title: Metabolic syndrome negatively influences disease progression and prognosis in aortic stenosis.
abstract: OBJECTIVE
  This study sought to examine the association between the metabolic syndrome (MS) and the progression of aortic stenosis (AS).
  
  
  BACKGROUND
  It has been suggested that aortic valve sclerosis and its progression to AS are caused by an atherosclerotic process. Metabolic syndrome is associated with a higher risk of vascular atherosclerosis. Thus, we hypothesized that the atherogenic features of MS could negatively influence disease progression and prognosis in patients with AS.
  
  
  METHODS
  We retrospectively analyzed the data of 105 consecutive patients (age 69 +/- 12 years, 64 men) with at least moderate AS. Of these patients, 40 (38%) had MS identified according to the modified clinical criteria proposed by the National Cholesterol Education Program-Adult Treatment Panel III. The hemodynamic progression of AS was assessed by the measurement of the annualized decrease in valve area during the follow-up period of the study, which averaged 28 +/- 13 months. Event-free survival was defined as the absence of death or aortic valve replacement during follow-up.
  
  
  RESULTS
  The hemodynamic progression of the stenosis was twice as fast (-0.14 +/- 0.13 cm2/year vs. -0.08 +/- 0.08 cm2/year, p = 0.008) and the three-year event-free survival was markedly lower (44 +/- 8% vs. 69 +/- 6%, p = 0.002) among patients with MS. In multivariate analysis, MS was found to be a strong independent predictor of both stenosis progression (p = 0.006) and event-free survival (odds ratio 3.85, 95% CI 1.96 to 7.58, p < 0.001).
  
  
  CONCLUSIONS
  The present study is the first to report that MS is associated with a faster disease progression and worse outcome in patients with AS. Such findings open new avenues of research and provide a strong impetus for the elaboration of additional prospective studies focusing on this association.
authors.affiliation: Laval Hospital Research Center/Québec Heart Institute, Department of Medicine, Laval University, Québec, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Briand
authors.forename: Isabelle
authors.initials: I
authors.lastname: Lemieux
authors.forename: Jean G
authors.initials: JG
authors.lastname: Dumesnil
authors.forename: Patrick
authors.initials: P
authors.lastname: Mathieu
authors.forename: Amélie
authors.initials: A
authors.lastname: Cartier
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Després
authors.forename: Marie
authors.initials: M
authors.lastname: Arsenault
authors.forename: Jacques
authors.initials: J
authors.lastname: Couet
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis