Petersen John L, Yow Eric, AlJaroudi Wael, Shaw Linda K, Goyal Abhinav, McGuire Darren K, Peterson Eric D, Harrington Robert A
Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, WA 98122, USA.
Circ Cardiovasc Qual Outcomes. 2010 Mar;3(2):165-72. doi: 10.1161/CIRCOUTCOMES.109.864447. Epub 2010 Feb 23.
Metabolic syndrome (MetSyn) is associated with increased cardiovascular risk in the general population. Its prognostic implications are less well defined in patients with coronary artery disease.
We analyzed patients in the Duke Database for Cardiovascular Disease with a diagnosis of incident obstructive coronary artery disease. Diabetes mellitus (DM) was classified as a clinical history of DM, use of hypoglycemic drugs, or fasting glucose of >or=126 mg/dL. MetSyn was defined as having 3 of 5 characteristics: fasting glucose >or=100 and <126 mg/dL, low high-density lipoprotein cholesterol (men, <40 mg/dL; women, <50 mg/dL), triglycerides >150 mg/dL, blood pressure >or=130/85 mm Hg, or use of antihypertensive therapy, or body mass index >or=27. Death, myocardial infarction, or stroke was assessed at 6 months, 1 year, then annually. Cox proportional hazards models were generated to compare mortality and cardiovascular events between groups. The primary cohort consisted of 5744 patients; 1831 (31.9%) had DM, 2491 (43.4%) had MetSyn, and 1422 (24.7%) had no DM/MetSyn. Median follow-up was 5 years. Compared with no DM/MetSyn patients, DM patients had a higher adjusted risk for mortality (hazard ratio, 1.47; 95% CI, 1.28 to 1.69) but MetSyn patients did not (hazard ratio, 0.94; 95% CI, 0.81 to 1.08). Similar results were found for the combined end points of death or myocardial infarction, and death, myocardial infarction, or stroke.
In a population of consecutive patients with a new diagnosis of coronary artery disease by angiography, MetSyn without DM was not an independent predictor of mortality or cardiovascular events.
代谢综合征（MetSyn）与普通人群心血管风险增加相关。其对冠状动脉疾病患者的预后影响尚不明确。
我们分析了杜克心血管疾病数据库中诊断为新发阻塞性冠状动脉疾病的患者。糖尿病（DM）分为有DM临床病史、使用降糖药物或空腹血糖≥126mg/dL。MetSyn定义为具备以下5项特征中的3项：空腹血糖≥100且<126mg/dL、低高密度脂蛋白胆固醇（男性<40mg/dL；女性<50mg/dL）、甘油三酯>150mg/dL、血压≥130/85mmHg或使用抗高血压治疗，或体重指数≥27。在6个月、1年时评估死亡、心肌梗死或中风情况，之后每年评估一次。生成Cox比例风险模型以比较各组间的死亡率和心血管事件。主要队列包括5744例患者；1831例（31.9%）有DM，2491例（43.4%）有MetSyn，1422例（24.7%）无DM/MetSyn。中位随访时间为5年。与无DM/MetSyn患者相比，DM患者调整后的死亡风险更高（风险比，1.47；95%CI，1.28至1.69），但MetSyn患者并非如此（风险比，0.94；95%CI，0.81至1.08）。对于死亡或心肌梗死以及死亡、心肌梗死或中风的联合终点，也发现了类似结果。
在通过血管造影新诊断为冠状动脉疾病的连续患者群体中，无DM的MetSyn并非死亡率或心血管事件的独立预测因素。
