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METABOLIC SYNDROME AND THE RISK OF ADVERSE CARDIOVASCULAR EVENTS AFTER AN ACUTE CORONARY SYNDROME: INSIGHTS FROM SOLID-TIMI 52 TRIAL
448 JACC April 5, 2016 Volume 67, Issue 13
Acute Coronary Syndromes METABOLIC SYNDROME AND THE RISK OF ADVERSE CARDIOVASCULAR EVENTS AFTER AN ACUTE CORONARY SYNDROME: INSIGHTS FROM SOLID-TIMI 52 TRIAL Moderated Poster Contributions Acute Coronary Syndromes Moderated Poster Theater, Poster Area, South Hall A1 Saturday, April 02, 2016, 4:15 p.m.-4:25 p.m. Session Title: Lipids and Metabolic Syndrome in ACS Abstract Category: 14. Acute Coronary Syndromes: Clinical Presentation Number: 1158M-05 Authors: Ilaria Cavallari, Christopher Cannon, Eugene Braunwald, Erica Goodrich, Kyungah Im, Mary Ann Lukas, Michelle O’Donoghue, Brigham and Women’s Hospital, Boston, MA, USA Background: The incremental prognostic value of the metabolic syndrome (MS) has been disputed. Little is known regarding the prognostic value of MS in patients after an ACS, including patients with diabetes mellitus (DM).
Methods: The presence of MS (2005 International Diabetes Federation) was assessed at baseline in SOLID-TIMI 52, a randomized trial of patients ≤30 days of hospitalization with ACS. Median follow-up was 2.5 years. The primary endpoint was major coronary events (MCE; CHD death, MI or urgent coronary revascularization). Cox proportional hazards models were adjusted for age, sex, baseline LDL and clinical predictors.
Results: At baseline, 65% (n=7,929) of patients had MS, 35% (n=4,247) had DM and 29% had both (n=3,584). The presence of MS was associated with a 24% increased risk of MCE (adj HR 1.24, 95% CI 1.11-1.37; p<0.001) and 28% increased risk of MI (adj HR 1.28, 95% CI 1.12-1.47; p<0.001). However, in patients without DM, MS was not associated with the risk of MCE (adj HR 1.08, 95% CI 0.94-1.23; p=0.27). Conversely, DM was a strong independent predictor of MCE in the absence of MS (adj HR 1.54, 95% CI 1.24-1.90; p<0.001). The presence of both DM and MS identified patients at highest risk of adverse outcomes (Figure), but the incremental value of MS was not significant relative to DM alone. Conclusions: In patients hospitalized with recent ACS, DM is a strong and independent predictor of adverse outcomes; however, the presence of MS provides only marginal incremental value for risk stratification.
Acute Coronary Syndromes METABOLIC SYNDROME AND THE RISK OF ADVERSE CARDIOVASCULAR EVENTS AFTER AN ACUTE CORONARY SYNDROME: INSIGHTS FROM SOLID-TIMI 52 TRIAL Moderated Poster Contributions Acute Coronary Syndromes Moderated Poster Theater, Poster Area, South Hall A1 Saturday, April 02, 2016, 4:15 p.m.-4:25 p.m. Session Title: Lipids and Metabolic Syndrome in ACS Abstract Category: 14. Acute Coronary Syndromes: Clinical Presentation Number: 1158M-05 Authors: Ilaria Cavallari, Christopher Cannon, Eugene Braunwald, Erica Goodrich, Kyungah Im, Mary Ann Lukas, Michelle O’Donoghue, Brigham and Women’s Hospital, Boston, MA, USA Background: The incremental prognostic value of the metabolic syndrome (MS) has been disputed. Little is known regarding the prognostic value of MS in patients after an ACS, including patients with diabetes mellitus (DM).
Methods: The presence of MS (2005 International Diabetes Federation) was assessed at baseline in SOLID-TIMI 52, a randomized trial of patients ≤30 days of hospitalization with ACS. Median follow-up was 2.5 years. The primary endpoint was major coronary events (MCE; CHD death, MI or urgent coronary revascularization). Cox proportional hazards models were adjusted for age, sex, baseline LDL and clinical predictors.
Results: At baseline, 65% (n=7,929) of patients had MS, 35% (n=4,247) had DM and 29% had both (n=3,584). The presence of MS was associated with a 24% increased risk of MCE (adj HR 1.24, 95% CI 1.11-1.37; p<0.001) and 28% increased risk of MI (adj HR 1.28, 95% CI 1.12-1.47; p<0.001). However, in patients without DM, MS was not associated with the risk of MCE (adj HR 1.08, 95% CI 0.94-1.23; p=0.27). Conversely, DM was a strong independent predictor of MCE in the absence of MS (adj HR 1.54, 95% CI 1.24-1.90; p<0.001). The presence of both DM and MS identified patients at highest risk of adverse outcomes (Figure), but the incremental value of MS was not significant relative to DM alone. Conclusions: In patients hospitalized with recent ACS, DM is a strong and independent predictor of adverse outcomes; however, the presence of MS provides only marginal incremental value for risk stratification.