2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Czech Republic.
2nd Department of Internal Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital, Pilsen, Czech Republic; Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic.
Eur J Intern Med. 2018 Jan;47:55-61. doi: 10.1016/j.ejim.2017.07.018. Epub 2017 Jul 26.
We aimed to clarify the impact of metabolic syndrome (MetS) as assessed by different definitions on the cardiovascular mortality in patients with coronary heart disease (CHD).
A total of 1692 patients, 6-24months after myocardial infarction and/or coronary revascularization at baseline, were followed in a prospective cohort study. MetS was identified using four different definitions: standard National Cholesterol Education Program definition (NCEP-ATPIII) based on the presence of ≥3 of the following factors: increased waist circumference, raised blood pressure, hypetriglyceridemia, low high-density lipoprotein cholesterol, and increased fasting glycemia; modified NCEP-ATPIII definition (similar, but omitting antihypertensive treatment as an alternative criterion); presence of "atherogenic dyslipidemia"; or "hypertriglyceridemic waist". The primary outcome was a fatal cardiovascular event at 5years.
During 5-year follow-up, 117 patients (6.9%) died from a cardiovascular cause. Patients with MetS by modified NCEP-ATPIII (n=1066, 63.0% of the whole sample) had significantly higher 5-year cardiovascular mortality [adjusted hazard risk ratio (HRR) 2.01 [95%CI:1.26-3.22]; p=0.003] than subjects without MetS. However, when testing single MetS component factors, the majority of attributable mortality risk was driven by increased fasting glycemia (≥5.6mmol/L) [HRR 2.69 (95%CI:1.29-5.62), p=0.009] and the significance of MetS disappeared. None of the other MetS definitions, i.e., standard NCEP-ATPIII (n=1210; 71.5%), "hypertriglyceridemic waist" (n=455; 26.9%) or "atherogenic dyslipidemia" (n=223; 13.2%) were associated with any significant mortality risk.
The co-incidence of MetS has a limited mortality impact in CHD patients, while an increase in fasting glycemia seems to be more a specific marker of mortality risk.
我们旨在阐明不同定义的代谢综合征（MetS）对冠心病（CHD）患者心血管死亡率的影响。
在一项前瞻性队列研究中，对基线时发生心肌梗死和/或冠状动脉血运重建后 6-24 个月的 1692 例患者进行随访。采用四种不同的定义来确定 MetS：基于以下 4 个因素中的≥3 个的标准国家胆固醇教育计划定义（NCEP-ATPIII）：腰围增加、血压升高、高甘油三酯血症、低高密度脂蛋白胆固醇和空腹血糖升高；改良的 NCEP-ATPIII 定义（相似，但省略了作为替代标准的抗高血压治疗）；存在“动脉粥样硬化性血脂异常”；或“高甘油三酯血症腰围”。主要结局为 5 年内的心血管致死性事件。
在 5 年的随访期间，有 117 例患者（6.9%）死于心血管原因。采用改良的 NCEP-ATPIII 的 MetS 患者（n=1066，占总样本的 63.0%）5 年心血管死亡率显著升高[校正后的危险风险比（HRR）为 2.01（95%CI：1.26-3.22）；p=0.003]。然而，当测试单个 MetS 成分因素时，大部分归因于死亡率的风险是由空腹血糖升高（≥5.6mmol/L）引起的[HRR 为 2.69（95%CI：1.29-5.62），p=0.009]，而 MetS 的意义则消失了。其他任何 MetS 定义，即标准 NCEP-ATPIII（n=1210；71.5%）、“高甘油三酯血症腰围”（n=455；26.9%）或“动脉粥样硬化性血脂异常”（n=223；13.2%）均与任何显著的死亡率风险无关。
MetS 的合并发生对 CHD 患者的死亡率影响有限，而空腹血糖升高似乎是死亡率风险的更特异标志物。
