concentration (Ͻ40 mg/dL in men, Ͻ50 mg/dL in women), and increased fasting glucose concentration (Ͼ110 mg/dL). The authors sought to determine whether metabolic syndrome is related to the extent of vascular damage in patients with manifestations of arterial disease. This was a cross-sectional survey of 502 patients derived from the Second Manifestations of Arterial Disease (SMART) study. Patients in this study were recently diagnosed with either coronary heart disease (n ϭ 502), stroke (n ϭ 236), peripheral arterial disease (n ϭ 218), or abdominal aortic aneurysm (n ϭ 89). Carotid intima media thickness, ankle-brachial index (ABI), and albuminuria were used as noninvasive markers of vascular damage. Values were adjusted for age and sex when appropriate.Metabolic syndrome was present in 45% of the study population. This included 57% of patients with peripheral arterial disease, 40% of patients with coronary heart disease, 43% of patients with stroke, and 45% of patients with abdominal aortic aneurysm. Patients with metabolic syndrome had increased intima media thickness (0.98 vs 0.92 mm; P Ͻ .01), more often decreased ABI (14% vs 10%; P ϭ .06), and increased prevalence of albuminuria (20% vs 15%; P ϭ .03) compared with patients without diagnosed metabolic syndrome. An increase in the number of components of metabolic syndrome was associated with an increase in mean intima medial thickening (P Ͻ .001), lower ABI (P Ͻ .01), and higher prevalence of albuminuria (P Ͻ .01).Comment: The data indicate that metabolic syndrome is a marker not only for increased risk for cardiovascular disease, but also for worse cardiovascular disease in patients with a manifestation of peripheral atherosclerosis. This is another bit of evidence to indicate the profound adverse health effects of obesity. Obesity is a risk factor not only for atherosclerosis, but also for more severe atherosclerosis.
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