Clinical Research
Myocardial Infarction
Metabolic Syndrome and Risk of Cardiovascular Events After Myocardial Infarction

https://doi.org/10.1016/j.jacc.2005.03.062Get rights and content
Under an Elsevier user license
open archive

Objectives

We aimed to assess the prevalence and prognostic role of metabolic syndrome (METS) and diabetes in post-myocardial infarction (MI) patients.

Background

Diabetes is a well known risk factor for patients with previous MI, but glycemic dysmetabolism develops over a protracted period of time. Scanty data are available on the role of METS in patients with previous MI.

Methods

Adjusted Cox’s regression models, having diabetes, death, major cardiovascular events (CVE), and hospitalization for congestive heart failure (CHF) during follow-up as outcome events, were fitted on 11,323 patients with prior MI enrolled in the GISSI-Prevenzione Trial.

Results

At baseline, 21% and 29% of patients had diabetes mellitus and METS, respectively. The METS patients had a significant (93%) increased risk of diabetes during follow-up. As compared with control subjects, the probability of death and CVE were higher in both METS (+29%, p = 0.002; +23%, p = 0.005) and diabetic patients (+68%, p <0.0001; +47%, p <0.0001), although diabetic but not METS patients were more likely to be hospitalized for CHF (+89%, p <0.0003 and +24%, p = 0.241). Moderate (−6% to −10%) and substantial (>−10%) weight reduction were associated with a significant (18% and 41%, respectively) decreased risk of diabetes. Weight gain was significantly associated with increased risk of diabetes. The risk conferred by METS and diabetes tended to be higher among women.

Conclusions

In patients with MI, METS and diabetes were highly prevalent and are associated with increased risk of death and CVE. Diabetes is also associated with increased risk of hospitalization for CHF. Weight reduction significantly decreased the risk of becoming diabetic in patients with METS.

Abbreviations and Acronyms

ACE
angiotensin-converting enzyme
BMI
body mass index
CHF
congestive heart failure
CVE
cardiovascular events
IR
insulin resistance
METS
metabolic syndrome
MI
myocardial infarction
NCEP-ATP III
National Cholesterol Education Program Adult Treatment Panel III
NYHA
New York Heart Association
PUFA
polyunsaturated fatty acids

Cited by (0)

This work was supported by the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico (GISSI); Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO); Istituto di Ricerche Farmacologiche Mario Negri – Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy. The names of the GISSI-Prevenzione Investigators are listed in reference 26.