P2.50 Endothelium Dysfunction is the Risk Factor for Cardiovascular Events in Metabolic Syndrome Patients Without Evidence of Coronary Heart Disease

Abstract

Background

Impaired function of endothelium has been reported to be the initial step in atherosclerosis and thus may be seen as either independent cardiovascular risk factor or a marker of a present underlying abnormality.

Materials

302 metabolic syndrome patients were examined (aged 36.4±2.1 years, 55% males). Baseline examination included routine clinical examination, laboratory tests, cardiac ultrasound, ECG- and blood pressure monitoring. As endothelium-dependent vasoreactivity is advocated as a measure of vascular health, using a high-resolution ultrasound, the diameter of the brachial artery at rest and during reactive hyperaemia (endothelial-dependent flow-mediated dilatation, DFMD%) was measured. Study group comprised 104 participants (37.0 ± 3.6 years, 54% males), with endothelium dysfunction (ED) at baseline, DFMD 189.2 ± 19.7%. Control group included 198 patients without ED (35.8 ± 2.6 years, 56% males), DFMD 143.5 ± 10.3%. Coronary heart disease (CHD) was excluded using coronary angiography or stress echocardiography. Follow-up assessments were performed at two and seven years (including stress echocardiography).

Results

at two years follow-up 36.5% of study group patients developed CHD comparing to 13.1% among the controls (RR= 2.78, =22.37); at seven years follow-up total CHD incidence was 0.865 for study group and 0.353 for controls (RR=2.45, = 71.71), fatal cardiovascular events were registered in 7.69% and 3.03% respectively (RR=2.57, = 3.325).

Conclusion

In patients with metabolic syndrome not having CHD endothelium dysfunction should be regarded as an independent risk factor.