Elsevier

American Heart Journal

Volume 146, Issue 3, September 2003, Pages 439-445
American Heart Journal

Clinical investigations
Metabolic syndrome and coronary angiographic disease progression: the Women’s Angiographic Vitamin & Estrogen trial

https://doi.org/10.1016/S0002-8703(03)00227-8Get rights and content

Abstract

Background

The metabolic syndrome is a cluster of clinical characteristics thought to be associated with increased coronary risk. This analysis evaluates angiographic progression of coronary disease in women who are postmenopausal with and without the metabolic syndrome enrolled in the Women’s Angiographic Vitamin & Estrogen (WAVE) trial, a randomized, controlled trial of hormone therapy and antioxidant vitamins.

Methods

A total of 425 women who are postmenopausal and have angiographic coronary disease were enrolled at 7 clinics between July 1997 and August 1999. Women were categorized as having the metabolic syndrome when they met the National Cholesterol Education Program Adult Treatment Panel III definition. Coronary angiograms were performed at baseline and after 2.8 ± 0.9 years (mean ± SD). Quantitative coronary angiographic analysis was performed at a core laboratory.

Results

Women with the metabolic syndrome (177/294, 60%) were more likely to be taking cholesterol-lowering medication (65% vs 51%, P = .01) and had higher body mass index (33 ± 6 vs 28 ± 6 kg/m2, P <.001). The mean reduction in minimum lumen diameter was greater (−0.041 ± 0.151 vs −0.023 ± 0.148 mm/year, P = .33) and new lesions were more frequent (34% vs 23%, P = .054) in women with the metabolic syndrome. In multivariate analysis, the metabolic syndrome was not an independent predictor of angiographic disease progression. However, clinical events (myocardial infarction, stroke, or coronary death) were more frequent among women with the metabolic syndrome (P = .02).

Conclusion

The metabolic syndrome was prevalent among postmenopausal women with coronary disease enrolled in the WAVE trial. Having the metabolic syndrome was not independently associated with changes in minimum lumen diameter or the development of new or progressing coronary lesions, but did confer an increased risk of clinical cardiovascular events.

Section snippets

Study population and measures

A total of 423 postmenopausal women were randomized at 7 clinics between July 1997 and August 1999. Study participants were required to have at least 1 non-intervened coronary stenosis of 15% to 75% on baseline angiography. Follow-up angiograms were obtained on 320 women; 22 women died, and 8 women had non-fatal MI during the study. Because the primary outcome for the main trial included imputed scores for clinical events, these women were not required to have exit angiograms. Additionally, 13

Results

Women with (n = 177) and without (n = 117) the metabolic syndrome were of similar age, ethnic distribution, and educational level (Table II). Although the cohort’s mean LDL cholesterol level exceeded the NCEP III goal of <100 mg/dL, only 60% of the women were taking a statin at baseline, 2% were taking a fibrate, and <1% were taking niacin. Women with the metabolic syndrome were less likely to be assigned to take active vitamins (P = .02). As a group, the women were sedentary; 14% and 13% of

Discussion

Sixty percent of WAVE trial participants met the NCEP III definition of the metabolic syndrome, considerably higher than the 24% prevalence reported in the general population, and higher than the 43% prevalence reported for women 60 to 69 years old.3 In women with the metabolic syndrome, the annual reduction in minimum lumen diameter was twice that of women without the metabolic syndrome, although these rates were not statistically different, and new lesions were more frequently observed in

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Supported by contracts (NO1-HV-68165, NO1-HV-68166, NO1-HV-68167, NO1-HV-68168, NO1-HV-68169, NO1-HV-68170) from the National Institutes of Health.

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