Endogenous carbon monoxide (CO) induces protective activity at physiological concentrations. When chronically elevated levels of CO are observed, it may reflect underlying oxidative stress, inflammation and vascular pathology. The blood CO levels are reflected by measures of exhaled CO. The aim of this paper was to investigate the relation of exhaled CO and the presence of cardiometabolic risk factors as well as the incidence of metabolic syndrome and cardiovascular disease (CVD). The study sample included 4,139 individuals (mean age: 46 years; 53% women) for a total of 14,943 examinations performed in the Framingham Heart Study. Analyses revealed that exhaled CO levels were significantly higher in younger compared with older individuals and in men compared with women. Exhaled CO was also positively associated with conventional cardiometabolic risk factors, such as diabetes and the cholesterol/HDL cholesterol ratio. In accordance, exhaled CO was associated with both prevalent and incident metabolic syndrome as well as incident CVD. For instance, elevated CO was asociated with CVD among individuals with or without baseline metabolic syndrome. These findings suggest that elevated CO may be a marker for the development of both metabolic syndrome and CVD.
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