1. Non-metabolic syndrome mean (DS) Metabolic syndrome mean (DS)
Arterial Stiffness in Patients with Metabolic Syndrome:
a Cross-Sectional Study in Guayaquil, Ecuador
Carlos Peñaherrera, MD1; Rubén Peñaherrera2; María Carolina Duarte, MD1; Ermesto Peñaherrera, MD1
1Department of Cardiology, Luis Vernaza Hospital; 2School of Medicine, Universidad de Especialidades Espíritu Santo
ABSTRACT
INTRODUCTION
RESULTS
DISCUSSION
Background: the risk for cardiovascular disease is increased by metabolic syndrome (MetS). Techniques that assess arterial rigidity and age provide insight on blood vessel function. We aimed to evaluate arterial stiffness in patients with MetS. Methodology: 2-month cross-sectional study. We included patients from the Cardiology Department with a full blood panel. We measured brachial and central augmentation indexes, central blood pressure, pulse wave velocity (PWV) and arterial age, using Arteriograph®. We used IDF criteria to diagnose MetS. Results: 95 patients were selected for analysis. 49.5% of our patients had MetS. We found significant differences in arterial measurements in MetS vs. non-MetS patients, with higher values in the former. We obtained non-significant results for the relationship between arterial age and MetS. We found non-significant correlation between age and PWV, and MetS was significantly more common in women. Conclusion: MetS patients have a higher grade of arterial stiffness. Arterial age was not related to MetS. Arteriograph® measurements are helpful to improve diagnosis and management of patients.
Metabolic syndrome is a highly prevalent condition which can chronically affect blood vessels, predisposing to myocardial infarction, stroke and peripheral artery disease. Most of the patients with metabolic syndrome have diabetes, and many of them also have hypertension.
The use of techniques that allow physicians to assess arterial rigidity and age, such as Arteriograph®, can provide insight into the function of the blood vessels in the presence of metabolic syndrome.
We conducted a study aimed to evaluate arterial stiffness measurements in patients with metabolic syndrome.
We included 100 patients during our 2-month study, and 5 patients met exclusion criteria, leaving us with 95 patients for analysis. 42 (44.2%) were female and 53 (55.8%) were male, with a mean age of 61.7 years (SD 13.1). We found that 58 (61.1%) of our patients had hypertension, 29 (30.5%) had diabetes, and 33 (34.7%) had left ventricular hypertrophy.
A total of 47 (49.5%) of our patients had metabolic syndrome, but an overall 82 (86.3%) had an increased abdominal girth. We found significant differences in PWV, augmentation indexes, and peripheral and central blood pressure between metabolic and non-metabolic syndrome patients, in which the latter had lower values, closer to normal (Table 1). When trying to assess the relationship between arterial age and metabolic syndrome, dividing patients by age group, we obtained non-significant results (p=0.32), which did not change after adjusting for smoking (p=0.28) or ventricular hypertrophy (p=0.71).
Finally, we obtained a non-significant correlation between age and PWV (p=0.32), however, we found a significant difference regarding the presence of metabolic syndrome between males and females (p<0.001), with it being more common in the latter.
We found significant differences for almost every variable measured by Arteriograph® when comparing metabolic syndrome with non-metabolic syndrome patients. Individuals with metabolic syndrome have an elevated pulse wave velocity, central and peripheral blood pressures, and increased augmentation indexes, indicating a higher grade of arterial stiffness. As hypertension is an important component of the syndrome, we believe it can contribute to these altered parameters.
Almost half of our patients had metabolic syndrome. However, a much higher percentage of them had an increased abdominal girth, as per ALAD criteria for Latino populations. Abdominal obesity is an independent risk factor for cardiovascular morbidity and mortality, and the finding of such alarming data must encourage population-based policies that promote weight losing, healthier diets, and exercise regimes in order to decrease these values.
Arterial age, was not found to be related to metabolic syndrome. Previous studies have shown that metabolic syndrome promotes the age-related increase of vascular stiffness, but arterial age as a parameter is a completely different and independent characteristic.
We observed no correlation between age and pulse wave velocity, which contrasts with what has been reported previously, where PWV increases with age in a linear fashion. Metabolic syndrome was significantly more prevalent in women, being similar to previously reported epidemiological data.
MATERIALS AND METHODS
Observational, cross-sectional study at Luis Vernaza hospital of Guayaquil, Ecuador, between November and December We included every patient admitted to the Department of Cardiology who had a full blood panel and echocardiogram made, and also individuals from our outpatient Cardiology clinic with a complete laboratory screening and echocardiogram from the last 2 months. Patients with agitation, incapacitating dyspnea, BMI >50 or abdominal girth >150 cm were excluded because of technical difficulties related to the procedure.
We obtained demographic and clinical data regarding age, gender, smoking, history of hypertension and/or diabetes, and history of left ventricular hypertrophy obtained from the echocardiogram. Also, we measured abdominal girth, and brachial blood pressure. Using the Arteriograph® system, we obtained measurements of brachial and central augmentation indexes, central blood pressure, pulse wave velocity (PWV) and arterial age, and we retrieved values for triglycerides, HDL cholesterol, glycaemia, and glycated hemoglobin from the laboratory data.
We used the International Diabetes Federation (IDF) criteria to diagnose metabolic syndrome, but the Latin American Diabetes Association (ALAD) criteria were used first to detect increased abdominal girth. Statistical analysis was conducted with SPSS Statistics® 22, using Student’s t test, chi-square test and Pearson’s correlation, with a p value of <0.05 accepted for significance.
Variable
Non-metabolic syndrome mean (DS)
Metabolic syndrome mean (DS)
t value
p value
Pulse wave velocity
8.4 (±1.5)
9.5 (±1.7)
1.1
0.001
Brachial systolic blood pressure
121.8 (±14.6)
138.3 (±17.9)
16.5
<0.001
Brachial diastolic blood pressure
76.6 (±10.1)
86.2 (±12.6)
9.6
Brachial augmentation index
-17.9 (±20.3)
-4.7 (±20.7)
13.2
0.002
Central (aortic) augmentation index
26.5 (±13)
32.1 (±11.7)
5.6
0.031
Central systolic blood pressure
122.8 (±15.5)
137.7 (±18.2)
14.9
Central diastolic blood pressure
75.9 (±10.4)
85.6 (±12.4)
9.8
Central pulse pressure
45.9 (±11.1)
51.8 (±15.8)
5.9
0.038
CONCLUSIONS
Patients with metabolic syndrome have increased arterial stiffness, as measured by the Arteriograph® device. Most patients with metabolic syndrome are women.
Metabolic syndrome is not related with an increased vascular age. Chronological age does not correlate with pulse wave velocity
This is the first use of an arterial stiffness device in our country, and its implementation can be helpful to improve diagnosis and management of patients with various cardiologic and metabolic diseases..
CONTACT
Ernesto Peñaherrera, MD
Ecuador Clinical Research
Website:
Table 1. Student’s t test of the main Arteriograph® variables between
metabolic and non-metabolic syndrome patients (n=95)
Disclaimer: the authors declare to have no conflicts of interest in the presentation of this data. Acknowledgements: We would like to thank Julio Chirinos, MD, for his feedback on this research.