Abstract

Introduction We set out to assess the prevalence of metabolic syndrome, and its effect on cardiovascular morbidity and mortality in the population with established coronary disease and to explore the inter-relationships between metabolic syndrome, diabetes, obesity and cardiovascular risk.

Methods We determined the presence of metabolic syndrome in 8397 patients with stable coronary disease from the European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease, with mean follow up of 4.2 years. Metabolic syndrome was defined using a modified version of the National Cholesterol Education Programme (NCEP) criteria.

Results Metabolic syndrome was present in 23.4% of the population and significantly predicted outcome; RR of cardiovascular mortality 1.82, 95% [CI 1.40-2.39]; and fatal and non-fatal MI 1.50, [95% CI 1.24-1.80]. The association with adverse outcomes remained significant after adjustment, RR of cardiovascular mortality after adjustment for conventional risks and diabetes 1.39 [95% CI 1.03-1.86]. Relative to normal weight individuals without diabetes or metabolic syndrome, normal weight dysmetabolic individuals (with either diabetes or metabolic syndome) were at substantially increased risk of cardiovascular death (RR 4.05 [95% CI 2.38- 6.89]). The relative risks of cardiovascular death for overweight and obese patients with dysmetabolic status were nominally lower (RR 3.01 [95% CI 1.94- 4.69] and 2.35 [95% CI 1.50- 3.68] respectively).

Conclusions Metabolic syndrome is associated with adverse cardiovascular outcome, independently of its associations with diabetes and obesity. A metabolic profile should form part of risk assessment in all patients with coronary disease, not just those who are obese.