| Objective and Background: The incidence of diabetes is rising year by year,which has become a major public health problem in China. Metabolic syndrome had been called the insulin resistance syndrome, X syndrome . It is the status that a variety of metabolic risk factors of cardiovascular disease assemble in the same individual. Its major components include central obesity, diabetes or impaired glucose regulation, hypertension and lipid disorders, in addition to microalbuminuria, hyperuricemia and other ingredients.Diabetes is closely related to each component of metabolic syndrome(MS). The incidence of metabolic syndrome in diabetic patients was significantly higher than non-diabetic population. Diabetes and metabolic syndrome are all dangerous factors of cardiovascular disease,which attracts people,s attention more and more. Pulse wave velocity (PWV) can accurately reflect the early indicators of arterial stiffness and is a simple, effective and economical non-invasive index which can assess the functional changes of arteries. PWV can be as early indicators of macrovascular disease in diabetes and metabolic syndrome populations. This paper studies the relation of various components of metabolic syndrome in diabetic patients with brachial ankle arterial pulse wave velocity (baPWV) and want to understand whether the components of metabolic syndrome increase the incidence of atherosclerosis or not and explore whether the diabetic patients with metabolic syndrome increase the risk of macrovascular disease or not.Methods: 905 cases of type 2 diabetic patients were selected in Shanghai Ruijin Hospital outpatient of endocrine and metabolic diseases from October 2006 to February 2007.The average age was 59.54±7.94(30-77)yeas old, including 391 males and 514 females. The patients were conducted a questionnaire survey of the study (age, duration of diabetes, previous history of cardiovascular disease, smoking and drinking history, taking the situation hypoglycemic agents), physical examination (height, weight, waist circumference, blood pressure), biochemical tests (glycosylated hemoglobin, serum cholesterol, serum low-density lipoprotein, high density lipoprotein, triglyceride), measured indicators of atherosclerosis (brachial-ankle pulse wave velocity, ankle-brachial index and toe brachial index). The patients were divided into different groups according to the following different indicators and SAS 9.2 statistical package were used for analysis.1,The patients were divided into normal (baPWV <1400cm / s )and abnormal(baPWV≥1400cm / s) group according to baPWV,and we compared the two groups of general information and related metabolic indicators.2,According to the number of each component of metabolic syndrome(MS), the patients were divided into four groups,which was Group 1 (DM), Group 2 (diabetes with one other components of metabolic syndrome abnormalities), group 3 (diabetic patients with two other components of metabolic syndrome abnormalities) and group 4 (diabetic patients with three or four other components of metabolic syndrome abnormalities).Then we compared the indicators of atherosclerosis(brachial ankle pulse wave velocity, ankle-brachial index and toe brachial index) in it;3,The patients were divided into two groups according to the presence of metabolic syndrome and we compared the two groups of general information and related metabolic indicators.4,According to the components of metabolic syndrome (waist circumference, systolic and diastolic blood pressure, TG and HDL-C) ,the patients were divided into normal and abnormal group and we compared the baPWV in the general population, male population and female population.5,Through simple correlation and multiple regression analysis we studied the relation of the components of metabolic syndrome with baPWV;6,BaPWV was regarded as the dependent variable and the different level of TG, HDL-C, glycosylated hemoglobin, waist circumference, systolic and diastolic blood pressure was thinked as independent variables ,we observed the change of the risk of abnormal baPWV when the level of each independent variables is increased by one standard deviation in multivariate logistic regression model.Results:1,The age, duration of diabetes, waist circumference, BMI, systolic blood pressure, diastolic blood pressure, glycated hemoglobin, TC, TG, LDL,metabolic syndrome and cardiovascular disease incidence of the patients with baPWV≥1400cm / s were significantly higher than that with baPWV < 1400cm / s (P <0.05). The proportion of drinkers, smokers ratio, gender ratio, and HDL-C had no significant difference between the two groups(P> 0.05).2,According to the number of each component of metabolic syndrome(MS), the patients were divided into four groups. The ABI And TBI had no significant difference among the four groups (P> 0.05).The baPWV of group 2,3 and 4 were significantly faster than group 1(P<0.05), group 3 and 4 were significantly faster than group 1(P<0.01)in total population; The baPWV of group 3 and 4 were significantly faster than group 1 and 2 in male population(P<0.05);The baPWV of group 3 and 4 were significantly faster than group 1 in female population(P<0.05).3,The age, proportion of women, BMI, waist circumference, systolic and diastolic blood pressure, TC, TG, LDL-C and baPWV of diabetic patients with metabolic syndrome were significantly higher than those without metabolic syndrome(P<0.05),but the proportion of smokers was significantly lower .The duration of diabetes, glycosylated hemoglobin, HDL-C, TBI, ABI and the proportion of drinkers had no significant difference between the two groups(P> 0.05).4,The baPWV of the patients with normal waist circumference was significantly faster than of that with abnormal(p <0.05) .The baPWV of the patients with normal systolic blood pressure was significantly faster than of that with abnormal (p <0.05). The baPWV of the patients with normal diastolic blood pressure was significantly faster than of that with abnormal(p <0.05). The baPWV of the patients with normal TG was significantly faster than of that with abnormal (p <0.05) in total and female population. But baPWV had no significant difference between HDL-C normal group and abnormal group in total and female population; The baPWV of the patients with normal waist circumference was significantly faster than of that with abnormal(p <0.05) . The baPWV of the patients with normal systolic blood pressure was significantly faster than of that with abnormal (p <0.05). The baPWV of the patients with normal diastolic blood pressure was significantly faster than of that with abnormal(p <0.05) in male population. But baPWV had no significant difference between HDL-C normal group and abnormal group and between TG normal group and abnormal group in male population.5,Pearson correlation analysis showed that age, duration of diabetes, BMI, waist circumference, HbA1c, DBP, SBP, TG, TC, LDL were significantly positive correlated with baPWV (P <0.05), but HDL-C was not correlated with baPWV (P> 0.05); Multiple stepwise regression analysis showed that age, duration of diabetes, systolic blood pressure, diastolic blood pressure, and glycated hemoglobin was independently correlated with baPWV.6,Multivariate logistic regression analysis show: In model 1(other factors are not adjusted)when TG , glycated hemoglobin, waist circumference, systolic and diastolic blood pressure increased by one standard deviation,the risk of abnormal baPWV increased. The odds ratio (95% CI) of TG, glycated hemoglobin, waist circumference, systolic and diastolic blood pressure specifically were 6.29 (2.09-22.70),3.32(1.58-7.27),1.60(1.33-1.93),2.78(2.21-3.52),1.77(1.46-2.16) each; In model 2(age, sex, duration of diabetes was adjusted)the above correlation still exists.The odds ratio (95% CI) of TG, glycated hemoglobin, waist circumference, systolic blood pressure, diastolic blood pressure were 2.00 (1.40-3.00), 1.43 (1.10 -1.92), 1.51 (1.16-2.00), 2.50 (1.83-3.47), 1.89 (1.46-2.48).Conclusion: 1,The baPWV and cardiovascular disease incidence of diabetic patients with metabolic syndrome were significantly higher than those without metabolic syndrome. The baPWV gradually increased with the number increasing of each component of metabolic syndrome. This showed that diabetic patients with metabolic syndrome increased the risk of arterial stiffness and macrovascular complications. Therefore, more attention should be paid to macrovascular complications in the diabetic patients with metabolic syndrome.2,Pearson correlation showed that waist circumference, systolic and diastolic blood pressure, TG were associated with baPWV in diabetic population. The baPWV of the patients with abnomal waist circumference, TG ,systolic and diastolic blood pressure were significantly higher than that with normal. This showed that the other components of metabolic syndrome were associated with arterial stiffness and macroangiopathy in diabetic patients. Therefore, blood sugar should be controled ,at the same time the level of weight, waist circumference, blood pressure and blood lipid and other metabolic syndrome components should also be controled in diabetic patients.3,Multivariate logistic regression analysis showed that after adjusting for age, sex, duration of diabetes,the risk of abnormal baPWV increased by 100%, 43 %, 51%, 150%, 89% when the level of TG, glycated hemoglobin, waist circumference, systolic and diastolic blood pressure increased by one standard deviation. Therefore,the risk of arterial stiffness and macrovascular complications were reduced by decreasing the level of TG, glycated hemoglobin, waist circumference, systolic and diastolic blood pressure in diabetic population. |
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