Wassink Annemarie M J, van der Graaf Yolanda, Olijhoek Jobien K, Visseren Frank L J
Department of Vascular Medicine, University Medical Centre Utrecht, Heidelbergiaan , 3508 GA Utrecht, The Netherlands.
Eur Heart J. 2008 Jan;29(2):213-23. doi: 10.1093/eurheartj/ehm582.
To investigate the vascular risk associated with Metabolic Syndrome (MetS) according to different clinical criteria with subsequent vascular events and all-cause mortality in patients with coronary artery disease, cerebrovascular disease, peripheral artery disease or abdominal aortic aneurysm and to examine whether patients with MetS at treatment goals for systolic blood pressure (SBP) or low density lipoprotein-cholesterol (LDL-c) level are still at elevated risk.
Prospective study of 3196 patients with a history or recent diagnosis of clinically manifest vascular disease. During a median follow-up of 3.2 years (interquartile range 1.4-5.4 years), 331 patients died and 373 patients experienced a first vascular event. National Cholesterol Education Program (NCEP) and revised NCEP (NCEP-R)-defined MetS were related to increased risk of vascular events [HR - hazard ratio 1.50 (95% CI - confidence interval 1.22-1.84) and 1.50 (1.22-1.87)] and all-cause mortality [HR 1.49(1.20-1.84) and 1.43 (1.14-1.78)]. Results were similar in the 2472 patients without type 2 diabetes (DM2) and localization of vascular disease; SBP-category (<140 or > or =140 mmHg) or LDL-category (<2.5 or > or =2.5 mmol/L) did not affect this relation.
In patients with various manifestations of atherosclerosis, presence of NCEP and NCEP-R-defined MetS is associated with increased risk of cardiovascular events and all-cause mortality, independently of the presence of DM2. This risk is significantly higher than the risk associated with International Diabetes Federation-defined MetS. Also in patients at treatment goals for SBP (<140 mmHg) or LDL-c (<2.5 mmol/L) according to current guidelines, presence of NCEP-R-defined MetS points to a higher vascular risk.
根据不同临床标准，研究代谢综合征（MetS）与冠状动脉疾病、脑血管疾病、外周动脉疾病或腹主动脉瘤患者随后发生的血管事件及全因死亡率之间的血管风险，并检查达到收缩压（SBP）或低密度脂蛋白胆固醇（LDL-c）水平治疗目标的MetS患者是否仍处于较高风险中。
对3196例有临床明显血管疾病病史或近期诊断的患者进行前瞻性研究。在中位随访3.2年（四分位间距1.4 - 5.4年）期间，331例患者死亡，373例患者发生首次血管事件。美国国家胆固醇教育计划（NCEP）和修订的NCEP（NCEP-R）定义的MetS与血管事件风险增加相关[风险比（HR）- 1.50（95%置信区间（CI）- 1.22 - 1.84）和1.50（1.22 - 1.87）]以及全因死亡率相关[HR 1.49（1.20 - 1.84）和1.43（1.14 - 1.78）]。在2472例无2型糖尿病（DM2）且有血管疾病定位的患者中结果相似；SBP类别（<140或≥140 mmHg）或LDL类别（<2.5或≥2.5 mmol/L）不影响这种关系。
在有各种动脉粥样硬化表现的患者中，NCEP和NCEP-R定义的MetS的存在与心血管事件和全因死亡率风险增加相关，与DM2的存在无关。这种风险显著高于国际糖尿病联盟定义的MetS相关风险。同样，在根据当前指南达到SBP（<140 mmHg）或LDL-c（<2.5 mmol/L）治疗目标的患者中，NCEP-R定义的MetS的存在表明血管风险更高。
