Long-term rates of cardiovascular events in patients with the metabolic syndrome according to severity of coronary-angiographic alterations

Objectives To assess the long-term risk of mortality and cardiovascular events, related to metabolic syndrome (MetS), in patients with less, or more severe coronary artery disease (CAD). Methods One thousand and eighty patients were divided in four groups, according to severity of CAD (1=less than 50% or nonsignificant stenoses; 2=greater or significant stenoses), and according to MetS (A=no; B=yes). Risk was evaluated with the Cox regression analysis. Results About 18.9% of patients had less and 81.1% more advanced CAD. MetS was present in 45.1% of the first and in 52.9% of the second group. At baseline, patients with MetS, or significant stenoses, had less favorable medical, biochemical, and angiographic characteristics. During a follow-up of 12.6 +/- 3.4 years, group 1B had higher incidence (16.3 vs. 7.1%) and hazard ratio [2.36 (1.001-5.57; P=0.0497)] of myocardial infarction than group 1A; group 2B had a higher incidence (19.0 vs. 11.7%) and hazard ratio [1.67 (1.18-2.37; P=0.0041)] of stroke than group 2A. Groups 2A and 2B, as compared with groups 1A and 1B, had a higher incidence of myocardial infarction (39.1 vs. 7.1; 41.8 vs. 16.3%); group 2B had higher incidence of stroke than group 1B (19.0 vs. 9.8%). After adjustment for common risk factors, group 2B retained an elevated risk of stroke. After additional adjustment for diabetes, no event was significantly related to MetS. Conclusion At baseline, coronary patients with MetS, or significant angiographic alterations, had more cardiovascular risk factors. During follow-up, both MetS and significant CAD increased the risk of cardiovascular morbidity but not of mortality. Coron Artery Dis 20: 1-8 (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.