Oxidative Stress and Vascular Inflammation in Post-menopausal Woman with Metabolic Syndrome

In the past decade, many clinicians have suggested that essential hypertension must be related to the renin-angiotensin system and to undefined renal dysfunction. These assumptions are motivated first by the efficacy of angiotensin converting-enzyme inhibitors (ACEI) or angiotensin II receptor blockers to reduce blood pressure in essential hypertension, even when plasma levels of angiotensin (Ang) are normal or slightly elevated. Angiotensin II exerts multiple effects on the cardiovascular system, including free radical production proposed as a mechanism participating in Ang II induced cardiovascular alterations. There is increasing evidence that inflammation and endothelial dysfunction are the most important pathogenic pathways explaining the propensity to atherosclerosis and its complications in metabolic syndrome. Most adipocytokines and proinflammatory biomarkers (adiponectin, cell adhesion molecules, TNF-alpha, IL, CRP) are elevated in the serum and vessel walls of patients with metabolic syndrome, being positive predictors for cardiovascular events. Aims: To evaluate the relationship between oxidative stress, hs C-reactive protein, apo A1/apo B and classical cardiovascular risk factors in newly diagnosed, never treated, nonsmoking, post-menopausal women (age: 57.18 +/- 6.68 years, TA: 158.8 +/- 9/ 91.75 +/- 7.75 mmHg) with uncomplicated essential hypertension with/without MetS and age-, sex-matched control group. Methods: The concentration of serum and erythrocyte superoxiddismutase (SOD), catalase (CAT) and malonaldialdehyde (MDA) were analysed by spectrofotometry. All the other risk factors (uric acid, fasting glucose, lipid profile) were assessed by validated standard procedures. C-reactive protein high sensitive (hs CRP), A-1 and B-100 apolipoproteins have been performed by a sandwich ELISA method. Results: Plasma levels of oxidative stress parameters determined and CRP are significantly higher than the control group (p < 0.0001). Oxidative stress markers are strongly correlated (r > 0.7) with the number of criteria for MetS and CRP, they have an average correlation with the age, weight, BMI, waist, fasting glucose, triglyceride, HDL-C and are not correlated with the BP values. The coefficient of determination is significantly increased between the number of criteria for the MetS and the oxidative stress parameters. Level of CRP activity is strongly correlated with the number of criteria for MetS, fasting glucose, oxidative stress markers and has an average correlation with TG, HDL-C. ApoA1/apoB ratio correlates strongly with CRP, fibrinogen, number of criteria for inclusion in the MetS and oxidative stress parameters. Conclusions: Increase oxidative stress activity and CRP levels are associated with MetS, but not with the BP values. Applying multiple linear regression, adjusted for sex, age, classical cardiovascular risk factors, systolic blood pressure is a powerful and independent determinant factor of oxidative stress parameters. A multimarker strategy may be useful in evaluating cardiovascular status in this type of patients.