Relationship Between The Value Changes Of Each Metabolic Components And CCA-IMT After The Multifactorial Intervention In Metabolic Syndrome

Background and Purpose: Metabolic syndrome (MS) increases the risk of cardiovascular disease, and each component of MS may be the independent risk factor of atherosclerosis (AS). The more components contribute to a higher incidence of AS. It is demonstrated that multifactorial intervention may delay the progression of AS and effectively decrease the cardiovascular end-point events in patients with MS, but few study reveals the relationship between sub-clinical AS and the components of MS. In our study, patients with type 2 diabetes mellitus (T2DM) accompanied with MS are treated with 5-year intensive therapy consisting of glycemic control, blood pressure control, treatment of dyslipidemia and a low dosage of aspirin to anti-platelet aggregation. We observe the change of each component of MS, the common carotid artery intima-media thickness (CCA-IMT), the occurrence of sub-clinical AS, and the relationship between the components of MS and sub-clinical AS. The goal is to investigate whether or not sub-clinical AS can be prevented or delayed by multifactorial intervention in patients with MS without macroangiopathy.Methods: 97 patients with MS and T2DM (with no evidence of clinical atherosclerotic disease of heart, brain, kidney and peripheral vascular, CCA-IMT≤1.0mm without plaque formation measured by ultrasound) were treated with multifactorial intervention, consisting of glycemic control, blood pressure control, treatment of dyslipidemia and a low dosage of aspirin to anti-platelet aggregation. Before and after intervention, patients'general information were collected; values of fasting plasma glucose (FPG), HbA1c, triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) were determined by blood samples from cubital vein after 12-hour overnight fasting; CCA-IMT was measured by ultrasound. After intervention, the changes of metabolic components including plasma glucose, blood pressure, serum lipids and CCA-IMT, the occurrence of sub-clinical AS and the relationship between it and the targeting of each component of MS were recorded for comparison, and the risk factors of MS were come up with by analysis of relevant factors.Results: After 5-year multifactorial intervention to patients with MS and T2DM, the dysmetabolism were improved and CCA-IMT was thickening little (before intervention 0.74±0.15mm, after intervention 0.75±0.17mm, P>0.05). Sub-clinical AS took place in 19 patients (19.58%), the incidence in non-targeted groups was higher than that in targeted ones (SBP 22.22% vs. 16.05%, DBP 45.45% vs. 16.28%, HbA1c 22.22% vs. 18.03%, TG 36.67% vs. 11.94%, TC 33.33% vs. 12.5%, LDL-C 32.56% vs. 9.26%, the former data of each couple was the incidence of sub-clinical AS of component which was non-targeted , the latter was that of targeted, and each P<0.05). Logistic regression analysis showed that with multifactorial intervention, the incidence of sub-clinical AS was related closely to age (OR=1.067, P=0.013), whether or not TG (OR=3.429, P=0.043) or LDL-C (OR=5.328, P=0.011) was targeted.Conclusions: The CCA-IMT can be prevented from thickening and plaque from formatting by five years of multifactorial intervention. Age and non-targeted TG and LDL-C are the risk factors of sub-clinical AS in patients with MS and T2DM.