title: Subclinical Vascular Dysfunction Associated with Metabolic Syndrome in African Americans and Whites.
abstract: BACKGROUND
  The diagnosis of metabolic syndrome (MetS) identifies individuals at risk for developing diabetes and cardiovascular disease. African Americans (AAs) have high rates of cardiovascular disease and subclinical vascular disease including arterial stiffness and microvascular dysfunction but have relatively low rates of MetS.
  
  
  OBJECTIVE
  The objective of the study was to evaluate the relationship between MetS and vascular function in a biracial cohort with the hypothesis that the diagnosis of MetS underestimates subclinical vascular disease in AAs.
  
  
  METHODS
  We measured components of MetS in a community-based cohort of 951 AAs and white subjects (aged 48.8 ± 11 y, 47% AA, 55% female).
  
  
  METHODS
  Using digital pulse amplitude tonometry, we estimated the reactive hyperemia index (RHI), a measure of microvascular endothelial function. Using applanation tonometry (Sphygmocor), central augmentation index (CAIx) and pulse wave velocity (PWV) were measured as indices of wave reflections and arterial stiffness, respectively.
  
  
  RESULTS
  MetS was present in 24.0% of subjects and was associated with increased PWV (P < .001) and CAIx (P < .001) and a trend to lower RHI (P = .068) in both races. However, in subjects without MetS, AAs had lower RHI (P < .001) and higher PWV (P = .003) and CAIx (P = .002) compared with white subjects. Addition of an extra MetS criterion point for AAs with hypertension eliminated the racial differences in PWV and CAIx but not RHI.
  
  
  CONCLUSIONS
  Although MetS is associated with microvascular dysfunction and increased arterial stiffness in both racial groups, AAs without MetS have greater vascular dysfunction compared with whites. Additional weighting for hypertension in AAs attenuated the racial differences in subclinical disease associated with MetS.
authors.affiliation: Emory Clinical Cardiovascular Research Institute (J.S., J.C.P., A.A.M., V.V., A.A.Q.), Emory University School of Medicine (M.L.T., L.P.), Department of Biostatistics and Bioinformatics (J.G.B.), Emory Rollins School of Public Health, and Emory University, School of Nursing (S.B.D.), Atlanta, Georgia 30322; Cardiovascular Research Institute (A.B.), Morehouse School of Medicine, Atlanta, Georgia 30310; Institute of Cardiovascular Science (R.S.P.), University College London, London WC1E 6BT, United Kingdom; and National Institutes of Health/National Heart, Lung, and Blood Institute (G.H.G.), Bethesda, Maryland 20824.
authors.forename: Jia
authors.initials: J
authors.lastname: Shen
authors.affiliation: Emory Clinical Cardiovascular Research Institute (J.S., J.C.P., A.A.M., V.V., A.A.Q.), Emory University School of Medicine (M.L.T., L.P.), Department of Biostatistics and Bioinformatics (J.G.B.), Emory Rollins School of Public Health, and Emory University, School of Nursing (S.B.D.), Atlanta, Georgia 30322; Cardiovascular Research Institute (A.B.), Morehouse School of Medicine, Atlanta, Georgia 30310; Institute of Cardiovascular Science (R.S.P.), University College London, London WC1E 6BT, United Kingdom; and National Institutes of Health/National Heart, Lung, and Blood Institute (G.H.G.), Bethesda, Maryland 20824.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Poole
authors.affiliation: Emory Clinical Cardiovascular Research Institute (J.S., J.C.P., A.A.M., V.V., A.A.Q.), Emory University School of Medicine (M.L.T., L.P.), Department of Biostatistics and Bioinformatics (J.G.B.), Emory Rollins School of Public Health, and Emory University, School of Nursing (S.B.D.), Atlanta, Georgia 30322; Cardiovascular Research Institute (A.B.), Morehouse School of Medicine, Atlanta, Georgia 30310; Institute of Cardiovascular Science (R.S.P.), University College London, London WC1E 6BT, United Kingdom; and National Institutes of Health/National Heart, Lung, and Blood Institute (G.H.G.), Bethesda, Maryland 20824.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Topel
authors.affiliation: Emory Clinical Cardiovascular Research Institute (J.S., J.C.P., A.A.M., V.V., A.A.Q.), Emory University School of Medicine (M.L.T., L.P.), Department of Biostatistics and Bioinformatics (J.G.B.), Emory Rollins School of Public Health, and Emory University, School of Nursing (S.B.D.), Atlanta, Georgia 30322; Cardiovascular Research Institute (A.B.), Morehouse School of Medicine, Atlanta, Georgia 30310; Institute of Cardiovascular Science (R.S.P.), University College London, London WC1E 6BT, United Kingdom; and National Institutes of Health/National Heart, Lung, and Blood Institute (G.H.G.), Bethesda, Maryland 20824.
authors.forename: Aurelian
authors.initials: A
authors.lastname: Bidulescu
authors.affiliation: Emory Clinical Cardiovascular Research Institute (J.S., J.C.P., A.A.M., V.V., A.A.Q.), Emory University School of Medicine (M.L.T., L.P.), Department of Biostatistics and Bioinformatics (J.G.B.), Emory Rollins School of Public Health, and Emory University, School of Nursing (S.B.D.), Atlanta, Georgia 30322; Cardiovascular Research Institute (A.B.), Morehouse School of Medicine, Atlanta, Georgia 30310; Institute of Cardiovascular Science (R.S.P.), University College London, London WC1E 6BT, United Kingdom; and National Institutes of Health/National Heart, Lung, and Blood Institute (G.H.G.), Bethesda, Maryland 20824.
authors.forename: Alanna A
authors.initials: AA
authors.lastname: Morris
authors.affiliation: Emory Clinical Cardiovascular Research Institute (J.S., J.C.P., A.A.M., V.V., A.A.Q.), Emory University School of Medicine (M.L.T., L.P.), Department of Biostatistics and Bioinformatics (J.G.B.), Emory Rollins School of Public Health, and Emory University, School of Nursing (S.B.D.), Atlanta, Georgia 30322; Cardiovascular Research Institute (A.B.), Morehouse School of Medicine, Atlanta, Georgia 30310; Institute of Cardiovascular Science (R.S.P.), University College London, London WC1E 6BT, United Kingdom; and National Institutes of Health/National Heart, Lung, and Blood Institute (G.H.G.), Bethesda, Maryland 20824.
authors.forename: Riyaz S
authors.initials: RS
authors.lastname: Patel
authors.affiliation: Emory Clinical Cardiovascular Research Institute (J.S., J.C.P., A.A.M., V.V., A.A.Q.), Emory University School of Medicine (M.L.T., L.P.), Department of Biostatistics and Bioinformatics (J.G.B.), Emory Rollins School of Public Health, and Emory University, School of Nursing (S.B.D.), Atlanta, Georgia 30322; Cardiovascular Research Institute (A.B.), Morehouse School of Medicine, Atlanta, Georgia 30310; Institute of Cardiovascular Science (R.S.P.), University College London, London WC1E 6BT, United Kingdom; and National Institutes of Health/National Heart, Lung, and Blood Institute (G.H.G.), Bethesda, Maryland 20824.
authors.forename: Jose G
authors.initials: JG
authors.lastname: Binongo
authors.affiliation: Emory Clinical Cardiovascular Research Institute (J.S., J.C.P., A.A.M., V.V., A.A.Q.), Emory University School of Medicine (M.L.T., L.P.), Department of Biostatistics and Bioinformatics (J.G.B.), Emory Rollins School of Public Health, and Emory University, School of Nursing (S.B.D.), Atlanta, Georgia 30322; Cardiovascular Research Institute (A.B.), Morehouse School of Medicine, Atlanta, Georgia 30310; Institute of Cardiovascular Science (R.S.P.), University College London, London WC1E 6BT, United Kingdom; and National Institutes of Health/National Heart, Lung, and Blood Institute (G.H.G.), Bethesda, Maryland 20824.
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Dunbar
authors.affiliation: Emory Clinical Cardiovascular Research Institute (J.S., J.C.P., A.A.M., V.V., A.A.Q.), Emory University School of Medicine (M.L.T., L.P.), Department of Biostatistics and Bioinformatics (J.G.B.), Emory Rollins School of Public Health, and Emory University, School of Nursing (S.B.D.), Atlanta, Georgia 30322; Cardiovascular Research Institute (A.B.), Morehouse School of Medicine, Atlanta, Georgia 30310; Institute of Cardiovascular Science (R.S.P.), University College London, London WC1E 6BT, United Kingdom; and National Institutes of Health/National Heart, Lung, and Blood Institute (G.H.G.), Bethesda, Maryland 20824.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Phillips
authors.affiliation: Emory Clinical Cardiovascular Research Institute (J.S., J.C.P., A.A.M., V.V., A.A.Q.), Emory University School of Medicine (M.L.T., L.P.), Department of Biostatistics and Bioinformatics (J.G.B.), Emory Rollins School of Public Health, and Emory University, School of Nursing (S.B.D.), Atlanta, Georgia 30322; Cardiovascular Research Institute (A.B.), Morehouse School of Medicine, Atlanta, Georgia 30310; Institute of Cardiovascular Science (R.S.P.), University College London, London WC1E 6BT, United Kingdom; and National Institutes of Health/National Heart, Lung, and Blood Institute (G.H.G.), Bethesda, Maryland 20824.
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.affiliation: Emory Clinical Cardiovascular Research Institute (J.S., J.C.P., A.A.M., V.V., A.A.Q.), Emory University School of Medicine (M.L.T., L.P.), Department of Biostatistics and Bioinformatics (J.G.B.), Emory Rollins School of Public Health, and Emory University, School of Nursing (S.B.D.), Atlanta, Georgia 30322; Cardiovascular Research Institute (A.B.), Morehouse School of Medicine, Atlanta, Georgia 30310; Institute of Cardiovascular Science (R.S.P.), University College London, London WC1E 6BT, United Kingdom; and National Institutes of Health/National Heart, Lung, and Blood Institute (G.H.G.), Bethesda, Maryland 20824.
authors.forename: Gary H
authors.initials: GH
authors.lastname: Gibbons
authors.affiliation: Emory Clinical Cardiovascular Research Institute (J.S., J.C.P., A.A.M., V.V., A.A.Q.), Emory University School of Medicine (M.L.T., L.P.), Department of Biostatistics and Bioinformatics (J.G.B.), Emory Rollins School of Public Health, and Emory University, School of Nursing (S.B.D.), Atlanta, Georgia 30322; Cardiovascular Research Institute (A.B.), Morehouse School of Medicine, Atlanta, Georgia 30310; Institute of Cardiovascular Science (R.S.P.), University College London, London WC1E 6BT, United Kingdom; and National Institutes of Health/National Heart, Lung, and Blood Institute (G.H.G.), Bethesda, Maryland 20824.
authors.forename: Arshed A
authors.initials: AA
authors.lastname: Quyyumi
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D002196:Capillaries / Q000473:pathology; D015331:Cohort Studies; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000209:etiology; D008297:Male; D008365:Manometry; D024821:Metabolic Syndrome / Q000150:complications* / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D063177:Pulse Wave Analysis; D012307:Risk Factors; D014652:Vascular Diseases / Q000150:complications* / Q000453:epidemiology; D059289:Vascular Stiffness; D044465:White People; D055815:Young Adult