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Research Article

Prevalence of atherosclerotic vascular disease among subjects with the metabolic syndrome with or without diabetes mellitus: the METS-GREECE Multicentre Study

Vasilios G. Athyros Atherosclerosis and Metabolic Syndrome Units, Aristotelian University, Hippocration Hospital, Thessaloniki, Greece; Second Prop. Department of Internal Medicine, Aristotelian University, Hippocration Hospital, Thessaloniki, Greece; Working Group for the Identification and Treatment of Metabolic Syndrome of the Greek Atherosclerosis Society, Athens, Greece; Working Group for the Identification and Treatment of Metabolic Syndrome of the Greek Society of General Practitioners, Thessaloniki, GreeceCorrespondence[email protected]

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Dimitri P. Mikhailidis Department of Clinical Biochemistry, Royal Free Hospital, Royal Free and University College Medical School, London, UK; Working Group for the Identification and Treatment of Metabolic Syndrome of the Greek Atherosclerosis Society, Athens, Greece

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Athanasios A. Papageorgiou Second Prop. Department of Internal Medicine, Aristotelian University, Hippocration Hospital, Thessaloniki, Greece; Working Group for the Identification and Treatment of Metabolic Syndrome of the Greek Atherosclerosis Society, Athens, Greece; Working Group for the Identification and Treatment of Metabolic Syndrome of the Greek Society of General Practitioners, Thessaloniki, Greece

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Triandafillos P. Didangelos Diabetes Center, Aristotelian University, Hippocration Hospital, Thessaloniki, Greece; Second Prop. Department of Internal Medicine, Aristotelian University, Hippocration Hospital, Thessaloniki, Greece

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Emmanuel S. Ganotakis Department of Internal Medicine, Medical School, University of Crete, Heraklion, Greece; Working Group for the Identification and Treatment of Metabolic Syndrome of the Greek Atherosclerosis Society, Athens, Greece; Working Group for the Identification and Treatment of Metabolic Syndrome of the Greek Society of General Practitioners, Thessaloniki, Greece

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Athanasios N. Symeonidis Working Group for the Identification and Treatment of Metabolic Syndrome of the Greek Society of General Practitioners, Thessaloniki, Greece

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Stella S. Daskalopoulou Department of Clinical Biochemistry, Royal Free Hospital, Royal Free and University College Medical School, London, UK; Working Group for the Identification and Treatment of Metabolic Syndrome of the Greek Atherosclerosis Society, Athens, Greece

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Anna I. Kakafika Second Prop. Department of Internal Medicine, Aristotelian University, Hippocration Hospital, Thessaloniki, Greece; Working Group for the Identification and Treatment of Metabolic Syndrome of the Greek Atherosclerosis Society, Athens, Greece

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Moses Elisaf Department of Internal Medicine, Medical School, University of Ioannina, Greece; Working Group for the Identification and Treatment of Metabolic Syndrome of the Greek Atherosclerosis Society, Athens, Greece; Working Group for the Identification and Treatment of Metabolic Syndrome of the Greek Society of General Practitioners, Thessaloniki, Greece

SUMMARY

Aims: To estimate the prevalence of vascular disease (coronary heart disease/stroke/peripheral arterial disease) in individuals with the metabolic syndrome (MetSyn) with or without diabetes mellitus (DM) when compared with subjects without the MetSyn.

Patients and methods: A cross-sectional analysis of a representative sample of Greek adults (n = 4153), men and women (49% and 51%, respectively), living in urban, semi-urban and rural areas (54%, 25% and 21%, respectively). The National Cholesterol Education Program – Adult Treatment Panel III definition of the MetSyn was used.

Results: The age-adjusted prevalence of the MetSyn was 23.6% [95% confidence interval (CI) = 22.4%–25.1%]; this was similar in men and women. The fully adjusted prevalence of vascular disease in those with the MetSyn (n = 984) was 29.4%, significantly higher than in those without (n = 3169, 9.6%, p < 0.0001), while subjects without both the MetSyn and DM had the lowest vascular disease prevalence (n = 3035, 8.9%). Subjects with the MetSyn but no DM (n = 674) had a vascular disease prevalence of 24.1% ( p < 0.0001 vs. those without the MetSyn), which was similar to that in subjects with DM without the MetSyn (n = 134, 25.4%), but lower than in those with both the MetSyn and DM (n = 310, 40.7%, p < 0.0001 vs. all). In comparison to those without the MetSyn [odds ratio (OR) = 1], the ORs of prevalent vascular disease, after multivariate analysis for age, sex and components of the MetSyn, and antiatherosclerotic drugs were: all MetSyn = 1.94 (95% CI = 1.35–2.47), with both MetSyn and DM = 3.04 (95% CI = 1.98–4.11) and with MetSyn but no DM = 1.48 (95% CI = 1.12–1.92).

Conclusions: The prevalence of vascular disease was markedly increased in the presence of the MetSyn. Those with both the MetSyn and DM had the highest prevalence of vascular disease, followed by those with the MetSyn without DM. Probably MetSyn without DM should be considered as a coronary heart disease-risk equivalent in future guidelines. This initiative would reset treatment targets and potentially provide additional benefit in patients with the MetSyn.

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