Metabolic syndrome provides minimal prognostic value for serious adverse events after ACS

Metabolic syndrome provides marginal prognostic value for the risk for major cardiovascular events in patients without diabetes who were recently hospitalized for acute coronary syndrome, according to data from the SOLID-TIMI 52 trial presented at the American College of Cardiology Scientific Session.

The study results also demonstrated that diabetes is a strong and independent predictor of adverse events in this patient population, according to researchers.

“In patients with diabetes, the incremental prognostic value of assessing the presence of metabolic syndrome was not significant relative to diabetes alone,” Ilaria Cavallari, MD, of Brigham and Women’s Hospital, told Cardiology Today.

Cavallari and colleagues assessed the presence of metabolic syndrome at baseline in the randomized trial, which included approximately 13,000 patients within 30 days of hospitalization for ACS. The presence of metabolic syndrome was assessed according to the International Diabetes Federation’s definition, which states that an individual must have central obesity and two of the following criteria: raised triglycerides, reduced HDL cholesterol, raised blood pressure or raised fasting plasma glucose.

The median follow-up time was 2.5 years. At baseline, 61.6% (n=7537) of patients had metabolic syndrome, 34.7% (n=4247) had diabetes and 29.3% (n=3584) had both conditions.

The results demonstrated that the presence of metabolic syndrome was associated with a significantly increased risk for major cardiovascular events (aHR = 1.29; 95% CI, 1.16-1.43), recurrent myocardial infarction (aHR = 1.3; 95% CI, 1.14-1.49) and new-onset diabetes (aHR = 2.77; 95% CI, 2.2-3.49).

However, in patients without diabetes, metabolic syndrome was not significantly associated with a risk for major cardiovascular events (aHR = 1.13; 95% CI, 0.99-1.29).

In addition, diabetes alone was a strong independent predictor of major cardiovascular events (aHR = 1.57; 95% CI, 1.27-1.95).

The presence of both diabetes and metabolic syndrome identified patients at highest risk for adverse outcomes, but the incremental value of metabolic syndrome was not significant relative to diabetes alone (aHR = 1.07; 95% CI, 0.87-1.31).

“The presence of metabolic syndrome was associated with a significantly increased risk of subsequent event[s], but this risk was mainly driven by the presence of hypertension and diabetes,” Cavallari said. “The incremental prognostic value of metabolic syndrome is only marginal once the presence of diabetes is established.” – by Julie Gotchel

Reference:

Cavallari I, et al. Lipids and Metabolic Syndrome in ACS. Presented at: American College of Cardiology Scientific Session; April 2-4, 2016; Chicago.

Disclosure: Cavallari reports that the study was funded by GlaxoSmithKline.