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Diabetology & Metabolic Syndrome
Published in: Diabetology & Metabolic Syndrome 1/2013

Open Access 01-12-2013 | Research

Association between presence of the metabolic syndrome and its components with carotid intima-media thickness and carotid and femoral plaque area: a population study

Authors: Andrie G Panayiotou, Maura Griffin, Panayiotis Kouis, Theodosis Tyllis, Niki Georgiou, Dawn Bond, Andrew N Nicolaides

Published in: Diabetology & Metabolic Syndrome | Issue 1/2013

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Abstract

Background

We aimed to explore the association between presence and number of components of the Metabolic Syndrome (MetS) and subclinical atherosclerosis outcomes (common carotid intima media thickness, plaque presence and sum of plaque area) in both the carotid and femoral bifurcations.

Methods

Cross-sectional analysis of 771 volunteers from the ongoing epidemiological Cyprus Study (46% male; mean age = 60.1 ± 9.8). (a) Carotid intima-media thickness (IMTcc), (b) sum of plaque area in the carotid bifurcations (sum of the largest plaques in each carotid bifurcation-SPAcar), (c) sum of plaque area in the femoral bifurcations (sum of the largest plaques in each femoral bifurcation-SPAfem) and (d) sum of plaque area in both carotid and femoral bifurcations (sum of the areas of the largest plaques present in each of the four bifurcations-SPA) were measured at baseline using ultrasound. Presence and number of components of the MetS was ascertained using the National Cholesterol Education Program ATPIII definition and their association tested using multivariable regression models.

Results

MetS was present in 259 (33.6%) individuals and was associated with a 0.02 mm increase in IMTcc (95% CI: 0.00 to 0.04, p = 0.047) after adjustment for age, sex, family history of CVD, alcohol consumption (BU/week) and smoking (pack-years). Each additional component of the MetS was associated with a 16% higher SPA (95% CI: 6.8% to 25.2%, pfor trend = 0.001), a 10% higher SPAcar (95% CI: 5% to 24%, pfor trend = 0.003) and a 14% higher SPAfem in the adjusted model.

Conclusions

We confirm an association between the MetS and IMTcc as well as report for the first time an association between the MetS and its components and femoral plaque area, in a general population over 40 years of age. Having any risk factors for the MetS increases the risk for subclinical atherosclerosis, with the risk increasing with each additional component. Using the dichotomous definition of the MetS may be overlooking the risk for subclinical atherosclerosis –and by inference future cardiovascular events- associated with having less than 3 risk factors.
Appendix
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Literature
1.
Grundy SM: Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol. 2008, 28 (4): 629-636. 10.1161/ATVBAHA.107.151092.CrossRefPubMed
2.
Alberti K, Zimmet P, Shaw J: Metabolic syndrome—a new world‒wide definition. A consensus statement from the international diabetes federation. Diabetic Med. 2006, 23 (5): 469-480. 10.1111/j.1464-5491.2006.01858.x.CrossRefPubMed
3.
Alberti K, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart J, James WPT, Loria CM, Smith SC: Harmonizing the metabolic syndrome a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009, 120 (16): 1640-1645. 10.1161/CIRCULATIONAHA.109.192644.CrossRefPubMed
4.
Bayturan O, Tuzcu EM, Lavoie A, Hu T, Wolski K, Schoenhagen P, Kapadia S, Nissen SE, Nicholls SJ: The metabolic syndrome, its component risk factors, and progression of coronary atherosclerosis. Arch Intern Med. 2010, 170 (5): 478-10.1001/archinternmed.2009.551.CrossRefPubMed
5.
Tzou WS, Douglas PS, Srinivasan SR, Bond MG, Tang R, Chen W, Berenson GS, Stein JH: Increased subclinical atherosclerosis in young adults with metabolic syndrome: the Bogalusa Heart Study. J Am Coll Cardiol. 2005, 46 (3): 457-463. 10.1016/j.jacc.2005.04.046.CrossRefPubMed
6.
Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, Rinfret S, Schiffrin EL, Eisenberg MJ: The metabolic syndrome and cardiovascular risk: a systematic review and meta-analysis. J Am Coll Cardiol. 2010, 56 (14): 1113-1132. 10.1016/j.jacc.2010.05.034.CrossRefPubMed
7.
Smith SR: Importance of diagnosing and treating the metabolic syndrome in reducing cardiovascular risk. Obesity. 2012, 14 (S6): 128S-134S.
8.
Gami AS, Witt BJ, Howard DE, Erwin PJ, Gami LA, Somers VK, Montori VM: Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol. 2007, 49 (4): 403-414. 10.1016/j.jacc.2006.09.032.CrossRefPubMed
9.
Malik S, Wong ND, Franklin SS, Kamath TV, Gilbert J, Pio JR, Williams GR: Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation. 2004, 110 (10): 1245-1250. 10.1161/01.CIR.0000140677.20606.0E.CrossRefPubMed
10.
Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR, Clegg LX: Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol. 1997, 146 (6): 483-494. 10.1093/oxfordjournals.aje.a009302.CrossRefPubMed
11.
Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M: Prediction of clinical cardiovascular events with carotid intima-media thickness. Circulation. 2007, 115 (4): 459-467. 10.1161/CIRCULATIONAHA.106.628875.CrossRefPubMed
12.
Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE: Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation. 1997, 96 (5): 1432-1437. 10.1161/01.CIR.96.5.1432.CrossRefPubMed
13.
Spence JD, Rundek T: Toward clinical applications of carotid ultrasound: intima-media thickness, plaque area, and three-dimensional phenotypes. Ultrasound and Carotid Bifurcation Atherosclerosis. 2012, London: Springer, 431-448.
14.
Spence JD: Ultrasound measurement of carotid plaque as a surrogate outcome for coronary artery disease. Am J Cardiol. 2002, 89 (4): 10-15. 10.1016/S0002-9149(01)02327-X.CrossRef
15.
Spence JD, Eliasziw M, DiCicco M, Hackam DG, Galil R, Lohmann T: Carotid plaque area a tool for targeting and evaluating vascular preventive therapy. Stroke. 2002, 33 (12): 2916-2922. 10.1161/01.STR.0000042207.16156.B9.CrossRefPubMed
16.
Griffin M, Nicolaides A, Tyllis T, Georgiou N, Martin RM, Bond D, Panayiotou A, Tziakouri C, Doré CJ, Fessas C: Carotid and femoral arterial wall changes and the prevalence of clinical cardiovascular disease. Vasc Med. 2009, 14 (3): 227-232. 10.1177/1358863X08101542.CrossRefPubMed
17.
Schmidt C, Fagerberg B, Hulthe J: Non-stenotic echolucent ultrasound-assessed femoral artery plaques are predictive for future cardiovascular events in middle-aged men. Atherosclerosis. 2005, 181 (1): 125-10.1016/j.atherosclerosis.2004.12.034.CrossRefPubMed
18.
Held C, Hjemdahl P, Eriksson S, Björkander I, Forslund L, Rehnqvist N: Prognostic implications of intima-media thickness and plaques in the carotid and femoral arteries in patients with stable angina pectoris. Eur Heart J. 2001, 22 (1): 62-72. 10.1053/euhj.1999.2006.CrossRefPubMed
19.
Vaudo G, Marchesi S, Siepi D, Brozzetti M, Mannarino MR, Pirro M, Schillaci G, Ciuffetti G, Lupattelli G, Mannarino E: Metabolic syndrome and preclinical atherosclerosis: focus on femoral arteries. Metab Clin Exp. 2007, 56 (4): 541-546. 10.1016/j.metabol.2006.11.016.CrossRefPubMed
20.
Pollex RL, Al-Shali KZ, House AA, Spence JD, Fenster A, Mamakeesick M, Zinman B, Harris SB, Hanley AJ, Hegele RA: Relationship of the metabolic syndrome to carotid ultrasound traits. Cardiovasc Ultrasound. 2006, 4: 28-10.1186/1476-7120-4-28.PubMedCentralCrossRefPubMed
21.
Hassinen M, Komulainen P, Lakka TA, Vaisanen SB, Haapala I, Gylling H, Alen M, Schmidt-Trucksass A, Nissinen A, Rauramaa R: Metabolic syndrome and the progression of carotid intima-media thickness in elderly women. Arch Intern Med. 2006, 166 (4): 444-CrossRefPubMed
22.
Rundek T, White H, Boden‒Albala B, Jin Z, Elkind MS, Sacco RL: The metabolic syndrome and subclinical carotid atherosclerosis: the Northern Manhattan Study. Journal of the cardiometabolic syndrome. 2007, 2 (1): 24-29. 10.1111/j.1559-4564.2007.06358.x.CrossRefPubMed
23.
Panayiotou A, Nicolaides A, Griffin M, Tyllis T, Georgiou N, Bond D, Martin R, Hoppensteadt D, Fareed J, Humphries S: Leukocyte telomere length is associated with measures of subclinical atherosclerosis. Atherosclerosis. 2010, 211 (1): 176-181. 10.1016/j.atherosclerosis.2010.01.037.CrossRefPubMed
24.
Cena H, Tesone A, Niniano R, Cerveri I, Roggi C, Turconi G: Prevalence rate of Metabolic Syndrome in a group of light and heavy smokers. Diabetology & metabolic syndrome. 2013, 5 (1): 28-10.1186/1758-5996-5-28.CrossRef
25.
Ogbera AO: Prevalence and gender distribution of the metabolic syndrome. Diabetol Metab Syndr. 2010, 2 (1): 4-10.1186/1758-5996-2-4.CrossRef
26.
Fujita N, Takei Y: Alcohol consumption and metabolic syndrome. Hepatology Research. 2011, 41 (4): 287-295. 10.1111/j.1872-034X.2011.00787.x.CrossRefPubMed
27.
Empana J, Zureik M, Gariepy J, Courbon D, Dartigues JF, Ritchie K, Tzourio C, Alperovitch A, Ducimetiere P: The metabolic syndrome and the carotid artery structure in noninstitutionalized elderly subjects the three-city study. Stroke. 2007, 38 (3): 893-899. 10.1161/01.STR.0000257983.62530.75.CrossRefPubMed
28.
Ahluwalia N, Drouet L, Ruidavets J, Perret B, Amar J, Boccalon H, Hanaire-Broutin H, Ferrieres J: Metabolic syndrome is associated with markers of subclinical atherosclerosis in a French population-based sample. Atherosclerosis. 2006, 186 (2): 345-353. 10.1016/j.atherosclerosis.2005.07.021.CrossRefPubMed
29.
Adolphe A, Cook LS, Huang X: A cross-sectional study of intima-media thickness, ethnicity, metabolic syndrome, and cardiovascular risk in 2268 study participants. Mayo Clin Proc. 2009, 84 (3): 221-228. 10.4065/84.3.221.PubMedCentralCrossRefPubMed
30.
Fadini GP, Coracina A, Inchiostro S, Tiengo A, Avogaro A, De Kreutzenberg SV: A stepwise approach to assess the impact of clustering cardiometabolic risk factors on carotid intima-media thickness: the metabolic syndrome no-more-than-additive. Eur J Cardiovasc Prev Rehabil. 2008, 15 (2): 190-196. 10.1097/HJR.0b013e3282f17bc3.CrossRefPubMed
31.
Xu L, Jiang CQ, Lam TH, Lin JM, Yue XJ, Cheng KK, Liu B, Jin YL, Zhang WS, Thomas GN: The metabolic syndrome is associated with subclinical atherosclerosis independent of insulin resistance: the Guangzhou Biobank Cohort study-CVD. Clin Endocrinol (Oxf). 2010, 73 (2): 181-188.
32.
Herder M, Arntzen KA, Johnsen SH, Mathiesen EB: The metabolic syndrome and progression of carotid atherosclerosis over 13 years. The Tromso study. Cardiovasc Diabetol. 2012, 11 (1): 77-10.1186/1475-2840-11-77.PubMedCentralCrossRefPubMed
33.
Hodis HN, Mack WJ, LaBree L, Selzer RH, Liu C, Liu C, Azen SP: The role of carotid arterial intima-media thickness in predicting clinical coronary events. Ann Intern Med. 1998, 128 (4): 262-269. 10.7326/0003-4819-128-4-199802150-00002.CrossRefPubMed
34.
Lin H, Liu C, Liao Y, Lin R, Chen C, Juo SH: The risk of the metabolic syndrome on carotid thickness and stiffness: sex and age specific effects. Atherosclerosis. 2010, 210 (1): 155-159. 10.1016/j.atherosclerosis.2009.11.027.CrossRefPubMed
35.
Iglseder B, Cip P, Malaimare L, Ladurner G, Paulweber B: The metabolic syndrome is a stronger risk factor for early carotid atherosclerosis in women than in men. Stroke. 2005, 36 (6): 1212-1217. 10.1161/01.STR.0000166196.31227.91.CrossRefPubMed
36.
Matoba Y, Inoguchi T, Suzuki S, Nasu S, Hashimoto T, Yanase T, Nawata H, Takayanagi R: Impact of metabolic syndrome on the progression of intima-media thickening in Japanese—a follow-up study. Diabetes Res Clin Pract. 2009, 86 (3): e50-e53. 10.1016/j.diabres.2009.09.013.CrossRefPubMed
37.
Ershova AI, Balakhonova TV, Meshkov AN, Rozhkova TA, Boytsov SA: Ultrasound markers that describe plaques are more sensitive than mean intima-media thickness in patients with familial hypercholesterolemia. Ultrasound Med Biol. 2012, 38 (3): 417-422. 10.1016/j.ultrasmedbio.2011.11.014.CrossRefPubMed
38.
Spence JD, Hackam DG: Treating arteries instead of risk factors a paradigm change in management of atherosclerosis. Stroke. 2010, 41 (6): 1193-1199. 10.1161/STROKEAHA.110.577973.CrossRefPubMed
39.
Mathiesen EB, Johnsen SH, Wilsgaard T, Bønaa KH, Løchen M, Njølstad I: Carotid plaque area and intima-media thickness in prediction of first-ever ischemic stroke a 10-year follow-Up of 6584 men and women: the Tromsø study. Stroke. 2011, 42 (4): 972-978. 10.1161/STROKEAHA.110.589754.CrossRefPubMed
40.
Johnsen SH, Mathiesen EB, Joakimsen O, Stensland E, Wilsgaard T, Løchen M, Njølstad I, Arnesen E: Carotid atherosclerosis is a stronger predictor of myocardial infarction in women than in men a 6-year follow-up study of 6226 persons: the Tromsø study. Stroke. 2007, 38 (11): 2873-2880. 10.1161/STROKEAHA.107.487264.CrossRefPubMed
41.
Inaba Y, Chen JA, Bergmann SR: Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: a meta-analysis. Atherosclerosis. 2012, 220 (1): 128-133. 10.1016/j.atherosclerosis.2011.06.044.CrossRefPubMed
42.
Dalager S, Paaske WP, Kristensen IB, Laurberg JM, Falk E: Artery-related differences in atherosclerosis expression implications for atherogenesis and dynamics in intima-media thickness. Stroke. 2007, 38 (10): 2698-2705. 10.1161/STROKEAHA.107.486480.CrossRefPubMed
43.
Kröger K, Kucharczik A, Hirche H, Rudofsky G: Atherosclerotic lesions are more frequent in femoral arteries than in carotid arteries independent of increasing number of risk factors. Angiology. 1999, 50 (8): 649-654. 10.1177/000331979905000805.CrossRefPubMed
44.
Langlois MR, Rietzschel ER, De Buyzere ML, De Bacquer D, Bekaert S, Blaton V, De Backer GG, Gillebert TC: Femoral plaques confound the association of circulating oxidized low-density lipoprotein with carotid atherosclerosis in a general population aged 35 to 55 years the Asklepios Study. Arterioscler Thromb Vasc Biol. 2008, 28 (8): 1563-1568. 10.1161/ATVBAHA.108.167346.CrossRefPubMed
45.
Nakanishi N, Takatorige T, Fukuda H, Shirai K, Li W, Okamoto M, Yoshida H, Matsuo Y, Suzuki K, Tatara K: Components of the metabolic syndrome as predictors of cardiovascular disease and type 2 diabetes in middle-aged Japanese men. Diabetes Res Clin Pract. 2004, 64 (1): 59-10.1016/j.diabres.2003.10.001.CrossRefPubMed
46.
Wilson PW, D’Agostino RB, Parise H, Sullivan L, Meigs JB: Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation. 2005, 112 (20): 3066-3072. 10.1161/CIRCULATIONAHA.105.539528.CrossRefPubMed
47.
Azevedo A, Bettencourt P, Almeida PB, Santos AC, Abreu-Lima C, Hense H, Barros H: Increasing number of components of the metabolic syndrome and cardiac structural and functional abnormalities–cross-sectional study of the general population. BMC cardiovascular disorders. 2007, 7 (1): 17-10.1186/1471-2261-7-17.PubMedCentralCrossRefPubMed
48.
Woodward M, Tunstall-Pedoe H: The metabolic syndrome is not a sensible tool for predicting the risk of coronary heart disease. European Journal of Cardiovascular Prevention & Rehabilitation. 2009, 16 (2): 210-214. 10.1097/HJR.0b013e3283282f8d.CrossRef
49.
Sone H, Tanaka S, Iimuro S, Oida K, Yamasaki Y, Oikawa S, Ishibashi S, Katayama S, Ito H, Ohashi Y: Components of metabolic syndrome and their combinations as predictors of cardiovascular disease in Japanese patients with type 2 diabetes. Implications for improved definition. Analysis from Japan Diabetes Complications Study (JDCS). J Atheroscler Thromb. 2009, 16: 380-387. 10.5551/jat.No117.CrossRefPubMed
50.
Rachas A, Raffaitin C, Barberger-Gateau P, Helmer C, Ritchie K, Tzourio C, Amouyel P, Ducimetière P, Empana J: Clinical usefulness of the metabolic syndrome for the risk of coronary heart disease does not exceed the sum of its individual components in older men and women. The three-City (3C) Study. Heart. 2012, 98 (8): 650-655. 10.1136/heartjnl-2011-301185.PubMedCentralCrossRefPubMed
51.
Sun D, Wang J, Jiang B, Li L, Li L, Wu L, Wu H, He Y: Metabolic syndrome vs. its components for prediction of cardiovascular mortality: a cohort study in Chinese elderly adults. Journal of Geriatric Cardiology. 2012, 9 (2): 123-10.3724/SP.J.1263.2012.01172.PubMedCentralCrossRefPubMed
52.
Reaven GM: The metabolic syndrome: time to get off the merry-go-round?. J Intern Med. 2011, 269 (2): 127-136. 10.1111/j.1365-2796.2010.02325.x.CrossRefPubMed
53.
National Institutes of Health: Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults – The evidence report. Obes Res. 1998, 6 (Suppl. 2): XI-209S-
Metadata
Title
Association between presence of the metabolic syndrome and its components with carotid intima-media thickness and carotid and femoral plaque area: a population study
Authors
Andrie G Panayiotou
Maura Griffin
Panayiotis Kouis
Theodosis Tyllis
Niki Georgiou
Dawn Bond
Andrew N Nicolaides
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Diabetology & Metabolic Syndrome / Issue 1/2013
Electronic ISSN: 1758-5996
DOI
https://doi.org/10.1186/1758-5996-5-44

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