Arterial Stiffness, the Metabolic Syndrome, and the Brain

The so-called metabolic syndrome (MetS) has been a topic of controversy ever since a critical debate started in 2005 on whether it exists or not, its definitions, and treatment alternatives.¹ Nevertheless, the constellation of cardiometabolic risk factors/markers in MetS is still a reality, even if the predictive ability of MetS for future cardiovascular events is not supposed to be more than the sum of its components. The most recent definition of MetS was presented in 2009² and is still not further revised. Recently the focus of interest in preventive cardiology has shifted to the role of arterial stiffness (arteriosclerosis) as a major driver of increased cardiovascular risk and increased total mortality, even adjusted for other cardiovascular risk factors/markers.^3,4 Furthermore, some of the metabolic abnormalities associated with MetS (increased glycemia, insulin resistance, dyslipidemia) are also characteristics of increased arterial stiffness, as measured by pulse-wave velocity (PWV) in large, elastic arteries, even adjusted for hemodynamic factors such as mean arterial blood pressure and heart rate.^5,6 In fact, these abnormalities have been included in the new concept of early vascular ageing^7,8 that is now being screened for in various populations.

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