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Cardiometabolic risk profiles in a Sri Lankan twin and singleton sample

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Lisa Harber-Aschan, Ioannis Bakolis, Nicholas Glozier, Khalida Ismail, Kaushalya Jayaweera, Gayani Pannala, Carmine Pariante, Fruhling Rijsdijk, Sisira Siribaddana, Athula Sumathipala, Helena M S Zavos, Patricia Zunszain, Matthew Hotopf

Original languageEnglish
Article numbere0276647
Pages (from-to)e0276647
JournalPLoS ONE
Volume17
Issue number11 November
DOIs
Accepted/In press11 Oct 2022
Published7 Nov 2022

Bibliographical note

Copyright: © 2022 Harber-Aschan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding Information: This research was funded in whole, or in part, by the Wellcome Trust [Grant number 093206/Z/10/Z] (https://wellcome.org/). For the purpose of open access, the author has applied a CC BY-ND public copyright licence to any Author Accepted Manuscript version arising from this submission. This paper represents independent research part funded by the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London (https://www.maudsleybrc.nihr.ac.uk/). I.B. was also funded by National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King’s College London NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The funders did not have a role in the study design; collection, analysis, or interpretation of data; the writing of the manuscript; or in the decision to submit the manuscript for publication. Publisher Copyright: Copyright: © 2022 Harber-Aschan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

INTRODUCTION: Prevention of cardiovascular disease and diabetes is a priority in low- and middle-income countries, especially in South Asia where these are leading causes of morbidity and mortality. The metabolic syndrome is a tool to identify cardiometabolic risk, but the validity of the metabolic syndrome as a clinical construct is debated. This study tested the existence of the metabolic syndrome, explored alternative cardiometabolic risk characterisations, and examined genetic and environmental factors in a South Asian population sample.

METHODS: Data came from the Colombo Twin and Singleton follow-up Study, which recruited twins and singletons in Colombo, Sri Lanka, in 2012-2015 (n = 3476). Latent class analysis tested the clustering of metabolic syndrome indicators (waist circumference, high-density lipoprotein cholesterol, triglycerides, blood pressure, fasting plasma glucose, medications, and diabetes). Regression analyses tested cross-sectional associations between the identified latent cardiometabolic classes and sociodemographic covariates and health behaviours. Structural equation modelling estimated genetic and environmental contributions to cardiometabolic risk profiles. All analyses were stratified by sex (n = 1509 men, n = 1967 women).

RESULTS: Three classes were identified in men: 1) "Healthy" (52.3%), 2) "Central obesity, high triglycerides, high fasting plasma glucose" (40.2%), and 3) "Central obesity, high triglycerides, diabetes" (7.6%). Four classes were identified in women: 1) "Healthy" (53.2%), 2) "Very high central obesity, low high-density lipoprotein cholesterol, raised fasting plasma glucose" (32.8%), 3) "Very high central obesity, diabetes" (7.2%) and 4) "Central obesity, hypertension, raised fasting plasma glucose" (6.8%). Older age in men and women, and high socioeconomic status in men, was associated with cardiometabolic risk classes, compared to the "Healthy" classes. In men, individual differences in cardiometabolic class membership were due to environmental effects. In women, genetic differences predicted class membership.

CONCLUSION: The findings did not support the metabolic syndrome construct. Instead, distinct clinical profiles were identified for men and women, suggesting different aetiological pathways.

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