Metabolic syndrome and the risk of adverse cardiovascular events after an acute coronary syndrome

Abstract

Background The incremental prognostic value of assessing the metabolic syndrome has been disputed. Little is known regarding its prognostic value in patients after an acute coronary syndrome. Design and methods The presence of metabolic syndrome (2005 International Diabetes Federation) was assessed at baseline in SOLID-TIMI 52, a trial of patients within 30 days of acute coronary syndrome (median follow-up 2.5 years). The primary endpoint was major coronary events (coronary heart disease death, myocardial infarction or urgent coronary revascularization). Results At baseline, 61.6% ( n = 7537) of patients met the definition of metabolic syndrome, 34.7% (n = 4247) had diabetes and 29.3% had both ( n = 3584). The presence of metabolic syndrome was associated with increased risk of major coronary events (adjusted hazard ratio (adjHR) 1.29, p < 0.0001) and recurrent myocardial infarction (adjHR 1.30, p < 0.0001). Of the individual components of the definition, only diabetes (adjHR 1.48, p < 0.0001) or impaired fasting glucose (adjHR 1.21, p = 0.002) and hypertension (adjHR 1.46, p < 0.0001) were associated with the risk of major coronary events. In patients without diabetes, metabolic syndrome was numerically but not significantly associated with the risk of major coronary events (adjHR 1.13, p = 0.06). Conversely, diabetes was a strong independent predictor of major coronary events in the absence of metabolic syndrome (adjHR 1.57, p < 0.0001). The presence of both diabetes and metabolic syndrome identified patients at highest risk of adverse outcomes but the incremental value of metabolic syndrome was not significant relative to diabetes alone (adjHR 1.07, p = 0.54). Conclusions After acute coronary syndrome, diabetes is a strong and independent predictor of adverse outcomes. Assessment of the metabolic syndrome provides only marginal incremental value once the presence or absence of diabetes is established.

High-intensity interval training improves metabolic syndrome and body composition in outpatient cardiac rehabilitation patients with myocardial infarction

“…Metabolic syndrome (MetS) is a constellation of cardiovascular risk factors that include abdominal adiposity, impaired glucose tolerance, hypertension, low serum high-density lipoprotein cholesterol and hypertriglyceridemia [1], and is associated with an eightfold increase in the risk of myocardial infarction (MI) [2]. Presence of MetS in patients with MI is associated with increased risk of adverse cardiovascular events and recurrent MI [3]. Obesity, especially abdominal adiposity is also considered an initial and principal pathophysiologic component of MetS [4].…”

Metabolic Syndrome and Development of Diabetes Mellitus: Predictive Modeling Based on Machine Learning Techniques

“…However, predictive risk factors are needed to allow clinicians to identify and monitor individuals at increased risk for developing type 2 diabetes. Numerous clinical trials and meta-analyses studies confirm that MetS, a cluster of risk factors or clinical and biological abnormalities [7], [8], demonstrates a significant relationship with cardiovascular disease and all-cause mortality [9], [10].…”

“…Numerous existing research studies have demonstrated the role MetS plays as a predictor of cardiovascular disease [12], [21]- [24] and reported that regardless of any clinical criteria or definition, it is the major outcome of cardiovascular disease [9], [14], [16]- [21]. Many reports have also confirmed a strong relationship between MetS and incident diabetes.…”

Scribbling the Cat: A Case of the “Miracle” Plant, Moringa oleifera

“…Metabolic syndrome (MetS) comprises of a cluster of risk factors that are related to glucose and lipid metabolism (obesity) as well as cardiovascular dysfunction (blood pressure) [109,110]. Recently, the prevalence of MetS health outcomes such as Type 2 diabetes are on the rise, posing a public health burden particularly in the developing world [111].…”