Metabolic Syndrome Increases Mortality in Heart Failure

BACKGROUND: Metabolic syndrome (MetS) is a risk factor for diabetes, cardiovascular disease, and heart failure, but little is known about the impact of MetS in patients who already have heart failure (HF). HYPOTHESIS: MetS increases mortality in HF. METHODS: We performed an analysis in 865 indigent HF patients enrolled in a HF disease management program at the Chabert Medical Center in Louisiana. All subjects were classified as having MetS if they met three or more of the National Cholesterol Education Program criteria. Mortality was defined using the Social Security Death Index. We calculated the relative hazard (RH) of death for those patients with and without MetS. RESULTS: The prevalence of MetS was 40% (95% confidence interval CI: 37-43). These subjects had similar ages (54.3+/-13.4 vs 55.7+/-12.8 years), more likely to be female (43% vs 33%), had similar baseline ejection fraction (31.4+/-9.7 vs 30.0+/-11.0), and New York Heart Association (NYHA) classification (2.20+/-0.9 vs 2.15+/-0.9). After 2.6+/-2.2 years of follow-up 24% of the MetS group died compared to 16% in the non-MetS group (p < 0.01). The RH of death for the MetS group was 1.5 (95% CI: 1.1-2.1) when compared to the non-MetS group after adjustment demographics, use of angiotensin-converting enzyme (ACE) inhibitor and beta-blocker, hematocrit, creatinine, educational level, and baseline ejection fraction. CONCLUSIONS: The prevalence of MetS is high in indigent HF patients, and it increases the risk of death. Physicians treating patients with HF need to address the current MetS epidemic in HF.