Micro- and macrovascular dysfunction evident with the metabolic syndrome
MedWire News: People with the metabolic syndrome display both micro- and macrovascular dysfunction even if they have neither diabetes nor cardiovascular disease (CVD), researchers have shown.
Sébastien Czernichow (INSERM, Paris, France) and colleagues suggest that this dysfunction may link the metabolic syndrome to CVD through factors relating to insulin resistance rather than blood pressure.
The team identified 36 individuals from an antioxidant prevention trial with the metabolic syndrome defined using the International Diabetes Federation Criteria, and matched each patient for age and gender with three healthy control individuals.
Analysis revealed that participants with the metabolic syndrome had a more deleterious hemodynamic phenotype than control individuals.
Pulse-wave velocity (PWV), used to measure large-artery function, was higher in participants with the metabolic syndrome than others (12.2 vs 10.7 m/s).
Furthermore, those with the metabolic syndrome had lower functional skin capillary density, used as a measure of small-artery function (83.1 vs 89.4 capillaries/mm2).
Functional capillary density was inversely related to fasting glucose, triglycerides, and estimated insulin resistance. However, capillary density related to neither blood pressure nor PWV.
In multivariate models, a 1-standard deviation change in certain metabolic syndrome components was associated with an increased risk for impaired PWV of at least 12 m/s and low functional capillary density of 80 capillaries/mm2 or less.
The odds ratio (OR) for impaired PWV was 1.65 per 12.1-mmHg increase in systolic blood pressure, while the OR for impaired capillary density was 1.65 with impaired fasting glucose per 0.6 mmol/l increase.
Each 0.5 mmol/l [44.3 mg/dl] increase in triglycerides was associated with both impaired PWV and capillary density, with ORs of 1.93 and 1.45, respectively.
Reporting in the journal Hypertension Research, the researchers say: “Our findings demonstrate that vascular dysfunction in the metabolic syndrome affects not only large but also small vessels and may link insulin resistance, abdominal adiposity and CVD.”
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By Anita Wilkinson