Article Text

Download PDFPDF
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;


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

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.