Article

The incremental prognostic value of assessing the metabolic syndrome
has been disputed. Little is known regarding its prognostic value in patients
after an acute coronary syndrome. Design and methods The presence of metabolic
syndrome (2005 International Diabetes Federation) was assessed at baseline in
SOLID-TIMI 52, a trial of patients within 30 days of acute coronary syndrome
(median follow-up 2.5 years). The primary endpoint was major coronary events
(coronary heart disease death, myocardial infarction or urgent coronary
revascularization). Results At baseline, 61.6% ( n = 7537) of patients met the
definition of metabolic syndrome, 34.7% (n = 4247) had diabetes and 29.3% had
both ( n = 3584). The presence of metabolic syndrome was associated with
increased risk of major coronary events (adjusted hazard ratio (adjHR) 1.29, p <
0.0001) and recurrent myocardial infarction (adjHR 1.30, p < 0.0001). Of the
individual components of the definition, only diabetes (adjHR 1.48, p < 0.0001)
or impaired fasting glucose (adjHR 1.21, p = 0.002) and hypertension (adjHR 1.46,
p < 0.0001) were associated with the risk of major coronary events. In patients
without diabetes, metabolic syndrome was numerically but not significantly
associated with the risk of major coronary events (adjHR 1.13, p = 0.06).
Conversely, diabetes was a strong independent predictor of major coronary events
in the absence of metabolic syndrome (adjHR 1.57, p < 0.0001). The presence of
both diabetes and metabolic syndrome identified patients at highest risk of
adverse outcomes but the incremental value of metabolic syndrome was not
significant relative to diabetes alone (adjHR 1.07, p = 0.54). Conclusions After
acute coronary syndrome, diabetes is a strong and independent predictor of
adverse outcomes. Assessment of the metabolic syndrome provides only marginal
incremental value once the presence or absence of diabetes is established.
- Diabète

Langue : ANGLAIS