Abstract 11251: Skinny but Unhealthy: Metabolic Syndrome in Lean T2DM Patients Leads to a Doubling of Cardiovascular Complications
BACKGROUND: Metabolic syndrome (MetS) and type 2 diabetes (T2DM) are two major comorbidities of obesity. Yet, a minority of obese without MetS is considered metabolically healthy, and therefore at lesser cardiovascular disease (CVD) risk. In contrast, the prevalence and impact of MetS among normal weight T2DM patients are barely documented.
Methods: The study included 1094 T2DM (mean age (SD) 67 (12) yrs; 66% males) divided according to presence of obesity (BMI >25 kg/m2; n=870; 80%) and/or MetS (n=876; 80%). Among normal-weight patients (n=224; 20%), those without MetS (n=130; NW-MetS[-] group) were compared to those with MetS (n=94; 42% of normal-weight T2DM; 9% of all T2DM; NW-MetS[+]), as regards their cardiometabolic phenotype.
RESULTS: There were no differences between groups in age; gender; diabetes/CVD family histories; diabetes duration; smoking; BP; and LDL-C. NW-MetS[+] had significantly higher BMI; waist; fat mass; visceral fat; liver steatosis and HbA1c, and significantly lower insulin sensitivity. They used significantly more CVD drugs (%): ACE-I (41 vs. 23); ARB (19 vs. 9); B-blockers (37 vs. 16); diuretics (30 vs. 15) and statins-fibrates (61-18 vs. 40-6). NW-MetS[+] had higher non-HDL-C (123 (39) vs 113 (30); p 0.0390); apoB (87 (25) vs. 81 (20); p 0.0474); and triglycerides (189 (145) vs. 95 (43) mg/dL in NW-MetS[-]; p<0.0001); and lower HDL-C (46 (18) vs. 60 (16); p<0.0001) and LDL size (LDL/apoB 1.00 (0.30) vs. 1.17 (0.24); p<0.0001) in NW-MetS[-]. Macroangiopathy (%) was present in 45 of NW-MetS[+] vs. 21 of NW-MetS[-] (p 0.0002), as coronary (27 vs. 14; p 0.0247) or peripheral artery disease (14 vs. 5; p 0.0340) and/or TIA/stroke (16 vs. 6; p 0.0244). Microangiopathy (%) was present in 57 of NW-MetS[+] vs. 37 of NW-MetS[-] (p 0.0028), as retinopathy (29 vs. 17; p 0.0487); neuropathy (33 vs. 15; p 0.0022); and/or albuminuria (91 (203) vs. 42 (105) μg/mg creat; p 0.0341).
CONCLUSIONS: The prevalence of metabolic syndrome is surprisingly high among normal weight T2DM. It is characterized by excess abdominal fat, and results in poorer glycemic control and residual atherogenic dyslipidemia. Alarmingly, it doubles the risk of all vascular complications in patients often erroneously considered at lower CVD risk because of their normal BMI.
- © 2013 by American Heart Association, Inc.