PREDICTORS OF SUBCLINICAL ISOLATED AND COMBINED ATHEROSCLEROTIC LESIONS IN MIDDLE-AGED MEN AND ITS CORRELATION WITH METABOLIC SYNDROME

Objective. To determine clinical, laboratory and instrumental predictors of subclinical isolated and combined atherosclerotic lesions in middle-aged men and its association with metabolic syndrome. design and methods. We examined 194 middle-aged men (44–60 years, WHO, 2009) with subclinical atherosclerotic arterial lesions: coronary artery (CA), extracranial artery (ECA) and peripheral artery (PA). The 1st subgroup included 40 men with isolated lesion in one arterial region (mean age — 53,6 ± 4,7 years): 17 subjects had CA lesion, 9 had ECA involvement, and 14 patients had PA lesion. The 2nd subgroup included 154 patients with combined lesions of 2 or more vascular pools (mean age — 52,1 ± 4,1 years). Both groups were comparable by age. Past acute myocardial infarction and stroke were exclusion criteria. All subjects underwent general clinical examination (medical history, physical examination, blood pressure (BP) and body mass index assessment), blood tests (lipids, coagulogram, inflammatory markers), ultrasonography (duplex scanning, power and color Doppler and spectral analysis of blood flow), stress-testing (stress-echocardiography, treadmill-test) and angiographic methods. The following parameters were analyzed in a logistic regression model as predictors of subclinical atherosclerosis: systolic and diastolic BP, total cholesterol, high-density lipoprotein cholesterol, triglycerides, basal and postprandial glucose level, homocysteine, fibrinogen, C-reactive protein (CRP), smoking and cardiovascular (CV) heredity factors, intima-media (IMT) thickness, total duration of exercise test and oxygen intake (MET) at stressechocardiography, and change of the ankle-brachial index (ABI) at treadmill-test.

Results. The most significant predictors of isolated CA atherosclerosis are the following: cardiovascular disease in close relatives, increased CRP and IMT, decreased exercise tolerance and increment of ejection fraction during stress-echocardiography, ECA — family CV history, increased CRP and IMT, for PA — hyperglycemia and reduction in ABI increase at the peak exercise. Combined subclinical atherosclerotic lesions were associated with family CV history, hyperhomocysteinemia, increased CRP, decrease of the total duration of stress-test, oxygen intake and increment of ejection fraction during stress-echocardiography, as well as decreased ABI elevation at the treadmill test. Combined subclinical atherosclerosis is also associated with traditional and additional components of metabolic syndrome (hyperhomocysteinemia and increased CRP).

Conclusions. Besides to the known association with arterial hypertension, dyslipidemia, vascular wall thickening, the following predictors of isolated arterial lesions were found: for CA — with family CV history, increased CRP, decreased exercise tolerance, and increment of ejection fraction at stress-echocardiography, for ECA — family CV history, increased CRP, for PA — hyperglycemia and decreased ABI elevation at the peak exercise. Subclinical multifocal atherosclerosis is closely associated with hyperhomocysteinemia, increased CRP and reduced exercise tolerance at stress-tests.

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