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Updated: Dec 20, 2025
Author Spotlight: Assessing the Cardiovascular Profile of Patients with Metabolic Syndrome
Published on: September 27, 2024
Metabolic syndrome is associated with reduced flow mediated dilation independent of obesity status
Victoria S Sprung1,2,3, Kelly A Bowden Davies1,3,4, Juliette A Norman1,3
1Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
Insights
Metabolic syndrome components, not obesity alone, significantly impair endothelial function (FMD), indicating a higher cardiovascular disease risk. This highlights metabolic health over BMI for predicting CVD outcomes.
Area of Science:
- Cardiovascular disease research
- Metabolic health and endothelial function
- Obesity and metabolic syndrome
Background:
- Metabolic health status, including metabolic syndrome (MetS) components, is a better predictor of cardiovascular disease (CVD) risk than Body Mass Index (BMI).
- Endothelial dysfunction is a key prognostic factor for incident CVD.
Purpose of the Study:
- To investigate the association between MetS and obesity with endothelial function.
- To determine if MetS components or obesity are stronger predictors of endothelial dysfunction.
Main Methods:
- Phenotyped 44 participants based on BMI (<30 vs. >30 kg/m²) and MetS criteria (MetS- vs. MetS+).
- Assessed flow-mediated dilation (FMD), body composition (including liver fat), diet, physical activity, and cardio-respiratory fitness.
- Analyzed data using ANOVA and linear regression.
Main Results:
- Individuals with MetS+ had significantly lower FMD than those with MetS- (P < 0.001).
- An increased number of MetS components correlated with reduced FMD (P = 0.005).
- MetS explained 19.7% of FMD variance, while BMI explained only 1.1%.
Conclusions:
- Components of MetS, rather than obesity itself, are associated with reduced endothelial function (FMD).
- Reduced FMD suggests diminished nitric oxide bioavailability, increasing CVD risk.
- Metabolic health status is a more critical factor than BMI in assessing CVD risk.
Background:
Data suggest that metabolic health status, incorporating components of metabolic syndrome (MetS), predicts cardiovascular disease (CVD) risk better than BMI. This study explored the association of MetS and obesity with endothelial function, a prognostic risk factor for incident CVD.
Methods:
Forty-four participants were phenotyped according to BMI as non-obese vs obese (<30 or >30 kg/m2) and according to the International Diabetes Federation criteria of MetS: ≤2 criteria MetS (MetS-) vs ≥3 criteria MetS (MetS+); (1.)non-obese MetS- vs (2.) non-obese MetS+ and (3.) obese MetS- vs (4.) obese MetS+. Flow-mediated dilation (FMD), body composition including liver fat (MRI and spectroscopy), dietary intake, intensities of habitual physical activity and cardio-respiratory fitness were determined. Variables were analysed using a one-factor between-groups ANOVA and linear regression; mean (95% CI) are presented.
Results:
Individuals with MetS+ displayed lower FMD than those with MetS-. For non-obese individuals mean difference between MetS+ and MetS- was 4.1% ((1.0, 7.3); P = 0.004) and obese individuals had a mean difference between MetS+ and MetS- of 6.2% ((3.1, 9.2); P < 0.001). Although there was no association between BMI and FMD (P = 0.27), an increased number of MetS components was associated with a lower FMD (P = 0.005), and after adjustment for age and sex, 19.7% of the variance of FMD was explained by MetS, whereas only 1.1% was explained by BMI.
Conclusions:
In this study cohort, components of MetS, rather than obesity per se, contribute to reduced FMD, which suggests a reduced bioavailability of nitric oxide and thus increased risk of CVD.
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