1897 Ferreira da Silva, et al: MetS prevalence in TA Personal non-commercial use only. The Journal of Rheumatology Copyright © 2013. All rights reserved. High Prevalence of Metabolic Syndrome in Takayasu Arteritis: Increased Cardiovascular Risk and Lower Adiponectin Serum Levels Thiago Ferreira da Silva, Maurício Levy-Neto, Eloisa Bonfá, and Rosa Maria R. Pereira ABSTRACT. Objective. The prevalence of metabolic syndrome (MetS) tends to be high among rheumatic patients, and cardiovascular disease is the leading cause of death in these conditions. We aimed to determine the prevalence of MetS in patients with Takayasu arteritis (TA) and its association with risk factors and adipokine and cytokine levels. Methods. A cross-sectional study was conducted in 45 consecutive women with TA and 47 healthy controls matched by age and body mass index. Results. The prevalence of MetS (International Diabetes Federation/American Heart Association criteria) was higher in TA compared to controls (33.34 vs 8.51%, p = 0.003). Patients with TA had a higher frequency of hypertension (p < 0.001) and dyslipidemia (p = 0.001) and higher levels of insulin (p = 0.021), homeostasis model assessment index (p = 0.024), apolipoprotein E (p = 0.029), resistin (p = 0.018), and C-reactive protein (CRP, p < 0.001) compared to healthy subjects, with similar levels of adiponectin and plasminogen activator inhibitor-1 (PAI-1; p > 0.05). Further analysis of patients with TA with and without MetS revealed a higher frequency of overweight/obesity (66.66 vs 26.66%, p = 0.022), higher Framingham score ≥ 1 (p = 0.032), and lower adiponectin levels (20.37 ± 21.16 vs 38.64 ± 22.62 μg/ml, p = 0.022) in the patients with MetS. No differences were found regarding disease duration, activity, glucocorticoid use, resistin, and PAI-1 levels in the 2 groups of patients with TA (p > 0.05). Patients with and without MetS showed no differences in cytokine levels [interleukin 12 (IL-12, IL-1a, IL-6) and tumor necrosis factor-α]. IL-6 had a positive Pearson corre- lation with CRP only in TA patients with MetS (r = 0.57; p = 0.050). Conclusion. A high prevalence of MetS was observed in patients with TA and this comorbidity seems to identify a subgroup of overweight/obese patients with high cardiovascular risk without a significant association with disease status. Further longitudinal studies are necessary to observe the effects of controlling this modifiable risk factor in the quality of life and survival of patients with TA. (First Release Sept 15 2013; J Rheumatol 2013;40:1897–904; doi:10.3899/jrheum.130162) Key Indexing Terms: TAKAYASU ARTERITIS METABOLIC SYNDROME ADIPONECTIN MORTALITY PREVALENCE From the Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. Supported by grants from Conselho Nacional de Desenvolvimento Científico e Tecnológico (#301411/2009-3 to EB and #300559/2009-7 to RMRP), and Federico Foundation (to EB and RMRP). T. Ferreira da Silva, MD; M. Levy-Neto, MD, PhD; E. Bonfá, MD, PhD; R.M.R. Pereira, MD, PhD, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. Address correspondence to Professor Pereira, Av. Dr. Arnaldo, 455 - 3º andar – Reumatologia, sala 3105 São Paulo — SP, 01246-903, Brazil; E-mail: rosamariarp@yahoo.com. Accepted for publication July 23, 2013. Metabolic syndrome (MetS) is characterized by a combi- nation of several cardiovascular risk factors (age, sex, smoking, hypertension, and dyslipidemia) that imply additional cardiovascular morbidity that is greater than the sum of the risk factors associated with each individual component 1,2 . The prevalence of MetS among autoimmune disorders ranges from 14 to 62.8%, and coronary heart disease is the leading cause of death among these patients 1,3,4,5 . Studies have shown that atherosclerosis is accelerated in patients with rheumatic diseases, especially in systemic vasculitis, although the causal factors have not yet been fully eluci- dated 5,6 . In fact, in Takayasu arteritis (TA), enhanced ather- osclerosis has been clearly documented by ultrasonography studies showing that atherosclerotic plaques in the carotid artery were about 10 times more frequent than in age-matched, sex-matched controls 6 . Adipose tissue seems to play an important role in this process, with the secretion of various hormones called adipokines 7,8 , which appear to contribute to the so-called “low-grade inflammatory states” that culminate in metabolic cardiovascular diseases 6,7 and insulin resistance 8 . This metabolic disturbance may be aggravated in autoimmune diseases because of the known intense inflam- matory process observed in these rheumatic conditions. TA is an inflammatory chronic vasculitis of unknown etiology, predominantly affecting the aorta and its major www.jrheum.org Downloaded on August 16, 2022 from