Impact of metabolic syndrome on atherosclerotic burden and cardiovascular prognosis
Christine Espinola-Klein1, Hans J Rupprecht, Christoph Bickel
1Department of Medicine II, Johannes Gutenberg-University, Mainz, and Department of Internal Medicine, Bundeswehrzentralkrankenhaus, Koblenz, Germany. espinola@uni-mainz.de
Insights
Metabolic syndrome (MS) significantly increases cardiovascular events in patients with coronary heart disease (CHD), regardless of atherosclerotic burden. Identifying MS is crucial for predicting poor prognosis and guiding treatment in high-risk populations.
Area of Science:
- Cardiology
- Metabolic Diseases
- Vascular Health
Background:
- Patients with metabolic syndrome (MS) face elevated risks of cardiovascular atherosclerosis.
- Coronary heart disease (CHD) patients with MS exhibit a higher incidence of adverse cardiovascular events.
- Understanding the interplay between MS, atherosclerotic burden, and cardiovascular outcomes is critical for risk stratification.
Purpose of the Study:
- To assess the impact of metabolic syndrome (MS) on cardiovascular prognosis.
- To evaluate the influence of atherosclerotic burden on cardiovascular events in patients with CHD.
- To determine if MS is an independent predictor of cardiovascular events in CHD patients with varying degrees of atherosclerosis.
Main Methods:
- Sonographic examination of carotid and leg arteries in 811 CHD patients.
- Classification of patients into low (CHD only) and high (CHD and peripheral atherosclerosis) atherosclerotic burden groups.
- Diagnosis of MS based on established criteria (triglycerides, HDL, BMI, blood pressure, fasting glucose).
Main Results:
- Metabolic syndrome (MS) presence significantly increased cardiovascular events in both low (21.2% vs 12.9%) and high (34.3% vs 26.5%) atherosclerotic burden groups.
- MS was identified as an independent predictor of cardiovascular events across all CHD patients (HR 1.7) and particularly in those with high atherosclerotic burden (HR 1.8).
- Follow-up data over a median of 6.7 years revealed a higher event rate in MS patients.
Conclusions:
- Metabolic syndrome (MS) markedly worsens the long-term prognosis for patients with coronary heart disease (CHD), irrespective of atherosclerotic burden.
- Patients with both high atherosclerotic burden and MS represent a high-risk population requiring intensified management.
- Early identification and aggressive treatment of MS in CHD patients are essential for improving cardiovascular outcomes.
Abstract:
Patients with metabolic syndrome (MS) are at increased risk of cardiovascular atherosclerosis. The aim of this study was to evaluate the impact of MS on cardiovascular prognosis in context with atherosclerotic burden. A total of 811 patients with coronary heart disease (CHD) were included and carotid and leg arteries were examined using sonographic methods. Patients with low (CHD only, n = 428, 52.8%) or high atherosclerotic burden (CHD and peripheral atherosclerosis, n=383, 47.2%) were compared. Patients with >or=3 of the following criteria: triglycerides>or=150 mg/dl, high-density lipoprotein cholesterol<40 mg/dl (men) and <50 mg/dl (women), body mass index>30 kg/m2, blood pressure>or=130/85 mm Hg, and fasting glucose>or=100 mg/dl were defined as having MS (n=349, 43.0%). Follow-up data (median 6.7 years) were available for 807 patients (99.5%), and 175 patients (21.7%) experienced cardiovascular events (myocardial infarction, death, and stroke). The presence of MS significantly increased cardiovascular events in patients with low and high atherosclerotic burden (low: MS yes 21.2%, MS no 12.9%, p=0.02; high: MS yes 34.3%, MS no 26.5%, p=0.01). MS could be identified as an independent predictor for cardiovascular events in all patients (hazard ratio 1.7, 95% confidence interval 1.3 to 2.3, p<0.0001, adjusted) and patients with high atherosclerotic burden in particular (hazard ratio 1.8, 95% confidence interval 1.2 to 2.6, p=0.005, adjusted). In conclusion, MS markedly worsens the long-term prognosis of patients with both low and high atherosclerotic burden. Moreover, patients with high atherosclerotic burden and MS should be considered a high-risk population and treated accordingly.
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