Cardiometabolic determinants of mortality in a geriatric population: Is there a 'reverse metabolic syndrome'?

Autor: Michel E. Safar, H. Safar, Jacques Blacher, Ulrich M. Vischer, P. Iaria, Pierre Ducimetière, K. Le Dudal, O. Henry, François Herrmann
Rok vydání: 2009
Předmět:
Male
Aging
Endocrinology
Diabetes and Metabolism
Blood Pressure
Kaplan-Meier Estimate
Overweight
Body Mass Index
Cohort Studies
chemistry.chemical_compound
Endocrinology
Risk Factors
Medicine
Prospective cohort study
Aged
80 and over
Cholesterol
HDL/blood
General Medicine
Diabetes Mellitus/*epidemiology/physiopathology
Cholesterol
LDL/blood
Cardiovascular Diseases
Female
lipids (amino acids
peptides
and proteins)
medicine.symptom
Mortality
medicine.medical_specialty
Insulin resistance
Diabetes mellitus
Internal medicine
Diabetes Mellitus
Internal Medicine
Humans
ddc:612
Aged
Proportional Hazards Models
Inflammation
Inflammation/epidemiology
business.industry
Cholesterol
Cardiovascular Diseases/epidemiology
Cholesterol
HDL
Malnutrition
nutritional and metabolic diseases
Cholesterol
LDL
medicine.disease
Blood pressure
chemistry
ddc:618.97
Malnutrition/epidemiology
Insulin Resistance
Metabolic syndrome
business
Body mass index
Zdroj: Diabetes & Metabolism, Vol. 35, No 2 (2009) pp. 108-114
ISSN: 1262-3636
DOI: 10.1016/j.diabet.2008.08.006
Popis: Aims Diabetes or insulin resistance, overweight, arterial hypertension, and dyslipidaemia are recognized risk factors for cardiovascular (CV) disease. However, their predictive value and hierarchy in elderly subjects remain uncertain. Methods We investigated the impact of cardiometabolic risk factors on mortality in a prospective cohort study of 331 elderly high-risk subjects (mean age±SD: 85±7years). Results Two-year total mortality was predicted by age, diabetes, low BMI, low diastolic blood pressure (DBP), low total and HDL cholesterol, and previous CV events. The effect of diabetes was explained by previous CV events. In non-diabetic subjects, mortality was predicted by high insulin sensitivity, determined by HOMA-IR and QUICKI indices. In multivariate analyses, the strongest mortality predictors were low BMI, low HDL cholesterol and previous myocardial infarction. Albumin, a marker of malnutrition, was associated with blood pressure, total and HDL cholesterol, and HOMA-IR. The inflammation marker CRP was associated with low total and HDL cholesterol, and high HOMA-IR. Conclusion In very old patients, low BMI, low DBP, low total and HDL cholesterol, and high insulin sensitivity predict total mortality, indicating a "reverse metabolic syndrome" that is probably attributable to malnutrition and/or chronic disorders. These inverse associations limit the relevance of conventional risk factors. Previous CV events and HDL cholesterol remain strong predictors of mortality. Future studies should determine if and when the prevention and treatment of malnutrition in the elderly should be incorporated into conventional CV prevention.
Databáze: OpenAIRE
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