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Metabolic syndrome and risk of coronary heart disease in a Pakistani cohort
  1. A S Wierzbicki1,
  2. S Nishtar2,
  3. P J Lumb1,
  4. M Lambert-Hammill1,
  5. C N Turner3,
  6. M A Crook1,
  7. M S Marber4,
  8. J Gill4
  1. 1Department of Chemical Pathology, St Thomas’s Hospital, London, UK
  2. 2Heartfile, 1-Park Road, Chak Shazad, Islamabad, Pakistan
  3. 3Department of Paediatrics, St Thomas’s Hospital
  4. 4Department of Cardiology, St Thomas’s Hospital
  1. Correspondence to:
    Dr Anthony S Wierzbick
    Department of Chemical Pathology, St Thomas’s Hospital, Lambeth Palace Road, London SE1 7EH, UK; anthony.wierzbickikcl.ac.uk

Abstract

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.

  • 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
  • coronary heart disease
  • Indian Asian
  • insulin resistance
  • metabolic syndrome
  • risk

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