Metabolic syndrome and mortality in stable coronary heart disease: relation to gender
Charlotte Kragelund1, Lars Køber, Jens Faber
1Department of Cardiology, Hvidovre University Hospital, Hvidovre, Denmark. kragelund@dadlnet.dk <kragelund@dadlnet.dk>
Insights
Metabolic syndrome (MS) increases mortality risk in women with stable coronary heart disease, but not in men. This finding is independent of other cardiovascular risk factors.
Area of Science:
- Cardiology
- Metabolic Health
- Epidemiology
Background:
- Metabolic syndrome (MS) is linked to type 2 diabetes and cardiovascular disease.
- Its impact on mortality in stable coronary heart disease (CHD) patients is unclear, as is its gender-specific association.
- Prognostic implications of MS in stable CHD require further investigation.
Purpose of the Study:
- To investigate the association between metabolic syndrome and all-cause mortality in patients with stable coronary heart disease.
- To determine if this association differs between men and women.
- To assess the prognostic value of MS independent of traditional cardiovascular risk factors.
Main Methods:
- A cohort of 1041 patients with stable coronary heart disease undergoing elective coronary angiography was studied.
- Baseline data included hypertension, BMI, lipids, glucose, and insulin.
- All-cause mortality was tracked over a median of 9.2 years.
Main Results:
- 30% of patients had metabolic syndrome (MS).
- MS was associated with higher rates of diabetes and three-vessel coronary artery disease.
- MS significantly increased all-cause mortality risk in women (HR=2.2, p=0.02) but not in men (HR=1.0, p=0.93).
Conclusions:
- Metabolic syndrome provides significant prognostic information in women with stable coronary heart disease.
- The association between MS and mortality in women is independent of conventional cardiovascular risk factors and disease severity.
- MS does not appear to be an independent predictor of mortality in men with stable coronary heart disease.
Background:
Metabolic syndrome (MS) is associated with subsequent development of type 2 diabetes and cardiovascular disease in the general population. The impact of MS on mortality in patients with stable coronary heart disease is less well defined, and the association of prognosis to gender is unknown.
Methods:
1041 patients with stable coronary heart disease, referred for elective coronary angiography were included in this study. At baseline, history of hypertension, body mass index, lipids, fasting plasma glucose, and insulin were recorded. All-cause mortality was determined after a median follow-up of 9.2 years.
Results:
At follow-up 296 (28%) patients had died. 315 (30%) patients had MS based on the definition by the World Health Organization. Patients with MS more frequently had diabetes and three-vessel disease of the coronary arteries. Men had a more severe risk profile than women. In a multivariable Cox regression analysis, MS was not associated with excess mortality risk in the overall population [adjusted HR=1.3 (95% CI: 0.7-2.3), p=0.43]. In gender specific analyses MS increased risk of all-cause mortality in women [adjusted HR=2.2 (95% CI: 1.1-4.3), p=0.02], but not in men [adjusted HR=1.0 (95% CI: 0.5-1.9), p=0.93].
Conclusions:
MS provides prognostic information in women, but not in men. This association was independent of conventional cardiovascular risk factors including previously unrecognised diabetes, and angiographic coronary artery disease.
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