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2010, Number 2

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Cir Cir 2010; 78 (2)

Síndrome metabólico, impacto clínico y angiográfico en pacientes con síndrome coronario agudo

Madrid-Miller A, Alcaraz-Ruiz A, Borrayo-Sánchez G, Almeida-Gutiérrez E, Vargas-Guzmán RM, Jáuregui-Aguilar R

Language: Spanish
References: 28
Page: 115-123
PDF size: 394.22 Kb.


ABSTRACT

Background: Metabolic syndrome (MetS) is represented by a cluster of various risk factors and is one of the most important public health problems of the 21st century. The aim of this study was to identify the impact of this syndrome in patients with acute coronary syndrome (ACS).
Methods: We included patients with ST and non ST segment elevation ACS. We divided patients into two groups: A) patients with MetS criteria and B) patients without MetS criteria. We compared the incidence of major cardiovascular events, severity of coronary artery disease (CAD), need for urgent revascularization and in-hospital mortality between groups.
Results: Among 917 patients with ACS, 421 (43.4%) fulfilled criteria of MetS. Age of patients in this group was 63.37 ± 9.95 years (compared with 61.77 ± 12.20 years in group B), 66.7% vs. 72.8% males, diabetes 70.3% vs. 33.3%, hypertension 87.6% vs. 40.5% and dyslipidemia 70.5% vs. 26.9%, respectively. ST-elevation ACS was more frequent in group A. We observed more severe CAD, and major cardiovascular events were more frequent in group A. Multivariate analysis demonstrated that hyperfibrinogenemia, hyperglycemia and MetS were independent predictors of heart failure and composite end point.
Conclusions: Incidence of MetS was high in patients with ACS, presented with more comorbidities and older patients, and was associated with poorer in-hospital outcome. It may be probable that the high inflammatory and prothrombotic response and more severe CAD in these patients increase the incidence of major cardiovascular events.


REFERENCES

  1. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2492.

  2. American College of Endocrinology Task Force on the Insulin Resistance Syndrome: American College of Endocrinology Position Statement on the Insulin Resistance Syndrome.. Endocr Pract 2003;9:236-252.

  3. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002;287:356-359.

  4. Ford ES, Giles WH, Mokdad AH. Increasing prevalence of metabolic syndrome among US adults. Diabetes Care 2004;27:2444-2449.

  5. Isomaa B, Alegren P, Tuomi T, Forsén B, Lahti K, Nissén M, et al. Cardiovascular morbidity and mortality associated with metabolic syndrome. Diabetes Care 2001;24:683-689.

  6. Olijhoek JK, van der Graaf Y, Banga JD, Algra A, Rabelink TJ, Visseren FL. SMART Study Group. The metabolic syndrome is associated with advanced vascular damage in patients with coronary heart disease, stroke, peripheral arterial disease or aortic aneurysm. Eur Heart J 2004;25:342-348.

  7. Balkau B, Charles MA, Drivsholm T, Borch-Johnsen K, Wareham N, Yudkin JS, et al. Frequency of the WHO metabolic syndrome in European cohorts, and an alternative definition of an insulin resistance syndrome. Diabetes Metab 2002;28:364–376.

  8. Ford ES. The metabolic syndrome and mortality from cardiovascular disease and all-causes: findings from the National Health and Nutrition Examination Survey II Mortality Study. Atherosclerosis 2004;173:309-314.

  9. Lara EA, Rosas PM, Pastelín G, Aguilar C, Attie F, Velázquez MO. Hipercolesterolemia e hipertensión arterial en México. Consolidación urbana actual con obesidad, diabetes y tabaquismo. Arch Cardiol Mex 2004;74:231-245.

  10. Solymoss BC, Bourassa MG, Campeau L, Sniderman A, Marcil M, Lespérance J, et al. Effect of increasing metabolic syndrome score on atherosclerotic risk profile and coronary artery disease angiographic severity. Am J Cardiol 2004;93:159-164.

  11. Zeller M, Steg PG, Ravisy J, Laurent Y, Janin-Manificat L, L’Huillier I, et al. Prevalence and impact of metabolic syndrome on hospital outcomes in acute myocardial infarction. Arch Intern Med 2005;165:1192-1198.

  12. Levantesi G, Macchia A, Marfisi RA, Franzosi MG, Maggioni AP, Nicolosi GL, et al. Metabolic syndrome and risk of cardiovascular events after myocardial infarction. J Am Coll Cardiol 2005;46:277-283.

  13. Solymoss BC, Bourassa MG, Marcil M, Levesque S, Varga S, Campeau L. Long-term rates of cardiovascular events in patients with the metabolic syndrome according to severity of coronary-angiographic alterations. Coronary Artery Dis 2009;20:1-8.

  14. Lopes NH, Paulitsch FS, Pereira AC, Góis AF, Gagliardi A, Garzillo CL, et al. Impact of metabolic syndrome on the outcome of patients with stable coronary artery disease: 2-year follow-up of the MASS II study. Coronary Artery Dis 2008;19:383-388.

  15. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002;288:2709-2716.

  16. Malik S, Wong ND, Franklin SS, Kamath TV, L’Italien GJ, Pio JR, et al. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation 2004;110:1245-1250.

  17. L’Italien G, Ford I, Shepherd J. The metabolic syndrome is an independent predictor of cardiac events in WOSCOPS males. J Am Coll Cardiol 2003;41:291A.

  18. Haffner SM, Lehto S, T. Ronnemaa, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. NEJM 1998;339:229–234.

  19. Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993;16:434-444.

  20. Yilmaz MB, Caldir V, Guray Y, Guray U, Altay H, Demirkan B, et al. Relation of coronary collateral vessel development in patients with a totally occluded right coronary artery to the metabolic syndrome. Am J Cardiol 2006;97:636-639.

  21. Kannel WB, Wolf OA, Castelli WP, D’Agostino RB. Fibrinogen and risk of cardiovascular disease. The Framingham study. JAMA 1987;258:1183-1186.

  22. Ernst E, Resch K. Fibrinogen as a cardiovascular risk factor: a meta-analysis and review of the literature. Ann Intern Med 1993;118:956-963.

  23. Ziakas A, Gavrilidis S, Giannoglou G, Souliou E, Gemitzis K, Kalampalika D, et al. In-hospital and long-term prognostic value of fibrinogen, CRP, and IL-6 levels in patients with acute myocardial infarction treated with thrombolysis. Angiology 2006;57:283-293.

  24. Marchioli R, Bomba E, Di Pasquale A, Geraci E, Giannuzzi P, Marfisi RM, et al. A chart of post-acute myocardial infarct risk: results in the first 18 months of the GSSI follow-up study. G Ital Cardiol 1998;28:416–433.

  25. Ray KK, Cannon CP, Cairns R, Morrow DA, Rifai N, Kirtane AJ, et al. Relationship between risk factors and C-reactive protein levels in patients receiving standard or intensive statin therapy for acute coronary syndrome in PROVE IT TIMI 22Trial. J Am Coll Cardiol 2005;46:1417-1424.

  26. Ridket PM, Wilson PW, Grundy SM. Should C-reactive protein be added to metabolic syndrome and to assessment of global cardiovascular risk? Circulation 2004;109:2818-2825.

  27. Kockx M, Gervois PP, Poulain P, Derudas B, Peters JM, González FJ, et al. Fibrates suppress fibrinogen gene expression in rodents via activation of PPAR-alfa. Blood 1999;93:2991- 2998.

  28. Staels B, Koenig W, Habib A, Merval R, Lebret M, Torra IP, et al. Activation of human aortic smooth muscle cells is inhibited by PPAR-α but not by PPAR-γ activators. Nature 1998;393:790-793.




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