title: Metabolic syndrome predicts vascular changes in whole body magnetic resonance imaging in patients with long standing diabetes mellitus.
abstract: BACKGROUND
  Although diabetic patients have an increased rate of cardio-vascular events, there is considerable heterogeneity with respect to cardiovascular risk, requiring new approaches to individual cardiovascular risk factor assessment. In this study we used whole body-MR-angiography (WB-MRA) to assess the degree of atherosclerosis in patients with long-standing diabetes and to determine the association between metabolic syndrome (MetS) and atherosclerotic burden.
  
  
  METHODS
  Long standing (> or = 10 years) type 1 and type 2 diabetic patients (n = 59; 31 males; 63.3 +/- 1.7 years) were examined by WB-MRA. Based on the findings in each vessel, we developed an overall score representing the patient's vascular atherosclerotic burden (MRI-score). The score's association with components of the MetS was assessed.
  
  
  RESULTS
  The median MRI-score was 1.18 [range: 1.00-2.41] and MetS was present in 58% of the cohort (type 2 diabetics: 73%; type 1 diabetics: 26%). Age (p = 0.0002), HDL-cholesterol (p = 0.016), hypertension (p = 0.0008), nephropathy (p = 0.0093), CHD (p = 0.001) and MetS (p = 0.0011) were significantly associated with the score. Adjusted for age and sex, the score was significantly (p = 0.02) higher in diabetics with MetS (1.450 [1.328-1.572]) compared to those without MetS (1.108 [0.966-1.50]). The number of MetS components was associated with a linear increase in the MRI-score (increase in score: 0.09/MetS component; r2 = 0.24, p = 0.038). Finally, using an established risk algorithm, we found a significant association between MRI-score and 10-year risk for CHD, fatal CHD and stroke.
  
  
  CONCLUSIONS
  In this high-risk diabetic population, WB-MRA revealed large heterogeneity in the degree of systemic atherosclerosis. Presence and number of traits of the MetS are associated with the extent of atherosclerotic burden. These results support the perspective that diabetic patients are a heterogeneous population with increased but varying prevalence of atherosclerosis and risk.
authors.affiliation: Department of Internal Medicine II, University Hospitals - Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Hannes M
authors.initials: HM
authors.lastname: Findeisen
authors.forename: Sabine
authors.initials: S
authors.lastname: Weckbach
authors.forename: Renée G
authors.initials: RG
authors.lastname: Stark
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
authors.forename: Klaus G
authors.initials: KG
authors.lastname: Parhofer
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000453:epidemiology / Q000473:pathology*; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000473:pathology*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000473:pathology*; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors
references.citation: N Engl J Med. 2010 Apr 29;362(17):1575-85
references.pmid: 20228401
references.citation: J Cardiovasc Magn Reson. 2009 Sep 17;11:36
references.pmid: 19761595
references.citation: Diabetes Care. 2009 Jan;32 Suppl 1:S13-61
references.pmid: 19118286
references.citation: Invest Radiol. 2009 Apr;44(4):242-50
references.pmid: 19212269
references.citation: JAMA. 2004 Jan 21;291(3):335-42
references.pmid: 14734596
references.citation: BMJ. 2008 Mar 22;336(7645):641
references.pmid: 18356232
references.citation: BMJ. 2008 Mar 22;336(7645):640
references.pmid: 18356231
references.citation: Circulation. 2004 Feb 24;109(7):855-60
references.pmid: 14757692
references.citation: Diabetes Care. 2007 Mar;30(3):707-12
references.pmid: 17327345
references.citation: Diabetes Care. 2009 May;32(5):950-2
references.pmid: 19196885
references.citation: Diabetes Care. 2007 Jan;30(1):162-72
references.pmid: 17192355
references.citation: Diabetologia. 1991 Dec;34(12):877-90
references.pmid: 1778353
references.citation: Diabet Med. 2009 Mar;26(3):306-9
references.pmid: 19317827
references.citation: Diabet Med. 2005 Oct;22(10):1420-6
references.pmid: 16176206
references.citation: Diabet Med. 2009 May;26(5):457-9
references.pmid: 19646182
references.citation: Diabetes Care. 2007 May;30(5):1248-54
references.pmid: 17303788
references.citation: Am J Cardiol. 2010 Mar 1;105(5):667-71
references.pmid: 20185014
references.citation: Am J Med. 2007 Sep;120(9 Suppl 1):S10-6; discussion S16-7
references.pmid: 17720354
references.citation: Lancet. 2001 Apr 7;357(9262):1086-91
references.pmid: 11297960
references.citation: Diabetologia. 2006 Jan;49(1):49-55
references.pmid: 16341841
references.citation: Diabetes Care. 2005 Sep;28(9):2289-304
references.pmid: 16123508
references.citation: Eur Radiol. 2008 Jun;18(6):1174-80
references.pmid: 18270716
references.citation: JAMA. 2003 Oct 8;290(14):1884-90
references.pmid: 14532317
references.citation: Stroke. 2007 May;38(5):1470-5
references.pmid: 17363718
references.citation: Eur Radiol. 2007 Oct;17(10):2692-6
references.pmid: 17977076
references.citation: N Engl J Med. 1998 Jul 23;339(4):229-34
references.pmid: 9673301
references.citation: Arch Intern Med. 2010 Feb 8;170(3):230-9
references.pmid: 20142567
references.citation: Cardiovasc Diabetol. 2007 Nov 27;6:36
references.pmid: 18042288
references.citation: Circulation. 2005 Oct 25;112(17):2735-52
references.pmid: 16157765
references.citation: Diabetes Care. 2004 Nov;27(11):2689-94
references.pmid: 15505006
references.citation: N Engl J Med. 2008 Feb 7;358(6):580-91
references.pmid: 18256393
references.citation: BMJ. 2002 Apr 20;324(7343):939-42
references.pmid: 11964337
references.citation: Clin Sci (Lond). 2001 Dec;101(6):671-9
references.pmid: 11724655
references.citation: N Engl J Med. 2008 Jun 12;358(24):2560-72
references.pmid: 18539916
references.citation: Diabetes. 2003 May;52(5):1210-4
references.pmid: 12716754