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CLINICAL RESEARCH: MYOCARDIAL INFARCTION

Metabolic Syndrome and Risk of Cardiovascular Events After Myocardial Infarction

Giacomo Levantesi, MD^_*, Alejandro Macchia, MD^_*, RosaMaria Marfisi, MS^_*, Maria G. Franzosi, MSc, Aldo P. Maggioni, MD, Gian L. Nicolosi, MD, Carlo Schweiger, MD^||, Luigi Tavazzi, MD^¶, Gianni Tognoni, MD^_*, Franco Valagussa, MD^#, Roberto Marchioli, MD^_*,_* on behalf of the GISSI-Prevenzione Investigators

^_* Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti
Centro Studi ANMCO, Firenze
Department of Cardiovascular Disease, Istituto Mario Negri, Milano
^|| Ospedale Civile, Presidio di Riabilitazione, Passirana di Rho, Milano
^¶ IRCCS Policlinico San Matteo, Pavia
^# Ospedale San Gerardo, Monza
Ospedale S. Maria degli Angeli, Pordenone, Italy.

Manuscript received November 9, 2004; revised manuscript received March 16, 2005, accepted March 29, 2005.

^_* Reprint requests and correspondence: Dr. Roberto Marchioli, Laboratory of Clinical Epidemiology of Cardiovascular Disease, Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Via Nazionale, 66030 Santa Maria Imbaro, Italy. (Email: marchioli{at}negrisud.it).

OBJECTIVES: We aimed to assess the prevalence and prognostic role of metabolic syndrome (METS) and diabetes in post-myocardial infarction (MI) patients.

BACKGROUND: Diabetes is a well known risk factor for patients with previous MI, but glycemic dysmetabolism develops over a protracted period of time. Scanty data are available on the role of METS in patients with previous MI.

METHODS: Adjusted Cox’s regression models, having diabetes, death, major cardiovascular events (CVE), and hospitalization for congestive heart failure (CHF) during follow-up as outcome events, were fitted on 11,323 patients with prior MI enrolled in the GISSI-Prevenzione Trial.

RESULTS: At baseline, 21% and 29% of patients had diabetes mellitus and METS, respectively. The METS patients had a significant (93%) increased risk of diabetes during follow-up. As compared with control subjects, the probability of death and CVE were higher in both METS (+29%, p = 0.002; +23%, p = 0.005) and diabetic patients (+68%, p <0.0001; +47%, p <0.0001), although diabetic but not METS patients were more likely to be hospitalized for CHF (+89%, p <0.0003 and +24%, p = 0.241). Moderate (–6% to –10%) and substantial (>–10%) weight reduction were associated with a significant (18% and 41%, respectively) decreased risk of diabetes. Weight gain was significantly associated with increased risk of diabetes. The risk conferred by METS and diabetes tended to be higher among women.

CONCLUSIONS: In patients with MI, METS and diabetes were highly prevalent and are associated with increased risk of death and CVE. Diabetes is also associated with increased risk of hospitalization for CHF. Weight reduction significantly decreased the risk of becoming diabetic in patients with METS.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   BMI = body mass index   CHF = congestive heart failure   CVE = cardiovascular events   IR = insulin resistance   METS = metabolic syndrome   MI = myocardial infarction   NCEP-ATP III = National Cholesterol Education Program Adult Treatment Panel III   NYHA = New York Heart Association   PUFA = polyunsaturated fatty acids

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