Association of metabolic syndrome and its components with arterial stiffness in Caucasian subjects of the MARK study: a cross-sectional trial

Leticia Gomez-Sanchez, Luis Garcia-Ortiz, M Carmen Patino-Alonso, Jose I Recio-Rodriguez, Rigo Fernando, Ruth Marti, Cristina Agudo-Conde, Emiliano Rodriguez-Sanchez, Jose A Maderuelo-Fernandez, Rafel Ramos, Manuel A Gomez-Marcos, MARK Group, Leticia Gomez-Sanchez, Luis Garcia-Ortiz, M Carmen Patino-Alonso, Jose I Recio-Rodriguez, Rigo Fernando, Ruth Marti, Cristina Agudo-Conde, Emiliano Rodriguez-Sanchez, Jose A Maderuelo-Fernandez, Rafel Ramos, Manuel A Gomez-Marcos, MARK Group

Abstract

Background: The cardio-ankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV) can reflect both central and peripheral arterial stiffness. Metabolic syndrome (MetS) and its components may increase arterial stiffness and the risk of cardiovascular diseases. However, the correlation of MetS and its components with arterial stiffness is still not clear. The primary aim of this study is thus the relationship using baPWV and CAVI in Caucasian adults with intermediate cardiovascular risk. The secondary aim is to analyze sex differences.

Methods: This study analyzed 2351 subjects aged 35-74 years (mean, 61.4 ± 7.7 years) comprising 61.7 % males and enrolled in the improving interMediAte Risk management (MARK) study. CAVI was measured using a VaSera VS-1500 ® device, and baPWV was calculated using a validated equation. MetS was defined based on the Joint Scientific Statement National Cholesterol Education Program III. Waist circumference, blood pressure, fasting plasma glucose, and lipid profile were measured.

Results: MetS was found in 51.9 % of the subjects. All MetS components except reduced HDL-cholesterol (p = 0.578) were associated with CAVI. High density lipoprotein cholesterol (p = 0.075) and waist circumference (p = 0.315) were associated with baPWV. The different MetS components that assess dyslipidemia using the stiffness measures show different associations according to patient sex. The high blood pressure component had a greater odds ratio (OR) for both baPWV ≥ 17.5 m/sec (OR = 6.90, 95 % CI 3.52-13.519) and CAVI ≥ 9 (OR = 2.20, 95 % CI 1.63-1.90).

Conclusions: MetS and all its components (except HDL-cholesterol with baPWV and CAVI and WC with baPWV) were associated with baPWV and CAVI. However, there were sex differences in the association of MetS and its components with baPWV and CAVI. Data from this study suggest a greater association of CAVI and baPWV values with MetS components in males than in females and indicate greater arterial stiffness in the event of simultaneously elevated blood pressure, fasting plasma glucose, and waist circumference. Trial Registration Clinical Trials.gov Identifier: https://ichgcp.net/clinical-trials-registry/NCT01428934" title="See in ClinicalTrials.gov">NCT01428934. Registered 2 September 2011. Last updated September 8, 2016.

Keywords: Arterial stiffness; Brachial-ankle pulse wave velocity; Cardio-ankle vascular index; Metabolic syndrome.

Figures

Fig. 1
Fig. 1
baPWV a and CAVI b according the MetS components in males and females. Data are given as mean ± standard error. baPWV and CAVI levels were compared using a Student’s t test. Mest criteria: abdominal obesity (n = 1055): WC ≥ 88 in females; ≥ 102 in males. BP (n = 1156): SBP ≥ 130 mmHg and/or DBP ≥ 85 mm Hg or antihypertensive drug treatment. Increase FPG (n = 872): FPG > 100 mg/dL or antidiabetic drug treatment. Reduced HDL-C (n = 667): HDL < 40 mg/dL in males and < 50 mg/dL in females. Increase TGC (n = 692): TGC > 150 mg/dL). baPWV brachial-ankle pulse wave velocity, CAVI cardio-ankle vascular index, BP blood pressure, FPG fasting plasma glucose, HDL-C high density lipoprotein cholesterol, TGC triglycerides, WC waist circumference. *p < 0.05 and **p < 0.01 between sexes
Fig. 2
Fig. 2
Multivariate analysis (ANCOVA). Brachial-ankle pulse wave velocity (baPWV) values in males and females (a) and cardio-ankle vascular index (CAVI) values in males and females (b). Values by number of MetS components. Adjusted by age. baPWV differences by number of MetS components in males between 0 and 1 components and 2, 3, and 4 components (p < 0.01); in females between 1 component and 3, 4, and 5 components (p < 0.01). Post-hoc contrasts were performed using a Bonferroni test. baPWV brachial-ankle pulse wave velocity, CAVI cardio-ankle vascular index, MetS metabolic syndrome
Fig. 3
Fig. 3
Impact of the specific groups of MetS components on brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) in the different groups. a Impact of the group in females on baPWV. b Impact of the group in males on baPWV. c Impact of the group in females on CAVI. d Impact of the group in males on CAVI. Data are given as mean ± standard error. baPWV and CAVI levels were compared using an ANOVA test, followed by post hoc analysis using a Bonferroni test. **p < 0.01 between the different groups and control; *p < 0.05 between the different groups and control. Group 1 Group MetS-mixed; Group 2 MetS-dyslipidemia; Group 3 Group MetS-increased insulin resistance; Group Control A group of 175 subjects without MetS, arterial hypertension, FPG or use of antihypertensive, lipid-lowering or antidiabetic drugs was used as control. baPWV brachial-ankle pulse wave velocity, CAVI cardio-ankle vascular index, MetS metabolic syndrome, FPG fasting plasma glucose

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