Metabolic syndrome abating the beneficial effect of pravastatin treatment on adhesion of endothelium by monocytes in subjects with hypercholesterolemia

Dysregulation of monocyte biology in metabolic syndrome

Metabolic syndrome (MetS), which constitutes a cardio-metabolic risk cluster, is becoming a global epidemic. It is a pro-inflammatory and pro-oxidant state that confers an increased risk of cardiovascular disease and diabetes. MetS is not only characterized by increased circulating biomarkers of inflammation and oxidative stress but also by dysregulation of a pivotal phagocyte, the circulating monocyte. Pertubations manifesting in monocytes of patients with MetS include increased Toll-like receptors, CD40-CD40L dyad, increased ER stress, increased CCR5 and Fc-γ receptors (CD32 and CD64). Additionally, the monocytes demonstrate increase in NADPH oxidase activity and decreased Nrf2, resulting in oxidative damage to biomolecules. Thus the dysregulated monocyte in MetS appears to be a critical cell in the predisposition of MetS patients to diabetes and CVD. Therapeutic strategies targeting monocytes can attenuate this risk and the most compelling data derives from studies with statin therapy.

Impaired spontaneous thrombolytic activity measured by global thrombosis test in males with metabolic syndrome

INTRODUCTION

In patients with metabolic syndrome (MetS), activity of the fibrinolytic system is generally surmised to be decreased through increased plasminogen activator inhibitor-1 (PAI-1) generation. However, there have been no detailed reports describing whether the clot lysis activity is more dominant than increased clot formation activity for production of the thrombotic state in MetS.

METHODS

The global thrombosis test (GTT) is a novel method designed to test both clot formation and clot lysis activities under physiological conditions by using non-anticoagulated blood samples in vitro. We used the GTT to examine the thrombotic or thrombolytic states in males with MetS.

RESULTS

Lysis time, which reflects spontaneous clot lysis activity, was significantly longer in MetS subjects (median, 1494s; range, 865-3596s; n=30) than in control subjects (median 1246s; range, 667-2239s; n=53). There was no significant difference between the two groups in occlusion time, which reflects platelet function. The mean level of PAI-1 was significantly higher in MetS subjects than in controls (mean ± SE, 8.7 ± 1.1 and 5.0 ± 0.5 ng/mL, respectively). PAI-1 level and lysis time were significantly correlated (r=0.400, P<0.01).

CONCLUSION

These results suggest that male patients with MetS are more likely than controls to experience a thrombotic state through decreased fibrinolytic activity due to increased PAI-1 generation, and that the GTT is useful for evaluating fibrinolytic activity in vitro.

Metabolic syndrome and renal injury

Both metabolic syndrome (MetS) and chronic kidney disease (CKD) are major global health issues. Current clinical markers used to reflect renal injury include albuminuria and estimated glomerular filtration rate (eGFR). Given the same eGFR level, urine albumin might be a better risk marker to predict progression of CKD and future development of cardiovascular diseases (CVDs). Serum Cystatin C is emerging as a new biomarker for early detection of renal injury associated with MetS and cardiovascular risk. In addition to each component, MetS per se influences the incidence and prognosis of renal injury and the odds ratios increased with the increase in the number of metabolic abnormalities. Hyperinsulinemia, activation of rennin-angiotensin-aldosterone system, increase of oxidative stress, and inflammatory cytokines are proposed to be the plausible biological link between MetS and CKD. Weight control, stick control of blood pressure, glucose, and lipids disorders may lead to lessening renal injury and even the subsequent CVD.