代谢综合征与冠状动脉造影疾病进展：女性血管造影维生素与雌激素试验

Metabolic syndrome and coronary angiographic disease progression: the Women's Angiographic Vitamin & Estrogen trial.

作者信息

Hsia Judith, Bittner Vera, Tripputi Mark, Howard Barbara V

机构信息

Department of Medicine, George Washington University, Washington, DC, USA.

出版信息

Am Heart J. 2003 Sep;146(3):439-45. doi: 10.1016/S0002-8703(03)00227-8.

DOI:10.1016/S0002-8703(03)00227-8

PMID:12947360

Abstract

BACKGROUND

The metabolic syndrome is a cluster of clinical characteristics thought to be associated with increased coronary risk. This analysis evaluates angiographic progression of coronary disease in women who are postmenopausal with and without the metabolic syndrome enrolled in the Women's Angiographic Vitamin & Estrogen (WAVE) trial, a randomized, controlled trial of hormone therapy and antioxidant vitamins.

METHODS

A total of 425 women who are postmenopausal and have angiographic coronary disease were enrolled at 7 clinics between July 1997 and August 1999. Women were categorized as having the metabolic syndrome when they met the National Cholesterol Education Program Adult Treatment Panel III definition. Coronary angiograms were performed at baseline and after 2.8 +/- 0.9 years (mean +/- SD). Quantitative coronary angiographic analysis was performed at a core laboratory.

RESULTS

Women with the metabolic syndrome (177/294, 60%) were more likely to be taking cholesterol-lowering medication (65% vs 51%, P =.01) and had higher body mass index (33 +/- 6 vs 28 +/- 6 kg/m(2), P <.001). The mean reduction in minimum lumen diameter was greater (-0.041 +/- 0.151 vs -0.023 +/- 0.148 mm/year, P =.33) and new lesions were more frequent (34% vs 23%, P =.054) in women with the metabolic syndrome. In multivariate analysis, the metabolic syndrome was not an independent predictor of angiographic disease progression. However, clinical events (myocardial infarction, stroke, or coronary death) were more frequent among women with the metabolic syndrome (P =.02).

CONCLUSION

The metabolic syndrome was prevalent among postmenopausal women with coronary disease enrolled in the WAVE trial. Having the metabolic syndrome was not independently associated with changes in minimum lumen diameter or the development of new or progressing coronary lesions, but did confer an increased risk of clinical cardiovascular events.

摘要

背景

代谢综合征是一组被认为与冠心病风险增加相关的临床特征。本分析评估了参加女性血管造影维生素与雌激素（WAVE）试验的绝经后患有和未患有代谢综合征的女性冠心病的血管造影进展情况，该试验是一项关于激素治疗和抗氧化维生素的随机对照试验。

方法

1997年7月至1999年8月期间，在7家诊所共纳入了425名绝经后且患有血管造影冠心病的女性。当女性符合美国国家胆固醇教育计划成人治疗小组第三次报告的定义时，被归类为患有代谢综合征。在基线时和2.8±0.9年（平均±标准差）后进行冠状动脉血管造影。在一个核心实验室进行定量冠状动脉血管造影分析。

结果

患有代谢综合征的女性（177/294，60%）更有可能正在服用降胆固醇药物（65%对51%，P = 0.01），且体重指数更高（33±6对28±6 kg/m²，P < 0.001）。患有代谢综合征的女性最小管腔直径的平均减小幅度更大（-0.041±0.151对-0.023±0.148 mm/年，P = 0.33），新病变更常见（34%对23%，P = 0.054）。在多变量分析中，代谢综合征不是血管造影疾病进展的独立预测因素。然而，患有代谢综合征的女性临床事件（心肌梗死、中风或冠状动脉死亡）更常见（P = 0.02）。