Abstract 11449: Metabolic Syndrome and Incident Peripheral Arterial Disease — The Multi-Ethnic Study of Atherosclerosis
Objective: The association of metabolic syndrome (MetS) with incident peripheral arterial disease (PAD) is unclear. We determined whether MetS was associated with incident PAD in community dwelling men and women free of clinical cardiovascular disease at baseline and enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA). We also determined whether elevated levels of inflammatory and hemostatic biomarkers appeared to mediate the association of MetS with incident PAD.
Methods: MetS was defined at baseline as the presence of three or more of the following components: elevated waist circumference (>/=102cm in men and >/=88cm in women), triglycerides >/=150mg/dL, reduced high-density lipoprotein cholesterol (<40mg/dL in men and <50mg/dL in women), blood pressure >/=130/85mmHg or taking blood pressure medication, and fasting glucose >/=100mg/dL and <126mg/dL. Persons with diabetes (fasting glucose >/=126mg/dL or diabetes medication use) were excluded. Incident PAD was defined as a decline in the ankle brachial index (ABI) from a normal range (ABI 0.90 -<1.40) at baseline to the presence of one of the following conditions at 3 year follow-up: a decline of ABI to <0.90 or medical record confirmed symptomatic lower extremity PAD (critical limb ischemia, revascularization, amputation).
Results: Among 4814 participants, 1373 (29%) had MetS at baseline. 48 (3.5%) persons with MetS developed PAD and 54 (1.6%) persons without MetS developed PAD. Baseline MetS was associated with a higher incidence of PAD (hazard ratio=2.09 [95% Confidence Interval (CI), 1.41 to 3.11], P <0.001) after adjusting for age, gender, race, smoking pack-years, blocks walked in the last week, and baseline ABI. Adjusting for levels of C-reactive protein (hazard ratio=2.10 [95% Confidence Interval (CI), 1.41 to 3.13], P <0.001) and fibrinogen (hazard ratio=2.12 [95% Confidence Interval (CI), 1.42 to 3.15], P <0.001) did not attenuate associations between MetS and incident PAD.
Conclusions: In conclusion, persons free of clinical cardiovascular disease who have MetS are at increased risk for the development of PAD. Our data suggest that this association is not mediated by inflammatory biomarkers.
- © 2010 by American Heart Association, Inc.