Metabolic Syndrome and Asymptomatic Peripheral Artery Disease in Subjects Over 60 Years of Age

Abstract

T he ankle-brachial index (ABI) is a noninvasive, low-cost, and useful test for detecting asymptomatic peripheral artery disease (PAD). An ABI Ͻ0.9 has a sensitivity of 95% and a specificity of 99% in identifying PAD when compared with arteriography (1). A low ABI predicts risk of cardiovascular death, myocardial infarction, PAD events, and stroke (2,3). Although an elevated prevalence of a low ABI has been described in subjects with metabolic syndrome and a history of cardiovascular disease (4), there is no information of its possible association in subjects in primary prevention. The objective of the present study was to investigate the association between metabolic syndrome and the presence of asymptomatic PAD, defined by the presence of a low ABI, in subjects Ͼ60 years of age without a history of cardiovascular disease or diabetes. Also, we assessed whether the association persisted after adjustment for classical risk factors.RESEARCH DESIGN AND METHODS -The participants of the study were subjects of both genders aged 60 -79 years who accessed the Fuencarral Health Centre (Madrid) and voluntarily agreed to have an ABI measurement. Of the 1,361 subjects in whom the ABI was measured, 360 were excluded from the present study because of a diagnosis of cardiovascular disease or diabetes. The final number of participants was 1,001. Blood was taken for laboratory analyses that included fasting glucose and the lipid profile. The study was approved by the Committee on Ethics and Clinical Investigation of the Hospital Carlos III in Madrid. All of the patients gave written informed consent.Subjects were diagnosed as having the metabolic syndrome if they met at least three of the following NCEP-ATP III (Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults) criteria (5): waist circumference Ͼ102 cm in men and Ͼ88 cm in women, triglyceride concentration Ն1.70 mmol/l (150 mg/dl), HDL cholesterol Ͻ1.03 mmol/l (Ͻ40 mg/ dl) in men and Ͻ1.29 mmol/l (Ͻ50 mg/ dl) in women, blood pressure Ն130/Ն85 mmHg or on antihypertensive medication, and fasting glucose Ն6.1 mmol/l (Ͼ110 mg/dl). The ABI measurement procedure has been previously described (6). Participants who had an ABI Ͻ0.90 were categorized as having a low ABI.Assessment to determine the 10-year risk for developing coronary heart disease was carried out using the Framingham risk score (5). High-risk subjects were defined as those with a 10-year risk for coronary heart disease Ͼ20%.The statistical analyses were performed with the SPSS statistical package. Comparisons between quantitative variables were performed by unpaired Student's t test and between qualitative variables by the 2 test. Relationships between asymptomatic PAD and the other measured variables were evaluated using multiple logistic regression analyses with the dependent variable being the presence of an ABI Ͻ0.90.RESULTS -A total of 1,001 subjects (67.1% women) participated in the study. Of them, 277 (27.6%) fulfille...

Association of Insulin Resistance and Inflammation With Peripheral Arterial Disease

“…Even after the exclusion of subjects with diabetes, there were graded increases in PAD prevalence with increasing HOMA-IR quartiles, although the associations between HOMA-IR and PAD were no longer statistically significant. Our data support prior observations that PAD is associated with the metabolic syndrome 11,12,36 and glucose intolerance, 13 both surrogate markers of insulin resistance. In contrast to the limited data on the association of insulin resistance and PAD, the link between inflammation and PAD has been well established.…”

Metabolic Syndrome, Inflammation, and Risk of Symptomatic Peripheral Artery Disease in Women

“…Much less information is available on the relationship between the MetS and incident lower extremity peripheral artery disease (PAD) with most data deriving from cross-sectional reports7–10. One of two previously published prospective evaluations suggested that the MetS is a predictor of end-stage PAD (lower extremity amputation or revascularization), but that this risk increase is largely attributable to the impact of diabetes alone11.…”

The association of the metabolic syndrome with QTc interval in NHANES III

“…A number of studies have shown that MetS is associated with cardiovascular diseases such as coronary heart disease (CHD) and peripheral vascular disease [2][3][4]. However, few studies have examined the association of this syndrome with electrocardiographic subclinical risk factors such as a long corrected QT interval (QTc) [5].…”