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ATHEROSCLEROSIS

Increased Subclinical Atherosclerosis in Young Adults With Metabolic Syndrome

The Bogalusa Heart Study

Wendy S. Tzou, MD^_*, Pamela S. Douglas, MD, FACC, Sathanur R. Srinivasan, PhD, M. Gene Bond, PhD, Rong Tang, MD, MS, Wei Chen, MD, PhD, Gerald S. Berenson, MD, FACC and James H. Stein, MD, FACC^_*,_*

^_* Atherosclerosis Imaging Research Program, Section of Cardiovascular Medicine, University Medical School, Madison, Wisconsin
Division of Cardiovascular Medicine, Duke University Medical Center, Durham, North Carolina
Tulane Center for Cardiovascular Health and Department of Epidemiology, Tulane University Health Sciences Center, New Orleans, Louisiana
Division of Vascular Ultrasound Research, Wake Forest University School of Medicine, Winston-Salem, North Carolina

Manuscript received February 9, 2005; revised manuscript received March 30, 2005, accepted April 13, 2005.

^_* Reprint requests and correspondence: Dr. James H. Stein, Department of Medicine, Section of Cardiovascular Medicine, University of Wisconsin Medical School, 600 Highland Avenue, G7/341 CSC (MC 3248), Madison, Wisconsin 53792 (Email: jhs{at}medicine.wisc.edu).

OBJECTIVES: The purpose of this study was to investigate the association of metabolic syndrome (MetS) with subclinical atherosclerosis, determined by ultrasound carotid intima-media thickness (CIMT) measurements, in young adults.

BACKGROUND: Metabolic syndrome is associated with subclinical atherosclerosis and increased cardiovascular risk in older and middle-aged adults; however, these associations have not been studied among young adults.

METHODS: Non-diabetic subjects from Bogalusa Heart Study, a longitudinal study of atherosclerosis in young adults, underwent B-mode ultrasonography of the carotid arteries. Metabolic syndrome was defined with the National Cholesterol Education Program Adult Treatment Panel III (MetS_NCEP) and World Health Organization (MetS_WHO) definitions. CIMT and MetS associations were evaluated with multivariable regression and area under receiver-operator characteristic curve (AUC) analyses.

RESULTS: Of 507 subjects (29% black, 39% male, mean [SD] age 32 [3] years), 67 (13%) had MetS_NCEP and 65 (13%) had MetS_WHO. Common (mean = 0.70 [0.11] mm vs. 0.66 [0.08] mm, p = 0.002) and internal CIMT (0.72 [0.21] mm vs. 0.68 [0.12] mm, p = 0.020) were higher among those with MetS_NCEP than those without MetS_NCEP. Common (0.69 [0.11] mm vs. 0.66 [0.08] mm, p = 0.020) and internal CIMT (0.73 [0.23] mm vs. 0.68 [0.12] mm, p = 0.012) also were higher among those with MetS_WHO than those without MetS_WHO. Composite CIMT increased with the number of MetS components present (MetS_NCEP r = 0.997, p < 0.001; MetS_WHO r = 0.946, p = 0.053). Metabolic syndrome_NCEP (AUC = 0.557, 95% confidence interval [CI] 0.513 to 0.601) and MetS_WHO (AUC = 0.539, 95% CI 0.495 to 0.584) both predicted composite CIMT 75th percentile.

CONCLUSIONS: In young adults, MetS is associated with increased atherosclerotic burden, and therefore, increased cardiovascular risk. These results support the importance of screening and early intervention in this population.

Abbreviations and Acronyms   AUC = area under receiver-operator characteristic curve   BMI = body mass index   BP = blood pressure   CI = confidence interval   CIMT = carotid intima-media thickness   HDL-C = high-density lipoprotein cholesterol   ICA = internal carotid artery   LDL-C = low-density lipoprotein cholesterol   MetS = metabolic syndrome   NCEP = National Cholesterol Education Program   OR = odds ratio   SBP = systolic blood pressure   WHO = World Health Organization

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