Metabolic syndrome and coronary artery disease: is there a gender specific effect?

Clustering of cardiovascular risk factors is observed in metabolic syndrome (MS), but the relative contribution of different factors to determine outcomes remains largely unknown. We investigated the influence of gender in the effect of MS in coronary vascular lesions in 385 patients who underwent first time coronary artery disease (CAD) assessment through coronary angiography.

Patients were stratified in two groups: metabolic syndrome (MS, N = 190) and non-metabolic syndrome (NMS, N = 195), according to standard criteria. Two vascular scores related to extension and severity of vascular lesions were determined by systematic analysis of 20 coronary segments.

MS was more prevalent in females (58.7 vs. 39.7%, p = 0.0005) and hypertension and low-HDL were the leading prevalent factors in the MS group. Scores for extension and severity of lesions were higher in the MS than in the NMS group (2.10 +/- 1.75 vs. 1.75 +/- 1.58; p = 0.01, and 1.49 +/- 1.29 vs. 1.25 +/- 1.15; p = 0.03, respectively). The impact of MS in CAD scores was more pronounced in females (OR 2.2, 95% CI 1.1-4.3, p = 0.02) than in males (OR 1.5, 95% CI 0.8-2.7, p = 0.17). Non-HDL cholesterol was the only risk factor influencing the scores in a gender specific manner, showing an increased impact in the female gender. Normal coronary angiograms were more frequent in females (p = 0.0001), especially in NMS. Collectively, these data suggest that MS is related to higher extension and severity of vascular lesions in this population regardless of gender but lipids and anthropometric parameters may differentially modulate the MS effect in a particular gender.