Abstract
BackgroundWe aimed to explore the association between presence and number of components of the Metabolic Syndrome (MetS) and subclinical atherosclerosis outcomes (common carotid intima media thickness, plaque presence and sum of plaque area) in both the carotid and femoral bifurcations.MethodsCross-sectional analysis of 771 volunteers from the ongoing epidemiological Cyprus Study (46% male; mean age = 60.1 ± 9.8). (a) Carotid intima-media thickness (IMTcc), (b) sum of plaque area in the carotid bifurcations (sum of the largest plaques in each carotid bifurcation-SPAcar), (c) sum of plaque area in the femoral bifurcations (sum of the largest plaques in each femoral bifurcation-SPAfem) and (d) sum of plaque area in both carotid and femoral bifurcations (sum of the areas of the largest plaques present in each of the four bifurcations-SPA) were measured at baseline using ultrasound. Presence and number of components of the MetS was ascertained using the National Cholesterol Education Program ATPIII definition and their association tested using multivariable regression models.ResultsMetS was present in 259 (33.6%) individuals and was associated with a 0.02 mm increase in IMTcc (95% CI: 0.00 to 0.04, p = 0.047) after adjustment for age, sex, family history of CVD, alcohol consumption (BU/week) and smoking (pack-years). Each additional component of the MetS was associated with a 16% higher SPA (95% CI: 6.8% to 25.2%, pfor trend = 0.001), a 10% higher SPAcar (95% CI: 5% to 24%, pfor trend = 0.003) and a 14% higher SPAfem in the adjusted model.ConclusionsWe confirm an association between the MetS and IMTcc as well as report for the first time an association between the MetS and its components and femoral plaque area, in a general population over 40 years of age. Having any risk factors for the MetS increases the risk for subclinical atherosclerosis, with the risk increasing with each additional component. Using the dichotomous definition of the MetS may be overlooking the risk for subclinical atherosclerosis –and by inference future cardiovascular events- associated with having less than 3 risk factors.
Highlights
IntroductionWe aimed to explore the association between presence and number of components of the Metabolic Syndrome (MetS) and subclinical atherosclerosis outcomes (common carotid intima media thickness, plaque presence and sum of plaque area) in both the carotid and femoral bifurcations
We aimed to explore the association between presence and number of components of the Metabolic Syndrome (MetS) and subclinical atherosclerosis outcomes in both the carotid and femoral bifurcations
When the number of components of the Mets was used in the analysis, each additional component was found to be associated with a 0.02 mm increase in the basic model and a 0.02 mm increase in the fully adjusted model
Summary
We aimed to explore the association between presence and number of components of the Metabolic Syndrome (MetS) and subclinical atherosclerosis outcomes (common carotid intima media thickness, plaque presence and sum of plaque area) in both the carotid and femoral bifurcations. The Metabolic Syndrome (MetS) currently affects about 25% of the adult population in Europe and this trend is on the rise both in developed but especially in developing countries [1], making it a global public health issue. It is usually defined as a cluster of three or more risk factors for cardiovascular disease (CVD), including hypertension, obesity and dyslipidemia which can identify individuals with increased insulin resistance. Atherosclerosis can be visualized non-invasively in the arterial wall with the use of high resolution ultrasound and ultrasonic measurements such as intima-media thickness (IMT) are often used as a surrogate end-point in epidemiological studies on CVD and coronary artery disease, with increased carotid IMT (IMTc) having been associated with both the presence and extent of coronary artery disease [10,11], while progression of IMTc has been associated with future cerebrovascular and coronary events [12]
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