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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.

View larger version (17K): [in a new window]   Figure 1 Survival curves of control subjects (bottom black line), patients with metabolic syndrome (middle black line), and diabetic patients (top black line). Normal patients: relative risk 1.00 (reference category); metabolic syndrome patients: relative risk 1.29, 95% confidence interval (CI) 1.10 to 1.51, p = 0.002; diabetic patients: relative risk 1.68, 95% CI 1.44 to 1.95, p < 0.0001. Cox proportional hazard model adjusted for age, gender, smoking habits, total cholesterol, presence of peripheral vascular disease, electrical instability, residual ischemia, left ventricular ejection fraction, n-3 polyunsaturated fatty acids, vitamin E, antiplatelet agents, angiotensin-converting enzyme inhibitors, statins at six months, and beta-blockers.

View larger version (15K): [in a new window]   Figure 2 Cardiovascular event-free survival curves of control subjects (bottom black line), patients with metabolic syndrome (middle black line), and diabetic patients (top black line). Normal patients: relative risk 1.00 (reference category); metabolic syndrome patients: relative risk 1.23, 95% confidence interval (CI) 1.06 to 1.42, p = 0.005; diabetic patients: relative risk 1.47, 95% CI 1.27 to 1.70, p < 0.0001. CV = cardiovascular. Methods as in Figure 1.

View larger version (14K): [in a new window]   Figure 3 Hospitalization for heart failure-free survival curves of control subjects (bottom black line), patients with metabolic syndrome (middle black line), and diabetic patients (top black line). Normal patients: relative risk 1.00 (reference category); metabolic syndrome patients: relative risk 1.24, 95% confidence interval (CI) 0.86 to 1.79, p = 0.241; diabetic patients: relative risk 1.89, 95% CI 1.34 to 2.67, p = 0.0003. CHF = congestive heart failure. Methods as in Figure 1.

View larger version (14K): [in a new window]   Figure 4 Diabetes-free survival curves for control subjects (thin black line) and patients with metabolic syndrome (thick black line). Normal patients: relative risk 1.00 (reference category); metabolic syndrome patients: relative risk 1.93, 95% confidence interval 1.69 to 2.19, p < 0.0001. Methods as in Figure 1.

View larger version (15K): [in a new window]   Figure 5 Diabetes-free survival curves according to the number of diagnostic components of the metabolic syndrome (METS): three components (bottom black line), four components (middle black line), and five components (top black line). Three METS components: relative risk 1.00 (reference category); four METS components: relative risk 1.60, 95% confidence interval (CI) 1.32 to 1.93, p < 0.0001; five METS components: relative risk 3.73, 95% CI 2.58 to 5.39, p < 0.0001. Methods as in Figure 1.

View larger version (10K): [in a new window]   Figure 6 Relative risk (RR) of diabetes according to body weight variation at six months after recruitment. Reference category: weight change <–5% (RR 1.00); weight change from 0% to +5% (RR 1.48, 95% confidence interval (CI) 1.25 to 1.75, p < 0.0001); weight change from +6% to +10% (RR 1.57, 95% CI 1.26 to 1.96, p < 0.0001); weight change from >+10% (RR 2.13, 95% CI 1.60 to 2.83, p < 0.0001); weight change from –6% to –10% (RR 0.82, 95% CI 0.63 to 1.08, p = 0.1664); weight change >–10% (RR 0.59, 95% CI 0.37 to 0.94, p < 0.0275). Cox proportional hazard model adjusted for age, gender, body mass index, smoking habits, total cholesterol, number of metabolic syndrome components, presence of peripheral vascular disease, electrical instability, residual ischemia, left ventricular ejection fraction, n-3 polyunsaturated fatty acids, vitamin E, antiplatelet agents, angiotensin-converting enzyme inhibitors, statins at six months, and beta-blockers.