OBJECTIVES: Previous studies have suggested that abnormal levels of cortisol and testosterone might increase the risk of serious somatic diseases. To test this hypothesis, we conducted a 5-year follow-up study in middle-aged men. METHODS: A population-based cohort study conducted in 1995 amongst 141 Swedish men born in 1944, in whom a clinical examination supplemented by medical history aimed to disclose the presence of cardiovascular disease (CVD) (myocardial infarction, angina pectoris, stroke), type 2 diabetes and hypertension were performed at baseline and at follow-up in the year 2000. In addition, salivary cortisol levels were measured repeatedly over the day. Serum testosterone concentrations were also determined. Using the baseline data, an algorithm was constructed, which classified the secretion pattern of cortisol and testosterone from each individual as being normal or abnormal. RESULTS: By the end of follow-up, men with an abnormal hormone secretion pattern (n = 73) had elevated mean arterial pressure (P = 0.003), fasting insulin (P = 0.009) and insulin : glucose ratio (P = 0.005) compared with men with a normal secretion pattern (n = 68). Body mass index, waist circumference, and waist : hip ratio were significantly elevated in both groups. However, the 5-year incidence of CVD, type 2 diabetes, and hypertension were significantly higher (P
The objective of this study was to estimate the prevalence of undiagnosed impaired glucose homeostasis in hypertensive subjects in the general population. The most reasonable screening strategy for glucose disorders was also assessed. We carried out an oral glucose tolerance test for 1106 hypertensive subjects aged 45 to 70 years without previously diagnosed diabetes or cardiovascular disease. Blood pressure, waist circumference, body mass index, and plasma lipids were also measured. Type 2 diabetes was found in 66 (6%) of the subjects, impaired glucose tolerance in 220 (20%), and impaired fasting glucose in 167 (15%). If we had carried out an oral glucose tolerance test only for those hypertensive subjects with fasting plasma glucose >or=5.6 mmol/L, we would have missed approximately 40% of the patients with impaired glucose tolerance. The International Diabetes Federation criteria of metabolic syndrome identified 96% of all the cases of type 2 diabetes and 88% of all the cases of impaired glucose tolerance. The prevalence of central obesity was alarming: 90% of the women and 82% of the men had a waist circumference >or=80 cm or >or=94 cm, respectively. Impaired glucose homeostasis and central obesity are common in hypertensive subjects. An oral glucose tolerance test is reasonable to carry out at least for the hypertensive subjects with metabolic syndrome. Weight stabilization is an important goal to treat hypertensive patients.
BACKGROUND AND PURPOSE: Leptin, an important hormone for body weight regulation, may be involved in the pathogenesis of cardiovascular manifestations of obesity. We tested whether leptin may be an independent risk marker for stroke in a case-referent study. METHODS: Definitive acute stroke events, defined by MONICA criteria, were identified from October 1, 1995 to April 30, 1999. Referents without known cardiovascular disease were randomly selected from a population census. Patient characteristics were taken from hospital files and leptin was analyzed in stored samples. Logistic regression analysis was used to determine possible differences in leptin levels between groups. RESULTS: One hundred and thirty-seven cases with ischemic stroke and 69 cases with hemorrhagic stroke were identified. In comparison with referents, male patients with stroke had significantly higher leptin levels. Both male and female stroke patients had increased blood pressure compared with the referents. In multivariate analyses, high leptin levels were associated with both ischemic (OR = 4.89; 95% CI: 1.89-12.62) and hemorrhagic (OR = 3.86; 95% CI: 1.13-13.16) stroke in men, and with ischemic stroke in women (OR = 4.10; 95% CI: 1.45-11.62). The combination of high leptin levels and increased blood pressure (systolic or diastolic) was associated with a strong positive interaction in males with hemorrhagic stroke. CONCLUSION: Leptin may be an important link for the development of cerebrovascular disease in the insulin resistance syndrome in men.
Hypertension (HTN) and noninsulin-dependent diabetes mellitus (NIDDM) are two non-communicable pandemic of the late 20th century and early 21st century. Despite the active prophylaxis measures performed by the State, there is a tendency to increase of HTN in Russia. Incidence rate of hypertension is depending of age and increases in patients of elderly age (80%). According to the International Diabetes Federation, 10% of people in Russia suffer NIDDM of different genesis. The authors covered the topical issues of modern strategies in antihypertensive therapy in patients with NIDDM and HTN according to large randomized trials. The authors analyzed the possibilities of conventional and modern therapies of hypertension, organoprotection, metabolic neutrality and impact on prognosis in patients with NIDDM. It is underlined that the renin-angiotensin-aldosterone system is a part of the cardiovascular continuum and links various risk factors, like end-stage of cardiovascular disease and chronic renal disease. Monitoring of arterial blood pressure is crucial for patients with essential hypertension and NIDDM. Pharmacological blockade of the renin-angiotensin-aldosterone system is the most desirable method of treatment of hypertension and noninsulin-dependent diabetes mellitus. This method reduces the risk of cardiovascular complications.
AIM of the study consisted in investigation of structure of risk factors and pathological changes of morphological and functional parameters of cardiovascular system, parameters of carbohydrate and lipid metabolism and their relationship with arterial hypertension (AH) in age groups younger than 35 years, 35 - 55, and older than 55 years. We examined 91 patients with AH and 158 subjects with normal blood pressure (BP). Both groups were divided into 3 age groups: 55 years. Examination included study of anamnesis, investigation of anthropometric parameters, indices of lipid and carbohydrate metabolism, determination of signs of involvement of large vessels and the heart, assessment of parameters of left ventricular diastolic function. Genotyping of a row of polymorphisms of renin angiotensin aldosterone system was also carried out. Association of each pathological sign with the presence of AH was calculated according to value of odds ratio.
Presence of AH in all selected age groups was significantly associated with signs of metabolic syndrome (except hypercholesterolemia for subjects before 35 years) and symptoms of involvement of large vessels and the heart (except diastolic left ventricular dysfunction according to IVRT criterion for subjects younger than 35 and older than 55 years). Contrary to persons with normal BP detection of heredity burdened with cardiovascular diseases was significantly associated with presence of AH in patients aged 35 - 55 years. Hypertriglyceridemia, lowering of low density lipoprotein cholesterol level, increased thickness of intima media complex of common carotid artery, as well as elevation of rate of propagation of pulse wave along elastic arteries were characterized by about equal degree of association with the presence of AH in all three age groups. Variants of polymorphisms of genes encoding elements of renin angiotensin aldosterone system (AGTT174M, ACE, AGTR1) were associated with presence of AH in younger and middle age groups.