Assessment of the prevalence of target organ damage at various stages of the cardiometabolic continuum. According to the ESSE RF study

Objective: to assess the prevalence of target organ damage (TOD) at various stages of the cardiometabolic continuum, including abdominal obesity (AO) without metabolic syndrome (MS), MS, and type 2 diabetes mellitus (DM).

Materials and methods: this study presents an analysis of data from a sample of residents of Tomsk (1,104 examined from an unorganized adult population of 25-64 years), performed within the framework of the ESSAY RF-2012 project (Epidemiology of Cardiovascular Diseases in the Regions of the Russian Federation). The analysis included the presence of LV hypertrophy (LVH), a decrease in glomerular filtration rate (GFR), an increase in the thickness of the intima-media complex (TIM), the presence of atherosclerotic plaques (ASP) in the common carotid arteries (CCA).

Results: TODs were already reported among individuals with isolated AO (without MS), whose prevalence was statistically significantly higher compared to those with normal body weight. Atherosclerosis of CCA turned out to be the most frequent TOD phenotype, ASP was detected in 22% of individuals with isolated AO, in 33% patients with MS and 35% patients with type 2 DM, the second most common was LVH, which was detected in 0.8%, 4,7% and 17,5% of cases, respectively, the least common was a decrease in GFR – in 1,37%, 3,7% and 6,7% of patients, respectively. Differences in the frequency of TOD in all groups were statistically significant (p < 0,01).

Conclusions: Thus, the prevalence of TODs detected already at the stage of isolated AO progressively increased from group to group, as they moved along the cardiometabolic continuum.

1. Ford ES, Capewell S. Proportion of the decline in cardiovascular mortality disease due to prevention versus treatment: public health versus clinical care. Annu Rev Public Health. 2011; 32:5–22. https://doi.org/10.1146/annurev-publhealth-031210-101211

2. Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, Giles WH, Capewell SExplaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med. 2007;356: 2388–2398. https://doi.org/10.1056/nejmsa053935

3. Artinian NT, Fletcher GF, Mozaffarian D, et al. American Heart Association Prevention Committee of the Council on Cardiovascular Nursing Interventions to PROMOTE physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation. 2010; 122: 406–441. https://doi.org/10.1161/cir.0b013e3181e8edf1

4. I.E. Chazova Chazova Yuliya Zhernakova Elena OshchepkovaS.A. Boytsov on Behalf of Study Pa Boytsov. Prevalence of Cardiovascular Risk Factors in Russian Population of Patients With Arterial Hypertension. Kardiologiia, October 2014;10:4-12 (in Russ.). https://dx.doi.org/10.18565/cardio.2014.10.4-12

5. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterolin Adults (Adult Treatment Panel III) Final Report. Circulation 2002;106:3143–421. PMID: 12485966

6. Alberti KG, Zimmet P, Shaw J, for the IDF Epidemiology Task Force Consensus Group. The metabolic syndrome—a new worldwide definition. Lancet 2005;366:1059–62. https://doi.org/10.1016/s0140-6736(05)67402-8

7. Després JP, Moorjani S, Lupien PJ, et al. Regional distribution of body fat, plasma lipoproteins, and cardiovascular disease. Arteriosclerosis. 1990; 10: 497–511. https://doi.org/10.1161/01.atv.10.4.497

8. Messier V, Karelis AD, Prud'homme D, et al. Identifying metabolically healthy but obese individuals in sedentary postmenopausal women. Obesity (Silver Spring). 2010; 18: 911–917. https://doi.org/10.1038/oby.2009.364

9. Wildman RP, Muntner P, Reynolds K, et al. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999–2004). Arch Intern Med. 2008; 168: 1617–1624. https://doi.org/10.1001/archinte.168.15.1617

10. Chazova I.E., Trubacheva I.A., Zhernakova Y.V., Oshchepkova E.V., Serebriakova V.N., Kaveshnikov V.S., Karpov R.S. The prevalence of arterial hypertension as a risk factor of cardiovascular diseases in one of the cities in Siberian Federal District. Systemic Hypertension. 2013;10(4):30-37. (in Russ.). https://doi.org/10.26442/SG28979

11. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–419. https://doi.org/10.1007/bf00280883

12. Shirai K, Utino J, Otsuka K, Takata M. A novel blood pressure-independent arterial wall stiffness parameter; cardio-ankle vascular index (CAVI). J Atheroscler Thromb. 2006 Apr;13(2):101-7. https://doi.org/10.5551/jat.13.101

13. van Vliet-Ostaptchouk JV, et al. The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies. BMC Endocr Disord. 2014;14:9. https://doi.org/10.1186/1472-6823-14-9

14. Brochu M, Tchernof A, Dionne IJ, Sites CK, Eltabbakh GH, Sims EA, Poehlman ET2001. What are the physical characteristics associated with a normal metabolic profile despite a high level of obesity in postmenopausal women? J Clin Endocrinol Metab 86:1020–1025. https://doi.org/10.1210/jcem.86.3.7365

15. Muscelli E, Camastra S, Gastaldelli A, Natali A, Masoni A, Pecori N, et al. Influence of duration of obesity on the insulin resistance of obese nondiabetic patients. Int J Obes Relat Metab Disord. 1998;22:262–267. https://doi.org/10.1038/sj.ijo.0800580

16. Achilike I, Hazuda HP, Fowler SP, Aung K, Lorenzo C Predicting the development of the metabolically healthy obese phenotype. Int J Obes (Lond). 2015 Feb;39(2):228-34. https://doi.org/10.1038/ijo.2014.113

17. Soriguer F, Gutierrez-Repiso C, Rubio-Martin E, et al. Metabolically healthy but obese, a matter of time? Findings from the prospective Pizarra study. J Clin Endocrinol Metab. 2013;98:2318–2325. https://doi.org/10.1210/jc.2012-4253

18. The CardioMetabolic Health Alliance. Working Toward a New Care Model for the Metabolic Syndrome. Journal of the American college of cardiology 2015;66(9):1050-1067. https://doi.org/10.1016/j.jacc.2015.06.1328

19. Ryden L., Grant P.G., Anker S.D., et.al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. The Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). European Heart Journal. https://doi.org/10.1093/eurheartj/eht108

20. Zhernakova Yu.V. Clinical characteristics of various variants of the course of the metabolic syndrome and the possibility of the effect of antihypertensive therapy on the level of blood pressure, the state of carbohydrate and lipid metabolism and the severity of obesity in patients with arterial hypertension and metabolic syndrome. Diss. Doctor of Medical Sciences, M., 2012. (in Russ.).

21. Sharipova G.M. Features of target organ damage in patients with arterial hypertension depending on the presence and absence of metabolic syndrome. Diss. Doctor of Medical Sciences, M., 2009. (in Russ.).

22. Ferrara LA, Cardoni O, Mancini M, Zanchetti A. Metabolic syndrome and left ventricular hypertrophy in a general population. Results from the Gubbio Study. J Hum Hypertens. 2007b Oct;21(10):795-801. https://doi.org/10.1038/sj.jhh.1002232

23. Hank Juo S., Lin H., Rundek T., Sabala E. et al. Genetic and Environmental Contributions to Carotid Intima-Media thickness and obesity phenotypes in the Northern Manhattan Family Study. Stroke. 2004;35(10):2243-2247. https://doi.org/10.1161/01.str.0000142132.20442.d8

24. Hoffmann IS, Jimenez E, Cubeddu LX. Urinary albumin excretion in lean, overweight and obese glucose tolerant individuals: its relationship with dyslipidaemia, hyperinsulinaemia and blood pressure. J Hum Hypertens. 2001 Jun;15(6):407-412. https://doi.org/10.1038/sj.jhh.1001193

25. Heiss G., Sharret A.R., Barnes R., Chambless L.E., Szklo M., Alzola C. Carotid atherosclerosis measured by B-mode ultrasound in population: associations with cardiovascular risk factors in the ARIC study. Am J Epidemiol. 1991;134(3):250-256. https://doi.org/10.1093/oxfordjournals.aje.a116078

26. Lorenz MW, von Kegler S, Steinmetz H, Markus HS, Sitzer M. Carotid intima-media thickening indicates a higher vascular risk across a wide age range: prospective data from the Carotid Atherosclerosis Progression Study (CAPS). Stroke. 2006 Jan;37(1):87-92. https://doi.org/10.1161/01.str.0000196964.24024.ea

27. Zimin Yu.V., Rodomanchenko T.V., Boyko T.A., Fedoseyeva A.V. Clinical and hemodynamic characteristics of hypertension associated with insulin resistance, relationship between LV myocardial mass and insulin hypersecretion. Cardiology 1998;4:9-13. (in Russ.).

28. Isomaa B, Almgren P, Tuomi T et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001;24:683–689. https://doi.org/10.2337/diacare.24.4.683

29. Alpert M.A. Obesity cardiomyopathy: pathophyzyology and evolution of clinical syndrome Am.J.Med.Sci. 2001; 32;225-236. https://doi.org/10.1097/00000441-200104000-00003

30. Chang Y, Yoo T, Ryu S et al. Abdominal obesity, systolic bood pressure and MAU in normotensive and euglicemic Korean men. Int. Obes (lond); 2006; 30(5):800-804. https://doi.org/10.1038/sj.ijo.0803210

31. Cbagnac A., Weinstein T, Korzets A, et al. Glomerular hemodinamics in severe obesity. Am J Renal Physio. 2000 May;278(5);F817-F822. https://doi.org/10.1152/ajprenal.2000.278.5.f817

32. Cirillo M., Senigalliesi L., Laurenzi M. et al. Microalbuminuria in nondiabetic adults; relations of blood pressure, body mass index, plasma cholesterol levels and smoking The GUBBIO Population Study. Arch. Intern. Med. 1998; 158(17):1933-1939. https://doi.org/10.1001/archinte.158.17.1933

33. Chen J, Muntner P, Hamm LL et al. The metabolic syndrome and chronic kidney disease in US adults. Ann Intern Med 2004;1403():167-74. https://doi.org/10.7326/0003-4819-140-3-200402030-00007