title: Prognostic impact of metabolic syndrome in patients with chronic heart failure: data from GISSI-HF trial.
abstract: OBJECTIVE
  The adverse prognostic impact of metabolic syndrome (METS) in unselected populations and in patients with coronary heart disease has been previously shown. The aim of the current analysis was to evaluate the impact of METS on prognosis in chronic heart failure (HF).
  
  
  METHODS
  International Diabetes Federation criteria were used for the diagnosis of METS. Adjusted Cox regression models with all-cause and HF death as outcomes were fitted in 6648 patients enrolled in GISSI-HF trial with no missing values for the variables of interest.
  
  
  RESULTS
  Risk of all-cause and HF death was significantly reduced in patients with METS compared to patients without METS (HR: 0.83, 95% CI: 0.72 to 0.95, p=0.005; HR: 0.76, 95% CI: 0.59 to 0.98, p=0.031; respectively). As compared with patients with no METS and no type 2 diabetes mellitus (DM), the risk of all-cause and HF death was significantly lower in patients with METS and no DM (HR: 0.76, 95% CI: 0.62 to 0.95, p=0.015; HR: 0.65, 95% CI: 0.42 to 0.99, p=0.046; respectively), whereas it was significantly increased in patients with DM and no METS (HR: 1.34, 95% CI: 1.21 to 1.48, p<0.001; HR: 1.44, 95% CI: 1.21 to 1.72, p<0.001; respectively). Patients with METS and DM showed no difference for risk of total and HF death compared with patients with no METS and no DM (HR: 1.03, 95% CI: 0.87 to 1.21, p=0.762; HR: 0.99; 95% CI: 0.73 to 1.35; p=0.963; respectively).
  
  
  CONCLUSIONS
  METS is associated with reduced all-cause and HF mortality in patients with HF. HF patients with DM without METS are at the highest risk of mortality, whereas METS attenuates mortality risk in HF patients with DM.
authors.affiliation: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy. Electronic address: fpperron@unina.it.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Perrone-Filardi
authors.affiliation: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Savarese
authors.affiliation: Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Scarano
authors.affiliation: Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Cavazzina
authors.affiliation: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.affiliation: Azienda Universitaria Ospedaliera Careggi, Florence, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Minneci
authors.affiliation: Centro Studi Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy.
authors.forename: Aldo Pietro
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: Maria Cecilia Hospital, GVM Care&Research, E.S. Health Science Foundation, Cotignola, RA, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.affiliation: Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.affiliation: Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy; Hematology/Oncology TDU, Quintiles Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Marchioli
mesh_terms: D000368:Aged; D002908:Chronic Disease; D004311:Double-Blind Method; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality*; D006801:Humans; D024821:Metabolic Syndrome / Q000175:diagnosis* / Q000401:mortality*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013223:Statistics as Topic
keywords: Chronic heart failure; Metabolic syndrome; Type 2 diabetes mellitus