CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 1, January/February 2011
AFRICA
29
to subject numbers, the present study population was too small
to achieve adequate statistical power in the case of some poly-
morphisms. However, the restriction of the study group to young
patients drawn from a homogeneous population base limits the
effects of non-genetic determinants, and provides an advantage
in the evaluation of genetic polymorphic variation and associa-
tive comparisons.
Conclusions
Our results show that the metabolic syndrome, as defined by both
the NCEP ATP III and IDF criteria, is a common occurrence in
young Asian Indian patients with AMI. Although obesity occurs
frequently in these individuals, no significant association was
found with any of the obesity-associated polymorphisms studied
and the metabolic syndrome, or with obesity as determined by
both waist circumference and BMI. This lack of association
mostly likely reflects the complex pathogenesis of obesity, which
involves environmental factors in addition to genetic compo-
nents. Certain genotypes, most notably the TT genotype of the
MC4R-associated gene and the TT genotype of the adiponectin
45T
→
G polymorphism may, however, exert a protective effect
on individual components of the metabolic syndrome, such as
blood glucose and triglyceride levels, while others such as the TT
genotype of the LEPR Q223R gene was associated with adverse
HDL cholesterol levels.
We thank Ms A Murally for typing this manuscript.
References
1. DeFronzo RA, Ferrannini E. Insulin resistance. A multifaceted syndrome
responsible for NIDDM, obesity, hypertension, dyslipidema, and athero-
sclerotic cardiovascular disease.
Diabetes Care
1991;
14
: 173–194.
2. Lindsay RS, Howard BV. Cardiovascular risk associated with the meta-
bolic syndrome.
Curr Diab Rep
2004;
4
: 63–68.
3. Koh KK, Han SH, Quon MJ. Inflammatory markers and the metabolic
syndrome insights from therapeutic interventions.
J Am Coll Cardiol
2005;
46
: 1978–1985.
4. Third Report of the National Cholesterol Education Program (NCEP)
Expert Panel on Detection, Evaluation and Treatment of High Blood
Cholesterol in Adults (Adult Treatment Panel III) final report.
Circulation
2002;
106
: 3134–3421.
5. International Diabetes Federation. The IDF consensus worldwide defini-
tion of the metabolic syndrome, April 14, 2005. Acessed at
.
idf.org/webdata/docs/Metac_syndrome_def.pdf/ on June 10, 2005.
6. Park YW, Zhu S, Palaniappan L,
et al
. The metabolic syndrome: preva-
lence and associated risk factor findings in the US population from the
Third National Health and Nutrition Examination Survey, 1988–1994.
Arch Intern Med
2003;
163
(4): 427–436.
7. Palaniappan L, Carnethon MR, Wang Y,
et al
. Predictors of the incident
metabolic syndrome in adults: the Insulin Resistance Atherosclerosis
Study.
Diabetes Care
2004;
27
: 788–793.
8. Kondo H, Shimomura I, Matsukawa Y,
et al
. Association of adiponectin
mutation with type 2 diabetes: a candidate gene for the insulin resistance
syndrome.
Diabetes
2002;
51
: 2325–2328.
9. Menzaghi C, Ercolino T, Di Paola R,
et al
. A haplotype in the adiponec-
tin locus is associated with obesity and other features of the insulin
resistance syndrome.
Diabetes
2002;
51
: 2306–2312.
10. Filippi E, Sentinelli F, Trischitta V,
et al
. Association of the human
adiponectin gene and insulin resistance.
Eur J Hum Genet
2004;
12
:
199–205.
11. Hu FB, Doria A, Li T,
et al
. Genetic variation at the adiponectin locus
and risk of type 2 diabetes in women.
Diabetes
2004;
53
: 209–213.
12. Ryo M, Nakamura T, Kihara S, Kumada M, Shibazaki S Takahashi M,
et al
. Adiponectin as a biomarker of the metabolic syndrome.
Circ J
2004;
68
: 975–981.
13. Yatagai T, Nagasaka S, Tamiguchi A, Fukushima M, Nakamura T, Kuroe
A,
et al
. Hypoadiponectinemia is associated with visceral fat accumula-
tion and insulin resistance in Japanese men with type 2 diabetes mellitus.
Metabolism
2003;
52
: 1274–1278.
14. Yamamoto Y, Hirose H, Saito I,
et al
. Adiponectin, an adipocyte-derived
protein, predicts future insulin-resistance: two-year follow-up study in
Japanese population.
J Clin Endocrinol Metab
2004;
89
: 87–90.
15. Han SH, Quon MJ, Kim JA,
et al
. Adiponectin and cardiovascular
disease: response to therapeutic interventions.
J Am Coll Cardiol
2007;
49
: 531–538.
16. Sattar N, Wannamethee G, Sarwar N,
et al
. Adiponectin and coronary
heart disease: a prospective study and meta-analysis.
Circulation
2006;
114
: 623–629.
17. Comuzzie AG, Funahashi T, Sonnenberg G,
et al
. The genetic basis of
plasma variation in adiponectin, a global endophenotype for obesity and
the metabolic syndrome.
J Clin Endocrinol Metab
2001;
86
: 4321–4325.
18. Mantzoros CS. The role of leptin in human obesity and disease: a review
of current evidence.
Ann Intern Med
1999;
130
: 871–881.
19. Echwald SM, Sorensen TD, Sorensen TI,
et al
. Amino acid variants in
the human leptin receptor: lack of association to juvenile onset obesity.
Biochem Biophys Res Commun
1997;
233
: 248–252.
20. Gotoda T, Manning BS, Goldstone AP,
et al
. Leptin receptor gene varia-
tion and obesity: lack of association in a white British male population.
Hum Mol Genet
1997;
6
: 869–876.
21. Farooqi IS, Keogh JM, Yeo GS, Lank EJ, Cheetham T, O’Rahilly S.
Clinical specturm of obesity and mutations in the melanocortin 4 recep-
tor gene.
N Engl J Med
2003;
348
: 1085–1095.
22. Biebermann H, Castaneda TR, van Landeghem F, von Deimiling A,
Escher F, Brabant G,
et al
. A role for beta-melanocyte-stimulating
hormone in human body-weight regulation.
Cell Metab
2006;
3
:
141–146.
23. Scuteri A, Sanna S, Chen WM, Uda M, Albai G, Strait J,
et al
. Genome-
wide association scan shows genetic variants in the FTO gene are asso-
ciated with obesity-related traits. E-publication 26th June 2009.
PLoS
Genet
2009;
3
: e115.
24. Frayling TM, Timpson NJ, Weedon MN,
et al
. A common variant in the
FTO gene is associated with body mass index and predisposes to child-
hood and adult obesity.
Science
2007;
316
: 889–894.
25. Ranjith N, Pegoraro RJ, Naidoo DP,
et al
. Metabolic syndrome in young
Asian Indian patients with myocardial infarction.
Cardiovasc J S Afr
2007;
18
: 21–26.
26. The Joint European Society of Cardiology/American College of
Cardiology Committee. Myocardial infarction redefined – a consen-
sus document of the Joint European Society of Cardiology/American
College of Cardiology Committee for the redefinition of myocardial
infarction.
J Am Coll Cardiol
2000;
36
: 959–969.
27. World Health Organization. Obesity: preventing and managing the
global epidemic. Report of a WHO Consultation on Obesity, Geneva,
3–5 June, 1997. Geneva, Switzerland: World Health Organization, 1998.
(WHO TRS 894).
28. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome
among US adults: findings form the third National Health and Nutrition
Examination Survey.
J Am Med Assoc
2002;
287
: 356–359.
29. Ford ES, Giles WH, Mokdad AH. Increasing prevalence of the metabolic
syndrome among U. S. Adults.
Diabetes Care
2004;
27
: 2444–2449.
30. Razak F, Anand SS, Shannon H,
et al
. Defining obesity cut points in a
multiethnic population.
Circulation
2007;
115
: 2111–2118.
31. Bajaj M, Banerji MA. Type 2 diabetes in South Asians: a pathophysi-
ologic focus on the Asian–Indian epidemic.
Curr Diab Rep
2004;
4
:
213–218.
32. Tanaka S, Horimai C, Katsukawa F. Ethnic differences in abdominal
visceral fat accumulation between Japanese, African–Americans, and
Caucasians: a meta-analysis.
Acta Diabetol
2003;
40
(Suppl 1) S302–
S304.
33. Baguleyan CG. Hospital data on coronary artery disease from North
Kerala. In: Vijayaraghavan G, ed.
Cardiovascular Disease Prevention
.
Trivandrum, India: Trivandrum Medical College, 1996: 54–59.
