Abstract
<p>Metabolic syndrome (MS) is a cluster of risk factors for cardiovascular disease (CVD) and type 2 Diabetes (T2D) that has received increased attention from both epidemiologists and clinicians. However, there is scarcity of studies on how to identify subjects at high risk for the MS, and how to reduce and reverse its components (i.e. dyslipidemia, obesity, hyperglycemia, and hypertension) and associated risk factors such as high C-reactive protein (CRP) levels (i.e., subclinical inflammation).This dissertation focused on known metabolic and underlying factors associated with MS including, dyslipidemia (i.e. high triglycerides and low HDL-cholesterol), insulin resistance (IR), obesity, and inflammation. First, using a population-based approach, we examined the prevalence of the MS and its components in Zulia State, Venezuela, and established associated demographic and clinical risk factors for the MS. Then, using a high-risk population approach with patients that attended a screening program for glucose intolerance at the University of Miami, we evaluated the relationships among IR, apolipoprotein (apo) C-III levels, and dyslipidemia, as well as the association of CRP with the MS and its components.We found that approximately 1 in 3 patients meet the National Cholesterol Education Program/Adult Treatment Panel III diagnostic criteria for the MS in Zulia State, Venezuela with low HDL-cholesterol (65.3%), abdominal obesity (42.9%) and HTN (38.1%) as the most frequent MS components. MS prevalence increased with age, degree of obesity, family history of diabetes and hypertension, and sedentary lifestyle. We also found that MS was associated with high apo C-III (>14 mg/dl) levels in Hispanics and white non-Hispanics, but not in African-Americans. Overall apo C-III was directly associated with hypertriglyceridemia and IR (high HOMAIR), while an inverse relationship with low-density lipoprotein (LDL) particle size was evident in all T2D subjects and only among normoglycemic subjects with MS. Finally, we found that elevated CRP levels are associated with the presence of abdominal obesity and IR but not with other MS components in this high-risk population for CVD and diabetes, suggesting a potential role of IR and obesity in the development of the subclinical inflammation associated with the MS.</p>