Carotid Atheromas On Panoramic Radiographs May Herald Occult Metabolic Syndrome

Objectives: Metabolic syndrome (MetS) arising from the “obesity epidemic” is characterized by the co-occurrence of 1) abdominal obesity (increased waist circumference; men: > 102 cm, women: > 88), 2) hypertriglyceridemia (> 150 mg/dL), 3) reduced levels of HDL cholesterol (men: < 40 mg/dL, women: < 50 mg/dL), 4) hypertension (> 130/85 mmHg), and 5) insulin resistance manifesting as fasting blood glucose levels between 110 and 125 mg/dL. These abnormalities act synergistically to promote atherosclerosis of the carotid and coronary arteries which increases the risk of stroke and myocardial infarction. The study objective was to evaluate a group of patients having calcified carotid atheromas on their panoramic radiographs and determine the prevalence of occult MetS. Methods: A dentist evaluated the medical records of 61 men and 4 women (age range 50-83 years, mean 67.4) having a panoramic radiograph with a calcified carotid artery atheroma. Individuals having all 5 diagnostic criteria for MetS and a negative history of carotid (TIA/CVA) and coronary (angina/MI) artery diseases were referred to an endocrinologist for a comprehensive physical examination. Results: The endocrinologist confirmed that all nine (N = 9) men (age range 50-75 years, mean 60.4) referred for evaluation had MetS and were free of overt cardiovascular disease. The mean waist circumference of these individuals was 115 cm, and while six of the individuals were receiving medication for dyslipidemia and nine were being medicated for hypertension, the entire group’s mean triglyceride level was 256 mg/dL, HDL cholesterol 35 mg/dL, blood pressure 145/81 mmHg and fasting plasma glucose 116 mg/dL. Conclusion: Approximately 14% of patients with carotid atheromas on their panoramic radiographs have undiagnosed MetS. They should be referred to a physician for confirmation of the diagnosis and treatment because they are at heightened risk for a future stroke and myocardial infarction unless aggressively managed.