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Disparities in cardio metabolic risk between Black and White women with polycystic ovary syndrome: a systematic review and meta-analysis.
Kazemi, M, Kim, JY, Parry, SA, Azziz, R, Lujan, ME
American journal of obstetrics and gynecology. 2021;(5):428-444.e8
Abstract
OBJECTIVE We conducted a systematic review and meta-analysis to summarize and quantitatively pool evidence on cardiometabolic health disparities between Black and White women with polycystic ovary syndrome in the United States in response to the call for further delineation of these disparities in the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. DATA SOURCES Databases of MEDLINE, Web of Science, and Scopus were searched initially through March 05, 2020, and confirmed on September 11, 2020. STUDY ELIGIBILITY CRITERIA Observational studies documenting cardiometabolic risk profile (glucoregulatory, lipid profile, anthropometric, and blood pressure status) in Black and White women with polycystic ovary syndrome were included. Studies on children (<17 years old) and pregnant or menopausal-aged women (>50 years) were excluded. The primary outcome was fasting glucose. Furthermore, data on major cardiovascular events (stroke, coronary heart disease, heart failure) and mortality rate (cardiovascular death, total mortality) were evaluated. METHODS Data were pooled by random-effects models and expressed as mean differences and 95% confidence intervals. Studies were weighted based on the inverse of the variance. Heterogeneity was evaluated by Cochran Q and I2 statistics. Study methodologic quality was assessed by the Newcastle-Ottawa scale. RESULTS A total of 11 studies (N=2851 [652 Black and 2199 White]) evaluated cardiometabolic risk profile and all had high quality (Newcastle-Ottawa scale score of ≥8). No studies reported on cardiovascular events and mortality rate. Black women had comparable fasting glucose (-0.61 [-1.69 to 2.92] mg/dL; I2=62.5%), yet exhibited increased fasting insulin (6.76 [4.97-8.56] μIU/mL; I2=59.0%); homeostatic model assessment of insulin resistance (1.47 [0.86-2.08]; I2=83.2%); systolic blood pressure (3.32 [0.34-6.30] mm Hg; I2=52.0%); and decreased triglyceride (-32.56 [-54.69 to -10.42] mg/dL; I2=68.0%) compared with White women (all, P≤.03). Groups exhibited comparable total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and diastolic blood pressure (all, P≥.06). CONCLUSIONS Black women with polycystic ovary syndrome have a greater tendency for an adverse cardiometabolic risk profile (increased insulin, homeostatic model assessment of insulin resistance, and systolic blood pressure) despite lower triglycerides than White women. Our observations support the consideration of these disparities for diagnostic, monitoring, and management practices in Black women and for future guideline recommendations. Given the heterogeneity among studies, future research should address the relative contributions of biologic, environmental, socioeconomic, and healthcare factors to the observed disparities. Furthermore, longitudinal research is required to address patient-pressing complications, including cardiovascular events and mortality rate in Black women with polycystic ovary syndrome as a high-risk yet understudied population.
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Relations between subclinical disease markers and type 2 diabetes, metabolic syndrome, and incident cardiovascular disease: the Jackson Heart Study.
Xanthakis, V, Sung, JH, Samdarshi, TE, Hill, AN, Musani, SK, Sims, M, Ghraibeh, KA, Liebson, PR, Taylor, HA, Vasan, RS, et al
Diabetes care. 2015;(6):1082-8
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OBJECTIVE The presence of subclinical disease measures has been directly associated with the development of cardiovascular disease (CVD) in whites. African Americans (AAs) in the U.S. are at higher risk of CVD compared with non-Hispanic whites; however, data on the prevalence of subclinical disease measures in AAs and their association to CVD remain unclear and may explain the higher CVD risk in this group. RESEARCH DESIGN AND METHODS We evaluated 4,416 participants attending the first examination of the Jackson Heart Study (mean age 54 years; 64% women) with available subclinical disease measures. RESULTS There were 1,155 participants (26%) with subclinical disease, defined as the presence of one or more of the following: peripheral arterial disease, left ventricular hypertrophy, microalbuminuria, high coronary artery calcium (CAC) score, and low left ventricular ejection fraction. In cross-sectional analyses using multivariable-adjusted logistic regression, participants with metabolic syndrome (MetS) or diabetes (DM) had higher odds of subclinical disease compared with those without MetS and DM (odds ratios 1.55 [95% CI 1.30-1.85] and 2.86 [95% CI 2.32-3.53], respectively). Furthermore, the presence of a high CAC score and left ventricular hypertrophy were directly associated with the incidence of CVD (265 events) in multivariable-adjusted Cox proportional hazards regression models (P < 0.05). In prospective analyses, having MetS or DM significantly increased the hazard of incident CVD, independent of the presence of subclinical disease (P < 0.001). CONCLUSIONS In our community-based sample of AAs, we observed a moderately high prevalence of subclinical disease, which in turn translated into a greater risk of CVD, especially in people with MetS and DM.
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Analysis of metabolic syndrome components in >15 000 african americans identifies pleiotropic variants: results from the population architecture using genomics and epidemiology study.
Carty, CL, Bhattacharjee, S, Haessler, J, Cheng, I, Hindorff, LA, Aroda, V, Carlson, CS, Hsu, CN, Wilkens, L, Liu, S, et al
Circulation. Cardiovascular genetics. 2014;(4):505-13
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BACKGROUND Metabolic syndrome (MetS) refers to the clustering of cardiometabolic risk factors, including dyslipidemia, central adiposity, hypertension, and hyperglycemia, in individuals. Identification of pleiotropic genetic factors associated with MetS traits may shed light on key pathways or mediators underlying MetS. METHODS AND RESULTS Using the Metabochip array in 15 148 African Americans from the Population Architecture using Genomics and Epidemiology (PAGE) study, we identify susceptibility loci and investigate pleiotropy among genetic variants using a subset-based meta-analysis method, ASsociation-analysis-based-on-subSETs (ASSET). Unlike conventional models that lack power when associations for MetS components are null or have opposite effects, Association-analysis-based-on-subsets uses 1-sided tests to detect positive and negative associations for components separately and combines tests accounting for correlations among components. With Association-analysis-based-on-subsets, we identify 27 single nucleotide polymorphisms in 1 glucose and 4 lipids loci (TCF7L2, LPL, APOA5, CETP, and APOC1/APOE/TOMM40) significantly associated with MetS components overall, all P<2.5e-7, the Bonferroni adjusted P value. Three loci replicate in a Hispanic population, n=5172. A novel African American-specific variant, rs12721054/APOC1, and rs10096633/LPL are associated with ≥3 MetS components. We find additional evidence of pleiotropy for APOE, TOMM40, TCF7L2, and CETP variants, many with opposing effects (eg, the same rs7901695/TCF7L2 allele is associated with increased odds of high glucose and decreased odds of central adiposity). CONCLUSIONS We highlight a method to increase power in large-scale genomic association analyses and report a novel variant associated with all MetS components in African Americans. We also identify pleiotropic associations that may be clinically useful in patient risk profiling and for informing translational research of potential gene targets and medications.
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Ethnic differences in triglyceride levels and high-density lipoprotein lead to underdiagnosis of the metabolic syndrome in black children and adults.
Sumner, AE
The Journal of pediatrics. 2009;(3):S7.e7-11
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The metabolic syndrome was designed to identify individuals at high risk for the development of type 2 diabetes and cardiovascular disease. Compared with whites, blacks have higher rates of diabetes and cardiovascular disease. Paradoxically, blacks have a lower prevalence of the metabolic syndrome. According to the criteria set by National Cholesterol Education Treatment Program-Adult Treatment Panel III, to diagnose the metabolic syndrome, 3 of 5 characteristics must be present. These characteristics are low high-density lipoprotein levels, increased triglyceride levels, central obesity, hypertension, and fasting hyperglycemia. Examining each of these factors individually, blacks are more likely than whites to have obesity, hypertension, and diabetes. In contrast, blacks are less likely than whites to have either elevated triglyceride or low high-density lipoprotein levels. Ethnic differences in lipid levels may largely explain why blacks have a lower than expected prevalence of the metabolic syndrome. In this review we will describe in children and adults ethnic differences in the epidemiologic study of conditions associated with the metabolic syndrome, as well as focus on each of the parameters of the metabolic syndrome. Overall, we conclude that an ethnic-specific formulation of the lipid criteria in the metabolic syndrome may lead to better identification of blacks at high risk for development of diabetes and cardiovascular disease.
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The moderating impact of ethnicity on metabolic outcomes during treatment with olanzapine and aripiprazole in patients with schizophrenia.
Meyer, JM, Rosenblatt, LC, Kim, E, Baker, RA, Whitehead, R
The Journal of clinical psychiatry. 2009;(3):318-25
Abstract
OBJECTIVE Race is strongly associated with risk for metabolic dysfunction, but there is limited prospective data concerning the impact of race on antipsychotic metabolic outcomes among patients with schizophrenia. METHOD This study is a post hoc analysis of data from a 26-week, double-blind, randomized trial of aripiprazole (N = 155) and olanzapine (N = 159) conducted from April 2000 through June 2001 in patients aged >or= 18 years with acute schizophrenia according to DSM-IV criteria. The data were analyzed on the basis of racial breakdown: white and black/Hispanic. Between-drug and within-drug outcomes were analyzed separately for each racial cohort across weight, lipid, and glucose parameters. RESULTS For white subjects (N = 167), olanzapine significantly worsened all metabolic parameters except high-density lipoprotein (HDL) cholesterol and fasting glucose, and this was significantly different than aripiprazole for every outcome except fasting glucose. In the black/Hispanic cohort (N = 137), olanzapine treatment resulted in adverse metabolic outcomes, and these changes were significantly different from aripiprazole for adiposity, total cholesterol, and non-HDL cholesterol. Aripiprazole decreased the odds of endpoint metabolic syndrome compared with olanzapine for all subjects (OR = 0.33, 95% CI = 0.19 to 0.55), the white cohort (OR = 0.20, 95% CI = 0.10 to 0.41), and black/Hispanic subjects (OR = 0.53, 95% CI = 0.25 to 1.12), but the black/Hispanic result was not statistically significant (p = .096). Within the aripiprazole group, white subjects had significantly lower risk for metabolic syndrome, but there was no significant difference in metabolic syndrome between white and black/Hispanic subjects exposed to olanzapine. CONCLUSIONS Race may be an important moderator of metabolic risk during atypical antipsychotic therapy. Olanzapine treatment is associated with greater effects on adiposity and lipids than aripiprazole in both white and black/Hispanic subjects, suggesting that antipsychotic choice and intensive monitoring are important in minimizing metabolic risk, especially in nonwhite patients.
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Metabolic syndrome in Black people of the African diaspora: the paradox of current classification, definition and criteria.
Gaillard, T, Schuster, D, Osei, K
Ethnicity & disease. 2009;(2 Suppl 2):S2-1-7
Abstract
According to the third National Health and Nutrition Examination Survey, African Americans have a lower prevalence of metabolic syndrome than do Whites. Recent reports in Blacks in other regions have confirmed these observations, but the rates vary. This lower rate of metabolic syndrome in Blacks can be partly ascribed to the lower prevalent rates of some major components of metabolic syndrome, namely serum triglyceride and high-density lipoprotein cholesterol levels in Blacks. This is in contrast with the higher prevalence of obesity (waist circumference) and blood pressure that meet National Cholesterol Education Program criteria in Blacks. Despite these seemingly favorable lipids and lipoprotein profiles, Blacks continue to have higher cardiovascular disease (CVD) mortality and morbidity, even in the absence of diabetes, than do Whites. Insulin resistance is more prevalent in Blacks than in Whites. However, the relationships among insulin resistance and CVD risk factors such as hypertension, high-density lipoprotein cholesterol, and triglycerides are weak in contrast with Whites. The paradox of more favorable lipid profile and conversely the higher rates of unfavorable blood pressure in Blacks calls into question the validity of the current criteria for metabolic syndrome in Blacks. Thus, it can be argued that each of the components of the metabolic syndrome carry different CVD risk factors in Blacks. The greater CVD mortality and morbidity in Blacks appear to be multifactorial. With the emerging epidemic of noncommunicable diseases, chronic kidney diseases due to both diabetes and hypertension have emerged as major CVD risks that are associated with increasing mortality and morbidity in Blacks. We need to emphasize specific components of metabolic syndrome, specifically blood pressure and chronic kidney disease, that carry higher CVD risk with associated greater morbidity and mortality for primary prevention of CVD and type 2 diabetes in Blacks. To this end, we believe the higher prevalence of hypertension and chronic kidney diseases in Blacks suggests that the current classification, definition, and criteria for metabolic syndrome in Blacks should be reconsidered.