PROGRAM FOR DETECTING DYSLIPIDEMIA AND VERIFICATION OF METABOLIC SYNDROME IN KAZAKH PATIENTS WITH ARTERIAL HYPERTENSION USING APOLIPOPROTEINS B AND A1
Introduction. Our study is devoted to the issues of improving the diagnosis of MS in patients with AH by including the apoB / apoA1 ratio in the MS verification algorithm. The relevance of the study is based on the widespread prevalence of MS and AH. Improvement of the current algorithm for the diagnosis of MS (IDF, 2005) in Kazakhs with hypertension will improve treatment and prophylactic measures.
The purpose of the study is to develop a program for identifying the nature of dyslipidemia and verifying MS using apoB and apoA1 in Kazakhs.
Materials and methods. A cross-sectional study was approved by the Ethics Committee of the Semey State Medical University (2015). Selection into the sample is two-level: 1st stage - selection of primary health care facilities, 2nd - selection of participants according to inclusion criteria. The level of total cholesterol, LDL, HDL, TG, apoB and apoA1, glucose was determined in the laboratory "Olympus" (ISO 15189: 2012). Statistical analysis - Stata: Release 15. Categorical variables were calculated as% and quantitative continuous variables as averages. The X2 test or Fisher's exact test was used to analyze qualitative variables. Comparison of the mean values of MS components between quartiles of laboratory parameters was carried out using one-way ANOVA. The trend of the variable components of MS by quartiles of laboratory parameters was calculated using the X2 linear trend. To determine the relationship between lipid profile and MS, multiple logistic regression was modeled with OR with 95% CI. The significance of the covariates was assessed using a likelihood ratio test.
Results. MS was detected in 54.5% of the participants, among them 62.8% were women; MS prevalence and gender distribution are similar to those of the general population. Regardless of gender, abdominal obesity and hyperglycemia were most often detected in patients. Statistically significant differences were revealed between men and women in terms of: HDL (p = 0.0001), apoA1 (p = 0.0001), apoB (p = 0.0001), apoB / apoA1 (p = 0.0001). It was found that the ratio apoB / apoA1 = 0.66 (sensitivity 70.1%, specificity 57.8%) is a cut off point for verifying MS in Kazakhs with AH after taking into account potential confounding factors.
Conclusions:
1. 54.5% of the study participants had MS, among them 62.8% were women; the findings are similar to those in the general population. Regardless of gender, the most common MS components in Kazakhs with AH were abdominal obesity and hyperglycemia;
2. A comprehensive program for the detection of dyslipidemia and verification of MS in Kazakhs with AH includes a clinical examination with the identification of risk factors for MS, and laboratory tests (TG, HDL, apoB, apoA1, calculation of apoB / apoA1). The index apoB / apoA1≥0.66, regardless of the presence of other criteria, confirms MS in this category of patients.
Dana Kozhakhmetova 1, Alma Nurtazina 1, Daulet Dautov 2,
Maksut Kazymov 1, Saltanat Adilgozhina 1, Dastan Saidualiev 1
1 NCJSC "Semey Medical University", Semey city, Republic of Kazakhstan;
2 Asfendiyarov Kazakh National Medical University, Almaty city, Republic of Kazakhstan
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8. Cubeddu L.X., Hoffmann I.S. Insulin resistance and upper-normal glucose levels in hypertension: A review. J. Hum. Hypertens. 2002. Vol.16. P.S52-S55.
9. Fava M.C., Agius R. Obesity and cardio-metabolic health. Br J Hosp Med (Lond). - Published Online: 22 Aug 2019 https://doi.org/10.12968/hmed.2019.80.8.466.
10. Huang F. et al. Both Serum Apolipoprotein B and the Apolipoprotein B/Apolipoprotein A-I Ratio Are Associated with Carotid Intima-Media Thickness. PLoS One. 2013. Vol. 8, №1. P. 1–7.
11. Jing F., Mao Y., Guo J. et al. The value of Apolipoprotein B/Apolipoprotein A1 ratio for metabolic syndrome diagnosis in a Chinese population: a cross-sectional study. Lipids Health Dis 13, 81 (2014). https://doi.org/10.1186/1476-511X-13-81.
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13. Liu L. et al. Impact of metabolic syndrome on the risk of cardiovascular disease mortality in the united states and in Japan. Am. J. Cardiol. Excerpta Medica. 2014. Vol. 113, №1. P. 84–89.
14. Mancia G. et al. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology. J. Hypertens. 2013. Vol.31, №10. P.1925-1938.
15. Nurtazina A., Kozhakhmetova D. et al. Apolipoprotein B/A1 ratio as a diagnostic alternative to triglycerides and HDL-cholesterol for the prediction of metabolic syndrome among hypertensives in Kazakhstan. Diagnostics. MDPI AG. - Published online: 23 July 2020. https://doi.org/10.3390/diagnostics10080510.
16. Onat A. et al. Serum apolipoprotein B predicts dyslipidemia, metabolic syndrome and, in women, hypertension and diabetes, independent of markers of central obesity and inflammation. Int. J. Obes. (Lond). 2007. Vol. 31, № 7. P. 1119–1125.
17. Pitsavos C. et al. Risk stratification of apolipoprotein B, apolipoprotein A1, and apolipoprotein B/AI ratio on the prevalence of the metabolic syndrome: The ATTICA study. Angiology. 2008. Vol. 59, № 3. P. 335–341.
18. Rapsomaniki E. et al. Blood pressure and incidence of twelve cardiovascular diseases: Lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet. 2014. Vol. 383, № 9932. P.1899-1911.
19. Rosenzweig J.L. et al. Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk: An Endocrine Society* Clinical Practice Guideline. J. Clin. Endocrinol. Metab. The Endocrine Society. 2019. Vol. 104, № 9. P.3939–3985.
20. Sniderman A.D. et al. Age and cardiovascular risk attributable to apolipoprotein b, low-density lipoprotein cholesterol or non-high-density lipoprotein cholesterol. J. Am. Heart Assoc. John Wiley and Sons Inc. Published online 2016 Oct 13. doi: 10.1161/JAHA.116.003665.
21. Townsend N. et al. Cardiovascular disease in Europe - Epidemiological update 2015. Eur. Heart J. 2015. - Vol. 36, № 40. P. 2696–2705.
22. Tune J.D. et al. Cardiovascular consequences of metabolic syndrome. Transl. Res. Elsevier Ltd. 2017. Vol. 183. P. 57–70.
23. Zhang F. et al. The association of triglyceride and glucose index, and triglyceride to high-density lipoprotein cholesterol ratio with prehypertension and hypertension in normoglycemic subjects: A large cross-sectional population study. J. Clin. Hypertens. 2021. Vol.23, №7. P. 1405–1412.
24. Zhou B. et al. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021. Vol. 398, №10304.
25. Zhu L. et al. The IDF Definition Is Better Suited for Screening Metabolic Syndrome and Estimating Risks of Diabetes in Asian American Adults: Evidence from NHANES 2011–2016. J. Clin. Med. MDPI AG. 2020. Vol.9, № 12. P.3871.
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Kozhakhmetova D., Nurtazina A., Dautov D., Kazymov M., Adilgozhina S., Saidualiev D. Program for detecting dyslipidemia and verification of metabolic syndrome in Kazakh patients with arterial hypertension using apolipoproteins B and A1 // Nauka i Zdravookhranenie [Science & Healthcare]. 2021, (Vol.23) 5, pp. 78-84. doi 10.34689/SH.2021.23.5.009Related publications:
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