Long-term rates of cardiovascular events in patients with the metabolic syndrome according to severity of coronary-angiographic alterations.
OBJECTIVE
To assess the long-term risk of mortality and cardiovascular events, related to metabolic syndrome (MetS), in patients with less, or more severe coronary artery disease (CAD).


METHODS
One thousand and eighty patients were divided in four groups, according to severity of CAD (1=less than 50% or nonsignificant stenoses; 2=greater or significant stenoses), and according to MetS (A=no; B=yes). Risk was evaluated with the Cox regression analysis.


RESULTS
About 18.9% of patients had less and 81.1% more advanced CAD. MetS was present in 45.1% of the first, and in 52.9% of the second group. At baseline, patients with MetS, or significant stenoses, had less favorable medical, biochemical, and angiographic characteristics. During a follow-up of 12.6+/-3.4 years, group 1B had higher incidence (16.3 vs. 7.1%) and hazard ratio [2.36 (1.001-5.57; P=0.0497)] of myocardial infarction than group 1A; group 2B had a higher incidence (19.0 vs. 11.7%) and hazard ratio [1.67 (1.18-2.37; P=0.0041)] of stroke than group 2A. Groups 2A and 2B, as compared with groups 1A and 1B, had a higher incidence of myocardial infarction (39.1 vs. 7.1; 41.8 vs. 16.3%); group 2B had higher incidence of stroke than group 1B (19.0 vs. 9.8%). After adjustment for common risk factors, group 2B retained an elevated risk of stroke. After additional adjustment for diabetes, no event was significantly related to MetS.


CONCLUSIONS
At baseline, coronary patients with MetS, or significant angiographic alterations, had more cardiovascular risk factors. During follow-up, both MetS and significant CAD increased the risk of cardiovascular morbidity but not of mortality.
Solymoss
Bela C
BC
Research Center, Montreal Heart Institute, Montreal, Quebec, Canada. BSolymoss@sympatico.ca
Bourassa
Martial G
MG
Marcil
Michel
M
Levesque
Sylvie
S
Varga
Susan
S
Campeau
Lucien
L
D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors