Analele Universității din Oradea, Fascicula: Ecotoxicologie, Zootehnie și Tehnologii de Industrie Alimntară Vol. XIVA, 2015 [631300]

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Analele Universității din Oradea, Fascicula: Ecotoxicologie, Zootehnie și Tehnologii de Industrie Alimntară Vol. XIV/A, 2015

ASSOCIATION BETWEEN METABOLIC SYNDROME AND RISK
OF CARDIOVASCULAR DISEASE

*Ferician Anca, Popa Amorin Remus

*Faculty of Medicine and Pharmacy Oradea , County Clinical Emergency Hospital Oradea,
Republicii Street no.37, Oradea 410167, Romania, e-mail: anca.moza @yahoo.com

Abstract
The purpose of this study is to determine the association between the co mponents used to
define metabolic syndrome and cardiovascular risk using different criteria stra tified by patient’s
predisposition to this disease.

Key words: metabolic syndrome, AHP, CVD, alcohol, nutrition.

INTRODUCTION

Cardiovascular diseases (CVD) are the most lethal diseases known to
the Western world and as the standard of living continues to grow CVD will
soon become the world’s leading cause of mortality. This means more
demanding challenges are being placed on scientific communities to
research and develop new and more specific diagnostic approaches to
unstable angina, acute myocardial infarction (AMI) and other life
threatening cardiovascular pathologies. In this field, different cardiac
markers .
As we know the term metabolic syndrome incorporates many
metabolic alternations, associated especially with abdominal obesity. The
abnormal features of the metabolic syndrome are: glucose intolerance,
dyslipidaemia, hypertension and ovarian polytheistic cancer (in women’ s
cases).
In order to be diagnosed with metabolic syndrome the patient must
show at least two of the characteristics mentioned before (Adult Treatment
Panel III; Bonow R.O., R.H. Eckel., 2003; Campia U., 2006).
Impaired glucose is a feature of metabolic syndrome, which means
that the glucose level is high, after two hours from ingestion of 75g of
glucose. The main role of impaired glucose in atherogenesis, remains
unclear, still many statistics and studies show that high level of plasmatic
glucose for a long period of time, can create alternations of the plasma of
lipoproteins and proteins.
An example of such alterations can be found in the increasing
concentration of glycosylated haemoglobin (DECODE Study Group, 2003;
Defronzo R.A., E. Ferrannini, 2001; Després J.P., 2012).

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Dyslipidaemia. The phenotype lipoprotein of the metabolic
syndrome includes the moderate elevation of the triglycerides plasma and
the level low level of HDL (1). The levels of the LDL cholesterol are not
high in individuals who are affected by the metabolic syndrome, still LDL
has abnormal physica l – chemical proprieties.
Triglycerides and CVD risk. Epidemiological studies have proven a
linear link between the levels of triglycerides and the risk for CVD (Campia
U., 2006). Besides the importance of each risk factor, an important role is
being played by insulin resistance, which seems to be a risk factor for the
emergence of CVD, but for type 2 diabetes as well (Durrington P.N. et al.,
2001; Eyre H. et al., 2004, Herbert R. et al., 2000).
Free fatty acids. The mechanism by which insulin resistance ca exert
an atherogenic effect, can be trough triglycerides or free fatty acids (FFA).
Herbert R. et al., 2000; Isomaa B. et al., 2001, Lakka H.M. et al., 2002).
The high concentrations of plasmatic FFA, are usual in type 2
diabetes cases. Insulin resistance in the fat, result in a flux of FFA, from the
fat, to the liver, causing even insulin resistance in the liver and in the
peripheral tissue. Free fatty acids block the oxidation of glucose and the
distribution of glucose, but also cause atherogenic dyslipidaemia, because it
leads to the generation of LDL particles in the liver, which lead to high level
triglycerides and apolipoprotein B (ApoB) (Malik S. et al., 2004, Martin A.,
2000; Mathieu P. et al., 2009, Murphy N.F. et al., 2006).
Metabolic syndrome is associated with arterial fibrillation. Its
presence is more distinct, at patients that suffer of arterial fibrillation, than
at patients who do not show signs of this affection, its presence is more
common for women than men: 34,2 % and 7,7 for women, 19, 3 and 10, 9
for men (Pan U., A. Cerami A., 2001; Sajin R. et al., 2001; Sowers, J. R., E.
D. Frohlich, 2004).
It is important to mention that the different combination of the most
harmful components of the metabolic syndrome, can be useful for clinical
practice (Steinmetz A. et al., 2001; Zicha J. et al., 2006).

MATERIAL AND METHODS

In this article, we review the prospective studies that investigate the
association between MetS and CVD. Data has been provided from a series
of studies by the Clinical Hospital for Emergencies Oradea, diagnosed using
ATOIII criteria. Interest in exploring the association between MetS and
CVD was sparked by a corssectional analysis.

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RESULTS AND DISCUSSIONS

1. Cardiovascular risk depending on sex
Table 1.
Framingham score and Score score variation on sex
Sex Framingham Score
Women 12,12±3,11 4,03±0,51
Men 13,14±3,12 4,97±0,72
Total 12,61±3,08 4,52±0,64

In out cohort study, the medium value of the Framingham score was
of 12,61, which meets a moderate CVD risk, for women, but also for men,
the score being insignificantly higher for men (13,14 vs 12,12) (p=0,782).
Even the Score score indicates a moderate risk in our cohort (4,52),
insignificantly higher for men than for women (4,97 vs 4,03) (p=0,106).
12,1213,14
Fem ei BarbatiScor Fram ingham

4,034,97
Fem ei BarbatiScor Score

Graphic no. 1. CVD risk depending on sex

2. CVD depending on age

Table 2.
Framingham score and Score score depending on age
Age Framingham Score
<30 years 8,81±1,79 0,62±0,22
31-40 years 9,12±2,02 1,11±0,45
41-50 years 11,07±2,38 3,27±0,92
51-60 years 12,27±3,11 4,52±1,11
61-70 years 15,00±3,75 5,44±1,64 Women Men Women M en

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>70 years 15,31±3,61 8,70±2,02
From the analysis of the medium values of the Framingham score
depending on age, we remark an elevation of it, if the age is higher. We can
distinguish 3 groups of age <40 years where the score is almost 9 (9,01),
between 41-60 years, where the score is almost 12 (11,73), and over 60
years, where the score is over 15 (15,10). In the case of the Score score, we
have a reduced risk at ages under 30 years, moderate between 31-60 and
high over 60 years.
8,819,1211,0712,2715,0015,31
<30 ani 31-40 ani 41-50 ani 51-60 ani 61-70 ani >70 aniScor Fram ingham
0,621,113,274,525,448,70
<30 ani 31-40 ani 41-50 ani 51-60 ani 61-70 ani >70 aniScor Score

Graphic no. 2. CVD depending on age

3. CVD risk depending on environmental factors

Table 3.
Framingham Score and Score score depending on environment
Area of origin Framingham Score
Rural 10,35±3,13 3,58±0,61
Urban 14,12±3,74 5,20±0,92

Framingham score and Score score were significantly higher in the
urban environment than the rural one (12,12 vs 10,35, respectively 5,20 vs
3,58) (p=0, 0047, respectively p=0, 003). <30 years 31-40 years 41-50 years 51-60 years 61-70 years >70 years <30 years 31-40 years 41-50 years 51-60 years 61-70 years >70 years

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10,3514,12
Rural UrbanScor Fram ingham
3,585,20
Rural UrbanScor Score

Graphic no. 3. CVD risk depending on the environment
4. CVD depending on life style
Nutrition
Table 4.
Framingham score and Score score depending on nutrition
Type of diet Framingham Score
Normocaloric+normolipidic 8,12±2,02 2,51±0,36
Normocaloric+hiperlipidic 14,58±3,71 4,12±0,72
Hipercaloric+normolipidic 14,07±3,52 4,60±0,65
Hipercaloric+hiperlipidic 18,21±3,77 8,21±1,55

The results obtained from the analysis of the Framingham score and
the Score score indicates the fact that nutrition has an essential role
regarding CVD. Thus, for patients with balanced nutrition (normocaloric
and normolipidic), the CVD risk was lower, respectively moderate (8, 12
respectively 2, 51), significantly lower than for the patients with excessive
nutrition from a caloric/or lipid point of view (16, 87, respectively 5, 98)
(p=0,031, respectively p< 0,001).
8,12
14,58
14,07
18,21Norm ocalorica+norm olipidica
Norm ocalorica+hiperlipidica
Hipercalorica+norm olipidica
Hipercalorica+hiperlipidicaScor Fram ingham

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2,51
4,12
4,60
8,21Norm ocalorica+norm olipidica
Norm ocalorica+hiperlipidica
Hipercalorica+norm olipidica
Hipercalorica+hiperlipidicaScor Score

Graphic no.4. CVD depending on nutrition

5. Alcohol intake
Table 5 .
Framingham score and Score score depending on alcohol intake
Frequency of alcohol intake Framingham Score
Daily 15,73±3,64 5,22±0,78
Occasionally 11,29±3,22 4,40±0,56
None 11,58±3,46 4,23±0,48

For patients that have daily alcohol intake the Framingham score
was significantly higher than for those who drink occasionally or never
(p=0,034). The Score score was insignificantly higher for patients that drink
daily in contrast to those who drink occasionally (p=0,090), and lower in
significance than those who never drink alcohol (p=0,045).

Graphic no.5. CVD depending on alcohol intake

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6. CVD risk depending on associated pathology
6.1. Arterial hypertension

Table 6.
Framingham score and Score score depending on AHP
Framingham Score
Without AHP 8,48±2,99 2,18±0,33
With AHP 15,01±3,06 5,88±0,81
HTA st.I 14,56±3,21 5,33±0,72
HTA st.II 15,16±3,46 5,94±0,84
HTA st.III 15,72±3,71 7,01±1,11

Framingham CVD risk for non-hypertensive patients was low (8,48),
while for hypertensive patients it was moderate (15,01), the difference was
significant (p<0,001). CVD Score score for non-hyper tensive patients was
moderate (2,18), while for hypertensive patients it was high (5,88), the
difference being significant (p< 0,001).

Graphic no.6. CVD depending on AHP

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7. CVD risk for patients affected by Metabolic Syndorme

Table 7.
Framingham score and Score score depending on metabolic syndrome
Framingham Score
Without MetS 8,21±3,32 2,51±0,38
With MetS 20,57±4,12 9,12±1,41

For patients with metabolic syndrome CVD risk is high,
Framingham score being 2,5 folds higher than patients not suffering of
metabolic syndrome (<0,001).

Graphic no. 7. CVD risk depending on metabolic syndrome

CONCLUSIONS

A series of studies have examined the relation between MetS and
CVD risk factors mentioned above.

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In this study the patients that have participated have had in their
family members that have been affected by the factors that we discussed
earlier.
In this study a number of 2.508 men have participated. Almost 34%
of the participants have fulfilled the criteria for being liable for metabolic
syndrome.
The recommendations in this cases would be to mention to the
patients that they adjust their life style, which include dietary modifications
and physical activity, as first line treatment for individuals with MetS.

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