title: Plasminogen Activator Inhibitor-1 and Diagnosis of the Metabolic Syndrome in a West African Population.
abstract: Metabolic syndrome (MetS) is diagnosed by the presence of at least 3 of the following: obesity, hypertension, hyperglycemia, hypertriglyceridemia, and low high-density lipoprotein. Individuals with MetS also typically have elevated plasma levels of the antifibrinolytic factor, plasminogen activator inhibitor-1 (PAI-1), but the relationships between PAI-1 and MetS diagnostic criteria are not clear. Understanding these relationships can elucidate the relevance of MetS to cardiovascular disease risk, because PAI-1 is associated with ischemic events and directly involved in thrombosis.
  
  
  
  In a cross-sectional analysis of 2220 Ghanaian men and women from urban and rural locales, we found the age-standardized prevalence of MetS to be as high as 21.4% (urban women). PAI-1 level increased exponentially as the number of diagnostic criteria increased linearly (P<10-13), supporting the conclusion that MetS components have a joint effect that is stronger than their additive contributions. Body mass index, triglycerides, and fasting glucose were more strongly correlated with PAI-1 than with canonical MetS criteria, and this pattern did not change when pair-wise correlations were conditioned on all other risk factors, supporting an independent role for PAI-1 in MetS. Finally, whereas the correlations between conventional risk factors did not vary significantly by sex or across urban and rural environments, correlations with PAI-1 were generally stronger among urban participants.
  
  
  
  MetS prevalence in the West African population we studied was comparable to that of the industrialized West. PAI-1 may serve as a key link between MetS, as currently defined, and the endpoints with which it is associated. Whether this association is generalizable will require follow-up.
authors.affiliation: Vanderbilt Genetics Institute, Vanderbilt University Medical School, Nashville, TN Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH Department of Genetics, Geisel School of Medicine, Dartmouth College, Hanover, NH.
authors.forename: Nuri
authors.initials: N
authors.lastname: Kodaman
authors.affiliation: Division of Epidemiology, Department of Thoracic Surgery, Vanderbilt University Medical School, Nashville, TN.
authors.forename: Melinda C
authors.initials: MC
authors.lastname: Aldrich
authors.affiliation: Vanderbilt Genetics Institute, Vanderbilt University Medical School, Nashville, TN Department of Genetics, Geisel School of Medicine, Dartmouth College, Hanover, NH.
authors.forename: Rafal
authors.initials: R
authors.lastname: Sobota
authors.affiliation: Division of Heart & Lungs, Department of Cardiology, UMC Utrecht, Utrecht, The Netherlands Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom.
authors.forename: Folkert W
authors.initials: FW
authors.lastname: Asselbergs
authors.affiliation: Department of Medicine, Vanderbilt University Medical School, Nashville, TN.
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Brown
authors.affiliation: Department of Genetics, Geisel School of Medicine, Dartmouth College, Hanover, NH Department of Biostatistics and Epidemiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Jason H
authors.initials: JH
authors.lastname: Moore
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH Department of Genetics, Geisel School of Medicine, Dartmouth College, Hanover, NH smw154@case.edu.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000097:blood; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology; D005215:Fasting; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000453:epidemiology; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood*; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data; D014280:Triglycerides / Q000097:blood; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D001786:Blood Glucose; D008076:Cholesterol, HDL; D007004:Hypoglycemic Agents; D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; D014280:Triglycerides
keywords: diabetes mellitus; epidemiology; fibrinolysis; hypertension; lipids; obesity