Patel Pratik A, Scott Christopher G, Rodeheffer Richard J, Chen Horng H
Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2016 May;91(5):623-33. doi: 10.1016/j.mayocp.2016.02.026. Epub 2016 Apr 8.
To define the natural history of patients with isolated metabolic syndrome (MS).
Metabolic syndrome is associated with increased risk of cardiovascular mortality. Patients with isolated MS are a subset of patients with MS who do not meet the diagnostic criteria of hypertension (HTN) and diabetes mellitus (DM). Data were collected prospectively on a population-based random sample of 1042 Olmsted County, Minnesota, residents aged 45 years or older who underwent clinical evaluation, medical record abstraction, and echocardiography (visit 1: January 1,1997, to December 31, 2000). The cohort was subdivided into healthy controls, those with isolated MS, and those with MS with HTN and/or DM groups. After 4 years, patients returned for visit 2 (September 1, 2001, to December 30, 2004). After visit 2, we have a median of 8.3 years of follow-up.
There was a higher incidence of HTN, DM, and obesity in the isolated MS group at visit 2 (P<.001) than in healthy controls. Patients with isolated MS did not have significantly higher rates of cardiovascular mortality (hazard ratio [HR], 0.85; 95% CI, 0.23-3.13; P=.80) or development of heart failure (HR, 1.29; 95% CI, 0.58-2.73; P=.53) compared with healthy controls over 8 years of follow-up after visit 2. However, patients with MS with HTN and/or DM had higher rates of cardiovascular mortality (HR, 2.40; 95% CI, 1.00-5.83; P=.02) and heart failure (HR, 2.24; 95% CI, 1.16-4.32; P=.02) compared with healthy controls over 8 years of follow-up after visit 2.
Isolated MS was associated with increased risk for the development of HTN, DM, and obesity, but not increased mortality or heart failure over an 8-year period compared with healthy controls. Future studies should determine whether aggressive management of risk factors in isolated MS will prevent progression to MS.
明确孤立性代谢综合征（MS）患者的自然病史。
代谢综合征与心血管疾病死亡率增加相关。孤立性MS患者是不符合高血压（HTN）和糖尿病（DM）诊断标准的MS患者亚组。前瞻性收集了明尼苏达州奥姆斯特德县1042名年龄在45岁及以上居民的基于人群的随机样本数据，这些居民接受了临床评估、病历摘要和超声心动图检查（第1次就诊：1997年1月1日至2000年12月31日）。该队列被分为健康对照组、孤立性MS患者组以及合并HTN和/或DM的MS患者组。4年后，患者返回进行第2次就诊（2001年9月1日至2004年12月30日）。第2次就诊后，我们有8.3年的中位随访时间。
在第2次就诊时，孤立性MS组的HTN、DM和肥胖发生率高于健康对照组（P<0.001）。在第2次就诊后的8年随访中，与健康对照组相比，孤立性MS患者的心血管疾病死亡率（风险比[HR]，0.85；95%置信区间[CI]，0.23 - 3.13；P = 0.80）或心力衰竭发生率（HR，1.29；95% CI，0.58 - 2.73；P = 0.53）没有显著升高。然而，在第2次就诊后的8年随访中，与健康对照组相比，合并HTN和/或DM的MS患者的心血管疾病死亡率（HR，2.40；95% CI，1.00 - 5.83；P = 0.02）和心力衰竭发生率（HR，2.24；95% CI，1.16 - 4.32；P = 0.02）更高。
与健康对照组相比，孤立性MS与HTN、DM和肥胖发生风险增加相关，但在8年期间并未增加死亡率或心力衰竭发生率。未来研究应确定对孤立性MS危险因素的积极管理是否能预防其进展为MS。
