Association of metabolic syndrome and its individual components with outcomes among patients with high-risk non–ST-segment elevation acute coronary syndromes

Mehta, Rajendra H.; Westerhout, Cynthia M.; Zheng, Yinggan; Giugliano, Robert P.; Huber, Kurt; Prabhakaran, Dorairaj; Harrington, Robert A.; Newby, Kristin; Armstrong, Paul W.; Investigators, Early Acs

doi:10.1016/j.ahj.2014.04.009

Cited by 14 publications

(22 citation statements)

References 26 publications

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“… 16) In a large multicenter study, it has been found that MetS patients have similar outcomes as non-MetS patients among NSTE-ACS cases. 17) We also demonstrated that there was no significant difference regarding the MACE incidence between MetS patients and non-MetS patients. This might be due to the presence of NSTE-ACS in our cohort and heterogeneous population.…”

Section: Discussionmentioning

confidence: 53%

White Blood Cell Count to Mean Platelet Volume Ratio Is a Prognostic Factor in Patients with Non-ST Elevation Acute Coronary Syndrome with or without Metabolic Syndrome

et al. 2016

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Background and ObjectivesLeukocyte and platelet have been found to be associated with metabolic syndrome (MetS). We aimed to determine the usefulness of a novel marker named white blood cell count to mean platelet volume ratio (WMR) for predicting outcomes of non-ST elevation acute coronary syndrome (NSTE-ACS) with or without MetS.Subjects and MethodsA total of 331 NSTE-ACS individuals (60±12.5 years, 57.4% male) were enrolled and followed for a median of 24 months. MetS was identified using the National Cholesterol Education Program Adult Treatment Panel III criteria.ResultsPatients were divided into two groups: high WMR (WMR≥720) and low WMR (WMR<720). Major adverse cardiovascular events (MACE) and MetS rates were significantly greater in the higher WMR group compared to those in the low WMR group (MACE: 14.3% vs. 25%, p=0.014; MetS: 50.9% vs. 75%, p<0.001). MetS was diagnosed in 62.2% of patients. MACE incidence in patients with or without MetS was comparable (p=0.737). Among MetS individuals, patients in the high WMR group had more MACE than the low WMR group (11.2% vs. 26.5%, p=0.007). However, MACE was comparable among non-MetS individuals (p=0.681). In multivariable Cox regression analysis, hazard ratios (HR) of MACE incidence for high-WMR in MetS individuals was 2.616 (95% confidence interval: 1.282–5.339, p=0.008). However, HR of MACE incidence for high WMR in non-MetS individuals was not significant.ConclusionAmong NSTE-ACS patients without revascularization therapy, elevated admission WMR was associated with an increased risk of developing composite MACE in MetS individuals but not in non-MetS patients.

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Section: Discussionmentioning

confidence: 53%

White Blood Cell Count to Mean Platelet Volume Ratio Is a Prognostic Factor in Patients with Non-ST Elevation Acute Coronary Syndrome with or without Metabolic Syndrome

et al. 2016

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“…Thus far, literature is inconclusive about the risk associated with MetS components and increasing MetS score. In a study with 9406 participants, it was concluded that MetS was not associated with 1-year mortality, while reduced HDL-cholesterol was associated with higher risk and raised triglycerides were associated with lower 1-year mortality risk [5]. In a case–control study, MetS was associated with higher risk of venous thromboembolism.…”

Section: Discussionmentioning

confidence: 99%

“…In a study including 4122 participants with a mean follow-up of 8.5 years, the risk of coronary heart disease increased with increasing number of MetS components [3]. In addition, there are also studies showing that separate components are more important for the risk of different outcomes than the combination of components in MetS [4, 5]. Obesity is a key component in MetS, becoming more relevant because of its increasing prevalence.…”

Section: Introductionmentioning

confidence: 99%

Association of metabolic syndrome and electrocardiographic markers of subclinical cardiovascular disease

Elffers

Mutsert

Lamb

et al. 2017

Diabetol Metab Syndr

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BackgroundThe metabolic syndrome (MetS) and its components are well-established risk factors for cardiovascular diseases (CVD). It is inconclusive whether MetS and MetS score are associated with electrocardiographic markers of subclinical CVD, therefore we investigated this in a population without pre-existing CVD.MethodsWe performed a cross-sectional analysis in the Netherlands Epidemiology of Obesity study, a population-based cohort including 6671 participants aged 45–65. We excluded participants with pre-existing CVD (n = 499) or missing MetS components (n = 58). MetS was defined based on a modified definition of Adult Treatment Panel III. Subclinical CVD parameters were determined with 12-lead ECGs. MetS score was defined as number of abnormal MetS components and obesity as Body Mass Index (BMI) ≥30 kg/m2. We performed weighted adjusted linear regression analyses.ResultsOur study population (n = 6114) had a mean (SD) BMI of 26.3 (4.4) kg/m2 and MetS was present in 24% of participants. All ECG parameters differed between participants with and without MetS. Per additional MetS component, heart rate was 0.17 SD (95% CI 0.15, 0.19) higher, P wave duration, QRS complex duration and corrected QT interval were longer [0.07 SD (0.05, 0.10), 0.04 SD (0.01, 0.06) and 0.05 SD (0.02, 0.08) respectively], P wave axis, T wave axis and QRS axis were lower [−0.10 SD (−0.12, −0.07), −0.07 SD (−0.10, −0.05) and −0.19 SD (−0.22, −0.16)] and percentage small Q-waves also increased per additional MetS component. Associations were stronger in non-obese than obese participants. In joint modelling of all MetS components, increased waist circumference showed strongest associations with ECG parameters.ConclusionsMetabolic syndrome score and its individual components, in particular abdominal obesity, are associated with ECG markers of subclinical CVD, showing the importance of limiting the amount of MetS components in both obese and non-obese persons.Electronic supplementary materialThe online version of this article (doi:10.1186/s13098-017-0238-9) contains supplementary material, which is available to authorized users.

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“…A recent study demonstrated that normal weight patients with cardiometabolic dysfunction are at similar or even higher risk of cardiovascular morbidity and all-cause mortality in comparison with overweight and obese patients with cardiometabolic dysfunction [ 38 ]. However, in another study in patients with non-ST-segment elevation acute coronary syndrome only two components of the metabolic syndrome (low high-density lipoprotein and high triglycerides) were associated with higher 1-year mortality when examined separately [ 39 ]. Furthermore, it has been suggested to differentiate between metabolically healthy and metabolically obese patients within the BMI groups to better understand the effects of metabolic syndrome [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Association of obesity and long-term mortality in patients with acute myocardial infarction with and without diabetes mellitus: results from the MONICA/KORA myocardial infarction registry

Colombo

Meisinger

Amann

et al. 2015

Cardiovasc Diabetol

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BackgroundParadoxically, beneficial effects of overweight and obesity on survival have been found in patients after cardiovascular events such as acute myocardial infarction (AMI). This obesity paradox has not been analyzed in AMI patients with diabetes even though their cardiovascular morbidity and mortality is increased compared to their counterparts without diabetes. Therefore, the objective of this long-term study was to analyze the association between body mass index (BMI) and all-cause mortality in AMI patients with and without diabetes mellitus.MethodsIncluded in the study were 1190 patients with and 2864 patients without diabetes, aged 28-74 years, recruited from a German population-based AMI registry. Patients were consecutively hospitalized between 1 January 2000 and 31 December 2008 with a first ever AMI and followed up until December 2011. Data collection comprised standardized interviews and chart reviews. To assess the association between BMI and long-term mortality from all causes, Cox proportional hazards models were calculated adjusted for risk factors, co-morbidities, clinical characteristics, in-hospital complications as well as medical and drug treatment.ResultsAMI patients of normal weight (BMI 18.5-24.9 kg/m2) had the highest long-term mortality rate both in patients with and without diabetes with 50 deaths per 1000 person years and 26 deaths per 1000 person years, respectively. After adjusting for a selection of covariates, a significant, protective effect of overweight and obesity on all-cause mortality was found in AMI patients without diabetes (overweight: hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.58-0.93; p=0.009; obesity: HR 0.64, 95% CI 0.47-0.87; p=0.004). In contrast, an obesity paradox was not found in AMI patients with diabetes. However, stratified analyses showed survival benefits in overweight AMI patients with diabetes who had been prescribed statins prior to AMI (HR 0.51, 95% CI 0.29-0.89, p=0.018) or four evidence-based medications at hospital-discharge (HR 0.52, 95% CI 0.34-0.80, p=0.003).ConclusionIn contrast to AMI patients without diabetes, AMI patients with diabetes do not experience a survival benefit from an elevated BMI. To investigate the underlying reasons for these findings, further studies stratifying their samples by diabetes status are needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-015-0189-0) contains supplementary material, which is available to authorized users.

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Association of metabolic syndrome and its individual components with outcomes among patients with high-risk non–ST-segment elevation acute coronary syndromes

Cited by 14 publications

References 26 publications

White Blood Cell Count to Mean Platelet Volume Ratio Is a Prognostic Factor in Patients with Non-ST Elevation Acute Coronary Syndrome with or without Metabolic Syndrome

White Blood Cell Count to Mean Platelet Volume Ratio Is a Prognostic Factor in Patients with Non-ST Elevation Acute Coronary Syndrome with or without Metabolic Syndrome

Association of metabolic syndrome and electrocardiographic markers of subclinical cardiovascular disease

Association of obesity and long-term mortality in patients with acute myocardial infarction with and without diabetes mellitus: results from the MONICA/KORA myocardial infarction registry

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