Treatment patterns and risk factor control in patients with and without metabolic syndrome in cardiac rehabilitation

Figures & data

Table 1 IDF definition of MetS^7,40

Parameter	Explanation
Central obesity	Defined as waist circumference ≥94 cm for European men and ≥80 cm for European women, with ethnicity specific values for other groups*
plus any two of the following four factors:
Raised TG	≥1.7 mmol/L (150 mg/dL) or specific treatment for this lipid abnormality
Reduced HDL-C	<1.03 mmol/L (40 mg/dL) in males <1.29 mmol/L (50 mg/dL) in females or specific treatment for this lipid abnormality
Raised blood pressure	Systolic: ≥130 mmHg or diastolic: ≥85 mmHg or treatment of previously diagnosed hypertension
Raised plasma glucose**	Fasting plasma glucose ≥5.6 mmol/L (100 mg/dL) or previously diagnosed type 2 diabetes

Notes:

* If BMI is >30 kg/m², central obesity can be assumed and waist circumference does not need to be measured;

** In clinical practice, impaired glucose tolerance is also acceptable, but all epidemiological reports of the prevalence of MetS should use only fasting plasma glucose and presence of previously diagnosed diabetes to assess this criterion. Prevalence also incorporating 2-hour glucose results can be added as supplementary findings.

Abbreviations: IDF, International Diabetes Federation; MetS, metabolic syndrome; TG, triglycerides; HDL-C, high density lipoprotein cholesterol; BMI, body mass index.

Table 2 Demographic and clinical factors in patients with and without MetS

Parameter	Total n = 27,904	MetS n = 15,819	No MetS n = 12,085	P value*	Odds ratio*
Demographics
Age, years	64.3 ± 11.5	64.6 ± 11.2	63.9 ± 11.8	<0.0001
Gender, male, %	71.7	67.6	77.2	<0.0001	0.62
Weight, kg	82.4 ± 16.1	87.0 ± 16.2	76.4 ± 13.8	<0.0001
Body mass index, kg/m^2	28.37 ± 4.78	30.0 ± 4.71	26.24 ± 3.95	<0.0001
Waist circumference, cm	99.5 ± 13.5	105.0 ± 11.8	92.5 ± 12.2	<0.0001
Diagnosis for CR
STEMI, %	41.1	38.7	44.3	<0.0001	0.79 (0.76–0.83)
NSTEMI, %	21.8	21.7	21.9	0.72	0.99 (0.93–1.05)
Unstable angina pectoris, %	16.7	17.3	15.9	<0.01	1.10 (1.04–1.18)
Therapy in acute hospital
PCI, %	55.1	52.7	58.3	<0.0001	0.80 (0.76–0.84)
Coronary artery bypass, %	39.5	42.2	35.9	<0.0001	1.30 (1.24–1.37)
Risk factors
Diabetes mellitus, %	35.7	52.1	14.0	<0.0001	6.66 (6.26–7.08)
Dyslipidemia, %	97.1	97.7	96.3	<0.0001	1.63 (1.42–1.88)
Arterial hypertension, %	86.9	94.6	76.8	<0.0001	5.26 (4.85–5.70)
Smoking, current, %	15.7	14.4	17.5	<0.0001	0.79 (0.74–0.85)
Smoking, previous, %	47.7	48.0	47.2	0.23	1.03 (0.98–1.08)
Peripheral arterial disease, %	12.2	12.9	11.3	<0.0001	1.16 (1.08–1.25)
Previous stroke, %	8.8	9.4	8.0	<0.0001	1.19 (1.10–1.30)
Positive family history, %	30.5	31.3	29.5	0.01	1.09 (1.03–1.15)

Note:

* P values and odds ratios refer to the comparison between the two groups (MetS versus no MetS) at entry.

Abbreviations: MetS, metabolic syndrome; CR, cardiac rehabilitation; STEMI, ST elevation myocardial infarction; NSTEMI, non-ST elevation myocardial infarction; PCI, percutaneous coronary intervention.

Table 3 Drug treatment at entry and discharge

Parameter	Total n = 27,904	MetS n = 15,819	No MetS n = 12,085	P value*	Odds ratio*
Statins, any %	79.9 → 95.2	79.7 → 95.2	80.2 → 95.4	0.30 → 0.40	0.97 → 0.95
Simvastatin, %	61.0 → 83.2	60.6 → 82.7	61.6 → 83.8	0.08 → <0.05	0.96 → 0.92
Dose, mg/day ± SD	30.4 ± 12.7 → 31.3 ± 13.9	30.5 ± 12.7 → 31.3 ± 13.9	30.3 ± 12.6 → 31.4 ± 13.9	0.34 → 0.41
Pravastatin, %	3.8 → 2.0	3.8 → 2.0	3.8 → 2.0	0.97 → 0.85	1.00 → 1.02
Atorvastatin, %	7.0 → 4.4	7.1 → 4.5	6.7 → 4.2	0.22 → 0.37	1.06 → 1.05
Fluvastatin, %	7.9 → 5.5	8.0 → 5.7	7.8 → 5.2	0.69 → <0.05	1.02 → 1.11
Other statin, %	0.5 → 1.8	0.5 → 1.8	0.4 → 1.8	0.24 → 0.86	1.23 → 0.98
CAI, %	7.2 → 47.2	7.6 → 47.0	6.7 → 47.3	<0.01 → 0.65	1.14 → 0.99
ASA, %	83.8 → 84.2	83.0 → 83.4	84.8 → 85.2	<0.0001 → <0.0001	0.88 → 0.87
ASA clopidogrel, %	45.2 → 42.0	42.2 → 39.0	49.2 → 46.0	<0.0001 → <0.0001	0.76 → 0.75
Beta blocker, %	86.2 → 89.5	87.1 → 90.3	85.0 → 88.6	<0.0001 → <0.0001	1.19 → 1.20
ACE inhibitor, %	71.5 → 72.6	72.0 → 73.3	70.9 → 71.6	<0.05 → <0.01	1.05 → 1.09
ARB, %	12.4 → 16.3	14.0 → 18.4	10.4 → 13.6	<0.0001 → <0.0001	1.41 → 1.44
Oral antidiabetic drug, %	15.3 → 16.9	22.9 → 25.3	5.3 → 6.1	<0.0001 → <0.0001	5.3 → 5.23
Insulin, %	12.3 → 12.6	18.1 → 18.5	4.7 → 4.8	<0.0001 → <0.0001	4.49 → 4.54

Notes:

* P values and odds ratios refer to the comparison between the two groups (MetS versus no MetS) at entry. Values are percentages at entry and → at discharge.

Abbreviations: MetS, metabolic syndrome; SD, standard deviation; CAI, cholesterol absorption inhibitor; ASA, acetylic salicylic acid; ACE, angiotensin converting enzyme; ARB, angiotensin receptor blocker.

Table 4 Parameters and treatment goal achievement at entry and discharge

Parameter	Total n = 27,904	MetS n = 15,819	No MetS n = 12,085	P value*	Odds ratio*
TC (mg/dL)	184.9 ± 48.0 → 152.6 ± 36.1	184.8 ± 49.6 → 151.0 ± 37.0	185.1 ± 45.3 → 155.0 ± 35.2	<0.05 → <0.0001	NA
LDL-C (mg/dL)	113.8 ± 39.1 → 86.1 ± 28.6	113.9 ± 40.1 → 85.4 ± 28.9	113.7 ± 37.6 → 87.1 ± 28.0	0.26 → <0.0001	NA
HDL-C (mg/dL)	43.2 ± 12.8 → 43.2 ± 12.0	39.9 ± 11.1 → 40.2 ± 10.6	48.2 ± 13.6 → 47.7 ± 12.7	<0.0001 → <0.0001	NA
TG (mg/dL)	157.4 ± 81.0 → 136.1 ± 71.3	178.1 ± 94.5 → 149.8 ± 76.1	126.0 ± 62.2 → 115.3 ± 57.4	<0.0001 → <0.0001	NA
Guideline achievement
LDL-C <100 mg/dL	38.7 → 73.8	39.4 → 74.6	37.5 → 72.8	<0.01 → <0.01	1.08 → 1.10
TC <200 mg/dL	66.7 → 90.3	66.4 → 90.7	67.3 → 89.8	0.12 → <0.05	0.96 → 1.10
HDL-C > 50 (w)/> 40 mg/dL (m)	44.0 → 44.4	27.4 → 30.8	69.2 → 64.9	<0.0001 → <0.0001	0.17 → 0.24
TG < 150 mg/dL	58.1 → 70.4	43.7 → 62.2	80.0 → 82.8	<0.0001 → <0.0001	0.19 → 0.34
HDL-C > 50/40 mg/dL + TG < 150 mg/dL	29.0 → 34.6	9.3 → 20.7	58.9 → 55.6	<0.0001 → <0.0001	0.07 → 0.21
LDL-C < 100 mg/dL + HDL-C > 50 or 40 mg/dL + TG < 150 mg/dL	11.5 → 25.9	4.2 → 15.9	22.5 → 41.1	<0.0001 → <0.0001	0.15→ 0.27
Systolic/diastolic BP at entry and discharge (mmHg)	130.5 ± 20.3/76.5 ± 11.5 → 122.3 ± 14.4/72.7 ± 9.3	132.8 ± 20.5/77.2 ± 11.7 → 123.9 ± 14.4/73.1 ± 9.4	127.4 ± 19.6/75.7 ± 11.2→ 120.2 ± 14.1/72.2 ± 9.1	<0.0001/<0.0001 → <0.0001/0.0001	NA
HbA1c (%) (entry only)	6.5 ± 1.1	6.6 ± 1.1	6.1 ± 1.0	<0.0001	NA
Creatinine (mg/dL)	1.2 ± 0.9 → 1.3 ± 0.95	1.2 ± 0.9 → 1.3 ± 0.95	1.2 ± 0.9 → 1.2 ± 0.95	<0.0001 → <0.0001	NA
Fasting blood glucose (mg/dL)	108.1 ± 33.3 → 103.3 ± 27.0	115.08 ± 36.21 → 108.57 ± 29.23	97.63 ± 25.01 → 94.53 ± 20.03	<0.0001 → <0.0001	NA
Max exercise (Watts)	77.3 ± 37.0 → 93.7 ± 39.3	75.5 ± 36.4 → 91.1 ± 38.8	79.3 ± 37.5 → 96.9 ± 39.6	<0.0001 → <0.0001	NA

Notes:

* P values and odds ratios refer to the comparison between the two groups (MetS vs no MetS) at entry and (indicated by the arrow →) at discharge.

Abbreviations: MetS, metabolic syndrome; TC, total cholesterol; NA, not applicable; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol; TG, triglycerides; w, women; m, men; BP, blood pressure; HbA_1c, glycosylated hemoglobin (HbA_1c values refer to entry visit).

Figure 1A LDL-C control rates.

Notes: LDL-C control was defined as <100 mg/dL.
Abbreviations: LDL-C, low density lipoprotein cholesterol; MetS, metabolic syndrome.

Figure 1B HDL-C control rates.

Notes: HDL-C control was defined as >50 mg/dL in females and >40 mg/dL in males.
Abbreviations: HDL-C, high density lipoprotein cholesterol; MetS, metabolic syndrome.

Figure 1C TG control rates at entry and discharge.

Notes: TG control was defined as <150 mg/dL.
Abbreviations: TG, triglycerides; MetS, metabolic syndrome.

Figure 1D Combined control rates (HDL-C and TG).

Notes: HDL-C control was defined as >50 mg/dL in females and >40 mg/dL in males. TG control was defined as <150 mg/dL.
Abbreviations: HDL-C, high density lipoprotein cholesterol; TG, triglycerides; MetS, metabolic syndrome.

Figure 1E Combined control rates (LDL-C, HDL-C, and TG).

Notes: LDL-C control was defined as <100 mg/dL. HDL-C control was defined as >50 mg/dL in females and >40 mg/dL in males. TG control was defined as <150 mg/dL.
Abbreviations: LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol; TG, triglycerides; MetS, metabolic syndrome.

Internation Diabetes FederationIDF worldwide definition of the metabolic syndrome Available from: http://www.idf.org/idf-worldwide-definition-metabolic-syndromeAccessed on December 22, 2010

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MaglianoDJShawJEZimmetPZHow to best define the metabolic syndromeAnn Med2006381344116448987

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