title: Metabolic syndrome and risk of coronary heart disease in a Pakistani cohort.
abstract: 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.
authors: Department of Chemical Pathology, St Thomas's Hospital, London SE1 7EH, UK. anthony.wierzbicki@kcl.ac.uk
authors: A S
authors: AS
authors: Wierzbicki
authors: S
authors: S
authors: Nishtar
authors: P J
authors: PJ
authors: Lumb
authors: M
authors: M
authors: Lambert-Hammill
authors: C N
authors: CN
authors: Turner
authors: M A
authors: MA
authors: Crook
authors: M S
authors: MS
authors: Marber
authors: J
authors: J
authors: Gill
mesh_terms: 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