Daly C A, Hildebrandt P, Bertrand M, Ferrari R, Remme W, Simoons M, Fox K M
Royal Brompton Hospital, London, UK.
Heart. 2007 Nov;93(11):1406-11. doi: 10.1136/hrt.2006.113084. Epub 2007 May 31.
To assess the prevalence of metabolic syndrome, and its effect on cardiovascular morbidity and mortality in patients with established coronary disease and to explore the inter-relationships between metabolic syndrome, diabetes, obesity and cardiovascular risk.
The presence of metabolic syndrome was determined in 8397 patients with stable coronary disease from the European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease, with mean follow-up of 4.2 years. Metabolic syndrome was defined using a modified version of the National Cholesterol Education Programme criteria.
Metabolic syndrome was present in 1964/8397 (23.4%) of the population and significantly predicted outcome; relative risk (RR) of cardiovascular mortality = 1.82 (95% CI 1.40 to 2.39); and fatal and non-fatal myocardial infarction RR = 1.50 (95% CI 1.24 to 1.80). The association with adverse outcomes remained significant after adjustment, RR of cardiovascular mortality after adjustment for conventional risks and diabetes = 1.39 (95% CI 1.03 to 1.86). In comparison with normal weight subjects without diabetes or metabolic syndrome, normal weight dysmetabolic subjects (with either diabetes or metabolic syndrome) were at substantially increased risk of cardiovascular death (RR = 4.05 (95% CI 2.38 to 6.89)). The relative risks of cardiovascular death for overweight and obese patients with dysmetabolic status were nominally lower (RR = 3.01 (95% CI 1.94 to 4.69) and RR = 2.35 (95% CI 1.50 to 3.68), respectively).
Metabolic syndrome is associated with adverse cardiovascular outcome, independently of its associations with diabetes and obesity. A metabolic profile should form part of the risk assessment in all patients with coronary disease, not just those who are obese.
评估代谢综合征的患病率及其对已确诊冠心病患者心血管发病率和死亡率的影响，并探讨代谢综合征、糖尿病、肥胖与心血管风险之间的相互关系。
在欧洲稳定型冠状动脉疾病培哚普利降低心脏事件试验中，对8397例稳定型冠心病患者进行代谢综合征的检测，平均随访4.2年。代谢综合征采用美国国家胆固醇教育计划标准的修订版进行定义。
1964/8397（23.4%）的人群存在代谢综合征，且显著预测预后；心血管死亡率的相对风险（RR）=1.82（95%可信区间1.40至2.39）；致命和非致命性心肌梗死的RR =1.50（95%可信区间1.24至1.80）。调整后与不良结局的关联仍然显著，调整传统风险和糖尿病后心血管死亡率的RR =1.39（95%可信区间1.03至1.86）。与无糖尿病或代谢综合征的正常体重受试者相比，正常体重代谢异常受试者（患有糖尿病或代谢综合征）心血管死亡风险大幅增加（RR =4.05（95%可信区间2.38至6.89））。代谢异常状态的超重和肥胖患者心血管死亡的相对风险名义上较低（分别为RR =3.01（95%可信区间1.94至4.69）和RR =2.35（95%可信区间1.50至3.68））。
代谢综合征与不良心血管结局相关，独立于其与糖尿病和肥胖的关联。代谢状况应成为所有冠心病患者风险评估的一部分，而不仅仅是肥胖患者。
