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CLINICAL RESEARCH: METABOLIC SYNDROME

Metabolic Syndrome and Early-Onset Coronary Artery Disease

Is the Whole Greater Than Its Parts?

Carlos Iribarren, MD, MPH, PhD^_*,,_*, Alan S. Go, MD^_*,, Gail Husson, MPH, Med^_*, Stephen Sidney, MD, MPH^_*, Joan M. Fair, ANP, PhD, Thomas Quertermous, MD, Mark A. Hlatky, MD^,|| and Stephen P. Fortmann, MD

^_* Kaiser Permanente Division of Research, Oakland, California
Departments of Epidemiology, Biostatistics, and Medicine, University of California, San Francisco, California
Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California
Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
^|| Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California

Manuscript received December 19, 2005; revised manuscript received February 10, 2006, accepted March 16, 2006.

^_* Reprint requests and correspondence: Dr. Carlos Iribarren, Research Scientist, Kaiser Permanente, Division of Research, 2000 Broadway, Oakland, California 94612. (Email: cgi{at}dor.kaiser.org).

OBJECTIVES: We sought to examine the association between the metabolic syndrome (MetS) (defined both by the 2001 National Cholesterol Educational Program Adult Treatment Panel III [ATP-III] definition and the American Heart Association/National Heart, Lung and Blood Institute [AHA/NHLBI] revision incorporating the lower threshold for impaired fasting glucose [IFG]) and early-onset coronary artery disease (CAD).

BACKGROUND: The impact of MetS on premature CAD has not been studied extensively. Lowering the threshold to define the IFG component (from 110 to 100 mg/dl) and the value of the syndrome as a whole versus its individual components are subjects of intense debate.

METHODS: We performed a case-control study with 393 early-onset CAD subjects (acute myocardial infarction, angina with 50% stenosis, or coronary revascularization) in men under age 46 years or women under age 56 years and 393 control subjects individually matched for gender, age, and race/ethnicity.

RESULTS: By conditional logistic regression, presence of ATP-III MetS without diabetes (adjusted odds ratio [adj-OR] 4.9; 95% confidence interval [CI] 3.4 to 8.0) and with diabetes (adj-OR 8.0, 95% CI 4.39 to 14.6) was a strong independent determinant of early-onset CAD. Using the AHA/NHLBI revision, these ORs became slightly stronger. However, neither definition of MetS remained significantly associated with early-onset CAD in multivariate models adjusting for individual components.

CONCLUSIONS: The presence of MetS imparts a high risk of early-onset clinical CAD, but the prognostic information associated with the syndrome is not greater than the sum of its parts.

Abbreviations and Acronyms   ADA = American Diabetes Association   ADVANCE = Atherosclerotic Disease, Vascular Function, and Genetic Epidemiology   AHA/NHLBI = American Heart Association/National Heart, Lung, and Blood Institute   CAD = coronary artery disease   CARDIA = Coronary Artery Risk Development in Young Adults   HOMA-IR = homeostasis model assessment of insulin resistance   IFG = impaired fasting glucose   KPNC = Kaiser Permanente of Northern California   MetS = metabolic syndrome   NCEP-ATP-III = National Cholesterol Educational Program Adult Treatment Panel III

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