Clusters of risk factors in metabolic syndrome and their influence on central blood pressure in a global study

Abstract

The effect of metabolic syndrome (MetS) and clusters of its components on central blood pressure (CBP) has not been well characterized. We aimed to describe the effect of MetS and clusters of its components on CBP in a large population and to identify whether this effect differs in men and women. We studied 15,609 volunteers (43% women) from 10 cohorts worldwide who participated in the Metabolic syndrome and Artery REsearch Consortium. MetS was defined according to the NCEP-ATP III criteria (GHTBW, glucose, high-density lipoprotein cholesterol, triglyceride, blood pressure, waist circumference). CBP was measured noninvasively and acquired from pulse wave analysis by applanation tonometry. MetS was associated with a 50% greater odds of having higher CSBP. After controlling for age, male sex, non HDL cholesterol, diabetes mellitus, and mean arterial pressure, only specific clusters of MetS components were associated with a higher CSBP; and some of them were significant in women but not in men. We identified "risky clusters" of MetS variables associated with high CSBP. Future studies are needed to confirm they identify subjects at high risk of accelerated arterial aging and, thus, need more intensive clinical management.

Figure 1

Central systolic blood pressure and pulse pressure values according to the number of altered MetS components. Men—black bars, women—gray bars. Numbers from 0 to 5 indicate the numbers of MetS components. Significant sex-specific differences in CSBP (p < 0.001) and in CPP (p < 0.001). Three components or more are considered typical of MetS.

Figure 2

Clusters of MetS components as determinants of high CSBP—controlling for age, diabetes mellitus, nonHDL-C, and mean blood pressure. Odds ratio (OR) with 95% confidence interval for specific MetS clusters of components in the whole population (upper panel), in men (central panel), and women (lower panel). We evaluated all the possible combinations of MetS components, but only specific clusters are described here. Abbreviations: All other MetS comb., all different combinations of metabolic syndrome components not depicted in the picture; MetS, metabolic syndrome; W, abdominal obesity; H, low HDL cholesterol; B, high blood pressure; T, triglycerides; G, glucose; MAP, mean arterial pressure. Not significant clusters in men: HTW, HBW, GHBW; in women: HTW; in the whole population: HTW.