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Myocardial infarction: metabolic syndrome appears associated with worse outcome


In patients with acute myocardial infarction ( AMI, heart attack ) metabolic syndrome appeared associated with worse in-hospital outcome, with a higher risk of development of severe heart failure.

Metabolic syndrome is a group of risk factors in an individual that may precede type 2 diabetes mellitus.
The definition for metabolic syndrome includes thresholds for waist circumference, concentrations of triglycerides, high-density lipoprotein ( HDL ) cholesterol, fasting blood glucose levels, and elevated blood pressure.
A survey found that metabolic syndrome was prevalent in 25 percent of white Americans and 44 percent of people 50 years and older.

Marianne Zeller, from the University of Burgundy, Dijon, France, and colleagues examined the prevalence of metabolic syndrome in 633 patients hospitalized with myocardial infarction.
Patients were admitted to the hospital within 24 hours of the onset of heart attack symptoms.
Participants were diagnosed with metabolic syndrome if they had three of five criteria: a waist circumference greater than 102 cm ( 40 inches ) in men and 88 cm ( 35 inches ) in women, high triglyceride levels, low HDL cholesterol levels, high blood glucose level, and high blood pressure.

The researchers found that 46 percent ( n = 290 ) of patients met the criteria for metabolic syndrome.
Patients with metabolic syndrome were older, more likely to be women, had a more frequent history of previous myocardial infarction than patients without metabolic syndrome, and had a higher number of cardiovascular risk factors.
The metabolic syndrome was associated with worse in-hospital outcomes, and an increased risk of heart failure.

Examining the metabolic syndrome criteria independently, the researchers found that hyperglycemia was a major determining factor associated with severe heart failure.

“ Our study showed the high prevalence of metabolic syndrome among patients with myocardial infarction and highlights the detrimental impact of metabolic syndrome on short-term outcomes, particularly heart failure, ” the authors write.
“ Finally, our study suggests that, among metabolic syndrome components, hyperglycemia has the strongest relation to increased incidence of congestive heart failure in patients with metabolic syndrome and myocardial infarction. Given the ever-increasing prevalence of metabolic syndrome worldwide, this finding has important clinical implications and confirms the importance of evaluating glycemic control during the acute phase of myocardial infarction.”

Source: Archives of Internal Medicine, 2005

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