Carotid Atherosclerosis and Coronary Heart Disease in the Metabolic Syndrome

Prospective data from the Bruneck Study

  1. Enzo Bonora, MD, PHD1,
  2. Stefan Kiechl, MD2,
  3. Johann Willeit, MD2,
  4. Friedrich Oberhollenzer, MD3,
  5. Georg Egger, MD3,
  6. Riccardo C. Bonadonna, MD1 and
  7. Michele Muggeo, MD1
  1. 1Division of Endocrinology and Metabolic Diseases, University of Verona Medical School, Verona, Italy
  2. 2Department of Neurology, University of Innsbruck Medical School, Innsbruck, Austria
  3. 3Department of Internal Medicine, City Hospital of Bruneck, Bruneck, Italy


    OBJECTIVE— The present study aimed at prospectively evaluating carotid atherosclerosis and coronary heart disease (CHD) in subjects with the metabolic syndrome.

    RESEARCH DESIGN AND METHODS— Within a prospective population-based survey examining 888 subjects aged 40–79 years, 303 subjects were identified as fulfilling World Health Organization (WHO) criteria and 158 as fulfilling the National Cholesterol Education Program (NCEP)-Adult Treatment Panel (ATP)-III criteria for diagnosing the metabolic syndrome. The 5-year change in carotid status, as assessed by echo-duplex scanning, and incident fatal and nonfatal CHD, as assessed by medical history and death certificates, were compared in subjects with the metabolic syndrome and in the rest of the sample (control subjects).

    RESULTS— Compared with the control subjects, subjects with the metabolic syndrome by WHO criteria had an increased 5-year incidence and progression of carotid atherosclerosis: 51 vs. 35% developed new plaques (P = 0.021) and 34 vs. 19% developed carotid stenosis >40% (P = 0.002) after adjusting for several confounders. Subjects with the metabolic syndrome by these criteria also had an increased incidence of CHD during follow-up: 8 vs. 3% in control subjects (P = 0.012). Similar results were found when the NCEP-ATPIII criteria were used.

    CONCLUSIONS— Subjects with the metabolic syndrome are at increased risk for both progressive carotid atherosclerosis and CHD.


    • Address correspondence and reprint requests to Professor Enzo Bonora, Endocrinologia e Malattie del Metabolismo, Ospedale Maggiore, Piazzale Stefani 1, 37126 Verona, Italy. E-mail: enzobonora{at}

      Received for publication 23 September 2002 and accepted in revised form 10 January 2003.

      E.B. has received honoraria from GlaxoSmithKline, Novartis, NovoNordisk, Eli Lilly, Pfizer, Aventis, Servier, Merck, Takeda, and Roche.

      A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

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