Long-term rates of cardiovascular events in patients with the metabolic syndrome according to severity of coronary-angiographic alterations.

Objectives: To assess the long-term risk of mortality and cardiovascular events, related to metabolic syndrome (MetS), in patients with less, or more severe coronary artery disease (CAD).

Methods: One thousand and eighty patients were divided in four groups, according to severity of CAD (1=less than 50% or nonsignificant stenoses; 2=greater or significant stenoses), and according to MetS (A=no; B=yes). Risk was evaluated with the Cox regression analysis.

Results: About 18.9% of patients had less and 81.1% more advanced CAD. MetS was present in 45.1% of the first, and in 52.9% of the second group. At baseline, patients with MetS, or significant stenoses, had less favorable medical, biochemical, and angiographic characteristics. During a follow-up of 12.6+/-3.4 years, group 1B had higher incidence (16.3 vs. 7.1%) and hazard ratio [2.36 (1.001-5.57; P=0.0497)] of myocardial infarction than group 1A; group 2B had a higher incidence (19.0 vs. 11.7%) and hazard ratio [1.67 (1.18-2.37; P=0.0041)] of stroke than group 2A. Groups 2A and 2B, as compared with groups 1A and 1B, had a higher incidence of myocardial infarction (39.1 vs. 7.1; 41.8 vs. 16.3%); group 2B had higher incidence of stroke than group 1B (19.0 vs. 9.8%). After adjustment for common risk factors, group 2B retained an elevated risk of stroke. After additional adjustment for diabetes, no event was significantly related to MetS.

Conclusion: At baseline, coronary patients with MetS, or significant angiographic alterations, had more cardiovascular risk factors. During follow-up, both MetS and significant CAD increased the risk of cardiovascular morbidity but not of mortality.