Endocrinology and Metabolism

Original Articles

Clinical Study
Urinary Albumin Excretion Reflects Cardiovascular Risk in Postmenopausal Women without Diabetes: The 2011 to 2013 Korean National Health and Nutrition Examination Survey: Hee Jung Ahn, Do Sik Moon, Da Yeong Kang, Jung In Lee, Da Young Kim, Jin Hwa Kim, Sang Yong Kim, Hak Yeon Bae; Endocrinol Metab. 2016;31(4):537-546. Published online November 3, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.4.537

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Background

The objective of the current study was to determine whether there was an association between urinary albumin excretion and cardiovascular disease (CVD) risk by estimating the Framingham Risk Score (FRS) in postmenopausal women without diabetes.

Methods

This study was based on data from the Korea National Health and Nutrition Examination Survey, which was conducted by the Korean Ministry of Health and Welfare in 2011 to 2013. Data on 2,316 postmenopausal women from a total of 24,594 participants was included in the analysis.

Results

The mean FRS was significantly different in each of the urinary albumin to creatinine ratio (UACR) subgroups, and it increased with UACR. The FRS was 12.69±0.12 in the optimal group, 14.30±0.19 in the intermediate normal group, 14.62±0.26 in the high normal group, and 15.86±0.36 in the microalbuminuria group. After fully adjusting for potential confounding factors, high normal levels and microalbuminuria were significantly associated with the highest tertile of FRS ([odds ratio (OR), 1.642; 95% confidence interval (CI), 1.124 to 2.400] and [OR, 3.385; 95% CI, 2.088 to 5.488], respectively) compared with the optimal subgroup. High normal levels and microalbuminuria were also significantly associated with a ≥10% 10-year risk of CVD ([OR, 1.853; 95% CI, 1.122 to 3.060] and [OR, 2.831; 95% CI, 1.327 to 6.037], respectively) after adjusting for potential confounding covariates.

Conclusion

Urinary albumin excretion reflects CVD risk in postmenopausal women without diabetes, and high normal levels and microalbuminuria were independently associated with a higher risk of CVD.

Citations

Citations to this article as recorded by

Association between urinary albumin creatinine ratio and cardiovascular disease
Yoo Jin Kim, Sang Won Hwang, Taesic Lee, Jun Young Lee, Young Uh, Gulali Aktas
PLOS ONE.2023; 18(3): e0283083. CrossRef
Relationship between Hypertension and the Declining Renal Function in Korean Adults
Jun Ho Lee
The Korean Journal of Clinical Laboratory Science.2021; 53(1): 32. CrossRef
Significance of Obstetrical History with Future Cardiovascular Disease Risk
Emmanuel Bassily, Cameron Bell, Sean Verma, Nidhi Patel, Aarti Patel
The American Journal of Medicine.2019; 132(5): 567. CrossRef
Articles inEndocrinology and Metabolismin 2016
Won-Young Lee
Endocrinology and Metabolism.2017; 32(1): 62. CrossRef

Obesity and Metabolism
Factors Associated with Glycemic Variability in Patients with Type 2 Diabetes: Focus on Oral Hypoglycemic Agents and Cardiovascular Risk Factors: Soyeon Yoo, Sang-Ouk Chin, Sang-Ah Lee, Gwanpyo Koh; Endocrinol Metab. 2015;30(3):352-360. Published online August 4, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.3.352

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Abstract PDF Supplementary Material PubReader

Background

The role of glycemic variability (GV) in development of cardiovascular diseases remains controversial, and factors that determine glucose fluctuation in patients with diabetes are unknown. We investigated relationships between GV indices, kinds of oral hypoglycemic agents (OHAs), and cardiovascular risk factors in patients with type 2 diabetes mellitus (T2DM).

Methods

We analyzed 209 patients with T2DM. The GV index (standard deviation [SD] and mean absolute glucose change [MAG]) were calculated from 7-point self-monitoring of blood glucose profiles. The patients were classified into four groups according to whether they take OHAs known as GV-lowering (A) and GV-increasing (B): 1 (A only), 2 (neither), 3 (both A and B), and 4 (B only). The 10-year risk for atherosclerotic cardiovascular disease (ASCVD) was calculated using the Pooled Cohort Equations.

Results

GV indices were significantly higher in patients taking sulfonylureas (SUs), but lower in those taking dipeptidyl peptidase-4 inhibitors. In hierarchical regression analysis, the use of SUs remained independent correlates of the SD (β=0.209, P=0.009) and MAG (β=0.214, P=0.011). In four OHA groups, GV indices increased progressively from group 1 to group 4. However, these did not differ according to quartiles of 10-year ASCVD risk.

Conclusion

GV indices correlated significantly with the use of OHAs, particularly SU, and differed significantly according to combination of OHAs. However, cardiovascular risk factors and 10-year ASCVD risk were not related to GV indices. These findings suggest that GV is largely determined by properties of OHAs and not to cardiovascular complications in patients with T2DM.

Citations

Citations to this article as recorded by

Prognostic value of longitudinal HbA1c variability in predicting the development of diabetic sensorimotor polyneuropathy among patients with type 2 diabetes mellitus: A prospective cohort observational study
Yun‐Ru Lai, Wen‐Chan Chiu, Chih‐Cheng Huang, Ben‐Chung Cheng, I‐Hsun Yu, Chia‐Te Kung, Ting Yin Lin, Hui Ching Chiang, Chun‐En Aurea Kuo, Cheng‐Hsien Lu
Journal of Diabetes Investigation.2024; 15(3): 326. CrossRef
Influence of dipeptidyl peptidase-4 inhibitors on glycemic variability in patients with type 2 diabetes: A meta-analysis of randomized controlled trials
Shangyu Chai, Ruya Zhang, Ye Zhang, Richard David Carr, Yiman Zheng, Swapnil Rajpathak, Miao Yu
Frontiers in Endocrinology.2022;[Epub] CrossRef
Glycemic Variability in Subjects with Diabetes and Hypogonadism during Testosterone Replacement Treatment: A Pilot Study
Giuseppe Defeudis, Ernesto Maddaloni, Giovanni Rossini, Alfonso Maria Di Tommaso, Rossella Mazzilli, Paolo Di Palma, Paolo Pozzilli, Nicola Napoli
Journal of Clinical Medicine.2022; 11(18): 5333. CrossRef
New Insights into the Role of Visit-to-Visit Glycemic Variability and Blood Pressure Variability in Cardiovascular Disease Risk
Jin J. Zhou, Daniel S. Nuyujukian, Peter D. Reaven
Current Cardiology Reports.2021;[Epub] CrossRef
Prevalence of glycemic variability and factors associated with the glycemic arrays among end-stage kidney disease patients on chronic hemodialysis
Abdul Hanif Khan Yusof Khan, Nor Fadhlina Zakaria, Muhammad Adil Zainal Abidin, Nor Azmi Kamaruddin
Medicine.2021; 100(30): e26729. CrossRef
Dipeptidyl-Peptidase-IV Inhibitors, Imigliptin and Alogliptin, Improve Beta-Cell Function in Type 2 Diabetes
Xu Liu, Yang Liu, Hongzhong Liu, Haiyan Li, Jianhong Yang, Pei Hu, Xinhua Xiao, Dongyang Liu
Frontiers in Endocrinology.2021;[Epub] CrossRef
HbA 1C variability and hypoglycemia hospitalization in adults with type 1 and type 2 diabetes: A nested case-control study
Victor W. Zhong, Juhaeri Juhaeri, Stephen R. Cole, Christina M. Shay, Penny Gordon-Larsen, Evangelos Kontopantelis, Elizabeth J. Mayer-Davis
Journal of Diabetes and its Complications.2018; 32(2): 203. CrossRef
Glucose fluctuation and the resultant endothelial injury are correlated with pancreatic β cell dysfunction in patients with coronary artery disease
Makoto Murata, Hitoshi Adachi, Shigeru Oshima, Masahiko Kurabayashi
Diabetes Research and Clinical Practice.2017; 131: 107. CrossRef
Efficacy of lifestyle interventions in patients with type 2 diabetes: A systematic review and meta-analysis
Xiao-Li Huang, Jian-Hua Pan, Dan Chen, Jing Chen, Fang Chen, Tao-Tao Hu
European Journal of Internal Medicine.2016; 27: 37. CrossRef

The Changes in Atherosclerotic Markers and Adiopocytokines after Treatment with Growth Hormone for the Patients with Hypopituitarism and Growth Hormone Deficiency.: Hyun Won Shin, In Kyung Jeong, Goo Yeong Cho, Cheul Young Choi, Jong Yeop Kim, Yeong Je Chae, Min Ho Cho, Byung Wan Lee, Seong Jin Lee, Chul Young Park, Eun Gyoung Hong, Hyeon Kyu Kim, Doo Man Kim, Jae Myung Yu, Sung Hee Ihm, Moon Ki Choi, Hyung Joon Yoo, Sung Woo Park; J Korean Endocr Soc. 2006;21(6):515-525. Published online December 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.6.515

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Abstract PDF

BACKGROUND
It is known that patients with hypopituitarism have a high mortality rate due to the presence of atherosclerosis, cardiovascular diseases and stroke. The aim of this study was the effect of growth hormone (GH) on the atherosclerotic markers and the adipocytokine levels. METHOD: The study was conducted on 13 adult patients with hypopituitarism and growth hormone deficiency (GHD), and they had been stabilized after receiving hormone replacement therapy for other insufficient pituitary hormones, other than GH, for more than one year. Before treatment with GH, we compared the lipid metabolism, glucose metabolism, cardiovascular risk factors and adipocytokine levels, including adiponectin, leptin, TNF-alpha and IL-6, between the GHD patients and 13 healthy adults who were of a similar age and gender distribution. Patients with GHD were treated with 1 U/day of GH for 6 months. We measured insulin-like growth factor-I (IGF-I), blood pressure, body composition, lipid metabolism, glucose metabolism and hs-CRP, cardiac function, adiponectin, leptin, TNF-alpha and IL-6 levels, flow mediated vasodilation (FMD) and nitroglycerin mediated vasodilation (NMD) before and after GH treatment. RESULTS: The patients with hypopituitarism and GHD showed significantly higher levels of total cholesterol (P = 0.002), low-density lipoprotein cholesterol (LDL-C) (P = 0.036), hs-CRP (P = 0.0087) and leptin (P < 0.001) than did the normal healthy adults. However, there was no difference between the normal adults and the patients with GHD for the systolic and diastolic BP, the levels of apoA, apoB, fasting blood glucose(FBG) and HOMA-IR. In the subjects with GHD after treatment with GH, the level of fat mass (P = 0.0017), total cholesterol (P = 0.004), LDL-C (P = 0.001), leptin (P = 0.013), TNF-alpha (P < 0.001) and hs-CRP (P = 0.0001) were significantly reduced, while lean body mass (P = 0.0161), FFA (P = 0.049) and FMD (P = 0.0051) showed a significant increase. However, there was no significant difference in the level of the systolic and diastolic BP, LDL-C, apoA, apoB, LP (a), HOMA-IR, ejection fraction, left ventricular posterior wall, E/A ratio, intraventricular septum, NMD, intima-media thickness, adiponectin, IL-6, FBG and fasting insulin before and after GH treatment. CONCLUSION: The subjects with GHD were vulnerable to cardiovascular disease. GH therapy for 6 months had a positive effect on their various cardiovascular risk factors.

Citations

Citations to this article as recorded by

Molecular Biology of Atherosclerosis
In-Kyung Jeong
Endocrinology and Metabolism.2010; 25(3): 166. CrossRef

The Effects on Visceral Fat and Cardiovascular Risk Factors of Testosterone Replacement in Secondary Hypogonadal Men.: Eui Sil Hong, Sung Yeon Kim, Young Ju Choi, Sang Wan Kim, Chan Soo Shin, Kyong Soo Park, Hak Chul Jang, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee; J Korean Endocr Soc. 2005;20(3):252-260. Published online June 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.3.252

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Abstract PDF

BACKGROUND
Increased body fat, abdominal obesity and insulin resistance are important clinical features in hypogonadal men. Several studies have demonstrated that a low testosterone concentration in men is associated with coronary heart disease, visceral obesity and insulin resistance. In this study, the effects of testosterone replacement therapy on the abdominal visceral fat and cardiovascular risk factors in hypogonadal men were investigated. METHODS: We selected 26 men with secondary hypogonadism (mean serum testosterone+/-SD 0.39+/- 0.57ng/mL), who were then treated with testosterone for 12 months. We measured the body composition, including the abdominal visceral fat area by abdominal CT at the L4 level, both before and 12 months after treatment, and the lipid profile, fasting plasma insulin, HOMA-IR and the serum homocysteine, CRP and IL-6 before and 6, 12 months after treatment. RESULTS: With respect to the body composition, the lean body mass had significantly increased 12 months after treatment(P= 0.002), but there were no significant changes in the body fat mass and abdominal visceral fat area. There was a trend toward a decreased fasting plasma insulin and HOMA-IR, but this did not reach statistical significance. The total cholesterol had decreased significantly at 12 months(P=0.04) and the HDL cholesterol decreased significantly over the course of study(P=0.02). There were no significant changes in the serum homocysteine, CRP and IL-6 after treatment. CONCLUSIONS: After 12 months testosterone replacement therapy in the 26 men with hypogonadism, the lean body mass had increased significantly, but there was no significant change on the abdominal visceral fat during the treatment period. Testosterone replacement had deleterious effect on HDL cholesterol, but not significant effects on insulin resistance and the serum homocysteine, CRP and IL-6. These results suggest that testosterone replacement therapy may have a few adverse effects on cardiovascular diseases in hypogonadal men. However, it will be necessary to examine the long-term effects of testosterone replacement on the incidence of cardiovascular events as well as the cardiovascular risk factors in men with hypogonadism

Citations

Citations to this article as recorded by

The Association of Level of Testosterone and Parameters of Obesity
Chong Hwa Kim
The Korean Journal of Obesity.2015; 24(1): 28. CrossRef
The Relationship between Various Obesity Indices and Level of Male Hormone according to Different Age Groups
Yoo-Jung Lee, Hyeon-Ju Kim, Mi-Hee Kong
The Korean Journal of Obesity.2014; 23(4): 245. CrossRef
Androgen Receptor Gene CAG Repeat Polymorphism and Effect of Testosterone Therapy in Hypogonadal Men in Korea
Min Joo Kim, Jin Taek Kim, Sun Wook Cho, Sang Wan Kim, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim
Endocrinology and Metabolism.2011; 26(3): 225. CrossRef
Effects of Androgen on the Cardiovascular System in the Aging Male
Jin Wook Kim, Je Jong Kim, Du Geon Moon
Korean Journal of Andrology.2011; 29(1): 10. CrossRef

Relationship between Circulating Osteoprotegerin and Cardiovascular Risk Factors in Women.: Ki Won Oh, Eun Joo Yun, Eun Sook Oh, Eun Jung Rhee, Won Young Lee, Ki Hyun Baek, Kun Ho Yoon, Moo Il Kang, Cheol Young Park, Moon Ki Choi, Hyung Joon Yoo, Sung Woo Park; J Korean Endocr Soc. 2005;20(1):52-63. Published online February 1, 2005

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Abstract PDF: BACKGROUND
Osteoprotegerin(OPG) is a recently identified cytokine, which acts as a decoy receptor for the receptor activator of NF-B ligand(RANKL). OPG has been shown to be an important inhibitor of osteoclastogenesis and arterial calcification in animal models. Recently, OPG has been proposed as a link molecule between osteoporosis and arterial calcification. However, the relationship between circulating OPG levels and cardiovascular disease in human populations is unclear. Thus, the aim of this study was to investigate the relationship between circulating OPG levels and cardiovascular risk factors in women. METHODS: The subjects were 286 women, with a mean age of 51.5 yr. The blood pressure, body mass index(BMI) and waist to hip ratio(WHR) were examined and the serum concentrations of OPG determined by ELISA. The fasting glucose levels, serum lipid profiles and follicle stimulating hormone (FSH) were measured by standard methods. RESULTS: A significant association was observed between the serum OPG levels, age and WHR(r=0.134, P<0.05). Also, the serum OPG levels were significantly correlated with the serum total cholesterol and low density lipoprotein cholesterol levels(r=0.175, P<0.01; r=0.176, P<0.01). Conversely, there was a nonsignificant relationship between the serum OPG levels, blood pressure and fasting glucose levels. The mean serum OPG levels were found to be about 11% greater in post-than premenopausal women(mean+/-SD, 1358.5+/-380.0 vs. 1228.8+/-407.7pg/mL, respectively(P<0.001). There was a significant association between the serum OPG and serum FSH levels(r=0.176, P<0.01). CONCLUSION: In conclusion, our data show that the levels of circulating OPG are partially associated with the cardiovascular risk factors and female hormonal status in healthy women. These data suggest that OPG may be an important paracrine factor of cardiovascular disease in human female populations.

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