title: The metabolic syndrome and risk of major coronary events in the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS).
abstract: The metabolic syndrome, which is a set of lipid and nonlipid risk factors of metabolic origin linked with insulin resistance, is believed to be associated with an elevated risk for cardiovascular disease, but few have studied this association in prospective long-term cardiovascular outcomes trials. Placebo data from the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) were used post hoc to estimate the long-term relative risk of major coronary events (MCEs) associated with the metabolic syndrome, after excluding diabetes mellitus. In 4S and AFCAPS/TexCAPS, respectively, placebo-treated patients with the metabolic syndrome were 1.5 (95% confidence interval 1.2 to 1.8) and 1.4 (95% confidence interval 1.04 to 1.9) times more likely to have MCEs than those without it. Of the components of the metabolic syndrome, low high-density lipoprotein levels were associated with elevated risk of MCEs in both studies, whereas high triglycerides in 4S and elevated blood pressure and obesity in AFCAPS/TexCAPS were associated with significantly increased relative risk. Patients with the metabolic syndrome showed increased risk of MCEs irrespective of their Framingham-calculated 10-year risk score category (>20% vs </=20%). These data demonstrate that the metabolic syndrome is associated with increased risk of MCEs in both hypercholesterolemic patients with coronary heart disease in 4S and in those with low high-density lipoprotein cholesterol but without coronary heart disease in AFCAPS/TexCAPS. It appears that the metabolic syndrome is associated with risk that is not entirely accounted for by traditional risk scoring paradigms.
authors.affiliation: Departments of Epidemiology, Merck Research Laboratories, West Point, Pennsylvania 19486, USA. cindy_giman@merck.com
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Girman
authors.forename: Thomas
authors.initials: T
authors.lastname: Rhodes
authors.forename: Michele
authors.initials: M
authors.lastname: Mercuri
authors.forename: Kalevi
authors.initials: K
authors.lastname: Pyörälä
authors.forename: John
authors.initials: J
authors.lastname: Kjekshus
authors.forename: Terje R
authors.initials: TR
authors.lastname: Pedersen
authors.forename: Polly A
authors.initials: PA
authors.lastname: Beere
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Gotto
authors.forename: Michael
authors.initials: M
authors.lastname: Clearfield
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D008076:Cholesterol, HDL / Q000097:blood; D003324:Coronary Artery Disease / Q000517:prevention & control*; D003327:Coronary Disease / Q000188:drug therapy / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D010919:Placebos; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D018570:Risk Assessment; D019821:Simvastatin / Q000627:therapeutic use*; D014280:Triglycerides / Q000097:blood
chemical_list: D000924:Anticholesteremic Agents; D008076:Cholesterol, HDL; D010919:Placebos; D014280:Triglycerides; D019821:Simvastatin