Metabolic Syndrome and Coronary Angiographic Disease Progression
Background: The metabolic syndrome is a cluster of clinical characteristics thought to be associated with increased coronary risk. This analysis evaluates angiographic progression of coronary disease in women who are postmenopausal with and without the metabolic syndrome enrolled in the Women's Angiographic Vitamin & Estrogen (WAVE) trial, a randomized, controlled trial of hormone therapy and antioxidant vitamins.
Methods: A total of 425 women who are postmenopausal and have angiographic coronary disease were enrolled at 7 clinics between July 1997 and August 1999. Women were categorized as having the metabolic syndrome when they met the National Cholesterol Education Program Adult Treatment Panel III definition. Coronary angiograms were performed at baseline and after 2.8 ± 0.9 years (mean ± SD). Quantitative coronary angiographic analysis was performed at a core laboratory.
Results: Women with the metabolic syndrome (177/294, 60%) were more likely to be taking cholesterol-lowering medication (65% vs 51%, P = .01) and had higher body mass index (33 ± 6 vs 28 ± 6 kg/m, P <.001). The mean reduction in minimum lumen diameter was greater (–0.041 ± 0.151 vs –0.023 ± 0.148 mm/year, P = .33) and new lesions were more frequent (34% vs 23%, P = .054) in women with the metabolic syndrome. In multivariate analysis, the metabolic syndrome was not an independent predictor of angiographic disease progression. However, clinical events (myocardial infarction, stroke, or coronary death) were more frequent among women with the metabolic syndrome (P = .02).
Conclusion: The metabolic syndrome was prevalent among postmenopausal women with coronary disease enrolled in the WAVE trial. Having the metabolic syndrome was not independently associated with changes in minimum lumen diameter or the development of new or progressing coronary lesions, but did confer an increased risk of clinical cardiovascular events.
The metabolic syndrome is a cluster of clinical characteristics thought to be associated with enhanced coronary risk. In 2001, the National Cholesterol Education Program Adult Treatment Panel III (NCEP III) identified the metabolic syndrome as a secondary target of therapy, recommending both lifestyle modification and treatment of individual risk factors. Components of the metabolic syndrome, which include abdominal obesity, blood pressure, and plasma lipid and glucose criteria, are highly concordant and closely associated with insulin resistance. In the National Health and Nutrition Examination Survey, 1988 to 1994 (NHANES III), the prevalence of the metabolic syndrome in the United States was 24%.
The severity of coronary risk has varied with the definition of the metabolic syndrome. In a Scandinavian population, coronary heart disease and stroke were increased 3-fold in individuals with impaired glucose tolerance, elevated fasting glucose levels, or diabetes mellitus and 2 of these conditions: obesity, hypertension, dyslipidemia, or microalbuminuria. In the Scandinavian Simvastatin Survival Study, which included patients with known coronary disease and elevated low-density lipoprotein (LDL) cholesterol levels, subjects with low levels of high-density lipoprotein (HDL) cholesterol and high plasma triglycerides, components of the NCEP III definition of the metabolic syndrome, had more coronary events than subjects with isolated high LDL (36% vs 21%) during a mean follow-up of 5.4 years. However, in a non-diabetic cohort of American Indians in the Strong Heart Study, the metabolic syndrome, as defined in NCEP III, was not predictive of cardiovascular events.
The Women's Angiographic Vitamin & Estrogen (WAVE) trial was a randomized trial with a 2 × 2 factorial design in which women who were postmenopausal with angiographic coronary disease were assigned to receive hormone therapy or placebo and antioxidant vitamins or placebo. This analysis compares the progression of angiographic coronary disease in WAVE participants with and without the metabolic syndrome.
Background: The metabolic syndrome is a cluster of clinical characteristics thought to be associated with increased coronary risk. This analysis evaluates angiographic progression of coronary disease in women who are postmenopausal with and without the metabolic syndrome enrolled in the Women's Angiographic Vitamin & Estrogen (WAVE) trial, a randomized, controlled trial of hormone therapy and antioxidant vitamins.
Methods: A total of 425 women who are postmenopausal and have angiographic coronary disease were enrolled at 7 clinics between July 1997 and August 1999. Women were categorized as having the metabolic syndrome when they met the National Cholesterol Education Program Adult Treatment Panel III definition. Coronary angiograms were performed at baseline and after 2.8 ± 0.9 years (mean ± SD). Quantitative coronary angiographic analysis was performed at a core laboratory.
Results: Women with the metabolic syndrome (177/294, 60%) were more likely to be taking cholesterol-lowering medication (65% vs 51%, P = .01) and had higher body mass index (33 ± 6 vs 28 ± 6 kg/m, P <.001). The mean reduction in minimum lumen diameter was greater (–0.041 ± 0.151 vs –0.023 ± 0.148 mm/year, P = .33) and new lesions were more frequent (34% vs 23%, P = .054) in women with the metabolic syndrome. In multivariate analysis, the metabolic syndrome was not an independent predictor of angiographic disease progression. However, clinical events (myocardial infarction, stroke, or coronary death) were more frequent among women with the metabolic syndrome (P = .02).
Conclusion: The metabolic syndrome was prevalent among postmenopausal women with coronary disease enrolled in the WAVE trial. Having the metabolic syndrome was not independently associated with changes in minimum lumen diameter or the development of new or progressing coronary lesions, but did confer an increased risk of clinical cardiovascular events.
The metabolic syndrome is a cluster of clinical characteristics thought to be associated with enhanced coronary risk. In 2001, the National Cholesterol Education Program Adult Treatment Panel III (NCEP III) identified the metabolic syndrome as a secondary target of therapy, recommending both lifestyle modification and treatment of individual risk factors. Components of the metabolic syndrome, which include abdominal obesity, blood pressure, and plasma lipid and glucose criteria, are highly concordant and closely associated with insulin resistance. In the National Health and Nutrition Examination Survey, 1988 to 1994 (NHANES III), the prevalence of the metabolic syndrome in the United States was 24%.
The severity of coronary risk has varied with the definition of the metabolic syndrome. In a Scandinavian population, coronary heart disease and stroke were increased 3-fold in individuals with impaired glucose tolerance, elevated fasting glucose levels, or diabetes mellitus and 2 of these conditions: obesity, hypertension, dyslipidemia, or microalbuminuria. In the Scandinavian Simvastatin Survival Study, which included patients with known coronary disease and elevated low-density lipoprotein (LDL) cholesterol levels, subjects with low levels of high-density lipoprotein (HDL) cholesterol and high plasma triglycerides, components of the NCEP III definition of the metabolic syndrome, had more coronary events than subjects with isolated high LDL (36% vs 21%) during a mean follow-up of 5.4 years. However, in a non-diabetic cohort of American Indians in the Strong Heart Study, the metabolic syndrome, as defined in NCEP III, was not predictive of cardiovascular events.
The Women's Angiographic Vitamin & Estrogen (WAVE) trial was a randomized trial with a 2 × 2 factorial design in which women who were postmenopausal with angiographic coronary disease were assigned to receive hormone therapy or placebo and antioxidant vitamins or placebo. This analysis compares the progression of angiographic coronary disease in WAVE participants with and without the metabolic syndrome.
Source...