title: Metabolic syndrome definitions and components in predicting major adverse cardiovascular events after kidney transplantation.
abstract: Metabolic syndrome (MetS) associates with cardiovascular risk post-kidney transplantation, but its ambiguity impairs understanding of its diagnostic utility relative to components. We compared five MetS definitions and the predictive value of constituent components of significant definitions for major adverse cardiovascular events (MACE) in a cohort of 1182 kidney transplant recipients. MetS definitions were adjusted for noncomponent traditional Framingham risk factors and relevant transplant-related variables. Kaplan-Meier, logistic regression, and Cox proportional hazards analysis were utilized. There were 143 MACE over 7447 patient-years of follow-up. Only the World Health Organization (WHO) 1998 definition predicted MACE (25.3 vs 15.5 events/1000 patient-years, P = 0.019). Time-to-MACE was 5.5 ± 3.5 years with MetS and 6.8 ± 3.9 years without MetS (P < 0.0001). MetS was independent of pertinent MACE risk factors except age and previous cardiac disease. Among MetS components, dysglycemia provided greatest hazard ratio (HR) for MACE (1.814 [95% confidence interval 1.26-2.60]), increased successively by microalbuminuria (HR 1.946 [1.37-2.75]), dyslipidemia (3.284 [1.72-6.26]), hypertension (4.127 [2.16-7.86]), and central obesity (4.282 [2.09-8.76]). MetS did not affect graft survival. In summary, although the WHO 1998 definition provides greatest predictive value for post-transplant MACE, most of this is conferred by dysglycemia and is overshadowed by age and previous cardiac disease.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Toronto, Toronto, ON, Canada; Renal Transplant Program, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: G V Ramesh
authors.initials: GV
authors.lastname: Prasad
authors.forename: Michael
authors.initials: M
authors.lastname: Huang
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Silver
authors.forename: Ali I
authors.initials: AI
authors.lastname: Al-Lawati
authors.forename: Lindita
authors.initials: L
authors.lastname: Rapi
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Nash
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Zaltzman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood* / Q000150:complications*; D015331:Cohort Studies; D048909:Diabetes Complications / Q000628:therapy; D050171:Dyslipidemias / Q000097:blood* / Q000150:complications; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: cardiovascular disease; diabetes; dyslipidemia; microalbuminuria; obesity