title: The adverse prognostic significance of the metabolic syndrome with and without hypertension in patients who underwent complete coronary revascularization.
abstract: OBJECTIVE
  The metabolic syndrome is associated with high risk for long-term coronary artery disease mortality. However, few studies have examined the prognostic importance of the metabolic syndrome with and without hypertension.
  
  
  METHODS
  The data of 1133 nondiabetic patients who underwent complete revascularization were analyzed. The patients were categorized by the presence of the metabolic syndrome using the modified American Heart Association/National Heart, Lung, and Blood Institute statement and by the presence of hypertension. All patients were divided into four groups: neither the metabolic syndrome nor hypertension (group 1); the metabolic syndrome without hypertension (group 2); hypertension without the metabolic syndrome (group 3); and both the metabolic syndrome and hypertension (group 4). Cox proportional hazards were used in adjusted analyses for all-cause and cardiac mortality, as well as for the composite incidence of fatal and nonfatal stroke.
  
  
  RESULTS
  The progress of 276 (24.4%) patients in group 1, 413 (36.5%) in group 2, 105 (9.3%) in group 3, and 339 (29.9%) in group 4 was analyzed. The mean follow-up was 10.4 +/- 3.4 years. Patients in group 4 had a higher risk of all-cause mortality (hazard ratio 1.78, P = 0.004). In addition, patients in groups 2 and 4 had a higher risk of cardiac mortality (group 2: hazard ratio 2.84, P = 0.04, group 4: hazard ratio 3.91, P = 0.001) and stroke (group 2: hazard ratio 2.46, P = 0.03, group 4: hazard ratio 2.09, P = 0.03).
  
  
  CONCLUSIONS
  The metabolic syndrome both with and without hypertension is associated with increased risk of cardiac mortality and stroke incidence in patients who underwent complete coronary revascularization.
authors.affiliation: Departments of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Kasai
authors.forename: Katsumi
authors.initials: K
authors.lastname: Miyauchi
authors.forename: Kan
authors.initials: K
authors.lastname: Kajimoto
authors.forename: Naozumi
authors.initials: N
authors.lastname: Kubota
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Dohi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kurata
authors.forename: Atsushi
authors.initials: A
authors.lastname: Amano
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000150:complications* / Q000401:mortality; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications*; D015994:Incidence; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000401:mortality; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D020521:Stroke / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome