A Study on the Prevalence of Metabolic Syndrome and Its Vascular Complications in Elderly with Metabolic Syndrome With or Without Diabetes

Aravindh, M (2006) A Study on the Prevalence of Metabolic Syndrome and Its Vascular Complications in Elderly with Metabolic Syndrome With or Without Diabetes. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: The concept of the metabolic syndrome has existed for at least 80 years. Initially constellation of risk factors like hypertension, hyperglycemia, and gout were included as a component of metabolic cardiovascular risk factor by Kylin in 1920. Later, in 1947, Vague found that upper body (android) adiposity was associated with metabolic abnormalities associated with type 2 diabetes and cardiovascular disease. Later constellation of metabolic abnormalities includes glucose intolerance (type 2 diabetes, impaired glucose tolerance, or impaired fasting glycaemia), insulin resistance, central obesity, dyslipidaemia, and hypertension as a component of metabolic syndrome, which is also known as syndrome X, or Insulin resistance syndrome. Subsequently, the National Cholesterol Education Program Adult Treatment Panel 3 have formulated definition of metabolic syndrome includes the essential components-glucose intolerance, obesity, hypertension, and dyslipidaemia which provide a tool for clinicians researchers. Both metabolic syndrome and diabetes are associated with increased prevalence of cardiovascular disease when they co-exist. We examined the role of metabolic syndrome alone without diabetes as a risk factor for cardiovascular disease in our study population. OBJECTIVES: 1. To estimate the prevalence of metabolic syndrome in the elderly. 2. To estimate the prevalence of vascular diseases (coronary heart disease/ stroke/ peripheral arterial disease) in elderly with the metabolic syndrome with or without diabetes when compared with subjects without metabolic syndrome. 3. To estimate whether metabolic syndrome alone without diabetes is an independent risk factor for vascular diseases in elderly. 4. To find the strength of correlation of metabolic syndrome components with vascular diseases. MATERIALS AND METHODS: A sample of 120 cases of elderly (60 years & above) men and women were selected by systematic sampling methods from our medical out patients department, Government General Hospital, 20 cases were excluded since they had hemorrhagic stroke and selected cases were analyzed for the presence of metabolic syndrome and vascular complications present in that group. The patients having three or more of the following criteria (according to the National Cholesterol Education Guidelines Adult Treatment Panel (ATP) 3 report) were defined as having the metabolic syndrome: 1. Waist circumference > 102 cm in men and > 88 cm in women. 2. Hypertriglyceridemia: ≥ 150 mg/dl (≥ 1.7 mmol/l). 3. Low HDL: < 40 mg/dl in men (<1.0 mmol/l) and < 50 mg/dl in women (<1.3 mmol/l). 5. High blood pressure: ≥ 130/85 mmHg or use of antihypertensive medication. 6. High fasting plasma venous glucose: ≥ 110 mg/dl (≥ 6.1 mmol/l) or treatment for diabetes. STATISTICAL ANALYSIS: Statistical analysis was carried out for 100 subjects [45 metabolic syndrome, 55 no metabolic syndrome] after categorizing each variable. Base line data was collected from patients with vascular disease and metabolic syndrome and without metabolic syndrome. Age, sex, lipid profile, non HDL cholesterol, components of the metabolic syndrome such as waist circumference, systemic BP > 130/85, fasting glucose > 110, Triglycerides >150, Low HDL < 40 mg/dl were analyzed. The significance of difference in means between two groups and the significance of difference in proportions were analyzed by Z test. The prevalence of vascular disease in the metabolic syndrome were analyzed and compared with non-metabolic syndrome group. Statistical significance was taken when two-sided p value < 0.05. Statistical analysis was carried out using standard formulae by Microsoft Excel 2003. The correlation between metabolic syndrome components and vascular disease was done by spearman’s rho methods. CONCLUSIONS: 1. The prevalence of metabolic syndrome in our study group was 45% and vascular disease (coronary artery disease/stroke) prevalence was markedly increased in the presence of the metabolic syndrome in the elderly. 2. Those with both the metabolic syndrome and diabetes had the highest prevalence of coronary artery disease and stroke, followed by those with the metabolic syndrome but without diabetes in the elderly. 3. The metabolic syndrome is significantly associated with vascular disease risk, even in the absence of diabetes in the elderly; probably metabolic syndrome alone without diabetes can be considered as a coronary heart disease-risk equivalent in future guidelines. 4. Among metabolic syndrome components, Arterial hypertension strongly correlated with stroke, Triglycerides strongly correlated with coronary artery disease and High density lipoprotein was inversely correlated with both coronary artery disease and stroke. 5. Both raised levels of low density lipoprotein and non-high density lipoprotein (not a component of metabolic syndrome) are strongly correlated with coronary artery disease in the metabolic syndrome group, and hence these can be considered as modifying components of metabolic syndrome.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Prevalence ; Metabolic Syndrome ; Vascular Complications ; Elderly ; Metabolic Syndrome ; With or Without Diabetes.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 24 Mar 2018 17:26
Last Modified: 25 Mar 2018 02:41
URI: http://repository-tnmgrmu.ac.in/id/eprint/6541

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