CARDIOVASCULAR MEDICINE

Metabolic syndrome and risk of coronary heart disease in a Pakistani cohort

A S Wierzbicki¹, S Nishtar², P J Lumb¹, M Lambert-Hammill¹, C N Turner³, M A Crook¹, M S Marber⁴, J Gill⁴

¹ Department of Chemical Pathology, St Thomas’s Hospital, London, UK
² Heartfile, 1-Park Road, Chak Shazad, Islamabad, Pakistan
³ Department of Paediatrics, St Thomas’s Hospital
⁴ Department of Cardiology, St Thomas’s Hospital

Correspondence to:
Correspondence to:
Dr Anthony S Wierzbick
Department of Chemical Pathology, St Thomas’s Hospital, Lambeth Palace Road, London SE1 7EH, UK; anthony.wierzbicki{at}kcl.ac.uk

Objective: To assess the relation of the metabolic insulin resistance syndrome (M-IRS) with coronary heart disease (CHD) in Pakistani patients.

Subjects: 200 patients with angiographic disease (CHD(+)) matched with 200 patients with chest pain without occlusive disease (CHD(–)).

Design: Prospective case–control study.

Setting: Tertiary referral cardiology unit in Pakistan.

Results: M-IRS was present in 37% of CHD(+) versus 27% of CHD(–) patients by criteria for white patients or 47% versus 42%, respectively, by Asian criteria (p < 0.001). After adjustment for other risk factors, M-IRS was not a significant predictor for CHD or angiographic disease. Age (p = 0.03), smoking (p < 0.001), diabetes-years (p = 0.003), sialic acid (p = 0.01), and creatinine (p = 0.008) accounted for the excess risk of CHD. Similarly, age (p = 0.005), creatinine (p < 0.001), cigarette pack-years (p = 0.02), diabetes-years (p = 0.003), and sialic acid (p = 0.08) were predictors of greater angiographic disease. M-IRS differed between Pakistani and white patients, as waist circumference correlated weakly (r = –0.03–0.08, p = 0.45–0.52) with triglycerides, high density lipoprotein cholesterol, systolic blood pressure, or glucose. Sialic acid was the only inflammatory marker associated with M-IRS.

Conclusions: Despite strong associations between individual risk factors associated with M-IRS and a univariate association between M-IRS and CHD in native Pakistanis, the principal discriminant risk factors in this group are age, smoking, inflammation, diabetes-years, and impaired renal function. The poor sensitivity of M-IRS for CHD reflects the high underlying prevalence of M-IRS, thus reducing sensitivity, confounding by other urban lifestyle traits, or a lack of association of waist circumference with M-IRS risk factors. The definition of M-IRS may have to be revised to increase its power as a discriminant risk factor for CHD in Pakistani populations.

Abbreviations: BMI, body mass index; CHD, coronary heart disease; HDL, high density lipoprotein; HOMA, homeostasis model assessment; M-IRS, metabolic insulin resistance syndrome; NCEP-ATP III, National Cholesterol Education Program Adult Treatment Panel III; WHO, World Health Organization

Keywords: coronary heart disease; Indian Asian; insulin resistance; metabolic syndrome; risk

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This article has been cited by other articles:

• Wierzbicki, A. S (2005). The role of dyslipidaemia in coronary heart disease. British Journal of Diabetes & Vascular Disease 5: S2-S6 [Abstract]