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Abstract. Godsland IF, Levya F, Walton C, Worthington M, Stevenson JC (Imperial College School of Medicine, London, UK). Associations of smoking, alcohol and physical activity with risk factors for coronary heart disease and diabetes in the first follow-up cohort of the Heart Disease and Diabetes Risk Indicators in a Screened Cohort study. J Intern Med 1998; 244: 33-41.Objectives. To investigate the associations between risk factors for cardiovascular disease and cigarette smoking, alcohol intake, and physical activity in a group of predominantly healthy men. Design. Cohort study with baseline characterisation, clinical follow-up, and identification of predictors of coronary artery disease and diabetes. Setting. University hospital metabolic day ward. Subjects. Participants in a company health programme (n = 742). Main outcome measures. Routine haematology and biochemistry, cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol (on a subset of 522 subjects), and glucose and insulin levels during a 3 h oral glucose tolerance test (OGTT). Results. Independent associations with previous cigarette smoking included high uric acid and low HDL cholesterol, and with current cigarette smoking, high haemoglobin and white cell count and low OGTT insulin. Increasing alcohol intake was associated with increasing blood pressure, uric acid, HDL cholesterol and fasting glucose. The moderate range of exercise intensity in this cohort was associated with decreasing systolic blood pressure, fasting insulin and OGTT glucose and insulin. Factor analysis distinguished principal factors comprising features of the metabolic syndrome with low physical activity, and high white cell count, high haemoglobin concentration and low HDL cholesterol with increasing previous and current cigarette smoking and alcohol intake. Conclusions. Some characteristics of the metabolic syndrome were seen with previous but not current smoking habit. Regular alcohol consumption was associated with mainly unfavourable metabolic characteristics, although there was an independent beneficial association with HDL cholesterol. The improved metabolic syndrome profile seen with increasing exercise is consistent with even moderate degrees of physical activity having beneficial effects on metabolism.

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Abstract-Syndromes of risk factor disturbance may contribute to the development of coronary heart disease and non-insulindependent diabetes mellitus, but their definition and quantification remain problematic. Using factor analysis, constellations of risk factor variables that could indicate distinct syndromes of metabolic disturbance were explored in the baseline data of the first follow-up cohort of 742 men from the Heart Disease and Diabetes Risk Indicators in a Screened Cohort (HDDRISC) study. The primary analysis considered 16 intercorrelated variables measured in more than 90% of cohort participants. A missing-values estimation routine was used to ensure inclusion of all participants in the analysis. Subanalyses were undertaken, including a repeat of the primary analysis on the 522 individuals who had received measurement of HDL cholesterol, an oblique rather than orthogonal factor rotation procedure performed on primary and HDL subset analyses, a repeat of these two primary and HDL subset analyses using only those participants with complete measurements, and a repeat of these six analyses including only the seven variables conventionally associated with the metabolic syndrome. The principal factor that emerged in all analyses undertaken comprised oral glucose tolerance test insulin and glucose response, serum uric acid, and body mass index. Fasting serum triglyceride concentration was included in this factor in 11 of the 12 analyses undertaken, fasting plasma insulin in 8, fasting plasma glucose in 5, and mean arterial pressure in 3. HDL cholesterol factored in isolation from insulin in all analyses undertaken. These findings provide strong support for a core metabolic cluster, which is unlikely to include blood pressure and does not include HDL. The factor scores relating to this cluster will provide a means of assessing its quantitative importance in prospective analysis of the development of CHD and diabetes in this cohort. (Arterioscler Thromb Vasc Biol. 1998;18:208-214.)Key Words: factor analysis Ⅲ metabolic syndrome Ⅲ cohort study Ⅲ insulin Ⅲ high density lipoprotein C oronary heart disease and diabetes mellitus share many risk factors in common, 1,2 and disturbances in these risk factors are themselves highly intercorrelated.3-5 It has been proposed that such intercorrelations indicate a distinct metabolic syndrome in which insulin resistance may have a central role. 6-8Such a syndrome could include impaired glucose tolerance, hyperinsulinemia, high blood pressure, hypertriglyceridemia and low HDL concentrations, increased levels of the antifibrinolytic factor plasminogen activator inhibitor-1, increased levels of the atherogenic small, dense LDL, hyperuricemia, postprandial hyperlipidemia, and central obesity.9 Mechanistic links can be proposed to explain these relationships and support the existence of a distinct metabolic syndrome.As yet, there appears to have been little attempt to quantify the metabolic syndrome or its clinical significance or even to determine to what extent it can be disting...

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Godsland IF, . Associations of smoking, alcohol and physical activity with risk factors for coronary heart disease and diabetes in the first follow-up cohort of the Heart Disease and Diabetes Risk Indicators in a Screened Cohort study. J Intern Med 1998; 244: 33-41.Objectives. To investigate the associations between risk factors for cardiovascular disease and cigarette smoking, alcohol intake, and physical activity in a group of predominantly healthy men. Design. Cohort study with baseline characterisation, clinical follow-up, and identification of predictors of coronary artery disease and diabetes. Setting. University hospital metabolic day ward. Subjects. Participants in a company health programme (n = 742). Main outcome measures. Routine haematology and biochemistry, cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol (on a subset of 522 subjects), and glucose and insulin levels during a 3 h oral glucose tolerance test (OGTT). Results. Independent associations with previous cigarette smoking included high uric acid and low HDL cholesterol, and with current cigarette smoking, high haemoglobin and white cell count and low OGTT insulin. Increasing alcohol intake was associated with increasing blood pressure, uric acid, HDL cholesterol and fasting glucose. The moderate range of exercise intensity in this cohort was associated with decreasing systolic blood pressure, fasting insulin and OGTT glucose and insulin. Factor analysis distinguished principal factors comprising features of the metabolic syndrome with low physical activity, and high white cell count, high haemoglobin concentration and low HDL cholesterol with increasing previous and current cigarette smoking and alcohol intake. Conclusions. Some characteristics of the metabolic syndrome were seen with previous but not current smoking habit. Regular alcohol consumption was associated with mainly unfavourable metabolic characteristics, although there was an independent beneficial association with HDL cholesterol. The improved metabolic syndrome profile seen with increasing exercise is consistent with even moderate degrees of physical activity having beneficial effects on metabolism.

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