Women with metabolic syndrome have an increased risk of developing symptomatic peripheral artery disease, compared with healthy women, according to a new analysis of the Women's Health Study.
“In this generally low-risk population of women, the excess risk associated with [metabolic syndrome] may be mediated through heightened inflammation and/or endothelial activation,” reported Dr. Aruna Pradhan of Brigham and Women's Hospital, Boston, and colleagues.
The prospective cohort study included a subgroup of 27,111 women, aged at least 45 years, who were enrolled in the Women's Health Study and followed for a median of 13 years (Circulation 2009 Sept. 8 [doi:10.1161/circulationaha.109.863092]).
About one-quarter of the study population (6,920) had metabolic syndrome, defined according to the ATP (Adult Treatment Panel) III guidelines as the presence of three or more of the following traits: a waist circumference of 88 cm or more; a triglyceride level of 150 mg/dL or greater; HDL cholesterol levels lower than 50 mg/dL; a blood pressure of at least 130/85 mm Hg; and abnormal glucose metabolism as identified by a fasting blood glucose level of at least 100 mg/dL.
Incident symptomatic peripheral artery disease (PAD), defined as intermittent claudication and/or peripheral artery surgery inclusive of catheter-based interventions, occurred in 114 women, 70 of them with metabolic syndrome and 44 without.
The hazard ratio for PAD with metabolic syndrome, compared with PAD without metabolic syndrome, was 1.62 on univariate analysis, and 1.48 after adjustment for patient age and smoking status.
Even among women who did not have metabolic syndrome, the risk for PAD increased with the number of metabolic syndrome traits. Compared with women who did not have any traits, those who had one or two traits had a 2.5-fold increased risk of PAD.
The hazard ratios for PAD were 0.98 with elevated body mass index, 1.39 for elevated triglycerides, 1.50 for hypertension, 1.60 for low HDL cholesterol, and 2.05 for dysglycemia, reported the authors.
By comparison, the hazard ratio associated with current smoking was 12.7.
“Smoking was by far the strongest risk in this population,” the researchers wrote. “This study underscores the importance of abstinence from smoking for the prevention of PAD.”