Differences Between Morbid Obesity With Metabolic Syndrome and Overweight Turkish Adult Participants in Multiple Atherosclerotic Cardiovascular Disease Risk Factors
Restricted accessResearch articleFirst published online February, 2021
Differences Between Morbid Obesity With Metabolic Syndrome and Overweight Turkish Adult Participants in Multiple Atherosclerotic Cardiovascular Disease Risk Factors
Obesity and metabolic syndrome (MetS) are public health problems and are increasing globally. We assessed the differences in lipid profiles through lipid testing, thrombotic and inflammatory parameters, and oxidative stress indexes between overweight and obese patients with MetS in a Turkish adult population. We included 100 obese (body mass index [BMI] >30 kg/m2) patients with MetS (66 women, 34 men, mean age 54.0 ± 10.1 years) and 15 overweight (BMI 25-30 kg/m2) individuals (11 women, 4 men, mean age 50.2 ± 14.5 years) as controls. The group with MetS had significantly higher levels of glycaemia, uric acid, high-sensitivity C-reactive protein, homocysteine, fibrinogen, total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, small dense LDL, oxidized LDL, apolipoprotein B (Apo B), lipoprotein (a), small and intermediate high-density lipoprotein (HDL) particles, oxidative stress index, and significantly lower levels of HDL-cholesterol (HDL-C), Apo A, and large HDL particles. In conclusion, obesity with MetS increase atherogenic dyslipidemia and thrombotic, inflammatory and oxidative stress biomarkers. Furthermore, obesity with MetS decreases protective mechanisms of atherosclerosis. We should at least try to prevent overweight individuals from becoming obese with MetS.
EckelRHYorkDARössnerS; et al.American Heart Association. Prevention Conference VII: Obesity, a worldwide epidemic related to heart disease and stroke: executive summary. Circulation. 2004;110:2968–75.
2.
NgMFlemingTRobinsonM, et al.Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–81.
3.
SansoyV.Obesity, abdominal obesity and their relation with other risk factors in Turkish adults. In: OnatA (ed.). TEKHARF. MAS: Istanbul, 2003, pp. 64–9.
4.
YumukVD. Prevalence of obesity in Turkey. Obes Rev. 2005;6:9–10.
5.
KellyTYangWChenCS, et al.Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond). 200832:1431–7.
6.
GrundySMCleemanJIDanielsSR, et al.Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Curr Opin Cardiol. 2006;21:1–6.
7.
OnatAYükselMKöroğluB, et al.Turkish Adult Risk Factor Study survey 2012: overall and coronary mortality and trends in the prevalence of metabolic syndrome. Turk Kardiyol Dern Ars. 2013;41:373–8.
8.
GrundySM. Hypertriglyceridemia, atherogenic dyslipidemia, and the metabolic syndrome. Am J Cardiol. 1998;81:18–25.
9.
AlbertiKGZimmetPShawJ; IDF Epidemiology Task Force Consensus Group. The metabolic syndrome: a new world-wide definition. Lancet. 2005;366:1059–62.
10.
NeatonJDBlackburnHJacobsD, et al.Serum cholesterol level and mortality findings for men screened in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group. Arch Intern Med. 1992;152:1490–500.
11.
CarrDBUtzschneiderKMHullRL, et al.Intra-abdominal fat is a major determinant of the National Cholesterol Education Program Adult Treatment Panel III criteria for the metabolic syndrome. Diabetes. 2004;53:2087–94.
12.
NievesDJCnopMRetzlaffB, et al.The atherogenic lipoprotein profile associated with obesity and insulin resistance is largely attributable to intra-abdominal fat. Diabetes. 2003;52:172–9.
13.
FangJAldermanMH. Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971-1992. National Health and Nutrition Examination Survey. JAMA. 2000;283:2404–10.
14.
CulletonBFLarsonMGKannelWB, et al.Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med. 1999;131:7–13.
15.
FeigDIKangDHJohnsonRJ. Uric acid and cardiovascular risk. N Engl J Med. 2008;359:1811–21.
16.
StecJJSilbershatzHToflerGH, et al.Association of fibrinogen with cardiovascular risk factors and cardiovascular disease in the Framingham Offspring Population. Circulation. 2000;102:1634–8.
17.
FolsomAR. Fibrinogen and cardiovascular risk markers. Blood Coagul Fibrinolysis. 1999;10:13–6.
18.
MillerMZhanMHavasS. High attributable risk of elevated C-reactive protein level to conventional coronary heart disease risk factors: the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2005;165:2063–8.
19.
RidkerPMDanielsonEFonsecaFA; et al.JUPITER Study Group. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359:2195–207.
20.
RidkerPMHennekensCHBuringJE, et al.C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000;342:836–43.
21.
WadleyAJVeldhuijzen van ZantenJJAldredS. The interactions of oxidative stress and inflammation with vascular dysfunction in ageing: the vascular health triad. Age (Dordr). 2013;35:705–18.
22.
WeinbrennerTSchröderHEscurriolV, et al.Circulating oxidized LDL is associated with increased waist circumference independent of body mass index in men and women. Am J Clin Nutr. 2006;83:30–5.
23.
WrightEJrScism-BaconJLGlassLC. Oxidative stress in type 2 diabetes: the role of fasting and postprandial glycaemia. Int J Clin Pract. 2006;60:308–14.
24.
PetrieJRGuzikTJTouyzRM. Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms. Can J Cardiol. 2018;34:575–84.
25.
NowickiGJŚlusarskaBPrystupaA, et al.Oxidative/Antioxidative Status in Patients after Myocardial Infarction and in Those without Cardiovascular Event Depending on Anthropometric Factors Defining Body Weight. Int J Environ Res Public Health. 2019;16:407t7.
26.
BlockGDietrichMNorkusEP, et al.Factors associated with oxidative stress in human populations. Am J Epidemiol. 2002;156:274–85.
27.
National cholesterol education program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143–421.
28.
EberlyLEPrineasRCohenJD, et al.Multiple Risk Factor Intervention Trial Research Group. Metabolic syndrome: risk factor distribution and 18-year mortality in the multiple risk factor intervention trial. Diabetes Care. 2006;29:123–30.
29.
BerneisKKKraussRM. Metabolic origins and clinical significance of LDL heterogeneity. J Lipid Res. 2002;43:1363–79.
30.
OkazakiMUsuiSIshigamiM, et al.Identification of unique lipoprotein subclasses for visceral obesity by component analysis of cholesterol profile in high-performance liquid chromatography. Arterioscler Thromb Vasc Biol. 2005;25:578–84.
31.
StampferMJKraussRMMaJ, et al.A prospective study of triglyceride level, low-density lipoprotein particle diameter, and risk of myocardial infarction. JAMA. 1996;276:882–8.
32.
BallantyneCM. Low-density lipoproteins and risk for coronary artery disease. Am J Cardiol. 1998;82:3–12.
33.
WilliamsPTSuperkoHRHaskellWL, et al.Smallest LDL particles are most strongly related to coronary disease progression in men. Arterioscler Thromb Vasc Biol. 2003;23:314–21.
34.
MikhailidisDPElisafMRizzoM, et al.“European panel on low density lipoprotein (LDL) subclasses”: a statement on the pathophysiology, atherogenicity and clinical significance of LDL subclasses. Curr Vasc Pharmacol. 2011;9:533–71.
35.
WitztumJLSteinbergD. The oxidative modification hypothesis of atherosclerosis: does it hold for humans?Trends Cardiovasc Med. 2001;11:93–102.
36.
MitraSGoyalTMehtaJL. Oxidized LDL, LOX-1 and atherosclerosis. Cardiovasc Drugs Ther. 2011;25:419–29.
37.
GómezMVilaJElosuaR, et al.Relationship of lipid oxidation with subclinical atherosclerosis and 10-year coronary events in general population. Atherosclerosis. 2014;232:134–40.
38.
Van DijkRAKolodgieFRavandiA, et al.Differential expression of oxidation-specific epitopes and apolipoprotein(a) in progressing and ruptured human coronary and carotid atherosclerotic lesions. J Lipid Res. 2012;53:2773–90.
39.
DaneshJCollinsRPetoR.Lipoprotein(a) and coronary heart disease. Meta-analysis of prospective studies. Circulation. 2000;102:1082–5.
40.
KamstrupPRTybjaerg-HansenASteffensenR, et al.Genetically elevated lipoprotein(a) and increased risk of myocardial infarction. JAMA. 2009;301:2331–9.
41.
ClarkeRPedenJFHopewellJC, et al.PROCARDIS Consortium. Genetic variants associated with Lp(a) lipoprotein level and coronary disease. N Engl J Med. 2009;361:2518–28.
42.
IvertTMalmströmHHammarN, et al.Cardiovascular events in patients under age fifty with early findings of elevated lipid and glucose levels - The AMORIS study. PLoS One. 2018;13: e0201972.
43.
SattarNWilliamsKSnidermanAD, et al.Comparison of the associations of apolipoprotein B and non-high-density lipoprotein cholesterol with other cardiovascular risk factors in patients with the metabolic syndrome in the Insulin Resistance Atherosclerosis Study. Circulation. 2004;110:2687–93.
44.
BrunzellJDDavidsonMFurbergCD, et al.Lipoprotein management in patients with cardiometabolic risk: consensus statement from the American Diabetes Association and the American College of Cardiology Foundation. Diabetes Care. 2008;31:811–22.
45.
KosmasCEMartinezISourlasA, et al.High-density lipoprotein (HDL) functionality and its relevance to atherosclerotic cardiovascular disease. Drugs Context. 2018;7:212525.
46.
ZhangYGordonS.MXiH, et al.HDL subclass proteomic analysis and functional implication of protein dynamic change during HDL maturation. Redox Biol. 2019;24:101222.
47.
NavabMReddySTVan LentenBJ, et al.HDL and cardiovascular disease: atherogenic and atheroprotective mechanisms. Nat Rev Cardiol. 2011;8:222–322.
48.
UeharaYSakuK.High-density lipoprotein and atherosclerosis: Roles of lipid transporters. World J Cardiol. 2014;6:1049–59.
