NEW ORLEANS — Young and middle-aged adults who meet criteria for metabolic syndrome are at a 2.5-fold greater risk of having subclinical atherosclerosis, Kwame O. Akosah, M.D., said at the annual scientific sessions of the American Heart Association.
This is true regardless of whether they have a low Framingham risk score or a normal-range C-reactive protein (CRP) level. The risk of subclinical atherosclerosis tied to metabolic syndrome is also independent of—and even greater than—that associated with diabetes mellitus, a coronary heart disease equivalent, added Dr. Akosah of the Gundersen Lutheran Health System, La Crosse, Wisc.
“It appeared in our study that metabolic syndrome was the driving force for developing early atherosclerosis, not high-sensitivity CRP or diabetes mellitus,” he said.
Dr. Akosah reported on 253 consecutive men and women, mostly in their 40s and 50s, who were evaluated for possible coronary artery disease in a group cardiology practice. All underwent carotid ultrasound assessed by blinded cardiologists for the presence of subclinical carotid atherosclerosis, a well-established marker for atherosclerosis in other vascular beds.
Subclinical carotid atherosclerosis (focal plaque and/or a mean intimal-medical thickness of 1.0 mm or more) was identified in 59% of subjects. Yet 89% of study participants had a low-risk Framingham risk score. And 37% didn't even have multiple major cardiovascular risk factors, Dr. Akosah said.
Among 75 subjects who met criteria for metabolic syndrome, 18 had concomitant diabetes. Another 17 subjects had diabetes without metabolic syndrome. The prevalence of subclinical carotid atherosclerosis was significantly greater in participants with metabolic syndrome than in those with diabetes only, or neither condition. (See box.)
In a multivariate logistic regression analysis, metabolic syndrome independently conferred a 2.5-fold increased risk of having subclinical atherosclerosis. Of note, CRP was not useful in risk stratification.
A disturbing finding was that 56% of subjects in the study didn't have a fasting blood glucose level taken along with their lipid measurements, making it impossible to properly assess them for the presence of metabolic syndrome.
“I would suggest that my colleagues in cardiology do a much better job in checking people for the full spectrum of metabolic syndrome,” Dr. Akosah suggested.
