Background:
Metabolic syndrome (MetS) is associated with endothelial dysfunction, and recognized as a risk factor of cardiovascular events after acute coronary syndromes (ACS). We examined whether the resolution of MetS would improve endothelial function and provide a beneficial effect on clinical outcome after ACS.
Methods:
We studied 60 patients with MetS who underwent a percutaneous revascularization procedure for ACS. MetS was defined using modified International Diabetes Federation criteria. Brachial artery flow-mediated dilation (FMD) and several risk parameters related to metabolic disorders were assessed at baseline and at 6 months. Each patient was given basic spoken advice on lifestyle modification and optimal medications before discharge. Patients were divided into 2 groups according to whether the criteria for MetS were fulfilled at 6 months: resolved MetS (R-MetS, n=35) and persistent MetS (P-MetS, n=25). Cardiovascular events were defined as cardiac death, stroke, myocardial infarction, unstable angina, and target vessel revascularization.
Results:
During the 1-year follow-up, 3 patients with R-MetS (8.6%) and 14 patients with P-MetS (56%) had cardiovascular events (p=0.0002). The extent of improvement in FMD was significantly greater in patients with R-MetS than those with P-MetS (change in FMD: 1.5 vs −1.2: p=0.007; respectively). In a multivariate logistic regression analysis, P-MetS was an independent predictor of cardiovascular events (odds ratio 18.4, 95%CI 1.67–28.5, p=0.025).
Conclusion:
The resolution of MetS is associated with the recovery of endothelial function and prevents cardiovascular events after ACS.
Multivariate logistic regression analysis
RELATIONSHIP OF HEART RATE AND CARDIOVASCULAR EVENTS IN PATIENTS AFTER ACUTE CORONARY SYNDROMES: AN ANALYSIS FROM THE PROVE-IT TIMI 22 TRIAL