Key result
Metabolic syndrome linked to ~113% higher MACE risk in patients with non-obstructive coronary disease.
Why the study?
Patients with metabolic syndrome may have a higher plaque burden that increases major adverse cardiovascular events, but the prevalence of high-risk coronary plaques and their prognostic relationship in these patients needed evaluation.
Does metabolic syndrome increase the prevalence of high-risk coronary plaques and the risk of major adverse cardiovascular events in patients with chest pain without obstructive heart disease?
Cohort (n=1,136)
No
Does metabolic syndrome increase the prevalence of high-risk coronary plaques and the risk of major adverse cardiovascular events in patients with chest pain without obstructive heart disease?
In patients with non-obstructive coronary artery disease, metabolic syndrome is associated with a higher prevalence of high-risk plaques on CCTA and independently predicts major adverse cardiovascular events.
Answers are grounded in this paper and cite their sources.
Supports closer surveillance in metabolic syndrome with non-obstructive CAD; leaves open whether modification reduces events.
BACKGROUND: Metabolic syndrome (MS) is a disorder, characterized by clusters of cardiovascular risk factors such as central obesity, insulin resistance, dyslipidemia and hypertension. Patients with MS may have a higher plaque burden that increases their risk of major adverse cardiovascular events (MACEs). This study aimed to analyze the prevalence of high-risk coronary plaques in patients with and without MS by coronary computed tomography angiography (CCTA) and to investigate the relationship between MS, high-risk coronary plaques, and their prognosis. METHODS: This was a retrospective cohort study of 1136 patients who underwent CCTA due to chest pain without obstructive heart disease (≥50% coronary stenosis) between January 2014 and December 2015 in our hospital. The relationships between high risk coronary plaques, MS, and other clinical factors were assessed. Multicollinearity analysis was performed to identify the collinearity between the variables. The proportional hazard assumption was checked and using Schoenfeld residual test. Cox proportional hazards model and Kaplan-Meier survival analysis assessed the relationship between MS, high-risk coronary plaques and MACEs. RESULTS: High-risk plaques were more frequent in the MS group than non-MS group (P = 0.004). MS (HR = 2.128, 95%CI: 1.524-2.970, P < 0.001), presence of high-risk plaques (HR = 11.059, 95%CI: 7.749-57.232, P < 0.001) and high sensitivity C-reactive protein (hsCRP) (HR = 1.629, 95%CI: 1.128-2.352, P = 0.009) were related with an increased risk of MACEs in patients with risk factors for coronary heart disease. In patients with high-risk plaques, MS (HR = 2.265, 95%CI: 1.629-3.150, P < 0.001) and hsCRP (HR = 1.267, 95%CI: 1.191-1.348, P = 0.004) were related with an increased risk of MACEs. Kaplan-Meier analysis showed differences in MACEs between the MS and non-MS groups in the whole population and those with high-risk plaques (both P < 0.0001). CONCLUSIONS: High-risk plaques were more common in patients with MS. MS and the presence of high-risk plaques were independent risk factors for MACEs.
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Xu et al. (2020) conducted a cohort in Chest pain without obstructive heart disease (n=1,136). Metabolic syndrome vs. Without metabolic syndrome was evaluated on Major adverse cardiovascular events (MACEs) (HR 2.128, 95% CI 1.524-2.970, p=<0.001).
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