Metabolic syndrome and incident peripheral artery disease – the Multi-Ethnic Study of Atherosclerosis

Abstract

OBJECTIVE We evaluated whether metabolic syndrome (MetS) is associated with an increased incidence of lower extremity peripheral artery disease (PAD) in community dwelling people free of clinical cardiovascular disease at baseline. We assessed whether higher levels of inflammatory biomarkers may mediate the association of MetS with incident PAD. METHODS MetS was defined at baseline as the presence of three or more of the following components: elevated waist circumference, triglycerides >/=150mg/dL, reduced high-density lipoprotein (HDL) cholesterol, blood pressure >/=130/85mmHg or taking blood pressure medication, and fasting glucose >/=100mg/dL and <126mg/dL. People with diabetes were excluded. Incident PAD was defined as a decline in the ankle-brachial index (ABI) from normal (ABI 0.90 –<1.40) at baseline to one of the following outcomes at 3 year follow-up: ABI decline to <0.90 combined with a decline ≥0.15 or medical record confirmed PAD outcome. Multivariable Poisson regression was used to estimate the association between MetS and incident PAD. RESULTS Among 4,817 participants without PAD at baseline, 1,382 (29%) had MetS. Adjusting for age, sex, race, smoking, physical activity, low-density lipoprotein cholesterol, baseline ABI, and other confounders, 23/1,382 (1.7%) people with MetS developed PAD vs. 30/3,435 (0.87%) people without MetS (risk ratio=1.78 [95% Confidence Interval (CI), 1.04 to 2.82], P=0.031). Adjusting for C-reactive protein, fibrinogen, or interleukin-6 did not attenuate this association. CONCLUSION People free of clinical cardiovascular disease with MetS are at increased risk for PAD. Our findings suggest that this association is not mediated by inflammation.

Metabolic Syndrome Augments the Risk of Early Neurological Deterioration in Acute Ischemic Stroke Patients Independent of Inflammatory Mediators: A Hospital‐Based Prospective Study

“…It is worthwhile to mention that, in accordance with prior studies [ 31 – 33 ], our data also confirmed that levels of plasma hsCRP (OR 1.05; 95% CI 1.01–1.09, P = 0.015), a marker of inflammation, were strongly correlated to MetS. We also found an increase in plasma levels of hsCRP (from 1.8 mg/L to 4.9 mg/L) per additional MetS component.…”

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

“…In addition to CVD, metabolic syndrome has been associated with incident AF, 91 recurrent AF after ablation, 92 HF, 93 PAD, 94 erectile dysfunction, 95 and cognitive decline. 96 Data from case-control studies, but not prospective studies, support an association with VTE.…”

GlycA, a Novel Inflammatory Marker and Its Association With Peripheral Arterial Disease and Carotid Plaque: The Multi-Ethnic Study of Atherosclerosis

“…From these medical records, PAD was classified as definite or probable and included symptomatic disease such as lower extremity claudication, atherosclerosis of the lower extremity, arterial embolism and/or thrombosis of the lower extremity, and abdominal aortic aneurysm. 28 Probable PAD required only a documented physician diagnosis of a PAD condition with symptoms. Definite PAD required one or more other criteria, such as ultrasound evidence of obstruction, an exercise test positive for claudication, revascularization for PAD, amputation for ischemia, ABI ≤0.8 (low ABI), imaging of an aortic aneurysm, or a vascular procedure for abdominal aortic aneurysm.…”