Inflammatory status in patients with metabolic syndrome.

We read the article ‘The influence of chosen adipocytokines on blood pressure values in patients with metabolic syndrome’ written by Musialik et al. with interest [1]. The authors aimed to investigate the impact of chosen adipocytokines, such as adiponectin, tumour necrosis factor alpha (TNF-α) receptors (sTNFR1, sTNFR2), and resistin, on the development of high blood pressure (BP), which is a significant risk factor for cardiovascular events. They concluded that the concentration of adiponectin was markedly lower in patients with metabolic syndrome (MetS) compared to the control group. In patients with MetS, sTNFR1 and sTNFR2 concentrations were significantly elevated and resistin level was significantly higher compared to control subjects. Negative correlations between adiponectin and the values of systolic (SBP) and diastolic (DBP) blood pressure were observed. Positive correlations between sTNFR2 and SBP and DBP values were found. Resistin levels correlated positively with SBP and DBP values. In a multiple regression model, the association of SBP with resistin level was observed in 32% of studied patients. They suggested that patients with MetS are diagnosed by the following disturbances: hypo- -adiponectinaemia, elevated concentrations of soluble receptors for TNF-α, and hyperresistinaemia. Increased concentration of resistin may play a role in the development of high blood pressure.Metabolic syndrome is a clinical entity comprising risk factors such as hypertension, glucose intolerance, atherogenic lipid profile, abdominal obesity, lack of physical activity, and increased inflammatory state. According to data from a previous study, MetS is described in more than 20% of men and 17% of women [2]. Most recent studies have demonstrated a correla-tion between inflammatory mediators and components of MetS. Particularly, interleukin 6 (IL-6), TNF-α, and C-reactive protein (CRP) levels have been observed to increase in MetS [3]. Another study has reported the association between the inflammatory markers and the severity of MetS [4]. These parameters indicat-ing inflammation in MetS may be early markers of developing cardiovascular events. Although the authors have shown that patients with MetS had significantly higher inflammatory mediators compared to those without MetS, they did not mention inflammatory mediators’ status according to severity of MetS in the present study. Elevated inflammatory mediators is a common indicator of atherosclerotic involvement of the vascular structure indicat-ing coronary artery disease, cerebrovascular disease, peripheral arterial disease and chronic inflammatory disease [5]. It can also be affected by the atherosclerotic risk factors such as smoking, alcohol consumption, hypercholesterolaemia, and hypothyroi-dism. The authors did not discuss in this study some of the factors affecting these markers, including smoking, alcohol consumption, insulin resistance, hypercholesterolaemia, hypothyroidism, heart failure, cerebrovascular disease, peripheral arterial disease and chronic inflammatory disease. It would be better if the authors had given information about these factors. In addition, the au-thors did not define clearly that MetS is independently associated with inflammatory parameters. It would be better if the authors had made a multivariate regression analysis, and adjusted for other related factors (e.g. smoking, hypercholesterolaemia, medications, and chronic inflammatory disease). Secondly, some medications such as antihypertensive treatment (including angiotensin-converting enzyme inhibitors, angiotensin receptor blocker, b-blocker), statins, medications for weight loss, and a medical history of drug addiction may influ-ence inflammatory mediators. It would be useful, and results might be different, if the authors had described these factors. Furthermore, the presence of MetS may be associated with many factors, including socioeconomic and lifestyle factors. Indi-viduals with a low level of education and of low socioeconomic status have been shown to be at a higher risk of MetS. They are usually characterised by incorrect dietary habits, low levels of physical activity and high levels of harmful habits, all of which increase the risk of metabolic abnormalities [6]. If these factors had been mentioned in the present study, its results would have been more robust.