Low HDL-C: key predictor of metabolic syndrome in African American women

New US data highlight racial disparities in awareness of heart disease as a leading cause of death in women. Among African American women only 43% are now aware (1). This is despite a higher prevalence of type 2 diabetes and metabolic syndrome and 2-4-fold greater cardiovascular morbidity and mortality in this group than in white women (2,3).

 

The metabolic syndrome (defined by the National Cholesterol Education Program Adult Treatment Panel III) assumes that each of the components of the metabolic syndrome carries an equal risk for CVD, irrespective of ethnicity. This may not necessarily be true.  In particular, African Americans manifest more insulin resistance with higher HDL cholesterol levels and lower triglyceride levels than white subjects (4).

 

In a survey by the Ohio State University, low HDL cholesterol was more important than elevated triglycerides as a predictor of metabolic syndrome in non-diabetic African-American women.

 

Gaillard T, Schuster D, Osei K. Differential impact of serum glucose, triglycerides, and high-density lipoprotein cholesterol on cardiovascular risk factor burden in non-diabetic, obese African American women: implications for the prevalence of metabolic syndrome. Advance publication: doi:10.1016/j.metabol.2009.09.035.

 

In the study, the authors characterised the cardiovascular risk factor clustering in 258 obese non-diabetic African American women (mean age 42.4 years, mean BMI 33.4 kg/m2) using tertiles of serum HDL cholesterol, triglycerides and glucose. Non-diabetic status was confirmed by oral glucose tolerance tests.

 

Overall 35.5% of subjects met the metabolic criteria for metabolic syndrome. Prevalence increased significantly from the third to the first HDL cholesterol tertile, from 1.2% at mean HDL cholesterol of 65.5 mg/dL to 42.3% in subjects with mean HDL cholesterol 38.1 mg/dL. There was no significant increase in metabolic syndrome prevalence comparing first and third triglyceride tertiles (7% vs 17%) (Fig 1.).

 

Commenting on these findings Professor Philip Barter, HDL Forum Editor said: ‘This cross-sectional study suggests that low HDL cholesterol is a stronger predictor of metabolic syndrome and potentially cardiovascular risk burden than elevated triglycerides in African American women. These data underline the need to weight the components of the metabolic syndrome taking into account racial differences.’

 

References

1. Mosca L, Mochari-Greenberger H, Dolor RJ et al. Twelve-year follow-up of Amrican women’s awareness of cardiovascular disease risk and barriers to heart health. Circ Cardiovasc Qual Outcomes 2010;doi: 10.1161/CIRCOUTCOMES.109.915538.

2. Park YW, Zhu S, Palaniappan L et al. The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med 2003;163:427-36.

3. Hutchinson RG, Watson RL, Davis CE et al. Racial differences in risk factors for atherosclerosis. The ARIC study: Atherosclerosis Risk in Communities. Angiology 1997;48:279-90.

4. Taylor H, Liu J, Wilson G et al. Distinct component profiles and high risk among African American with the metabolic syndrome: the Jackson Heart Study. Diabetes Care 2008;31:1248-52.


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