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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Isolated vascular risk factors (e.g. hypercholesterolemia, hypertension, etc) are not commonly found in high risk patients. In fact, more often, constellations of risk factors are detected, giving rise to a so-called polymetabolic syndrome. Among the associated factors, insulin-resistance with altered carbohydrate tolerance, hypertriglyceridemia, hypertension and reduced HDL-cholesterol levels are most often described. Recent epidemiological studies underline the possible genetic basis of this syndrome, as shown in the highly consanguineous Utah population. The major determinant of the syndrome seems to be insulin-resistance. Development of hypertension within this syndrome may be linked to hyperinsulinemia, with increased intracellular Ca++ and/or obesity. The reduction of HDL-cholesterol may be secondary to the hypertriglyceridemia, again secondary to hyperstimulation, most likely from hyperinsulinemia. In the polymetabolic syndrome frequent alterations in the hemocoagulative system, mainly hyperfibrinogenemia/reduction of fibrinolysis, are recognized. Recently a circulating antagonist of fibrinolysis, PAI-1 has been described: PAI-1 levels are significantly correlated to those of plasma triglycerides. Regulation of fibrinogenemia is, instead, more complex and may only be partly linked to an increase of circulating lipids/lipoproteins. Development and stabilization of the syndrome, with the consequent vascular alterations, may be effectively prevented or treated by diet, and also by specific drugs. The choice is addressed to drugs reducing insulin-resistance and/or plasma triglycerides, possibly also raising HDL-cholesterol and reducing fibrinogen; among the possible options, bezafibrate seems to exert the largest number of effects.
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PMID:[The physiopathology and pharmacological approach to multiple metabolic and blood coagulation syndromes, the characteristics of atherogenesis]. 184 8

Postoperative deep-vein thrombosis can lead to fatal pulmonary embolism on one side, and the development of a disabling postthrombotic syndrome, which can occur after some time. General thrombo-embolic prophylaxis can reduce the risk of postoperative thrombo-embolic complications. Predisposing factors include age, obesity, immobilization and recumbency. Cardiovascular diseases, malignant neoplasms, venous disorders, diseases associated with increased viscosity of blood, past deep-vein thrombosis and pulmonary embolisms, some infectious diseases with raised fibrinogen levels, and inherited or acquired clotting factor deficiency syndromes (antithrombin III, protein C, protein S) have an elevated risk of thrombosis. The surgery itself, when taking more than 20 minutes and performed under general anesthesia, is a major risk factor, as proven initiation of thrombosis is often on the operation table. Patients receiving regional or local anesthesia have a clearly reduced risk of thrombosis. After general surgery without thrombosis prophylaxis, a deep-vein thrombosis can be demonstrated by the fibrinogen uptake test in about 30% of all patients over the age of 40. After abdominal surgery an incidence of thrombosis of 14-33%, and after hip surgery an incidence of nearly 50%, have been established by means of the fibrinogen uptake test. However only 10% of these thromboses are expressed clinically. We therefore recommend Liquid Crystal Contact Thermography, which has a sensitivity of 94% and a specificity of over 80%, as a non-invasive, easily performed screening method in the diagnosis of deep-vein thrombosis. Apart from the physical methods, the use of heparin is also indicated in thrombo-embolic prophylaxis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The thrombo-embolic risk in surgery. 193 69

Hyperinsulinaemia is said to be a risk factor for cardiovascular disease, but the extent to which different insulinaemic measures are associated with vascular risk factors in ostensibly healthy individuals, and whether they operate independently in men and women, remains uncertain. The association between risk factors and various insulinaemic measures was examined in 148 men and 118 women who were normoglycaemic, normotensive, and non-obese (body mass index in men less than 27, in women less than 25). A 75 g glucose tolerance test was administered after blood sampling for fibrinogen, lipids, lipoproteins and insulin. Insulin was also measured after 1 and 2 hours. Significant univariate correlations (p less than 0.01) were most consistently recorded between insulinaemic measures and fasting serum triglycerides in men and women, whilst systolic blood pressure only correlated with insulinaemia in women, and diastolic blood pressure correlated with fasting and 2 hour insulinaemic measures in men and women. Inconsistent associations were noted with total serum cholesterol in men and women, with high density lipoprotein cholesterol, body mass index, apoprotein B and A1 in men, and with fibrinogen in women. Age was not correlated with any insulinaemic measure in men or women. Differences in vascular risk factors between quintiles of the insulinaemic measures were examined, after correction for body mass index. The dominant association with fasting and post-glucose load insulinaemic measures was with triglycerides, especially in women, with less frequent graded differences between quintiles observed for total cholesterol, and diastolic and systolic blood pressures in men and women. The incidence of other risk factors often only differed in the lowest or highest quintile in comparison to other quintiles, suggesting a threshold rather than a graded effect. Furthermore, differences in HDL cholesterol and apoprotein B were only recorded for top quintiles of post-glucose challenge/integrated insulinaemic measures in men, whilst serum fibrinogen concentrations only differed significantly in women in the top insulinaemic area under the curve quintile. In the absence of additional risk factors such as diabetes, hypertension and obesity, insulinaemic measures are not consistently related to blood pressure and measures of lipid metabolism and coagulation, and are thus a weak predictor of other cardiovascular risk factors. The vascular risk profile associated with insulin appears somewhat different in apparently healthy men and women.
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PMID:The association of different measures of insulinaemia with vascular risk factors in healthy normoglycaemic normotensive non-obese men and women. 194 34

The euglobulin fibrinolytic activity was measured in 56 non-insulin-dependent diabetics and 118 age-matched healthy controls before and after venous occlusion for 5 min at 100 mmHg of the left antecubital vein. In the basal state, fibrinolytic activity was impaired in diabetics compared with controls (93.1 +/- 6.7 vs 101.6 +/- 0.9 BAU) (P less than 0.05) and plasma fibrinogen level was increased but this did not reach statistical significance (467.3 +/- 264.1 vs 359.2 +/- 200.2 mg/dl). In diabetics, stimulated fibrinolysis following venous occlusion was depressed compared with controls (110.6 +/- 3.9 vs 121.6 +/- 1.9 BAU) (P less than 0.05). No relation of fibrinolytic activity to age, duration of diabetes, obesity, serum triglyceride, HbA1c, or 24 h proteinuria was demonstrated. In the diabetic retinopathy group, the fibrinolytic activity was lower than in the non-retinopathy group. Diabetics with long-standing diabetes (10 years or more) who remained free from retinopathy had significantly increased fibrinolytic activity than the diabetics with short-standing diabetes (less than 10 years) who have developed retinopathy (P less than 0.05). These findings imply a poor fibrinolytic activity, not in all diabetics, but only in those with retinopathy, and this may play a role in the development of diabetic retinopathy.
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PMID:Euglobulin fibrinolytic activity in NIDDM patients. 195 78

Epidemiologic research indicates that glucose intolerance and hypertension are interrelated phenomena, each powerfully predisposing to atherosclerotic cardiovascular disease. Both diabetic and hypertensive patients have greater amounts of atherogenic risk factors, including dyslipidemia, hyperuricemia, elevated fibrinogen, and left ventricular hypertrophy. Diabetic persons have an increased prevalence of hypertension (50%), and glucose intolerance is more common in hypertension (15% to 18%). Both share a strong relationship to excess weight, but the excess of hypertension in diabetic persons occurs in both lean and obese subjects. Diabetes doubles the risk of hypertension associated with overweight. The risk of coronary disease, stroke, and peripheral arterial disease increases with increasing blood pressure to the same degree in diabetic persons as in nondiabetic persons, but at any level of blood pressure, diabetic persons have a doubled risk of these outcomes. Both diabetic and hypertensive patients are particularly prone to silent or unrecognized myocardial infarctions. Greater efforts at primary prevention of both hypertension and diabetes are clearly needed, including efforts at weight control, exercise, limitation of salt intake, and control of blood lipid levels. In either diabetic or hypertensive candidates for cardiovascular disease, optimization of the chances of avoiding sequelae requires a comprehensive multifactorial approach. Prevention requires more than normalization of either the blood sugar or blood pressure. Rational preventive measures must also include weight reduction, a fat-modified diet, cessation of smoking cigarettes, raising high-density lipoprotein, lowering low-density lipoprotein, and reduction of fibrinogen. Hypertension, obesity, insulin resistance, hyperinsulinemia, hypertriglyceridemia, and low high-density lipoprotein cholesterol tend to coexist.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The epidemiology of impaired glucose tolerance and hypertension. 200 55

More than the character of the blood pressure elevation, the cardiovascular risk profile should be the prognostic guide for antihypertensive therapeutic decision-making. Hypertension tends to occur in association with other risk factors which augment the risk and need to be considered in evaluating the hazard of hypertension, the urgency for treatment, and the choice of treatment. Elevated blood pressure is often accompanied by blood lipid abnormality, obesity, electrocardiograph (ECG) abnormality, glucose intolerance, and elevated fibrinogen and hematocrit, all of which enhance the risk of cardiovascular sequelae of hypertension. Hypertensive patients at particularly increased risk of cardiovascular events are those with an increased total/HDL-cholesterol ratio, ECG abnormality, impaired glucose tolerance, or the cigarette smoking habit. The risk of a cardiovascular event among hypertensive patients varies over more than a 10-fold range depending on the number of these coexistent risk factors. Multivariate risk formulations are available to allow a composite estimate of the joint conditional probability of a cardiovascular outcome in hypertensive patients with multiple risk factors. Since some antihypertensive agents can adversely affect blood lipids, glucose tolerance, or uric acid values, the risk profile must also be taken into account in choosing the optimal antihypertensive therapy. Also, hypertension is commonly associated with angina, myocardial infarction, left ventricular hypertrophy, stroke, or cardiac failure. These too must be taken under consideration in judging the urgency for treatment and the choice of agents. Thus, hypertension is best regarded as a component of a cardiovascular risk profile in implementing optimal therapy and in assessing its efficacy.
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PMID:The clinical heterogeneity of hypertension. 204 9

The study aimed to evaluate the behaviour of two pre-thrombotic markers (hyperfibrinogenemia and hypoanti-thrombinemia) in obesity which is considered a factor of atherogenous risk. Ninety-three obese subjects were included in the study (29 M, 64 F, mean age 55 +/- 6, BMI 33 +/- 1), including 62 Type 2 diabetics. The following were assayed in each subject: glucose, total cholesterol, triglycerides (enzymatic method), fibrinogen (coagulometric method) and anti-thrombin III (chromogenic method). Results were assessed in relation to sex, age (0-50, 51-65, over 65), BMI (upto 30, 31-35, over 35), waist/hip ratio (upto 0.95, 0.96-1.02, over 1.02), cholesterolemia (upto 200, 201-250, over 250 mg%) and triglyceridemia (upto 150, 151-200, over 200 mg%). A significant increase (0.05) in fibrinogenemia was observed in the subjects aged between 51-65, with BMI above 35, with an intermediate waist/hip ratio (0.96-1.02) and with cholesterolemia over 250 mg%; reduced values of anti-thrombin III were found in subjects over 65 years old and with the lowest waist-hip ratio (upto 0.95); no significant data were obtained for the other parameters and for the correlation between fibrinogen and anti-thrombin III. The pro-thrombotic importance of hyperfibrinogenemia is underlined in obese subjects; this is proportional to age, to the degree of overweight and levels of cholesterolemia, even if equivocal results emerge with regard to the "android" variety. The reduction of anti-thrombin III is correlated to senility and, surprisingly, to the gynoid-type waist/hip ratio.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Fibrinogen and antithrombin III in obese subjects]. 209 57

The relationship between hypertension, glucose metabolism, fibrinogen and plasminogen activator inhibitor of endothelial cell type (PAI-1) was studied under conditions in which the influence of obesity and adipose tissue distribution (waist/hip ratio) were controlled. Twenty-two non-obese, middle-aged men with normal blood pressure (n = 11) and untreated mild hypertension (n = 11), respectively, participated in the study. Cholesterol, triglyceride and insulin levels were higher in hypertensive men than in the control group. Glucose disposal was studied as an indicator of insulin sensitivity using the euglycaemic clamp technique. The insulin effect tended to be less marked in men with hypertension. PAI-1 was higher in hypertensive men compared to the controls. A strong positive correlation was observed between PAI-1 and insulin levels as well as blood pressure. PAI-1 and fibrinogen levels correlated negatively with the rate of glucose disposal. Thus, even in these non-obese and mildly hypertensive individuals, an enhanced metabolic risk factor profile for cardiovascular disease was found. The metabolic aberrations were related to elevated fibrinogen and PAI-1 levels which, in turn, increase the risk of thrombus formation.
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PMID:Elevated fibrinogen and plasminogen activator inhibitor (PAI-1) in hypertension are related to metabolic risk factors for cardiovascular disease. 232 74

The authors present the results of their blind prospective comparative study of the postoperative thromboembolic protection of 490 gynecologic patients. Among them 250 (51%) were protected by a low dose heparin (LDH) subcutaneously in 12-hour intervals, 240 (49%) received heparindihydergot (HDHE). Thromboembolisms diagnosed by the 125J fibrinogen uptake test appeared in 26 (10.4%) patients protected by LDH and 23 (9.6%) by HDHE. The most frequent risk factors in patients with thromboembolisms were malignant diseases, obesity, varicose veins, hypertension and a history of deep vein thrombosis or pulmonary embolism. Haemorrhages appeared in 7 (2.8%) patients protected by LDH and 8 (3.3%) by HDHE.
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PMID:[Prevention of thromboembolic disease in gynecologic surgery]. 221 51

The author investigated in a long term study of 8.7 +/- +/- 3.9 years risk factors of atherosclerosis (RFA) in 70 offspring of both parents suffering from non-insulin-dependent diabetes. Their mean age at the onset of the investigation was 35.2 +/- 7.4 years. The author assessed the incidence of obesity, hypertension, hyperglycaemia and hyperinsulinaemia after oGTT, elevated levels of cholesterol, triglycerides, fibrinogen and a reduced ratio of HDL on electrophoresis. As risk factors they considered: Broca's index above 110%, blood pressure above 150/90 mm Hg and other values above the average + 2SD recorded in a control group of 33 healthy non-obese subjects without a diabetic family-history; HDL values lower than the mean--2SD of controls. During the investigation period the incidence of obesity increased significantly (P less than 0.01); of hypertension (P less than 0.01); hyperglycaemia (P less than 0.05); hyperinsulinaemia (P less than 0.001) and the incidence of a low HDL ratio (P less than 0.01). The mean RFA values were lowest in offspring with a normal oGTT, higher in liminal glucose tolerance and highest in impaired glucose tolerance and diabetes. The most important RFA include an elevated fibrinogen level. The results indicate that in subjects with a high genetic risk of the development of non-insulin dependent diabetes already in the earliest stage conditions for the development of atherosclerosis are present.
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PMID:[Risk factors for atherosclerosis in the early stages of diabetes]. 233 28


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