Preclinical atherosclerosis and metabolic syndrome increase cardio- and cerebrovascular events rate: a 20-year follow up

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.

Hypertriglyceridemia: a too long unfairly neglected major cardiovascular risk factor

“…Hypertriglyceridemia, as one of the components of the MS, is closely related to a constellation of metabolic risk factors including a central distribution of adiposity or visceral obesity, insulin resistance, impaired glucose tolerance, hypertension, and high TG and/or low HDL-C, associated with an atherogenic, procoagulant, and proinflammatory state [56][57][58][59][60][61][62][63][64].…”

Metabolic Syndrome: From the Pathophysiology to the Treatment. A Comprehensive Review

“…Relationship between metabolic syndrome and CVD Many studies have shown that patients with the metabolic syndrome have more prevalent and greater risk to develop CVD (59)(60)(61)(62)(63)(64)(65). In these studies, the increased CVD risk ranged from 30 to 400%; this wide variation is probably due to the population, the inclusion criteria, and the length of follow-up.…”

“…In studies demonstrating that metabolic syndrome was associated with higher CVD risk (59)(60)(61)(62)(63)(64)(65)(66)(67), this excess risk remained after adjustment for other conventional risk factors. This would suggest that if other risk factors are included in the definition, the predictive value of the syndrome may improve.…”

Metabolic syndrome and peripheral arterial disease

“…1,6,8,12 A prospective study published by Novo et al showed that in the subgroup of patients with MetS, the prevalence of subclinical atherosclerosis, defined as increased IMT (common carotid IMT > 0.90 mm) with or without atherosclerotic plaque, was significantly higher than in participants without MetS and defined this Syndrome as a CV risk factor: participants with MetS had a significantly higher prevalence of vascular disease in a 20-year follow-up (49%) than participants without MetS (29%) (p < 0.01). 9,13 Conversely, little is known about the predictive role of MetS in peripheral arterial disease (PAD), which affecting about 27 million people in Europe and the United States. Brevetti et al found that more than 50% of PA D patients met the criteria for rATP III-MetS.…”