Metabolic Syndrome in APS Associated With Arterial Thrombosis, Cardiovascular Biomarkers

Metabolic syndrome was noted among one-fourths of patients with antiphospholipid syndrome.

Metabolic syndrome, found among one-fourths of patients with antiphospholipid syndrome (APS), is associated with arterial thrombosis, cardiovascular biomarkers, and subclinical atherosclerosis, according to study results published in Frontiers in Immunology.

Research has shown that cardiovascular disease, including stroke and myocardial infarction, is a leading cause of morbidity and mortality among patients with APS. 

Researchers conducted a cross-sectional study evaluating the prevalence of metabolic syndrome among patients diagnosed with APS, rheumatoid arthritis (RA) and diabetes. 

Three sets of diagnostic criteria used to define metabolic syndrome included the updated Joint Interim Statement (JIS) proposed by participating organizations; the International Diabetes Federation (IDF); and the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII).

Data regarding clinical and laboratory parameters, as well as disease-related medications at initial visit, were recorded.

In total, 138 patients with APS (median age, 44.9 years; 70% women) were included in the study and matched 1:1 for age and sex with patients with RA and diabetes.

Awareness of MetS among clinicians and patients with APS…could help to improve cardiovascular health in APS.

Based on JIS, IDF, and NCEP-ATPIII criteria, the prevalence of metabolic syndrome in patients with APS was comparable with that in patients with RA and diabetes (23.91%, 23.19% and 20.29% vs 17.39%, 17.39%, and 13.04%, and 44.2%, 44.2%, and 40.58%, respectively).

Of note, the researchers found that metabolic syndrome was significantly higher among patients who were 40 years and older than those who were younger than 40 years. 

Overall, a 3.5-fold increased risk for metabolic was noted among patients with APS and arterial thrombosis, using the IDF criteria (P =.030). An approximately 26% decrease in odds for metabolic syndrome was observed with an increase in physical activity by 1 hour per week, according to JIS and IDF. Atherosclerotic plaques were correlated with a 4- to 6.5-fold increase in risk for metabolic syndrome, using JIS, IDF, and modified NCEP-ATPIII (odds ratios [ORs], 6.37, 4.69, and 4.15, respectively). In addition, a marked increase in atherosclerotic plaque presence was noted with a metabolic syndrome diagnosis, based on JIS, IDF, and NCEP-ATPIII (ORs, 3.44, 2.92, and3.53, respectively).

Researchers concluded, “Awareness of [metabolic syndrome] among clinicians and patients with APS, as well as thorough screening and control of traditional CV [risk factors] following similar [cardiovascular disease] (CVD) prevention measures to those implemented in other diseases of high CVD risk, could help to improve cardiovascular health in APS.” 


Bolla E, Tentolouris N, Sfikakis PP, Tektonidou MG. Metabolic syndrome in antiphospholipid syndrome versus rheumatoid arthritis and diabetes mellitus: Association with arterial thrombosis, cardiovascular risk biomarkers, physical activity, and coronary atherosclerotic plaques. Front Immunol. 2023;13:1077166. Published January 9, 2023. doi:10.3389/fimmu.2022.1077166