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RESUMEN Introducción: la preeclampsia (PE) es la principal causa de morbimortalidad materno-fetal en nuestro país. Alteraciones hemodinámicas precoces durante el embarazo podrían predecir la evolución a PE. El machine learning (ML) permite el hallazgo de patrones ocultos que podrían detectar precozmente el desarrollo de PE. Objetivos: desarrollar un árbol de clasificación con variables de hemodinamia no invasiva para predecir precozmente desarrollo de PE. Material y métodos: estudio observacional prospectivo con embarazadas de alto riesgo (n=1155) derivadas del servicio de Obstetricia desde enero 2016 a octubre 2022 para el muestreo de entrenamiento por ML con árbol de clasificación j48. Se seleccionaron 112 embarazadas entre semanas 10 a 16, sin tratamiento farmacológico y que completaron el seguimiento con el término de su embarazo con evento final combinado (PE): preeclampsia, eclampsia y síndrome HELLP. Se evaluaron simultáneamente con cardiografía de impedancia y velocidad de onda del pulso y con monitoreo ambulatorio de presión arterial de 24 hs (MAPA). Resultados: presentaron PE 17 pacientes (15,18%). Se generó un árbol de clasificación predictivo con las siguientes variables: índice de complacencia arterial (ICA), índice cardíaco (IC), índice de trabajo sistólico (ITS), cociente de tiempos eyectivos (CTE), índice de Heather (IH). Se clasificaron correctamente el 93,75%; coeficiente Kappa 0,70, valor predictivo positivo (VPP) 0,94 y negativo (VPN) 0,35. Precisión 0,94, área bajo la curva ROC 0,93. Conclusión: las variables ICA, IC, ITS, CTE e IH predijeron en nuestra muestra el desarrollo de PE con excelente discriminación y precisión, de forma precoz, no invasiva, segura y con bajo costo.
ABSTRACT Background: Preeclampsia (PE) is the main cause of maternal-fetal morbidity and mortality in our country. Early hemodynamic changes during pregnancy could predict progression to PE. Machine learning (ML) enables the discovery of hidden patterns that could early detect PE development. Objectives: The aim of this study was to build a classification tree with non-invasive hemodynamic variables for the early prediction of PE occurrence. Results: Seventeen patients (15.18%) presented PE. A predictive classification tree was generated with arterial compliance index (ACI), cardiac index (CI), cardiac work index (CWI), ejective time ratio (ETR), and Heather index (HI). A total of 93.75% patients were correctly classified (Kappa 0.70, positive predictive value 0.94 and negative predictive value 0.35; accuracy 0.94, and area under the ROC curve 0.93). Conclusion: ACI, CI, CWI, ETR and HI variables predicted the early development of PE in our sample with excellent discrimination and accuracy, non-invasively, safely and at low cost.
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To analyze the relationship between the level of BP achieved with treatment and the risk for development of preeclampsia/eclampsia (PE), we conducted a historical cohort study on 149 consecutive pregnant women with treated chronic hypertension, evaluated between January 1, 2016, and November 31, 2022. According to office BP readings and ambulatory blood pressure monitoring (ABPM) performed after 20 weeks of gestation, the cohort was classified in controlled hypertension, white-coat uncontrolled hypertension, masked uncontrolled hypertension and sustained hypertension. Risks for the development of PE were estimated using logistic regression. One hundred and twenty-four pregnant women with a control BP evaluation were included in this analysis. The rates of PE were 19.4%, 27.3%, 44.8% and 47.1% for controlled, white-coat uncontrolled, masked uncontrolled and sustained uncontrolled hypertension, respectively. Compared with women with controlled hypertension, the relative risk for PE increased markedly in women with sustained uncontrolled (OR 3.69, 95% CI, 1.19-11.45) and masked uncontrolled (OR 3.38, 95% CI, 1.30-11.45) hypertension, but not in those with white-coat uncontrolled (OR 1.56 95% CI, 0.36-6.70); adjustment for covariates did not modify the results. Each mmHg higher of systolic and diastolic daytime ABPM increased the relative risk for PE ~4% and ~5%, respectively. Each mmHg higher of systolic and diastolic nocturnal BP increased the risk ~5% and ~6%, respectively. When these risks were adjusted for ABPM values in opposite periods of the day, only nocturnal ABPM remained as a significant predictor. In conclusion, masked uncontrolled hypertension implies a substantial risk for the development of PE, comparable to those of sustained uncontrolled. The presence of nocturnal hypertension seems important.
Assuntos
Eclampsia , Hipertensão , Hipertensão Mascarada , Pré-Eclâmpsia , Hipertensão do Jaleco Branco , Humanos , Feminino , Gravidez , Pressão Sanguínea/fisiologia , Pré-Eclâmpsia/epidemiologia , Monitorização Ambulatorial da Pressão Arterial , Gestantes , Estudos de Coortes , Hipertensão do Jaleco Branco/complicações , Hipertensão Mascarada/epidemiologiaRESUMO
We previously showed that masked hypertension is a frequent finding in high-risk pregnancies and a strong predictor of preeclampsia/eclampsia. However, neonatal consequences of masked hypertension have not been deeply analyzed. Consequently, the aim of this study was to determine if masked hypertension is a risk factor for poor neonatal outcome. We evaluated a cohort of 588 high-risk pregnant women (29 ± 7 years old with 27 ± 6 weeks of gestation at blood pressure evaluation); 22.1%, 8.5%, 2.9%, and 2.6% had history of hypertension, diabetes, collagen diseases and chronic renal disease, respectively. According to the data of office and ambulatory blood pressures monitoring, women was classified as normotension (61.7%), white-coat hypertension (5.4%), masked hypertension (21.6%) and sustained hypertension (11.2%) respectively. Compared to normotension, all neonatal outcomes were worst in women with masked hypertension; neonates had lower mean birth weight (2577 (842) vs. 3079 (688) g, P < 0.001), higher prevalence of very low (12.1% vs 2.0%, P = .002) and extremely low birth weight (4.3% vs 0%, P < 0.001), and low one-minute APGAR score (7.8% vs 1.8%, P < 0.001). Furthermore, 14.2% needed admission to neonatal intensive care unit (NICE) (P = 0.001). Compared with normotension the risk for poor the combined neonatal outcome (admission to NICE plus still born) was significantly higher in masked hypertension (adjusted OR 2.58 95% CI 1.23-5.40) but not in white-coat hypertension (adjusted OR 0.41 95% CI 0.05-3.12). In conclusion, in high-risk pregnancies, masked hypertension was a strong and independent predictor for poor neonatal outcomes.
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Hipertensão , Hipertensão Mascarada , Hipertensão do Jaleco Branco , Recém-Nascido , Humanos , Feminino , Gravidez , Adulto Jovem , Adulto , Hipertensão do Jaleco Branco/diagnóstico , Hipertensão do Jaleco Branco/epidemiologia , Hipertensão Mascarada/diagnóstico , Hipertensão Mascarada/epidemiologia , Gravidez de Alto Risco , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão ArterialRESUMO
The objectives of this study were 1-to evaluate the prevalence of masked chronic hypertension in pregnant women classified as gestational hypertension 2-to compare the risks of developing preeclampsia in true gestational hypertension vs those women classified as having gestational hypertension but who had had masked hypertension in the first half of pregnancy. We conducted a cohort study in consecutive high-risk pregnancies who were evaluated before 20 weeks of gestation. Women who developed gestational hypertension (normotension in the office before 20 weeks of gestation and office BP ≥ 140/90 mmHg and/or antihypertensive treatment in the second half of gestation) were divided, according to an ABPM performed before 20 weeks of pregnancy, in two subgroups: subgroup 1-if their ABPM was normal, and subgroup 2-if they had masked chronic hypertension. Risks for preeclampsia (PE) were estimated and compared with normotensive women. Before 20 weeks of gestation, 227 women were evaluated (age 32 ± 6 years, median gestation age 15 weeks); 67 had chronic hypertension (29.5%). Of the remaining 160, 39 developed gestational hypertension (16 in subgroup 1 and 23 insubgroup 2. Compared with normotensive pregnant women, subgroup 1 of women with gestational hypertension did not increase the risk of developing PE (OR = 0.76, 95% CI = 0.16-6.65). Conversely, subgroup 2 of gestational hypertension increased the risk of PE more than 4 times (0R = 4.47 CI = 1.16-12.63). Risk estimation did not change substantially after the adjustment for multiple possible confounders. In conclusion, the59% of women initially diagnosed as gestational hypertensive according to current recommendations had masked chronic hypertension and a very high risk of developing PE.
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Hipertensão Induzida pela Gravidez , Hipertensão , Hipertensão Mascarada , Pré-Eclâmpsia , Feminino , Gravidez , Humanos , Adulto , Lactente , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/epidemiologia , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/epidemiologia , Hipertensão Mascarada/diagnóstico , Hipertensão Mascarada/epidemiologia , Estudos de Coortes , Hipertensão/diagnóstico , Pressão SanguíneaRESUMO
To test the hypothesis that nocturnal hypertension identifies risk for early-onset preeclampsia/eclampsia (PE), we conducted an historical cohort study of consecutive high-risk pregnancies between 1st January 2016 and 31st March 2020. Office blood pressure (BP) measurements and ambulatory blood pressure monitoring (ABPM) were performed. The cohort was divided into patients without PE or with early- or late-onset PE (<34 and ≥34 weeks of gestation, respectively). The relative risks of office and ABPM hypertension for the development of late- or early-onset PE were estimated with multinomial logistic regression using no PE as a reference category. Four hundred and seventy-seven women (mean age 30 ± 7 years, with 23 ± 7 weeks of gestation at the time of the BP measurements) were analyzed; 113 (23.7%) developed PE, 69 (14.5%) developed late-onset PE, 44 (9.2%) developed early-onset PE. Office and ambulatory BP increased between the groups, and women who developed early-onset PE had significantly higher office and ambulatory BP values than those with late-onset PE or without PE. Hypertension prevalence increased across groups, with the highest values in early-onset PE. Nocturnal hypertension was the most prevalent finding and was highly prevalent in women who developed early-onset PE (88.6%); only 1.6% of women without nocturnal hypertension developed early-onset PE. Additionally, nocturnal hypertension was a stronger predictor for early-onset PE than for late-onset PE (adjusted OR, 5.26 95%CI 1.67-16.60) vs. 2.06, 95%CI 1.26-4.55, respectively). In conclusion, nocturnal hypertension was the most frequent BP abnormality and a significant predictor of early-onset PE in high-risk pregnancies.
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Hipertensão , Pré-Eclâmpsia , Adulto , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Estudos de Coortes , Feminino , Humanos , Hipertensão/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Gravidez de Alto Risco , Adulto JovemRESUMO
AIMS: To evaluate arterial stiffness indicators in people with prediabetes (PreD) and its possible pathogenesis. MATERIALS AND METHODS: Pulse wave velocity (PWV) was measured in 208 people with FINDRISC ≥ 13 (57 ± 8 years old, 68.7% women) and thereafter divided into those having either normal glucose tolerance (NGT) or PreD. In each subgroup we also identified those with/out insulin resistance (IR) measured by the triglyceride/HDL-c ratio (normal cut off values previously established in our population). Clinical and metabolic data were collected for all participants. PWV was compared between subgroups using independent t test. RESULTS: Women and men had comparable clinical and metabolic characteristics with obesity (BMI ≥ 30) and antihypertensive-statin treatment, almost half with either NGT or PreD. Whereas 48% of NGT people presented IR (abnormally high TG/HDL-c ratio), 52% had PreD. PWV was significantly higher only in those with a complete picture of metabolic syndrome (MS). CONCLUSIONS: Since PWV was significantly impaired in people with a complete picture of MS, clinicians must carefully search for early diagnosis of this condition and prescribe a healthy life-style to prevent development/progression of CVD. This proactive attitude would provide a cost-effective preventive strategy to avoid CVD's negative impact on patients' quality of life and on health systems due to their higher care costs.
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Adherence to antihypertensive medication is an important challenge that doctors often face in the treatment of hypertension. Good adherence is crucial to prevent cardiovascular complications. In consequence, the present study aimed at determining the prevalence of adherence to antihypertensive treatment and identifying associated clinical variables. A multicenter cross-sectional study was conducted in 12 cities of Argentina. A systematic sampling was performed in order to select patients with hypertension and under pharmacological treatment for at least 6 months. Physicians took three BP measurements, and the level of adherence was assessed using the self-administered Morisky questionnaire (MMAS-8). Participants were classified into three levels of adherence: high adherence-MMAS score of 8; medium adherence-MMAS scores of 6 to <8; and low adherence-MMAS scores of <6. A total of 1111 individuals (62 ± 12 years old, women 49.4%) were included in the present analysis; 159 (14.3%), 329 (29.6%) and 623 (56.1%) patients had low, medium, and high adherence, respectively. The prevalence of controlled hypertension increased only in high adherent patients: 42.8%, 42.2%, and 64.5% for low, medium, and high adherence groups, respectively. Similarly, systolic BP was lower only in the high adherence group. High educational level (OR 3.47, 95% CI 2.68-4.49) and diuretic treatment (OR 0.64, 95% CI 0.47-0.88) were independent predictors of high adherence. In conclusion, more than a half of treated hypertensive patients had a high level of adherence. These patients had lower BP values and higher control levels. A high educational level predicts high adherence.
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Hipertensão , Idoso , Anti-Hipertensivos/uso terapêutico , Argentina/epidemiologia , Estudos Transversais , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Masculino , Adesão à Medicação , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: To determine if there is an office blood pressure (BP) value below which out-of-office measurements are unnecessary in high-risk pregnant women. METHODS: We conducted a prospective cohort study in women in the second half of high-risk pregnancies. Office BP measurements and ambulatory blood pressure monitoring (ABPM) was performed. The cohort was divided according to quartiles of office BP and in normotension, white-coat hypertension, masked hypertension and sustained hypertension. The risks for preeclampsia/eclampsia for each category were estimated. RESULTS: Three hundred seventy-three women (30â±â7 years with 32â±â4 weeks of gestation) were included; 69 women (18.5%) developed preeclampsia/eclampsia. Risk for preeclampsia/eclampsia increased in a stepwise manner through quartiles of systolic office BP (8.8, 13.4, 19.6 and 32.3%, Pâ<â0.001) and diastolic office BP (6.5, 13.7, 19.6 and 34,4%, Pâ<â0.001). OR increased significantly through quartiles of systolic (Pâ=â0.004) and diastolic (Pâ<â0.001) office BP; the significance becomes evident between the second and third quartile, the cut-off point between these was 125/76âmmHg. Prevalence of white-coat and masked hypertension were 3.8 and 24.7%, respectively. Using ABPM, 14/61 office hypertensive women were reclassified as white-coat hypertension but 92/312 normotensive women as masked hypertension. OR for preeclampsia/eclampsia increased significantly in women with masked hypertension. Absolute risk for preeclampsia/eclampsia in women with office BP less than 125/75âmmHg was similar than that in women with normal ABPM, 7.2 and 7.1%, respectively. CONCLUSION: Masked hypertension was a prevalent and high-risk condition. Office BP at least 125/75âmmHg in the second half of gestation seems appropriate to indicate out-of-office measurements in high-risk pregnancies.
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Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea , Hipertensão Induzida pela Gravidez/diagnóstico , Gravidez de Alto Risco , Adulto , Argentina/epidemiologia , Determinação da Pressão Arterial , Estudos de Coortes , Feminino , Humanos , Hipertensão , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Mascarada/epidemiologia , Gravidez , Prevalência , Estudos Prospectivos , Hipertensão do Jaleco Branco/epidemiologia , Adulto JovemRESUMO
Blood pressure (BP) was assessed by patients themselves in recently published trials. Self-measured office blood pressure (SMOBP) seems particularly interesting for limited health resources regions. The aim of our study was to evaluate the relationship between SMOBP values and those estimated by ambulatory blood pressure monitoring (ABPM). Six hundred seventy-seven patients were evaluated using both, SMOBP and ABPM. The differences between SMOBP and daytime ABPM were evaluated with paired "t" test. The correlations among SMOBP and ABPM were estimated using Pearson's r. The accuracy of SMOBP to identify abnormal ABPM was determined using area under ROC curve (AUC). Sensitivity, specificity, and positive and negative predictive values were calculated for different SMOBP cut-points. Using the average of three readings, systolic SMOBP was higher (3.7 (14.2) mmHg, p < 0.001) and diastolic SMOBP lower (1.5 (8.1) mmHg, p < 0.001) than ABPM. Both BP estimates had a significant correlation, r = 0.67 and r = 0.75 (p < 0.01) for systolic and diastolic BP, respectively. Systolic SMOBP predicted systolic abnormal ABPM; the AUC were 0.80 (0.77-0.84) and 0.78 (0.74-0.81) for daytime and 24 h hypertension, respectively. Diastolic SMOBP predicted diastolic hypertension, AUC 0.86 (0.83-0.88) for both daytime and 24 h hypertension. Neither correlations nor AUCs improved significantly using the average of five readings. SMOBP ≥ 160/90 mmHg was highly specific (>95%) to identify individuals with hypertension in the ABPM; SMOBP < 130/80 mmHg reasonably discarded abnormal ABPM. In conclusion, a high proportion of individuals could be classified adequately using SMOBP, reducing the necessity of healthcare resources and supporting its utility for screening purposes.
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Determinação da Pressão Arterial/métodos , Hipertensão/diagnóstico , Programas de Rastreamento/métodos , Adulto , Idoso , Pressão Sanguínea , Feminino , Recursos em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , AutocuidadoRESUMO
OBJECTIVE: The aim was to evaluate the relationships among insulin resistance markers and nocturnal and diurnal hypertension in normotensive or mildly untreated hypertensive adults. METHODS: The study was performed in both female and male adults referred to the Cardiometabolic Unit of the Hospital San Martín, La Plata, Argentina, in order to perform an ambulatory blood pressure measurement (ABPM) for the evaluation of a possible hypertensive disorder. The population was stratified according to their ABPM in: 1-presence or absence of diurnal hypertension and 2-presence or absence of nocturnal hypertension; both conditions were analyzed separately. Fasting plasma insulin (FPI), homeostasis model assessment of insulin resistance (HOMA-IR), and triglycerides (TG)/high-density lipoprotein cholesterol (HDL-C) ratio were used as surrogate markers of insulin resistance and compared among subjects with vs. without diurnal or nocturnal hypertension. RESULTS: One hundred and five patients, 55 women, 47 (11) years old, and 50 men, 44 (16) years old, were included. Diurnal and nocturnal hypertension were found in 60% and 64% of the sample, respectively. There were no significant differences among the levels of insulin resistance markers between individuals with or without diurnal hypertension. In contrast, individuals with nocturnal hypertension were more insulin resistant irrespectively of whether they were evaluated using FPI (P = 0.016), HOMA-IR (P = 0.019), or TG/HDL-C ratio (P = 0.011); FPI differences remained significant after adjustment for sex, age, and obesity indicators (P = 0.032). CONCLUSIONS: Nocturnal but not diurnal hypertension was related to higher levels of 3 insulin resistance markers in normotensive and untreated mildly hypertensive adults; this relationship seems partially independent of obesity.
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Glicemia/metabolismo , Pressão Sanguínea , Ritmo Circadiano , Hipertensão/fisiopatologia , Resistência à Insulina , Insulina/sangue , Lipídeos/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina , Biomarcadores/sangue , Determinação da Pressão Arterial , Feminino , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico , Fatores de Risco , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Hypertension is a recognized strong risk factor for cardiovascular disease. However, no data was available in our country to quantify the relationship between blood pressure and cardiovascular event. OBJECTIVE: to quantify the risk of cardiovascular events according to blood pressure categories. METHODS: A prospective epidemiological study was conducted in 1526 inhabitants from Rauch City, (Buenos Aires, Argentina) between 1997 and 2012. Subjects were classified into one of these blood-pressure categories: 1-optimal, 2-normal, 3-high-normal, 4-grade 1 hypertension, 5-grade 2 hypertension and 6-grade 3 hypertension. The first CVD event, including unstable angina pectoris, fatal and non-fatal myocardial infarction, myocardial revascularization, and fatal or non-fatal stroke, was defined as the primary endpoint. Multivariable Cox proportional-hazards regression models were used to estimate the relative risk (HR) of CVD according to base-line blood-pressure categories. RESULTS: In 2012, 1124 individuals (73.7% of the baseline sample), 719 women and 405 men (in 1997, aged 45±16 and 46±16 respectively) or their relatives in case of death, could be surveyed again in order to obtain information concerning incident CVD events. Cardiovascular event rates and HR values increased in a stepwise manner across the blood pressure categories (p for trend across categories <0.001 in both sex); however, in subjects aged ≥55 years a j-curve phenomenon was observed, showing the lowest incidence in the high-normal category. In all categories CVD events rates were higher for men. CONCLUSION: This study quantified relationships between BP and CVD starting from high-normal blood pressure in Argentina.
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Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/fisiopatologia , Adolescente , Adulto , Idoso , Argentina , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Adulto JovemRESUMO
OBJECTIVE: The aim was to evaluate the prevalence of nocturnal and masked hypertension and the prognostic values of these blood pressure (BP) abnormalities in normotensive women coursing a high-risk pregnancy. METHODS: The study was performed in pregnant women with 20 or more weeks of gestation coursing a high-risk pregnancy, sent to a specialized hypertension department to perform a prospective defined protocol of BP evaluation. Women with office BP at least 140/90âmmHg were excluded. An ambulatory monitoring of BP was performed to identify masked and nocturnal hypertension (defined according to the current guidelines). The adjusted risk for development of preeclampsia/eclampsia (PEEC) was estimated using logistic regression. The ability of SBP and DBP to identify risk of PEEC was estimated using area under the receiver-operating characteristic curves. RESULTS: Eighty-seven women (29â±â7 years old, 30â±â5 weeks of pregnancy) were included in this analysis. The prevalence of masked hypertension was 33.3%. Nocturnal hypertension was found in 42.5% of the women. Remarkably, 27.0% of the women with nocturnal hypertension had normal 24-h values according to ambulatory BP monitoring. Twenty-two patients developed PEEC; adjusted relative risks increased with the presence of nocturnal (odds ratioâ=â4.72, 95% confidence interval 1.25-19.43, Pâ=â0.023) or masked hypertension (odds ratioâ=â7.81, 95% confidence interval 2.6-22.86, Pâ=â0.001). Nocturnal SBP and DBP had the highest abilities to predict PEEC (area under the curveâ=â0.77 and 0.80, respectively). CONCLUSION: Masked and nocturnal hypertension are frequent findings in normotensive women coursing a high-risk pregnancy, and their presence implies an increased risk to develop PEEC.
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Hipertensão Induzida pela Gravidez/epidemiologia , Gravidez de Alto Risco , Adulto , Feminino , Humanos , Gravidez , Adulto JovemRESUMO
The aim of this study was to test the hypothesis that cardiovascular disease occurs to the greatest extent in persons with prediabetes mellitus who are also insulin resistant. In 2003, 664 non-diabetic women (n = 457) and men (n = 207), aged 52 ± 16 and 53 ± 15 years, were surveyed during a programme for cardiovascular disease prevention. Fasting plasma glucose concentrations defined participants as having normal fasting plasma glucose (fasting plasma glucose <5.6 mmol/L) or prediabetes mellitus (fasting plasma glucose ⩾ 5.6 and <7.0 mmol/L). The tertile of prediabetes mellitus subjects with the highest fasting plasma insulin concentration was classified as insulin resistant. Baseline cardiovascular disease risk factors were accentuated in prediabetes mellitus versus normal fasting glucose, particularly in prediabetes mellitus/insulin resistant. In 2012, 86% of the sample were surveyed again, and the crude incidence for cardiovascular disease was higher in subjects with prediabetes mellitus versus normal fasting glucose (13.7 vs 6.0/100 persons/10 years; age- and sex-adjusted hazard ratio = 1.88, p = 0.052). In prediabetes mellitus, the crude incidences were 22.9 versus 9.6/100 persons/10 years in insulin resistant versus non-insulin resistant persons (age- and sex-adjusted hazard ratio = 2.36, p = 0.040). In conclusion, cardiovascular disease risk was accentuated in prediabetes mellitus/insulin resistant individuals, with a relative risk approximately twice as high compared to prediabetes mellitus/non-insulin resistant subjects.
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Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Jejum , Resistência à Insulina/fisiologia , Estado Pré-Diabético/sangue , Adulto , Idoso , Glicemia/análise , Doenças Cardiovasculares/complicações , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Feminino , Teste de Tolerância a Glucose , Humanos , Incidência , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , RiscoRESUMO
This study compares the ability of an elevated triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio, using sex-specific cut-points, to identify insulin-resistant individuals within a population without known cardiac disease or diabetes with that obtained using the diagnostic criteria of the metabolic syndrome (MetS). Measurements were made of waist circumference (WC), systolic and diastolic blood pressure, fasting plasma glucose, fasting plasma insulin (FPI), plasma TG and plasma HDL-C concentrations in 1102 women and 464 men. These data were used to classify subjects as being insulin resistant (FPI concentration in the upper quartile) and having the MetS or an elevated TG/HDL-C ratio (>2.5 and >3.5 for women and men, respectively). The sensitivity and specificity with which the two indices identified insulin-resistant subjects were similar (43% and 81% for TG/HDL-C ratio and 45% and 82% for MetS), as the number of individuals was found with either an elevated TG/HDL-C ratio (n = 386) or the MetS (n = 384). Eighty-one per cent of the individuals were identified concordantly. Cardio-metabolic risk profiles in 'low-risk' individuals identified by a low TG/HDL-C ratio were comparable to those who did not have the MetS, and this was also the case when comparing 'high-risk' groups identified by having the MetS or an elevated TG/HDL-C ratio. These findings suggest that TG/HDL-C concentration ratio is as adequate as MetS diagnosis to identify insulin-resistant subjects.
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HDL-Colesterol/sangue , Resistência à Insulina/fisiologia , Síndrome Metabólica/sangue , Triglicerídeos/sangue , Adulto , Idoso , Glicemia/metabolismo , Índice de Massa Corporal , Feminino , Humanos , Insulina/sangue , Masculino , Síndrome Metabólica/diagnóstico , Pessoa de Meia-Idade , Circunferência da Cintura/fisiologiaRESUMO
Results of recent studies using the ratio of plasma triglyceride (TG) to high-density lipoprotein (HDL) cholesterol concentration to identify insulin-resistant patients at increased cardiometabolic risk have emphasized that the cut point used for this purpose will vary with race. Because TG and HDL cholesterol concentrations vary with gender, this analysis was initiated to define gender-specific plasma TG/HDL cholesterol concentration ratios that best identified high-risk subjects among women (n = 1,102) and men (n = 464) of primarily European ancestry. Insulin resistance was defined as the 25% of the population with the highest values for fasting plasma insulin concentration and homeostasis model assessment of insulin resistance. Using TG/HDL concentration ratios >2.5 in women and >3.5 in men identified subgroups of men and women that were comparable in terms of insulin resistance and associated cardiometabolic risk, with significantly higher values for fasting plasma insulin, homeostasis model assessment of insulin resistance, blood pressure, body mass index, waist circumference, and glucose and TG concentrations and lower HDL cholesterol concentrations than in women and men below these cut points. The sensitivity and specificity of these gender-specific cut points to identify insulin-resistant subjects were about 40% and about 80%, respectively. In conclusion, the plasma TG/HDL cholesterol concentration ratio that identifies patients who are insulin resistant and at significantly greater cardiometabolic risk varies between men and women.