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Male and Female Influence of Metabolic Syndrome in People with Type 2 Diabetes 

May 30, 2020
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Deonna Andrews, PharmD Candidate 2020 of Florida Agricultural & Mechanical University College of Pharmacy and Pharmaceutical Sciences 

Of the many ways diabetes can complicate a persons life, metabolic syndrome is one more thing to add to the list, particularly metabolic syndrome in women.

Patients with diabetes often experience metabolic syndrome, which is the clustering of at least three risk factors such as hyperlipidemia, insulin resistance, and obesity as a marker of inflammation in the same person. Lower extremity arterial disease is characterized by the narrowing or clogging of the arteries leading to a gradual reduction of blood supply to the lower limbs. Patients with this set of disorders are associated with an increased risk of functional impairment, limb loss, myocardial infarction, stroke, and death. Researchers have identified the relationship between these two, reporting that the prevalence of the metabolic syndrome is 58% in patients with lower extremity arterial disease.  

Previous studies have studied the relationship between metabolic syndrome and the incidence of lower extremity arterial disease. One included a 14 year follow up study observing the relationship of metabolic syndrome and the incidence of end-stage peripheral vascular disease, suggesting that metabolic syndrome was a risk predictor of lower extremity arterial disease, consequently leading to diabetes. Additionally, there is a separate study analysis in womens health that revealed metabolic syndrome in women was associated with an increased risk of lower extremity arterial disease in middle-aged, healthy females. While these present substantial evidence on this matter, they did not provide insight into the relationship between metabolic syndrome and the prevalence of lower extremity arterial disease in patients with type 2 diabetes.  

The objective of this study was to investigate the relationship between metabolic syndrome and lower extremity arterial disease in type 2 diabetes patients. This was a cross-sectional study inclusive of 30 hospitals in different geographic regions of China. Data were derived from 8,374 patients who had type 2 diabetes from the respective cooperative hospitals. Inclusive of this study were patients that had a well-documented diagnosis of type 2 diabetes, age 40 years or older, were diagnosed with or without lower extremity arterial disease, and indicators of metabolic syndrome are recorded entirely. Data collection was gathered using a standard questionnaire to obtain relevant information from each participant inclusive of demographic characteristics, health behaviors, and medical history. 

As far as statistical analysis, demographic data, and clinical characteristics for lower extremity arterial disease were presented as the mean, standard deviation or percentages. Either a one-way analysis or Kruskal-Wallis test was used for the continuous variables and Pearson tests for categorical variables to compare the baseline of the study participants according to the groups that had been classified as being non-lower extremity arterial disease and lower extremity arterial disease in all enrolled, male, and female patients. Metabolic syndrome and the prevalence of lower extremity arterial disease were analyzed using a univariable logistic regression and multivariable logistic regression. Factors for adjustment for the multivariable logistic regression included duration of diabetes, patient type, ALT, AST, serum creatinine, current smoking, years of smoking, the number of cigarettes, and family history of premature cardiovascular disease. A two-sided p-value of less than 0.05 was considered statistically significant. 

Researchers found that of the 8,374 participants in this study, 1809 were diagnosed with lower extremity arterial disease. In the non-lower extremity arterial disease group, 2,967 participants were associated with the prevalence of metabolic syndrome and 826 participants in the lower extremity arterial disease group. 3,012 females were in the non-lower extremity arterial disease group, and 841 were in the lower extremity arterial disease group. 3,553 males were in the non-lower extremity arterial disease group, and 968 were in the lower extremity arterial disease group. As for the prevalence of metabolic syndrome, in the non-lower extremity arterial disease group and the lower extremity arterial disease group, there were 1,393 and 468 in females and 1,619 and 460 in males, respectively.  

A significant limitation of this study exists, inclusive of the difficulty to infer the causality between metabolic syndrome and the risk for lower extremity arterial disease through a cross-sectional study, prospective data. 

In conclusion, metabolic syndrome is associated with an increased risk of lower extremity arterial disease in female type 2 diabetes patients. Also, there was no association between metabolic syndrome and lower extremity in males. It is thought that estrogen and other sex hormones have vein protective properties that reduce the prevalence of atherosclerosis in women of a younger age. Yet, estrogen is a risk factor for the development of vascular disease in women of older age.  

Practice Pearls: 

  • The prevalence of the metabolic syndrome is increasing in patients with lower extremity arterial disease. 
  • The association between the two is more prevalent in females with type 2 diabetes. 
  • Limitations exist regarding the methods of this study. 

 

Chen, H. Zhu, F. Shen, et al., Sex-influenced association of metabolic syndrome with lower extremity arterial disease in type 2 dia…, Journal of Diabetes and Its Complications, https://doi.org/10.1016/j.jdiacomp.2020.107537

 

Deonna Andrews, PharmD Candidate 2020 of Florida Agricultural & Mechanical University College of Pharmacy and Pharmaceutical Sciences  

 

See more about the impact of metabolic syndrome in women and men.