Introduction:
Arterial stiffness is an indicator of subclinical cardiovascular disease (CVD) and is associated with increased CVD risk. The determinants of arterial stiffness may be explained in part by a clustering of metabolic abnormalities (as defined by the metabolic syndrome). Our goal was to examine the association of central and peripheral arterial stiffness (as measured by carotid-femoral, brachial-ankle, and femoral-ankle pulse wave velocity) with the metabolic syndrome in older adults. We predicted higher arterial stiffness (i.e. higher pulse wave velocity measurements) in persons with compared to persons without the metabolic syndrome.
Methods:
We analyzed 3542 persons without diabetes at the ARIC Visit 5 examination in 2011-13 (61% female; 18% African American; median age 75 yrs). The metabolic syndrome was defined as ≥3 of the following: (1) abdominal obesity (waist circumference ≥102 cm in males and ≥88 cm in females); (2) hypertriglyceridemia (≥150 mg/dL), (3) low HDL-cholesterol (<40 mg/dL in males and <50 mg/dL in females), (4) high blood pressure (BP) (systolic BP ≥130 mmHg and/or diastolic BP≥85 mmHg and/or BP-lowering medications), and (5) high fasting glucose (≥100 mg/dL). Pulse wave velocity (PWV) included carotid-femoral PWV (cfPWV), brachial-ankle PWV (baPWV), and femoral-ankle PWV (faPWV); values were measured using the Colin VP-1000 Plus system (Omron Co., Ltd., Kyoto, Japan). Multivariable regression, with adjustment for age, sex, and race-center, was used to evaluate the association of cfPWV, baPWV, and faPWV with the metabolic syndrome, with each component metabolic abnormality, and with the number of metabolic abnormalities.
Results:
The prevalence of metabolic syndrome was 49% (SE 2); the three metabolic abnormalities with the highest prevalence were abdominal obesity (63% (SE 1)), elevated fasting glucose (60% (SE 1)), and high blood pressure (76% (SE 1)). A majority of participants had two (29% (SE 3)) or three (28% (SE 3)) metabolic abnormalities. Persons with the metabolic syndrome had a higher mean cfPWV (54 cm/s; 95% CI: 35, 73 cm/s), higher mean baPWV (22; 95% CI: 2, 42 cm/s, respectively), and lower mean faPWV (-18 cm/s; 95% CI: -31, -6 cm/s) compared to persons without the metabolic syndrome. Each additional metabolic abnormality was associated with a 28 cm/s (95% CI: 20, 36 cm/s) higher cfPWV, 19 cm/s (95% CI: 11, 27 cm/s) higher baPWV, and 6 cm/s (95% CI: -11, -1 cm/s) lower faPWV.
Conclusion:
Metabolic syndrome and each additional metabolic abnormality was positively associated with cfPWV and baPWV, and inversely associated with faPWV in older adults. Abdominal obesity, elevated fasting glucose, and high blood pressure were the most common metabolic abnormalities in this cohort of older men and women. Having the metabolic syndrome and its abnormalities may contribute to arterial stiffness that is predictive of CVD events and mortality.
Olmesartan Improves Pulse Wave Velocity and Lowers Central Systolic Blood Pressure and Ambulatory Blood Pressure in Patients With Metabolic Syndrome
