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Hosseini K, Khalaji A, Behnoush AH, Soleimani H, Mehrban S, Amirsardari Z, Najafi K, Fathian Sabet M, Hosseini Mohammadi NS, Shojaei S, Masoudkabir F, Aghajani H, Mehrani M, Razjouyan H, Hernandez AV. The association between metabolic syndrome and major adverse cardiac and cerebrovascular events in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Sci Rep 2024; 14:697. [PMID: 38184738 PMCID: PMC10771421 DOI: 10.1038/s41598-024-51157-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/01/2024] [Indexed: 01/08/2024] Open
Abstract
Metabolic syndrome (MetS) poses an additional risk for the development of coronary artery disease and major adverse cardiac and cerebrovascular events (MACCE). In this study, we investigated the association between MetS and its components and MACCE after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). The presence of MetS was calculated at baseline using the NCEP-ATP III criteria. The primary outcome was MACCE and its components were secondary outcomes. Unadjusted and adjusted Cox Regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CI) of the association between MetS or its components and MACCE and its components. A total of 13,459 ACS patients who underwent PCI (MetS: 7939 and non-MetS: 5520) with a mean age of 62.7 ± 11.0 years (male: 72.5%) were included and median follow-up time was 378 days. Patients with MetS had significantly higher MACCE risk (adjusted HR [aHR] 1.22, 95% CI 1.08-1.39). The only component of MACCE that exhibited a significantly higher incidence in MetS patients was myocardial infarction (aHR 1.43, 95% CI 1.15-1.76). MetS components that were significantly associated with a higher incidence of MACCE were hypertension and impaired fasting glucose. Having three MetS components did not increase MACCE (aHR 1.12, 95% CI 0.96-1.30) while having four (aHR 1.32, 95% CI 1.13-1.55) or five (aHR 1.42, 95% CI 1.15-1.75) MetS components was associated with a higher incidence of MACCE. MetS was associated with a higher risk of MACCE in ACS patients undergoing PCI. Among MACCE components, myocardial infarction was significantly higher in patients with MetS. Impaired fasting glucose and hypertension were associated with a higher risk of MACCE. Identifying these patterns can guide clinicians in choosing appropriate preventive measures.
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Affiliation(s)
- Kaveh Hosseini
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohammad Khalaji
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Behnoush
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hamidreza Soleimani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saghar Mehrban
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Amirsardari
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kimia Najafi
- Hakim Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Negin Sadat Hosseini Mohammadi
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Shojaei
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Aghajani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mehrani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadie Razjouyan
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Adrian V Hernandez
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA
- Unidad de Revisiones Sistemáticas y Meta-Análisis (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
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Hu B, Xiao C, Wang Z, Jia D, Yang S, Jia S, Zhai G, Han H, Xu X, Shi D, Zhou Y. Relationship between Metabolic Syndrome and Clinical Outcome in Patients Treated with Drug-Eluting Stenting after Rotational Atherectomy for Complex Calcified Coronary Lesions. J Clin Med 2022; 11:jcm11144192. [PMID: 35887955 PMCID: PMC9322199 DOI: 10.3390/jcm11144192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/11/2022] [Accepted: 07/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background and aims: although an association between metabolic syndrome (MS) and cardiovascular disease risk has been documented, the relationship in patients with complex calcified coronary lesions undergoing rotational atherectomy (RA) and drug-eluting stent(DES) insertion remains controversial. Here, the influence of MS on outcomes was assessed. Methods and results: we retrospectively included 398 patients who underwent RA and DES insertion for complex calcified coronary lesions in our institution between June 2015 and January 2019. The modified Adult Treatment Plan III was used to diagnose MS. The endpoint was major adverse cardiovascular events (MACEs), comprising mortality from all causes, myocardial infarction, and target vessel revascularization (TVR). In all, 173 (43.5%) patients had MS. MS was significantly associated with MACE over the 28.32 ± 6.79-month follow-up period (HR 1.783, 95% CI from 1.122 to 2.833) even after adjustment for other possible confounders. Conclusion: MS was frequently observed in patients treated with RA with DES insertion for complex calcified coronary lesions. MS independently predicted MACE in these patients.
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Affiliation(s)
- Bin Hu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Changbo Xiao
- Department of Cardiovascular Surgery, Henan Chest Hospital, Zhengzhou 450001, China;
| | - Zhijian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Dean Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Shiwei Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Shuo Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Guangyao Zhai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Hongya Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Xiaohan Xu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Dongmei Shi
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (B.H.); (Z.W.); (D.J.); (S.Y.); (S.J.); (G.Z.); (H.H.); (X.X.); (D.S.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
- Correspondence: ; Tel.: +86-10-64456489; Fax: +86-10-64456461
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Obesity Paradox of All-Cause Mortality in 4,133 Patients Treated with Coronary Revascularization. J Interv Cardiol 2021; 2021:3867735. [PMID: 34887705 PMCID: PMC8616700 DOI: 10.1155/2021/3867735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/02/2021] [Indexed: 01/14/2023] Open
Abstract
Objectives The purpose of this study was to determine whether there is a dose-response relationship between body mass index (BMI) and all-cause mortality in patients after coronary revascularization. Methods The MIMIC-III database (version 1.4) was used as the sample population. For variables with less than 10% of values missing, we used the mice package of R software for multiple imputations. Cox regression was used to determine the risk factors of all-cause mortality in patients. RCSs were used to observe the relationship between BMI and all-cause mortality. Additional subgroup and sensitivity analyses were also performed to explore whether the conclusion can be applied to specific groups. Results Both univariate and multivariate Cox models indicated that the mortality risk was lower for overweight patients than for normal-weight patients (P < 0.05). In RCS models, BMI had a U-shaped relationship with all-cause mortality of patients after coronary artery bypass grafting (CABG) (P for nonlinearity = 0.0028). There was a weak U-shaped relationship between BMI and all-cause mortality after percutaneous coronary intervention (PCI), but the nonlinear relationship between these two parameters was not significant (P for nonlinearity = 0.1756). Conclusions The obesity paradox does exist in patients treated with CABG and PCI. RCS analysis indicated that there was a U-shaped relationship between BMI and all-cause mortality in patients after CABG. After sex stratification, the relationship between BMI and all-cause mortality in male patients who received PCI was L-shaped, while the nonlinear relationship among females was not significant.
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Slezák D, Mayer O, Bruthans J, Seidlerová J, Rychecká M, Gelžinský J, Mateřánková M, Karnosová P, Wohlfahrt P, Cífková R, Filipovský J. The Prognostic Importance of Impaired Fasting Glycemia in Chronic Coronary Heart Disease Patients. Exp Clin Endocrinol Diabetes 2018; 129:29-35. [PMID: 30157533 DOI: 10.1055/a-0684-9601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Impaired glucose metabolism represents one the most important cardiovascular risk factors, with steeply raising prevalence in overall population. We aimed to compare mortality risk of impaired fasting glycaemia (IFG) and overt diabetes mellitus (DM) in patients with coronary heart disease (CHD). STUDY DESIGN prospective cohort study METHODS: A total of 1685 patients, 6-24 months after myocardial infarction and/or coronary revascularization at baseline, were followed in a prospective cohort study. Overt DM was defined as fasting glucose ≥ 7 mmol/L and/or use of antidiabetic treatment, while IFG as fasting glucose 5.6-6.99 mmol/L, but no antidiabetic medication. The main outcomes were total and cardiovascular mortality during 5 years of follow-up. RESULTS During follow-up of 1826 days, 172 patients (10.2%) deceased, and of them 122 (7.2%) from a cardiovascular cause. Both exposures, overt DM (n=623, 37.0% of the whole sample) and IFG (n=436, 25.9%) were associated with an independent increase of 5-year total mortality, compared to normoglycemic subjects [fully adjusted hazard risk ratio (HRR) 1.63 (95%CI: 1.01-2.61)]; p=0.043 and 2.25 (95%CI: 1.45-3.50); p<0.0001, respectively]. In contrast, comparing both glucose disorders one with each other, no significant differences were found for total mortality [HRR 0.82 (0.53-1.28); p=0.33]. Taking 5-years cardiovascular mortality as outcome, similar pattern was observed [HRR 1.96 (95%CI: 1.06-3.63) and 3.84 (95%CI: 2.19-6.73) for overt DM and IFG, respectively, with HRR 0.63 (95%CI: 0.37-1.07) for comparison of both disorders]. CONCLUSIONS Impaired fasting glycaemia adversely increases mortality of CHD patients in the same extent as overt DM.
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Affiliation(s)
- David Slezák
- Fakultni Nemocnice Plzen, 2nd Dept. of Internal Medicine, Plzen, Czech Republic
| | - Otto Mayer
- Fakultni Nemocnice Plzen, 2nd Dept. of Internal Medicine, Plzen, Czech Republic
| | - Jan Bruthans
- Fakultni Thomayerova nemocnice s poliklinikou, Centre for Cardiovascular Prevention , Praha, Czech Republic
| | - Jitka Seidlerová
- Fakultni Nemocnice Plzen, 2nd Dept. of Internal Medicine, Plzen, Czech Republic
| | - Martina Rychecká
- Fakultni Nemocnice Plzen, Dept. of Cardiology, Plzen, Czech Republic
| | - Julius Gelžinský
- Fakultni Nemocnice Plzen, 2nd Dept. of Internal Medicine, Plzen, Czech Republic
| | - Markéta Mateřánková
- Fakultni Nemocnice Plzen, 2nd Dept. of Internal Medicine, Plzen, Czech Republic
| | - Petra Karnosová
- Fakultni Nemocnice Plzen, 2nd Dept. of Internal Medicine, Plzen, Czech Republic
| | - Peter Wohlfahrt
- Fakultni Thomayerova nemocnice s poliklinikou, Centre for Cardiovascular Prevention , Praha, Czech Republic
| | - Renata Cífková
- Fakultni Thomayerova nemocnice s poliklinikou, Centre for Cardiovascular Prevention , Praha, Czech Republic
| | - Jan Filipovský
- Fakultni Nemocnice Plzen, 2nd Dept. of Internal Medicine, Plzen, Czech Republic
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Mayer O, Bruthans J, Seidlerová J, Karnosová P, Vaněk J, Hronová M, Gelžinský J, Cvíčela M, Wohlfahrt P, Cífková R, Filipovský J. Prospective study of metabolic syndrome as a mortality marker in chronic coronary heart disease patients. Eur J Intern Med 2018; 47:55-61. [PMID: 28755847 DOI: 10.1016/j.ejim.2017.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 06/27/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND We aimed to clarify the impact of metabolic syndrome (MetS) as assessed by different definitions on the cardiovascular mortality in patients with coronary heart disease (CHD). METHODS A total of 1692 patients, 6-24months after myocardial infarction and/or coronary revascularization at baseline, were followed in a prospective cohort study. MetS was identified using four different definitions: standard National Cholesterol Education Program definition (NCEP-ATPIII) based on the presence of ≥3 of the following factors: increased waist circumference, raised blood pressure, hypetriglyceridemia, low high-density lipoprotein cholesterol, and increased fasting glycemia; modified NCEP-ATPIII definition (similar, but omitting antihypertensive treatment as an alternative criterion); presence of "atherogenic dyslipidemia"; or "hypertriglyceridemic waist". The primary outcome was a fatal cardiovascular event at 5years. RESULTS During 5-year follow-up, 117 patients (6.9%) died from a cardiovascular cause. Patients with MetS by modified NCEP-ATPIII (n=1066, 63.0% of the whole sample) had significantly higher 5-year cardiovascular mortality [adjusted hazard risk ratio (HRR) 2.01 [95%CI:1.26-3.22]; p=0.003] than subjects without MetS. However, when testing single MetS component factors, the majority of attributable mortality risk was driven by increased fasting glycemia (≥5.6mmol/L) [HRR 2.69 (95%CI:1.29-5.62), p=0.009] and the significance of MetS disappeared. None of the other MetS definitions, i.e., standard NCEP-ATPIII (n=1210; 71.5%), "hypertriglyceridemic waist" (n=455; 26.9%) or "atherogenic dyslipidemia" (n=223; 13.2%) were associated with any significant mortality risk. CONCLUSIONS The co-incidence of MetS has a limited mortality impact in CHD patients, while an increase in fasting glycemia seems to be more a specific marker of mortality risk.
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Affiliation(s)
- Otto Mayer
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic.
| | - Jan Bruthans
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic; Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Jitka Seidlerová
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Petra Karnosová
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Jiří Vaněk
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
| | - Markéta Hronová
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Julius Gelžinský
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
| | - Martina Cvíčela
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic
| | - Peter Wohlfahrt
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; International Clinical Research Centre, St. Anne's University Hospital, Brno, Czech Republic
| | - Renata Cífková
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; International Clinical Research Centre, St. Anne's University Hospital, Brno, Czech Republic
| | - Jan Filipovský
- 2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic
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Younis A, Goldkorn R, Goldenberg I, Geva D, Tzur B, Mazu A, Younis A, Fisman Z, Tannenbaum A, Klempfner R. Impaired Fasting Glucose Is the Major Determinant of the 20-Year Mortality Risk Associated With Metabolic Syndrome in Nondiabetic Patients With Stable Coronary Artery Disease. J Am Heart Assoc 2017; 6:JAHA.117.006609. [PMID: 29079562 PMCID: PMC5721758 DOI: 10.1161/jaha.117.006609] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background We wanted to explore the association of metabolic syndrome (MetS) versus its individual components with 20‐year all‐cause mortality among patients with stable coronary artery disease. Methods and Results The cohort comprised 12 403 nondiabetic patients with stable coronary artery disease who were enrolled in the Bezafibrate Infarction Prevention Registry between February 1990 and October 1992 and followed up through December 2014. The study cohort was divided into 4 groups: patients without MetS or impaired fasting glucose (IFG), patients with IFG but without MetS, patients with MetS but without IFG, and patients with both MetS and IFG. Kaplan‐Meier survival analysis showed that at 20 years of follow‐up, the rates of all‐cause mortality were the highest among patients with both MetS and IFG (66%). Patients with IFG without MetS experienced a significantly higher mortality rate compared with those with MetS without IFG (61% versus 56%; log‐rank P<0.001). Multivariable Cox proportional hazard analysis showed that the final Cox model demonstrated that the additive effect of MetS (hazard ratio, 1.13; 95% confidence interval, 1.1–1.16; P=0.02) and IFG (hazard ratio, 1.54; 95% confidence interval, 1.46–1.62; P<0.001) on 20 years mortality was nonsignificant (hazard ratio, 1.01; 95% confidence interval, 0.93–1.11; P=0.69). IFG was associated with the most pronounced increase in mortality risk among the individual components (hazard ratio, 1.22; 95% confidence interval, 1.14–1.3; P<0.001). Conclusions Our findings suggest that IFG alone is a major independent predictor of long‐term mortality among patients with stable coronary artery disease versus other components of the MetS.
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Affiliation(s)
- Arwa Younis
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel .,Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronen Goldkorn
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Goldenberg
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Diklah Geva
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Tzur
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anna Mazu
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
| | - Anan Younis
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
| | - Zvi Fisman
- Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Tannenbaum
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert Klempfner
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.,Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lyubarova R, Robinson JG, Miller M, Simmons DL, Xu P, Abramson BL, Elam MB, Brown TM, McBride R, Fleg JL, Desvigne-Nickens P, Ayenew W, Boden WE. Metabolic syndrome cluster does not provide incremental prognostic information in patients with stable cardiovascular disease: A post hoc analysis of the AIM-HIGH trial. J Clin Lipidol 2017; 11:1201-1211. [PMID: 28807460 DOI: 10.1016/j.jacl.2017.06.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 06/17/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Metabolic syndrome (MS) is a well-known risk factor for the development of cardiovascular (CV) disease; yet, controversy persists whether it adds incremental prognostic value in patients with established CV disease. OBJECTIVES This study was performed to determine if MS is associated with worse CV outcomes in patients with established CV disease treated intensively with statins. METHODS We performed a post hoc analysis of the Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides and Impact on Global Health Outcomes trial, in which patients with established CV disease and atherogenic dyslipidemia (n = 3414) were randomly assigned to receive extended release niacin or placebo during a mean 36-month follow-up, to assess whether the presence of MS or the number of MS components contributed to CV outcomes. RESULTS The composite primary end point of CV events occurred in 15.1% of patients without MS vs 13.8%, 16.9%, and 16.8% of patients with MS in the subsets with 3, 4, and 5 MS components, respectively (corresponding adjusted hazard ratios 0.9, 1.1, and 1.1 relative to patients without MS), P = .55. Comparing subgroups with 3 vs 4 or 5 MS components, there was no significant difference in either the composite primary end point or secondary end points. Patients with diabetes mellitus had higher event rates, with or without the presence of MS. CONCLUSIONS The presence of MS was not associated with worse CV outcomes in the AIM-HIGH population. The rate of CV events in statin-treated Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides and Impact on Global Health Outcomes patients with MS was not significantly influenced by the number of MS components.
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Affiliation(s)
- Radmila Lyubarova
- Department of Medicine, Albany Medical Center, Albany Medical College, Albany, NY, USA.
| | - Jennifer G Robinson
- Department of Epidemiology, College of Public Health, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Michael Miller
- Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Debra L Simmons
- Department of Internal Medicine, University of Utah, Utah Diabetes and Endocrinology Center, Salt Lake City, UT, USA
| | - Ping Xu
- Axio Research LLC, Seattle, WA, USA
| | - Beth L Abramson
- Cardiac Prevention Centre and Women's Cardiovascular Health, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Todd M Brown
- Department of Medicine, University of Alabama Health Science Center at Birmingham, Birmingham, AL, USA
| | | | - Jerome L Fleg
- Division of Cardiovascular Science, National Institutes of Health, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Science, National Institutes of Health, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | | | - William E Boden
- Department of Medicine, VA New England Healthcare System, Boston, MA, USA
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Bundhun PK, Wu ZJ, Chen MH. Impact of Modifiable Cardiovascular Risk Factors on Mortality After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of 100 Studies. Medicine (Baltimore) 2015; 94:e2313. [PMID: 26683970 PMCID: PMC5058942 DOI: 10.1097/md.0000000000002313] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/05/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023] Open
Abstract
Modifiable cardiovascular risk factors such as obesity, hypertension, dyslipidemia, smoking, diabetes mellitus, and metabolic syndrome can easily give rise to coronary heart disease (CHD). However, due to the existence of the so-called "obesity paradox" and "smoking paradox," the impact of these modifiable cardiovascular risk factors on mortality after percutaneous coronary intervention (PCI) is still not clear. Therefore, in order to solve this issue, we aim to compare mortality between patients with low and high modifiable cardiovascular risk factors after PCI. Medline and EMBASE were searched for studies related to these modifiable cardiovascular risk factors. Reported outcome was all-cause mortality after PCI. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated, and the pooled analyses were performed with RevMan 5.3 software. A total of 100 studies consisting of 884,190 patients (330,068 and 514,122 with high and low cardiovascular risk factors respectively) have been included in this meta-analysis. Diabetes mellitus was associated with a significantly higher short and long-term mortality with RR 2.11; 95% CI: (1.91-2.33) and 1.85; 95% CI: (1.66-2.06), respectively, after PCI. A significantly higher long-term mortality in the hypertensive and metabolic syndrome patients with RR 1.45; 95% CI: (1.24-1.69) and RR 1.29; 95% CI: (1.11-1.51), respectively, has also been observed. However, an unexpectedly, significantly lower mortality risk was observed among the smokers and obese patients. Certain modifiable cardiovascular risk subgroups had a significantly higher impact on mortality after PCI. However, mortality among the obese patients and the smokers showed an unexpected paradox after coronary intervention.
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Affiliation(s)
- Pravesh Kumar Bundhun
- From the Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P.R. China
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Ayça B, Kafadar D, Avsar M, Avci İİ, Akın F, Okuyan E, Dinckal MH. Lower Muscle Strength and Increased Visceral Fat Associated With No-reflow and High Gensini Score in STEMI. Clin Appl Thromb Hemost 2015; 23:367-373. [DOI: 10.1177/1076029615613159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The impact of fat distribution, muscle mass, and muscle strength on no-reflow and severity of coronary artery disease in patients with ST-segment elevation myocardial infarction (STEMI) remains unclear. Objective: To investigate association between muscle strength and fat and muscle mass and severity of coronary atherosclerosis. Methods: We included 218 patients with STEMI who had undergone primary percutaneous coronary intervention. We evaluated the no-reflow phenomenon in infarct-related artery and calculated Gensini scores from initial angiograms as indicative of coronary atherosclerosis severity. The patients were divided into 2 groups as patients with no-reflow and with thrombolysis in myocardial infarction grade 3 flow and patients with low (<55) Gensini and with high (≥55) Gensini. Patients’ total fat, muscle mass, visceral fat mass, and muscle strength were measured via body composition analyzer and handgrip dynamometer. Results: High Gensini patients had a greater body mass index (BMI) and lower handgrip strength and more visceral fat ( P = .05, P = .017, and P < .001, respectively). The patients with no-reflow had significantly lower handgrip strength and more visceral fat (both, P < .001). In multivariate regression analysis, visceral fat and handgrip strength were associated with high no-reflow rate and high Gensini scores in patients with STEMI ( P = .001, P = .014, P = .022, and P = .010; respectively). Conclusion: Increased visceral fat and lower handgrip strength may be related to increased no-reflow rate and coronary plaque burden in STEMI. Visceral fat and muscle strength may be better prognostic markers than weight, BMI, total fat, and muscle mass in coronary artery disease.
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Affiliation(s)
- Burak Ayça
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - Didem Kafadar
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - Murat Avsar
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - İ. İlker Avci
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - Fatih Akın
- Department of Cardiology, Muğla Sıtkı Koçman University, Medical School, Muğla, Turkey
| | - Ertugrul Okuyan
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - M. Hakan Dinckal
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
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Tie HT, Shi R, Li ZH, Zhang M, Zhang C, Wu QC. Risk of major adverse cardiovascular events in patients with metabolic syndrome after revascularization: A meta-analysis of eighteen cohorts with 18,457 patients. Metabolism 2015; 64:1224-34. [PMID: 26231436 DOI: 10.1016/j.metabol.2015.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/04/2015] [Accepted: 06/30/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To provide a comprehensive evaluation of the association between metabolic syndrome (MetS) and major adverse cardiovascular events (MACE) and to clarify the effect of revascularization methods among them in patients with coronary artery disease (CAD) undergoing successful revascularization. METHODS PubMed and Embase databases were searched. Cohort studies evaluating the association between MetS and risk of MACE and providing the hazard ratio (HR) with 95% confidence interval (CI) or sufficient data to calculate HR and its 95%CI among patients after revascularization were included. The pooled estimates were performed by using a random-effects model despite heterogeneity. Subgroup and sensitivity analyses were also conducted adherence to guidelines. RESULTS Eighteen trials with 18457 patients were included. Overall, MetS was associated with significant increased risks of MACE (HR 1.47, 95%CI 1.26-1.72, I(2)=46.4%, PH=0.016, P<0.001) and all-cause mortality (HR 1.58, 95%CI 1.29-1.92, I(2)=45.6%, PH=0.075, P<0.001) in CAD patients received revascularization. The results remained stable and robust in our subgroup analysis. However, no significant increased risk of MACE or all-cause mortality was found in patients undergoing coronary artery bypass graft (CABG) or drug-eluting stent (DES) in the sensitivity analysis. CONCLUSION MetS was associated with increased risks of MACE and all-cause mortality in patients after revascularization, but not in patients receiving CABG or DES. Therefore, prevention and treatment of MetS are extremely necessary in patients undergoing revascularization. Moreover, CABG and DES should be recommended for CAD patients with MetS and future researches are still warranted.
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Affiliation(s)
- Hong-Tao Tie
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Rui Shi
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zhen-Han Li
- The First College of Clinical Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Min Zhang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Cheng Zhang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Qing-Chen Wu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Lee Y, Lim YH, Shin JH, Park J, Shin J, Kim KS. The Impact of Metabolic Syndrome on Clinical Outcomes After Everolimus-Eluting Stent Implantation. Am J Cardiol 2015; 116:717-24. [PMID: 26115900 DOI: 10.1016/j.amjcard.2015.05.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
Abstract
As it is controversial whether metabolic syndrome (MetS) affects cardiovascular outcomes in patients who underwent percutaneous coronary intervention (PCI), we investigated the impact of MetS on clinical outcomes in patients who underwent PCI with everolimus-eluting stents (EESs). Patients who underwent PCI with EESs from 2009 to 2013 were included in this single-center, prospective cohort study. A composite event consisted of repeat revascularization, nonfatal myocardial infarction, and cardiac death. Of 903 patients observed for 4.9 years (median 1.8 years), 570 were diagnosed with MetS. The MetS group displayed more severe coronary artery disease and underwent more extensive PCIs than did the non-MetS group. The overall composite event rate was not significantly different between the MetS and the non-MetS group (11.9% vs 13.2%, p = 0.572). Kaplan-Meier survival analysis showed no significant difference in the event-free survival of the composite event between the 2 groups (p = 0.700). A multivariable Cox regression analysis showed that MetS was not associated with the composite event, whereas total stent length, decreased renal function, diabetes, and the absence of abdominal obesity were associated with the composite event. Abdominal obesity was associated with decreased risk of the composite event, alleviating unfavorable clinical outcomes of patients with diabetes in the MetS group. In conclusion, MetS has no impact on the clinical outcomes of patients who underwent PCI with EESs, although the MetS group exhibited more severe coronary artery disease and underwent more extensive PCIs. The paradoxical association between obesity and favorable clinical outcomes may explain this result.
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Impact of metabolic syndrome on myocardial injury and clinical outcome after percutaneous coronary intervention. Herz 2014; 40:129-35. [PMID: 24962253 DOI: 10.1007/s00059-014-4103-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/11/2014] [Accepted: 04/06/2014] [Indexed: 10/25/2022]
Abstract
AIMS This study tested the associations between metabolic syndrome, postprocedural myocardial injury, and clinical outcome after percutaneous coronary intervention. PATIENTS AND METHODS We evaluated 204 patients who fulfilled the study criteria and were scheduled for elective percutaneous coronary intervention. The patients were divided into a metabolic syndrome group and a control group according to the definition of metabolic syndrome. Creatine kinase-MB and troponin I levels were measured at baseline, at 8 h, and 24 h after the procedure, while clinical outcomes were followed up for 1 year. RESULTS The incidence of postprocedural myocardial injury was significantly higher in the metabolic syndrome group than in the control group as indicated by either blood creatine kinase-MB elevation (32.9 % vs. 17.2 %, p = 0.010) or troponin I elevation (34.2 % vs. 17.2 %, p = 0.006). Postprocedural peak values of creatine kinase-MB (5.724 ± 7.678 ng/ml vs. 3.097 ± 5.317 ng/ml, p < 0.001) and troponin I (0.066 ± 0.093 ng/ml vs. 0.038 ± 0.079 ng/ml, p < 0.001) were also significantly higher in the metabolic syndrome group than in the control group. On multiple regression analysis, metabolic syndrome was independently associated with troponin I elevation (odds ratio 2.24, 95 % confidence interval, CI, 1.04-4.80, p = 0.039). During the 1-year follow-up, cardiac events occurred in 28.9 % of patients with metabolic syndrome and 17.9 % of controls, and there was a trend toward increased adverse outcomes in the metabolic syndrome group (hazard ratio 1.67, 95 % CI 0.93-3.00, p = 0.071, log rank test). CONCLUSION The results of this study demonstrate that metabolic syndrome is associated with postprocedural myocardial injury and with increased cardiac events.
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Cassuto J, Feher A, Lan L, Patel VS, Kamath V, Anthony DC, Bagi Z. Obesity and statins are both independent predictors of enhanced coronary arteriolar dilation in patients undergoing heart surgery. J Cardiothorac Surg 2013; 8:117. [PMID: 23631400 PMCID: PMC3658876 DOI: 10.1186/1749-8090-8-117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 04/16/2013] [Indexed: 11/10/2022] Open
Abstract
Background A paradoxical inverse relationship between body mass index, morbidity and mortality in patients with ischemic heart disease has been noted; but the underlying mechanisms remain unclear. Given that coronary resistance arteries are the primary regulators of myocardial blood flow, we examined the effects of obesity and medication on dilator function in coronary microvessels. Methods Bradykinin-induced coronary dilation was assessed by videomicroscopy in ex vivo coronary arterioles obtained from 64 consecutive patients undergoing heart surgery. Multi-variable linear regression and logistic regression were used to investigate the effects of obesity (BMI ≥ 30 kg/M2) and the influences of medications on vessel responses. Results In isolated, pressurized (80 mmHg) coronary arterioles of obese and non-obese patient the active (73±4 vs. 79±13 μm) and passive (111 ± 5.5 vs. 118 ± 5.0 μm) diameters were similar. Bradykinin elicited substantial dilation in coronary arterioles, with a similar magnitude in obese and non-obese patients (to 10-8 M: 55 ± 5% vs. 46 ± 5%, P = 0.20), but with significantly enhanced sensitivity in obesity (EC50: 8.2x10-9 M vs. 1.9x10-8 M, respectively, P = 0.03). When adjusted for other risk factors and medications, obesity and statins were determined to be the only positive predictors of enhanced dilation, as assessed with multiple regression analysis. Moreover, obese patients with or without statin exhibited significantly increased coronary dilation to bradykinin, when compared to non-obese patients without statin therapy. Conclusions Obesity and statin therapy are independently associated with an enhanced dilator function of coronary arterioles in patients undergoing heart surgery, which may offer a potential mechanism for the better cardiovascular outcome described earlier as the obesity paradox.
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