Abstract
BackgroundIntima-media thickness (IMT) is a validated marker of preclinical atherosclerosis and a predictor of cardiovascular events.PatientsWe studied a population of 529 asymptomatic patients (age 62 ± 12.8 years), divided into two groups of subjects with and without Metabolic Syndrome (MetS).MethodsAll patients, at baseline, have had a carotid ultrasound evaluation and classified in two subgroups: the first one without atherosclerotic lesions and the second one with preclinical atherosclerosis (increased IMT or asymptomatic carotid plaque). Cardiovascular endpoints were investigated in a 20-years follow-up.ResultsThere were 242 cardiovascular events: 144 among patients with MetS and 98 among in healthy controls (57.4% vs. 35.2%; P < 0.0001). 63 events occurred in patients with normal carotid arteries, while 179 events occurred in patients with preclinical atherosclerosis (31.8% vs. 54.1%; P < 0.0001). Of the 144 total events occurred in patients with MetS, 36 happened in the subgroup with normal carotid arteries and 108 in the subgroup with preclinical atherosclerosis (45% vs. 63.15%; P = 0.009). 98 events occurred in patients without MetS, of which 27 in the subgroup with normal carotid arteries and 71 in the subgroup with preclinical atherosclerosis (22.88% vs. 44.37%; P = 0.0003). In addition, considering the 63 total events occurred in patients without atherosclerotic lesions, 36 events were recorded in the subgroup with MetS and 27 events in the subgroup without MetS (45% vs. 22.88%; P = 0.0019). Finally, in 179 total events recorded in patients with preclinical carotid atherosclerosis, 108 happened in the subgroup with MetS and 71 happened in the subgroup without MetS (63.15% vs. 44.37%; P = 0.0009). The Kaplan-Meier function showed an improved survival in patients without atherosclerotic lesions compared with patients with carotid ultrasound alterations (P = 0.01, HR: 0.7366, CI: 0.5479 to 0.9904).ConclusionsPreclinical atherosclerosis leads to an increased risk of cardiovascular events, especially if it is associated with MetS.
Highlights
The atherosclerotic process starts in childhood and proceeds silently over a long period of time before clinical manifestations
Preclinical atherosclerosis leads to an increased risk of cardiovascular events, especially if it is associated with Metabolic Syndrome (MetS)
Our population of 529 patients was divided into two categories, a first one with 251 patients suffering from metabolic syndrome and another one with 278 control subjects who had from 0 to 2 risk factors, so considered as controls
Summary
The atherosclerotic process starts in childhood and proceeds silently over a long period of time before clinical manifestations. Carotid artery Intima-Media Thickness (IMT) reflects the structural deterioration of the arterial wall, so it is considered a significant predictive marker of generalized atherosclerosis because of its correlation with coronary artery disease and it may predict future cardiovascular events in adults [1]. It is associated with established vascular risk factors (hypertension, dyslipidemia, diabetes mellitus, and smoking) or with less-conventional risk factors such as homocysteine, inflammation markers (C-reactive protein, fibrinogen) or uric acid [2,3,4,5,6,7,8,9,10,11]. Patients: We studied a population of 529 asymptomatic patients (age 62 ± 12.8 years), divided into two groups of subjects with and without Metabolic Syndrome (MetS)
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