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The relationship of three common definitions of the metabolic syndrome with sub-clinical carotid atherosclerosis

  • Erica Paras
    Affiliations
    School of Kinesiology, Simon Fraser University, Harbour Centre Campus, 515 West Hastings. St. Vancouver, British Columbia, Canada V6B 5K3
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  • G.B. John Mancini
    Affiliations
    Division of Cardiology, University of British Columbia, Canada
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  • Scott A. Lear
    Correspondence
    Corresponding author at: School of Kinesiology, Simon Fraser University, Harbour Centre Campus, 515 West Hastings. St. Vancouver, British Columbia, Canada V6B 5K3. Tel.: +1 604 682 2344x62778; fax: +1 604 806 8590.
    Affiliations
    School of Kinesiology, Simon Fraser University, Harbour Centre Campus, 515 West Hastings. St. Vancouver, British Columbia, Canada V6B 5K3

    Division of Cardiology, University of British Columbia, Canada
    Search for articles by this author

      Abstract

      Background

      Presence of the metabolic syndrome (MetS) increases a patient's risk for future cardiovascular disease. However, there is no consensus as to which of the proposed definitions should be used. Therefore, using carotid atherosclerotic burden as an index of cumulative effects of atherosclerotic risk factors, we assessed the association of the three commonly used MetS definitions with sub-clinical atherosclerosis in a primary prevention population and determined if this association was independent of the component risk factors.

      Methods and results

      A multi-ethnic cohort of 796 men and women without cardiovascular disease was assessed for demographics, risk factors, properties of the carotid arteries using ultrasound and presence or absence of MetS based on each of the World Health Organization (WHO), the National Cholesterol Education Program Expert Panel (NCEP) and the International Diabetes Federation (IDF) definitions. Using any definition, 29% of the cohort had MetS. After adjusting for age, gender, ethnicity and smoking status, participants with MetS had greater intima-media thickening and total area (intima-media area and focal lesion area combined) than participants without MetS. Only participants meeting the WHO MetS criteria had a greater prevalence of focal lesions. After further adjustment for the individual risk factor components of each MetS definition separately, none of MetS definitions was associated with any of the carotid artery measures.

      Conclusions

      All three MetS definitions were associated with measures of sub-clinical carotid atherosclerosis and these associations were entirely mediated through the risk factor components of MetS.

      Keywords

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      References

        • Borgman M.
        • McErlean E.
        What is the metabolic syndrome? Prediabetes and cardiovascular risk.
        J Cardiovasc Nurs. 2006; 21: 285-290
        • Brien S.E.
        • Katzmarzyk P.T.
        Physical activity and the metabolic syndrome in Canada.
        Appl Physiol Nutr Metab. 2006; 31: 40-47
        • Pollex R.L.
        • Al-Shali K.Z.
        • House A.A.
        • et al.
        Relationship of the metabolic syndrome to carotid ultrasound traits.
        Cardiovasc Ultrasound. 2006; 4: 28
        • Fan A.Z.
        Metabolic syndrome and progression of atherosclerosis among middle-aged US adults.
        J Atheroscler Thromb. 2006; 13: 46-54
        • Tenenbaum A.
        • Motro M.
        • Schwammenthal E.
        • Fisman E.Z.
        Macrovascular complications of metabolic syndrome: an early intervention is imperative.
        Int J Cardiol. 2004; 97: 167-172
        • Wallenfeldt K.
        • Hulthe J.
        • Fagerberg B.
        The metabolic syndrome in middle-aged men according to different definitions and related changes in carotid artery intima-media thickness (IMT) during 3 years of follow-up.
        J Intern Med. 2005; 258: 28-37
        • Saely C.H.
        • Koch L.
        • Schmid F.
        • et al.
        Adult Treatment Panel III 2001 but not International Diabetes Federation 2005 criteria of the metabolic syndrome predict clinical cardiovascular events in subjects who underwent coronary angiography.
        Diabetes Care. 2006; 29: 901-907
        • Scuteri A.
        • Najjar S.S.
        • Morrell C.H.
        • Lakatta E.G.
        The metabolic syndrome in older individuals: prevalence and prediction of cardiovascular events: the Cardiovascular Health Study.
        Diabetes Care. 2005; 28: 882-887
        • Scuteri A.
        • Najjar S.S.
        • Muller D.C.
        • et al.
        Metabolic syndrome amplifies the age-associated increases in vascular thickness and stiffness.
        J Am Coll Cardiol. 2004; 43: 1388-1395
        • Despres J.P.
        • Lemieux I.
        Abdominal obesity and metabolic syndrome.
        Nature. 2006; 444: 881-887
        • Wassink A.M.
        • Olijhoek J.K.
        • Visseren F.L.
        The metabolic syndrome: metabolic changes with vascular consequences.
        Eur J Clin Invest. 2007; 37: 8-17
        • Feinstein S.B.
        Contrast ultrasound imaging of the carotid artery vasa vasorum and atherosclerotic lesion neovascularization.
        J Am Coll Cardiol. 2006; 48: 236-243
        • Jashnani K.D.
        • Kulkarni R.R.
        • Deshpande J.R.
        Role of carotid intima-media thickness in assessment of atherosclerosis: an autopsy study.
        Indian Heart J. 2005; 57: 319-323
        • Kablak-Ziembicka A.
        • Przewlocki T.
        • Kostkiewicz M.
        • et al.
        Relationship between carotid intima-media thickness, atherosclerosis risk factors and angiography findings in patients with coronary artery disease.
        Przegl Lek. 2003; 60: 612-616
        • Kablak-Ziembicka A.
        • Tracz W.
        • Przewlocki T.
        • et al.
        Association of increased carotid intima-media thickness with the extent of coronary artery disease.
        Heart. 2004; 90: 1286-1290
        • Anand S.S.
        • Yusuf S.
        • Vuksan V.
        • et al.
        Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE).
        Lancet. 2000; 356: 279-284
        • Lu B.
        • Yang Y.
        • Song X.
        • et al.
        An evaluation of the International Diabetes Federation definition of metabolic syndrome in Chinese patients older than 30 years and diagnosed with type 2 diabetes mellitus.
        Metabolism. 2006; 55: 1088-1096
        • Alberti K.G.
        • Zimmet P.Z.
        Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation.
        Diabet Med. 1998; 15: 539-553
      1. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001;285:2486–2497.

      2. International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome; 2005.

        • Sone H.
        • Tanaka S.
        • Ishibashi S.
        • et al.
        The new worldwide definition of metabolic syndrome is not a better diagnostic predictor of cardiovascular disease in Japanese diabetic patients than the existing definitions: additional analysis from the Japan Diabetes Complications Study.
        Diabetes Care. 2006; 29: 145-147
        • Sone H.
        • Mizuno S.
        • Fujii H.
        • et al.
        Is the diagnosis of metabolic syndrome useful for predicting cardiovascular disease in asian diabetic patients? Analysis from the Japan Diabetes Complications Study.
        Diabetes Care. 2005; 28: 1463-1471
        • Deepa M.
        • Farooq S.
        • Datta M.
        • Deepa R.
        • Mohan V.
        Prevalence of metabolic syndrome using WHO, ATPIII and IDF definitions in Asian Indians: the Chennai Urban Rural Epidemiology Study (CURES-34).
        Diabetes Metab Res Rev. 2007; 23: 127-134
        • Lorenzo C.
        • Williams K.
        • Hunt K.J.
        • Haffner S.M.
        The National Cholesterol Education Program – Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes.
        Diabetes Care. 2007; 30: 8-13
        • Kahn R.
        • Buse J.
        • Ferrannini E.
        • et al.
        The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes.
        Diabetes Care. 2005; 28: 2289-2304
        • Lear S.A.
        • Birmingham C.L.
        • Chockalingam A.
        • Humphries K.H.
        Study design of the multicultural community health assessment trial (M-CHAT)—a comparison of body fat distribution in four distinct populations.
        Ethn Dis. 2006; 16: 96-100
        • Sjostrom L.
        • Rissanen A.
        • Andersen T.
        • et al.
        • European Multicentre Orlistat Study Group
        Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients.
        Lancet. 1998; 352: 167-172
        • Friedewald W.T.
        • Levy R.I.
        • Fredrickson D.S.
        Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.
        Clin Chem. 1972; 18: 499-502
        • Aminbakhsh A.
        • Frohlich J.
        • Mancini G.B.
        Detection of early atherosclerosis with B mode carotid ultrasonography: assessment of a new quantitative approach.
        Clin Invest Med. 1999; 22: 265-274
        • Chan S.Y.
        • Mancini G.B.
        • Kuramoto L.
        • et al.
        The prognostic importance of endothelial dysfunction and carotid atheroma burden in patients with coronary artery disease.
        J Am Coll Cardiol. 2003; 42: 1037-1043
        • Zureik M.
        • Touboul P.J.
        • Bonithon-Kopp C.
        • et al.
        Differential association of common carotid intima-media thickness and carotid atherosclerotic lesions with parental history of premature death from coronary heart disease: the EVA study.
        Arterioscler Thromb Vasc Biol. 1999; 19: 366-371
        • Anand S.S.
        • Yi Q.
        • Gerstein H.
        • et al.
        Relationship of metabolic syndrome and fibrinolytic dysfunction to cardiovascular disease.
        Circulation. 2003; 108: 420-425
        • Lakka H.M.
        • Laaksonen D.E.
        • Lakka T.A.
        • et al.
        The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men.
        JAMA. 2002; 288: 2709-2716
        • Vasan R.S.
        • Sullivan L.M.
        • Wilson P.W.
        • et al.
        Relative importance of borderline and elevated levels of coronary heart disease risk factors.
        Ann Intern Med. 2005; 142: 393-402