| BackgroudCardiovascular disease is a long-term process, and Metabolic Syndrome (MS) is a cluster of risk factors of cardiovascular diseases. The potential clinical significance of MS is to identify individuals without obvious clinical symptoms, but with high risk. And it is great significant that the individuals with MS are early detected and intervented to be a promising way to prevent and reduce the risk of cardiovascular atherosclerotic diseases. Carotid atherosclerosis has been reflected in atherosclerotic lesions of the body as a "window". It is important to explore the association of MS and carotid atherosclerosis to understand the role of MS in the formation of atherosclerosis. In different populations, the research results of MS diagnosed by different definitions and subclinical atherosclerosis are not same. Due to the lack of this information in China, we conduct this study in two elderly community based populations in Beijing to explore the relationship of MS and carotid atherosclerosis and to estimate the effects of MS diagnosed by different definitions.ObjectiveThe study was conducted:1. explore the relationship of MS and carotid atherosclerosis and the related risk factors in community based population in Beijing,2. estimate the effects of MS diagnosed by different definitions for a reference to selecting appropriate criteria,3. assess the effect of blood pressure on the association of MS and carotid atherosclerosis.MethodsA cross-sectional study was conducted in 2 communities based populations in Beijing, in 2008. The 1640 people have reviewed, the response rate was 83%(1640/1980). Carotid ultrasound was measured in 1371 subjects, with the participant rate 84%(1640/1980). The individuals were selected with completed information and without acute coronary syndrome, stroke, cancer, a history of end stage renal disease. The final analyses included 1266 subjects (598 men,671 women), aged 45～69. MS was defined by IDF, the revised NCEP ATPⅢ(ATPⅢ-R) and "Guideline of Dyslipidemia Control for Chinese Adult" ("Guideline"). SPSS 13.0 software packgage was used for the data analysis.The mean of the intima-media thickness (IMT) was compared by Student's t-test, ANOVA and covariate ANOVA. The presence of carotid atherosclertic plaque was compared by x2-test and logistic model was used for multivariable analysis. A value of P<0.05 was considered statistically significant.Results1. The prevalence of MS according to different definitionsThe prevalence of MS by IDF, ATP III-R and "Guideline" criteria was 39.0% (men:36.8%, women:41.0%),43.3%(men:43.1%, women:43.6%) and 39.9%(men: 37.5%, women:25.0%). The Kappa value for the measure of the agreement between each pair of the 3 definitions was 0.911,0.719and 0.730 respectively, highly accordant.2. MS and common carotid artery intima-media thicknessThe all means of CCA-IMT were 0.76±0.16mm for MS groups and 0.71±0.17mm for non-MS groups, diagnosed with the 3 criteria. The means of IMT were significantly higher (P<0.001) in all MS groups than non-MS groups, diagnosed with the 3 criteria independent of age, gender, LDL-C, current smoking and drinking habit, and also higher in men than women with MS (IDF:P=0.019, ATPⅢ-R: P=0.048, C:P=0.026).In multivariate liner analyses, MS diagnosed by 3 definitions was independently associated with increases in IMT after the adjustment of the traditional factors (standardizated P=0.12, P<0.05; standardizatedβ=0.11, P<0.05; standardizatedβ=0.10, P<0.05), and the similar risk in both men and women.3. MS and the prevalence of carotid atherosclertic plaqueThe presences of carotid atherosclertic plaque were significantly higher in all MS groups than non-MS groups (P<0.05), but the difference was not signifint in men according to IDF difinition (P=0.085). And the presences of carotid atherosclertic plaque were significantly higher in men than women with MS, except "Guideline" definition (P=0.255).In logistic regression models, MS diagnosed by 3 definitions was independently associated with increases in the prevalence of carotid atherosclertic plaque after the adjustment of age, gender, LDL-C, current smoking and drinking habit. ORs were 1.50(95%CI:1.16-1.94),1.70 (95%CI:1.31-2.19) and 1.77(95%CI:1.35-2.32), respectively. In women, the risk of carotid atherosclertic plaque increased 62%,78% and 124% respectively in MS groups than non-MS groups according to 3 definitions. But in men, the risk of carotid atherosclertic plaque was 1.59 fold in MS group than non-MS group diagnosed only by ATPⅢ-R definition (P<0.05).4. The numbers of MS compents and carotid atherosclerosisAs the numbers of MS compents increase, IMT and the presences of carotid atherosclertic plaque raised significantly (P<0.05) and there were not significant different between 3 difinitions at the same level (P<0.05).5. Carotid artery atherosclerosis by the status of MS/Hypertension according to ATPⅢ-R and "Guideline" definitionsThe prevanlence of hypertention was 46.8% in all population. And the prevalence of hypertension was 65.4% and 69.8% in the MS individuals diagnosed by ATPⅢ-R and "Guideline" definitions, respectively.IMT and the presences of carotid atherosclertic plaque were all significantly higher in MS+/HT-,MS-/HT+and MS+/HT+groups than MS-/HT-group (P<0.05). After adjustment for the traditional factors, the differences of IMT were significant (P<0.05). In hypertensives, IMT was only significanrly higher in MS group than non-MS group according to ATPⅢ-R definition (P<0.05), and the presences of carotid atherosclertic plaque was only significanrly greater in MS group than non-MS group according to "Guideline" definition (P<0.05).Adjusted of age, sex, LDL-C, current smoking and current drinking habit, MS was independently associated with increases in the prevalence of carotid atherosclertic plaque. ORs were 1.40(95%CI:0.93-2.09) for MetS+/HT-,2.11(95%CI:1.48-3.01) for MetS-/HT+and 2.81 (95%CI:2.04-3.87) for MetS+/HT+respectively, compared to the reference group (MetS-/HT-) accortding to ATPⅢ-R definition. And according to "Guideline", ORs were 1.34(95%CI:0.83-2.14) for MetS+/HT-, 2.01 (95%CI:1.47-2.76) for MetS-/HT+and 2.97(95%CI:2.12-4.16) for MetS+/HT+respectively, compared to the reference group (MetS-/HT-). Also, hypertension was also an independent predictor in the model (OR=2.07,95%CI: 1.59-2.70) according to 2 definitions.ConclusionsIt is highly accordant to the measure of the agreement between each pair of the IDF, ATP III-R and "Guideline" definitions in the middle-aged community based population.After adjusted of age, sex, LDL-C, current smoking and current drinking habit, the means of IMT were higher in MS groups than non-MS groups diagnosed by 3 definitions and men with MS were higher than women with MS. Also, MS would significantly increase the risk of IMT.The prevalences of carotid atherosclertic plaque were higher in MS groups than non-MS groups diagnosed by 3 definitions, but it is not significant in men with MS diagnosed by IDF definition. The prevalences were significantly greater in men than women with MS, except "Guideline" definition. MS diagnosed by 3 definitions was independently associated with increases in the prevalence of carotid atherosclertic plaque in women. But in men, it was still by ATPⅢ-R definition.As the numbers of MS compents increase, IMT and the presences of carotid atherosclertic plaque raised significantly and there were not significant different between 3 difinitions at the same level.Adjusted of traditional factors, MS diagnosed by ATPⅢ-R and "Guideline" definitions was independently associated with increases in the prevalence of carotid atherosclertic plaque. Also, hypertension was also an independent predictor according to 2 definitions.
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