The metabolic syndrome and progression of carotid atherosclerosis over 13 years. The Tromsø study

Abstract

BackgroundThe metabolic syndrome (MetS) is associated with increased risk of cardiovascular disease. In this study, we examine if metabolic syndrome predicts progression of atherosclerosis over 13 years.MethodsParticipants were 1442 men and 1532 women in the population-based Tromsø Study who underwent carotid ultrasound examinations at baseline in the 4th (1994–5) and at follow-up in the 6th survey (2007–8). Of these, 278 men and 273 women fulfilled the criteria for the MetS, defined according to a modified version of the National Cholesterol Education Program Adult Treatment Panel III (NCEP, ATPIII). Carotid atherosclerosis was assessed as total plaque area (TPA) and mean intima-media thickness (IMT) at follow-up and as change in IMT and TPA from baseline to follow-up. Associations between MetS and its components and carotid atherosclerosis were assessed in linear regression models adjusted for age, total cholesterol and daily smoking, stratified by sex.ResultsIMT and TPA levels at follow-up (p < 0.0001) and progression of TPA (p = 0.02) were higher in the MetS group compared to the non-MetS group. In stepwise multivariable models, MetS was associated with TPA (β = 0.372 mm2, p = 0.009) and IMT (β = 0.051 mm, p < 0.0001) in men, and with IMT (β = 0.045 mm, p = 0.001) in women after 13 years of follow-up, but not with progression of IMT or TPA. In analyses stratified by age, MetS predicted progression of IMT (β = 0.043 mm, p = 0.046) and TPA (β = 1.02 mm2, p = 0.002) in men below 50 years of age. Hypertension was predictive of follow-up TPA and IMT in both genders and of progression of TPA in women. Impaired glucose tolerance was associated with follow up levels of IMT and TPA as well as progression in IMT in men. None of the other components of MetS were associated with progression of atherosclerosis.ConclusionsSubjects with MetS had higher levels of IMT and TPA at follow up than those without MetS. Mets predicted progression of IMT and TPA in those below 50 years of age, but not in other age groups, indicating that MetS may be involved in the initiation of the atherosclerotic process.

Metabolic Syndrome and Early Carotid Atherosclerosis in the Elderly

“…In other words, MetS predicted the occurrence of new carotid plaque and may be correlated with changes in IMT over time. These results are consistent with the findings of several longitudinal 15,16,23,24) and cross-sectional studies 14,25,26) that addressed the relationships between MetS, carotid plaque and C-IMT. In the present study, the presence of carotid plaque was associated with accelerated C-IMT changes (Cont Table 1 stress and proinflammatory signaling in the vessel wall 38) .…”

“…MetS is also associated with early carotid atherosclerosis 13,14) . Several prospective studies have shown that MetS is associated with the progression of atherosclerosis 15,16) . These studies highlight the importance of MetS in the atherosclerotic process.…”

“…Furthermore, the occurrence of carotid plaque in relation to the participant characteristics did not change significantly between the first and second surveys ( Table 1). 16,27) . These findings suggest that MetS plays an important role in the initiation or acceleration of the early carotid atherosclerotic process.…”

Hypertriglyceridemia: a too long unfairly neglected major cardiovascular risk factor

“…Hypertriglyceridemia, as one of the components of the MS, is closely related to a constellation of metabolic risk factors including a central distribution of adiposity or visceral obesity, insulin resistance, impaired glucose tolerance, hypertension, and high TG and/or low HDL-C, associated with an atherogenic, procoagulant, and proinflammatory state [56][57][58][59][60][61][62][63][64].…”

The metabolic syndrome entanglement: cutting the Gordian knot

“…Analyzing the progression of carotid atherosclerosis, it should be stressed that subjects with MS have higher levels of intima-media thickness (IMT) and total plaque area at follow up than those without MS. MS predicts progression of IMT in individuals below 50 years of age, but not in older age groups, suggesting thus that MS may be involved in the initial steps of the atherosclerotic process [31].…”