Metabolic Syndrome, Prediabetes, and Brain Abnormalities on MRI in Patients With Manifest Arterial Disease: The SMART-MR Study

Abstract

OBJECTIVEMetabolic syndrome (MetS) is a cluster of cardiovascular risk factors leading to atherosclerosis and diabetes. Diabetes is associated with both structural and functional abnormalities of the brain. MetS, even before diabetes is diagnosed, may also predispose to cerebral changes, probably through shared mechanisms. We examined the association of MetS with cerebral changes in patients with manifest arterial disease. RESEARCH DESIGN AND METHODSCross-sectional data on MetS and brain MRI were available in 1,232 participants with manifest arterial disease (age 58.6 6 10.1 years; 37% MetS). Volumes of brain tissue, ventricles, and white matter hyperintensities (WMH) were obtained by automated segmentation and expressed relative to intracranial volume. Infarcts were distinguished into lacunar and nonlacunar infarcts. RESULTSThe presence of MetS (n = 451) was associated with smaller brain tissue volume (B 20.72% [95% CI 20.97, 20.47]), even in the subgroup of patients without diabetes (B 20.42% [95% CI 20.71, 20.13]). MetS was not associated with an increased occurrence of WMH or cerebral infarcts. Impaired glucose metabolism, abdominal obesity, and elevated triglycerides were individual components associated with smaller brain volume. Obesity and hypertriglyceridemia remained associated with smaller brain volume when patients with diabetes were excluded. Hypertension was associated with an increased occurrence of WMH and infarcts. CONCLUSIONSIn patients with manifest arterial disease, presence of MetS is associated with smaller brain volume, even in patients without diabetes. Screening for MetS and treatment of its individual components, in particular, hyperglycemia, hypertriglyceridemia, and obesity, may prevent progression of cognitive aging in patients with MetS, even in a prediabetic stage.It is increasingly recognized that both the metabolic syndrome (MetS) and diabetes are associated with accelerated cognitive decline in older individuals (1-3). Brain imaging studies in patients with diabetes report an increased occurrence of brain atrophy and vascular lesions (white matter hyperintensities [WMH] and lacunar infarcts [LIs]) (4). However, there is limited current literature about the relation

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