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Should Metabolic Syndrome Be Considered A Coronary Heart Disease Equivalent?

Gundersen Lutheran Health System, La Crosse, WI

PURPOSE: The National Cholesterol Education Program (NCEP III) has addressed Metabolic Syndrome (MS) as a secondary target of therapy and emphasized management of underlying causes. However, few prospective studies have addressed the contribution of MS in the risk for developing premature coronary heart disease (CHD). We aimed to determine the rate of MS in subjects screened for primary prevention and to determine its significance in predicting premature CHD.

METHODS: 253 young to middle-aged adults without known coronary artery disease (CAD) scheduled for elective coronary angiogram were prospectively enrolled. Men >/= 55 and women >/= 65 were excluded, along with those treated with lipid therapy or known CHD. MS was defined per NCEP III as the presence of >/= 3 of the following traits: low HDL (men <40 mg/dL, women <50 mg/dL), high triglyceride (>/=150 mg/dL), hypertension (>/=130/85 mm Hg), fasting glucose (>/=110 mg/dL), and BMI >/=30 (surrogate for waist circumference). CAD was defined as stenosis >/=50%.

RESULTS: Mean age was 51±8. Women comprised 55% of cohort. Severe CAD was diagnosed in 77 (30%) subjects. Of the 35 subjects with type II diabetes, 18 had MS. MS was present in 75 (30%) subjects. Of the subjects with both MS and diabetes mellitus, 56% had CAD. In subjects with diabetes mellitus alone, 47% had CAD compared to 42% with MS alone and 22% of subjects without either MS or diabetes mellitus. Odds for MS in predicting CAD were 2.6 (CI:1.5-4.6;p=0.001). Of the five traits of MS, elevated triglyceride (OR:2.7, CI:1.5-4.6; p<0.001), low HDL (OR:2.1, CI:1.2-3.7; p=0.006), and fasting glucose (OR:2.8, CI:1.4-5.5;p=0.003) also predicted CAD.

CONCLUSION: In this population of young to middle-aged adults with no known history of CAD, as many as 30% had MS. MS was associated with CAD. The rate of diagnosis of CAD among subjects with MS was similar to and independent of diabetes mellitus.

CLINICAL IMPLICATIONS: Individuals with MS may warrant aggressive management similar to those having a CHD equivalent.

DISCLOSURE: K.O. Akosah, None.