Marroquin Oscar C, Kip Kevin E, Kelley David E, Johnson B Delia, Shaw Leslee J, Bairey Merz C Noel, Sharaf Barry L, Pepine Carl J, Sopko George, Reis Steven E
Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pa, USA.
Circulation. 2004 Feb 17;109(6):714-21. doi: 10.1161/01.CIR.0000115517.26897.A7.
The metabolic syndrome, which is characterized by a constellation of fasting hyperglycemia, hypertriglyceridemia, low HDL cholesterol, hypertension, and/or abdominal obesity, is a risk factor for the development of coronary artery disease (CAD) and cardiovascular events. The interrelationship between metabolic status and CAD on cardiovascular risk in women is not known.
We evaluated interrelationships between angiographic CAD, the metabolic syndrome, and incident cardiovascular events among 755 women from the Women's Ischemia Syndrome Evaluation (WISE) study who were referred for coronary angiography to evaluate suspected myocardial ischemia; 25% of the cohort had the metabolic syndrome at study entry. Compared with women with normal metabolic status, women with the metabolic syndrome had a significantly lower 4-year survival rate (94.3% versus 97.8%, P=0.03) and event-free survival from major adverse cardiovascular events (death, nonfatal myocardial infarction, stroke, or congestive heart failure; 87.8% versus 93.5%, P=0.003). When the subjects were stratified by the presence or absence of angiographically significant CAD at study entry, in women with angiographically significant CAD, the metabolic syndrome resulted in significantly higher risk of cardiovascular events than in women with normal metabolic status (hazard ratio 4.93, 95% CI 1.02 to 23.76; P=0.05), whereas it did not result in increased 4-year cardiovascular risk in women without angiographically significant CAD (hazard ratio 1.41, 95% CI 0.32 to 6.32; P=0.65).
These data suggest that in women with suspected myocardial ischemia, the metabolic syndrome modifies the cardiovascular risk associated with angiographic CAD. Specifically, the metabolic syndrome was found to be a predictor of 4-year cardiovascular risk only when associated with significant angiographic CAD.
代谢综合征以空腹血糖升高、高甘油三酯血症、低高密度脂蛋白胆固醇、高血压和/或腹部肥胖为特征，是冠状动脉疾病（CAD）和心血管事件发生的危险因素。代谢状态与CAD之间对女性心血管风险的相互关系尚不清楚。
我们在755名来自女性缺血综合征评估（WISE）研究的女性中评估了血管造影CAD、代谢综合征与心血管事件发生之间的相互关系，这些女性因疑似心肌缺血而接受冠状动脉造影检查；25%的队列在研究开始时患有代谢综合征。与代谢状态正常的女性相比，患有代谢综合征的女性4年生存率显著降低（94.3%对97.8%，P = 0.03），且无重大不良心血管事件（死亡、非致命性心肌梗死、中风或充血性心力衰竭）的生存率也显著降低（87.8%对93.5%，P = 0.003）。当根据研究开始时是否存在血管造影显著CAD对受试者进行分层时，在血管造影显著CAD的女性中，代谢综合征导致心血管事件风险显著高于代谢状态正常的女性（风险比4.93，95%置信区间1.02至23.76；P = 0.05），而在无血管造影显著CAD的女性中，代谢综合征并未导致4年心血管风险增加（风险比1.41，95%置信区间0.32至6.32；P = 0.65）。
这些数据表明，在疑似心肌缺血的女性中，代谢综合征改变了与血管造影CAD相关的心血管风险。具体而言，仅当与显著的血管造影CAD相关时，代谢综合征才被发现是4年心血管风险的预测因素。
