Evaluation of the Metabolic Syndrome in Hypertensive Patients: Results From the ICEBERG Study

Abstract

The Intensive/Initial Cardiovascular Examination Regarding Blood Pressure Levels: Evaluation of Risk Groups (ICEBERG) study was aimed at evaluating the components of the metabolic syndrome (MS) for cardiovascular risk stratification in hypertensive patients. The ICEBERG study consisted of 2 subprotocols: ICEBERG-1, conducted at 20 university hospitals, and ICEBERG-2, conducted at 197 primary health care centers. Each subprotocol had 2 patient profiles: patients diagnosed with hypertension and receiving medical treatment (treated group) and patients who had not received antihypertensive treatment (untreated group). MS was defined in the Third Report of the National Cholesterol Education Program Adult Treatment Panel as the presence of at least 3 of the following abnormalities: decreased plasma high-density lipoprotein cholesterol level, increased plasma triglyceride level, hypertension, increased fasting glucose level, and obesity. In a total of 4039 patients, 65.0% had MS, 30.2% had 3 components, 15.0% had 2 components, and 24.8% had 4 components. The most common accompanying component to hypertension was abdominal obesity. Therefore, this study underlined the value of questioning metabolic components in patients with high-normal or high blood pressure to identify individuals with high added risk of cardiovascular disease.

Traditional coronary risk factors in healthy Turkish military personnel between 20 and 50 years old: focus on high-density lipoprotein cholesterol

“…The exercise level in this population can also be assumed to be more than that of the general population. In this aspect, despite a potentially different life style compared to whole Turkish population, the HDL-c was not substantially different from the recent epidemiologic studies even the ones evaluating the individuals with high cardiovascular risk (21)(22)(23)(24). Secondly, exclusion of 4 patients with coronary artery disease from the analyses might have contributed the relatively high levels of HDL-c, though the small number of these participants is unlikely to influence the results.…”

“…Similarly, Mahley et al (26) showed that HDL-c in prepubertal Turkish children was not low compared to that in children of similar age group in different countries, another finding supporting the idea that HDL-c is not "genetically" low in Turkish population. As summarized previously, recent epidemiologic studies showed that HDL-c was not as low as TEKHARF and Turkish Heart Study stated (21)(22)(23)(24). It is difficult to conclude the reason(s) of the low HDL-c in TEKHARF and Turkish Heart Study.…”

“…In their study aiming to find out the prevalence of metabolic syndrome in Turkish adults, Kozan et al (21) found that average HDL-c in 2110 male participants was 46.3±16.6 mg/dL, which was very close to our findings. In another countrywide epidemiologic study, mean HDL-c was 48.7±19.1 mg/dL in nearly 8500 hypertensive patients (22). In the Prevalence, Awareness, Treatment and Control of Hypertension in Turkey (the PatenT) study, HDL-c was <40 mg/dL in only 35.1% of the male hypertensive population (23).…”

Comment on ‘Traditional coronary risk factors in healthy Turkish military personnel between 20 and 50 years old: focus on high-density lipoprotein cholesterol’

“…Thirdly, tbe main focus of our study was that, altbough Turkish population was regarded as a population with characteristically low HDL-C in relatively old studies (2, 3), we don't tbink so according to tbe recent epidemiologic studies including ours (4)(5)(6). In addition, wbat we observe in our daily clinical practice is HDL-C cbanges little and stays witbin a narrow band during follow-up of the patients.…”

“…There are some studies in which 24-hour urinary sodium excretion was followed during salt restriction (3,4). On the contrary, some investigators did not follow 24-hour urinary sodium excretion (2,5). Surely, it would be better to restrict salt followed by urinary sodium excretion.…”