title: Impact of metabolic syndrome on the progression of coronary calcium and of coronary artery disease assessed by repeated cardiac computed tomography scans.
abstract: BACKGROUND
  It is not clear how severe metabolic syndrome (MS) affects the development of coronary atherosclerosis.
  
  
  METHODS
  This was an observational, retrospective cohort study with Koreans who received health check-ups voluntarily. A total of 2426 subjects had baseline and follow-up coronary artery calcium score (CACS) data. Among them, 1079 had coronary computed tomography angiography (CCTA) data. We compared baseline CACS and any progression in subjects with and without MS. A more detailed analysis was conducted for coronary artery disease (CAD), which was defined by coronary artery stenosis (≥50 %), multivessel involvement, and coronary plaques in those patients with CCTA data.
  
  
  RESULTS
  At baseline, subjects with MS (34.0 %, n = 825) had higher CACS and more significant coronary artery stenosis, multivessel involvement, and atheromatous plaques than those without MS (P < 0.05 for all). In the follow-up (median 1197 days), subjects with MS showed significant increases in CACS and progression of CAD compared with counterparts without MS, in parallel with the numbers of MS components. Finally, MS was a significant predictor for the progression of CACS (hazard ratio 1.32; 95 % confidence interval 1.06-1.64) and progression of coronary artery stenosis and/or development of vulnerable plaque (hazard ratio 1.47, 95 % confidence interval 1.01-2.15) after adjusting for other cardiovascular risk factors.
  
  
  CONCLUSIONS
  Subjects with MS showed progression of CAD as assessed by CACS and CCTA over ~3 years. Therefore, more vigilant screening for coronary vascular health is needed among those with MS.
authors.affiliation: Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, South Korea.|Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-Gu, Seongnam, 463-707, South Korea.
authors.forename: Lee Kyung
authors.initials: LK
authors.lastname: Kim
authors.affiliation: Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, South Korea.|Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, 39th FL. Gangnam Finance Center, 737 Yeoksam-dong, Gangnam-gu, Seoul, 135-984, South Korea.
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Yoon
authors.affiliation: Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, South Korea.|Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-Gu, Seongnam, 463-707, South Korea.
authors.forename: Dong-Hwa
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, South Korea.|Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-Gu, Seongnam, 463-707, South Korea.
authors.forename: Kyoung Min
authors.initials: KM
authors.lastname: Kim
authors.affiliation: Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, South Korea.|Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-Gu, Seongnam, 463-707, South Korea.
authors.forename: Sung Hee
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, South Korea.
authors.forename: Kyong Soo
authors.initials: KS
authors.lastname: Park
authors.affiliation: Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, South Korea.|Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-Gu, Seongnam, 463-707, South Korea.
authors.forename: Hak Chul
authors.initials: HC
authors.lastname: Jang
authors.affiliation: Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, South Korea.|Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, 39th FL. Gangnam Finance Center, 737 Yeoksam-dong, Gangnam-gu, Seoul, 135-984, South Korea.
authors.forename: Min-Kyung
authors.initials: MK
authors.lastname: Kim
authors.affiliation: Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, South Korea.|Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, 39th FL. Gangnam Finance Center, 737 Yeoksam-dong, Gangnam-gu, Seoul, 135-984, South Korea.
authors.forename: Hyo Eun
authors.initials: HE
authors.lastname: Park
authors.affiliation: Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, South Korea. sychoi9@gmail.com.|Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, 39th FL. Gangnam Finance Center, 737 Yeoksam-dong, Gangnam-gu, Seoul, 135-984, South Korea. sychoi9@gmail.com.
authors.forename: Su-Yeon
authors.initials: SY
authors.lastname: Choi
authors.affiliation: Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, South Korea. limsoo@snu.ac.kr.|Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-Gu, Seongnam, 463-707, South Korea. limsoo@snu.ac.kr.
authors.forename: Soo
authors.initials: S
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D002118:Calcium / Q000378:metabolism*; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000000981:diagnostic imaging; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000009:adverse effects; D058226:Plaque, Atherosclerotic / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D061205:Vascular Calcification / Q000150:complications
chemical_list: D002118:Calcium
keywords: Coronary artery calcium; Coronary artery disease; Longitudinal cohort study; Metabolic syndrome