Multisite atherosclerosis in subjects with metabolic syndrome and diabetes and relation to cardiovascular events: The Multi-Ethnic Study of Atherosclerosis

Yanglu Zhao, Marcella A. Evans, Matthew A. Allison, Alain G. Bertoni, Matthew J. Budoff, Michael H. Criqui, Shaista Malik, Pamela Ouyang, Joseph F. Polak, Nathan D. Wong

Research output: Contribution to journalArticlepeer-review

Abstract

Background and aims: The extent and relation of multisite atherosclerosis to cardiovascular disease (CVD) in metabolic syndrome (MetS) and diabetes (DM) are not well documented. We examined the extent of multisite atherosclerosis and its prognostic value for CVD events in MetS and DM. Methods: In CVD-free subjects from the Multi-Ethnic Study of Atherosclerosis, multisite atherosclerosis was measured as: (1) the number of arterial beds involved (coronary calcium>0, abdominal aortic calcium>0, carotid intima-media thickness ≥1 mm and ankle brachial index<1 or ≥1.4); (2) a composite score summing the quartile rank for each atherosclerosis measure. Hazard ratios (HRs) and c-statistics were calculated for incident CVD and coronary heart disease (CHD) over 10.6 years. Results: Of 1675 individuals (mean age 64 years, 51% male), 33.4% had MetS and 15.9% had DM. The number of atherosclerotic sites was higher in those with DM (mean ± SD = 1.67 ± 1.15) and MetS (1.49 ± 1.12) versus neither MetS/DM (1.09 ± 1.09) (p < 0.0001). CVD rates per 1000 person-years ranged from 3.5, 8.2, and 10.0 in those with 0 sites positive to 35.1, 79.6 and 103.4 in those with 4 sites positive among neither DM/MetS, MetS and DM groups, respectively. HRs (95% CI) for CVD comparing those with 4 vs. 0 atherosclerotic sites were 4.0 (0.8–19.1), 4.9 (2.0–12.0), and 14.4 (3.6–57.6), respectively. C-statistics adding multisite atherosclerosis measures increased over models without the measures and with CIMT or ABI but not CAC. Conclusions: Multisite atherosclerosis is greater with MetS or DM, and predicts CVD and CHD events. Risk prediction is improved over CIMT and ABI but not CAC.

Original languageEnglish (US)
Pages (from-to)202-209
Number of pages8
JournalAtherosclerosis
Volume282
DOIs
StatePublished - Mar 2019

Keywords

  • Cardiovascular disease
  • Diabetes
  • Metabolic syndrome
  • Multisite atherosclerosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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