The metabolic syndrome in black hypertensive women waist circumference more strongly related than body Mass index

Objective. To examine the association between measures of obesity and features of the metabolic  syndrome in treated black female hypertensive subjects.Design. Cross-sectional study.Setting. An urban primary health care centre in Mamelodi, Pretoria.Subjects. Women with hypertension and without known diabetes mellitus or secondary causes of  hypertension. In total124 women participated, with a mean age of 56.9 years (standard deviation (SO) 11.0) and mean body mass index (BMI) of 34.1 kg/m' (SO 8.1).Main outcome measures. Blood pressure, glucose, insulin and lipid levels.Results. Waist circumference and waist-hip ratio were more strongly associated with insulin, uric acid,  glucose and triglycerides than was BMI. Statistically significant associations were found between waist circumference and low high-density lipoprotein HOL cholesterol (standardised regression coefficient --0.006, standard error of the mean (SEM) 0.002), log triglycerides (0.007, SEM 0.003), uric acid (0.002, SEM 0.001) and log insulin (0.012, SEM 0.003). BMI was only significantly associated with uric acid  (0.002, SEM 0.002) and log insulin (0.009, SEM 0.004).Conclusion. In a group of black hypertensive women measures of central obesity were more strongly  associated with components of the metabolic syndrome than BMI

Estimation of individual beneficial and adverse effects of intensive glucose control for patients with type 2 diabetes

AIMS/HYPOTHESIS: Intensive glucose control reduces the risk of vascular complications while increasing the risk of severe hypoglycaemia at a group level. We sought to estimate individual beneficial and adverse effects of intensive glucose control in patients with type 2 diabetes. METHODS: We performed a post hoc analysis of the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial, a randomised controlled trial evaluating standard vs intensive glucose control (HbA1c target ≤6.5% [48 mmol/mol]). In 11,140 participants, we estimated the individual 5 year absolute risk reduction (ARR) for the composite outcome of major micro- and macrovascular events and absolute risk increase (ARI) for severe hypoglycaemia for intensive vs standard glucose control. Predictions were based on competing risks models including clinical characteristics and randomised treatment. RESULTS: Based on these models, 76% of patients had a substantial estimated 5 year ARR for major vascular events (>1%, 5 year number-needed-to-benefit [NNTB5] 200). Similarly, 36% of patients had a substantial estimated ARI for severe hypoglycaemia (5 year number-needed-to-harm [NNTH5] 200). When assigning similar or half the weight to severe hypoglycaemia compared with a major vascular event, net benefit was positive in 85% or 99% of patients, respectively. Limiting intensive treatment to the 85% patient subgroup had no significant effect on the overall incidence of major vascular events and severe hypoglycaemia compared with treating all patients. CONCLUSIONS/INTERPRETATION: Taking account of the effects of intensive glucose control on major micro- and macrovascular events and severe hypoglycaemia for individual patients, the estimated net benefit was positive in the majority of the participants in the ADVANCE trial. The estimated individual effects can inform treatment decisions once individual weights assigned to positive and adverse effects have been specified. TRIAL REGISTRATION: ClinicalTrials.gov NCT00145925