Metabolic syndrome components increase CV risk, but not syndrome itself

9 March 2010

MedWire News: Patients with the metabolic syndrome have greater progression of atherosclerosis than those without, but this is largely explained by high triglycerides and obesity, say researchers.

Stephen Nicholls (Cleveland Clinic, Ohio, USA) and colleagues carried out a systematic review and meta-analysis to assess mechanisms associated with adverse cardiovascular prognosis, more specifically atherosclerosis progression, in patients with the metabolic syndrome.

In total, seven clinical trials were included in the analysis, including 3459 patients, of whom 1998 had the metabolic syndrome and 1461 did not.

The trials monitored coronary atheroma progression using intravascular ultrasonography, and patients with and without the metabolic syndrome were compared with regard to their clinical characteristics and atheroma burden at baseline and after serial evaluation.

As reported in the Archives of Internal Medicine, the team found that patients with the metabolic syndrome had significantly greater progression of percent atheroma volume (PAV) than those without the syndrome at 0.53% versus 0.23%.

Multivariate analysis indicated that presence of the metabolic syndrome was associated with a 25% increase in relative risk for progression of PAV.

However, analysis of the individual components of the metabolic syndrome showed that only hypertriglyceridemia and a body mass index above 30 kg/m² were associated with atherosclerosis progression, with increased relative risks of 26% and 18%, respectively.

When individual components of the metabolic syndrome were adjusted for, the metabolic syndrome no longer predicted progression of PAV.

In an accompanying commentary, Eric Ding (Harvard University, Boston, Massachusetts, USA) and colleagues remarked: “Although the definition and clinical utility of metabolic syndrome continue to be debated, the concept may ultimately be a more useful research tool rather than a clinical tool and more relevant for prevention than for medical treatment.”

They added: “Therefore, we should start with emphasis on improving the unhealthy lifestyle, which is the root cause of all components of metabolic syndrome.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

Arch Intern Med 2010; 170: 478–484, 484–485