Metabolic Syndrome and Heart Disease
- People with metabolic syndrome (MS) have a 2-fold risk of heart disease and heart attack (3-fold risk in women) compared to people without this condition.1-4 The risk of heart disease in people with MS is almost as high as those with diabetes and those who have both carry an exceptionally poor prognosis.1, 5
- MS is a major determinant of presence and severity of clinical and subclinical inflammation, coronary atherosclerosis, acute coronary syndrome (ACS) and left ventricular dysfunction, heart failure and its complications.6-12
- Presence of MS generally predicts unstable lipid-rich vulnerable plaques and death from premature CAD.13-15 Accelerated disease progression is often observed in the setting of MS.16
- MS is highly associated with ACS in young subjects (<45 years of age) and seems to be more valuable than established cardiovascular risk calculators.17 It appears that a high proportion of young Indians with ACS may have MS and deserve more studies.
- Prevalence of MS is 50% to 60% in people with ACS and as high as 80% in women.18 MS confers a poor in-hospital and long-term prognosis such as recurrent ischemia, heart failure and recurrent major acute coronary events (MACE) and death independent of the presence of diabetes.19-24
- The rate of coronary angioplasty, stent and bypass surgery (CARP) is almost double in people with MS and carries a poor prognosis.25 The risk is markedly increased in those who have diabetes in addition to MS.26, 27
- MS was associated with a higher prevalence and severity of left ventricular diastolic dysfunction (LVDD), which is further aggravated in people with concomitant diabetes. Such patients should receive appropriate medical care to prevent early heart failure.28
- Among men age 45 years and older and women 55 years and older, the MS confers moderately high risk of CAD (10-year risk of 10%-20%) and therefore requires lower, stricter LDL cholesterol targets (<70 mg/dl) especially among Asian Indians.29
- MS is an independent determinant of angiographically significant CAD, particularly among those individuals at low 10-year risk for future coronary events.30
- The risk of CAD among Asian Indians with MS appears to be similar or higher, compared to whites regardless of the criteria used including SAM-NCEP criteria.31-34
- In the COURAGE trial of patients with coronary artery disease (CAD) who received the state of the art medical therapy, MS was a predictor of heightened risk of recurrent events. The risk of death or recurrent heart attack was not much different for people with diabetes or MS but was double among those who had both despite intensive medical therapy and maximum modification of lifestyle (Figure 055).5
- The MS often coexist with chronic kidney disease, microalbuminuria and CAD.35
- The CAD risk associated with MS is substantially lower among those who are physically active.36 Thus physical activity not only prevents the development of diabetes but also reduces the risk of people with this condition.
- MetS confer greater risk of CAD in women particularly younger women and appears to be a crucial factor in the high risk of heart disease in non-smoking pre-menopausal Indian women. (see Figure 109)
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35. Gobal F, Deshmukh A, Shah S, Mehta JL. Triad of metabolic syndrome, chronic kidney disease, and coronary heart disease with a focus on microalbuminuria death by overeating. J Am Coll Cardiol. Jun 7 2011;57(23):2303-2308.
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