Gender differences in association between metabolic syndrome and carotid intima media thickness
Metabolic syndrome (Mets) is a cluster of cardiovascular risk factors which can predicts cardiovascular disease (CVD). Carotid intima-media thickness (CIMT) is known as a surrogate measure of subclinical atherosclerosis and predictor of CVD. Although, it has shown the association between Mets and CIMT, this relation regarding sex differences is limited. We aimed to find out whether gender differences in this association.
In this cross-sectional study, we recorded height, weight, waist circumference (WC), blood pressure, and lipid profiles. We used Mets; defined based on NCEP ATP III definition, and traditional cardiovascular risk factors; age, body mass index (BMI), WC, hyperlipidemia, and hypertension, in multivariate regression models which including;. The CIMT measurement < 0.73 or ≥0.73 mm was considered as low- or high risk to CVD.
Overall, 150 subjects were enrolled to study that their ages were 36-75 years. The 47.3% of them (71 subjects) had Mets. CIMT was increased in Mets group compared non-Mets group (P = 0.001). In logistic regression analysis, a significant association was found between Mets and CIMT in women, but not in men (p = 0.002, and p = 0.364, respectively). After adjustment to age, WC, BMI, hypertension and hyperlipidemia, this association was significant just in women (p = 0.011) independent of WC, BMI, hyperlipidemia and hypertension.
Our data showed that MetS is a stronger risk factor for subclinical atherosclerosis in women than in men. So, we suggest the assessment of CIMT along with definition Mets in middle-aged women could be lead to earlier detection of at risk individuals to CVD.
- Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) 2001, 2486–2497. [JAMA]
- Lorenzo C, Okoloise M, Williams K, Stern MP, Haffner SM, San Antonio Heart Study: The metabolic syndrome as predictor of type 2 diabetes: the San Antonio heart study. Diabetes Care 2003, 26:3153–3159. CrossRef
- Bonora E, Kiechl S, Willeit J, et al.: Carotid atherosclerosis and coronary heart disease in the metabolic syndrome prospective data from the Bruneck Study. Diabetes Care 2003, 26:1251–1257. CrossRef
- McNeill AM, Rosamond WD, Girman CJ, et al.: The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study. Diabetes Care 2005, 28:385–390. CrossRef
- Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002, 285:356–359. CrossRef
- Fakhrzadeh H, Ebrahimpour P, Pourebrahim R, et al.: Metabolic Syndrome and its Associated Risk Factors in Healthy Adults: A Population-Based Study in Iran. Metab Syndr Relat Disord 2006, 4:28–34. CrossRef
- Chambless LE, Heiss G, Folsom AR, et al.: Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol 1997, 146:483–494. CrossRef
- Sibal L, Agarwal SC, Home PD: Carotid intima-media thickness as a surrogate marker of cardiovascular disease in diabetes. Diabetes Metab Syndr Obes 2011, 4:23–34. CrossRef
- Sipilä K, Moilanen L, Nieminen T, et al.: Metabolic syndrome and carotid intima media thickness in the Health 2000 Survey. Atherosclerosis 2009, 204:276–281. CrossRef
- Hulthe J, Bokemark L, Wikstrand J, et al.: The metabolic syndrome, LDL particle size, and atherosclerosis: the Atherosclerosis and Insulin Resistance (AIR) study. Arterioscler Thromb Vasc Biol 2000, 20:2140–2147. CrossRef
- Scuteri A, Najjar SS, Muller DC, et al.: Metabolic syndrome amplifies the age associated increases in vascular thickness and stiffness. J Am Coll Cardiol 2004, 43:1388–1395. CrossRef
- McNeill AM, Rosamond WD, Girman CJ, et al.: Prevalence of coronary heart disease and carotid arterial thickening in patients with the metabolic syndrome (The ARIC Study). Am J Cardiol 2004, 94:1249–1254. CrossRef
- Skilton MR, Moulin P, Serusclat A, et al.: A comparison of the NCEPATPIII, IDF and AHA/NHLBI metabolic syndrome definitions with relation to early carotid atherosclerosis in subjects with hypercholesterolemia or at risk of CVD: evidence for sex-specific differences. Atherosclerosis 2007, 190:416–422. CrossRef
- Iglseder B, Cip P, Malaimare L, et al.: The metabolic syndrome is a stronger risk factor for early carotid atherosclerosis in women than in men. Stroke 2005, 36:1212–1217. CrossRef
- Nishida M, Moriyama T, Ishii K, et al.: Effects of IL-6, adiponectin, CRP and metabolic syndrome on subclinical atherosclerosis. Clin Chim Acta 2007, 384:99–104. CrossRef
- Empana JP, Zureik M, Gariepy J, et al.: The metabolic syndrome and the carotid artery structure in non institutionalized elderly subjects: the three-city study. Stroke 2007, 38:893–899. CrossRef
- Cardiovascular diseaseshttp://www.who.int/who/Europe/cardiovascular/disease. Accessed 2012
- Thygesen K, Alpert JS, White HD, Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction: Universal definition of myocardial infarction. Eur Heart J 2007, 28:2525–2538. CrossRef
- American Heart Association: Angina pectoris. http://www.americanheart.org/presenter.jhtml?identifier=4472. Accessed March 14, 2011
- Dogan S, Duivenvoorden R, Grobbee DE, et al.: Completeness of carotid intima media thickness measurements depends on body composition: the RADIANCE 1 and 2 trials. J Atheroscler Thromb 2010, 17:526–535. CrossRef
- Hodis HN, Mack WJ, LaBree L, et al.: The role of carotid arterial intima-media thickness in predicting clinical coronary events. Ann Int Med 1998, 128:262–269.
- Rosenson RS, Freeman MW, Saperia GM: Measurement of serum lipids and lipoproteins. http://www.uptodate.com/contents/measurement-of-serum-lipids-and-lipoproteins
- Caballero AE: Metabolic and vascular abnormalities in subjects at risk for type 2 diabetes: the early start of a dangerous situation. Arch Med Res 2005, 36:241–249. CrossRef
- Galassi A, Reynolds K, He J: Metabolic syndrome and risk of cardiovascular disease: a meta-analysis. Am J Med 2006, 119:812–819. CrossRef
- Hassinen M, Komulainen P, Lakka TA, et al.: Metabolic syndrome and the progression of carotid intima-media thickness in elderly women. Arch Intern Med 2006, 166:444–449.
- Isomaa B, Almgren P, Tuomi T, et al.: Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001, 24:683–689. CrossRef
- Tzou WS, Douglas PS, Srinivasan SR, et al.: Increased subclinical atherosclerosis in young adults with metabolic syndrome: the Bogalusa Heart Study. J Am Coll Cardiol 2005, 46:457–463. CrossRef
- World Health Organization: Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Part 1: Diagnosis and Classification of Diabetes Mellitus. Geneva, Switzerland: World Health Organization; 1999.
- Laaksonen DE, Lakka HM, Niskanen LK, et al.: Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol 2002, 156:1070–1077. CrossRef
- Meigs JB, Wilson PW, Nathan DM, et al.: Prevalence and characteristics of the metabolic syndrome in the San Antonio Heart Framingham Offspring Studies. Diabetes 2003, 52:2160–2167. CrossRef
- Cartier A, Côté M, Lemieux I, et al.: Sex differences in inflammatory markers: what is the contribution of visceral adiposity? Am J Clin Nutr 2009, 89:1307–1314. CrossRef
- Flanagan DE, Vaile JC, Petley GW, et al.: Gender differences in the relationship between leptin, insulin resistance and the autonomic nervous system. Regul Pept 2007, 140:37–42. CrossRef
- Kloting I, kovacs P, vanden Brandt J: Sex-specific and sex-independent quantitative trait loci for facets of the metabolic syndrome in WOKW rats. Biochem Biophys Res Commun 2001, 284:150–156. CrossRef
- Poulsen P, Vaag A, Kyvik K, et al.: Genetic versus environmental etiology of the metabolic syndrome among male and female twins. Diabetologia 2001, 44:537–543. CrossRef
- Ahluwalia N, Drouet L, Ruidavets JB, et al.: Metabolic syndrome is associated with markers of subclinical atherosclerosis in a French population-based sample. Atherosclerosis 2006, 186:345–353. CrossRef
- O’Leary DH, Polak JF, Kronmal RA, Cardiovascular Health Study Collaborative Research Group, et al.: Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med 1999, 340:14–22. CrossRef
- Davis PH, Dawson JD, Mahoney LT, et al.: Increased carotid intimal-medial thickness and coronary calcification are related in young and middle-aged adults. The Muscatine study. Circulation 1999, 100:838–842. CrossRef
- Barrett-Connor E: Sex differences in coronary heart disease. Why are women so superior? The 1995 Ancel Keys lecture. Circulation 1997, 95:252–264. CrossRef
- Cobble M, Bale B: Carotid intima-media thickness: knowledge and application to everyday practice. Postgrad Med 2010, 122:10–18. CrossRef
- Pannacciulli N, De Pergola G, Ciccone M, et al.: Effect of family history of type 2 diabetes on the intima-media thickness of the common carotid artery in normal-weight, overweight, and obese glucose-tolerant young adults. Diabetes Care 2003, 26:1230–1234. CrossRef
- Scuteri A, Najjar SS, Morrell CH, et al.: The metabolic syndrome in older individuals: prevalence and prediction of cardiovascular events. The Cardiovascular Health Study. Diabetes Care 2005, 28:882–887. CrossRef
- Urbina EM, Srinivasan SR, Tang R, et al.: Impact of multiple coronary risk factors on the intima-media thickness of different segments of carotid artery in healthy young adults (The Bogalusa Heart Study). Am J Cardiol 2002, 90:953–958. CrossRef
- Gender differences in association between metabolic syndrome and carotid intima media thickness
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Journal of Diabetes and Metabolic Disorders
- Online Date
- September 2012
- Online ISSN
- BioMed Central
- Additional Links
- Metabolic syndrome
- Cardiovascular disease
- Carotid intima-media thickness
- Author Affiliations
- 1. Endocrinology & Metabolism Research Center, Tehran University of Medical Sciences, Fifth floor, Dr. Shariati Hospital, North Kargar Ave, Tehran, 14114, Iran