title: Low-grade inflammation can partly explain the association between the metabolic syndrome and either coronary artery disease or severity of peripheral arterial disease: the CODAM study.
abstract: BACKGROUND
  Low-grade inflammation has been hypothesized to underlie the coronary artery disease (CAD) risk associated with the metabolic syndrome, but the evidence is not conclusive. For peripheral arterial disease (PAD; as measured by the ankle-arm index), this association has not been studied before. The aim was to study whether the association between the metabolic syndrome and CAD or the severity of PAD can be explained by low-grade inflammation.
  
  
  METHODS
  The Cohort study Diabetes and Atherosclerosis Maastricht population includes 574 subjects, with an increased risk of type 2 diabetes, of whom 560 were included in the analyses (343 males; age: 59.5 +/- 7.0 years). The inflammation markers that were measured were C-reactive protein, interleukin 6, soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1 and serum amyloid A. All analyses were adjusted for age, sex and smoking.
  
  
  RESULTS
  Logistic regression showed that the metabolic syndrome was significantly associated with CAD [odds ratio (OR) = 1.86, 95% CI: 1.21; 2.84, P = 0.004]. Further adjustment for inflammatory status, as captured in a combination of the inflammation markers (using an averaged Z-score), resulted in significant associations of both the metabolic syndrome and inflammatory status with CAD [OR(metabolic syndrome) (95% CI) = 1.58 (1.01; 2.46), P = 0.044; OR(inflammation) (95% CI) = 1.59 (1.14; 2.21), P = 0.007]. Linear regression analysis showed similar results for the ankle-arm index.
  
  
  CONCLUSIONS
  The association between the metabolic syndrome, on the one hand, and prevalence of CAD or the severity of PAD, on the other, can be partly but not completely, 26% and 29% respectively, explained by low-grade inflammation.
authors.affiliation: Laboratory for Metabolism and Vascular Medicine, Maastricht University, Maastricht, The Netherlands. marjon.jacobs@intmed.unimaas.nl
authors.forename: M
authors.initials: M
authors.lastname: Jacobs
authors.forename: M M J
authors.initials: MM
authors.lastname: van Greevenbroek
authors.forename: C J H
authors.initials: CJ
authors.lastname: van der Kallen
authors.forename: I
authors.initials: I
authors.lastname: Ferreira
authors.forename: E E
authors.initials: EE
authors.lastname: Blaak
authors.forename: E J M
authors.initials: EJ
authors.lastname: Feskens
authors.forename: E H J M
authors.initials: EH
authors.lastname: Jansen
authors.forename: C G
authors.initials: CG
authors.lastname: Schalkwijk
authors.forename: C D A
authors.initials: CD
authors.lastname: Stehouwer
mesh_terms: D055109:Ankle Brachial Index; D002097:C-Reactive Protein / Q000378:metabolism*; D003324:Coronary Artery Disease / Q000097:blood* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D055105:Waist Circumference
chemical_list: D015850:Interleukin-6; D018799:Intercellular Adhesion Molecule-1; D002097:C-Reactive Protein