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."
-end-
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

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