The Metabolic Syndrome, Its Component Risk Factors, and Progression of Coronary Atherosclerosis
The Metabolic Syndrome, Its Component Risk Factors, and Progression of Coronary Atherosclerosis
复制标题
DOI：
10.1001/archinternmed.2009.551
复制
发表时间：
2010-03-08
影响因子：
--
通讯作者：
Nicholls, Stephen J.
中科院分区：
文献类型：
--
作者：
Bayturan, Ozgur;Tuzcu, E. Murat;Nicholls, Stephen J.
背景：代谢综合征（MetS）患者心血管预后不良的机制尚不清楚。我们试图探讨代谢综合征及其组成危险因素与冠状动脉粥样硬化进展的关联。方法：我们对3459例参与7项临床试验的患者进行了系统回顾，这些临床试验用血管内超声检查监测冠状动脉粥样硬化进展。比较有或无MetS患者的临床特征、基线时冠状动脉粥样硬化负荷和系列评价的变化。斑块进展（动脉粥样硬化体积百分比[PAV]增加>= 5%）、代谢综合征及其危险因素之间的关系进行了研究。003）。多变量分析显示，MetS与PAV进展的可能性更大相关（校正比值比[OR]，1.25; 95%置信区间[CI]，1.05-1.48; P =. 01）。当在模型中使用单个组分代替MetS时，高胆固醇血症（OR，1.26; 95%CI，1.06-1.49; P =. 008)体重指数≥ 30（1.18，1.00-1.40; P =. 05)预测PAV的进展。然而，在调整其个体成分后，MetS不再是独立的预测因子（OR，1.04; 95%CI，0.79-1.37; P =. 79）.结论：尽管在代谢综合征的背景下观察到疾病进展加速，但这是由于个体成分风险因素的存在，而不是综合征本身的存在。
Background: The mechanism that confers adverse cardiovascular prognosis in patients with the metabolic syndrome (MetS) remains unclear. We sought to investigate the association of MetS and its component risk factors with progression of coronary atherosclerosis.Methods: We performed a systematic review of 3459 patients who participated in 7 clinical trials that monitored coronary atheroma progression with intravascular ultrasonography. Patients with or without MetS were compared with regard to clinical characteristics, coronary atheroma burden at baseline, and change on serial evaluation. Relationships between plaque progression (>= 5% increase in percent atheroma volume [PAV]), MetS, and its component risk factors were investigated.Results: The metabolic syndrome was highly prevalent and was associated with greater progression of PAV (+0.51% +/- 0.23% vs +/- 0.23% +/- 0.24%; P =. 003). Multivariable analysis showed that MetS was associated with a greater likelihood of undergoing progression of PAV ( adjusted odds ratio [OR], 1.25; 95% confidence interval [CI], 1.05-1.48; P =. 01). When the individual components were used in the model instead of MetS, hypertriglyceridemia (OR, 1.26; 95% CI, 1.06-1.49; P =. 008) and a body mass index of 30 or higher (1.18, 1.00-1.40; P =. 05) predicted progression of PAV. However, after adjusting for its individual components, MetS was no longer an independent predictor (OR, 1.04; 95% CI, 0.79-1.37; P =. 79).Conclusion: Although accelerated disease progression is observed in the setting of MetS, this is owing to the presence of individual component risk factors rather than to the presence of the syndrome itself.