BACKGROUND: Several studies have shown that individuals with metabolic syndrome have high incidence of vascular event in association with endothelial dysfunction and atherosclerosis. Endothelial dysfunction manifested as impaired brachial artery flow-mediated dilatation (FMD) and increased carotid intima-media thickness (IMT) is likewise associated with endothelial dysfunction in the coronary circulation, which may be manifested as impairment or obstruction of normal coronary blood flow with resultant myocardial ischemia. Thus the objectives of the study are: to determine the prevalence of endothelial dysfunction in patients with metabolic syndrome and to determine the correlation of endothelial dysfunction and occurrence of inducible ischemia.
METHODS AND RESULTS: A total of 106 patients underwent executive check-up in St. Luke's Medical Center from October 1, 2005 to December 31, 2005. Only 41 subjects (39 percent) were diagnosed to have metabolic syndrome and was included in the study. All subjects underwent endothelial function evaluation and symptom-limited treadmill exercise testing using the modified Bruce protocol to reveal presence of inducible myocardial ischemia. Of the 41 subjects, 16 (39 percent) were females and 25 (61 percent) were males. The mean age was 55.4 years + 10.6 years. Twelve subjects (29.3 percent) showed endothelial dysfunction 7 of which had an abnormal TET. Results from chi-square test showed that among patients with metabolic syndrome, endothelial dysfunction (p= 0.029), HDL levels (p=0.018) and smoking (p <0.001), were found to be significantly associated with an abnormal TET. Logistic regression analysis among patients with metabolic syndrome and endothelial dysfunction showed 5.2 times higher to have inducible ischemia by TET (95 percent CI= 1.0 to 26.8) and subjects who smoke were 16.5 times higher to have an abnormal TET result (95 percent CI= 2.9 to 93.3). 0.1 Though not statistically significant, subjects with metabolic syndrome and low HDL showed a trend to have inducible ischemia by TET (95 percent CI= 0 to 0.7).
CONCLUSION: There is an association between endothelial dysfunction and inducible ischemia; and risk factors like cigarette smoking and low HDL level predict occurrence of inducible ischemia on TET. (Author)
The objective of this study is to determine the prevalence of endothelial dysfunction in patients with metabolic syndrome seen at St. Luke's Medical Center and to determine the correlation of endothelial dysfunction and occurrence of inducible ischemia among patients with MS.