title: Metabolic syndrome in nondiabetic individuals associated with maladaptive carotid remodeling: the Hoorn Study.
abstract: BACKGROUND
  The metabolic syndrome (MetS) is associated with an increased risk of stroke. Arterial remodeling could play an important role herein as maladaptive remodeling is a risk factor for stroke. The purpose of this study was to investigate whether MetS was associated with maladaptive remodeling of the carotid artery and if any such association was independent of hemodynamic variables.
  
  
  METHODS
  We studied 385 (n = 195 women) nondiabetic, elderly subjects. A MetS z-score (average of sex-specific z-scores of the five MetS traits) was constructed. Intima-media thickness (IMT) and interadventitial diameter (IAD) were assessed by ultrasonography, and lumen diameter (LD), and circumferential wall stress (CWS) were calculated. Multiple linear regression analysis was used to investigate the association between MetS and carotid remodeling.
  
  
  RESULTS
  After adjustment for age, sex, height, prior cardiovascular disease (CVD), dyslipidemia, and smoking, MetS was independently associated with a greater IAD (regression coefficient (β) per s.d. increase in MetS z-score (95% confidence interval), 0.45 mm (0.28; 0.63)), LD (0.41 mm (0.25; 0.58)) and CWS (5.56 kPa (3.71; 7.42)). These associations were attenuated after additional adjustment for inflammatory, metabolic and particularly hemodynamic variables, but remained statistically significant. No significant association was found between MetS and IMT (0.020 mm (-0.006; 0.046)).
  
  
  CONCLUSIONS
  MetS is associated with maladaptive remodeling of the carotid artery, which is the result of changes in LD, IAD, and, to a lesser extent, IMT. This process is independent of hemodynamic variables. Whether this association and process will be observed in a broader population and explains the increased risk of stroke in MetS deserves further study.
authors.affiliation: Department of Medicine, Catharina Hospital, Eindhoven, The Netherlands. hanneke.beijers@catharina-ziekenhuis.nl
authors.forename: Hanneke J B H
authors.initials: HJ
authors.lastname: Beijers
authors.forename: Ronald M A
authors.initials: RM
authors.lastname: Henry
authors.forename: Bert
authors.initials: B
authors.lastname: Bravenboer
authors.forename: Isabel
authors.initials: I
authors.lastname: Ferreira
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Dekker
authors.forename: Giel
authors.initials: G
authors.lastname: Nijpels
authors.forename: Coen D A
authors.initials: CD
authors.lastname: Stehouwer
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000453:epidemiology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012307:Risk Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D014463:Ultrasonography