title: Metabolic syndrome, endothelial dysfunction, and risk of cardiovascular events: the Northern Manhattan Study (NOMAS).
abstract: BACKGROUND
  Metabolic syndrome (MetS) predisposes to cardiovascular disease. Endothelial dysfunction is thought to be an important factor in the pathogenesis of atherosclerosis. We tested the hypothesis that both MetS and endothelial dysfunction are vascular risk factors and provide additive prognostic values in predicting cardiovascular events in a multiethnic community sample.
  
  
  METHODS
  The study population consisted of 819 subjects (467 female, mean age 66.5 +/- 8.8 years, 66% Hispanic) enrolled in the NOMAS. Metabolic syndrome was defined using the revised Adult Treatment Panel III criteria. Brachial artery flow-mediated dilation (FMD) was measured using high-resolution ultrasound. Endothelial dysfunction was defined as FMD <8.44% (lower 3 quartiles). Cox proportional hazards models were used to assess the effect of MetS and endothelial dysfunction on risk of cardiovascular events.
  
  
  RESULTS
  During 81 +/- 21 months of follow-up, events occurred in 84 subjects. Metabolic syndrome was independently associated with cardiovascular events in a multivariate model, including cardiovascular risk factors (adjusted hazard ratio 2.08, 95% CI 1.27-3.40). Subjects with both MetS and endothelial dysfunction were at higher risk for cardiovascular events than those with either one of them alone (adjusted hazard ratio 2.60, 95% CI 1.14-5.92).
  
  
  CONCLUSIONS
  Metabolic syndrome is associated with incident cardiovascular events. Combined use of MetS and FMD identifies those who are at higher risk of cardiovascular events. Metabolic syndrome and noninvasive FMD testing can be used concurrently for cardiovascular risk prediction.
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
authors.forename: Takeki
authors.initials: T
authors.lastname: Suzuki
authors.forename: Kumiko
authors.initials: K
authors.lastname: Hirata
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.forename: Tanja
authors.initials: T
authors.lastname: Rundek
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Miyake
authors.forename: Bernadette
authors.initials: B
authors.lastname: Boden-Albala
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
authors.forename: Ralph
authors.initials: R
authors.lastname: Sacco
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
mesh_terms: D000328:Adult; D000368:Aged; D001916:Brachial Artery / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D014652:Vascular Diseases / Q000401:mortality*