title: Metabolic syndrome predicts restenosis after carotid endarterectomy.
abstract: BACKGROUND
  Carotid endarterectomy (CEA) is an effective surgical option for stroke prophylaxis for most patients. Restenosis after CEA can lead to additional interventions and adverse outcomes, but the factors that predict restenosis are poorly understood. This study examined which risk factors, such as metabolic syndrome (MetS), are associated with restenosis after CEA.
  
  
  METHODS
  This retrospective study examined the records of all patients who underwent CEA at the Veterans Affairs Connecticut Healthcare System during a 4-year period. Metabolic syndrome was defined as the presence of 3 or more of the following: hypertension (blood pressure ≥130 mmHg/≥85 mmHg); serum triglycerides ≥150 mg/dL; high-density lipoprotein ≤40 mg/dL; BMI ≥25 kg/m(2); and fasting blood glucose ≥110 mg/dL. Major adverse events were defined as death, stroke, or MI. Restenosis was defined as >50% stenosis on follow-up imaging.
  
  
  RESULTS
  Seventy-eight patients underwent 79 CEAs during the study period. All patients were male and 76% were white. Mean patient age was 72.6 years. The mean duration of follow-up was 5.2 years. Sixty-seven percent of patients had MetS. Patients with MetS were comparable with those without MetS in demographics and preoperative comorbidities, except for increased hypertension and diabetes, as expected, and chronic renal insufficiency (p = 0.05). There was no significant difference in long-term survival or freedom from MAE between patients with and without MetS. Restenosis was significantly higher in patients with MetS (p = 0.02) and occurred 2 years after CEA in patients with MetS only, with a large increase in restenosis after 5 years (p = 0.018). MetS was an independent predictor of restenosis in multivariable analysis (p = 0.01).
  
  
  CONCLUSIONS
  Metabolic syndrome is an independent predictor for restenosis after CEA in a high-risk population. More frequent and/or long-term surveillance might be warranted in patients with MetS after CEA.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Willis T
authors.initials: WT
authors.lastname: Williams
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Roland
authors.initials: R
authors.lastname: Assi
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Hall
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Clinton D
authors.initials: CD
authors.lastname: Protack
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Daniel Y
authors.initials: DY
authors.lastname: Lu
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Wong
authors.affiliation: VA Connecticut Healthcare System, West Haven, CT.
authors.forename: Penny
authors.initials: P
authors.lastname: Vasilas
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT; VA Connecticut Healthcare System, West Haven, CT. Electronic address: alan.dardik@yale.edu.
authors.forename: Alan
authors.initials: A
authors.lastname: Dardik
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D003237:Connecticut / Q000453:epidemiology; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000453:epidemiology; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors