Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University of Naples Federico II, Italy.
Nutr Metab Cardiovasc Dis. 2010 Nov;20(9):676-82. doi: 10.1016/j.numecd.2009.05.016. Epub 2009 Aug 20.
Metabolic syndrome (MetS) was reported to be associated with increased cardiovascular risk in various settings, however its prognostic impact in peripheral arterial disease (PAD) is scanty.
We prospectively studied 173 patients with intermittent claudication and ankle/brachial index (ABI)<0.90, in whom MetS was defined using the criteria of both the revised version of the Adults Treatment Panel III (rATP III) and the International Diabetes Federation (IDF). Of these patients, 52.6% met the rATP III and 54.9% the IDF criteria for MetS. During a median follow-up of 31 months, 54 cardiovascular events occurred. Kaplan-Meier curves showed a greater incidence of ischemic events in patients with MetS than in those without. However, adjusted Cox analyses revealed that only IDF-MetS was independently associated with increased cardiovascular risk (HR=1.91, 95% CI 1.03-3.51, p=0.038). Kaplan-Meier curves for the four groups of patients delineated according to the bootstrapped ABI cut-off value (0.73) and the presence or absence of IDF-MetS revealed that the syndrome improved the predictive power of ABI alone. Actually, among patients with an ABI≤0.73, those with IDF-MetS had a higher cardiovascular risk than those without the syndrome (HR=2.55, 95% CI 1.22-5.12, p=0.012). This was confirmed by c-statistic, which was 0.56 for ABI alone and increased to 0.65 (p=0.046) when IDF-Mets was added to the pressure index.
In PAD, IDF-MetS, but not rATP III-MetS, is associated with an increased risk of cardiovascular events. Furthermore, IDF-MetS adds to the prognostic value of ABI, currently the most powerful prognostic indicator in PAD.
代谢综合征（MetS）在多种情况下与心血管风险增加相关，但在周围动脉疾病（PAD）中的预后影响尚不清楚。
我们前瞻性研究了 173 例间歇性跛行和踝臂指数（ABI）<0.90 的患者，其中 MetS 采用修订版成人治疗小组 III（rATP III）和国际糖尿病联合会（IDF）的标准进行定义。这些患者中，52.6%符合 rATP III，54.9%符合 IDF 的 MetS 标准。在中位随访 31 个月期间，发生了 54 例心血管事件。Kaplan-Meier 曲线显示 MetS 患者的缺血性事件发生率更高。然而，调整后的 Cox 分析显示，只有 IDF-MetS 与心血管风险增加独立相关（HR=1.91，95%CI 1.03-3.51，p=0.038）。根据 bootstrap ABI 截断值（0.73）和是否存在 IDF-MetS 将患者分为四组的 Kaplan-Meier 曲线显示，该综合征改善了 ABI 单独的预测能力。实际上，在 ABI≤0.73 的患者中，有 IDF-MetS 的患者心血管风险高于没有该综合征的患者（HR=2.55，95%CI 1.22-5.12，p=0.012）。这一点通过 C 统计量得到了证实，ABI 单独的 C 统计量为 0.56，当将 IDF-Mets 添加到压力指数中时，增加到 0.65（p=0.046）。
在 PAD 中，IDF-MetS 而非 rATP III-MetS 与心血管事件风险增加相关。此外，IDF-MetS 增加了 ABI 的预后价值，ABI 是目前 PAD 中最强大的预后指标。
