Metabolic Syndrome Clusters and Arterial Stiffness: Unraveling Early Predictors of Cardiovascular Risk in a Follow-Up Study.

Background: The aim of this study was to assess the association between different metabolic syndrome (MetS) component clusters, arterial stiffness as measured by aortic pulse wave velocity (aPWV) and cardio-ankle vascular index (CAVI), and the incidence of major cardiovascular events during long-term follow-up.

Methods: The prospective cohort study included 5307 participants with MetS, aged 40 to 64 years, who had no evident cardiovascular disease and were enrolled in the Lithuanian High Cardiovascular Risk primary prevention program. All participants were followed up for an average of 4.57 ± 2.74 years to monitor the occurrence of major cardiovascular events. Arterial stiffness was assessed using aPWV and CAVI measurements. The associations between different MetS component clusters, arterial stiffness, and cardiovascular outcomes were analyzed.

Results: During the follow-up period, 3.34% of the subjects experienced a major cardiovascular event. Individuals meeting four MetS criteria had a higher risk of events compared to those meeting three. Elevated triglycerides and elevated glucose were each significantly associated with increased risk. Specific MetS combinations, particularly clusters involving WTHB (increased waist circumference [W], elevated triglycerides [T], decreased HDL cholesterol [H], and elevated blood pressure [B]), as well as WBG (waist circumference, blood pressure, and glucose [G]), were significantly associated with cardiovascular events. The cross-sectional analysis also revealed that arterial stiffness, assessed as aPWV, was significantly higher in subjects with the WBG, WTBG, and WTHBG clusters. Meanwhile, higher CAVI was associated with the WTBG cluster. In the logistic regression analysis, the presence of the following clusters was linked to more than twice increased odds for having extremely stiff arteries: WTBG (OR = 2.351) and WTHBG (OR = 2.201) for aPWV values above the 95th percentile (>11.3 m/s) and WTB (OR = 2.096) for CAVI values above the 95th percentile (>10.2).

Conclusions: Our findings demonstrate that higher risk of CV events is associated with increased arterial stiffness and higher number of MetS components present, as well as with the presence of specific MetS components; in particular, increased levels of triglycerides and glucose. Furthermore, the cross-sectional analysis demonstrated that subjects with the unfavorable combination of MetS components, such as WTBG, WTHBG, and WTB, are more than twice as likely to have extremely stiff arteries.