Metabolic Syndrome in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) Study

Abstract

Abstract-The prevalence of the metabolic syndrome (National Cholesterol Education Program Adult Treatment Panel III criteria) and its relationships with daily life blood pressures, cardiac damage, and prognosis were determined in 2013 subjects from a Northern Italian population aged 25 to 74 years. Home blood pressure, 24-hour blood pressure, and left ventricular mass index (echocardiography) were also measured. Cardiovascular and noncardiovascular deaths were registered over 148 months. Metabolic syndrome was found in 16.2% of the sample, an office blood pressure elevation being the most frequent (95.4%) and the blood glucose abnormality the least frequent (31.5%) component. There was in metabolic syndrome a frequent elevation in home and/or 24-hour average blood pressure, as well as a greater left ventricular mass index and prevalence of left ventricular hypertrophy, which was manifest even when data were adjusted for between-group differences, including blood pressure. The adjusted risk of cardiovascular and all-cause mortality was greater in metabolic syndrome subjects (ϩ71.0% and ϩ37.0%; PϽ0.05), a further marked increase being observed with left ventricular hypertrophy or "in-office" and "out-of-office" blood pressure elevations. The increased risk was related to the blood pressure and the blood glucose component of metabolic syndrome, with no contribution of the remaining components. Thus, metabolic syndrome is common in a Mediterranean population in which it significantly increases the long-term risk of death. Cardiac abnormalities and increases in home and 24-hour blood pressure are common in metabolic syndrome, and their occurrence further enhances the risk. The contribution of metabolic syndrome components to the risk, however, is unbalanced and mainly related to blood pressure and glucose abnormalities. Key Words: metabolic syndrome Ⅲ blood pressure Ⅲ cardiac hypertrophy Ⅲ cardiovascular morbidity Ⅲ cardiovascular mortality I n the last few years, growing attention has been devoted to a condition defined as metabolic syndrome (MS) based on the various clustering of alterations in glucose and lipid metabolism and blood pressure (BP). Several studies have shown that this syndrome has a high prevalence in many populations from various continents. 1-5 Cross-sectional and longitudinal studies have also shown that MS is associated with an increase in risk of cardiovascular (CV) disease and death, 5,6 -15 posing the problem of which therapeutic interventions are needed to protect affected individuals.In the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) Study, we measured office, home, and ambulatory BP together with a number of metabolic and echocardiographic variables in a large sample of a population from an urban district in the northeast outskirts of Milan. Patients were then followed for Ͼ12 years during which information on the incidence of CV and all-cause deaths was obtained by collection of death certificates. This gave us a chance to obtain, in the context of a general population, i...

Metabolic Syndrome and Early Death

“…1 We also discuss, in light of that study's findings, how relevant conventional definitions of the MetS are for identifying individuals at high risk of early death.…”

“…3 The adjusted hazard rate ratios for cardiovascular and all-cause mortality associated with MetS in the entire study population were Ϸ1.7 and 1.4, respectively, which were both of modest statistical significance. Mancia et al 1 determined that not all of the components of the MetS significantly contribute to the prediction of mortality. For those that do (ie, blood pressure and hyperglycemia), the pathological processes that link elevations in these traits with fatal events are well described elsewhere, and it is clear that both factors can independently and, in combination, severely damage vital organs and tissues.…”

“…1 We also discuss, in light of that study's findings, how relevant conventional definitions of the MetS are for identifying individuals at high risk of early death.The MetS describes a constellation of metabolic and cardiovascular disease risk factors. Although varying definitions of the MetS exist, all of the commonly used definitions include a measure of obesity, hyperglycemia, hypertension, and dyslipidemia.…”

Heart Rate and Its Association With the Main Risk Factors in the Population of Men and Women of Working Age

“…В нашем исследовании найдены также ассоциации с повышенным уровнем глюкозы и повышенным уровнем ТГ (р=0,0001). Ав-торы некоторых одномоментных исследований [17][18][19][20] также сообщили о связи между тахикардией и метаболическими факторами.…”

Relationships between metabolic syndrome and left ventricular mass in hypertensive patients: does sex matter?

“…[2][3][4][5][6][7][8][9][10][11][12] In some studies the CV morbidity and mortality risk associated with MetS has been examined separately in men and women and sometimes the prognostic impact of MetS was found to be higher in the female sex. 3,4 The development of asymptomatic structural and functional abnormalities at cardiac level in hypertensive patients with MetS may partially explain the occurrence of CV complications in this population.…”