Metabolic syndrome in peripheral arterial disease: relationship with severity of peripheral circulatory insufficiency, inflammatory status, and cardiovascular comorbidity.

OBJECTIVE

Metabolic syndrome is defined by the clustering in the same person of at least three risk factors such as hyperglycemia, hypertriglyceridemia, low levels of high-density lipoprotein, hypertension, and abdominal obesity. In patients with peripheral arterial disease (PAD), we investigated the prevalence of metabolic syndrome and its relationship with the severity of peripheral circulatory insufficiency, inflammatory status, and cardiovascular comorbidity.

METHODS

The presence of metabolic syndrome was assessed in 154 consecutive PAD patients (115 men, 39 women). Inflammatory status was assessed by measuring serum levels of C-reactive protein (CRP).

RESULTS

Metabolic syndrome was present in 51.9% (42.7 % in men, 74.3% in women, P < .01). Patients with an ankle/brachial index (ABI) <0.64 (median) were more likely to have metabolic syndrome than those with less severe PAD (63.9% vs 42.8%, P < .02). The association between a low ABI and metabolic syndrome was maintained after adjustment for age and sex (odds ratio [OR], 2.19; 95% confidence interval [CI], 1.03 to 4.68). Compared with PAD patients without metabolic syndrome, those with the syndrome had greater body mass index (28.2 [25.6; 29.8] kg/m(2) vs 26.1 [24.2; 27.7] kg/m(2), P < .01) and higher levels of CRP (3.9 [1.6; 7.6] mg/L vs 2.0 [1.1; 3.7] mg/L, P < .02). A previous myocardial infarction was documented in 58.2% of patients with and in 37.5% of those without metabolic syndrome (P < .01). At multivariate analysis, metabolic syndrome was significantly associated with previous myocardial infarction also after adjustment for ABI (OR, 2.15; 95% CI, 1.06 to 4.38).

CONCLUSIONS

Metabolic syndrome is present in >50% of PAD patients. The finding that well-established indicators of increased cardiovascular risk such as low ABI and increased CRP levels cluster with metabolic syndrome suggests that identification of this syndrome in these high-risk patients could indicate an even greater risk of cardiovascular events.