Women and children face the music of the deadly quartet

November 12, 2000

NEW ORLEANS, Nov. 13 - A cluster of heart disease risk factors is significantly more dangerous for women than men, and in the future the next generation may be at even greater risk than their parents, according to results from two studies presented today at the American Heart Association's Scientific Sessions 2000. The first study, from the Cleveland Clinic Foundation, reports that individuals who underwent coronary artery bypass graft surgery (CABG) were more likely to die if they had any of the four risk factors sometimes called "the deadly quartet" - obesity, diabetes, high blood pressure and high triglyceride levels. Women with all four risk factors had five times the risk of death as men with all four risk factors.

Dennis L. Sprecher, M.D., director of preventive cardiology at the Cleveland Clinic Foundation, Cleveland, Ohio, studied 6,428 individuals who underwent heart bypass graft surgery for eight to 10 years following their procedure. Bypass surgery is a procedure to graft new blood vessels around blocked ones to increase blood flow to the heart. The researchers found that survival rates for these individuals decreased with each of the four risk factors. Individuals who had one risk factor were twice as likely to die within 10 years as those with no risk factors. Those with four risk factors were four times as likely to die within 10 years after surgery. When researchers looked at the differences between men and women, they found that the "deadly quartet" was much more dangerous for women.

"If a man and woman have equivalent levels of elevated risk the woman will still have a higher risk of mortality. With just one risk factor, women had nearly three times the risk of death as men," he adds. A second study looked at 688 rural youth between ages 11 and 14. Researchers examined a similar clustering of heart disease risk factors called multiple metabolic syndrome (MMS), which is marked by high insulin levels, high blood pressure and specific changes in cholesterol - either high triglycerides or low levels of high-density lipoprotein (HDL), the so-called "good" cholesterol that helps protect against heart disease.

The youth study separated the participants into one of eight groups: one with no risk factors, three with only one risk factor, three with two risk factors and one group with all three risk factors. Researchers found that obesity was much more common in children with MMS risk factors. Depending on the risk factor, individuals with only one were two to six times more likely to be obese; those with two risk factors were eight to 14 times more likely to be obese. If all three risk factors were present the likelihood of obesity jumped to 53 times.

"Since MMS is considered a precursor to type II diabetes, and obesity in youth is increasing, we should expect a major increase in type II diabetes and coronary heart disease in the future," says JoAnne S. Harrell, Ph.D., a professor of nursing and director of the Center for Research on Preventing and Managing Chronic Illness in Vulnerable People at University of North Carolina at Chapel Hill.

Her study looked at hyperinsulinemia - high levels of insulin in the blood - rather than diabetes because hyperinsulinemia appears about 10 years before the onset of type II diabetes.

"I was amazed when I found out how many of these kids were at increased risk, seven times the number one would have expected," she says. "We have to take steps to halt the epidemic of obesity in our children and adolescents."

Both researchers felt that preventing obesity in young people is the only way to reverse the alarming trends they see.

"Obesity is rampant in this country and increasing," Sprecher says. "Diabetes is increasing dramatically in older people and alarmingly in young people."

"The people in my study have already developed heart disease. They've already had bypass surgery," Sprecher says. "It's clear that the obesity and the clustering of metabolic syndrome factors are as evident in childhood as they are later on in adulthood. We need to target cardiovascular risk factors in the pediatric population."
Sprecher's co-author is Gregory L. Pearce, M.S. Harrell's co-authors include Robert G. McMurray, Ph.D.; Shrikant I. Bangdiwala, Ph.D.; Shibing Deng, M.S.; Chyrise Bradley, M.A.; Marsha Davenport, M.D.; and John Buse, M.D.

NR00-1184 (SS2000/Sprecher-Harrell)

American Heart Association

Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.