Relationship between metabolic syndrome and the presence of silent coronary artery disease in young adults

ABSTRACT

To assess the association of metabolic syndrome with the presence of ischemic heart disease in young asymptomatic adults. This study is a cross-sectional analytic study that was conducted in order to find out the relationship between metabolic syndrome and the presence of ischemic heart disease in asymptomatic young adults. One hundred young adults with metabolic syndrome diagnosed either according to the WHO criteria or NCEP criteria were included in the study. Exclusion criteria Ischemic heart disease, Previous cerebrovascular stroke, impaired liver or renal functions, Patients with cardiomyopathy [hypertrophic, dilated or ischemic], and valvular or congenital heart disease. All patients included in the study were subjected to Full history taking and complete general and local examination of the heart, chest and abdomen. 12 leads resting ECG. Laboratory investigations including Blood sugar level, lipid profile, kidney and liver function. Complete echo-Doppler study of the heart for assessment of LV systolic and diastolic function and assessment of valves for exclusion. Exercise electrocardiography and carotid ultrasonography. Results of the study showed that 64 patients [64%] had metabolic syndrome according to the NCEP criteria and 71 patients [71%] had metabolic syndrome according to the WHO criteria. 35 patients [35%] fulfilled both the criteria of the NCEP and WHO. According to the diagnosis of NCEP and WHO criteria; there was no significant difference between the two groups regarding the different clinical and demographic parameters measured [P> 0.05]. Results of the current study showed that 46 patients [46%] had increased carotid intima-media thickness [CIMT] [defined as > 8 mm in any of the 3 measurements of the carotid artery] and 54 patients [54%] had normal IMT. There was no significant difference between the two groups regarding the intima media thickness measured at the common carotid artery, bulb and internal carotid artery [P> 0.05]. 21 patients [21%] had significant ST segment changes during exercise and 79 patients [79%] had non-significant ST segment changes. There was significant difference between the patients with positive exercise stress testing and those with negative stress testing regarding the intima media thickness measured at the common carotid artery, bulb and internal carotid artery [P < 0.05]. There was significant positive correlation between intima media thickness and age, fasting blood sugar and body I mass index [r=0.517, 0.680 and 0.678 respectively and P <0.001 for all correlations]. There was significant negative correlation between intima media thickness and METs and exercise duration [r=0.754, -0.761 respectively and P < 0.001]. Young adults with metabolic syndrome are at a high risk for the development of atherosclerotic diseases. Obese subjects with criteria of metabolic syndrome have to be evaluated for the presence of silent myocardial ischemia and risk factor reduction to prevent the progress of the atherosclerotic process. Carotid Intima-Media thickness is an early indicator for atherosclerotic coronary artery disease and could be used for evaluation of young adults with metabolic syndrome