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

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

doi:10.1186/1758-5996-5-44

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

Diabetol Metab Syndr. 2013 Aug 20:5:44. doi: 10.1186/1758-5996-5-44. eCollection 2013.

Authors

Andrie G Panayiotou¹, Maura Griffin², Panayiotis Kouis³, Theodosis Tyllis⁴, Niki Georgiou⁴, Dawn Bond², Andrew N Nicolaides⁵

Affiliations

¹ Cyprus International Institute for Environmental and Public Health in association with Harvard School of Public Health, Cyprus University of Technology, P.O. Box: 50329, Limassol, Cyprus ; The Cyprus Cardiovascular Disease Educational and Research Trust, 2 Kyriacou Matsi, Nicosia 2368, Cyprus.
² Vascular Noninvasive Screening and Diagnostic Centre, 30 Weymouth street, W1G 7BS, London, UK.
³ Cyprus International Institute for Environmental and Public Health in association with Harvard School of Public Health, Cyprus University of Technology, P.O. Box: 50329, Limassol, Cyprus.
⁴ Vascular Screening and Diagnostic Centre, 2 Kyriacou Matsi, Nicosia 2368, Cyprus.
⁵ The Cyprus Cardiovascular Disease Educational and Research Trust, 2 Kyriacou Matsi, Nicosia 2368, Cyprus ; Vascular Noninvasive Screening and Diagnostic Centre, 30 Weymouth street, W1G 7BS, London, UK ; Vascular Screening and Diagnostic Centre, 2 Kyriacou Matsi, Nicosia 2368, Cyprus ; Department of Vascular Surgery, Imperial College, London SW72BX, UK.

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.

Keywords: Atherosclerotic plaques; Carotid; Femoral; IMT; Metabolic syndrome; Metabolic syndrome components; Plaque area.