Udell Jacob A, Steg Ph Gabriel, Scirica Benjamin M, Eagle Kim A, Ohman E Magnus, Goto Shinya, Alsheikh-Ali Alawi A, Porath Avi, Corbalan Ramon, Umez-Eronini Amarachi A, Hoffman Elaine B, Wilson Peter W F, Bhatt Deepak L
Women's College Hospital, University of Toronto, Toronto, Canada.
Université Paris-Diderot, DHU Fire, AP-HP and INSERM U-698, Paris, France.
Eur J Prev Cardiol. 2014 Dec;21(12):1531-40. doi: 10.1177/2047487313500541. Epub 2013 Aug 5.
The incidence of metabolic syndrome (MetS), diabetes mellitus (DM), and their coexistence is increasing but whether MetS increases cardiovascular risk beyond component risk factors is controversial.
We compared the risk of cardiovascular death, myocardial infarction, or stroke among patients with MetS, newly detected DM, established DM, or coexistent MetS and DM in the global REduction of Atherothrombosis for Continued Health (REACH) registry.
Outpatients with or at risk for atherothrombosis were recruited between 1 December 2003 and 31 December 2004 and followed up to 4 years for cardiovascular events. Risk was compared in patients with or without MetS or DM after adjustment for age, sex, risk factors, vascular disease, fasting blood glucose, therapy, and region.
Among 44,548 REACH participants, 17,887 (40%) were without MetS or DM; 6459 had MetS (15%); 12,059 had established DM (27%); 7503 had both (17%); and 640 had newly detected DM (1%). Presence of MetS was not associated with higher cardiovascular events (12.6%, adjusted HR 0.98, 95% CI 0.89-1.08). In addition, once DM was evident, patients with coexistent MetS had similar increased risk (16.1%, adjusted HR 1.33, 95% CI 1.21-1.47) as DM alone (16.7%, adjusted HR 1.36, 95% CI 1.24-1.48). Newly detected DM was associated with increased cardiovascular risk (18.5%, adjusted HR 1.26, 95% CI 1.02-1.57), similar to longstanding DM. MetS was associated with incident DM (adjusted OR 1.94).
In the REACH registry, presence of newly detected DM but not metabolic syndrome was associated with an increased risk of cardiovascular events.
代谢综合征（MetS）、糖尿病（DM）及其共存的发生率正在上升，但MetS是否会增加超出各组成风险因素的心血管风险仍存在争议。
在全球心血管疾病持续健康研究（REACH）注册研究中，我们比较了患有MetS、新诊断的DM、已确诊的DM或同时患有MetS和DM的患者发生心血管死亡、心肌梗死或中风的风险。
在2003年12月1日至2004年12月31日期间招募有动脉粥样硬化血栓形成或有风险的门诊患者，并对心血管事件进行长达4年的随访。在对年龄、性别、风险因素、血管疾病、空腹血糖、治疗和地区进行调整后，比较有无MetS或DM患者的风险。
在44,548名REACH参与者中，17,887名（40%）没有MetS或DM；6459名患有MetS（15%）；12,059名患有已确诊的DM（27%）；7503名两者都有（17%）；640名新诊断为DM（1%）。MetS的存在与较高的心血管事件发生率无关（12.6%，调整后的风险比0.98，95%置信区间0.89-1.08）。此外，一旦DM明显，同时患有MetS的患者与单独患有DM的患者风险增加相似（16.1%，调整后的风险比1.33，95%置信区间1.21-1.47）（16.7%，调整后的风险比1.36，95%置信区间1.24-1.48）。新诊断的DM与心血管风险增加相关（18.5%，调整后的风险比1.26，95%置信区间1.02-1.57），与长期DM相似。MetS与新发DM相关（调整后的比值比1.94）。
在REACH注册研究中，新诊断的DM而非代谢综合征的存在与心血管事件风险增加相关。
