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The adverse prognostic significance of the metabolic syndrome with and without hypertension in patients who underwent complete coronary revascularization

Kasai, Takatoshia; Miyauchi, Katsumia; Kajimoto, Kanb; Kubota, Naozumia; Dohi, Tomotakaa; Kurata, Takeshia; Amano, Atsushib; Daida, Hiroyukia

doi: 10.1097/HJH.0b013e32832961cf
Original papers: Metabolic aspects

Objectives The metabolic syndrome is associated with high risk for long-term coronary artery disease mortality. However, few studies have examined the prognostic importance of the metabolic syndrome with and without hypertension.

Methods The data of 1133 nondiabetic patients who underwent complete revascularization were analyzed. The patients were categorized by the presence of the metabolic syndrome using the modified American Heart Association/National Heart, Lung, and Blood Institute statement and by the presence of hypertension. All patients were divided into four groups: neither the metabolic syndrome nor hypertension (group 1); the metabolic syndrome without hypertension (group 2); hypertension without the metabolic syndrome (group 3); and both the metabolic syndrome and hypertension (group 4). Cox proportional hazards were used in adjusted analyses for all-cause and cardiac mortality, as well as for the composite incidence of fatal and nonfatal stroke.

Results The progress of 276 (24.4%) patients in group 1, 413 (36.5%) in group 2, 105 (9.3%) in group 3, and 339 (29.9%) in group 4 was analyzed. The mean follow-up was 10.4 ± 3.4 years. Patients in group 4 had a higher risk of all-cause mortality (hazard ratio 1.78, P = 0.004). In addition, patients in groups 2 and 4 had a higher risk of cardiac mortality (group 2: hazard ratio 2.84, P = 0.04, group 4: hazard ratio 3.91, P = 0.001) and stroke (group 2: hazard ratio 2.46, P = 0.03, group 4: hazard ratio 2.09, P = 0.03).

Conclusion The metabolic syndrome both with and without hypertension is associated with increased risk of cardiac mortality and stroke incidence in patients who underwent complete coronary revascularization.

aDepartments of Cardiology, Japan

bCardiovascular Surgery, Juntendo University School of Medicine, Tokyo, Japan

Received 26 May, 2008

Revised 5 January, 2009

Accepted 15 January, 2009

Correspondence to Dr Katsumi Miyauchi, MD, Department of Cardiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan Tel: +81 3 5802 1056; fax: +81 3 5689 0627; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.