Metabolic syndrome is associated with peripheral endothelial dysfunction amongst men

Figures & data

Table 1 Patients’ characteristics

Characteristic	Normal RH-PAT index (N=385)	Abnormal RH-PAT index (N=293)	P-value
Age – mean±SD (yr)	52.1±13.5	51.7±13.6	0.6863
Male sex – no./total no. (%)	133/385 (34.5)	127/293 (43.3)	0.0196
Body mass index – mean±SD	27.1±5.5	29.6±6.5	<0.0001
Race of ethnic group – no./total no. (%)			0.3205
White	345/385 (89.6)	268/293 (91.5)
Black	1/385 (0.3)	2/293 (0.007)
Asian	5/385 (1.3)	7 (2.4)
Other	34/385 (8.8)	16/293 (5.5)
Smoking (past or current) – no./total no. (%)	140/385 (36.4)	115/293 (39.3)	0.4423
Obstructive CVD – no./total no. (%)	72/385 (18.7)	77/293 (26.3)	0.0182
Dyslipidemia – no./total no. (%)	251/385 (65.2)	222/293 (75.8)	0.0030
MetS – no./total no. (%)	109/385 (28.3)	140/293 (47.8)	<0.0001
MetS components – no./total no. (%)
BMI≥25 kg/m^2	234/385 (60.8)	224/293 (76.5)	<0.0001
Type 2 diabetes	23/385 (6.0)	30/293 (10.2)	0.0404
FPG≥100 mg/dL	105/332 (31.6)	106/258 (41.1)	0.0174
Hypertension	165/385 (42.9)	130/293 (44.4)	0.6941
SBP≥130 mmHg	115/384 (30.0)	83/293 (28.3)	0.6461
DBP≥85 mmHg	67/384 (17.5)	40/293 (13.7)	0.1798
MetS range HDL	70/329 (21.3)	90/271 (33.2)	0.0010
Triglycerides≥150 mg/dL	78/329 (23.7)	85/271 (31.4)	0.0359
Lab data- mean±SD; no/total no. of individuals (%)
FPG (mg/dL)	98.5±20.4; 332/385 (86.2)	101.5±23.3; 258/293 (88.1)	0.1083
Hemoglobin A1C (%)	5.77±1.02; 80/385 (20.8)	5.71±0.92; 93/293 (31.7)	0.6913
Total cholesterol (mg/dL)	192.4±49.4; 329/385 (85.5)	185±42.3; 270/293 (92.2)	0.0874
LDL cholesterol (mg/dL)	108.9±42.5; 324/385 (84.2)	104.4±36.4; 266/293 (90.8)	0.1636
HDL cholesterol (mg/dL)	59.4±17.6; 329/385 (85.5)	54.4±17.3; 271/293 (92.5)	0.0005
Non HDL cholesterol (mg/dL)	133.0±48.2; 329/385 (85.5)	131.6±42.9; 270/293 (92.2)	0.7066
Triglycerides (mg/dL)	124.0±89.3; 329/385 (85.5)	141.2±102.7; 271/293 (92.5)	0.0309
eGFR (mL/min/1.73 m^2)	74.7±17.0; 335/385 (87.0)	77.8±20.7; 262/293 (89.4)	0.0529

Note: Bold values indicate P <0.05.

Abbreviations: RH-PAT, reactive hyperemia-peripheral arterial tonometry; SD, standard deviation; CVD, cardiovascular disease; DLP, dyslipidemia; MetS, metabolic syndrome; BMI, body mass index; FPG, fasting plasma glucose; SBP, systolic blood pressure; DBP, diastolic blood pressure; HDL, high-density lipoprotein; LDL, low-density lipoprotein; eGFR, estimated glomerular filtration rate.

Table 2 Patients’ characteristics stratified by sex

	All	Women	Men	P-value^‡
	(N=678)	(N=418; 61.7%)	(N=260; 38.3%)
Age – mean (yr)±SD	51.9±13.5	51.7±13.8	52.3±13.1	0.5587
BMI – mean (kg/m^2)±SD	28.2±6.0	27.5±6.4	29.2±5.2	0.0003
Obesity – no. (%)	223 (32.9)	121 (28.9)	102 (39.2)	0.0056
Obstructive CVD	149 (22.0)	62 (14.8)	87 (33.5)	<0.0001
Smoking (past or current) – no. (%)	255 (37.6)	141 (33.7)	114 (43.8)	0.0082
Dyslipidemia no. (%)	473 (69.8)	271 (64.8)	202 (77.7)	0.0004
MetS no. (%)	249 (36.7)	138 (33.0)	111 (42.7)	0.011
MetS components:
BMI≥25 kg/m^2 no. (%)	458 (67.6)	249 (59.6)	209 (80.4)	<0.0001
Type2 diabetes no. (%)	53 (7.8)	27 (6.5)	26 (10)	0.0949
FPG≥100 mg/dL no. (%)	211 (35.8)	116 (31.5)	95 (42.8)	0.0057
Hypertension no. (%)	295 (43.5)	174 (41.6)	121 (46.5)	0.2097
SBP≥130 mmHg no. (%)^a	198 (29.2)	120 (28.8)	78 (30.0)	0.7337
DBP≥85 mmHg no. (%)^a	107 (15.8)	65 (15.6)	42 (16.2)	0.8442
MetS range HDL-C^b	160 (26.7)	102 (27.5)	58 (25.3)	0.56
Triglycerides≥150 no. (%)^b	163 (27.2)	88 (23.7)	75 (32.8)	0.0157
Abnormal RH-PAT index. no. (%)	293 (43.2)	166 (39.7)	127 (48.8)	0.0196

Notes: Bold values indicate P<0.05. ^‡P-value comparing women to men; ^aOne female patient missed data of systolic and diastolic blood pressure; ^b78 individuals (11.5%) missed data of serum HDL and triglycerides, 47 of them women (11.2% of women) and 31 men (11.9% of men).

Abbreviations: SD, standard deviation; BMI, body mass index; CVD, cardiovascular disease; MetS, metabolic syndrome; FPG, fasting plasma glucose; SBP, systolic blood pressure; DBP, diastolic blood pressure; HDL-C, high-density lipoprotein cholesterol; RH-PAT, reactive hyperemia-peripheral arterial tonometry.

Table 3 Mean RH-PAT index in MetS with stratification by sex

Group	MetS	No.	Mean RH-PAT index±SD	P-value^‡
All the subjects	(+)	249	2.01±0.64	<0.0001
	(–)	429	2.26±0.64
Women	(+)	138	2.07±0.66	0.0042
	(–)	280	2.27±0.67
Men	(+)	111	1.93±0.60	<0.0001
	(–)	149	2.25±0.59

Notes: Bold values indicate P<0.05. ^‡P-value comparing subjects with vs without MetS in the same group.

Abbreviations: RH-PAT, reactive Hyperemia-peripheral arterial tonometry; MetS, metabolic syndrome; SD, standard deviation.

Table 4 The association between MetS and abnormal RH-PAT index

Stratified by	Variable	No. with MetS/all (%)	No with abnormal index/all (%)	OR (95% CI); P-value
None
	MetS	249/678 (36.7)	293/678 (43.2)	2.32 (1.68–3.19); <0.0001
Age
≤50 yr	MetS	90/305 (29.5)	139/305 (45.6)	2.45 (1.48–4.06); 0.0004
>50 yr	MetS	159/373 (42.6)	154/373 (41.3)	2.41 (1.58–3.69); <0.0001
Sex
Women	MetS	138/418 (33.0)	166/418 (39.7)	1.58 (1.04–2.39); 0.0302
Men	MetS	111/260 (42.7)	127/260 (48.9)	3.89 (2.31–6.54); <0.0001
Obstructive CVD
(+)	MetS	82/149 (55.0)	77/149 (51.7)	3.27 (1.67–6.42); 0.0005
(–)	MetS	167/529 (31.6)	216/529 (40.8)	1.96 (1.35–2.85); 0.0003
Smoking status
Never	MetS	140/423 (33.1)	178/423 (42.1)	1.93 (1.28–2.91); 0.0016
Past/current	MetS	109/255 (42.8)	115/255 (45.1)	3.04 (1.81–5.09); <0.0001
DLP
(–)	MetS	14/205 (6.8)	71/205 (34.6)	3.75 (1.20–11.64); 0.0157
(+)	MetS	235/473 (49.7)	222/473 (46.9)	2.03 (1.41–2.94); 0.0001
Obesity (BMI≥30 kg/m^2)
(–)	MetS	98/455 (21.5)	168/455 (36.9)	1.90 (1.21–2.98); 0.0052
(+)	MetS	151/223 (67.7)	125/223 (56.1)	1.84 (1.05–3.25); 0.0337

Note: Bolded OR, CI and P-values are statistically significant.Abbreviations: MetS, metabolic syndrome; RH-PAT, reactive hyperemia-peripheral arterial tonometry; OR, odds ratio; CI, confidence interval; CVD, cardiovascular disease; DLP, dyslipidemia; BMI, body mass index.

Figure 1 Odds ratio with 95% confidence interval for the association of metabolic syndrome and its individual components with abnormal Reactive Hyperemia-Peripheral Arterial Tonometry index based on multivariate analysis adjusting for: age, sex, presence of obstructive cardiovascular disease, smoking status, and elevated low-density lipoprotein cholesterol (LDL-C) (LDL-C≥130 mg/dL or treatment by statin and/or ezetimibe).

Abbreviation: Mets, metabolic syndrome.

Figure 2 Odds ratio with 95% confidence interval for the association of metabolic syndrome and its individual components with abnormal Reactive Hyperemia-Peripheral Arterial Tonometry index based on multivariate analysis adjusting for: age, presence of obstructive cardiovascular disease, smoking status,and elevated low-density lipoprotein cholesterol (LDL-C) (LDL-C≥130 mg/dL or treatment by statin and/or ezetimibe) in women (A) and men (B) The 95% CI for type2 diabetes in men is between 0 and indefinite, so it’s not shown.

Abbreviations: MetS, metabolic syndrome.

Table 5 The modification effect of statin treatment on the association between MetS, as well as MetS components, and abnormal RH-PAT

Variable	Group	None statin treated			Statin treated			P-value of interaction
		No. with variable/all (%)	No. with abnormal RH-PAT index/all (%)	OR (95% CI); P	No. with variable/all (%)	No. with abnormal RH-PAT index/all (%)	OR (95% CI); P
Mets	All	104/394 (26.4)	159/394 (40.4)	2.63 (1.66–4.16); <0.0001	145/284 (51.1)	134/284 (47.2)	1.94 (1.21–3.11); 0.0059	0.3625
	Women	67/273 (24.5)	107/273 (39.2)	2.40 (1.37–4.20); 0.0020	71/145 (49.0)	59/145 (40.7)	0.90 (0.47–1.75); 0.7635	0.0275
	Men	37/121 (30.6)	52/121 (43.0)	3.12 (1.40–6.95); 0.0047	74/139 (53.2)	75/139 (54.0)	4.32 (2.12–8.80); <0.0001	0.5519
MetS components
Overweight (BMI≥25 kg/m^2)	All	242/394 (61.4)	159/394 (40.4)	1.92 (1.26–2.95); 0.0025	216/284 (76.1)	134/284 (47.2)	2.25 (1.27–4.00); 0.0050	0.6666
T2D	All	24/394 (6.1)	159/394 (40.4)	2.62 (1.12–6.13); 0.0225	29/284 (10.2)	134/284 (47.2)	1.22 (0.57–2.64); 0.6052	0.1926
FPG≥100 mg/dL	All	102/349 (29.2)	145/349 (41.6)	1.63 (1.02–2.59); 0.0395	109/241 (45.2)	113/241 (46.9)	1.30 (0.78–2.16); 0.3128	0.5224
HTN	All	124/394 (31.5)	159/394 (40.4)	1.00 (0.65–1.54); 0.9928	171/284 (60.2)	134/284 (47.2)	0.96 (0.60–1.55); 0.8682	0.9072
MetS range HDL	All	92/351 (26.2)	151/351 (43.0)	2.23 (1.38–3.62); 0.0010	68/249 (27.3)	120/249 (48.2)	1.41 (0.81–2.47); 0.2287	0.2230
Triglycerides≥150 mg/dL	All	90/351 (25.6)	151/351 (43.0)	1.46 (0.90–2.37); 0.1209	73/249 (29.3)	120/249 (48.2)	1.45 (0.84–2.52); 0.1794	0.9887

Note: Bolded OR, CI and P-values are statistically significant.

Abbreviations: RH-PAT, reactive hyperemia-peripheral arterial tonometry; MetS, metabolic syndrome; BMI, body mass index; T2D, type 2 diabetes; FPG, fasting plasma glucose; HTN, hypertension; HDL, high-density lipoprotein.