Comparison of the Effect of the Metabolic Syndrome and Multiple Traditional Cardiovascular Risk Factors on Vascular Function

Abstract

Objective: To assess the effect of the metabolic syndrome (MetS) on endothelial function and compare these findings to those in individuals with a similar burden of traditional cardiovascular (CV) risk factors (Ն3) without MetS. Patients and Methods: Both MetS and multiple CV risk factors were identified from 1103 individuals who underwent the evaluation of endothelial function at the Mayo Clinic, in Rochester, Minnesota, from July 1, 2000, through July 31, 2011. Endothelial function was measured using digital arterial tonometry by assessing reactive hyperemia-induced vasodilation in one arm and adjusting for changes in the contralateral arm (reactive hyperemia index [RHI]). Results: A total of 316 individuals with MetS and 210 with multiple risk factors were assessed. Endothelial dysfunction was more pronounced in the MetS group compared with the multiple risk factor group (mean Ϯ SD natural logarithmic RHI, 0.61Ϯ0.25 and 0.68Ϯ0.28, respectively; Pϭ.006). Leukocyte count (7.00Ϯ1.89 ϫ 10 9 /L vs 6.41Ϯ1.76 ϫ 10 9 /L, respectively; Pϭ.001) and high-sensitivity C-reactive protein level (1.78Ϯ1.53 mg/L vs 1.48Ϯ1.42 mg/L, respectively; Pϭ.01) were higher in the MetS group compared with the multiple risk factor group. After adjustment for covariates and 6 traditional CV risk factors in a multivariate regression model, MetS had a significant and independent influence on natural logarithmic RHI (␤ϭϪ.11; Pϭ.01). Conclusion: The current study found that individuals with MetS have a higher degree of endothelial dysfunction and inflammation compared with individuals with multiple CV risk factors and may therefore have an increased CV risk beyond the contributions of multiple traditional risk factors.

Coronary Endothelial Dysfunction, Obesity and Metabolic Syndrome

“…We found a statistically independent association between MetS and coronary microvascular endothelial dysfunction particularly in relation to increasing MetS risk factor burden. Our results are in agreement with findings in the peripheral circulation where endothelial responses to pressure alterations to finger cuff (using digital arterial tonometry), to increased flow in the brachial artery and to ACH in the femoral microcirculation were impaired in subjects with MetS [16,19,20]. Although we also observed increasing epicardial endothelial dysfunction with exposure to MetS components, this relationship did not persist after adjustment for the presence of CAD.…”

“…Although a previous study found a correlation between CRP levels and forearm vascular endothelial function, adjustment for obesity or MetS was not performed [52]. Others have confirmed our observations [16,22,53]. Furthermore, despite higher CRP levels in obese subjects and in those with MetS as previously reported, the association between endothelial dysfunction and MetS was not affected by further adjustment for CRP levels.…”

“…Peripheral arterial endothelial dysfunction has been observed in obese children and adults, and in those with MetS, even after adjustment for conventional risk factors [16][17][18][19][20][21]. Although an independent association between obesity and coronary endothelial dysfunction has been described [22], the incremental influence of the MetS variables and low-grade systemic inflammation on coronary endothelial function remains unknown.…”

Arterial Function in Cardio-Metabolic Diseases: From the Microcirculation to the Large Conduits

“…infusion of endothelium-dependent agonists) challenge. 38,39 However, this blunted vasodilator response may be dependent on the length of exposure to the altered metabolic state, as younger adults with MetS demonstrated preserved endothelium-dependent vasodilation of the microvasculature. 40 In addition, there is enhanced vasoconstriction depicted by increased circulating endothelin-1 in MetS, 41 and increased vasoconstrictor tone after endothelin-1 infusion in diabetic patients with MetS.…”

Is High Leukocyte Count Synonymous With the Presence of Endothelial Dysfunction or Atherosclerosis?

“…8 Besides patients with low cardiovascular risk, we have recently shown that higher leukocyte count is associated with endothelial dysfunction in patients with high cardiovascular risk. 9 Therefore, we are also looking forward to future studies on the effect of antiinflammatory treatment and reduction in leukocyte count on primary prevention.…”