ǂThe ǂinfluence of atherogenic dyslipidemia on subclinical atherosclerosis in patients with metabolic syndrome

[С. Т. Костић]

[11], 181 list

Biografija autora: list 181 Bibliografija: list. 135-176

Cardiology

Objectives: Determine the presence of atherogenic dyslipidemia (AD) in subjects with MetS and the relationship between MetS components and the presence and severity of asymptomatic atherosclerosis; Determine the presence of atherogenic lipid subfractions and their association with the presence of asymptomatic atherosclerosis. Methodology: The study included 130 subjects with no cardiovascular complaints. The clinical group consisted of subjects with MetS (n=65), and the control group comprised (KG) subjects without MetS (n=65). Within the groups, subjects with atherogenic dyslipidemia were defined. Non-invasive cardiac diagnostics were performed on all participants: Color doppler ultrasonography of the main blood vessels of the neck with measurement of the intima-media thickness and detection of atherosclerotic plaques, echocardiographic examination, and exercise stress test. Standard and specific laboratory analyses were conducted (oxidized LDL-C, PAI-1, NO metabolites - NO2-/NO3, iNOS) and determination of lipid particles using nuclear magnetic resonance spectroscopy. Results: The number of components defining MetS correlates well with subclinical atherosclerosis of the carotid arteries. The average intima-media thickness of the carotid arteries, the average number of plaques, and the average stenosis in subjects with MetS were significantly greater than in the control group (p<0.001 for all), as was the frequency of thickened intimamedia thickness ≥0.9 mm and carotid plaques. Intima-media thickness correlates with AD components. The presence of plaques in the carotid arteries is associated with age, fatty liver, values of total and LDL cholesterol, HgA1C, NO metabolites, iNOS, and systolic blood pressure, with the most significant association shown with Non-HDL-C. In subjects with MetS and AD, a higher percentage of triglyceride-rich lipoproteins, VLDL, and chylomicrons were present compared to individuals without MetS (43.91 vs. 23.91%, p<0.001), as well as the total content of all atherogenic lipid subfractions - VLDL, HM, LDL (67.74 vs. 50.40%, p<0.001). The MetS group subjects have higher values of oxLDL-C, PAI-1, and iNOS compared to the control group. The prevalence of fatty liver is statistically significantly higher in patients with AD (90.9% vs. 66.7%, p=0.03). The presence of fatty liver correlates with remnant cholesterol, PAI-1, and the waist/hip ratio. Individuals with asymptomatic carotid stenosis more frequently have moderate microalbuminuria, stage A2, and a higher albumin/creatinine ratio. Diastolic relaxation disorder is more common in MetS compared to KG and they have a larger left ventricular mass. ST segment depression on exercise stress testing is statistically significantly more frequent in patients with asymptomatic carotid atherosclerosis. Conclusion: A high percentage (63%) of individuals with MetS have AD. Asymptomatic individuals with newly diagnosed MetS at routine check-ups already exhibit early vascular damage (asymptomatic atherosclerosis of the carotid arteries), heart (impaired diastolic relaxation), liver (non-alcoholic fatty liver), and kidneys (microalbuminuria). Non-invasive diagnostic methods, such as Color doppler of neck blood vessels and echocardiography, enable the identification of individuals with the earliest target organ changes, providing opportunities for implementing preventive and therapeutic measures. The method of nuclear magnetic resonance spectroscopy allows direct determination of atherogenic lipid subfractions, offering additional benefit in cardiovascular risk assessment.

Metabolički sindrom; Aterogena dislipidemija; Asimptomatska ateroskleroza; Kardiovaskularna prevencija

Metabolic syndrome; Atherogenic dyslipidemia; Asymptomatic atherosclerosis; Cardiovascular prevention

616.13-004.6:616.1-084(043.3)

B530

Cardiology

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