Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA.
J Am Coll Cardiol. 2011 Jul 5;58(2):131-7. doi: 10.1016/j.jacc.2011.02.046.
Our purpose was to clarify the clinical utility of identifying metabolic syndrome (MetS) in patients with coronary artery disease (CAD).
It is uncertain whether MetS influences prognosis in patients with CAD and whether the risk associated with MetS exceeds the risk associated with the sum of its individual components.
In a post hoc analysis, we compared the incidence of death or myocardial infarction (MI) in stable CAD patients in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial according to the presence (+) or absence (-) of MetS and diabetes: Group A, -MetS/-diabetes; Group B, +MetS/-diabetes; Group C, -MetS/+diabetes; and Group D, +MetS/+diabetes. We explored which MetS components best predicted adverse outcomes and whether MetS had independent prognostic significance beyond its individual components.
Of 2,248 patients, 61% had MetS and 34% diabetes. Risk for death or MI increased from Group A (14%) to Group D (25%, p < 0.001). Hypertension (hazard ratio [HR]: 1.30; 95% confidence interval [CI]: 0.98 to 1.71; p = 0.07), low high-density lipoprotein cholesterol (HR: 1.26; 95% CI: 1.03 to 1.55; p = 0.03), and elevated glucose (HR: 1.17; 95% CI: 0.96 to 1.47; p = 0.11) most strongly predicted death or MI. MetS was associated with an increased risk of death or MI (unadjusted HR: 1.41; 95% CI: 1.15 to 1.73; p = 0.001). However, after adjusting for its individual components, MetS was no longer significantly associated with outcome (HR: 1.15; 95% CI: 0.79 to 1.68; p = 0.46). Allocation to initial percutaneous coronary intervention did not affect the incidence of death or MI within any group.
Among stable CAD patients in the COURAGE trial, the presence of MetS identified increased risk for death or MI, but MetS did not have independent prognostic significance after adjusting for its constituent components. The addition of early percutaneous coronary intervention to optimal medical therapy did not significantly reduce the risk of death or MI regardless of MetS or diabetes status. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation [COURAGE]; NCT00007657).
本研究旨在阐明在冠状动脉疾病（CAD）患者中识别代谢综合征（MetS）的临床应用价值。
MetS 是否会影响 CAD 患者的预后，以及 MetS 相关风险是否超过其各个组成部分的风险，目前尚不确定。
在 COURAGE（经皮冠状动脉介入治疗与强化药物治疗比较研究）试验的一项事后分析中，我们根据是否存在 MetS 和糖尿病，将稳定型 CAD 患者分为四组：A 组，-MetS/-糖尿病；B 组，+MetS/-糖尿病；C 组，-MetS/+糖尿病；D 组，+MetS/+糖尿病。我们探讨了哪些 MetS 成分最能预测不良结局，以及 MetS 是否具有独立于其各个组成部分的预后意义。
在 2248 例患者中，61%患有 MetS，34%患有糖尿病。死亡或心肌梗死（MI）的风险从 A 组（14%）增加到 D 组（25%，p < 0.001）。高血压（风险比[HR]：1.30；95%置信区间[CI]：0.98 至 1.71；p = 0.07）、低高密度脂蛋白胆固醇（HR：1.26；95%CI：1.03 至 1.55；p = 0.03）和高血糖（HR：1.17；95%CI：0.96 至 1.47；p = 0.11）与死亡或 MI 的发生关系最为密切。MetS 与死亡或 MI 风险增加相关（未经调整的 HR：1.41；95%CI：1.15 至 1.73；p = 0.001）。然而，在调整了其各个组成部分后，MetS 与结局之间不再存在显著相关性（HR：1.15；95%CI：0.79 至 1.68；p = 0.46）。初始经皮冠状动脉介入治疗的分配并未影响任何组中死亡或 MI 的发生率。
在 COURAGE 试验的稳定型 CAD 患者中，MetS 的存在提示死亡或 MI 的风险增加，但在调整其组成成分后，MetS 并无独立的预后意义。与最佳药物治疗相比，早期经皮冠状动脉介入治疗并不能显著降低死亡或 MI 的风险，而不论 MetS 或糖尿病状态如何。（经皮冠状动脉介入治疗与强化药物治疗比较研究[COURAGE]；NCT00007657）。
