Kragelund Charlotte, Køber Lars, Faber Jens, Steffensen Rolf, Hildebrandt Per
Department of Cardiology, Hvidovre University Hospital, Hvidovre, Denmark.
Int J Cardiol. 2007 Sep 14;121(1):62-7. doi: 10.1016/j.ijcard.2007.04.068. Epub 2007 Jun 12.
Metabolic syndrome (MS) is associated with subsequent development of type 2 diabetes and cardiovascular disease in the general population. The impact of MS on mortality in patients with stable coronary heart disease is less well defined, and the association of prognosis to gender is unknown.
1041 patients with stable coronary heart disease, referred for elective coronary angiography were included in this study. At baseline, history of hypertension, body mass index, lipids, fasting plasma glucose, and insulin were recorded. All-cause mortality was determined after a median follow-up of 9.2 years.
At follow-up 296 (28%) patients had died. 315 (30%) patients had MS based on the definition by the World Health Organization. Patients with MS more frequently had diabetes and three-vessel disease of the coronary arteries. Men had a more severe risk profile than women. In a multivariable Cox regression analysis, MS was not associated with excess mortality risk in the overall population [adjusted HR=1.3 (95% CI: 0.7-2.3), p=0.43]. In gender specific analyses MS increased risk of all-cause mortality in women [adjusted HR=2.2 (95% CI: 1.1-4.3), p=0.02], but not in men [adjusted HR=1.0 (95% CI: 0.5-1.9), p=0.93].
MS provides prognostic information in women, but not in men. This association was independent of conventional cardiovascular risk factors including previously unrecognised diabetes, and angiographic coronary artery disease.
代谢综合征（MS）与普通人群中2型糖尿病和心血管疾病的后续发生相关。MS对稳定型冠心病患者死亡率的影响尚不明确，且预后与性别的关联未知。
本研究纳入了1041例因择期冠状动脉造影而转诊的稳定型冠心病患者。在基线时，记录高血压病史、体重指数、血脂、空腹血糖和胰岛素水平。在中位随访9.2年后确定全因死亡率。
随访时，296例（28%）患者死亡。根据世界卫生组织的定义，315例（30%）患者患有MS。患有MS的患者更常患有糖尿病和冠状动脉三支病变。男性的风险状况比女性更严重。在多变量Cox回归分析中，MS与总体人群的额外死亡风险无关[调整后风险比（HR）=1.3（95%置信区间：0.7 - 2.3），p = 0.43]。在按性别进行的分析中，MS增加了女性全因死亡风险[调整后HR = 2.2（95%置信区间：1.1 - 4.3），p = 0.02]，但在男性中未增加[调整后HR = 1.0（95%置信区间：0.5 - 1.9），p = 0.93]。
MS对女性有预后提示作用，但对男性没有。这种关联独立于包括先前未识别的糖尿病和血管造影显示的冠状动脉疾病在内的传统心血管危险因素。
