PURPOSE: Metabolic syndrome predisposes to diabetes and coronary artery disease, but the impact of metabolic syndrome on outcomes in patients with established coronary artery disease is uncertain. We sought to establish the independent prognostic implications of metabolic syndrome in the setting of percutaneous intervention for coronary artery disease.
METHODS: We evaluated 1216 patients for whom complete lipid profiles were available, among a cohort of 1955 veterans undergoing percutaneous coronary intervention at the New York VA between 1990 and 2005 (158 metabolic syndrome, 568 diabetes, 490 control). Metabolic syndrome was defined as the presence of at least 3 of the following criteria: body mass index (BMI)>30, hypertension, high density lipoprotein (HDL)<35mg/dL, triglyceride>150mg/dL, fasting glucose>110mg/dL.
RESULTS: Metabolic syndrome patients were younger than controls (63.6±9 (SD) versus 65.8±11 years p<0.01), with higher BMI (31.7±4 versus 26.1±4 p<0.0001), greater incidence of hypertension (96.1% versus 51.2% p<0.0001), lower HDL (33.4±7 versus 42.8±11 p<0.0001), higher triglycerides (233.6 versus 142.1 p<0.0001) and higher glucose (108.3±29 versus 104.2±24 p=0.08). Metabolic syndrome patients also had increased incidence of prior myocardial infarction (34.1% versus 25.3% p=0.03), were more likely to have a history of tobacco use (87.3% versus 78.9% p=0.03), and had higher creatinine (1.45±1.6 versus 1.1±0.39 p<0.0001). Diabetics were slightly older than metabolic syndrome patients (65.8±10 p<0.01), but had similar BMI (31.3±5 NS), less hypertension (89.3% p=0.01), higher HDL (37.6±16 p<0.001) and lower triglycerides (199.7±139 p=0.01). Diabetics had an increased incidence of prior MI (41.4% p=0.03) but were less likely to have used tobacco (78.9% p=0.03) and had similar creatinine (1.36±0.9 NS).
CONCLUSION: Despite younger age, patients with metabolic syndrome in our data set had far more high-risk clinical characteristics than control, including increased incidence of prior myocardial infarction, history of tobacco use and impaired renal function. Furthermore, metabolic syndrome patients had more smoking and hypertension than diabetics.
CLINICAL IMPLICATIONS: The high-risk clinical characteristics of metabolic syndrome patients must be accounted for in multivariate analysis to assess the independent effect of metabolic syndrome on prognosis in patients undergoing percutaneous intervention.
DISCLOSURE: Binita Shah, None.