High-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) are strong predictors of atherosclerosis. Statin-induced changes in the ratio of LDL-C to HDL-C (LDL-C/HDL-C) predicted atherosclerosis progression better than LDL-C or HDL-C alone. However, the best predictor of subclinical atherosclerosis remains unknown. Our objective was to investigate this issue by measuring changes in carotid intima-media thickness (IMT). A total of 1,920 subjects received health examinations in 1999, and were followed up in 2007. Changes in IMT (follow-up IMT/baseline IMT × 100) were measured by ultrasonography. Our results showed that changes in IMT after eight years were significantly related to HDL-C (inversely, P < 0.05) and to LDL-C/HDL-C ratio (P < 0.05). When the LDL-C/HDL-C ratios were divided into quartiles, analysis of covariance showed that increases in the ratio were related to IMT progression (P < 0.05). This prospective study demonstrated the LDL-C/HDL-C ratio is a better predictor of IMT progression than HDL-C or LDL-C alone.

Abstract-Aldosterone plays a role in hypertension, and hypertension is prevalent in patients with insulin resistance.Cross-sectional studies have reported that plasma aldosterone levels are higher in patients with insulin resistance. However, it is not known whether plasma aldosterone levels predict the development of insulin resistance. Subjects of the present study were 1235 local residents (490 men and 745 women) who participated in health screenings in Japan in 1999. Plasma aldosterone levels were measured by radioimmunoassay. We investigated the cross-sectional relationship between plasma aldosterone levels and insulin resistance (homeostasis model assessment index Ն1.73 according to the diagnostic criteria used in Japan) in 1088 nondiabetic participants. At the 10-year follow-up, 141 subjects had died, and 260 subjects refused re-examination. We performed a prospective analysis of 564 subjects to predict incident insulin resistance. We found a significant (PϽ0.001) cross-sectional relationship between plasma aldosterone and homeostasis model assessment index at baseline. In the prospective analysis, a significantly higher (PϽ0.05) relative risk ( he most important physiological role of aldosterone is to control water homeostasis and electrolytes balance. High levels of adrenal aldosterone secretion cause hypertension, that is, primary aldosteronism, a well-known form of secondary hypertension. Moreover, high plasma aldosterone levels predict the development of hypertension. 1 In view of the fact that aldosterone is a mineral corticosteroid, the association of aldosterone and hypertension is not doubted. Recently, the association between aldosterone and obesity or insulin resistance has attracted much attention. Experimental evidence suggests an interaction between aldosterone and insulin. 2 Aldosterone induces hypokalemia, which may modulate insulin secretion, has direct effects on insulin receptor function, 3,4 causes pancreatic ␤-cell dysfunction or even apoptosis, 5 interferes with insulin signaling pathways, 6 and decreases insulin sensitivity in human adipocytes in vitro. 7 Moreover, aldosterone reduces the expression of insulinsensitizing factors, such as adiponectin and peroxisome proliferator-activated receptor-␥, in obese, diabetic mice. 8 In addition to the above-mentioned in vitro and animal studies, several clinical studies reported an association between plasma aldosterone levels and insulin resistance. Plasma aldosterone levels are elevated in hypertensive obese subjects. 9 Cross-sectional studies have shown an association between plasma aldosterone levels and insulin resistance in hypertensive and normotensive subjects. 10,11 Moreover, insulin resistance was restored by surgical intervention or mineralocorticoid receptor blocker in primary hyperaldosteronism. 12 However, contradictory results were reported by other investigators showing no difference of glucose metabolism in a relatively small number of subjects with primary hyperaldosteronism and essential hypertension 13 and showing no cha...

Aims/IntroductionEzetimibe lowers serum lipid levels by inhibiting intestinal absorption of dietary and biliary cholesterol. However, the effect of ezetimibe on insulin resistance remains unclear. The aim of the present study was to examine this issue in patients with metabolic syndrome in local-dwelling Japanese, who were not being treated with lipid-lowering drugs.Materials and MethodsIn 2009, 1,943 participants received a health examination in the Tanushimaru Study, a Japanese cohort of the Seven Countries Study, of whom 490 participants had metabolic syndrome. Among them, 61 participants (41 men and 20 women) were examined in the present study. They were treated with 10 mg of ezetimibe once a day for 24 weeks, combined with standard diet and exercise therapy.ResultsBodyweight (P < 0.001), body mass index (P < 0.001), systolic blood pressure (P = 0.003), diastolic blood pressure (P < 0.001), triglycerides (P = 0.002), non-high-density lipoprotein cholesterol (P = 0.001), low-density lipoprotein cholesterol (P < 0.001) and homeostasis model assessment of insulin resistance (P = 0.011) significantly decreased after the observational period. There were no statistically significant differences in the effects of ezetimibe between men and women. Univariate analysis showed that the reduction of homeostasis model assessment of insulin resistance was not associated with the improvement of other metabolic components.ConclusionsEzetimibe combined with standard diet and exercise therapy improves not only bodyweight and atherogenic lipid profiles, but also insulin resistance, blood pressure and anthropometric factors in metabolic syndrome in local-dwelling Japanese. Interestingly, the improvement of insulin resistance had no correlation with other metabolic components.

The present study demonstrated that HSP 27 levels were strongly related to renal dysfunction and habitual smoking in a dose-response manner in a Japanese general population.