SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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C.H. Saely1 , S. Aczel1 , T. Marte1 , G. Hoefle2 , P. Langer1 , H. Drexel1

1Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria, 2Department of Internal Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria

Background: Prospective data on the metabolic syndrome (MS) in patients characterized by coronary angiography are scarce.
Methods: We enrolled 756 consecutive patients undergoing coronary angiography for the evaluation of suspected myocardial ischemia. According to ATP III criteria, we defined the MS as the presence of any three of: waist circumference >102 cm in men and >88 cm in women, triglycerides of 150 mg/dl or higher, HDL cholesterol < 40 mg/dl in men and < 50 mg/dl in women, blood pressure of 130/85 mmHg or higher, or fasting glucose of 110 mg/dl or higher.
Results: The HOMA index of insulin resistance increased significantly with an increasing number of MS risk factors (p for trend < 0.001). In Cox regression analyses adjusting for age, gender, significant coronary stenoses at baseline, smoking, body mass index, LDL cholesterol, and use of aspirin, of antihypertensive drugs and of lipid-lowering drugs, the MS significantly predicted vascular events (n = 95) during a follow-up period of 2.2 ± 0.5 years among men (OR = 2.12 [1.26-3.57]; p = 0.005) and women (OR = 5.52 [1.60-22.47]; p = 0.017), and among patients with diabetes mellitus type 2 (OR = 3.89 [1.12-3.52]; p = 0.033) as well as among non-diabetic patients (OR = 2.05 [1.13-3.71]; p = 0.018). Cardiovascular risk increased gradually with an increasing number of components of the MS (p for trend < 0.001). After additional adjustment for HOMA insulin resistance the MS remained significantly predictive for the incidence of vascular events (OR = 2.26 [1.25-4.09]; p = 0.007).
Conclusions: The metabolic syndrome is gradually and independently predictive for future cardiovascular events in men and women, and in patients with diabetes mellitus type 2 as well as in non-diabetic patients. Insulin resistance does not explain the full amount of risk inferred by the metabolic syndrome.

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