title: Preclinical atherosclerosis and metabolic syndrome increase cardio- and cerebrovascular events rate: a 20-year follow up.
abstract: BACKGROUND
  Intima-media thickness (IMT) is a validated marker of preclinical atherosclerosis and a predictor of cardiovascular events.
  
  
  METHODS
  We studied a population of 529 asymptomatic patients (age 62 ± 12.8 years), divided into two groups of subjects with and without Metabolic Syndrome (MetS).
  
  
  METHODS
  All patients, at baseline, have had a carotid ultrasound evaluation and classified in two subgroups: the first one without atherosclerotic lesions and the second one with preclinical atherosclerosis (increased IMT or asymptomatic carotid plaque). Cardiovascular endpoints were investigated in a 20-years follow-up.
  
  
  RESULTS
  There were 242 cardiovascular events: 144 among patients with MetS and 98 among in healthy controls (57.4% vs. 35.2%; P < 0.0001). 63 events occurred in patients with normal carotid arteries, while 179 events occurred in patients with preclinical atherosclerosis (31.8% vs. 54.1%; P < 0.0001). Of the 144 total events occurred in patients with MetS, 36 happened in the subgroup with normal carotid arteries and 108 in the subgroup with preclinical atherosclerosis (45% vs. 63.15%; P = 0.009). 98 events occurred in patients without MetS, of which 27 in the subgroup with normal carotid arteries and 71 in the subgroup with preclinical atherosclerosis (22.88% vs. 44.37%; P = 0.0003). In addition, considering the 63 total events occurred in patients without atherosclerotic lesions, 36 events were recorded in the subgroup with MetS and 27 events in the subgroup without MetS (45% vs. 22.88%; P = 0.0019). Finally, in 179 total events recorded in patients with preclinical carotid atherosclerosis, 108 happened in the subgroup with MetS and 71 happened in the subgroup without MetS (63.15% vs. 44.37%; P = 0.0009). The Kaplan-Meier function showed an improved survival in patients without atherosclerotic lesions compared with patients with carotid ultrasound alterations (P = 0.01, HR: 0.7366, CI: 0.5479 to 0.9904).
  
  
  CONCLUSIONS
  Preclinical atherosclerosis leads to an increased risk of cardiovascular events, especially if it is associated with MetS.
authors.affiliation: Chair of Cardiovascular Disease and Centre for the Early Diagnosis of Preclinical and Multifocal Atherosclerosis and for Secondary Prevention, Department of Internal Medicine and Specialties (DIBIMIS), University of Palermo, Via del Vespro n, 139-90127, Palermo, Italy. salvatore.novo@unipa.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Novo
authors.forename: Angelica
authors.initials: A
authors.lastname: Peritore
authors.forename: Rosaria Linda
authors.initials: RL
authors.lastname: Trovato
authors.forename: Francesco Paolo
authors.initials: FP
authors.lastname: Guarneri
authors.forename: Daniela
authors.initials: D
authors.lastname: Di Lisi
authors.forename: Ida
authors.initials: I
authors.lastname: Muratori
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Novo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000453:epidemiology; D017545:Aortic Aneurysm, Thoracic / Q000453:epidemiology; D058070:Asymptomatic Diseases / Q000453:epidemiology; D015992:Body Mass Index; D002340:Carotid Artery Diseases / Q000453:epidemiology*; D059168:Carotid Intima-Media Thickness; D002561:Cerebrovascular Disorders / Q000453:epidemiology*; D050171:Dyslipidemias / Q000453:epidemiology; D004691:Endarterectomy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000453:epidemiology*; D009765:Obesity / Q000453:epidemiology; D058226:Plaque, Atherosclerotic / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology; D018615:Ultrasonography, Doppler, Color