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Impact of metabolic syndrome and C-reactive protein on outcome after coronary stenting

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Abstract

Metabolic syndrome (MS) identifies cardiovascular risk; however, there is little information regarding the evolution of patients with MS after stent implantation. The aim of this single-center study is to evaluate the possible association between MS and clinical restenosis, after adjustment for high-sensitivity C-reactive protein (hs-CRP) and angiographic predictors of restenosis. In a longitudinal study, 159 patients (89 with and 70 without MS) were studied. Criteria for MS were: elevated blood pressure (systolic ≥130 mmHg, diastolic ≥85 mmHg or drug treatment for hypertension; elevated fasting glucose (>100 mg/dl) or drug treatment for elevated glucose; reduced HDL-cholesterol (<40 mg/dl in men and <50 mg/dl in women) or drug treatment for reduced HDL-cholesterol; elevated triglycerides (≥150 mg/dl) or drug treatment for elevated triglycerides; and obesity (body mass index >28.8 kg/m2). The primary end point was the rate of major adverse clinical events (MACE): cardiovascular death, myocardial infarction, or target lesion revascularization (TLR) during the 12-month follow-up period. The secondary end point was the rate of TLR. MS was neither identified as predictor of MACE [hazard ratio (HR): 0.844; 95% CI: 0.41–1.74; p=0.648], nor TLR (HR: 1.05; 95% CI: 0.44–2.50; p=0.91), even when controlled for hs-CRP levels and angiographic predictors of restenosis. Also, no significant interaction between MS and hs-CRP was found (p=0.135 and p=0.194, for MACE and TLR, respectively). This study shows that patients with MS do not have an additional risk of MACE, even when controlled for angiographic predictors of restenosis and hs-CRP.

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References

  1. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001, 285: 2486–97.

    Google Scholar 

  2. Grundy SM, Cleeman JI, Daniels SR, et al; American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation 2005, 112: 2735–52.

    Article  PubMed  Google Scholar 

  3. Wilson PW, D’Agostino RB, Parise H, Sullivan L, Meigs JB. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation 2005, 112: 3066–72.

    Article  PubMed  CAS  Google Scholar 

  4. Eberly LE, Prineas R, Cohen JD, et al; Multiple Risk Factor Intervention Trial Research Group. Metabolic syndrome: risk factor distribution and 18-year mortality in the multiple risk factor intervention trial. Diabetes Care 2006, 29: 123–30.

    Article  PubMed  Google Scholar 

  5. Marroquin OC, Kip KE, Kelley DE, et al; Women’s Ischemia Syndrome Evaluation Investigators. Metabolic syndrome modifies the cardiovascular risk associated with angiographic coronary artery disease in women: a report from the Women’s Ischemia Syndrome Evaluation. Circulation 2004, 109: 714–21.

    Article  PubMed  CAS  Google Scholar 

  6. Ridker PM, Wilson PW, Grundy SM. Should C-reactive protein be added to metabolic syndrome and to assessment of global cardiovascular risk? Circulation 2004, 109: 2818–25.

    Article  PubMed  CAS  Google Scholar 

  7. Rana JS, Monraats PS, Zwinderman AH, et al; GENDER study. Metabolic syndrome and risk of restenosis in patients undergoing percutaneous coronary intervention. Diabetes Care 2005, 28: 873–7.

    Article  PubMed  Google Scholar 

  8. Hoffmann R, Stellbrink E, Schröder J, et al. Impact of the metabolic syndrome on angiographic and clinical events after coronary intervention using bare-metal or sirolimus-eluting stents. Am J Cardiol 2007, 100: 1347–52.

    Article  PubMed  CAS  Google Scholar 

  9. Kastrati A, Elezi S, Dirschinger J, Hadamitzky M, Neumann FJ, Schomig A. Influence of lesion length on restenosis after coronary stent placement. Am J Cardiol 1999, 83: 1617–22.

    Article  PubMed  CAS  Google Scholar 

  10. Kastrati A, Schömig A, Elezi S, et al. Predictive factors of restenosis after coronary stent placement. J Am Coll Cardiol 1997, 30: 1428–36.

    Article  PubMed  CAS  Google Scholar 

  11. Cutlip DE, Chauhan MS, Baim DS, et al. Clinical restenosis after coronary stenting: perspectives from multicenter clinical trials. J Am Coll Cardiol 2002, 40: 2082–9.

    Article  PubMed  Google Scholar 

  12. Malik S, Wong ND, Franklin SS, et al. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation 2004, 110: 1245–50.

    Article  PubMed  Google Scholar 

  13. Girman CJ, Rhodes T, Mercuri M, et al; 4S Group and the AF-CAPS/TexCAPS Research Group. The metabolic syndrome and risk of major coronary events in the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS). Am J Cardiol 2004, 93: 136–41.

    Article  PubMed  CAS  Google Scholar 

  14. Ninomiya JK, L’Italien G, Criqui MH, Whyte JL, Gamst A, Chen RS. Association of the metabolic syndrome with history of myocardial infarction and stroke in the Third National Health and Nutrition Examination Survey. Circulation 2004, 109: 42–6.

    Article  PubMed  Google Scholar 

  15. Elezi S, Kastrati A, Pache J, et al. Diabetes mellitus and the clinical and angiographic outcome after coronary stent placement. J Am Coll Cardiol 1998, 32: 1866–73.

    Article  PubMed  CAS  Google Scholar 

  16. Abizaid A, Kornowski R, Mintz GS, et al. The influence of diabetes mellitus on acute and late clinical outcomes following coronary stent implantation. J Am Coll Cardiol 1998, 32: 584–9.

    Article  PubMed  CAS  Google Scholar 

  17. Singh M, Gersh BJ, McClelland RL, et al. Predictive factors for ischemic target vessel revascularization in the Prevention of Restenosis with Tranilast and its Outcomes (PRESTO) trial. J Am Coll Cardiol 2005, 45: 198–203.

    Article  PubMed  CAS  Google Scholar 

  18. Chen LC, Chen YH, Lin SJ, et al. Clinical and angiographic determinants of adverse cardiac events in patients with stent restenosis. Catheter Cardiovasc Interv 2002, 55: 331–7.

    Article  PubMed  Google Scholar 

  19. Lerakis S, El-Chami MF, Patel AD, et al. Effect of lipid levels and lipid-lowering therapy on restenosis after coronary artery stenting. Am J Med Sci 2006, 331: 270–3.

    Article  PubMed  Google Scholar 

  20. Gurm HS, Whitlow PL, Kip KE; BARI Investigators. The impact of body mass index on short- and long-term outcomes inpatients undergoing coronary revascularization. Insights from the bypass angioplasty revascularization investigation (BARI). J Am Coll Cardiol 2002, 39: 834–40.

    PubMed  Google Scholar 

  21. Gurm HS, Brennan DM, Booth J, Tcheng JE, Lincoff AM, Topol EJ. Impact of body mass index on outcome after percutaneous coronary intervention (the obesity paradox). Am J Cardiol 2002, 90: 42–5.

    Article  PubMed  Google Scholar 

  22. Rana JS, Mittleman MA, Ho KK, Cutlip DE. Obesity and clinical restenosis after coronary stent placement. Am Heart J 2005, 150: 821–6.

    Article  PubMed  Google Scholar 

  23. Sattar N, Gaw A, Scherbakova O, et al. Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Circulation 2003, 108: 414–9.

    Article  PubMed  CAS  Google Scholar 

  24. Ridker PM, Buring JE, Cook NR, Rifai N. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation 2003, 107: 391–7.

    Article  PubMed  Google Scholar 

  25. Rexrode KM, Buring JE, Manson JE. Abdominal and total adiposity and risk of coronary heart disease in men. Int J Obes Relat Metab Disord 2001, 25: 1047–56.

    Article  PubMed  CAS  Google Scholar 

  26. Dagenais GR, Yi Q, Mann JF, Bosch J, Pogue J, Yusuf S. Prognostic impact of body weight and abdominal obesity in women and men with cardiovascular disease. Am Heart J 2005, 149: 54–60.

    Article  PubMed  Google Scholar 

  27. Win HK, Caldera AE, Maresh K, et al; EVENT Registry Investigators. Clinical outcomes and stent thrombosis following off-label use of drug-eluting stents. JAMA 2007, 297: 2001–9.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Hemodynamic Unit/Cardiology Division, Hospital de Clinicas de Porto Alegre, Sala 2059, 2o andar, Rua Ramiro Barcelos 2350 90.035.003, Porto Alegre, RS, Brazil

    G. R. Iturry-Yamamoto MD, PhD, A. C. Zago, W. C. Manfroi & A. J. Zago

  2. Group for Research and Graduate Studies, Cardiology Lab, Clinic Hospital of Porto Alegre (HCPA), Brazil

    E. H. Moriguchi

  3. Clinical Pathology Department, Clinic Hospital of Porto Alegre (HCPA), Brazil

    J. L. Camargo

  4. Endocrinology Division, Clinic Hospital of Porto Alegre (HCPA), Porto Alegre, RS, Brazil

    J. L. Gross

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  1. G. R. Iturry-Yamamoto MD, PhD
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  2. A. C. Zago
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  3. E. H. Moriguchi
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  4. W. C. Manfroi
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  5. J. L. Camargo
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  7. A. J. Zago
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Correspondence to G. R. Iturry-Yamamoto MD, PhD.

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Iturry-Yamamoto, G.R., Zago, A.C., Moriguchi, E.H. et al. Impact of metabolic syndrome and C-reactive protein on outcome after coronary stenting. J Endocrinol Invest 32, 383–386 (2009). https://doi.org/10.1007/BF03345730

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