Metabolic syndrome with sleep apnea ups risk for heart events in hospitalized women
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Key takeaways:
- Screenings for obstructive sleep apnea “should not be ignored” in women hospitalized with acute coronary syndrome.
- Comorbid sleep apnea and metabolic syndrome drive CV risk for women hospitalized with ACS.
Women hospitalized with acute coronary syndrome who have metabolic syndrome are 1.7 times more likely to experience a major adverse CV or cerebrovascular event if they also have comorbid obstructive sleep apnea, researchers reported.
“Existing data have suggested that the pathophysiology mechanisms of obstructive sleep apnea [OSA] and metabolic syndrome interact with each other and that both have adverse effects on the prognosis of patients with ACS,” Shaoping Nie, MD, PhD, of the division of cardiology and the Center for Coronary Artery Disease at Beijing Anzhen Hospital, China, and colleagues wrote in Clinical Cardiology. “In addition, both OSA and metabolic syndrome have gender differences in the pathogenesis, clinical symptoms, prevalence of comorbidities, and cardiovascular consequences. However, whether OSA increases the risk of recurrent cardiovascular events in ACS patients with metabolic syndrome has not been directly investigated.”
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In a prospective study, Nie and colleagues 1,927 patients hospitalized with ACS who underwent portable sleep breathing monitoring. Researchers defined OSA as an apnea‐hypopnea index (AHI) of at least 15 events per hour. The primary endpoint was major adverse CV and cerebrovascular events, including CV death, MI, stroke, ischemia‐driven revascularization, or hospitalization for unstable angina or HF.
Within the cohort, 77.1% of participants had metabolic syndrome and 52.6% had OSA.
During 2.9 years of follow‐up, the cumulative incidence of major adverse CV and cerebrovascular events was similar among participants with and without OSA who had metabolic syndrome (adjusted HR = 1.29 95% CI, 0.99-1.67; P = .06) and did not have metabolic syndrome (aHR = 1.21; 95% CI, 0.73-2.03; P = .46).
In analyses stratified by sex, women who had OSA and comorbid metabolic syndrome had an almost twofold risk for major adverse CV and cerebrovascular events compared with women who had metabolic syndrome but no OSA, with an adjusted HR or 1.7 (95% CI, 1.01-3.09; P = .04). This association was not observed for men.
“In hospitalized ACS patients with metabolic syndrome, comorbid OSA was associated with an increased risk of subsequent events among women,” the researchers wrote. “In response to the call for attention to cardiovascular disease in women, OSA screening should not be ignored in ACS patients, especially when combined with metabolic syndrome.”
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