Electrocardiogram Abnormalities Associated With Metabolic Syndrome: The Hispanic Community Health Study/Study of Latinos

Abstract

Background

Metabolic syndrome (MetS) is a prognostic cluster of physiologic risk factors that may develop into cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Electrocardiogram abnormalities (ECGA) can be instrumental in identifying the early stages of disease and may be associated with MetS in Hispanic Americans.

Objective

To explore the relationships between MetS and major and minor ECGA in the Hispanic population (Hypothesis 1) and determine whether gender-ethnic subgroups moderate these relationships (Hypothesis 2).

Methods

This secondary data analysis was conducted using large-scale data from the cohort study Hispanic Community Health Study/Study of Latinos (N = 13,628; 59% women and 41% men). Major ECGA encompassed 9 abnormalities including pathologic Q waves and left ventricular hypertrophy. Minor ECGA were tested independently of major ECGA. MetS was classified into 4 categories delineating metabolic abnormalities and related medication use. Multinomial logistic regression and Hayes’ PROCESS macro were used for statistical analysis.

Results

Major ECGA were significantly associated with the presence of MetS and/or related medication use, whereas minor ECGA abnormalities were associated with MetS for participants who also took MetS-related medications only. Gender moderated the association between MetS and minor ECGA such that women with minor ECGA had a higher likelihood of MetS when compared to men.

Conclusions

Findings suggest that early recognition and associated treatment of major and minor ECGA can be important to prevent MetS and further morbidities in the Hispanic population.

Keywords

metabolic syndrome electrocardiogram abnormalities Hispanic

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References

Abiodun

Oladimeji

Bamidele

Adewole

Mayowa

(2019). Prevalence of ECG abnormalities among adults with metabolic syndrome in a Nigerian Teaching Hospital. African Health Sciences, 19(4), 2829–2838. https://doi.org/10.4314/ahs.v19i4.4

Agarwal

Thakur

Gupta

(2021). Electrocardiography indices in healthy metabolic syndrome patients: Markers for future cardiovascular risk. Journal of Clinical and Preventive Cardiology, 10(1), 2–7. https://doi.org/10.4103/jcpc.jcpc_52_20

Aguilar

Bhuket

Torres

Liu

Wong

R. J.

(2015). Prevalence of the metabolic syndrome in the United States, 2003-2012. JAMA: The Journal of the American Medical Association, 313(19), 1973–1974. https://doi.org/10.1001/jama.2015.4260

Alberti

Zimmet

Shaw

(2006). Metabolic syndrome-a new world-wide definition. A consensus statement from the international diabetes federation. Diabetic Medicine, 23(5), 469–480. https://doi.org/10.1111/j.1464-5491.2006.01858.x

Allison

M. A.

Budoff

M. J.

Wong

N. D.

Blumenthal

R. S.

Schreiner

P. J.

Criqui

M. H.

(2008). Prevalence of and risk factors for subclinical cardiovascular disease in selected US hispanic ethnic groups: The multi-ethnic study of Atherosclerosis. American Journal of Epidemiology, 167(8), 962–969. https://doi.org/10.1093/aje/kwm402

Boen

C. E.

Hummer

R. A.

(2019). Longer—but harder—lives? Journal of Health and Social Behavior, 60(4), 434–452. https://doi.org/10.1177/0022146519884538

Bradford

Shah

A.J.

Usoro

Haisty

Wesley

Soliman

E.Z.

(2015). Abnormal electrocardiographic QRS transition zone and risk of mortality in individuals free of cardiovascular disease. Europace, 17(1), 131–136. https://doi.org/10.1093/europace/euu149

Burroughs Peña

Swett

Schneiderman

Spevack

D. M.

Ponce

S. G.

Talavera

G. A.

Kansal

M. M.

Daviglus

M. L.

Cai

Hurwitz

B. E.

Llabre

M. M.

Rodriguez

C. J.

(2018). Cardiac structure and function with and without metabolic syndrome: The echocardiographic study of Latinos (Echo-SOL). BMJ Open Diabetes Research and Care, 6(1), Article e000484. https://doi.org/10.1136/bmjdrc-2017-000484

Capielo Rosario

Schaefer

Ballesteros

Rentería

David

E. J. R.

(2019). A caballo regalao no se le Mira el Colmillo: Colonial mentality and Puerto Rican depression. Journal of Counseling Psychology, 66(4), 396–408. https://doi.org/10.1037/cou0000347

10.

Cassells

Haffner

(2006). The metabolic syndrome: Risk factors and management. The Journal of Cardiovascular Nursing, 21(4), 306–313. https://doi.org/10.1097/00005082-200607000-00012

11.

Castañeda

S. F.

Buelna

Giacinto

R. E.

Gallo

L. C.

Sotres-Alvarez

Gonzalez

Fortmann

A. L.

Wassertheil-Smoller

Gellman

M. D.

Giachello

A. L.

Talavera

G. A.

(2015). Cardiovascular disease risk factors and psychological distress among hispanics/latinos: The hispanic community health study/study of Latinos (HCHS/SOL). Preventive Medicine, 87, 144–150. https://doi.org/10.1016/j.ypmed.2016.02.032

12.

CDC . (2020). National Health and Nutrition Examination Survey. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/about/factsheets/factsheet_nhanes.htm

13.

Dawson

B. A.

(2009). Discrimination, stress, and acculturation among Dominican immigrant women. Hispanic Journal of Behavioral Sciences, 31(1), 96–111. https://doi.org/10.1177/0739986308327502

14.

Denes

Garside

D. B.

Lloyd-Jones

Gouskova

Soliman

E. Z.

Ostfeld

Zhang

Z.-M.

Camacho

Prineas

Raij

Daviglus

M. L.

(2013). Major and minor electrocardiographic abnormalities and their association with underlying cardiovascular disease and risk factors in hispanics/latinos (from the hispanic community health study/study of Latinos). The American Journal of Cardiology, 112(10), 1667–1675. https://doi.org/10.1016/j.amjcard.2013.08.004

15.

Essilfie

Shavelle

D. M.

Tun

Platt

Kobayashi

Mehra

Matthews

R. V.

Clavijo

Gaglia

M. A.

(2016). Association of elevated triglycerides and acute myocardial infarction in young Hispanics. Cardiovascular Revascularization Medicine, 17(8), 510–514. https://doi.org/10.1016/j.carrev.2016.06.001

16.

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults . (2001). Executive summary of the Third report of the national cholesterol education program (NCEP) expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment Panel III). JAMA: The Journal of the American Medical Association, 285(19), 2486–2497. https://doi.org/10.1001/jama.285.19.2486

17.

Goldman

Hod

Chetrit

Danker

(2019). Incidental abnormal ECG findings and long-term cardiovascular morbidity and all-cause mortality: A population based prospective study. International Journal of Cardiology, 295, 36–41. https://doi.org/10.1016/j.ijcard.2019.08.015

18.

Grundy

S. M.

Brewer

H. B.

Cleeman

J. I.

Smith

S. C.

Lenfant

National Heart, Lung, and Blood Institute, American Heart Association . (2004). Definition of metabolic syndrome: Report of the national heart, lung, and blood institute/American heart association conference on scientific issues related to definition. Arteriosclerosis, Thrombosis, and Vascular Biology, 24(2), Article 13. https://doi.org/10.1161/01.ATV.0000111245.75752.C6

19.

Hayes

A. F.

(2013). Introduction to mediation, moderation, and conditional process analysis. Guilford Press.

20.

Healy

Lloyd-Jones

(2016). Association of traditional cardiovascular risk factors with development of major and minor electrocardiographic abnormalities: A systematic Review. Cardiology in Review, 24(4), 163–169. https://doi.org/10.1097/CRD.0000000000000109

21.

Heiss

Snyder

M. L.

Loehr

Aviles-Santa

Yanping

Schneiderman

Llabre

M. M.

Cowie

Carnethon

Kaplan

Giachello

Gallo

(2014). Prevalence of metabolic syndrome among Hispanics/Latinos of diverse background: The Hispanic community health study/study of Latinos. Diabetes Care, 37(8), 2391–2399. https://doi.org/10.2337/dc13-2505

22.

Hispanic Community Health Study (2008). Manual 5: Electrocardiography assessment. http://www.cscc.unc.edu/hchs/

23.

Isasi

C. R.

Ayala

G. X.

Sotres-Alvarez

Madanat

Penedo

Loria

C. M.

Elder

J. P.

Daviglus

M. L.

Barnhart

Siega-Riz

A. M.

Van Horn

Schneiderman

(2015). Is acculturation related to obesity in hispanic/latino adults? Results from the hispanic community health study/study of Latinos. Journal of Obesity, 2015, 186276–186278. https://doi.org/10.1155/2015/186276

24.

Kastorini

Panagiotakos

D. B.

Georgousopoulou

E. N.

Laskaris

Skourlis

Zana

Chatzinikolaou

Chrysohoou

Puddu

P. E.

Tousoulis

Stefanadis

Pitsavos

(2015). Metabolic syndrome and 10-year cardiovascular disease incidence: The ATTICA study. Nutrition, Metabolism, and Cardiovascular Diseases, 26(3), 223–231. https://doi.org/10.1016/j.numecd.2015.12.010

25.

Kim

Lee

Kim

Seo

(2020). Oncology nurses’ knowledge and awareness on metabolic syndrome in cancer survivors and the perceived barriers to the provision of related care: A mixed-method study. European Journal of Cancer Care, 29(2), Article e13227. https://doi.org/10.1111/ecc.13227

26.

LaVange

L. M.

Kalsbeek

W. D.

Sorlie

P. D.

Avilés-Santa

L. M.

Kaplan

R. C.

Barnhart

Liu

Giachello

Lee

D. J.

Ryan

Criqui

M. H.

Elder

J. P.

(2010). Sample design and cohort selection in the hispanic community health study/study of Latinos. Annals of Epidemiology, 20(8), 642–649. https://doi.org/10.1016/j.annepidem.2010.05.006

27.

Lear

S. A.

Gasevic

(2019). Ethnicity and metabolic syndrome: Implications for assessment, management and prevention. Nutrients, 12(1), Article 15. https://doi.org/10.3390/nu12010015

28.

Meyer

M.L.

Gotman

N.M.

Soliman

E.Z.

Whitsel

E.A.

Arens

Cai

Daviglus

M.L.

Denes

González

H.M

Moreiras

Talavera

G.A.

Heiss

(2016). Association of glucose homeostasis measures with heart rate variability among Hispanic/Latino adults without diabetes: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Cardiovascular Diabetology, 15(45). https://doi.org/10.1186/s12933-016-0364-y

29.

Padilla

Steiner

J. F.

Havranek

E. P.

Beaty

Davidson

A. J.

Bull

(2011). A comparison of different measures of acculturation with cardiovascular risk factors in Latinos with hypertension. Journal of Immigrant and Minority Health, 13(2), 284–292. https://doi.org/10.1007/s10903-010-9434-5

30.

Park

Blanck

H. M.

Dooyema

C. A.

Ayala

G. X.

(2016). Association between sugar-sweetened beverage intake and proxies of acculturation among U.S. Hispanic and non-hispanic white adults. American Journal of Health Promotion, 30(5), 357–364. https://doi.org/10.1177/0890117116646343

31.

Poirier

Giles

T. D.

Bray

G. A.

Hong

Stern

J. S.

Pi-Sunyer

F. X.

Eckel

R. H.

(2006). Obesity and cardiovascular disease: Pathophysiology, evaluation, and effect of weight loss. Arteriosclerosis, Thrombosis, and Vascular Biology, 26(5), 968–976. https://doi.org/10.1161/01.ATV.0000216787.85457.f3

32.

Prineas

R. J.

Crow

R. S.

Zhang

Z. M.

(2009). The Minnesota code manual of electrocardiographic findings. Springer Science & Business Media.

33.

Strizich

Hanna

D. B.

Giacinto

R. E.

Castañeda

S. F.

Sotres-Alvarez

Pirzada

Llabre

M. M.

Schneiderman

Avilés-Santa

L. M.

Kaplan

R. C.

(2015). Comparing measures of overall and central obesity in relation to cardiometabolic risk factors among US Hispanic/Latino adults. Obesity, 23(9), 1920–1928. https://doi.org/10.1002/oby.21176

34.

Rautaharju

P. M.

Zhang

Gregg

R. E.

Haisty

W. K.

Vitolins

M. Z.

Curtis

A. B.

Warren

Horaĉek

M. B.

Zhou

S. H.

Soliman

E. Z.

(2013). Normal standards for computer-ECG programs for prognostically and diagnostically important ECG variables derived from a large ethnically diverse female cohort: The Women's Health Initiative (WHI). Journal of Electrocardiology, 46(6), 707–716. https://doi.org/10.1016/j.jelectrocard.2013.05.136

35.

Rautaharju

P. M.

Zhang

Haisty

W. K.

Gregg

R. E.

Warren

Horaĉek

M. B.

Kucharska-Newton

A. M.

Rosamond

Soliman

E. Z.

(2014). Race- and sex-associated differences in rate-adjusted QT, QTpeak, ST elevation and other regional measures of repolarization: The Atherosclerosis Risk in Communities (ARIC) Study. Journal of Electrocardiology, 47(3), 342–350. https://doi.org/10.1016/j.jelectrocard.2014.01.012

36.

Rodriguez

Allison

Daviglus

Isasi

Keller

Leira

Palaniappan

Piña

Ramirez

Rodriguez

Sims

(2014). Status of cardiovascular disease and stroke in hispanics/latinos in the United States: A science advisory from the American heart association. Circulation (New York, N.Y.), 130(7), 593–625. https://doi.org/10.1161/CIR.0000000000000071

37.

Silva

Palhares

Ribeiro

Gomes

Macfarlane

Ribeiro

Marcolino

(2021). Prevalence of major and minor electrocardiographic abnormalities in one million primary care Latinos. Journal of Electrocardiology, 64, 36–41. https://doi.org/10.1016/j.jelectrocard.2020.11.013

38.

Sorlie

P. D.

Avilés-Santa

L. M.

Wassertheil-Smoller

Kaplan

R. C.

Daviglus

M. L.

Giachello

A. L.

Schneiderman

Raij

Talavera

Allison

LaVange

Chambless

L. E.

Heiss

(2010). Design and implementation of the hispanic community health study/study of Latinos. Annals of Epidemiology, 20(8), 629–641. https://doi.org/10.1016/j.annepidem.2010.03.015

39.

Thigula

(2017). Effect of hormone replacement therapy on biochemical parameters in post-menopausal women. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 6(10), Article 4631. https://doi.org/10.18203/2320-1770.ijrcog20174454

40.

Virani

S. S.

Alonso

Aparicio

H. J.

Benjamin

E. J.

Bittencourt

M. S.

Callaway

C. W.

Carson

A. P.

Chamberlain

A. M.

Cheng

Delling

F. N.

Elkind

M. S. V.

Evenson

K. R.

Ferguson

J. F.

Gupta

D. K.

Khan

S. S.

Kissela

B. M.

Knutson

K. L.

Lee

C. D.

Lewis

T. T.

Tsao

C. W.

(2021). Heart disease and stroke statistics-2021 update: A report from the American heart association. Circulation (New York, N.Y.), 143(8), e254–e743. https://doi.org/10.1161/CIR.0000000000000950

41.

Vishnu

Gurka

M. J.

DeBoer

M. D.

(2015). The severity of the metabolic syndrome increases over time within individuals, independent of baseline metabolic syndrome status and medication use: The Atherosclerosis Risk in Communities Study. Atherosclerosis, 243(1), 278–285. https://doi.org/10.1016/j.atherosclerosis.2015.09.025

42.

von Elm

Altman

D. G.

Egger

Pocock

S. J.

Gotzsche

P. C.

Vandenbroucke

J. P.

(2007). The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Bulletin of the World Health Organization, 85(11), 867–872. https://doi.org/10.2471/blt.07.045120