Effect of increasing metabolic syndrome score on atherosclerotic risk profile and coronary artery disease angiographic severity

https://doi.org/10.1016/j.amjcard.2003.09.032Get rights and content

Abstract

The metabolic syndrome (MS) is a frequent cause of coronary artery disease (CAD), and recently the National Cholesterol Education Program Adult Treatment Panel III suggested its diagnosis in the presence of 3 to 5 quantitatively defined markers. Because the consequences of the MS are likely related to the number and diversity of markers, we studied the relation between the number of markers—the MS score—and the degree of abdominal obesity, risk factor profile, and severity of CAD. One thousand one hundred eight subjects of a mostly white population with symptoms of CAD (793 men and 315 women; 58.1 ± 9.8 years of age) were divided into 6 groups based on their MS scores. A low high-density lipoprotein cholesterol level was the most frequently observed marker, followed by increased blood pressure, triglycerides, waist circumference, and fasting glucose. As the MS score increased so did abdominal obesity, parameters of “nontraditional” dyslipidemia with surrogate markers of dense low-density lipoprotein and high-density lipoprotein particles, blood pressure, fasting glucose, insulin, and the homeostatic model assessment insulin resistance index. Similarly, an increasing MS score was significantly related to more severe coronary angiographic alterations and higher frequencies of unstable angina, myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting. Therefore, the MS score provides a clinically useful index of MS severity and the associated atherosclerotic risk factor profile. It also correlates with the angiographic severity of CAD and its clinical complications.

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Methods

We collected clinical, biochemical, and angiographic information in 1,108 consecutive patients (793 men and 315 women; age 58.1 ± 9.8 years) who underwent elective coronary angiography between April 1991 and March 1992. Most patients were white and of French-Canadian origin. All patients signed an informed consent form permitting the anonymous use of their data for research purposes, and the study was approved by our Internal Ethics Review Board.

Our database contained information about all the

Relative frequency of patients with 0 to 5 markers of the MS and relative frequency of various markers

The distribution of patients with a 0 to 5 MS score is listed in Table 1. In most groups, a low HDL cholesterol was the most frequent abnormality, followed by high normal or elevated blood pressure and increased triglycerides, waist circumference, and glucose levels.

Demographic and clinical characteristics of patients with the MS

Results are listed in TABLE 2, TABLE 3. As the number of constituents of the MS rose, so did age and blood pressure. Particularly striking was the progressive increase in the indexes of body weight and abdominal obesity (Table 2).

Discussion

As previously emphasized3 and as shown in the present study, >50% of our patients with CAD fulfilled the diagnostic criteria of the MS as recently defined by NCEP ATP III.1 This high incidence underscores the clinical importance of this diagnosis. Most of our patients were of French-Canadian origin; patients from different ethnic groups, or those without CAD, may have a lower prevalence of MS. As stated earlier, the MS has been shown to affect at least 20% of the U.S. adult population, and its

Acknowledgements

We are grateful to: A.M. Poirier, RN, for her excellent contribution in the collection of baseline clinical data; C. Hudon, RT, F. Lair, RT, M. Pilon, RT, and the other biochemistry laboratory technicians for measuring the chemical parameters; and D. Campeau and F. Thériault for their secretarial help in the preparation of this manuscript.

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