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Author Spotlight: Assessing the Cardiovascular Profile of Patients with Metabolic Syndrome
Published on: September 27, 2024
Association between cardiovascular-kidney-metabolic syndrome, inflammatory biomarkers, and cardiovascular outcomes:
Muhammad Imtiaz Ahmad1, Parag Chevli2, Saeid Mirzai2
1Department of Internal Medicine, Section on Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Insights
Systemic inflammation, measured by interleukin-6 (IL-6), modifies the risk of atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF) in cardiovascular-kidney-metabolic (CKM) syndrome stages. IL-6 levels may refine risk stratification for CKM syndrome patients.
Area of Science:
- Cardiology
- Metabolic Syndrome
- Inflammation Research
Background:
- Cardiovascular-kidney-metabolic (CKM) syndrome is a cluster of conditions impacting cardiovascular and kidney health.
- The association between CKM syndrome stages and atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF) requires further investigation.
- The role of inflammatory markers, such as interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP), in modifying these risks is unclear.
Purpose of the Study:
- To investigate the association between CKM syndrome stages (0-3) and the risk of ASCVD and HF.
- To determine if this association is modified by systemic inflammation, specifically IL-6 and hsCRP levels.
Main Methods:
- Utilized data from 6579 participants in the Multi-Ethnic Study of Atherosclerosis (MESA).
- Estimated restricted mean survival time (RMST) differences for ASCVD-free and HF-free survival across CKM syndrome stages.
- Stratified analyses by IL-6 and hsCRP levels to assess interactions with CKM syndrome stages.
Main Results:
- CKM stage 3 was associated with significantly shorter ASCVD-free survival compared to stage 0.
- Elevated IL-6 levels amplified the negative impact of CKM stages on ASCVD-free survival (interaction p=0.002).
- Similar patterns were observed for HF-free survival, with elevated IL-6 significantly worsening outcomes in CKM stages 2 and 3.
Conclusions:
- Systemic inflammation, particularly IL-6, plays a significant role in modifying the risk of ASCVD and HF associated with CKM syndrome.
- IL-6 measurement may offer a valuable tool for refining risk stratification and prognosis in patients with CKM syndrome.
- Further research is warranted to confirm the clinical utility of IL-6 in managing CKM syndrome.
Background:
This study investigated the association between cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3 and atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF), as well as whether this association varies by interleukin-6 and high-sensitivity C-reactive protein (hsCRP).
Methods:
6579 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) were included. Restricted mean survival time (RMST) differences in ASCVD and HF-free survival by CKM syndrome stage, stratified by inflammatory markers, were estimated.
Results:
Over a median follow-up of 17.5 years (IQR: 10.5-18.4 years), participants with CKM stage 3 demonstrated significantly shorter ASCVD-free survival compared to stage 0 (-1.94 years; 95 % CI: -2.27, -1.61). Subgroup analysis by IL-6 levels demonstrated differential RMST across CKM stages, with participants having above-median IL-6 levels showing greater survival reduction (-2.5 years; 95 % CI: -3.50, -1.85) than those with below-median levels (-1.46 years; 95 % CI: -1.84, -1.07) (interaction p = 0.002). For heart failure outcomes, categorization by IL-6 levels displayed similar patterns by CKM stage (interaction p = 0.006). Among participants with elevated IL-6, both CKM stages 2 and 3 were associated with reduced HF-free survival (-0.40 years [95 % CI: -0.69, -0.01], and -0.87 years [95 % CI: -1.18, -0.55], respectively). Conversely, participants with lower IL-6 levels showed a significant reduction in HF-free survival only at the CKM stage 3 level (-0.36 years: 95 % CI: -0.57, -0.14). hsCRP stratification yielded comparable results but without significant interactions for either cardiovascular outcome.
Conclusions:
These findings suggest that systemic inflammation, as measured by IL-6, may modify the risk of ASCVD and HF associated with CKM syndrome. Therefore, IL-6 measurement could potentially refine risk stratification and prognosis of CKM syndrome stages. However, further studies are needed to assess the clinical relevance of this approach.
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