Impact of metabolic syndrome on clinical outcomes after new generation drug-eluting stent implantation: The ‘obesity paradox’ phenomenon is still apparent

The Impact of Metabolic Syndrome on Clinical Outcomes After Everolimus-Eluting Stent Implantation

“…21e23 Similar results were also observed in patients who had undergone DES implantation. 12,20 Therefore, the obesity paradox associated with cardiovascular outcomes remains a subject of active debate. Potential reasons for the obesity paradox included greater metabolic reserves in obese patients, 5 nonpurposeful weight loss in advanced heart diseases, 24 and more aggressive medical treatments for DM, hypertension, and dyslipidemia in obese patients.…”

Risk of major adverse cardiovascular events in patients with metabolic syndrome after revascularization: A meta-analysis of eighteen cohorts with 18457 patients

“…Studies were published between 2005 and 2014, with sample sizes varying from 157 to 6352. Ten trials [10][11][12][14][15][16][17]19,20,[23][24][25]28] were performed in eastern countries (China, Japan, and Korea) and the remaining [9,13,18,21,22,26,27,29] in western countries (Italy, USA, Germany, Greece, and Brazil). Of these trials, three of them with four publications [12,16,21,27] were conducted in patients without DM.…”

“…Participants underwent revascularization by PCI in 16 studies, CABG in two studies [9,12], and PCI or CABG in the remaining two [11,15]. PCI was performed via DES in five studies [10,21,[27][28][29], BMS in two studies [13,24], and DES/BMS in the other ones. The definitions of MetS were according to National Cholesterol Education Program/Adult Treatment Panel III in 13 studies [9,11,13,[17][18][19][20][23][24][25][26]28,29], American Heart Association and the National Heart, Lung, and Blood Institute in four studies [12,[14][15][16]21,22,27], and International Diabetes Federation in the other one [10].…”

“…PCI was performed via DES in five studies [10,21,[27][28][29], BMS in two studies [13,24], and DES/BMS in the other ones. The definitions of MetS were according to National Cholesterol Education Program/Adult Treatment Panel III in 13 studies [9,11,13,[17][18][19][20][23][24][25][26]28,29], American Heart Association and the National Heart, Lung, and Blood Institute in four studies [12,[14][15][16]21,22,27], and International Diabetes Federation in the other one [10]. In eleven studies [10][11][12][13][14][15][16][17]19,20,[22][23][24]26], the association between MACE and MetS was adjusted by several potential confounding factors.…”

“…MetS was reported to be associated with increased risks of type 2 diabetes mellitus (DM), cardiovascular and cerebrovascular events, and chronic kidney disease (CKD) [5][6][7][8]. Several studies [9][10][11][12][13][14][15][16][17][18][19][20] have reported that MetS is an independent risk factor of major adverse cardiovascular events (MACE) in patients with CAD undergoing revascularization, nevertheless, some others indicate that no impact [21][22][23][24][25][26][27][28] and even protective effect [29] of MetS exists in these patients.…”