Clinical Briefs
Clinical Briefs
The Metabolic Syndrome and Total and Cardiovascular Disease Mortality in Middle-Aged Men
The metabolic syndrome (MBS) has 2 currently popular definitions. According to the National Cholesterol Education Program, MBS exists when a patient has at least 3 of the following characteristics: fasting glucose (FPG) > 110 mg/dL, abdominal obesity, triglycerides > 150, HDL < 40 mg/dL, and elevated blood pressure (> 130/85). The World Health Organization (WHO) definition stratifies things just a bit differently, defining MBS as either hyperinsulinemia (upper quartile of the adult, nondiabetic population) or FPG, and any 2 or more of abdominal obesity, dyslipidemia (triglycerides > 150 mg/dL or HDL < 35), and BP > 140/90. Despite these modest differences, the criteria basically define the same group of individuals. Lakka and associates prospectively studied for a mean of 11.6 years a random, age-stratified sample of men in Finland (n = 2682) aged 42 and older, to examine cardiovascular and overall mortality in relation to MBS.
MBS patients had reduced (79%) Kaplan-Meier estimates of overall survival when compared with patients without MBS. Similarly, CHD mortality was 2.4-3.4 times higher in persons with MBS. The prevalence of MBS at baseline was 9-14%. The public health impact of MBS is substantial. Whether specific treatment of MBS will reduce mortality has not been determined.
Lakka HM, et al. JAMA. 2002;288: 2709-2716.
Effects of Amlodipine Fosinopril Combination on Microalbuminuria in Hypertensive Type 2 Diabetic Patients
Numerous studies have confirmed the role of ACE inhibitors in modulation of microalbuminuria. The data on effects of calcium channel blockers (CCB) have been conflicting, especially as concerns dihydropyridine CCB (eg, amlodipine, felodipine, nifedipine). Fogari and associates addressed the effects of fosinopril (FOS) and amlodipine (AML), alone or in combination (COM), in an open-labeled, randomized, prospective, parallel group study for 4 years (n = 309).
By 3 months’ time, the FOS group had demonstrated a decline in urinary albumin excretion (UAE), which decreased slightly further in the first year, and then stabilized. The AML group also demonstrated a decline in UAE, but not until 18 months into the study, after which point the UAE stabilized. COM therapy produced an impact at 3 months, which increased at 12 months and again at 36 months, and was statistically significantly greater than either monotherapy.
The mechanism by which COM therapy is superior to either monotherapy is uncertain, but the greater reduction in BP achieved (approximately 12/5 greater reduction by the former) is thought to have figured prominently.
Fogari R, et al. Am J Hypertens. 2002;15:1042-1049.
Relation Between Alcohol Consumption and C-Reactive Protein Levels in the Adult United States Population
Epidemiologic data consistently indicate that moderate intake of alcohol (ETOH) is associated with reductions in cardiovascular mortality. Though the mechanism by which this effect is achieved is uncertain, increases in HDL by alcohol may explain as much as 50% of the protective effect.
C-reactive protein (CRP) is increasingly recognized as an independent risk factor for cardiovascular endpoints, suggesting an important role of inflammation in promoting atherosclerotic events. To evaluate the relationship between CRP and ETOH, Mainous and associates analyzed data from the National Health and Nutrition Evaluation Survey (NHANES III), which included complete information on 11,572 US adults.
Almost half of the NHANES population were alcohol abstainers; CRP levels in abstainers were significantly greater than in those who drink alcohol, regardless of level of alcohol ingestion. The mechanism by which ETOH might reduce CRP (or inflammation) remains unknown. A small trial of ETOH in healthy volunteers has shown a reduction in CRP and is stimulus for follow-up evaluation in larger studies.
Stewart SH, et al. J Am Board Fam Pract. 2002;15:437-442.
The Metabolic Syndrome and Total and Cardiovascular Disease Mortality in Middle-Aged Men; Effects of Amlodipine Fosinopril Combination on Microalbuminuria in Hypertensive Type 2 Diabetic Patients; Relation Between Alcohol Consumption and C-Reactive Protein Levels in the Adult United States Population
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