Presence of the metabolic syndrome does not impair coronary collateral vessel formation in patients with documented coronary artery disease.
OBJECTIVE
The metabolic syndrome confers an increased risk for cardiovascular morbidity and mortality. The presence of coronary collaterals may have beneficial effects during myocardial ischemia and may improve cardiovascular outcome in patients with coronary artery disease. Impaired collateral formation could be one of the reasons for the increased cardiovascular risk in patients with the metabolic syndrome. The aim of the present study was to determine the influence of the metabolic syndrome and insulin resistance on the presence of coronary collaterals.


METHODS
We conducted a cross-sectional study in 227 patients referred for elective percutaneous transluminal coronary angioplasty to the University Medical Centre Utrecht. The metabolic syndrome was diagnosed according to Adult Treatment Panel III, and homeostasis model assessment of insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI) were used to quantify insulin resistance. Coronary collaterals were graded with Rentrop's classification. Rentrop grade >/=1 indicated the presence of collaterals. Results were adjusted for age, sex, and severity of coronary artery disease.


RESULTS
A total of 103 patients (45%) were diagnosed with the metabolic syndrome. There was no association between the metabolic syndrome and the presence of coronary collateral formation (odds ratio [OR] 1.2 [95% CI 0.7-2.0]). Also, the degree of insulin resistance was not related to the presence of coronary collaterals. The OR for HOMA-IR (highest versus lowest tertile) was 0.7 (0.3-1.5) and for QUICKI (lowest versus highest tertile) 0.8 (0.4-1.6).


CONCLUSIONS
The metabolic syndrome and insulin resistance are not related to the presence of coronary collaterals in patients with documented coronary artery disease.
Olijhoek
Jobien K
JK
Department of Internal Medicine, Section of Vascular Medicine, University Medical Centre Utrecht, F02.126, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands. j.k.olijhoek@amcutrecht.nl
Koerselman
Jeroen
J
de Jaegere
Peter P Th
PP
Verhaar
Marianne C
MC
Grobbee
Diederick E
DE
van der Graaf
Yolanda
Y
Visseren
Frank L J
FL
D052242:Adiponectin; D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D049628:Body Size; D015331:Cohort Studies; D003327:Coronary Disease / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D036341:Intercellular Signaling Peptides and Proteins / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000503:physiopathology*; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D012727:Sex Characteristics
D052242:Adiponectin; D001786:Blood Glucose; D007328:Insulin; D036341:Intercellular Signaling Peptides and Proteins