Prof Naveed Sattar, University of Glasgow

In this short video, Dr. Naveed Sattar, Professor in Metabolic Medicine at University of Glasgow / Honorary Consultant in Clinical Biochemistry, Glasgow Royal Infirmary, in the United Kingdom, provides some insight as to why people with lupus are at greater risk for cardiovascular disease. Dr. Sattar moderated a session at the 2009 American College of Rheumatology (ACR) Annual Scientific Meeting on this topic. In this short video, Dr. Naveed Sattar, Professor in Metabolic Medicine at University of Glasgow / Honorary Consultant in Clinical Biochemistry, Glasgow Royal Infirmary, in the United Kingdom, provides some insight as to why people with lupus are at greater risk for cardiovascular disease. Dr. Sattar moderated a session at the 2009 American College of Rheumatology (ACR) Annual Scientific Meeting on this topic.

Previous studies, mostly in men, have suggested a smaller 10 to 12 per cent increase in diabetes among statin users, said Naveed Sattar, a metabolism and diabetes researcher at the University of Glasgow who did not take part in the study. Those numbers may be more accurate because they come from trials in which participants were randomly assigned to take a statin or not, which can better account for possible differences in groups of patients, he said, noting that this kind of observational study can't prove cause-and-effect. Still, "broadly speaking, this kind of confirms that statins may well increase diabetes risk," Sattar said. The reasons why remain unclear, but the effect of statins on the muscles and liver may lead the body to make slightly more sugar than it normally would, or cause users to exercise a bit less, he added.

This is noteworthy because early prediction might identify people who may benefit from aggressive lifestyle changes such as diet and exercise to delay or derail the disease process, says lead author Naveed Sattar, M.D., an honorary consultant in clinical biochemistry at the Glasgow Royal Infirmary in Scotland.The new definition of the metabolic syndrome, also known as syndrome X, was developed by the U.S. National Cholesterol Education Panel (NCEP).Glucose intolerance is usually the fourth or fifth condition to appear," Sattar says.Researchers knew that the metabolic syndrome predisposes people to CHD and diabetes, but little data existed on whether this simpler definition would be as predictive as the older, more stringent criteria."This is the first prospective study to show that the new criteria predict excess risk for both CHD and diabetes," he says.Researchers used data from 6,447 men in the West of Scotland Coronary Prevention Study (WOSCOPS) to test the NCEP's recently proposed definition.WOSCOPS is a primary prevention trial that proved the effectiveness of the cholesterol-lowering drug pravastatin for reducing heart disease death and disability.All the men participating in the trial had moderately elevated cholesterol levels.Sattar's group substituted body mass index figures collected in WOSCOPS for abdominal obesity.Using the new definition, 26 percent of the men had the metabolic syndrome.They had 1.7 times the risk of a CHD event and 3.5 times the risk of developing diabetes during 4.9 years of follow-up, Sattar says.Sattar's group also looked at another variable, the inflammatory marker C-reactive protein (CRP) that other studies have linked to the development of heart disease and diabetes.

However, early hopes that leptin could do the same for overweight humans have been dashed, says study author Naveed Sattar, M.D., Ph.D. Overweight and obese people seem to have some sort of resistance to leptin, he explains."This is the first evidence that leptin may be an independent risk factor for the development of coronary heart disease," says Sattar, senior lecturer in endocrinology and metabolism and an honorary consultant in clinical biochemistry at Glasgow Royal Infirmary in Scotland."Leptin appears to be as strong a predictor as some well-recognized risk factors such as high systolic blood pressure or low levels of high-density lipoprotein (HDL) cholesterol."He cautions that these results must be confirmed by other studies before recommending routine leptin testing."Leptin is such a brilliant blood marker for body fat for people at any weight and it is not difficult to measure," he says.When they looked at risk of cardiovascular events, Sattar's team found a 25 percent increased risk for every 30 percent rise in leptin levels, an amount identified in the article as one standard deviation.The researchers report that leptin remained a risk factor independent of body mass index (BMI), a commonly used way to determine if someone is overweight (BMI of 25 or higher) or obese (BMI of 30 or greater).In addition, leptin levels increased along with levels of C-reactive protein (CRP) - a marker for inflammation in the body that is strongly associated with the development of heart disease.However, when the two proteins were studied together, leptin was still a significant marker for heart disease.Regarding the BMI findings, he explains that leptin is a better indication of fat mass, since people can have the same body mass index but have different amounts of fat in their bodies.The finding that leptin, a fat protein, is linked to heart disease risk independently from CRP, an inflammation marker, strongly suggests that fat may be important in heart disease risk, says Sattar."Leptin may give important information about the development of heart and blood vessel disease," he says.