title: Carotid arterial stiffness is marginally higher in the metabolic syndrome and markedly higher in type 2 diabetes mellitus in patients with manifestations of arterial disease.
abstract: BACKGROUND
  Insulin resistance is generally considered to be of major importance in the pathophysiology of the metabolic syndrome and type 2 diabetes mellitus, both high-risk conditions for cardiovascular complications. Carotid artery stiffness is increasingly recognized as an important predictor of cardiovascular morbidity and mortality. Therefore, in the present study we determined whether the metabolic syndrome (MetSyn) and type 2 diabetes mellitus (DM2) are associated with carotid artery stiffness in patients with already clinical manifestations of arterial disease.
  
  
  RESULTS
  A cross-sectional study in 2105 patients with manifest arterial disease (cerebral, coronary or peripheral artery disease, renal artery stenosis or an aneurysm of the abdominal aorta) was performed. The difference in carotid stiffness between patients with and without MetSyn and with and without DM2 was studied with linear regression analysis. Compared to patients without DM2 (N=1112), patients with DM2 (N=301) had significantly higher arterial stiffness (distension -18.5 (-35.1;-1.9) 95% CI/distensibility -1.8 (-2.2;-1.4) 95% CI). Generally, there was a trend of higher carotid stiffness in patients with MetSyn (N=922) compared to patients without (N=1112) MetSyn (distension -9.6 (-21.5;2.3) 95% CI/distensibility -2.0 (-2.6;-1.4) 95% CI). Excluding the patients with also DM2 (N=230) from the MetSyn-group diminished this relation (distension -5.7 (-18.8;7.4) 95% CI/distensibility -1.1 (-1.6;-0.6) 95% CI). Furthermore, in the population as a whole, carotid artery stiffness increased with increasing number of components of the metabolic syndrome (p=0.08 for distension/p< or =0.001 for distensibility). In addition, this association was not as clear after exclusion of the patients with DM2 from the MetSyn-group (p=0.24 for distension/p<0.001 for distensibility). From all the components of the MetSyn only high blood pressure and high fasting glucose influenced the carotid artery stiffness.
  
  
  CONCLUSIONS
  We concluded that (increasing number of components of) the metabolic syndrome were associated with marginally higher carotid artery stiffness, while type 2 diabetes was associated with a marked increase in carotid artery stiffness, in patients with already clinical manifestations of arterial disease.
authors: Department of Internal Medicine, Section of Vascular Medicine, University Medical Center Utrecht, The Netherlands. fabrice.martens@wolmail.nl
authors: Fabrice M A C
authors: FM
authors: Martens
authors: Yolanda
authors: Y
authors: van der Graaf
authors: Joke M
authors: JM
authors: Dijk
authors: Jobien K
authors: JK
authors: Olijhoek
authors: Frank L J
authors: FL
authors: Visseren
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002339:Carotid Arteries / Q000503:physiopathology*; D002340:Carotid Artery Diseases / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006943:Hyperglycemia; D006973:Hypertension / Q000503:physiopathology; D008297:Male; D008365:Manometry; D024821:Metabolic Syndrome / Q000503:physiopathology*; D008875:Middle Aged