Clinical Characteristic Of Vascular Lesion In Metabolic Syndrome With Or Without Diabetes

Many clinical studies have shown that the cluster of risk factors such as type 2 diabetes mellitus(T2DM),hypertension,disorder of lipid metabolism and central obesity often assembled with the same patient,which was identified as metabolic syndrome(MS) by WHO in 1999.The main consequence of MS is atherosclerotic cardiovascular disease (ASCVD).The prevalence of MS and its complication of cardiovascular and periphery conduit vessels have been incredibly increasing in the past decades.Carotid artery is considered to be a reflection of atherosclerosis(AS) all over the body.As a result,detection of carotid artery lesion by ultrasound techniques is widely used to evaluate cardiovascular disease indirectly.Being an index,Ankle brachial pressure indices(ABI) is used to assess the statement of peripheral vascular function and analyze prognosis in the clinic.Recently the change of carotid and peripheral AS in MS with hypertension and type 2 diabetes were observed,which was reported rarely in patients with different glycometabolism levels.This study aims to investigate the characteristics of the vascular lesion in the MS with or without T2DM subjects and provide some valuable suggestion to prevent ASCVD.Subjects and Methods:1.SubjectsEight hundred and seventy six patients aged 31-78 years old(male 482,and female 394) were recruited in investigation.336 non-diabetic hypertensive patients(FPG＜5.6mmol/L) were divided into two groups in primary part.1) Without MS(MS-,211);2) with MS(MS+,125).665 MS patients were also divided into two groups in second part.1) without DM(MS-DM,217); 2) with DM(MS+DM,448).The MS definition was suggested by the IDF criteria in 2005.2.MethodsAll patients were collected venous blood to assay FPG,fasting insulin(FIN),fasting total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-c),low density lipoprotein cholesterol(LDL-c).Some subjects were collected venous blood to assay glycosylated hemoglobin Alc(HbAlc),C reactive protein(CRP) and free fatty acids (FFA).Some subjects run oral glucose tolerance test and insulin releasing test.All patients were observed to survey blood pressure,the height,body weight and waist circumference(WC),then calculated the body mass index(BMI).Some patients were observed to measure the visceral adipose tissue area(VA) and the subcutaneous adipose tissue area(SA) by computed tomography.Carotid artery of all patients were observed by Color Doppler ultrasonography.The inner diameter of the common carotid artery(CCA),the intima-media thickness(IMT) of the CCA and the blood flow rate of CCA,internal carotid artery(ICA) were measured,then calculated resistent index,plaque index and incidence rate of plaque.Some patients were measured ABI by the Dopplex Assist.Results:1.Results in primary part1.1 WC,BMI,VA and SA of MS+ were significantly higher than those of MS-.The level of FPG,2hPG FIN,HOMA-IR,HbAlc,TG and LDL-c were significantly higher in MS+(P＜0.05,P＜0.01).The level of HDL-c and SBP were higer in MS-(P＜0.05,P＜0.01).1.2 SBP and DBP were significantly linear correlated with IMT in MS+.Age and SBP were significantly linear correlated with IMT in MS-.1.3 IMT,PI and ABI were similar in two groups.No significant difference of the incidence rate of carotid plaque and PAD was observed between two groups.2.Results in second part2.1 Age was significantly higher in MS+DM compared with MS-DM.The level of FPG,2hPG,HOMA-IR,HbAlc,TG,HDL-c,TG,FFA and CRP were significantly higher in MS+DM compared with MS-DM(P＜0.05,P＜0.01).VA,SA were significantly linear correlated with FFA(P＜0.01)2.2 Age,WC and TC were significantly linear correlated with IMT in MS+DM.Age and SBP were significantly linear correlated with IMT in MS-DM.2.3 Compared with MS-DM,the RI-ICA,CCA-IMT,PI and incidence rate of carotid plaque and PAD were significantly higher in MS+DM(P＜0.05,P＜0.01). 2.4 The stratified analysis confirms that CCA-IMT was significantly higher in MS+DM when age≥60years compared with MS-DM.Conclusions:1.As far as carotid artery or peripheral vascular lesion are concerned,there is no significant difference between MS and non-MS group in normal FPG patients.2.In normal FPG patients,MS patients suffered more serious insulin resistance and metablic disturbance than non-MS subjects,who have higher risk of DM.3.When MS patients are complicated with DM,the vascular damage is accelerated by disturbance of glucose metabolism.Therefore,positive intervention is strongly suggested to be taken to prevent patients with MS from developing DM.