Girman Cynthia J, Rhodes Thomas, Mercuri Michele, Pyörälä Kalevi, Kjekshus John, Pedersen Terje R, Beere Polly A, Gotto Antonio M, Clearfield Michael
Departments of Epidemiology, Merck Research Laboratories, West Point, Pennsylvania 19486, USA.
Am J Cardiol. 2004 Jan 15;93(2):136-41. doi: 10.1016/j.amjcard.2003.09.028.
The metabolic syndrome, which is a set of lipid and nonlipid risk factors of metabolic origin linked with insulin resistance, is believed to be associated with an elevated risk for cardiovascular disease, but few have studied this association in prospective long-term cardiovascular outcomes trials. Placebo data from the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) were used post hoc to estimate the long-term relative risk of major coronary events (MCEs) associated with the metabolic syndrome, after excluding diabetes mellitus. In 4S and AFCAPS/TexCAPS, respectively, placebo-treated patients with the metabolic syndrome were 1.5 (95% confidence interval 1.2 to 1.8) and 1.4 (95% confidence interval 1.04 to 1.9) times more likely to have MCEs than those without it. Of the components of the metabolic syndrome, low high-density lipoprotein levels were associated with elevated risk of MCEs in both studies, whereas high triglycerides in 4S and elevated blood pressure and obesity in AFCAPS/TexCAPS were associated with significantly increased relative risk. Patients with the metabolic syndrome showed increased risk of MCEs irrespective of their Framingham-calculated 10-year risk score category (>20% vs </=20%). These data demonstrate that the metabolic syndrome is associated with increased risk of MCEs in both hypercholesterolemic patients with coronary heart disease in 4S and in those with low high-density lipoprotein cholesterol but without coronary heart disease in AFCAPS/TexCAPS. It appears that the metabolic syndrome is associated with risk that is not entirely accounted for by traditional risk scoring paradigms.
代谢综合征是一组源于代谢的脂质和非脂质风险因素，与胰岛素抵抗相关，被认为与心血管疾病风险升高有关，但很少有人在前瞻性长期心血管结局试验中研究这种关联。斯堪的纳维亚辛伐他汀生存研究（4S）和空军/德克萨斯冠状动脉粥样硬化预防研究（AFCAPS/TexCAPS）的安慰剂数据在排除糖尿病后被用于事后分析，以估计与代谢综合征相关的主要冠状动脉事件（MCE）的长期相对风险。在4S和AFCAPS/TexCAPS中，接受安慰剂治疗的代谢综合征患者发生MCE的可能性分别是未患代谢综合征患者的1.5倍（95%置信区间1.2至1.8）和1.4倍（95%置信区间1.04至1.9）。在这两项研究中，代谢综合征的各组成部分中，低高密度脂蛋白水平均与MCE风险升高相关，而在4S中高甘油三酯以及在AFCAPS/TexCAPS中血压升高和肥胖与相对风险显著增加相关。无论根据弗雷明汉计算的10年风险评分类别（>20%对≤20%）如何，代谢综合征患者发生MCE的风险均增加。这些数据表明，在4S中患有冠心病的高胆固醇血症患者以及在AFCAPS/TexCAPS中高密度脂蛋白胆固醇低但无冠心病的患者中，代谢综合征均与MCE风险增加相关。代谢综合征似乎与传统风险评分范式无法完全解释的风险相关。
