Hu Rong, Ma Chang-sheng, Nie Shao-ping, Lü Qiang, Kang Jun-ping, Du Xin, Zhang Yin, Gao Ying-chun, He Li-qun, Jia Chang-qi, Liu Xin-min, Dong Jian-zeng, Liu Xiao-hui, Chen Fang, Zhou Yu-jie, Lü Shu-zheng, Wu Xue-Si
Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences, Beijing 100029, China.
Chin Med J (Engl). 2006 Nov 20;119(22):1871-6.
People with metabolic syndrome are at higher risk for developing coronary artery disease (CAD). The effect of the metabolic syndrome on outcomes in patients with preexisting CAD has not been well studied. This study was conducted to assess the prevalence, characteristics, in hospital and long term prognosis of CAD with metabolic syndrome and to determine the factors influencing the prognosis of the disease.
The DESIRE registry contains data of 3696 patients with CAD between 2001 and 2004. Mean long term followup was (829 +/- 373) days. Diagnosis of metabolic syndrome was based on modified International Diabetes Federation (IDF) Worldwide Definition of the Metabolic Syndrome, using body mass index (BMI) instead of waist circumference.
Of 2596 patients with complete records of height, weight, and so on, 1280 (49.3%) were identified with metabolic syndrome. The patients with metabolic syndrome had higher level of body mass index, systolic blood pressure, diastolic blood pressure, fasting glucose and disordered blood lipid (all P < 0.0001), with higher creatinine [(10.5 +/- 4.3) mg/L vs (9.9 +/- 2.9) mg/L, P < 0.0001] and the number of white blood cells [(7.49 +/- 2.86) x 10(9)/L vs (7.19 +/- 2.62) x 10(9)/L, P = 0.008) compared with those without metabolic syndrome. The patients with metabolic syndrome showed severer coronary angiographic alterations (left main artery and/or > or = 2-vessel) (73.6% vs 69.6%, P = 0.031). There were no significant differences of major adverse cardiac and cerebral events (MACCE) or mortality in hospital between the two groups. During followup, the ratio of MACCE in CAD with metabolic syndrome patients increased significantly (11.8% vs 10.0%, P = 0.044). Fasting blood glucose (> or = 1000 mg/L) and triglyceride (TG, > or = 1500 mg/L) were responsible for most of the increased risk associated with the metabolic syndrome (adjusted OR 1.465, 95% CI 1.037 - 1.874, P = 0.032; OR 1.378, 95% CI 1.014 - 1.768, P = 0.044).
The prevalence of metabolic syndrome was very high in CAD patients. The metabolic syndrome confers a higher risk of long term MACCE in patients with CAD, and dysglycaemia and hypertriglycaemia appear to be responsible for most of the associated risk.
代谢综合征患者患冠状动脉疾病（CAD）的风险更高。代谢综合征对已患有CAD患者预后的影响尚未得到充分研究。本研究旨在评估合并代谢综合征的CAD的患病率、特征、住院情况及长期预后，并确定影响该疾病预后的因素。
DESIRE注册研究包含了2001年至2004年间3696例CAD患者的数据。平均长期随访时间为（829±373）天。代谢综合征的诊断基于修改后的国际糖尿病联盟（IDF）全球代谢综合征定义，使用体重指数（BMI）代替腰围。
在2596例有完整身高、体重等记录的患者中，1280例（49.3%）被诊断为代谢综合征。代谢综合征患者的体重指数、收缩压、舒张压、空腹血糖和血脂紊乱水平更高（均P<0.0001），肌酐水平[(10.5±4.3)mg/L vs (9.9±2.9)mg/L，P<0.0001]和白细胞计数[(7.49±2.86)×10⁹/L vs (7.19±2.62)×10⁹/L，P = 0.008]也高于无代谢综合征的患者。代谢综合征患者的冠状动脉造影改变更严重（左主干和/或≥2支血管病变）（73.6% vs 69.6%，P = 0.031）。两组患者的主要不良心脑血管事件（MACCE）或住院死亡率无显著差异。随访期间，合并代谢综合征的CAD患者的MACCE发生率显著增加（11.8% vs 10.0%，P = 0.044）。空腹血糖（≥1000mg/L）和甘油三酯（TG，≥1500mg/L）是与代谢综合征相关的大部分风险增加的原因（调整后的OR为1.465，95%CI为1.037 - 1.874，P = 0.032；OR为1.378，95%CI为1.014 - 1.768，P = 0.044）。
CAD患者中代谢综合征的患病率非常高。代谢综合征使CAD患者发生长期MACCE的风险更高，血糖异常和高甘油三酯血症似乎是大部分相关风险的原因。
