Evaluating CMR

Metabolic Syndrome and Type 2 Diabetes/CVD Risk

Usefulness of Hypertriglyceridemic Waist

Hypertriglyceridemic Waist and Coronary Risk

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Additional findings from the first publication on hypertriglyceridemic waist revealed that only the simultaneous presence of elevated waist girth and triglyceride concentrations was associated with coronary artery disease (CAD) assessed by angiography (3). In a sample of 287 men who underwent an angiographic procedure for symptoms of CAD, men whose waist circumference and triglyceride levels were elevated had higher odds of being diagnosed with significant CAD than men with a waist circumference <90 cm and triglyceride concentrations <2.0 mmol/l (Odds ratio: 3.6, 95% CI: 1.17-10.93, p<0.03). In isolation, an elevated waist circumference or hypertriglyceridemia did not significantly increase CAD. Furthermore, in a small study of heart transplant patients, the odds of CAD increased fourfold, though this finding was not statistically significant because of the small sample size (n=83) (12). The usefulness of hypertriglyceridemic waist and the NCEP-ATP III clinical criteria in establishing risk of all-cause and cardiovascular mortality as well as predicting the annual progression rate of aortic calcification was examined in a sample of more than 550 women followed for 8.5 years (17). Survival curves analysis for all-cause or cardiovascular mortality indicated that survival rates dropped significantly in women with an elevated waist girth and high triglyceride concentrations compared to women without these conditions. Moreover, relative risk for all-cause mortality (hazard ratio: 2.2, 95% CI: 1.3-3.6, p<0.01) and cardiovascular death (hazard ratio: 4.7, 95% CI: 2.2-9.8, p<0.001) associated with hypertriglyceridemic waist was significant even after adjusting for age, smoking, and LDL cholesterol. These findings were repeated in a sub-analysis that excluded women with diabetes. The annual progression rate of aortic calcification was significantly greater in women meeting the NCEP-ATP III criteria or with hypertriglyceridemic waist. However, the highest rates were observed in subgroups with both high waist girth and triglyceride levels, regardless of the presence/absence of NCEP-ATP III criteria.

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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.
12. Sénéchal M, Lemieux I, Beucler I, et al. Features of the metabolic syndrome of "hypertriglyceridemic waist" and transplant coronary artery disease. J Heart Lung Transplant 2005; 24: 819-26.
17. Tanko LB, Bagger YZ, Qin G, et al. Enlarged waist combined with elevated triglycerides is a strong predictor of accelerated atherogenesis and related cardiovascular mortality in postmenopausal women. Circulation 2005; 111: 1883-90.