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Metabolic syndrome and incident peripheral artery disease - the Multi-Ethnic Study of Atherosclerosis.

ABSTRACT: We evaluated whether metabolic syndrome (MetS) is associated with an increased incidence of lower extremity peripheral artery disease (PAD) in community dwelling people free of clinical cardiovascular disease at baseline. We assessed whether higher levels of inflammatory biomarkers may mediate the association of MetS with incident PAD.MetS was defined at baseline as the presence of three or more of the following components: elevated waist circumference, triglycerides ?150 mg/dL, reduced high-density lipoprotein (HDL) cholesterol, blood pressure ?130/85 mm Hg or taking blood pressure medication, and fasting glucose ?100 mg/dL and <126 mg/dL. People with diabetes were excluded. Incident New PAD was defined among people with a normal ankle brachial index (ABI) at baseline (i.e. baseline ABI of 0.90 to 1.40) and consisted of one of the following outcomes during 3-year follow-up: ABI decline to < 0.90 combined with a decline ?0.15 or medical record confirmed PAD outcome. Multivariable Poisson regression was used to estimate the association between MetS and incident PAD.Among 4817 participants without PAD at baseline, 1382 (29%) had MetS. Adjusting for age, sex, race, smoking, physical activity, low-density lipoprotein cholesterol, baseline ABI, and other confounders, 23/1382 (1.7%) people with MetS developed PAD vs. 30/3435 (0.87%) people without MetS (risk ratio = 1.78 [95% Confidence Interval (CI), 1.04 to 2.82], P = 0.031). Adjusting for C-reactive protein, fibrinogen, or interleukin-6 did not attenuate this association.People free of clinical cardiovascular disease with MetS are at increased risk for PAD. Our findings suggest that this association is not mediated by inflammation.

SUBMITTER: Vidula H

PROVIDER: S-EPMC5656388 | biostudies-literature | 2015 Nov

REPOSITORIES: biostudies-literature

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Metabolic syndrome and incident peripheral artery disease - the Multi-Ethnic Study of Atherosclerosis.

Vidula Himabindu H Liu Kiang K Criqui Michael H MH Szklo Moyses M Allison Matthew M Sibley Christopher C Ouyang Pamela P Tracy Russell P RP Chan Cheeling C McDermott Mary M MM

Atherosclerosis 20150903 1

<h4>Objective</h4>We evaluated whether metabolic syndrome (MetS) is associated with an increased incidence of lower extremity peripheral artery disease (PAD) in community dwelling people free of clinical cardiovascular disease at baseline. We assessed whether higher levels of inflammatory biomarkers may mediate the association of MetS with incident PAD.<h4>Methods</h4>MetS was defined at baseline as the presence of three or more of the following components: elevated waist circumference, triglyce ...[more]

PMID: 26398292

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Project description:BACKGROUND:Worldwide clinical practice guidelines for dyslipidemia emphasize allocating statin therapy to those at the highest absolute atherosclerotic cardiovascular disease (CVD) risk. METHODS AND RESULTS:We examined 5534 Multi-Ethnic Study of Atherosclerosis (MESA) participants who were not on baseline medications for dyslipidemia. Participants were classified by baseline coronary artery calcium (CAC) score (>0, ? 100) and the common clinical scheme of counting lipid abnormalities (LA), including low-density lipoprotein cholesterol ? 3.36 mmol/L (130 mg/dL), high-density lipoprotein cholesterol <1.03 mmol/L (40 mg/dL) for men or <1.29 mmol/L (50 mg/dL) for women, and triglycerides ? 1.69 mmol/L (150 mg/dL). Our main outcome measure was incident CVD (myocardial infarction, angina resulting in revascularization, resuscitated cardiac arrest, stroke, cardiovascular death). Over a median follow-up of 7.6 years, more than half of events (55%) occurred in the 21% of participants with CAC ? 100. Conversely, 65% of events occurred in participants with 0 or 1 LA. In those with CAC ? 100, CVD rates ranged from 22.7 to 29.5 per 1000 person-years across LA categories. In contrast, with CAC=0, CVD rates ranged from 2.7 to 5.9 per 1000 person-years across LA categories. Individuals with 0 LA and CAC ? 100 had a higher event rate compared with individuals with 3 LA but CAC=0 (22.7 versus 5.9 per 1000 person-years). Similar results were obtained when we classified LA using data set quartiles of total cholesterol/high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, or low-density lipoprotein particle concentration and guideline categories of low-density lipoprotein cholesterol or non-high-density lipoprotein cholesterol. CONCLUSIONS:CAC may have the potential to help match statin therapy to absolute CVD risk. Across the spectrum of dyslipidemia, event rates similar to secondary prevention populations were observed for patients with CAC ? 100.

Dataset Information

Metabolic syndrome and incident peripheral artery disease - the Multi-Ethnic Study of Atherosclerosis.

Publications

Metabolic syndrome and incident peripheral artery disease - the Multi-Ethnic Study of Atherosclerosis.

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