Metabolic syndrome and risk of coronary heart disease in a Pakistani cohort.
OBJECTIVE
To assess the relation of the metabolic insulin resistance syndrome (M-IRS) with coronary heart disease (CHD) in Pakistani patients.


METHODS
200 patients with angiographic disease (CHD(+)) matched with 200 patients with chest pain without occlusive disease (CHD(-)).


METHODS
Prospective case-control study.


METHODS
Tertiary referral cardiology unit in Pakistan.


RESULTS
M-IRS was present in 37% of CHD(+) versus 27% of CHD(-) patients by criteria for white patients or 47% versus 42%, respectively, by Asian criteria (p < 0.001). After adjustment for other risk factors, M-IRS was not a significant predictor for CHD or angiographic disease. Age (p = 0.03), smoking (p < 0.001), diabetes-years (p = 0.003), sialic acid (p = 0.01), and creatinine (p = 0.008) accounted for the excess risk of CHD. Similarly, age (p = 0.005), creatinine (p < 0.001), cigarette pack-years (p = 0.02), diabetes-years (p = 0.003), and sialic acid (p = 0.08) were predictors of greater angiographic disease. M-IRS differed between Pakistani and white patients, as waist circumference correlated weakly (r = -0.03-0.08, p = 0.45-0.52) with triglycerides, high density lipoprotein cholesterol, systolic blood pressure, or glucose. Sialic acid was the only inflammatory marker associated with M-IRS.


CONCLUSIONS
Despite strong associations between individual risk factors associated with M-IRS and a univariate association between M-IRS and CHD in native Pakistanis, the principal discriminant risk factors in this group are age, smoking, inflammation, diabetes-years, and impaired renal function. The poor sensitivity of M-IRS for CHD reflects the high underlying prevalence of M-IRS, thus reducing sensitivity, confounding by other urban lifestyle traits, or a lack of association of waist circumference with M-IRS risk factors. The definition of M-IRS may have to be revised to increase its power as a discriminant risk factor for CHD in Pakistani populations.
Wierzbicki
A S
AS
Department of Chemical Pathology, St Thomas's Hospital, London SE1 7EH, UK. anthony.wierzbicki@kcl.ac.uk
Nishtar
S
S
Lumb
P J
PJ
Lambert-Hammill
M
M
Turner
C N
CN
Crook
M A
MA
Marber
M S
MS
Gill
J
J
D003324:Coronary Artery Disease / Q000208:ethnology / Q000209:etiology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000208:ethnology; D008875:Middle Aged; D010154:Pakistan / Q000208:ethnology