Metabolic syndrome and risk of cardiovascular events after myocardial infarction
Metabolic syndrome and risk of cardiovascular events after myocardial infarction
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DOI：
10.1016/j.jacc.2005.03.062
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发表时间：
2005-07-19
影响因子：
24
通讯作者：
Marchioli, R
中科院分区：
文献类型：
--
作者：
Levantesi, G;Macchia, A;Marchioli, R
我们的目的是评估代谢综合征（METS）和糖尿病在心肌梗死（MI）后患者中的患病率和预后作用。背景糖尿病是既往MI患者的一个众所周知的危险因素，但血糖代谢异常在一段延长的时间内发展。METS在既往MI患者中作用的数据很少。方法将糖尿病、死亡、主要心血管事件（CVE）和随访期间因充血性心力衰竭（CHF）住院作为结局事件，对11，323例入选GISSI-Escherzione试验的既往MI患者进行了调整后的考克斯回归模型拟合。分别有21%和29%的患者患有糖尿病和METS。METS患者在随访期间糖尿病风险显著增加（93%）。与对照组相比，METS组的死亡概率和CVE均较高（+29%，p = 0.002;+23%，p = 0.005）和糖尿病患者（+68%，p <0.0001;+ 47%，p> 0.0001），尽管糖尿病但非METS患者更可能因CHF住院（+89%，p <0.0003和+24%，p = 0.241）。中度（-6%至-10%）和显著（>-10%）体重减轻与糖尿病风险显著降低（分别为18%和41%）相关。体重增加与糖尿病风险增加显著相关。METS和糖尿病的风险往往是较高的妇女。结论在MI患者中，METS和糖尿病是非常普遍的，并与死亡和CVE的风险增加。糖尿病还与CHF住院风险增加相关。体重减轻显著降低了METS患者患糖尿病的风险。(c)2005年，美国心脏病学会基金会。
OBJECTIVES We aimed to assess the prevalence and prognostic role of metabolic syndrome (METS) and diabetes in post-myocardial infarction (MI) patients.BACKGROUND Diabetes is a well known risk factor for patients with previous MI, but glycemic dysmetabolism develops over a protracted period of time. Scanty data are available on the role of METS in patients with previous MI.METHODS Adjusted Cox's regression models, having diabetes, death, major cardiovascular events (CVE), and hospitalization for congestive heart failure (CHF) during follow-up as outcome events, were fitted on 11,323 patients with prior MI enrolled in the GISSI-Prevenzione Trial.RESULTS At baseline, 21% and 29% of patients had diabetes mellitus and METS, respectively. The METS patients had a significant (93%) increased risk of diabetes during follow-up. As compared with control subjects, the probability of death and CVE were higher in both METS (+29%, p = 0.002; +23%, p = 0.005) and diabetic patients (+68%, p < 0.0001; +47%, p > 0.0001), although diabetic but not METS patients were more likely to be hospitalized for CHF (+89%, p < 0.0003 and +24%, p = 0.241). Moderate (-6% to -10%) and substantial (> - 10%) weight reduction were associated with a significant (18% and 41%, respectively) decreased risk of diabetes. Weight gain was significantly associated with increased risk of diabetes. The risk conferred by METS and diabetes tended to be higher among women.CONCLUSIONS In patients with MI, METS and diabetes were highly prevalent and are associated with increased risk of death and CVE. Diabetes is also associated with increased risk of hospitalization for CHF. Weight reduction significantly decreased the risk of becoming diabetic in patients with METS. (c) 2005 by the American College of Cardiology Foundation.