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Metabolic syndrome is associated with extension of coronary artery disease in patients with non-ST segment elevation acute coronary syndromes

BirhanYilmaz, Mehmet; Guray, Umit; Guray, Yesim; Altay, Hakan; Demirkan, Burcu; Caldir, Vedat; Cay, Serkan; Refiker, Meltem Ege; Sasmaz, Hatice; Korkmaz, Sule

Pathophysiology and Natural History
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Background Metabolic syndrome (MS) comprises a group of factors that are associated with increased risk for cardiovascular events. Acute coronary syndromes account for the most important part of cardiovascular events with considerable morbidity and mortality. We aimed to investigate the association of MS with extension of coronary artery disease in patients presenting with non-ST segment elevation (NSTE) acute coronary syndromes (ACS).

Methods Three hundred and six consecutive patients (220 men, 86 women patients) with the diagnosis of NSTE ACS, who were hospitalized within the first 24 h of their chest pain in the coronary care unit, were prospectively enrolled into our study. Patients with elevation of troponins (T or I) were classified as NSTE myocardial infarction (MI) and otherwise as unstable angina pectoris (USAP). Components of MS were noted as previously identified. Coronary angiograms were evaluated by two authors, who were blinded to the study plan and each other, via Sullivan's method.

Results MS was noted in 49% of all patients, and was significantly more common in women than in men (62.8 versus 43.6%, P=0.003). The mean total stenosis score of patients with MS was significantly higher than for those without MS (16±6 versus 12±5, P<0.001), and the mean extension score of patients with MS was significantly higher than for those without MS (63±29 versus 44±26, P<0.001). The presence of MS together with some clinical factors and poor total cholesterol/high-density lipoprotein cholesterol ratio, hypertension and diabetes mellitus, was found to be independently predictive of extension of coronary artery disease (CAD) in a group of patients presenting with NSTE ACS.

Conclusions MS is independently associated with CAD extension, and hence, might account for poor cardiovascular outcomes through CAD extension in patients with NSTE ACS.

Metabolic syndrome (MS) has been currently increasingly identified, and found to be associated with increased risk for cardiovascular events. Acute coronary syndromes (ACS) have considerable frequency along with increased morbidity and mortality among population. We searched the association of MS with extension of coronary artery disease (CAD) in patients presenting with non ST segment elevation (NSTE) ACS. We evaluated 306 consecutive patients with the diagnosis of NSTE ACS, hospitalised within the first 24 hours of their chest pain into coronary care unit, and noted components of MS. Coronary angiograms were evaluated according to Sullivan's method. MS was noted in half of all patients, and was more frequent in female patients than in male patients (62.8% v.s. 43.6%, P=0.003). Mean total stenosis and extension scores of patients with MS was significantly higher than those without MS. Presence of MS, poor total cholesterol/HDL cholesterol ratio, hypertension, diabetes mellitus, were found to be independently predictive of extension of CAD in a group of patients presenting with NSTE ACS. MS might account for CAD extension in patients with NSTE ACS.

Yuksek Ihtisas Education and Research Hospital, Cardiology Clinic, Sihhiye, Turkey

Correspondence and requests for reprints to Dr Mehmet Birhan Yilmaz, SSK Bloklari 70/7 06170 Yenimahalle Ankara Turkey.

Tel: +90 312 387183; e-mail: cardioceptor@ttnet.net.tr

Received 16 March 2005 Accepted 14 April 2005

© 2005 Lippincott Williams & Wilkins, Inc.