Key result
Metabolic syndrome is linked to ~4.9-fold higher odds of early-onset CAD in non-diabetic adults.
Why the study?
The impact of metabolic syndrome on premature CAD has not been studied extensively. In addition, lowering the impaired fasting glucose threshold from 110 to 100 mg/dl and the value of the syndrome as a whole versus its individual components remain debated.
Does the presence of metabolic syndrome (defined by ATP-III or AHA/NHLBI criteria) increase the risk of early-onset coronary artery disease beyond its individual components in men under age 46 and women under age 56?
Case-Control (n=786)
Does the presence of metabolic syndrome (defined by ATP-III or AHA/NHLBI criteria) increase the risk of early-onset coronary artery disease beyond its individual components in men under age 46 and women under age 56?
Although metabolic syndrome is strongly associated with a high risk of early-onset clinical coronary artery disease, it does not provide prognostic information beyond the sum of its individual components.
Answers are grounded in this paper and cite their sources.
MetS signals high early CAD risk but adds no independent value beyond components; leaves open whether syndrome diagnosis improves risk stratification.
Objectives We sought to examine the association between the metabolic syndrome (MetS) (defined both by the 2001 National Cholesterol Educational Program Adult Treatment Panel III [ATP-III] definition and the American Heart Association/National Heart, Lung and Blood Institute [AHA/NHLBI] revision incorporating the lower threshold for impaired fasting glucose [IFG]) and early-onset coronary artery disease (CAD). Background The impact of MetS on premature CAD has not been studied extensively. Lowering the threshold to define the IFG component (from 110 to 100 mg/dl) and the value of the syndrome as a whole versus its individual components are subjects of intense debate. Methods We performed a case-control study with 393 early-onset CAD subjects (acute myocardial infarction, angina with > or =50% stenosis, or coronary revascularization) in men under age 46 years or women under age 56 years and 393 control subjects individually matched for gender, age, and race/ethnicity. Results By conditional logistic regression, presence of ATP-III MetS without diabetes (adjusted odds ratio [adj-OR] 4.9; 95% confidence interval [CI] 3.4 to 8.0) and with diabetes (adj-OR 8.0, 95% CI 4.39 to 14.6) was a strong independent determinant of early-onset CAD. Using the AHA/NHLBI revision, these ORs became slightly stronger. However, neither definition of MetS remained significantly associated with early-onset CAD in multivariate models adjusting for individual components. Conclusions The presence of MetS imparts a high risk of early-onset clinical CAD, but the prognostic information associated with the syndrome is not greater than the sum of its parts.
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Iribarren et al. (2006) conducted a case-control in Early-onset coronary artery disease (n=786). Metabolic syndrome (ATP-III and AHA/NHLBI definitions) vs. Absence of metabolic syndrome was evaluated on Early-onset coronary artery disease (acute myocardial infarction, angina with ≥50% stenosis, or coronary revascularization) (OR 4.9, 95% CI 3.4-8.0). Metabolic syndrome strongly increased early-onset CAD risk without and with diabetes, though not independently of its individual components.
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