Metabolic syndrome, preclinical atherosclerosis and future cardiovascular events

Abstract

Background and purpose: IMT is a validated marker of
subclinical atherosclerosis. The current study aimed to
evaluate the influence of carotid atherosclerosis and
metabolic syndrome (MetS) on prediction of CV events
during a 20-years follow-up.
Methods: We studied a population of 529 asymptomatic patients (62 yrs ±12.79) at baseline, divided into
3 groups according to the results of carotid ultrasound
examination: 1) without atherosclerotic lesions (IMT< 0,9
mm); 2) with increased carotid intima-media thickness
(IMT> 0,9 mm and< 1,5 mm); 3)with atherosclerotic
plaque (IMT> 1,5 mm). In each of these groups, we identified two subgroups of subjects with or without MetS.
Cardiovascular endpoints were investigated in a 20-years
follow-up: acute myocardial infarction (AMI), angina pectoris, transient ischemic attack (TIA), ischemic stroke and
cardiovascular death. Differences between groups were
compared by the chi-square test for categorical variables.
Free-events survival was tested by Kaplan-Meyer function.
Results: There were 242 CV events, 144 among patients
with MetS and 98 among healthy controls
(57.4%vs.35.2%; P<0.0001). 63 events occurred in
patients with normal carotid arteries while 179 events
occurred in patients with subclinical atherosclerosis
(31.8% vs. 54.1%; P<0.0001). In equality of preclinical
atherosclerosis, it was observed a greater risk in patients
with MetS compared to controls. In the 63 total events
occurred in patients without atherosclerotic lesions, 36
events were recorded in the subgroup with MetS and 27
in the subgroup without MetS (45% vs. 22,88%;
P=0.0018). Among 179 total events recorded in patients
with atherosclerotic lesions, 108 events happened in the
subgroup with MetS and 71 events in the subgroup without MetS (63.15% vs. 44.37%; P= 0.0009). The KaplanMeyer function showed an improved survival in patients
without atherosclerotic lesions compared to patients with
carotid ultrasound alterations (P= 0.0159, HR: 0.7366,
CI:0.5479- 0.9904).
Conclusions: We suggest investigating the presence of
preclinical atherosclerosis in all patients > 45 years old with a cluster of risk factors, because in primary prevention IMT measurement can give further information for a
better stratification of global CV risk