The metabolic syndrome, diabetes, and subclinicalatherosclerosis assessed by coronary calcium

Wong, Nathan D.; Sciammarella, Maria; Polk, Donna M.; Gallagher, Amy; Miranda-Peats, Lisa; Whitcomb, Brian W.; Hachamovitch, Rory; Friedman, John D.; Hayes, Sean W.; Berman, Daniel S.

doi:10.1016/s0735-1097(03)00193-1

Cited by 196 publications

(41 citation statements)

References 18 publications

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“…Other measures which more directly reflect atherosclerosis burden may be more important for further risk stratification of the patient with DM, such as coronary calcium which has been shown to add prognostic value in such patients. 13–14 MetS, however, is a more heterogeneous condition associated with a wide variation in CVD risk, 26 with many persons at intermediate risk where further evaluation such as by echo LV mass, may be helpful for risk stratification; our data support this by showing a modest added value for echo LV mass in risk prediction in such persons and in those without MetS.…”

Section: Discussionsupporting

confidence: 64%

“…10 There is a need to better identify what further screening methods for subclinical CVD can further improve risk prediction in persons with MetS and DM. 11 For instance, it is known such persons demonstrate a greater extent of myocardial ischemia 12 and coronary calcium 13,14 , with the latter providing prognostic value for CVD events. 15 Whether subclinical CVD evidenced by higher LV mass provides significant incremental prognostic value in predicting CVD events over standard risk factors in these conditions is unclear, especially in those with MetS and DM and in older persons who have a longer exposure to these conditions.…”

Section: Introductionmentioning

confidence: 99%

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LV Mass as a Predictor of CVD Events in Older Adults With and Without Metabolic Syndrome and Diabetes

Hoang¹,

Zhao²,

Gardin³

et al. 2015

JACC: Cardiovascular Imaging

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Objective We examined the prognostic significance of left ventricular (LV) mass for cardiovascular disease (CVD) events in older adults with and without metabolic syndrome (MetS) and diabetes (DM). Background MetS and DM are associated with increased CVD risk, but it is unclear in these groups whether subclinical CVD evidenced by increased LV mass improves risk prediction over standard risk factors in older individuals. Methods We studied 3,724 adults (mean age 72.4 ± 5.4, 61.0% female, 4.4% African American) from the Cardiovascular Health Study who had MetS (but without DM), DM, or neither condition. Cox regression examined the association of LV mass (alone and indexed by height and body surface area [BSA]) determined by echocardiography with CVD events, including coronary heart disease (CHD), stroke, heart failure (HF), and CVD death, as well as total mortality. We also assessed the added prediction, discriminative value and net reclassification improvement (NRI) for clinical utility of LV mass over standard risk factors. Results Over a mean follow-up of 14.2 ± 6.3 years, 2,180 subjects experienced CVD events, including 986 CVD deaths. After adjustment for age, gender and standard risk factors, LV mass was positively associated with CVD events in those with MetS (hazard ratio [HR]=1.4, p<0.001) and without MetS (HR=1.4, p<0.001), but not DM (HR=1.0, p=0.62), with similar findings for LV mass indexed for height or BSA. Adding LV mass to standard risk factors moderately improved the prediction accuracy in the overall sample and MetS group from changes in C-statistics (p<0.05). Categorical-free net reclassification improvement increased significantly by 17–19% in those with MetS. Findings were comparable for CHD, CVD mortality and total mortality. Conclusions LV mass is associated with increased CVD risk and provides modest added prediction and clinical utility over standard risk factors in older persons with and without MetS, but not with DM.

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Section: Discussionsupporting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

LV Mass as a Predictor of CVD Events in Older Adults With and Without Metabolic Syndrome and Diabetes

Hoang¹,

Zhao²,

Gardin³

et al. 2015

JACC: Cardiovascular Imaging

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“…Modified Asian ATP III criteria are the same as original ATP III except waist circumference (WC) greater than 90 cm in men and 80 cm in women [4]. Diagnosis requires having any three of five risk factors: abnormal WC, TG levels ≥150.0 mg/dL or pharmacologic treatment (Rx), HDL-C levels: <40.0 mg/dL in male and <50.0 mg/dL in female; or Rx, blood pressure: >130 mm Hg systolic and >85 mm Hg diastolic or Rx, and FBG concentration >100.0 mg/dL or Rx [11]. …”

Section: Methodsmentioning

confidence: 99%

Pattern of Thyroid Dysfunction in Patients with Metabolic Syndrome and Its Relationship with Components of Metabolic Syndrome

et al. 2015

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BackgroundThyroid dysfunction (TD) and metabolic syndrome (MetS) are known risk factors for atherosclerotic cardiovascular disease (ASCVD). TD is risk factor for ASCVD mediated by the effects of thyroid hormones on lipid metabolism and blood pressure hence the components of MetS. It is possible that coexistence of these two disease entities and unrecognized TD in patients with MetS might substantially increase ASCVD risk. Moreover, little is known about the relationship between TD and the components of MetS. Thus, the purpose of this study was to evaluate the pattern of TD in patients with MetS and its relationship with components of the MetS.MethodsA total of 358 previously diagnosed patients with MetS were recruited in the study. The thyroid function test parameters were measured to classify TD at Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal. Statistical analyses were performed using SPSS version 16.0 to evaluate pattern and relationship.ResultsThe overall prevalence of TD in patients with MetS was 31.84% with high prevalence of subclinical hypothyroidism (29.32%). We found no evidence of a relationship between TD and components of MetS, although there was significant difference in waist circumference between four groups of TD.ConclusionPatients with MetS had subclinical hypothyroidism greatly. Although there was no evidence of any relationship between thyroid status and all components of MetS, TD should be taken into account when evaluating and treating patients with MetS to reduce the impending risk.

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“…DM has been evaluated by CAC in multiple studies, and the increased prevalence of CAC in DM is well documented, as is the worse prognosis in those with CAC. [3][4][5][6][7][8][9][10] In CCTA evaluations, Pundziute et al 9 noted more diseased segments, calcified and non-calcified plaques in 215 patients with symptomatic DM compared to individuals with no DM, and Scholte et al 10 in 70 patients with asymptomatic DM reported plaque in 80%, 41% of which were non-calcified. Neither paper evaluated patients with IFG.…”

Section: Discussionmentioning

confidence: 99%

“…1 To examine its relationship with clinical coronary artery disease (CAD), a systematic literature review of 18 studies reported a significant but modest relative risk of 1.18-1.20. 2 In the symptomatic and asymptomatic population, there are numerous studies documenting the increased association of DM with subclinical atherosclerosis, [3][4][5][6][7][8][9][10] but there are no data for pre-diabetes. Consequently, this study was designed to establish the role of IFG in plaque formation in asymptomatic patients compared to patients with DM and participants with normal fasting glucose (NFG), as measured by coronary computed tomographic angiography (CCTA).…”

mentioning

confidence: 99%

Impaired fasting glucose is associated with increased severity of subclinical coronary artery disease compared to patients with diabetes and normal fasting glucose: evaluation by coronary computed tomographic angiography

et al. 2016

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ObjectiveThis study was designed to evaluate the severity of subclinical atherosclerosis in patients with asymptomatic impaired fasting glucose (IFG) compared to those with diabetes mellitus (DM) and normal fasting glucose (NFG), as measured by coronary computed tomographic angiography (CCTA).DesignSubjects were divided into three groups: NFG (<100 mg/dL), IFG (100–125 mg/dL) and DM. Coronary artery calcium on non-contrast CT and plaque analysis on CCTA were performed.SettingUniversity hospital, single centre.Participants216 asymptomatic participants prospectively underwent CCTA for the evaluation of coronary artery disease (CAD).Primary and secondary outcome measuresAtherosclerotic plaque burden in IFG compared to NFG patients.Results2664 segments were analysed in 120 NFG, 44 IFG and 52 DM participants. The mean calcium scores were 178±395, 259±510 and 414±836 for NFG, IFG and DM, respectively (p=0·037). The mean plaque burdens in the NFG, IFG and DM groups were 0.31±0.45, 0.50±0.69 and 0.68±0.69, respectively (p=0·0007). A greater proportion of patients with DM (19/52, 36.5%) and IFG (13/44, 29.5%) had obstructive CAD compared to those with NFG (16/120, 13.3%) (p=0.0015). The number of segments with severe disease was significantly higher in the DM (60/637, 9.4%) and IFG (42/539, 7.8%) groups compared to that in the NFG group (34/1488, 2.3%) (p=0.0001).Conclusions(1) IFG and DM have significantly higher, but comparable, calcium scores, plaque burden and obstructive CAD compared to NFG in asymptomatic individuals. (2) Pending corroboration by other reports, more intensive efforts may be devoted to the evaluation and treatment of patients with IFG.

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The metabolic syndrome, diabetes, and subclinicalatherosclerosis assessed by coronary calcium

Abstract: Those with MetS or diabetes have an increased likelihood of CAC compared with those having neither condition.

Cited by 196 publications

References 18 publications

LV Mass as a Predictor of CVD Events in Older Adults With and Without Metabolic Syndrome and Diabetes

LV Mass as a Predictor of CVD Events in Older Adults With and Without Metabolic Syndrome and Diabetes

Pattern of Thyroid Dysfunction in Patients with Metabolic Syndrome and Its Relationship with Components of Metabolic Syndrome

Impaired fasting glucose is associated with increased severity of subclinical coronary artery disease compared to patients with diabetes and normal fasting glucose: evaluation by coronary computed tomographic angiography

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