1–4.2; P = 0.036) and a relative increase in nadir CD4 cell count (beta coefficient 0.003; P < 0.0001).Conclusion:ART-related obesity and type 2 diabetes are becoming increasing problems in Central Africans with HIV disease. A relative increase in nadir CD4 count and traditional religion status appear to be the strongest independent predictors of type 2 diabetes.

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“…One approach is to define AD as the combined occurrence of high TG levels and low HDL-C. This is not performed routinely for the following reasons: a lack of consensual cutoff values across gender, ethnicities and underlying conditions; a requirement for baseline lipid values prior to any LLD, and/or prior to insulin administration in T2DM; a sine qua non association criterion does not capture imbalances in respective contributions between these non-LDL lipid abnormalities; and a coincident criterion may underestimate the magnitude of AD in groups with spontaneously low TG, or with elevated TG levels prior to TG-lowering or insulin therapies [ACCORD Study Group et al 2010a;Fruchart et al 2010;Hermans and Fruchart, 2010;Dehout et al 2008;Sumner et al 2005].…”

Section: Non-ldls and Non-ldl Dyslipidaemiamentioning

confidence: 99%

“…a decrease in the level of TG above which LDL-C calculation is deemed imprecise or clinically discordant with estimated LDL-C; 2. for atherogenic ratios, providing doctors with the non-HDL-C/HDL-C ratio instead of or in addition to the total cholesterol/HDL-C ratio, because the former provides a costless surrogate, albeit as effective as the apoB/ apoA-I ratio, as recently reported in patients with diabetes [Hermans et al 2007]; 3. the establishment of ethnic-specific cutoffs for defining the presence of AD, including values for patients of Afro-American descent or from sub-Saharan Africa [Dehout et al 2008;Sumner et al 2005]; 4. the provision of the log(TG)/HDL-C ratio to better characterize non-LDL dyslipidaemia and AD, AD as a continuous rather than a dichotomic variable [Bittner et al 2009;da Luz et al 2008;Kannel et al 2008;Dobiásová and Frohlich, 2001]. …”

Section: Laboratory Assessmentmentioning

confidence: 99%

Reducing vascular events risk in patients with dyslipidaemia: an update for clinicians

Hermans¹,

Fruchart²

2011

Therapeutic Advances in Chronic Disease

Self Cite

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Reducing the risk of vascular events in patients with dyslipidaemia requires cardiovascular disease risk stratification and lifestyle/pharmacological intervention on modifiable risk factors. Reduction of low-density lipoprotein cholesterol (LDL-C) with statins is highly effective in reducing cardiovascular disease in patients with and without diabetes, but leaves unaddressed a sizeable residual vascular risk (RvR), which is rarely quantified in routine clinical practice. Such RvR may relate to lack of strict target attainment for all atherogenic variables [LDL-C, non-high-density lipoprotein cholesterol (HDL-C) and/or apolipoprotein B 100 ]. Another substantial lipid-related and modifiable RvR component is related to atherogenic dyslipidaemia, especially as global rates of obesity, type 2 diabetes and metabolic syndrome are increasing. Atherogenic dyslipidaemia is associated with insulin-stimulated verylow-density lipoprotein overproduction and reduced reverse cholesterol transport. The hallmark of atherogenic dyslipidaemia is the coexistence of low HDL-C and elevated triglycerides. Therapeutic lifestyle changes and combination lipid-lowering therapy with drugs targeting atherogenic dyslipidaemia (such as fibrates or innovative drugs targeting atherogenic dyslipidaemia and/or apolipoprotein B 100 metabolism) on top of background statins, have a potential to reduce RvR in high-risk groups, as shown in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, in which combination therapy with simvastatin plus fenofibrate decreased macrovascular risk in patients with diabetes and atherogenic dyslipidaemia, and retinopathy risk irrespective of baseline lipids.

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Metabolic syndrome in Bantu subjects with type 2 diabetes from sub-Saharan extraction

Cited by 27 publications

References 31 publications

Reducing residual vascular risk in patients with atherogenic dyslipidemia: where do we go from here?

Reducing residual vascular risk in patients with atherogenic dyslipidemia: where do we go from here?

Nadir CD4+, religion, antiretroviral therapy, incidence of type 2 diabetes mellitus, and increasing rates of obesity among black Africans with HIV disease

Reducing vascular events risk in patients with dyslipidaemia: an update for clinicians

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