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Metabolic Syndrome, CRP and Cardiovascular Events
The impact of metabolic syndrome on mortality from coronary heart disease (CHD) or CVD was examined in a prospective cohort of 6,255 subjects representative of the U.S. adult population at large and who were followed for a mean of 13.3 years. Although the presence of diabetes predicted all mortality endpoints, the presence of metabolic syndrome in nondiabetic subjects also strongly predicted CHD and CVD mortality, and metabolic syndrome was a stronger predictor of CVD, CHD and total mortality than were its individual components. However, even subjects with only one or two metabolic syndrome characteristics were at increased risk, suggesting that risk reduction is not optimal unless all components of metabolic syndrome have been clinically addressed. These findings were reinforced by a post-hoc analysis of data from the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) and the Scandinavian Simvastatin Survival Study (4S), indicating that metabolic syndrome is associated with a risk for major cardiac events that is not accounted for entirely by traditional risk-scoring systems. These studies suggest the need for intensified treatment recommendations, even in persons with only one or two metabolic syndrome risk factors.
Figure 2. Age-adjusted mean (SE) CRP levels in women and men according to the number of components of metabolic syndrome. A highly significant relationship (P trend <0.0001) was observed between the number of components of metabolic syndrome present and CRP levels.
The relationship of CRP to metabolic syndrome and cardiovascular (stabilizing the heart rhythm in conditions in which the heart is beating too fast or in an irregular rhythm) events was examined in 3,037 men and women enrolled in the Framingham Offspring Study. Over a seven-year period, 189 cardiovascular events occurred, and the mean age-adjusted CRP levels for those with 0, one, two, three, four or five metabolic syndrome traits ranged 2.2-6.6 mg/L (Figure 2). Metabolic syndrome and CRP at baseline were independently related to risk of cardiovascular (affect the heart and circulation) events, even after adjustments for age and sex.
Figure 3. Relative risks of future cardiovascular events in apparently healthy women according to the number of components of the metabolic syndrome and CRP levels above or below 3 mg/L. CRP levels >3 mg/L at baseline added prognostic information at all levels of severity of the metabolic syndrome, particularly among those with three, four or five characteristics (P<0.001 for all).
Another study explored the relationship among CRP, metabolic syndrome and incident cardiovascular (treating supraventricular tachycardia, a rhythm disturbance of the heart) events in 14,719 apparently healthy women. At study entry, 24% of the cohort had metabolic syndrome. The median CRP at baseline for those having 0, one, two, three, four or five characteristics of metabolic syndrome ranged 0.68-5.75 mg/L. Over the eight-year follow-up, event-free survival based on CRP >3 mg/L or <3 mg/L was similar to that in women having >3 or <3 characteristics of metabolic syndrome. Elevated CRP added clinically significant prognostic information at all levels of severity of metabolic syndrome, with additive effects observed for those with four or five metabolic syndrome characteristics (all PO.001) (Figure 3).
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