Vol 8, No 8-9 (2007): Practical Diabetology
Other materials agreed with the Editors
Published online: 2007-09-08
Prevalence and prognostic impact of subclinical cardiovascular disease in individuals with the metabolic syndrome and diabetes
Diabetologia Praktyczna 2007;8(8-9):315-329.
Abstract
Data are limited regarding prevalence and prognostic
significance of subclinical cardiovascular disease
(CVD) in individuals with metabolic syndrome.
We investigated prevalence of subclinical CVD in
1,945 Framingham Offspring Study participants
(mean age 58 years; 59% women) using electrocardiography,
echocardiography, carotid ultrasound,
ankle-brachial blood pressure, and urinary albumin
excretion. We prospectively evaluated the incidence
of CVD associated with metabolic syndrome and
diabetes according to presence versus absence of
subclinical disease. Cross-sectionally, 51% of 581
participants with metabolic syndrome had subclinical
disease in at least one test, a frequency higher
than individuals without metabolic syndrome [multivariable-
adjusted odds ratio 2.06 (95% CI: 1.67-
2.55); p < 0.0001). On follow-up (mean 7.2 years),
139 individuals developed overt CVD, including
59 with metabolic syndrome (10.2%). Overall, metabolic
syndrome was associated with increased CVD
risk [multivariableadjusted hazards ratio (HR) 1.61
(95% CI: 1.12-2.33)]. Participants with metabolic syndrome
and subclinical disease experienced increased
risk of overt CVD [2.67 (1.62-4.41) compared with those without metabolic syndrome, diabetes, or subclinical
disease], whereas the association of metabolic
syndrome with CVD risk was attenuated in
absence of subclinical disease [HR 1.59 (95% CI: 0.87–2.90)]. A similar attenuation of CVD risk in absence
of subclinical disease was observed also for diabetes.
Subclinical disease was a significant predictor
of overt CVD in participants without metabolic syndrome
or diabetes [1.93 (1.15-3.24)]. In our community-based sample, individuals with metabolic
syndrome have a high prevalence of subclinical atherosclerosis
that likely contributes to the increased
risk of overt CVD associated with the condition.