Vol 28, No 2 (2022)
Research paper
Published online: 2022-08-16
Prevalence and impact of metabolic syndrome on outcomes of acute coronary syndrome patients in two different countries
1
, 1, 2, 1, 3, 2, 1, 3, 13
, 1, 2, 1, 3, 2, 1, 3, 13
DOI: 10.5603/AA.2022.0008
Acta Angiologica 2022;28(2):44-51.
Abstract
Introduction: This study aimed to ascertain the prevalence of metabolic syndrome (MetS) in patients from
Hungary and Iraq, suffering from acute coronary syndrome (ACS) and investigate the effects of MetS on
hospital outcomes, in particular mortality and its relation to differences in patients’ baseline characteristics.
Material and methods: A prospective cohort study was conducted in two cardiac centers between
May 2018 and May 2019. It included 164 consecutive ACS patients: 64 patients from the Cardiac Clinic
in Pécs, Hungary and 100 patients from Al Nassiryah Heart Center, Iraq. Baseline characteristics, clinical
management, and in-hospital and 30-day post-discharge outcomes were recorded.
Results: Prevalence of metabolic syndrome among ACS patients in Iraq? was not significantly higher than
in Hungary (25.0% vs 34.1%; P = 0.306). There were no significant differences in age between those
with and without MetS (64.2 vs 63.3 years; P = 0.394). MetS was associated with a higher median BMI
(28.0 vs 23.7 kg/m2; P < 0.001), hyperlipidemia (37.8% vs 12.8%; P < 0.001), hypertension (48.8% vs
27.4%; P = 0.024), high cholesterol (5.4 vs 4.1 mmol/L; P < 0.001), high LDL-C (3.5 vs 2.6 mmol/L;
P < 0.001), and high triglycerides (1.4 vs 1.1 mmol/L; P < 0.001). MetS was associated with a higher
risk of out hospital re-infarction (12.8% vs 3.7%; P = 0.031) and MACE (17.7% and 6.1%; P = 0.027).
Conclusions: Current study did not show any significant difference in the incidence of MetS between
ACS patients in the two countries. But patients with MetS were significantly more likely to be associated
with MACE (P = 0.027).
Keywords: metabolic syndromeoutcomesacute coronary syndromeprevalencemajor adverse cardiovascular events
References
- Alberti K, Zimmet P, Shaw J. The metabolic syndrome—a new worldwide definition. The Lancet. 2005; 366(9491): 1059–1062.
- 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(17): 2735–2752.
- Al-Rasadi K, Sulaiman K, Panduranga P, et al. Prevalence, characteristics, and in-hospital outcomes of metabolic syndrome among acute coronary syndrome patients from Oman. Angiology. 2011; 62(5): 381–389.
- Saklayen MG. Saklayen M. G. The Global Epidemic of the Metabolic Syndrome, Curr Hypertens Rep. 2018; 20(2): 12.
- Medina FX, Solé-Sedeno JM, Bach-Faig A, et al. Obesity, Mediterranean Diet, and Public Health: A Vision of Obesity in the Mediterranean Context from a Sociocultural Perspective. Int J Environ Res Public Health. 2021; 18(7).
- Stanek A, Brożyna-Tkaczyk K, Myśliński W. The Role of Obesity-Induced Perivascular Adipose Tissue (PVAT) Dysfunction in Vascular Homeostasis. Nutrients. 2021; 13(11).
- Stanek A, Brożyna-Tkaczyk K, Zolghadri S, et al. The Role of Intermittent Energy Restriction Diet on Metabolic Profile and Weight Loss among Obese Adults. Nutrients. 2022; 14(7).
- Van Gaal LF, Mertens IL, De Block CE. Mechanisms linking obesity with cardiovascular disease. Nature. 2006; 444(7121): 875–880.
- Rochlani Y, Pothineni NV, Kovelamudi S, et al. Metabolic syndrome: pathophysiology, management, and modulation by natural compounds. Ther Adv Cardiovasc Dis. 2017; 11(8): 215–225.
- Fahed G, Aoun L, Bou Zerdan M, et al. Metabolic Syndrome: Updates on Pathophysiology and Management in 2021. Int J Mol Sci. 2022; 23(2).
- Stanek A, Fazeli B, Bartuś S, et al. The Role of Endothelium in Physiological and Pathological States: New Data. Biomed Res Int. 2018; 2018: 1098039.
- Feinberg M, Schwartz R, Tanne D, et al. Impact of the Metabolic Syndrome on the Clinical Outcomes of Non-Clinically Diagnosed Diabetic Patients With Acute Coronary Syndrome. The American Journal of Cardiology. 2007; 99(5): 667–672.
- Clavijo LC, Pinto TL, Kuchulakanti PK, et al. Metabolic syndrome in patients with acute myocardial infarction is associated with increased infarct size and in-hospital complications. Cardiovasc Revasc Med. 2006; 7(1): 7–11.
- Rashed A, Gombocz K, Alotti N, et al. Is sternal rewiring mandatory in surgical treatment of deep sternal wound infections? J Thorac Dis. 2018; 10(4): 2412–2419.
- Rátgéber L, Lenkey Z, Németh Á, et al. The effect of physical exercise on arterial stiffness parameters in young sportsmen. Acta Cardiol. 2015; 70(1): 59–65.
- Burián Z, Pakai A, Cziráki A, et al. Novel Aspects of Differences in Arterial Stiffness Parameters during Short Abstinent Period in Smokers vs. Non-smokers. Artery Research. 2020; 26(4): 212.
- Takami T, Saito Y. Effects of smoking cessation on central blood pressure and arterial stiffness. Vasc Health Risk Manag. 2011; 7: 633–638.
- Czernin J, Waldherr C. Cigarette smoking and coronary blood flow. Prog Cardiovasc Dis. 2003; 45(5): 395–404.
- Salahuddin S, Prabhakaran D, Roy A. Pathophysiological Mechanisms of Tobacco-Related CVD. Glob Heart. 2012; 7(2): 113–120.
- Rosner SA, Stampfer MJ. The heart-breaking news about tobacco: it's all bad. Lancet. 2006; 368(9536): 621–622.
- Collet JP, Thiele H, Barbato E, et al. ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021; 42(14): 1289–1367.
- Thygesen K, Alpert JS, Jaffe AS, et al. ESC Scientific Document Group. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019; 40(3): 237–269.
- Roffi M, Patrono C, Collet JP, et al. ESC Scientific Document Group . 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016; 37(3): 267–315.
- Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019; 74(10): e177–e232.
- Alberti KG, Eckel RH, Grundy SM, et al. International Diabetes Federation Task Force on Epidemiology and Prevention, Hational Heart, Lung, and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, International Association for the Study of Obesity. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009; 120(16): 1640–1645.
- 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(19): 2486–2497.
- Almahmeed W, Arnaout MS, Chettaoui R, et al. Coronary artery disease in Africa and the Middle East. Ther Clin Risk Manag. 2012; 8: 65–72.
- Zubaid M, Rashed W, Alsheikh-Ali AA, et al. Disparity in ST-segment Elevation Myocardial Infarction Practices and Outcomes in Arabian Gulf Countries (Gulf COAST Registry). Heart Views. 2017; 18(2): 41–46.
- Al Suwaidi J, Zubaid M, El-Menyar AA, et al. Prevalence of the metabolic syndrome in patients with acute coronary syndrome in six middle eastern countries. J Clin Hypertens (Greenwich). 2010; 12(11): 890–899.
- Ahamad J, Toufeeq I, Khan MA, et al. Oleuropein: A natural antioxidant molecule in the treatment of metabolic syndrome. Phytother Res. 2019; 33(12): 3112–3128.
- Kisbenedek A, Szabo Sz, Polyak E, et al. Analysis oftrans-resveratrol in oilseeds by high-performance liquid chromatography. Acta Alimentaria. 2014; 43(3): 459–464.
- Gódi S, Erőss B, Gyömbér Z, et al. Centralized care for acute pancreatitis significantly improves outcomes. J Gastrointestin Liver Dis. 2018; 27(2): 151–157.
- Cziráki A, Ajtay Z, Nagy A, et al. Early post-operative thrombosis of the prosthetic mitral valve in patient with heparin-induced thrombocytopenia. J Cardiothorac Surg. 2012; 7: 23.
- Füge K, Makai A, Breitenbach Z, et al. testtömegindex és az egészséges táplálkozáshoz kapcsolódó attitűdök – egy reprezentatív felmérés első eredményei ÚJ DIÉTA: A MAGYAR DIETETIKUSOK LAPJA (2001-) 24 : 4 pp. 2-4. 2015; 3: p.
- Kovacs VA, Bakacs M, Kaposvari C, et al. [Hungarian Diet and Nutritional Status Survey 2014. I. Nutritional status of the Hungarian adult population]. Orv Hetil. 2017; 158(14): 533–540.
- Mansour A, Al-Hassan A, Al-Jazairi M. Cut-off values for waist circumference in rural Iraqi adults for the diagnosis of metabolic syndrome. Rural and Remote Health. 2007.
- Kalan Farmanfarma K, Kaykhaei MA, Adineh HA, et al. Prevalence of metabolic syndrome in Iran: A meta-analysis of 69 studies. Diabetes Metab Syndr. 2019; 13(1): 792–799.
- Zeller M, Steg PG, Ravisy J, et al. Observatoire des Infarctus de Côte-d'Or Survey Working Group. Prevalence and impact of metabolic syndrome on hospital outcomes in acute myocardial infarction. Arch Intern Med. 2005; 165(10): 1192–1198.