Krannert Institute of Cardiology and Roudebush VA Medical Center, Indiana University, Indianapolis, USA.
Metab Syndr Relat Disord. 2010 Jun;8(3):223-8. doi: 10.1089/met.2009.0079.
The impact of metabolic syndrome on the prediction of coronary artery disease (CAD) in subjects with multiple traditional risk factors is unknown.
We enrolled 2,626 consecutive subjects who underwent clinically indicated stress imaging studies using echocardiography or single-photon emission computed tomography (SPECT) myocardial perfusion. Patients with known CAD were excluded leaving 1256 subjects. Metabolic syndrome was defined by National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. The number of traditional risk factors and the presence of metabolic syndrome were compared with the results of stress imaging. Logistic regression analysis was used to assess the impact of metabolic syndrome on CAD prevalence in subjects with limited (<or=2) traditional risk factors and multiple (>or=3) risk factors.
Metabolic syndrome was present in 540 (43%) of subjects. Presence of metabolic syndrome was associated with a nonsignificant 3%-4% increase in overall prevalence of CAD. Metabolic syndrome did not increase the prevalence of CAD in those with multiple (>or=3) traditional risk factors (metabolic syndrome 25% vs. no metabolic syndrome 21%, P = 0.62) or in those with limited (<or=2) risk factors (metabolic syndrome 19% vs. no metabolic syndrome 16%, P = 0.13). The presence of multiple versus limited risk factors had poor accuracy for prediction of CAD with area under the receiver operating curve (ROC) = 0.52. Information on the presence or absence of metabolic syndrome did not improve identification of CAD, ROC area of 0.54, P = not significant (N.S.). None of the five individual components of metabolic syndrome showed significant association with CAD.
The addition of metabolic syndrome to traditional risk factors does not increase the prevalence of CAD determined by stress imaging.
代谢综合征对有多种传统危险因素的患者中冠心病（CAD）预测的影响尚不清楚。
我们纳入了 2626 例连续行超声心动图或单光子发射计算机断层扫描（SPECT）心肌灌注检查的临床指征明确的患者。排除已知 CAD 的患者后，共纳入 1256 例患者。代谢综合征采用美国国家胆固醇教育计划成人治疗专家组第三次报告（NCEP ATP III）标准进行定义。比较了传统危险因素的数量和代谢综合征的存在与应激成像结果之间的关系。采用 logistic 回归分析评估代谢综合征对存在有限（≤2 个）传统危险因素和多个（>3 个）危险因素的患者 CAD 患病率的影响。
代谢综合征存在于 540 例（43%）患者中。代谢综合征的存在与 CAD 总患病率增加 3%-4%无关。在存在多个（>3 个）传统危险因素的患者中（代谢综合征 25%，无代谢综合征 21%，P=0.62）或在存在有限（≤2 个）危险因素的患者中（代谢综合征 19%，无代谢综合征 16%，P=0.13），代谢综合征均未增加 CAD 的患病率。与曲线下面积（ROC）为 0.52 的传统危险因素相比，存在多个危险因素对 CAD 的预测准确性较差。ROC 面积为 0.54，P=不显著（N.S.），代谢综合征的存在或缺失的信息并不能改善 CAD 的识别。代谢综合征的五个组成部分与 CAD 均无显著相关性。
在应激成像确定的 CAD 患病率方面，代谢综合征的加入并未增加传统危险因素的患病率。
