Metabolic syndrome and risk of coronary heart disease in a Pakistani cohort
A S Wierzbicki1, S Nishtar, P J Lumb
1Department of Chemical Pathology, St Thomas's Hospital, London SE1 7EH, UK. anthony.wierzbicki@kcl.ac.uk
Insights
Metabolic insulin resistance syndrome (M-IRS) showed a univariate association with coronary heart disease (CHD) in Pakistani patients. However, age, smoking, inflammation, diabetes duration, and renal function were the primary predictors of CHD risk in this population.
Area of Science:
- Cardiology
- Metabolic Syndrome
- Public Health
Background:
- Metabolic insulin resistance syndrome (M-IRS) is a cluster of conditions that increase the risk of cardiovascular disease.
- Understanding the relationship between M-IRS and coronary heart disease (CHD) is crucial for effective prevention strategies, particularly in diverse ethnic groups.
Purpose of the Study:
- To investigate the association between metabolic insulin resistance syndrome (M-IRS) and coronary heart disease (CHD) in a Pakistani population.
- To identify key risk factors for CHD in Pakistani patients, considering the potential influence of M-IRS.
Main Methods:
- A prospective case-control study was conducted involving 200 patients with confirmed CHD and 200 controls without significant coronary artery disease.
- Patients were recruited from a tertiary referral cardiology unit in Pakistan.
Main Results:
- Metabolic insulin resistance syndrome (M-IRS) was more prevalent in patients with coronary heart disease (CHD) compared to controls, irrespective of diagnostic criteria (37% vs. 27% or 47% vs. 42%).
- After adjusting for other risk factors, M-IRS was not a significant independent predictor of CHD. Key predictors identified were age, smoking, diabetes duration, sialic acid (an inflammatory marker), and creatinine (indicating renal function).
- Waist circumference showed a weak correlation with metabolic parameters in Pakistani patients, suggesting potential differences in M-IRS manifestation compared to white populations.
Conclusions:
- While individual M-IRS-associated risk factors and a univariate link between M-IRS and CHD exist in Pakistanis, age, smoking, inflammation, diabetes duration, and renal function are the primary discriminators of CHD risk.
- The poor sensitivity of M-IRS as a CHD predictor in this population may be due to high M-IRS prevalence, confounding lifestyle factors, or a weak association with waist circumference.
- The definition and diagnostic criteria for M-IRS may require adaptation for improved accuracy in predicting CHD risk within Pakistani populations.
Objective:
To assess the relation of the metabolic insulin resistance syndrome (M-IRS) with coronary heart disease (CHD) in Pakistani patients.
Subjects:
200 patients with angiographic disease (CHD(+)) matched with 200 patients with chest pain without occlusive disease (CHD(-)).
Design:
Prospective case-control study.
Setting:
Tertiary referral cardiology unit in Pakistan.
Results:
M-IRS was present in 37% of CHD(+) versus 27% of CHD(-) patients by criteria for white patients or 47% versus 42%, respectively, by Asian criteria (p < 0.001). After adjustment for other risk factors, M-IRS was not a significant predictor for CHD or angiographic disease. Age (p = 0.03), smoking (p < 0.001), diabetes-years (p = 0.003), sialic acid (p = 0.01), and creatinine (p = 0.008) accounted for the excess risk of CHD. Similarly, age (p = 0.005), creatinine (p < 0.001), cigarette pack-years (p = 0.02), diabetes-years (p = 0.003), and sialic acid (p = 0.08) were predictors of greater angiographic disease. M-IRS differed between Pakistani and white patients, as waist circumference correlated weakly (r = -0.03-0.08, p = 0.45-0.52) with triglycerides, high density lipoprotein cholesterol, systolic blood pressure, or glucose. Sialic acid was the only inflammatory marker associated with M-IRS.
Conclusions:
Despite strong associations between individual risk factors associated with M-IRS and a univariate association between M-IRS and CHD in native Pakistanis, the principal discriminant risk factors in this group are age, smoking, inflammation, diabetes-years, and impaired renal function. The poor sensitivity of M-IRS for CHD reflects the high underlying prevalence of M-IRS, thus reducing sensitivity, confounding by other urban lifestyle traits, or a lack of association of waist circumference with M-IRS risk factors. The definition of M-IRS may have to be revised to increase its power as a discriminant risk factor for CHD in Pakistani populations.
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