Evaluating CMR

Metabolic Syndrome and Type 2 Diabetes/CVD Risk

Usefulness of Hypertriglyceridemic Waist

History of Hypertriglyceridemic Waist

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There is growing evidence that variables other than traditional risk factors may facilitate the identification of individuals at elevated risk of coronary heart disease (CHD). In this regard, prospective data from the Québec Cardiovascular Study showed that some features of the metabolic syndrome (the atherogenic metabolic triad: elevated insulin and apolipoprotein B concentrations and small LDL particles) often found in abdominally obese individuals substantially increase CHD risk, while individuals without this triad of unconventional risk markers of abdominal obesity and the metabolic syndrome have a lower CHD risk (1). Furthermore, the risk associated with these features remained highly significant even after traditional risk factors such as LDL cholesterol, HDL cholesterol, and triglyceride levels were taken into account (1). These findings suggest that paying attention to markers of the metabolic syndrome in abdominally obese patients could refine CHD risk assessment beyond the risk factors traditionally used in clinical practice. Since several markers of the metabolic syndrome cannot be used on a large scale in clinical practice due to accessibility, cost, and standardization problems (with the exception of apolipoprotein B, which is now standardized (2)), a research group from Université Laval sought to develop a simple and inexpensive screening tool to help general practitioners identify individuals at risk of developing CHD because of the presence of abdominal obesity and features of the metabolic syndrome.

The simultaneous presence of an increased waist circumference and elevated fasting triglyceride concentrations (hypertriglyceridemic waist) could be used as an initial screening phenotype to identify a subgroup of patients likely to be characterized by features of the metabolic syndrome, such as fasting hyperinsulinemia, elevated apolipoprotein B, and higher amounts of small LDL particles: the atherogenic metabolic triad (Figure) (3). It is important to emphasize that waist girth should be measured and interpreted along with fasting triglyceride concentrations because not all individuals with an elevated waist girth have intra-abdominal (visceral) fat and are at high risk of type 2 diabetes or cardiovascular disease (CVD).


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1. Lamarche B, Tchernof A, Mauriège P, et al. Fasting insulin and apolipoprotein B levels and low-density lipoprotein particle size as risk factors for ischemic heart disease. JAMA 1998; 279: 1955-61.
2. Marcovina S and Packard CJ. Measurement and meaning of apolipoprotein AI and apolipoprotein B plasma levels. J Intern Med 2006; 259: 437-46.
3. Lemieux I, Pascot A, Couillard C, et al. Hypertriglyceridemic waist. A marker of the atherogenic metabolic triad (hyperinsulinemia, hyperapolipoprotein B, small, dense LDL) in men? Circulation 2000; 102: 179-84.