Prevalence and prognostic impact of subclinical cardiovascular disease in individuals with the metabolic syndrome and diabetes
Prevalence and prognostic impact of subclinical cardiovascular disease in individuals with the metabolic syndrome and diabetes
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DOI：
10.2337/db07-0078
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发表时间：
2007-06-01
期刊：
影响因子：
7.7
通讯作者：
Vasan, Ramachandran S.
中科院分区：
文献类型：
--
作者：
Ingelsson, Erik;Sullivan, Lisa M.;Vasan, Ramachandran S.
关于代谢综合征（MetS）患者亚临床心血管疾病（CVD）的患病率和预后意义的数据有限。我们通过心电图、超声心动图、颈动脉超声、踝臂血压和尿白蛋白排泄，调查了1,945名FRA后代研究参与者（平均年龄58岁; 59%为女性）亚临床CVD的患病率。我们根据亚临床疾病的存在与否，前瞻性地评估了与代谢综合征和糖尿病相关的心血管疾病的发病率。在横断面研究中，581名MetS患者中有51%在至少一项测试中患有亚临床疾病，其发生率高于无MetS的个体（多变量调整优势比2.06 [95%CI 1.67-2.55]; P < 0.0001）。在随访（平均7.2年）中，139人出现明显的CVD，其中59人患有MetS（10.2%）。总体而言，MetS与CVD风险增加相关（多变量校正风险比[HR] 1.61 [95% CI 1.12-2.33]）。MetS和亚临床受试者。与无MetS、糖尿病或亚临床疾病的患者相比，MetS患者明显CVD风险增加（2.67 [1.62-4.41]），而在无亚临床疾病的情况下，MetS与CVD风险的相关性减弱（HR 1.59 [95%CI 0.87-2.90]）。在没有亚临床疾病的情况下，也观察到糖尿病的心血管疾病风险的类似降低。亚临床疾病是无代谢综合征或糖尿病的受试者明显CVD的重要预测因子（1.93 [1.15-3.24]）。在我们以社区为基础的样本中，MetS患者亚临床动脉粥样硬化的患病率很高，这可能导致与该疾病相关的明显CVD风险增加。
Data are limited regarding prevalence and prognostic significance of subclinical cardiovascular disease (CVD) in individuals with metabolic syndrome (MetS). 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 uriary albumin excretion. We prospectively evaluated the incidence of CVD associated with MetS and diabetes according to presence versus absence of subclinical disease. Cross-sectionally, 51% of 581 participants with MetS had subclinical disease in at least one test, a frequency higher than individuals without MetS (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 MetS (10.2%). Overall, MetS was associated with increased CVD risk (multivariable-adjusted hazards ratio [HR] 1.61 [95% CI 1.12-2.33]). Participants with MetS and subclinical. disease experienced increased risk of overt CVD (2.67 [1.62-4.41] compared with those without MetS, diabetes, or subclinical diseease), whereas the association of MetS with CVD risk was tenuated 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 MetS or diabetes (1.93 [1.15-3.24]). In our community-based sample, individuals with MetS have a high prevalence of subclinical atherosclerosis that likely contributes to the increased risk of overt CVD associated with the condition.