Kodaman Nuri, Aldrich Melinda C, Sobota Rafal, Asselbergs Folkert W, Brown Nancy J, Moore Jason H, Williams Scott M
Vanderbilt Genetics Institute, Vanderbilt University Medical School, Nashville, TN Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH Department of Genetics, Geisel School of Medicine, Dartmouth College, Hanover, NH.
Division of Epidemiology, Department of Thoracic Surgery, Vanderbilt University Medical School, Nashville, TN.
J Am Heart Assoc. 2016 Oct 3;5(10):e003867. doi: 10.1161/JAHA.116.003867.
Metabolic syndrome (MetS) is diagnosed by the presence of at least 3 of the following: obesity, hypertension, hyperglycemia, hypertriglyceridemia, and low high-density lipoprotein. Individuals with MetS also typically have elevated plasma levels of the antifibrinolytic factor, plasminogen activator inhibitor-1 (PAI-1), but the relationships between PAI-1 and MetS diagnostic criteria are not clear. Understanding these relationships can elucidate the relevance of MetS to cardiovascular disease risk, because PAI-1 is associated with ischemic events and directly involved in thrombosis.
In a cross-sectional analysis of 2220 Ghanaian men and women from urban and rural locales, we found the age-standardized prevalence of MetS to be as high as 21.4% (urban women). PAI-1 level increased exponentially as the number of diagnostic criteria increased linearly (P<10), supporting the conclusion that MetS components have a joint effect that is stronger than their additive contributions. Body mass index, triglycerides, and fasting glucose were more strongly correlated with PAI-1 than with canonical MetS criteria, and this pattern did not change when pair-wise correlations were conditioned on all other risk factors, supporting an independent role for PAI-1 in MetS. Finally, whereas the correlations between conventional risk factors did not vary significantly by sex or across urban and rural environments, correlations with PAI-1 were generally stronger among urban participants.
MetS prevalence in the West African population we studied was comparable to that of the industrialized West. PAI-1 may serve as a key link between MetS, as currently defined, and the endpoints with which it is associated. Whether this association is generalizable will require follow-up.
代谢综合征（MetS）的诊断依据是存在以下至少3项：肥胖、高血压、高血糖、高甘油三酯血症和低高密度脂蛋白。患有MetS的个体血浆中抗纤溶因子纤溶酶原激活物抑制剂-1（PAI-1）水平通常也会升高，但PAI-1与MetS诊断标准之间的关系尚不清楚。了解这些关系有助于阐明MetS与心血管疾病风险的相关性，因为PAI-1与缺血性事件相关且直接参与血栓形成。
在对来自城乡地区的2220名加纳男性和女性进行的横断面分析中，我们发现MetS的年龄标准化患病率高达21.4%（城市女性）。随着诊断标准数量呈线性增加，PAI-1水平呈指数上升（P<10），这支持了以下结论：MetS各组分具有联合效应，其强度大于各组分单独作用之和。体重指数、甘油三酯和空腹血糖与PAI-1的相关性比与典型MetS标准的相关性更强，当对所有其他危险因素进行成对相关性分析时，这种模式并未改变，这支持了PAI-1在MetS中具有独立作用的观点。最后，虽然传统危险因素之间的相关性在性别或城乡环境中没有显著差异，但与PAI-1的相关性在城市参与者中通常更强。
我们研究的西非人群中MetS的患病率与西方工业化国家相当。PAI-1可能是目前定义的MetS与其相关终点之间的关键联系。这种关联是否具有普遍性还需要后续研究。
