The metabolic syndrome, its component risk factors, and progression of coronary atherosclerosis.
BACKGROUND
The mechanism that confers adverse cardiovascular prognosis in patients with the metabolic syndrome (MetS) remains unclear. We sought to investigate the association of MetS and its component risk factors with progression of coronary atherosclerosis.


METHODS
We performed a systematic review of 3459 patients who participated in 7 clinical trials that monitored coronary atheroma progression with intravascular ultrasonography. Patients with or without MetS were compared with regard to clinical characteristics, coronary atheroma burden at baseline, and change on serial evaluation. Relationships between plaque progression (> or =5% increase in percent atheroma volume [PAV]), MetS, and its component risk factors were investigated.


RESULTS
The metabolic syndrome was highly prevalent and was associated with greater progression of PAV (+0.51% +/- 0.23% vs +0.23% +/- 0.24%; P = .003). Multivariable analysis showed that MetS was associated with a greater likelihood of undergoing progression of PAV (adjusted odds ratio [OR], 1.25; 95% confidence interval [CI], 1.05-1.48; P = .01). When the individual components were used in the model instead of MetS, hypertriglyceridemia (OR, 1.26; 95% CI, 1.06-1.49; P = .008) and a body mass index of 30 or higher (1.18, 1.00-1.40; P = .05) predicted progression of PAV. However, after adjusting for its individual components, MetS was no longer an independent predictor (OR, 1.04; 95% CI, 0.79-1.37; P = .79).


CONCLUSIONS
Although accelerated disease progression is observed in the setting of MetS, this is owing to the presence of individual component risk factors rather than to the presence of the syndrome itself.
Bayturan
Ozgur
O
Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, OH 44195, USA.
Tuzcu
E Murat
EM
Lavoie
Andrea
A
Hu
Tingfei
T
Wolski
Kathy
K
Schoenhagen
Paul
P
Kapadia
Samir
S
Nissen
Steven E
SE
Nicholls
Stephen J
SJ
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002986:Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D015228:Hypertriglyceridemia / Q000150:complications; D008297:Male; D008432:Mathematical Computing; D024821:Metabolic Syndrome / Q000097:blood / Q000150:complications* / Q000209:etiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D018084:Ultrasonography, Interventional
D015415:Biomarkers; D014280:Triglycerides