{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T22:46:03Z","timestamp":1784328363228,"version":"3.55.0"},"reference-count":70,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2016,10,3]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Metabolic syndrome (MetS) is diagnosed by the presence of at least 3 of the following: obesity, hypertension, hyperglycemia, hypertriglyceridemia, and low high\u2010density lipoprotein. Individuals with MetS also typically have elevated plasma levels of the antifibrinolytic factor, plasminogen activator inhibitor\u20101 (\n              <jats:styled-content style=\"fixed-case\">PAI<\/jats:styled-content>\n              \u20101), but the relationships between\n              <jats:styled-content style=\"fixed-case\">PAI<\/jats:styled-content>\n              \u20101 and MetS diagnostic criteria are not clear. Understanding these relationships can elucidate the relevance of MetS to cardiovascular disease risk, because\n              <jats:styled-content style=\"fixed-case\">PAI<\/jats:styled-content>\n              \u20101 is associated with ischemic events and directly involved in thrombosis.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              In a cross\u2010sectional analysis of 2220 Ghanaian men and women from urban and rural locales, we found the age\u2010standardized prevalence of MetS to be as high as 21.4% (urban women).\n              <jats:styled-content style=\"fixed-case\">PAI<\/jats:styled-content>\n              \u20101 level increased exponentially as the number of diagnostic criteria increased linearly (\n              <jats:italic>P<\/jats:italic>\n              &lt;10\n              <jats:sup>\u221213<\/jats:sup>\n              ), 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\n              <jats:styled-content style=\"fixed-case\">PAI<\/jats:styled-content>\n              \u20101 than with canonical MetS criteria, and this pattern did not change when pair\u2010wise correlations were conditioned on all other risk factors, supporting an independent role for\n              <jats:styled-content style=\"fixed-case\">PAI<\/jats:styled-content>\n              \u20101 in MetS. Finally, whereas the correlations between conventional risk factors did not vary significantly by sex or across urban and rural environments, correlations with\n              <jats:styled-content style=\"fixed-case\">PAI<\/jats:styled-content>\n              \u20101 were generally stronger among urban participants.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              MetS prevalence in the West African population we studied was comparable to that of the industrialized West.\n              <jats:styled-content style=\"fixed-case\">PAI<\/jats:styled-content>\n              \u20101 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\u2010up.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.116.003867","type":"journal-article","created":{"date-parts":[[2016,10,4]],"date-time":"2016-10-04T00:36:59Z","timestamp":1475541419000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Plasminogen Activator Inhibitor\u20101 and Diagnosis of the Metabolic Syndrome in a West African Population"],"prefix":"10.1161","volume":"5","author":[{"given":"Nuri","family":"Kodaman","sequence":"first","affiliation":[{"name":"Vanderbilt Genetics Institute, Vanderbilt University Medical School, Nashville, TN"},{"name":"Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH"},{"name":"Department of Genetics, Geisel School of Medicine, Dartmouth College, Hanover, NH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melinda C.","family":"Aldrich","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, Department of Thoracic Surgery, Vanderbilt University Medical School, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafal","family":"Sobota","sequence":"additional","affiliation":[{"name":"Vanderbilt Genetics Institute, Vanderbilt University Medical School, Nashville, TN"},{"name":"Department of Genetics, Geisel School of Medicine, Dartmouth College, Hanover, NH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Folkert W.","family":"Asselbergs","sequence":"additional","affiliation":[{"name":"Division of Heart &amp; Lungs, Department of Cardiology, UMC Utrecht, Utrecht, The Netherlands"},{"name":"Durrer Center for Cardiogenetic Research, ICIN\u2010Netherlands Heart Institute, Utrecht, The Netherlands"},{"name":"Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy J.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Medicine, Vanderbilt University Medical School, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason H.","family":"Moore","sequence":"additional","affiliation":[{"name":"Department of Genetics, Geisel School of Medicine, Dartmouth College, Hanover, NH"},{"name":"Department of Biostatistics and Epidemiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott M.","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH"},{"name":"Department of Genetics, Geisel School of Medicine, Dartmouth College, Hanover, NH"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.192644"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/1741826710389422"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2012.04105.x"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2011.02.012"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijo.0803189"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.coph.2004.10.003"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200006153422406"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2012.09074.x"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.it.2003.10.013"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000052617.91920.FD"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1023\/A:1011955018052"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.21.1843"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1210\/en.2003-0285"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1006\/excr.1997.3540"},{"key":"e_1_3_4_16_2","first-page":"673","article-title":"Contribution of PAI\u20101 in cardiovascular pathology","volume":"97","author":"Alessi MC","year":"2004","unstructured":"Alessi MC, Juhan\u2010Vague I. Contribution of PAI\u20101 in cardiovascular pathology. Arch Mal Coeur Vaiss. 2004;97:673\u2013678.","journal-title":"Arch Mal Coeur Vaiss"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.atv.0000242905.41404.68"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.coph.2005.01.007"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-07-517060"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.99.19.2496"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/MAJ.0b013e318065c3a1"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2007.03.024"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.291.21.2616"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc10-0990"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1038\/35036627"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1753-4887.1998.tb01722.x"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.107.699579"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.atv.0000139012.45265.e0"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2014.12.036"},{"key":"e_1_3_4_30_2","first-page":"1","article-title":"Effects of non\u2010normality on distribution of sample product\u2010moment correlation coefficient","volume":"21","author":"Kowalski CJ","year":"1972","unstructured":"Kowalski CJ. Effects of non\u2010normality on distribution of sample product\u2010moment correlation coefficient. J R Stat Soc C\u2010App. 1972;21:1\u201312.","journal-title":"J R Stat Soc C\u2010App"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.95.3.576"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/B978-012373960-5.00335-X"},{"key":"e_1_3_4_33_2","unstructured":"Ahmad OB Boschi\u2010Pinto C Lopez AD Murray CJL Lozano R Inoue M. Age standardization of rates: a new WHO standard (technical report). GPE Discussion Paper Series. 2001."},{"key":"e_1_3_4_34_2","volume-title":"Biometry: the Principles and Practice of Statistics in Biological Research","author":"Sokal RR","year":"1995","unstructured":"Sokal RR, Rohlf FJ. Biometry: the Principles and Practice of Statistics in Biological Research. 3rd ed. New York: W.H. Freeman; 1995.","edition":"3"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02162161"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000088846.10655.e0"},{"key":"e_1_3_4_37_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrg2468"},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc06-0671"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60602-9"},{"key":"e_1_3_4_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.11.095"},{"key":"e_1_3_4_41_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.89.15.6998"},{"issue":"1","key":"e_1_3_4_42_2","first-page":"14","article-title":"Plasminogen activator inhibitor type\u20101 (PAI\u20101) and its role in cardiovascular disease","volume":"82","author":"Nordt TK","year":"1999","unstructured":"Nordt TK, Peter K, Ruef J, Kubler W, Bode C. Plasminogen activator inhibitor type\u20101 (PAI\u20101) and its role in cardiovascular disease. Thromb Haemost. 1999;82(suppl 1):14\u201318.","journal-title":"Thromb Haemost"},{"key":"e_1_3_4_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(93)92062-X"},{"key":"e_1_3_4_44_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2005.061895"},{"key":"e_1_3_4_45_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.557132"},{"key":"e_1_3_4_46_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1467-789X.2002.00056.x"},{"key":"e_1_3_4_47_2","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.53.2.336"},{"key":"e_1_3_4_48_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1432-1033.2003.03453.x"},{"key":"e_1_3_4_49_2","doi-asserted-by":"publisher","DOI":"10.1160\/TH13-01-0075"},{"key":"e_1_3_4_50_2","doi-asserted-by":"publisher","DOI":"10.1210\/en.2013-1888"},{"key":"e_1_3_4_51_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0037-1614091"},{"key":"e_1_3_4_52_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.32.6.965"},{"key":"e_1_3_4_53_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0008-6363(00)00260-1"},{"key":"e_1_3_4_54_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.022608799"},{"key":"e_1_3_4_55_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.coph.2005.01.008"},{"key":"e_1_3_4_56_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ymgme.2014.04.007"},{"key":"e_1_3_4_57_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2002-021267"},{"key":"e_1_3_4_58_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.169404"},{"key":"e_1_3_4_59_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.00183.2009"},{"key":"e_1_3_4_60_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2016.05.002"},{"key":"e_1_3_4_61_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2002-38256"},{"key":"e_1_3_4_62_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-9150(98)00281-0"},{"key":"e_1_3_4_63_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/74.5.631"},{"key":"e_1_3_4_64_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijo.0802192"},{"key":"e_1_3_4_65_2","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.47.5.699"},{"key":"e_1_3_4_66_2","doi-asserted-by":"publisher","DOI":"10.1089\/met.2006.0029"},{"key":"e_1_3_4_67_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0305524101"},{"key":"e_1_3_4_68_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009-1030"},{"key":"e_1_3_4_69_2","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.107.159228"},{"key":"e_1_3_4_70_2","doi-asserted-by":"publisher","DOI":"10.1038\/450494a"},{"key":"e_1_3_4_71_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.109.852756"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.116.003867","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T10:13:16Z","timestamp":1715595196000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.116.003867"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10,3]]},"references-count":70,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2016,10,3]]}},"alternative-id":["10.1161\/JAHA.116.003867"],"URL":"https:\/\/doi.org\/10.1161\/jaha.116.003867","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,10,3]]},"assertion":[{"value":"2016-05-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-09-01","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-10-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e003867"}}