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Carotid Artery Remodeling in Middle-Aged Women With the Metabolic Syndrome (from the “Progetto ATENA” Study)

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The prevalence of the metabolic syndrome (MS) is rapidly growing, especially in women. This analysis was designed to evaluate whether preclinical vascular changes are detectable in middle-aged women with the MS. Five thousand sixty-two women participated in a prospective study of the causes of cardiovascular disease in women (the “Progetto Atena” study). Three hundred ten women underwent high-resolution B-mode ultrasound examinations. Common carotid intima-media thickness (IMT) and internal and external diameters were measured using a computerized system. The National Cholesterol Education Program Adult Treatment Panel III criteria were used to classify participants as having the MS. Seventy-three subjects fulfilled the criteria for the MS. Women with the MS were slightly older and had greater serum total cholesterol and higher levels of serum insulin and lipid peroxidation compared with women without the MS. The group with the MS had a greater mean IMT (1.24 ± 0.27 vs 1.10 ± 0.20 mm, p <0.0001) and larger mean values for diameters (7.9 ± 1.0 vs 7.4 ± 0.7 mm, p <0.0001 for external diameter; 6.1 ± 0.8 vs 5.8 ± 0.6 mm, p <0.005 for internal diameter). The average increase in wall thickness was greater than in vessel diameter, as evidenced by the greater relative wall thickness in women with the MS (0.41 ± 0.09 vs 0.38 ± 0.07, p <0.005). In conclusion, carotid structural changes are noninvasively detectable in asymptomatic middle-aged women with the MS. These modifications indicate a dynamic process of arterial remodeling by which the vascular system responds to atherosclerotic stimuli.

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Study population

We studied a cohort of 310 middle-aged women living in the area of Naples (southern Italy) participating in the “Progetto ATENA” study.1 The general objective of this project is to investigate the causes of those chronic diseases that have a major impact on the female population. The total study cohort, enrolled within a 4-year period, consisted of 5,062 women aged 30 to 69 years. Potential participants with previous diagnoses of myocardial infarction, stroke, and major cancers were excluded.

Results

Seventy-three subjects (23%) fulfilled the Adult Treatment Panel III criteria for the MS.

Women with the MS were slightly older and had higher levels of serum cholesterol, serum insulin, and thiobarbituric acid–reactive substances (Table 1). The group with the MS had a greater mean IMT (1.24 ± 0.27 vs 1.10 ± 0.20 mm, p < 0.0001) and greater mean values for diameters (7.9 ± 1.0 vs 7.4 ± 0.7 mm, p <0.0001 for external diameter; 6.1 ± 0.8 vs 5.8 ± 0.6 mm, p <0.005 for internal diameter). The

Discussion

Coronary artery disease represents a major cause of death and disability in women. In Mediterranean countries, an increase in its incidence is expected in the years ahead in relation to the profound changes in lifestyle leading to the increased incidence of obesity and associated metabolic alterations.11 In women 30 to 74 years of age who were participants in the Second National Health and Nutrition Examination Survey, the MS carried a twofold risk for coronary artery disease mortality.12

A few

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The “Progetto Atena” study was supported by funds from Consiglio Nazionale delle Ricerche, Rome, Italy; “Progetto Finalizzato Biotecnologie” and “Progetto Finalizzato FATMA”; Ministero dell’ Universita’ e Della Ricerca Scientifica e Tecnologica, Rome, Italy; MURST 1998, no. 9806174392-008, and MIUR 2002, no. 0655949-004; and Compagnia di San Paolo, Turin, Italy.

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