Adults with Metabolic Syndrome at Increased Risk for Coronary Artery Calcification

Findings presented Tuesday highlight the importance of managing MetS components like obesity, high blood pressure and blood glucose/insulin resistance to prevent long-term heart disease.

“Metabolic Syndrome is a very common cluster of conditions that include high waist measurement, high blood pressure, high triglycerides or blood fats, low good cholesterol and high blood pressure. It occurs in about 40% of the adult population,” said J. Jeffrey Carr, MD, MS, Cornelius Vanderbilt Professor of Radiology and Radiological Sciences and professor of biomedical informatics and cardiovascular medicine at Vanderbilt University in Nashville, TN.

“Few studies have been able to look at the cause-and-effect relationship of metabolic syndrome to coronary artery disease in otherwise healthy adults through middle age and beyond,” Dr. Carr said.

He and his colleagues sought to examine the relationship between MetS and the development of subclinical coronary artery disease.

Study Looked At Variety of Determinants

The team used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a long-term, multicenter research effort that investigates the development of cardiovascular disease and its risk factors over time in a diverse cohort of adults in the U.S., starting in 1985 when they were in their 20s until now when they are in their 60s.

The study tracks participants’ health and lifestyle factors to understand how behaviors, genetics and social determinants influence heart health across decades.

Dr. Carr and colleagues measured the entire cohort using a dedicated cardiac CT exam in 2010 and 2011 at the year 25 exam. They excluded from the current analysis anyone that developed CAC (mean age 50 years) and classified their metabolic status. 

Ten years later, the cohort was evaluated for lung disease by chest CT, and these were analyzed for incident CAC. “This study leveraged deep-learning techniques, a form of ‘artificial intelligence’ or AI to help our team identify CAC on the CT scans of the chest; however, the AI was followed by human ‘real intelligence’ or ‘RI’ to supervise which, in my opinion, is essential for getting at the truth,” Dr. Carr said.

According to Dr. Carr, 18.9% of the adults had MetS when they were an average age of 50 years, and all had a CAC score of zero. Ten years later, 29% of those without and 44% of those with criteria for MetS developed CAC and subclinical coronary heart disease. 

“We were surprised at how strong the association between metabolic syndrome and development of coronary artery disease was over a relatively short time period in middle age,” Dr. Carr said. “Those who had MetS were over twice as likely to develop CAC compared to those without it—a 100% relative increase in our strongest marker for heart disease. Adults with CAC score of zero have less than a 1% risk of developing clinical coronary heart disease over the next five years.”

The results of the study were consistent in individuals identifying as Black or white race, and females or males. Abdominal obesity and high blood pressure were most strongly associated with the development of CAC.

Bending the Curve Toward Better Health

Understanding the impact of MetS on CAC development, Dr. Carr said that prevention and treatment of common risk factors may help reduce CAC development at middle age and later life. 

“Many widely accessible, inexpensive generic medicines are available for metabolic syndrome conditions such as high blood pressure, high blood sugar and high triglycerides,” Dr. Carr said. “For everyone we know, increasing our levels of activity and improving our diet quality has many benefits. In addition, recent advances in managing metabolic aspects of our culture and western diet, specifically GLP-1’s, while expensive in the near term have already been shown to have major cardiovascular benefits beyond losing weight.”

“A major point of our research is that it is never too late to improve your health and that even in our fifties we have the potential to bend the curve favorably relative to coronary heart disease in both men and women,” Dr. Carr concluded.

Access the presentation, “Metabolic Syndrome and 10-Year Incidence of Subclinical Coronary Heart Disease in Middle Adult Life,” (T3-SSCA05-5) on demand at RSNA.org/MeetingCentral