Impaired Fasting Glucose Is the Major Determinant of the 20‐Year Mortality Risk Associated With Metabolic Syndrome in Nondiabetic Patients With Stable Coronary Artery Disease

Abstract

BackgroundWe wanted to explore the association of metabolic syndrome (MetS) versus its individual components with 20‐year all‐cause mortality among patients with stable coronary artery disease.Methods and ResultsThe cohort comprised 12 403 nondiabetic patients with stable coronary artery disease who were enrolled in the Bezafibrate Infarction Prevention Registry between February 1990 and October 1992 and followed up through December 2014. The study cohort was divided into 4 groups: patients without MetS or impaired fasting glucose (IFG), patients with IFG but without MetS, patients with MetS but without IFG, and patients with both MetS and IFG. Kaplan‐Meier survival analysis showed that at 20 years of follow‐up, the rates of all‐cause mortality were the highest among patients with both MetS and IFG (66%). Patients with IFG without MetS experienced a significantly higher mortality rate compared with those with MetS without IFG (61% versus 56%; log‐rank P<0.001). Multivariable Cox proportional hazard analysis showed that the final Cox model demonstrated that the additive effect of MetS (hazard ratio, 1.13; 95% confidence interval, 1.1–1.16; P=0.02) and IFG (hazard ratio, 1.54; 95% confidence interval, 1.46–1.62; P<0.001) on 20 years mortality was nonsignificant (hazard ratio, 1.01; 95% confidence interval, 0.93–1.11; P=0.69). IFG was associated with the most pronounced increase in mortality risk among the individual components (hazard ratio, 1.22; 95% confidence interval, 1.14–1.3; P<0.001).ConclusionsOur findings suggest that IFG alone is a major independent predictor of long‐term mortality among patients with stable coronary artery disease versus other components of the MetS.

Effect of metabolic syndrome on coronary heart disease in rural minorities of Xinjiang: a retrospective cohort study

“…Due to differences in study populations and varying definitions of metabolic syndrome, although the degree of effect of metabolic syndrome in various studies were different, they were all concordant with the present study regard to the finding that metabolic syndrome is a risk factor for CHD. A study comprised of 12,403 patients showed that mandatory diagnostic requirements for (≥ 3) risk factors for metabolic syndrome, which can cause the predictive value of these factors to be lost completely or partly [18]. The present study solidifies the view that metabolic syndrome has a weaker impact on CHD than elevated blood pressure and elevated FBG after adjusting the components using multivariate analysis.…”

“…Insulin resistance has an indisputable role in the basis of metabolic syndromerelated pathophysiology; the mechanisms of this adverse effect is acceleration of the production of circulating malondialdehyde-modified low density lipoprotein and impairment of endothelial function [20]. We found that elevated FBG (adjusted HR 1.82; 95% CI 1.38-2.38) increased the risk of CHD, studies have reported that FBG is a better marker of insulin resistance, which might be because inflammation and impaired endothelial function worsen the risk of CHD [18,21]. Previous research on CHD and the metabolic syndrome components reported different conclusions, mostly in relation to about whether blood pressure plays a pivotal role in the progression of CHD [22,23].…”

Anthropometrics, Metabolic Syndrome, and Mortality Hazard

“…WC is the anthropometric component of the MS definition, and some authors even consider above-cutpoint WC values to be mandatory for diagnosis of MS. WC conceptually is considered a measure of abdominal obesity, but statistically it differs little from the even more widely used body mass index (BMI), as the correlation between the two in large population studies is typically close to 0.9. Given this high correlation, BMI has even been taken to replace WC for the definition of MS in cohorts where WC data were unavailable [ 2 ]. A derivative of WC and hip circumference (HC) that is also taken to indicate abdominal obesity is WC/HC ratio [ 3 – 6 ], which has lesser, but still substantial correlation with BMI of ∼0.4 [ 7 ].…”

“…MS is known to be a risk factor for all-cause mortality, as well as onset of cardiovascular disease and diabetes [ 11 ], although whether it improves prediction over just using some of its individual components continues to be investigated [ 2 , 12 , 13 ]. Similarly, the anthropometric indices combined into ARI, particularly ABSI, have been shown to predict mortality hazard and morbidity onset [ 14 – 25 ].…”

Association of Metabolic Syndrome and Its Components with Survival of Older Adults

“…In another study, Krakauer et al showed that hyperglycemia, hypertension, and low HDL made the greatest association of MetS with mortality hazard ratio (23). A cohort study with 20 years follow-up showed that patients with MetS and impaired blood glucose had the highest mortality rate in comparison with those who did not have MetS or hyperglycemia (24). Another prospective study represented that during 5-year follow-up, patients with MetS had significantly higher cardiovascular mortality and mortality risk was mostly attributed to hyperglycemia (25).…”