Leziunile vasculare in sindromul metabolic – mecanisme de producere, identificare precoce, corelatii prognostice

Abstract

Metabolic syndrome amplifies and accelerates the risk of atherosclerosis with its associate effect on morbidity and mortality. Central obesity and insulin resistance are thought to represent common underlying factors of the syndrome, which features a chronic low-grade inflammatory state. Highly sensitive CRP (hsCRP) levels in plasma tend to be elevated in subjects with insulin resistance and obesity; elevated levels of hsCRP are predictors of both cardiovascular disease and diabetes. The adipose tissue is a source of several molecules, such as leptin, plasminogen activator inhibitor 1 (PAI-1), TNF-α, angiotensinogen and IL-6, that are collectively called adipokines and directly contribute to oxidative damage and vascular inflammation. Sub clinical atherosclerosis may be also assessed by coronary carotid intima-medial thickness (IMT) and velocity of the pressure wave along an arterial system, known as pulse wave velocity (PWV). PWV measurement is recommended for early detection of organ damages or estimation of the cardiovascular risk, as well as for the evaluation of the effectiveness of the treatment as a surrogate marker. Identification and treatment of the early vascular atherosclerosis lesions could be very important in cardiovascular events risk reduction.