doi: 10.1161/01.CIR.0000115517.26897.A7
(Circulation. 2004;109:714-721.)
© 2004 American Heart Association, Inc.
Clinical Investigation and Reports |
Metabolic Syndrome Modifies the Cardiovascular Risk Associated With Angiographic Coronary Artery Disease in Women
A Report From the Women’s Ischemia Syndrome Evaluation
From the Cardiovascular Institute (O.C.M., S.E.R.), Department of Epidemiology (K.E.K., B.D.J.), and the Division of Endocrinology (D.E.K.), the University of Pittsburgh, Pittsburgh, Pa; Emory University (L.J.S.), Department of Health Policy & Management, Rollins School of Public Health, Atlanta, Ga; Division of Cardiology, Cedars-Sinai Medical Center (C.N.B.M.), Los Angeles, Calif; Division of Cardiology, Rhode Island Hospital (B.L.S.), Providence, RI; Division of Cardiology, University of Florida (C.J.P.), Gainesville, Fla; and Division of Heart and Vascular Diseases (G.S.), National Heart, Lung, and Blood Institute, Bethesda, Md.
Correspondence to Steven E. Reis, MD, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213. E-mail reisse{at}msx.upmc.edu
Received December 17, 2003; accepted December 17, 2003.
Background— The metabolic syndrome, which is characterized by a constellation of fasting hyperglycemia, hypertriglyceridemia, low HDL cholesterol, hypertension, and/or abdominal obesity, is a risk factor for the development of coronary artery disease (CAD) and cardiovascular events. The interrelationship between metabolic status and CAD on cardiovascular risk in women is not known.
Methods and Results— We evaluated interrelationships between angiographic CAD, the metabolic syndrome, and incident cardiovascular events among 755 women from the Women’s Ischemia Syndrome Evaluation (WISE) study who were referred for coronary angiography to evaluate suspected myocardial ischemia; 25% of the cohort had the metabolic syndrome at study entry. Compared with women with normal metabolic status, women with the metabolic syndrome had a significantly lower 4-year survival rate (94.3% versus 97.8%, P=0.03) and event-free survival from major adverse cardiovascular events (death, nonfatal myocardial infarction, stroke, or congestive heart failure; 87.8% versus 93.5%, P=0.003). When the subjects were stratified by the presence or absence of angiographically significant CAD at study entry, in women with angiographically significant CAD, the metabolic syndrome resulted in significantly higher risk of cardiovascular events than in women with normal metabolic status (hazard ratio 4.93, 95% CI 1.02 to 23.76; P=0.05), whereas it did not result in increased 4-year cardiovascular risk in women without angiographically significant CAD (hazard ratio 1.41, 95% CI 0.32 to 6.32; P=0.65).
Conclusions— These data suggest that in women with suspected myocardial ischemia, the metabolic syndrome modifies the cardiovascular risk associated with angiographic CAD. Specifically, the metabolic syndrome was found to be a predictor of 4-year cardiovascular risk only when associated with significant angiographic CAD.
Key Words: metabolic syndrome • coronary disease • inflammation • obesity • women
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