Metabolic Syndrome Is Not Associated With Increased Mortality or Cardiovascular Risk in Nondiabetic Patients With a New Diagnosis of Coronary Artery Disease

Petersen, John L.; Yow, Eric; AlJaroudi, Wael; Shaw, Linda K.; Goyal, Abhinav; McGuire, Darren K.; Peterson, Eric D.; Harrington, Robert A.

doi:10.1161/circoutcomes.109.864447

Cited by 10 publications

(6 citation statements)

References 37 publications

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“…It has also been suggested that hyperglycemia per se, more than the metabolic syndrome as an entity, predicts the prognosis and outcome in CVD [7], [18], [24], [25], [26], and that young women are especially prone to the negative effects of both [27]. The present study shows that FMD was lower and prevalence of ED was higher in women with hyperglycemia.…”

Section: Discussionsupporting

confidence: 54%

“…Our findings support the notion that endothelial dysfunction is an important mechanism of gender-specific effects on CVD in patients with the metabolic syndrome, hyperglycemia or diabetes mellitus. Furthermore, the metabolic syndrome used as an entity may mask important differences in the sensitivity to specific risk factors, especially hyperglycemia, in assessing health and mortality [24], [25], [32].…”

Section: Discussionmentioning

confidence: 99%

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Cardiovascular Risk Factors Have Larger Impact on Endothelial Function in Self-Reported Healthy Women than Men in the HUNT3 Fitness Study

et al. 2014

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BackgroundSeveral studies suggest that cardiovascular risk factors comprising the metabolic syndrome have larger effects on the development of cardiovascular disease in women than in men. A recent study in self-reported healthy subjects demonstrated a marked gender difference in endothelial dysfunction that may be an important precursor of manifest cardiovascular disease. The aim of the present study was to determine whether the association between endothelial function and cardiovascular risk factors is different in self-reported healthy women compared to self-reported healthy men.Methods and ResultsAssociations between endothelial function (flow mediated dilation, FMD, of the brachial artery measured by ultrasound), anthropometric variables, peak oxygen uptake (VO2peak), blood pressure, serum lipids, blood glucose and a questionnaire on general health and lifestyle including smoking status were studied by logistic and linear regression in 2 528 women and 2 211 men aged 20–89 years, free from self-reported cardiovascular disease. In women with hyperglycemia, endothelial dysfunction (FMD ≤0%) occurred twice as frequently as in male counterparts. The presence of the metabolic syndrome, high blood pressure and low VO2peak increased the prevalence of endothelial dysfunction more in women than in men.ConclusionEndothelial dysfunction is more strongly associated with cardiovascular risk factors in self-reported healthy women than in self-reported healthy men. This finding could explain why the metabolic syndrome, and especially hyperglycemia, is associated with higher cardiovascular risk and a worse prognosis in women.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Cardiovascular Risk Factors Have Larger Impact on Endothelial Function in Self-Reported Healthy Women than Men in the HUNT3 Fitness Study

et al. 2014

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“…While there is some evidence of an increased risk in the stable coronary artery disease population,(1) this was mostly observed in patients with concomitant diabetes. (10) Our study shows that the diagnosis of MetS made in the setting of an AMI also confers a poor prognosis, independent of diabetes.…”

Section: Discussionmentioning

confidence: 63%

The Reliability and Prognosis of In-Hospital Diagnosis of Metabolic Syndrome in the Setting of Acute Myocardial Infarction

Arnold

Lipska

et al. 2013

Journal of the American College of Cardiology

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Objectives To examine the reliability and prognostic importance of an in-hospital diagnosis of MetS in the setting of AMI. Background As the factors that comprise the metabolic syndrome (MetS) are believed to be altered in the setting of an acute myocardial infarction (AMI), the diagnosis of MetS during AMI hospitalization and its prognostic significance have not been studied. Methods We assessed patients within a multicenter registry for metabolic factors at baseline and 1-month post-AMI and followed them for mortality and rehospitalizations. The accuracy of an inpatient diagnosis of MetS was calculated, using a 1-month follow-up as the gold standard. Patients were categorized based on MetS diagnosis at baseline and 1 month, and the combined endpoint of death or rehospitalization over 12 months was compared between groups. Results Of 1129 patients hospitalized for AMI, diagnostic criteria for MetS were met by 69% during AMI hospitalization and 63% at 1 month. Inpatient MetS diagnosis had a sensitivity and specificity for outpatient diagnosis of 87% and 61%, respectively, and was associated with an 11 times increased odds of an outpatient diagnosis (c-index=0.74). Compared with patients without MetS during hospitalization and follow-up, patients classified as MetS during AMI but not follow-up had worse outcomes; while those classified MetS at follow-up had the worst outcomes (rates for combined endpoint: 27% vs. 37% vs. 38%; log-rank p=0.01). Conclusions In a large cohort of AMI patients, the diagnosis of MetS is common and can be made with reasonable accuracy during AMI. It is associated with poor outcomes, regardless of whether the diagnosis is confirmed during subsequent outpatient visit, and identifies a high-risk cohort of patients that may benefit from more aggressive risk factor modification.

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“…Some authors have raised the question of whether it has additive prognostic value for CAD in tandem with its individual components. It was suggested that attempts to define a criteria of the MetS that simultaneously predicts for CAD and diabetes are unhelpful because the MetS had weak or no association with cardiovascular risk (6, 10, 18, 19). Those findings indicated that the MetS is a marker of CAD risk, but not above and beyond the risk associated with its individual components.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, the MetS has come to the fore as a major risk factor of CAD (3, 4). Isomaa et al (5) reported that patients with the MetS had a higher incidence of CAD and increased all-cause mortality than those without it, but other researchers failed to verify these relationships (6, 7). Thus, unlike diabetes mellitus, which is a well-known established risk factor for CAD (8, 9), whether MetS has an additive impact on the development of CAD in addition to its individual components (e.g., hypertension, diabetes) is controversial (10).…”

Section: Introductionmentioning

confidence: 99%

Differential Relationship between Metabolic Syndrome Score and Severity of Coronary Atherosclerosis as Assessed by Angiography in a Non-Diabetic and Diabetic Korean Population

et al. 2011

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Whether the metabolic syndrome (MetS) has prognostic value for coronary artery disease (CAD) beyond its individual components is controversial. We compared the relationship between the number of MetS components and CAD severity as assessed by angiography in non-diabetic and diabetic subjects. We consecutively enrolled 527 patients who underwent their first coronary angiography. Patients were divided into four groups according to the number of MetS components: 0/1, 2, 3, and 4/5. A coronary atherosclerosis score was used to quantify the extent of atherosclerotic involvement. The relationship between the MetS score and angiographic CAD severity or clinical presentation was compared between non-diabetic and diabetic subjects. Individuals with the MetS (n = 327) had a higher prevalence of CAD (60% vs 32%, P < 0.001), multi-vessel disease (34% vs 16%, P < 0.001), and acute coronary syndromes (49% vs 26%, P < 0.001) than those without the MetS. In the non-diabetic group, atherosclerosis score increased with the MetS score (1.0 ± 2.1, 2.0 ± 2.9, 2.8 ± 2.9, and 3.6 ± 3.9, P < 0.001) whereas there was no significant difference in the diabetic group (0.5 ± 1.0, 5.2 ± 4.7, 4.2 ± 2.9, and 4.4 ± 3.5, P = 0.102). The MetS score is related to CAD severity in non-diabetic patients but the association between the MetS score and angiographic CAD severity may be obscured in the presence of diabetes.

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Metabolic Syndrome Is Not Associated With Increased Mortality or Cardiovascular Risk in Nondiabetic Patients With a New Diagnosis of Coronary Artery Disease

Abstract: Background-Metabolic

Cited by 10 publications

References 37 publications

Cardiovascular Risk Factors Have Larger Impact on Endothelial Function in Self-Reported Healthy Women than Men in the HUNT3 Fitness Study

Cardiovascular Risk Factors Have Larger Impact on Endothelial Function in Self-Reported Healthy Women than Men in the HUNT3 Fitness Study

The Reliability and Prognosis of In-Hospital Diagnosis of Metabolic Syndrome in the Setting of Acute Myocardial Infarction

Differential Relationship between Metabolic Syndrome Score and Severity of Coronary Atherosclerosis as Assessed by Angiography in a Non-Diabetic and Diabetic Korean Population

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