title: The vascular effects of metabolic impairment clusters in subjects of different ethnicities.
abstract: BACKGROUND
  Although metabolic syndrome affects vascular function, the impact of individual impairments and their clustering is unclear.
  
  
  OBJECTIVE
  To assess the vascular impact of metabolic impairments before they reach treatment thresholds in different ethnic groups.
  
  
  METHODS
  Metabolic variables, inflammatory markers, endothelium dependent vasodilatation (EDV) and carotid intima media thickness (CIMT) were measured in population samples of 82 Caucasians and 78 matched Afro-Caribbeans with no vascular disease. Insulin resistance was assessed using homeostasis model assessment (HOMA-IR). EDV was measured as the change in the height of the inflection point of the digital volume pulse following intravenous infusion of 5 mcg/min of albuterol (DeltaRIDeltaLB). Regression models were used to investigate the independent effects of metabolic impairment clusters and their interaction with ethnicity on EDV and CIMT.
  
  
  RESULTS
  HOMA-IR (2.4-3.8, p < 0.0001), IL-6 levels (1.1-2.8 pg/mL, p = 0.02) and CIMT (0.71-0.83 mm, p = 0.009) increased whereas in DeltaRIBASELINE (77.6-72.9 percentage points, p < 0.0001) and DeltaRIDeltaLB (15.5-7.1 percentage points, p < 0.0001) decreased with the number of metabolic impairments present. DeltaRIDeltaLB decreased by 1.6 (95% CI 0.2-3.7) percentage points and CIMT increased by 0.06 (95% CI 0.02-0.10) mm for each metabolic impairment present after adjusting for age, gender, ethnicity and HOMA-IR. There were significant interactions between Afro-Caribbean ethnicity and metabolic impairments for IL-6 (p = 0.037) and DeltaRIDeltaLB (p = 0.002).
  
  
  CONCLUSIONS
  Clustering of metabolic impairments is associated with inflammatory activation, impaired EDV and increased CIMT even before reaching treatment thresholds for individual impairments. This effect was more marked in Afro-Caribbean subjects.
authors.affiliation: Cardiovascular Division, King's College London School of Medicine, London, UK.
authors.forename: Curtis
authors.initials: C
authors.lastname: Rambaran
authors.forename: Philip
authors.initials: P
authors.lastname: Chowienczyk
authors.forename: James
authors.initials: J
authors.lastname: Ritter
authors.forename: Ajay
authors.initials: A
authors.lastname: Shah
authors.forename: Rainford
authors.initials: R
authors.lastname: Wilks
authors.forename: Terrence
authors.initials: T
authors.lastname: Forrester
authors.forename: Lalit
authors.initials: L
authors.lastname: Kalra
mesh_terms: D000328:Adult; D000368:Aged; D000420:Albuterol; D044383:Black People; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D001823:Body Composition; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D008076:Cholesterol, HDL / Q000097:blood; D005260:Female; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000208:ethnology; D008297:Male; D024821:Metabolic Syndrome / Q000208:ethnology*; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D017540:Tunica Media / Q000000981:diagnostic imaging; D014463:Ultrasonography; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000208:ethnology*; D044465:White People
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D007328:Insulin; D014280:Triglycerides; D000420:Albuterol