Metabolic syndrome predicts vascular changes in whole body magnetic resonance imaging in patients with long standing diabetes mellitus

Background: Although diabetic patients have an increased rate of
cardio-vascular events, there is considerable heterogeneity with
respect to cardiovascular risk, requiring new approaches to
individual cardiovascular risk factor assessment. In this study we
used whole body-MR-angiography (WB-MRA) to assess the degree of
atherosclerosis in patients with long-standing diabetes and to
determine the association between metabolic syndrome (MetS) and
atherosclerotic burden. Methods: Long standing (>= 10 years)
type 1 and type 2 diabetic patients (n = 59; 31 males; 63.3 +/- 1.7
years) were examined by WB-MRA. Based on the findings in each
vessel, we developed an overall score representing the patient's
vascular atherosclerotic burden (MRI-score). The score's
association with components of the MetS was assessed. Results: The
median MRI-score was 1.18 [range: 1.00-2.41] and MetS was present
in 58% of the cohort (type 2 diabetics: 73%; type 1 diabetics:
26%). Age (p = 0.0002), HDL-cholesterol (p = 0.016), hypertension
(p = 0.0008), nephropathy (p = 0.0093), CHD (p = 0.001) and MetS (p
= 0.0011) were significantly associated with the score. Adjusted
for age and sex, the score was significantly (p = 0.02) higher in
diabetics with MetS (1.450 [1.328-1.572]) compared to those without
MetS (1.108 [0.966-1.50]). The number of MetS components was
associated with a linear increase in the MRI-score (increase in
score: 0.09/MetS component; r(2) = 0.24, p = 0.038). Finally, using
an established risk algorithm, we found a significant association
between MRI-score and 10-year risk for CHD, fatal CHD and stroke.
Conclusion: In this high-risk diabetic population, WB-MRA revealed
large heterogeneity in the degree of systemic atherosclerosis.
Presence and number of traits of the MetS are associated with the
extent of atherosclerotic burden. These results support the
perspective that diabetic patients are a heterogeneous population
with increased but varying prevalence of atherosclerosis and risk.