The Impact of Metabolic Syndrome, Homocysteine, and B Vitamins on Carotid Artery Intima-Media Thickness in Hypertensive Patients.
OBJECTIVE
To examine the correlation between metabolic syndrome (MS), plasma total homocysteine (tHcy) level, and serum B vitamin levels on carotid intima-media thickness (CIMT) in hypertensive patients.


METHODS
A total of 73 medically treated hypertensive patients (42 men, mean age 70.7 years), fasted for 10 hours, and provided fasting blood samples for measurement of plasma tHcy, serum folic acid, and serum vitamin B12 levels. Additionally, B-mode ultrasound of the distal right common carotid arteries was performed on all participants.


RESULTS
There were 50 patients with and 23 patients without MS. Patients with MS had larger CIMT than patient without (0.81 ± 0.13 vs. 0.74 ± 0.10 mm, p = 0.018). Patients with MS had larger waist circumference (p < 0.001), higher body mass index (p < 0.001), elevated serum triglyceride level (p < 0.001), lower serum high density lipoprotein level (p = 0.016), higher prevalence of diabetes mellitus (p = 0.012), higher prevalence of hyperlipidemia (p = 0.019), and a higher prevalence of fibrate usage (p = 0.025) than patients without MS. In univariate analysis, CIMT correlated significantly with the presence of MS (r = 0.256; p = 0.029), usage of angiotensin receptor blocker (ARB; r = -0.256; p = 0.029), and male gender (r = 0.247; p = 0.035). The relationships between CIMT and serum folic acid level (r = -0.212; p = 0.072) or statin usage (r = 0.207; p = 0.079) were borderline significant. In multivariate regression analysis, after adjusting for age and gender, only usage of ARB (β value -0.078, 95% CI: -0.140 to -0.015, p = 0.016) and the presence of MS (β value 0.075, 95% CI: 0.020 to 0.131, p = 0.009) were associated with CIMT. In anothermodel, after adjusting four additional parameters including age, gender, systolic blood pressure and usage of statin, usage of ARB (β value -0.074, 95% CI: -0.137 to -0.011, p = 0.022) and presence of MS (β value 0.069, 95% CI: 0.012 to 0.125, p = 0.017) remained significantly correlated with CIMT.


CONCLUSIONS
MS and usage of ARB are associated with CIMT in hypertensive patients.


BACKGROUND
Folic acid; Homocysteine, Intima-media thickness, Metabolic syndrome.
Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan;
Chung-Pin
CP
Liu
Department of Business Administration, Chihlee Institute of Technology, New Taipei City, Taiwan;
Yu-Li
YL
Lin
Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan;
Yen-Hung
YH
Lin
Graduate Institution of Clinical Pharmacy, National Taiwan University College of Medicine, Taipei, Taiwan.
Kuan-Yin
KY
Pao
Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan;
Vin-Cent
VC
Wu
Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan;
Ta-Chen
TC
Su
Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan;
Chi-Sheng
CS
Hung
Graduate Institution of Clinical Pharmacy, National Taiwan University College of Medicine, Taipei, Taiwan.
Churn-Shiouh
CS
Gau
Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan;
Juey-Jen
JJ
Hwang