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Does metabolic syndrome attenuate the advantages of being a young woman regarding the risk of cardiovascular disease?
International Journal of Cardiology 114 (2007) 277 – 278 www.elsevier.com/locate/ijcard
Letter to the Editor
Does metabolic syndrome attenuate the advantages of being a young woman regarding the risk of cardiovascular disease? Hasan Turhan *, Ertan Yetkin Inonu University Medical Faculty, Department of Cardiology, Malatya, Turkey Received 19 October 2005; accepted 15 November 2005 Available online 5 April 2006
Dear Editor; Epidemiologic studies have reported a dramatic increase in the prevalence of metabolic syndrome in patients with cardiovascular disease [1– 4]. The combination of various cardiovascular risk factors comprising the metabolic syndrome is expected to interact synergistically causing or accelerating the development of atherosclerosis. Although the association between metabolic syndrome and coronary artery disease, either clinical or subclinical, has been well established, the impact of age and gender on the development of atherosclerosis in patients with metabolic syndrome remains to be clarified. In a recently published article, Tong et al. [5] evaluated the metabolic syndrome-associated coronary artery disease prevalence in different age-gender subpopulations including 35- to 54-year-old women, 55- to 74-year-old women, 35- to 54-year-old men and 55- to 74-year-old men. Metabolic syndrome-associated coronary artery disease prevalence in women aged 35 –54 years has been shown to be the same as in the control, whereas in women aged 55– 74 years and in men aged 35– 54 years or 55 –74 years, this prevalence has been found to be about 2-fold that of the control. They have attributed this finding to the protective effects of endogenous estrogen in young women. Recently, Tzou et al. [6] have reported that metabolic syndrome is associated with increased carotid intima media thickness as a finding of subclinical atherosclerosis in asymptomatic young adults (61% female). Moreover, Iglseder et al. [7] have also reported a significant association between metabolic syndrome and increased * Corresponding author. Tel.: +90 422 3410660/4503. E-mail address: [email protected] (H. Turhan). 0167-5273/$ - see front matter D 2006 Published by Elsevier Ireland Ltd. doi:10.1016/j.ijcard.2005.11.070
carotid intima media thickness in middle aged subjects and this relation has been shown to be more pronounced in female subjects. Previously, we have investigated the prevalence of metabolic syndrome in young individuals with angiographically proven premature coronary artery disease [1]. In this study, the prevalence of metabolic syndrome has been detected to be significantly higher in young females compared with young males (73% vs. 31% respectively). In agreement with our findings, Baltali et al. [2] have also reported a higher prevalence of metabolic syndrome in young females with coronary artery disease. Besides, Lanz et al. [8] and Gorter et al. [9] have shown a higher prevalence of metabolic syndrome in females with coronary artery disease compared with males. In their study, Tong et al. [5] have defined the coronary artery disease as the presence of positive medical history of heart attack. Clearly, this definition underestimates the prevalence of coronary artery disease in the general population as stated also by the authors. The difference in the definition of coronary artery disease may explain the lower prevalence of coronary artery disease in young women with metabolic syndrome reported by Tong et al. Because of this limitation, it is not reasonable to ascribe the lower prevalence of coronary artery disease to the beneficial effects of endogenous estrogen in young women with metabolic syndrome. In conclusion, most of the data obtained from previous studies have suggested an association between metabolic syndrome and premature cardiovascular disease in young women. So, the available data have suggested that metabolic syndrome may be considered as a factor attenuating the advantages of being a young woman regarding the risk of cardiovascular disease.
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H. Turhan, E. Yetkin / International Journal of Cardiology 114 (2007) 277 – 278
References [1] Turhan H, Yasar AS, Basar N, Bicer A, Erbay AR, Yetkin E. High prevalence of metabolic syndrome among young women with premature coronary artery disease. Coron Artery Dis 2005;16:37 – 40. [2] Baltali M, Gokcel A, Kiziltan HT, et al. Association between the metabolic syndrome and newly diagnosed coronary artery disease. Diabetes Nutr Metab 2003;16:169 – 75. [3] Solymoss BC, Bourassa MG, Lesperance J, et al. Incidence and clinical characteristics of the metabolic syndrome in patients with coronary artery disease. Coron Artery Dis 2003;14:207 – 12. [4] Solymoss BC, Bourassa MG, Campeau L, et al. Effect of increasing metabolic syndrome score on atherosclerotic risk profile and coronary artery disease angiographic severity. Am J Cardiol 2004;93:159 – 64. [5] Tong W, Lai H, Yang C, Ren S, Dai S, Lai S. Age, gender and metabolic syndrome-related coronary heart disease in U.S. adults. Int J Cardiol 2005;104:288 – 91.
[6] Tzou WS, Douglas PS, Srinivasan SR, et al. Increased subclinical atherosclerosis in young adults with metabolic syndrome: the Bogalusa Heart Study. J Am Coll Cardiol 2005;46:457 – 63. [7] Iglseder B, Cip P, Malaimare L, Ladurner G, Paulweber B. The metabolic syndrome is a stronger risk factor for early carotid atherosclerosis in women than in men. Stroke 2005;36:1212 – 7. [8] Lanz JR, Pereira AC, Martinez E, Krieger JE. Metabolic syndrome and coronary artery disease: is there a gender specific effect? Int J Cardiol 2006;107:317 – 21. [9] Gorter PM, Olijhoek JK, van der Graaf Y, Algra A, Rabelink TJ, Visseren FL, SMART Study Group. Prevalence of the metabolic syndrome in patients with coronary heart disease, cerebrovascular disease, peripheral arterial disease or abdominal aortic aneurysm. Atherosclerosis 2004;173:363 – 9.
Letter to the Editor
Does metabolic syndrome attenuate the advantages of being a young woman regarding the risk of cardiovascular disease? Hasan Turhan *, Ertan Yetkin Inonu University Medical Faculty, Department of Cardiology, Malatya, Turkey Received 19 October 2005; accepted 15 November 2005 Available online 5 April 2006
Dear Editor; Epidemiologic studies have reported a dramatic increase in the prevalence of metabolic syndrome in patients with cardiovascular disease [1– 4]. The combination of various cardiovascular risk factors comprising the metabolic syndrome is expected to interact synergistically causing or accelerating the development of atherosclerosis. Although the association between metabolic syndrome and coronary artery disease, either clinical or subclinical, has been well established, the impact of age and gender on the development of atherosclerosis in patients with metabolic syndrome remains to be clarified. In a recently published article, Tong et al. [5] evaluated the metabolic syndrome-associated coronary artery disease prevalence in different age-gender subpopulations including 35- to 54-year-old women, 55- to 74-year-old women, 35- to 54-year-old men and 55- to 74-year-old men. Metabolic syndrome-associated coronary artery disease prevalence in women aged 35 –54 years has been shown to be the same as in the control, whereas in women aged 55– 74 years and in men aged 35– 54 years or 55 –74 years, this prevalence has been found to be about 2-fold that of the control. They have attributed this finding to the protective effects of endogenous estrogen in young women. Recently, Tzou et al. [6] have reported that metabolic syndrome is associated with increased carotid intima media thickness as a finding of subclinical atherosclerosis in asymptomatic young adults (61% female). Moreover, Iglseder et al. [7] have also reported a significant association between metabolic syndrome and increased * Corresponding author. Tel.: +90 422 3410660/4503. E-mail address: [email protected] (H. Turhan). 0167-5273/$ - see front matter D 2006 Published by Elsevier Ireland Ltd. doi:10.1016/j.ijcard.2005.11.070
carotid intima media thickness in middle aged subjects and this relation has been shown to be more pronounced in female subjects. Previously, we have investigated the prevalence of metabolic syndrome in young individuals with angiographically proven premature coronary artery disease [1]. In this study, the prevalence of metabolic syndrome has been detected to be significantly higher in young females compared with young males (73% vs. 31% respectively). In agreement with our findings, Baltali et al. [2] have also reported a higher prevalence of metabolic syndrome in young females with coronary artery disease. Besides, Lanz et al. [8] and Gorter et al. [9] have shown a higher prevalence of metabolic syndrome in females with coronary artery disease compared with males. In their study, Tong et al. [5] have defined the coronary artery disease as the presence of positive medical history of heart attack. Clearly, this definition underestimates the prevalence of coronary artery disease in the general population as stated also by the authors. The difference in the definition of coronary artery disease may explain the lower prevalence of coronary artery disease in young women with metabolic syndrome reported by Tong et al. Because of this limitation, it is not reasonable to ascribe the lower prevalence of coronary artery disease to the beneficial effects of endogenous estrogen in young women with metabolic syndrome. In conclusion, most of the data obtained from previous studies have suggested an association between metabolic syndrome and premature cardiovascular disease in young women. So, the available data have suggested that metabolic syndrome may be considered as a factor attenuating the advantages of being a young woman regarding the risk of cardiovascular disease.
278
H. Turhan, E. Yetkin / International Journal of Cardiology 114 (2007) 277 – 278
References [1] Turhan H, Yasar AS, Basar N, Bicer A, Erbay AR, Yetkin E. High prevalence of metabolic syndrome among young women with premature coronary artery disease. Coron Artery Dis 2005;16:37 – 40. [2] Baltali M, Gokcel A, Kiziltan HT, et al. Association between the metabolic syndrome and newly diagnosed coronary artery disease. Diabetes Nutr Metab 2003;16:169 – 75. [3] Solymoss BC, Bourassa MG, Lesperance J, et al. Incidence and clinical characteristics of the metabolic syndrome in patients with coronary artery disease. Coron Artery Dis 2003;14:207 – 12. [4] Solymoss BC, Bourassa MG, Campeau L, et al. Effect of increasing metabolic syndrome score on atherosclerotic risk profile and coronary artery disease angiographic severity. Am J Cardiol 2004;93:159 – 64. [5] Tong W, Lai H, Yang C, Ren S, Dai S, Lai S. Age, gender and metabolic syndrome-related coronary heart disease in U.S. adults. Int J Cardiol 2005;104:288 – 91.
[6] Tzou WS, Douglas PS, Srinivasan SR, et al. Increased subclinical atherosclerosis in young adults with metabolic syndrome: the Bogalusa Heart Study. J Am Coll Cardiol 2005;46:457 – 63. [7] Iglseder B, Cip P, Malaimare L, Ladurner G, Paulweber B. The metabolic syndrome is a stronger risk factor for early carotid atherosclerosis in women than in men. Stroke 2005;36:1212 – 7. [8] Lanz JR, Pereira AC, Martinez E, Krieger JE. Metabolic syndrome and coronary artery disease: is there a gender specific effect? Int J Cardiol 2006;107:317 – 21. [9] Gorter PM, Olijhoek JK, van der Graaf Y, Algra A, Rabelink TJ, Visseren FL, SMART Study Group. Prevalence of the metabolic syndrome in patients with coronary heart disease, cerebrovascular disease, peripheral arterial disease or abdominal aortic aneurysm. Atherosclerosis 2004;173:363 – 9.