Effects of Metabolic Syndrome on Cardiovascular Outcomes of Psoriatic Patients with Coronary Artery Disease: A Single Center Retrospective Cohort Study

Figures & data

Figure 1 Flow chart showing the selection of patients.

Abbreviations: MACEs, major adverse cardiovascular events; MetS, metabolic syndrome.

Table 1 Baseline Clinical Characteristics of the Non-MetS and MetS Groups

Parameter	Entire Cohort (n=307)	Non-MetS Group (n=213)	MetS Group (n=94)	P value
Age, years (n=307)	58.64 ± 9.99	58.77 ± 10.09	58.35 ± 9.81	0.733
Male, % (n=307)	270 (87.9)	197 (92.5)	73 (77.7)	<0.001
BMI, kg/m^2 (n=307)	26.07 ± 3.30	25.26 ± 2.88	27.90 ± 3.48	<0.001
Current smoker, %(n=307)	203 (66.1)	143 (67.1)	60 (63.8)	0.573
Hypertension, % (n=307)	174 (56.7)	93 (43.7)	81 (86.2)	<0.001
Diabetes, % (n=307)	147 (47.9)	71 (33.3)	76 (80.9)	<0.001
Hyperlipidemia, % (n=307)	290 (94.5)	199 (93.4)	91 (96.8)	0.233
Family history of CAD, % (n=307)	42 (13.7)	29 (13.6)	13 (13.8)	0.96
Previous stroke, % (n=307)	27 (8.8)	16 (7.5)	11 (11.7)	0.232
Peripheral vascular disease, % (n=307)	15 (4.9)	8 (3.8)	7 (7.4)	0.273
ACS type	194 (63.2)	134 (62.9)	60 (63.8)	0.878
STEMI, %	42 (13.7)	33 (15.5)	9 (9.6)	0.164
NSTEMI, %	28 (9.1)	16 (7.5)	12 (12.8)	0.141
UA, %	124 (40.4)	85 (39.9)	39 (41.5)	0.794
Medication at discharge (n=305)
Aspirin, %	281 (92.1)	198 (93.8)	83 (88.3)	0.097
P2Y12 inhibitors, %	248 (81.3)	169 (80.1)	79 (84.0)	0.414
ACEIs/ARBs, %	155 (50.8)	96 (45.5)	59 (62.8)	0.005
β-blockers, %	256 (83.9)	179 (84.8)	77 (81.9)	0.521
Statin, %	295 (96.7)	203 (96.2)	92 (97.9)	0.685
Psoriasis characteristics
Disease duration, years (n=277)	20 (15, 30)	23 (18, 30)	20 (13, 30)	0.2
Phototherapy, % (n=266)	33 (12.4)	24 (12.9)	9 (11.3)	0.708
Nonbiologic systemic treatment, % (n=266)	110 (41.4)	84 (45.2)	26 (32.5)	0.054
Biologic treatment, % (n=266)	28 (10.5)	22 (11.8)	6 (7.5)	0.292

Notes: Continuous variables are expressed as mean ± standard deviation or median (25th, 75th percentile); categorical variables are presented as number and percentages in parentheses. Missing data varied by variables.

Abbreviations: ACEIs, angiotensin-converting enzyme inhibitors; ACS, acute coronary syndrome; ARBs, angiotensin receptor blockers; BMI, body mass index; CAD, coronary artery disease; MetS, metabolic syndrome; NSTEMI, non-ST-segment elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction; UA, unstable angina.

Table 2 Biochemical and Coronary Characteristics of the Non-MetS and MetS Groups

Parameter	Entire Cohort (n=307)	Non-MetS Group (n=213)	MetS Group (n=94)	P value
White blood cell count, ×10^9/L (n=307)	7.28 ± 2.33	7.16 ± 2.34	7.58 ± 2.29	0.152
Hemoglobin, g/L (n=307)	146.28 ± 16.49	147.06 ± 15.98	144.50 ± 17.55	0.21
Platelet count, ×10^9/L (n=307)	230.72 ± 63.94	225.70 ± 61.66	242.07 ± 67.78	0.038
Glucose, mmol/L (n=306)	6.19 (5.22, 7.88)	5.74 (5.06, 7.02)	7.66 (6.02, 10.31)	<0.001
eGFR, mL/min/1.73m^2 (n=307)	87.64 ± 20.65	88.55 ± 20.43	85.58 ± 21.11	0.245
hsCRP, mg/L (n=272)	1.57 (0.65, 3.72)	1.37 (0.57, 3.2)	2.06 (1.08, 4.35)	0.005
HbA1c, % (n=302)	6.2 (5.7, 7.1)	6 (5.6, 6.7)	7 (6.2, 8.1)	<0.001
TC, mmol/L (n=302)	3.82 (3.21, 4.45)	3.81 (3.24, 4.46)	3.84 (3.16, 4.42)	0.753
LDL-c, mmol/L (n=302)	2.26 (1.76, 2.85)	2.29 (1.77, 2.91)	2.18 (1.72, 2.78)	0.346
HDL-c, mmol/L (n=302)	1.06 (0.89, 1.26)	1.13 (0.97, 1.33)	0.94 (0.82, 1.10)	<0.001
TG, mmol/L (n=302)	1.49 (1.07, 2.02)	1.29 (1.03, 1.70)	1.97 (1.34, 2.53)	<0.001
LVEF, % (n=299)	62 (58, 65)	61 (57, 65)	63 (59.5, 65)	0.29
Culprit vessel (n=305)
LAD, % (n=305)	265 (86.9)	179 (84.8)	86 (91.5)	0.112
LCX, % (n=305)	208 (68.2)	141 (66.8)	67 (71.3)	0.441
RCA, % (n=305)	221 (72.5)	152 (72.0)	69 (73.4)	0.805
LM, % (n=305)	45 (14.8)	29 (13.7)	16 (17.0)	0.456

Notes: Continuous variables are expressed as mean ± standard deviation or median (25th, 75th percentile); categorical variables are presented as number and percentages in parentheses. Missing data varied by variables.

Abbreviations: eGFR, estimated glomerular filtration rate; HbA1c, glycosylated hemoglobin type A1C; HDL-c, high-density lipoprotein cholesterol; hsCRP, high-sensitivity C-reactive protein; LAD, left anterior descending artery; LCX, left circumflex artery; LDL-c, low-density lipoprotein cholesterol; LM, left main artery; LVEF, left ventricular ejection fraction; MetS, metabolic syndrome; RCA, right circumflex artery; TC, total cholesterol; TG, triglycerides.

Table 3 Clinical Outcomes of the Two Groups

Parameter	Entire Cohort (n=291)	Non-MetS Group (n=204)	MetS Group (n=87)	P value
MACEs, %(n=291)	71 (24.4)	42 (20.6)	29 (33.3)	0.020
All-cause death, % (n=291)	10 (3.4)	7 (3.4)	3 (3.4)	1.000
Non-fatal myocardial infarction, % (n=291)	55 (18.9)	32 (15.7)	23 (26.4)	0.032
Non-fatal stroke, % (n=291)	5 (1.7)	3 (1.5)	2 (2.3)	0.996
Unplanned revascularization, %(n=291)	26 (8.9)	14 (6.9)	12 (13.8)	0.058
Re-hospitalization, %(n=291)	12 (4.1)	8 (3.9)	4 (4.6)	1.000

Abbreviations: MACEs, major adverse cardiovascular events; MetS, metabolic syndrome.

Table 4 Univariate and Multivariate Cox Regression Analysis of Risk Factors for MACEs in All Patients

Parameter	Univariate Cox Regression Analysis			Multivariate Cox Regression Analysis
	HR	95% CI	p	HR	95% CI	p
Age, years	0.985	0.962–1.008	0.196	0.989	0.967–1.013	0.378
Male	0.577	0.316–1.054	0.074	0.674	0.351–1.295	0.236
MetS	1.773	1.014–2.847	0.018	1.738	1.045–2.891	0.033
Current smoker	0.836	0.518–1.351	0.465
Family history of CAD	1.370	0.75–2.505	0.306
Previous stroke	1.048	0.454–2.420	0.913
Peripheral vascular disease	1.438	0.524–3.946	0.481
ACS	1.047	0.646–1.698	0.851
Disease duration of psoriatic	0.987	0.966–1.010	0.269
White blood cell count, ×10^9/L	1.119	1.031–1.215	0.007	1.042	0.949–1.145	0.386
Hemoglobin, g/L	0.99	0.977–1.004	0.158
Platelet count, ×10^9/L	1.004	1.001–1.008	0.01	1.004	1.000–1.008	0.059
eGFR, mL/min/1.73m^2	0.997	0.986–1.009	0.643
hsCRP, mg/L	1.049	0.988–1.113	0.115
LVEF, %	0.967	0.945–0.990	0.005	0.968	0.945–0.991	0.006
Culprit vessel
LAD	1.973	0.794–4.900	0.143
LCX	1.147	0.692–1.901	0.595
RCA	1.226	0.717–2.097	0.457
LM	0.799	0.382–1.571	0.552

Abbreviations: 95% CI, 95% confidence interval; ACS, acute coronary syndrome; CAD: coronary artery disease; eGFR: estimated glomerular filtration rate; hsCRP, high-sensitivity C-reactive protein; LAD, left anterior descending artery; LCX, left circumflex artery; LM, left main artery; LVEF, left ventricular ejection fraction; MACEs, major adverse cardiovascular events; MetS, metabolic syndrome; RCA, right circumflex artery.

Figure 2 Kaplan–Meier estimated event rates for patients with and without MetS. (A) Survival curves for the outcome of MACE in patients between two groups; (B) survival curves for the outcome of all-cause death in patients between two groups; (C) survival curves for the outcome of non-fatal myocardial infarction in patients between two groups; (D) survival curves for the outcome of non-fatal stroke in patients between two groups; (E) survival curves for the outcome of unplanned revascularization in patients between two groups; (F) survival curves for the outcome of re-hospitalization in patients between two groups.

Abbreviations: MACEs, major adverse cardiovascular events; MetS, metabolic syndrome.