Ligita Ryliškytė

Metabolic syndrome across Europe: Different clusters of risk factors

Background: Metabolic syndrome (MetS) remains a controversial entity. Specific clusters of MetS components – rather than MetS per se – are associated with accelerated arterial ageing and with cardiovascular (CV) events. To investigate whether the distribution of clusters of MetS components differed cross-culturally, we studied 34,821 subjects from 12 cohorts from 10 European countries and one cohort from the USA in the MARE (Metabolic syndrome and Arteries REsearch) Consortium. Methods: In accordance with the ATP III criteria, MetS was defined as an alteration three or more of the following five components: elevated glucose (G), fasting glucose ≥110 mg/dl; low HDL cholesterol, < 40mg/dl for men or <50 mg/dl for women; high triglycerides (T), ≥150 mg/dl; elevated blood pressure (B), ≥130/≥85 mmHg; abdominal obesity (W), waist circumference >102 cm for men or >88 cm for women. Results: MetS had a 24.3% prevalence (8468 subjects: 23.9% in men vs. 24.6% in women, p < 0.001) with an age-associated increase in its prevalence in all the cohorts. The age-adjusted prevalence of the clusters of MetS components previously associated with greater arterial and CV burden differed across countries (p < 0.0001) and in men and women (p < 0.0001). In details, the cluster TBW was observed in 12% of the subjects with MetS, but was far more common in the cohorts from the UK (32.3%), Sardinia in Italy (19.6%), and Germany (18.5%) and less prevalent in the cohorts from Sweden (1.2%), Spain (2.6%), and the USA (2.5%). The cluster GBW accounted for 12.7% of subjects with MetS with higher occurrence in Southern Europe (Italy, Spain, and Portugal: 31.4, 18.4, and 17.1% respectively) and in Belgium (20.4%), than in Northern Europe (Germany, Sweden, and Lithuania: 7.6, 9.4, and 9.6% respectively). Conclusions: The analysis of the distribution of MetS suggested that what follows under the common definition of MetS is not a unique entity rather a constellation of cluster of MetS components, likely selectively risky for CV disease, whose occurrence differs across countries.

The impact of systemic sclerosis on arterial wall stiffness parameters and endothelial function

Systemic sclerosis (SSc) is characterized by thickening and fibrosis of skin and internal organs that is associated with vascular damage. SSc may lead to arterial dysfunction and premature aging of the arteries. However, its relationship with parameters of arterial wall dysfunction has not been fully explored. To determine if carotid–radial pulse wave velocity (PWV), aortic augmentation index (AIx) and endothelial function are altered in SSc patients, 17 consecutive patients with SSc and 34 age- and gender-matched controls were included in our study. PWV and AIx were assessed non-invasively by applanation tonometry. The endothelium-dependent flow-mediated dilatation (FMD) test in a brachial artery was performed by the ultrasound system. The blood investigations included serum lipid profile, glucose, and high-sensitivity CRP (hsCRP) measurements. As compared to controls, SSc patients had significantly higher medians of the AIx (p = 0.002) and the PWV (p = 0.04) and the median of the FMD was significantly lower (p = 0.001). Stepwise linear regression including comorbid factors showed that SSc was a significant independent predictor of all arterial wall parameters measures. SSc patients have increased AIx and PWV and lower FMD as compared to control subjects. The relationship between SSc and measures of arterial wall parameters still remains unclear. Though replication of the results presented here is required, we conclude that SSc has a great impact on large and conduit arteries damage.

Lithuanian High Cardiovascular Risk (LitHiR) primary prevention programme - rationale and design

Lithuanian High Cardiovascular Risk (LitHiR) primary prevention programme - rationale and design Objectives: According to the latest WHO data, coronary heart disease deaths in Lithuania reached 38.3% of total deaths. Based on the unfavourable situation with cardiovascular morbidity and mortality in Lithuania the Lithuanian High Cardiovascular Risk (LitHiR) programme aimed at estimation and aggressive managing of cardiovascular risk factors. This paper describes the Lithuanian High Cardiovascular Risk programme protocol. Design and methods: In 2006 the Lithuanian High Cardiovascular Risk programme was started. LitHiR programme recruited men - at the age of 40-54 years and women - 50-64 years without overt cardiovascular disease. The two-level approach - primary health care institutions (PHCI) and specialized cardiovascular prevention units (CVPU) - was applied. The subjects selected were tested for cardiovascular risk and those with high cardiovascular risk were sent to secondary (CVPU) level, for other the plan of preventive measures of risk factor reduction was created. In years 2006-2010 overall 266,391 persons (36.9% from all target population) were examined. Among them 164,657 subjects (61.8%) were tested for the first time, 68,832 (25.8%) were tested repeatedly one time, 32,848 subjects (12.3%) were tested repeatedly for two and more times. Conclusions: The programme aimed at estimation and managing of cardiovascular risk factors striving to reduce acute cardiovascular event related morbidity and mortality, to slow down the progression of sub-clinical atherosclerosis into overt cardiovascular disease, to increase the number of newly identified cases of diabetes, metabolic syndrome and latent course of atherosclerosis related diseases, to decrease hospitalizations for treatment of arterial hypertension and coronary heart disease.

Predictive models for type 2 diabetes onset in middle-aged subjects with the metabolic syndrome

ObjectiveTo investigate the predictive value of different biomarkers for the incidence of type 2 diabetes mellitus (T2DM) in subjects with metabolic syndrome.MethodsA prospective study of 525 non-diabetic, middle-aged Lithuanian men and women with metabolic syndrome but without overt atherosclerotic diseases during a follow-up period of two to four years. We used logistic regression to develop predictive models for incident cases and to investigate the association between various markers and the onset of T2DM.ResultsFasting plasma glucose (FPG), body mass index (BMI), and glycosylated haemoglobin can be used to predict diabetes onset with a high level of accuracy and each was shown to have a cumulative predictive value. The estimated area under the receiver-operating characteristic curve (AUC) for this combination was 0.92. The oral glucose tolerance test (OGTT) did not show cumulative predictive value. Additionally, progression to diabetes was associated with high values of aortic pulse-wave velocity (aPWV).ConclusionT2DM onset in middle-aged metabolic syndrome subjects can be predicted with remarkable accuracy using the combination of FPG, BMI, and HbA1c, and is related to elevated aPWV measurements.

Association of cardio-ankle vascular index with cardiovascular risk factors and cardiovascular events in metabolic syndrome patients

OBJECTIVES We aimed to investigate the association between arterial stiffness assessed as cardio-ankle vascular index (CAVI) and cardiovascular (CV) risk factors and CV events in the middle-aged metabolic syndrome (MS) patients. MATERIALS AND METHODS A follow-up study was carried out in 2106 middle-aged (53.83±6.17 years old, 62% women) MS subjects without overt atherosclerotic disease. Patients were initially recruited in 2009-2011 as participants of the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program and followed up for 3.8±1.7 years for CV events. Thorough cardiometabolic risk assessment was carried out at inclusion. RESULTS Subjects with higher CAVI had worse lipid and glucose metabolism profile: elevated total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), decreased high-density lipoprotein cholesterol (HDL-C), higher fasting and oral glucose tolerance test (OGTT) glucose levels (all P<0.001), and lower fasting insulin (P=0.021). Greater age (P<0.001), heart rate (P=0.016), and mean arterial pressure (P<0.001) were also associated with higher CAVI. Over the follow-up period, 93 (4.4%) patients developed a cardiovascular event: 55 (2.6%) patients had myocardial infarction and 38 (1.8%) suffered a cerebrovascular event. Fatal CV events comprised 6.5% (n=6) of all CV events. CAVI was statistically significantly associated with occurrence of myocardial infarction (P=0.027) and total cardiovascular events (P=0.045), but not cerebrovascular events (P=0.65). However, this association was dependent on age and gender. CONCLUSIONS In the middle-aged MS patients, higher CAVI was associated with altered lipid and glucose metabolism, older age, greater heart rate and mean arterial pressure, and worse cardiovascular outcome.

Prevalence of cardiovascular risk factors in Lithuanian middle-aged subjects participating in the primary prevention program, analysis of the period 2009–2012

Abstract Background. The aim of this study was to assess the prevalence and changes of cardiovascular risk factors in the middle-aged Lithuanian subjects after conducting the primary prevention program. Design and methods. Four cross-sectional investigations of cardiovascular risk factors were conducted in 2009 (n = 9625), 2010 (n = 7716), 2011 (n = 5018) and 2012 (n = 4348). The program recruited men aged 40–54 and women aged 50–64 without overt cardiovascular disease. Results. During the period 2009–2012, the mean number of risk factors significantly increased (from 3.95 to 4.03, p < 0.001), while the numbers of people having metabolic syndrome (from 34.1% to 28.7%; p < 0.001), arterial hypertension (from 60.2% to 54.5%; p < 0.001), the average body mass index (BMI) value (from 29.17 to 28.92 kg/m2; p = 0.001) and abdominal obesity (from 48.4% to 45.3%; p < 0.001) significantly decreased. The percentage of subjects with dyslipidemia, as well as the average values of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides, remained unchanged. The percentage of smoking subjects have significantly increased (from 19.3% to 22.7%; p < 0.001). Conclusions. The analysis showed that the prevalence of arterial hypertension, metabolic syndrome and obesity in Lithuania is slowly decreasing while conducting the primary prevention program; however, dyslipidemia, diabetes mellitus and smoking are still hard to manage for both genders.

Aortic stiffness is an independent determinant of left ventricular diastolic dysfunction in metabolic syndrome patients.

Abstract Background: We aimed to evaluate the relationship between arterial stiffness and left ventricular diastolic dysfunction (LVDD) in metabolic syndrome (MetS) patients. Methods: A cross-sectional study was conducted in 1208 subjects without overt atherosclerotic disease. According to the cardiac ultrasound, patients were divided into two groups: with LVDD (LVDD+, n = 1119) and without LVDD (LVDD–, n = 89). Arterial stiffness parameters [carotid–femoral pulse wave velocity (cfPWV) and aortic augmentation index (AIxHR75)] were assessed by applanation tonometry. Results: In comparison to LVDD–, LVDD + patients were older (55 ± 6 vs 51 ± 6 years, p < 0.001), and had higher cfPWV (8.8 ± 1.6 vs 7.9 ± 1.34 m/s, p < 0.001), AIxHR75 (24.7 ± 10.2 vs 19.7 ± 10, p < 0.001), mean arterial pressure (108 ± 12 vs 101 ± 10 mmHg, p < 0.001), heart rate (66 ± 10 vs 61 ± 9 bpm, p < 0.001), left ventricular mass index (LVMI) (109 ± 24 vs 97 ± 22, p < 0.001) and body mass index (BMI) (32 ± 5 vs 30 ± 4 kg/m2, p < 0.001). We found significant correlations between cfPWV, AIxHR75 and the ratio of early to late transmitral velocities (E/A) (rcfPWV = –0.19, rAIxHR75 = –0.15, p < 0.001), early diastolic mitral annular velocity (E′) (rcfPWV = –0.25, rAIxHR75 = –0.18, p < 0.05) and E/E′ ratio (rcfPWV = 0.17, rAIxHR75 = 0.14, p < 0.001). Univariate analysis revealed that the presence of LVDD is associated with age [odds ratio (OR) 1.84], BMI (OR 1.63), waist circumference (WC) (OR 1.52), cfPWV (OR 2.18), AIxHR75 (OR 1.55), mean aortic blood pressure (OR 1.94), aortic pulse pressure (OR 1.78), mean common carotid artery intima–media thickness (OR 1.16), heart rate (OR 1.4) and LVMI (OR 1.79) (all p < 0.05). After performing stepwise multiple logistic regression analysis, only cfPWV and BMI or WC remained significant predictors of the presence of LVDD (p < 0.05). Conclusion: cfPWV is a significant determinant of LVDD in subjects with MetS.

Prevalence of high-risk profile in middle-aged subjects with arterial hypertension: A nationwide survey

Abstract Hypertension is the most common non-communicable disease and the leading cause of cardiovascular disease in the world. It presents an important public health challenge in both economically developed and developing countries. In 2006, the Lithuanian High Cardiovascular Risk programme was launched. The programme recruited men aged 40–54 and women aged 50–64 without overt cardiovascular disease. We analysed a group of 23,204 subjects included in the programme at the primary level. Arterial hypertension was present in 57.6% of the subjects: 63.2% in the females and 49.2% in the males. In the hypertensive middle-aged subjects, grade 1 hypertension was present in 53.1%, grade 2 in 22.4%, and grade 3 in merely 5.9% of the subjects. The prevalence of a minimum of three concomitant risk factors among the hypertensive patients was 78.0%, compared with 52.1% in the patients without hypertension (p < 0.001). Blood pressure goals were attained in 20.8% of the hypertensive women and in 14.4% of the hypertensive men. In Lithuania, a high prevalence of hypertension was characteristic of middle-aged subjects. Although the blood pressure elevation had not reached high levels, the presence of at least three risk factors concomitant to hypertension was more expressed in them compared with the non-hypertensive subjects.

Positive impact of a 4-week duration supervised aerobic training on anthropometric, metabolic, hemodynamic and arterial wall parameters in metabolic syndrome subjects

Summary Objectives: Metabolic syndrome (MetS) is linked to the development of type 2 diabetes and increased risk of cardiovascular disease (CVD). Physical inactivity is one of the main pathophysiological factors of MetS subjects. The aim of this study was to evaluate if 4-week supervised aerobic training had any impact on anthropometric, metabolic, hemodynamic and arterial wall parameters in MetS subjects. Design and methods: 57 MetS subjects were randomly selected from a Lithuanian High Cardiovascular Risk (LitHiR) national primary prevention programme. Hemodynamic, cardiometabolic risk and arterial wall parameters were evaluated after the 4-week supervised aerobic training. Results: After 4 weeks of aerobic training there was statistically significant decrease in body mass index from 30.58 ± 3.7 to 30.3 ± 3.55 kg/m2 (p = 0.010), waist circumference from 104.24 ± 9.46 to 102.9 ± 9.48 cm (p = 0.003), decrease of LDL cholesterol from 4.21 ± 1.15 to 3.78 ± 1 mmol/l (p = 0.032) and high sensitivity C-reactive protein from 2.01 ± 2.36 to 1.64 ± 1.92 mg/l (p = 0.009), decrease of diastolic blood pressure (BP) from 83.06 ± 10.18 to 80.38 ± 8.98 mmHg (p = 0.015), mean BP from 100.03 ± 10.70 to 97.31 ± 8.88 mmHg (p = 0.027) and aortic stiffness, assessed as carotid-femoral pulse wave velocity, from 8.34 ± 1.26 to 7.91 ± 1.15 m/s (p = 0.034). Conclusions: In subjects with MetS even short-duration (4-week) supervised aerobic exercise training is associated with improvement of some anthropometric, metabolic and hemodynamic parameters as well as the decrease in aortic stiffness. This training modality could be recommended for initiation of physical training and could increase motivation for further physical activity.

Diagnostic value of electrocardiogram stress testing in patients with metabolic syndrome

Summary Objectives:The aim of this study was to assess the diagnostic value of exercise stress testing to detect coronary heart disease (CHD) in the group of patients with metabolic syndrome. Design and methods: 2803 patients without prior diagnosis of CHD and identified metabolic syndrome were investigated. Subjects underwent electrocardiogram (ECG) stress testing and, depending on the results, coronary angiography and/or coronary computed tomography angiography to detect hemodynamically significant stenosis. CHD was confirmed, if lumen narrowing ≥ 50% of coronary arteries was found. Results: Exercise stress testing was interpreted as positive in 12% patients (71.7% women and 28.3% men). CHD was diagnosed in 45 patients (1.6%), 23 of them had positive exercise stress testing. ECG stress testing was more frequently positive in patients, who had typical/atypical anginal chest pain, dyspnea and/or non-anginal chest pain, in comparison to asymptomatic patients (16.6% vs 8.9%, p <0.001). CHD was more often diagnosed in symptomatic patients compared to patients with no symptoms (6.1% vs 0.7%, p < 0.001, women 5.3% vs 0.6%, p < 0.001, men respectively 8% vs 0.8%, p < 0.001). Conclusions: Diagnostic value of exercise stress testing for detecting CHD is limited in population with metabolic syndrome. CHD was more prevalent in patients with chest pain or dyspnea than in asymptomatic patients.