The Effect Of Different Metabolic Components On The Increased Of Carotid Intima-media Thickness In Patients With Metabolic Syndrome

Objective:Increased carotid intima-media thickness is a manifestation of early carotid atherosclerosis,which is the main marker for predicting the risk of cardiovascular and cerebrovascular diseases.Metabolic syndrome is currently a global epidemic of public health disease,which increases the risk of carotid atherosclerosis and cardiovascular and cerebrovascular diseases,however,the correlation between different metabolic components and carotid intima-media thickening in patients with metabolic syndrome is relatively few and controversial.To investigate the association of metabolic components with carotid intima-media thickness in a community population with metabolic syndrome,and to provide evidence for the prevention of carotid atherosclerosis and atherosclerotic cardiovascular disease.Methods:This was a cross-sectional study based on the REACTION study initiated by the Chinese Medical Association.Community residents who met the 2020 CDS diagnostic criteria for metabolic syndrome were enrolled from July 2014 to December2014.According to the inclusion and exclusion criteria,a total of 2187 subjects were included in this study.The general information and laboratory indicators of the subjects were collected,including age,gender,smoking history,drinking history,waist circumference,systolic blood pressure,uric acid,total cholesterol,triglyceride,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,etc.According to whether carotid intima-media thickness was increased,the patients were divided into increased carotid intima-media thickness group and normal carotid intima-media thickness group.According to the 2020 CDS diagnostic criteria for metabolic syndrome,2187 subjects were divided into 16 groups according to the different combinations of MS components:Q1 group-Q16 group.A total of 10 groups with only three metabolic syndrome components,Q1 group only included abdominal obesity,hyperglycemia and hypertension;Q2 group only included abdominal obesity,hyperglycemia,and hypertriglyceridemia;Q3 group only included abdominal obesity,hyperglycemia and low high-density lipoprotein cholesterol;Q4 group only included abdominal obesity,hypertension and hypertriglyceridemia.Q5 group only included abdominal obesity,hypertension and low high-density lipoprotein cholesterol;Q6 group only included abdominal obesity,high triglyceride and low high-density lipoprotein cholesterol;Q7group only included hyperglycemia,hypertension and hypertriglyceridemia.Group Q8included only high blood glucose,hypertension and low high density lipoprotein cholesterol;Q9 group only contained high blood glucose,high triglyceride,and low high-density lipoprotein cholesterol;The Q10 group contained only hypertension,high triglycerides,and low HDL cholesterol.A total of five groups with only four metabolic syndrome components,Q11 group included abdominal obesity,hyperglycemia,hypertension and hypertriglyceridemia;Q12 group included abdominal obesity,hyperglycemia,hypertension and low high-density lipoprotein cholesterol;Q13 group included abdominal obesity,hypertension,high TG and low high-density lipoprotein cholesterol;Q14 group included high blood glucose,hypertension,high triglyceride and low high-density lipoprotein cholesterol;Q15 group included abdominal obesity,high blood glucose,high triglyceride,and low high-density lipoprotein cholesterol.There is a group of five metabolic syndrome components,Q16 group included abdominal obesity,hyperglycemia,hypertension,high triglyceride and low high-density lipoprotein cholesterol.The detection rate of increased carotid intima-media thickness was compared between groups with 3 metabolic syndrome components and groups with 4-5 metabolic syndrome components,R*C contingency table analysis was used to compare the rates among multiple groups,and chi-square test was used to compare the rates between the two groups with differences.Univariate and multivariate Logistic regression models were used to analyze the relationship between metabolic syndrome components and carotid intima-media thickness.P<0.05 was considered statistically significant.Results:1.The detection rates of increased carotid intima-media thickness among the groups with different aggregation patterns of the three components were compared,and the results showed that the detection rates of increased carotid intima-media thickness among the groups were statistically significant(χ~2=20.116,P=0.005).At the same time,there was a significant difference in the detection rate of increased carotid intima-media thickness between Q1 group and Q6 group.The detection rate of increased carotid intima-media thickness in Q1 group(abdominal obesity,hyperglycemia,hypertension)was4.364 times higher than that in Q6 group(abdominal obesity,high triglyceride,low high-density lipoprotein cholesterol).and the difference was statistically significant(χ2=15.343,P<0.001,OR=4.364,95%CI:1.972-9.657).There was no significant difference in the detection rate of increased carotid intima-media thickness among the Q11-Q16 groups with 4 and 5 components(P>0.05).The results showed that there was no significant difference in the detection rate of increased carotid intima-media thickness between the Q1 group with the highest detection rate of increased carotid intima-media thickness,and the Q11-Q16 group with 4 and 5 components(P>0.05).2.There were significant differences in fasting blood glucose,2-hour postprandial blood glucose,mean systolic blood pressure,waist circumference,triglyceride,high-density lipoprotein cholesterol,age,gender,smoking history,hypertension history,diabetes history,and uric acid between the increased carotid intima-media thickness group and the normal carotid intima-media thickness group at baseline.Taking fasting blood glucose,2-hour postprandial blood glucose,mean systolic blood pressure,waist circumference,triglyceride,high-density lipoprotein cholesterol,age,gender,smoking history,history of hypertension,history of diabetes,and uric acid as independent variables,and carotid intima-media thickness as dependent variable,univariate Logsitic analysis showed that waist circumference,2-hour postprandial blood glucose,mean systolic blood pressure,age,gender,smoking history,history of hypertension,history of diabetes,and uric acid were positively correlated with the increase of carotid intima-media thickness(P<0.05).3.Taking the increase of carotid intima-media thickness as the dependent variable and age,gender,smoking history,history of hypertension,history of diabetes,uric acid,waist circumference,mean systolic blood pressure,and 2-hour postprandial blood glucose as the independent variables,multivariate Logsitic regression analysis(forward LR method)showed that age,smoking history and diabetes history were positively correlated with the increase of carotid intima-media thickness(P<0.05).Among the components of metabolic syndrome,waist circumference was still positively correlated with the increase of carotid intima-media thickness(P<0.05),it was suggested that for every 1 standard deviation increase in waist circumference,the risk of increased carotid intima-media thickness increased by 0.032 times.Conclusions:1.In the population with metabolic syndrome,the proportion of increased carotid intima-media thickness in patients with abdominal obesity with hyperglycemia and hypertension was significantly higher than that in patients with abdominal obesity with high triglyceride and low high-density lipoprotein cholesterol components.2.Waist circumference,smoking history,diabetes history and age were positively correlated with carotid intima-media thickening.