Predictors of ischaemic heart disease in a Malaysian population with the metabolic syndrome

Aims Cardiovascular disease is the foremost cause of mortality in Malaysia but little is known about the prevalence of the metabolic syndrome and its associations with other known cardiovascular risk markers. We undertook a population-based study to examine these. Methods For the study, 4341 subjects were selected using a multistage stratified sampling method. Subjects were interviewed for personal and past medical history. Biomedical markers and anthropometric indices were measured. The metabolic syndrome was defined using the harmonized criteria. The associations between the metabolic syndrome and cardiovascular risk markers, including high-sensitivity C-reactive protein, microalbuminuria and HbA1c were examined. Results The prevalence of the metabolic syndrome was 42.5. Subjects with the metabolic syndrome are significantly more likely to have higher BMI (> 25 kg/m2), HbA1c = 42 mmol/mol (6.0%), LDL (= 2.6 mmol/l), elevated albumin:creatinine ratio (> 2.5 mu g/mmol creatinine for men, 3.5 mu g/mmol creatinine for women) and high-sensitivity C-reactive protein (> 3 mg/l); odds ratio 5.48, 6.14, 1.44, 3.68 and 1.84, respectively, P 48 mmol/mol (6.5%) is associated with increased relative risk of elevated albumin:creatinine ratio, high-sensitivity C-reactive protein and LDL (relative risk 3.10, 2.46 and 1.65 respectively, P < 0.001). Conclusions We confirmed the high prevalence of the metabolic syndrome in Malaysia. Our study revealed a strong relationship between risk markers of elevated BMI, HbA1c, LDL, albumin:creatinine ratio and high-sensitivity C-reactive protein with the presence of the metabolic syndrome, putting them at a statistically high risk for cardiovascular mortality

Socioedemographic determinants of glycaemic control in young diabetic patients in peninsular Malaysia

Recent studies have shown that good glycaemic control can prevent the development of diabetic complications in type 1 and type 2 diabetes. We wished to observe the glycaemic control in patients from different centres in Peninsular Malaysia and the factors that determine it. We recruited 926 patients with diabetes diagnosed before age 40 years from seven different centres, with proportionate representation from the three main ethnic groups. Clinical history and physical examination were done and blood taken for HbA(1c) and fasting glucose. The overall glycaemic control was poor with geometric mean HbA(1c) of 8.6 whilst 61.1 of the patients had HbA(1c) greater than 8. Glycaemic control in patients with type 2 diabetes varied between various centres and ethnic groups, with the best control obtained in Chinese patients. Significant predictors of HbA(1c) in both type 1 and type 2 diabetes include access to nurse educators, ethnic background and WHR. In type 2 diabetes, use of insulin was a significant predictor, while in type 1 diabetes, household income was a significant predictor. Socioeconomic status did not have a significant effect in type 2 diabetes. There were no significant differences in the glycaemic control in patients with different educational status. In conclusion, glycaemic control in big hospitals in Malaysia was poor, and was closely related to the availability of diabetes care facilities and ethnic group, rather than socioeconomic status. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved

Prevalence of glutamic acid decarboxylase antibodies amongst young Malaysian diabetics

This study determined the prevalence of glutamic acid decarboxylase antibodies (GAD Ab) in a group of 926 young Malaysian diabetics of three ethnic groups, Malay, Chinese, and Indian. Patients were clinically diagnosed to be Type 1 or Type 2 before the age of 40 years. The overall GAD Ab positivity was 17.4 (161/926), significantly higher in the Type 1 than the Type 2 diabetics (35.5, 116/329 vs. 7.5, 45/597, P = 0.0001). Compared to GAD Ab negative patients, seropositive diabetics were diagnosed at younger age (21.2 +/- 0.9 vs. 27.4 +/- 0.3 y, P = 0.0001), had lower fasting (289 +/- 27.4 vs. 640 +/- 17.6 pmol/l, P = 0.0001) and post-glucagon C-peptide levels (527 +/- 51.8 vs. 1030 +/- 28.9 pmol/l, P = 0.0001). There were no racial differences in the prevalence of GAD Ab; of the total Type 1, 30.8, 36.4, and 39.4 were Malay, Chinese, and Indian diabetics, respectively and of the total Type 2, 8.8, 8.2, and 4.4 were Malay, Chinese, and Indian diabetics respectively. There was a curvilinear relationship between GAD Ab and the post-glucagon C-peptide levels, suggesting that GAD Ab do play a role in the beta-cells destruction and could be an important immune marker for the LADA group. This study reconfirmed previous reports that the autoimmune mechanisms in the Type 1 Asian diabetics are indeed different from the Caucasians, and further investigations should be carried out to explain the differences. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved

Clustering of metabolic syndrome factors in Malaysian population: Asian criteria revisited

Introduction: Metabolic syndrome (MetS) had been known as clustering of risk factors for cardiovascular disease and diabetes. Over the years, clinical criteria had been revised to highlight importance of various risk factors in defining MetS. Studies had reported different clustering of factors based on different population characteristics. Objective: Our study aimed to identify the clustering factors among our Malaysian population based on sexes and 4 major ethnic groups namely Malay, Chinese, Indian and other minor ethnic Methods: A national cross sectional study was done covering both Peninsular and East Malaysia. Subjects� sociodemographic, body mass index (BMI), waist, hip and neck circumference, blood pressure, fasting triglycerides (TG) and HDL-cholesterol and glucose, urine microalbumin and serum insulin were taken. Principal component factor analysis with Varimax rotation was done to identify the clustering based on sex and ethnic groups. Results: One thousand two hundred and sixty eight male and 2355 female subjects were recruited. Majority of subjects were Malays (63.0) followed by Chinese (13.3), Indian (7.4) and other ethnic groups (13.8) which followed the population composition in Malaysia. Four factors were identified for both men and women. The factors were anthropometry, glycemia, blood pressure and dyslipidemia given the cumulative percent of variance of 69.4 and 65.9 respectively. There are 4 factors identified for Malay, Chinese and Aborigines but 5 factors for Indian ethnic groups given cumulative percent of variance explained ranged from 65.1 to 77.7. Discussion and Conclusion: BMI, neck circumference, blood pressure, Fasting TG and HDL had a high factor loading in both sexes suggesting that for field screening, diagnostic criteria would be adequate criteria. These factors also showed a similar pattern of loading by different ethnic groups. In conclusion,in Malaysian population, at least one measurement from each components namely anthropometric, blood pressure, glycemia and dyslipidemia is adequate to diagnose MetS