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Prevalence and Prognostic Impact of Subclinical Cardiovascular Disease in Individuals with the Metabolic Syndrome and Diabetes

¹The Framingham Study, 73 Mt. Wayte Ave Suite 2, Framingham, MA
²Department of Biostatistics, Boston University, Boston, MA
³Section of General Internal Medicine, Boston University School of Medicine, Boston, MA
⁴The Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
⁵Department of Preventive Medicine, Boston University School of Medicine, Boston, MA
⁶Cardiology Section, Boston University School of Medicine, Boston, MA
⁷Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
⁸General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
⁹The National Heart, Lung, and Blood Institute, Bethesda, MD
¹⁰Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA
¹¹Departments of Neurology and Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA
¹²Department of Mathematics and Statistics, Boston University, Boston, MA

Correspondence: vasan{at}bu.edu

Objective.: Data are limited regarding prevalence and prognostic significance of subclinical cardiovascular disease (CVD) in individuals with metabolic syndrome (MetS).

Research Design and Methods.: We investigated prevalence of subclinical CVD in 1945 Framingham Offspring Study participants (mean age, 58 years; 59% women) using electrocardiography, echocardiography, carotid ultrasound, ankle-brachial blood pressure, and urinary albumin excretion. We evaluated prospectively the incidence of CVD associated with MetS and diabetes according to presence versus absence of subclinical disease.

Results.: Cross-sectionally, 51% of the 581 participants with MetS had subclinical disease in at least one test, a frequency higher than individuals without MetS (multivariable-adjusted odds ratio, 2.06; 95% confidence interval [CI], 1.67-2.55; p<0.0001). On follow-up (mean 7.2 years), 139 individuals developed overt CVD, including 59 with MetS (10.2%). Overall, MetS was associated with increased CVD risk (multivariable-adjusted hazards ratio [HR] 1.61, 95% CI 1.12-2.33). Participants with MetS and subclinical disease experienced increased risk of overt CVD (adjusted-HR 2.67, 95% CI 1.62-4.41, compared to those without MetS, diabetes or subclinical disease), whereas the association of MetS with CVD risk was attenuated in absence of subclinical disease (HR 1.59, 95% CI 0.87-2.90). A similar attenuation of CVD risk in absence of subclinical disease was observed also for diabetes. Subclinical disease was a significant predictor of overt CVD in participants without MetS or diabetes (HR 1.93, 95% CI 1.15-3.24).

Conclusions.: In our community-based sample, individuals with MetS have a high prevalence of subclinical atherosclerosis that likely contributes to the increased risk of overt CVD associated with the condition.

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