Gazzaruso Carmine, Solerte Sebastiano B, De Amici Emanuela, Mancini Marco, Pujia Arturo, Fratino Pietro, Giustina Andrea, Garzaniti Adriana
IRCCS Maugeri Foundation Hospital, Pavia, Italy.
Am J Cardiol. 2006 Jan 15;97(2):236-9. doi: 10.1016/j.amjcard.2005.07.133. Epub 2005 Dec 1.
Metabolic syndrome is associated with elevated morbidity and mortality for overt coronary artery disease (CAD). In diabetic patients, CAD is often silent. The relation between metabolic syndrome and silent CAD has never been studied. We investigated whether metabolic syndrome is associated with silent CAD in patients with type 2 diabetes mellitus. We evaluated the prevalence of metabolic syndrome in 169 patients with uncomplicated diabetes and angiographically verified silent CAD and in 158 diabetic patients without myocardial ischemia on exercise electrocardiography, 48-hours ambulatory electrocardiography, and stress echocardiography. The groups were comparable for gender, age, glycemic control, and diabetes duration. Metabolic syndrome was defined according to the National Cholesterol Education Program criteria. To estimate insulin resistance in patients treated with diet alone or oral agents (122 patients with CAD and 115 patients without CAD), the Homeostasis Model Insulin-Resistance Assessment (HOMA) was used. The prevalence of metabolic syndrome (59.8% vs 44.3%, p = 0.005) and HOMA (5.4 +/- 2.1 vs 4.9 +/- 2.8, p = 0.044) were significantly higher in those with CAD than in those without CAD. Multiple logistic regression analysis showed that the metabolic syndrome was associated with silent CAD (odds ratio 2.44, 95% confidence interval 1.19 to 5.02, p = 0.015). Among patients on diet alone or oral agents, the HOMA was the strongest predictor of silent CAD (odds ratio 10.16, 95% confidence interval 2.60 to 39.63, p < 0.001). In conclusion, our data have shown an independent association of metabolic syndrome and insulin resistance with silent CAD in patients with type 2 diabetes mellitus. Other studies are needed to establish whether metabolic syndrome and HOMA are reliable markers to identify diabetic patients for additional screening for silent CAD.
代谢综合征与显性冠状动脉疾病（CAD）的发病率和死亡率升高相关。在糖尿病患者中，CAD往往无症状。代谢综合征与无症状CAD之间的关系从未被研究过。我们调查了代谢综合征是否与2型糖尿病患者的无症状CAD相关。我们评估了169例患有单纯性糖尿病且经血管造影证实为无症状CAD的患者以及158例经运动心电图、48小时动态心电图和负荷超声心动图检查无心肌缺血的糖尿病患者中代谢综合征的患病率。两组在性别、年龄、血糖控制和糖尿病病程方面具有可比性。代谢综合征根据国家胆固醇教育计划标准定义。为了评估仅接受饮食治疗或口服药物治疗的患者（122例CAD患者和115例无CAD患者）的胰岛素抵抗，使用了稳态模型胰岛素抵抗评估（HOMA）。CAD患者中代谢综合征的患病率（59.8%对44.3%，p = 0.005）和HOMA（5.4±2.1对4.9±2.8，p = 0.044）显著高于无CAD患者。多因素逻辑回归分析显示，代谢综合征与无症状CAD相关（比值比2.44，95%置信区间1.19至5.02，p = 0.015）。在仅接受饮食治疗或口服药物治疗的患者中，HOMA是无症状CAD的最强预测指标（比值比10.16，95%置信区间2.60至39.63，p < 0.001）。总之，我们的数据表明代谢综合征和胰岛素抵抗与2型糖尿病患者的无症状CAD独立相关。需要其他研究来确定代谢综合征和HOMA是否是识别糖尿病患者进行无症状CAD额外筛查的可靠标志物。
