Differential Relationship between Metabolic Syndrome Score and Severity of Coronary Atherosclerosis as Assessed by Angiography in a Non-Diabetic and Diabetic Korean Population

ABSTRACT

Whether the metabolic syndrome (MetS) has prognostic value for coronary artery disease (CAD) beyond its individual components is controversial. We compared the relationship between the number of MetS components and CAD severity as assessed by angiography in non-diabetic and diabetic subjects. We consecutively enrolled 527 patients who underwent their first coronary angiography. Patients were divided into four groups according to the number of MetS components 0/1, 2, 3, and 4/5. A coronary atherosclerosis score was used to quantify the extent of atherosclerotic involvement. The relationship between the MetS score and angiographic CAD severity or clinical presentation was compared between non-diabetic and diabetic subjects. Individuals with the MetS (n = 327) had a higher prevalence of CAD (60% vs 32%, P < 0.001), multi-vessel disease (34% vs 16%, P < 0.001), and acute coronary syndromes (49% vs 26%, P < 0.001) than those without the MetS. In the non-diabetic group, atherosclerosis score increased with the MetS score (1.0 +/- 2.1, 2.0 +/- 2.9, 2.8 +/- 2.9, and 3.6 +/- 3.9, P < 0.001) whereas there was no significant difference in the diabetic group (0.5 +/- 1.0, 5.2 +/- 4.7, 4.2 +/- 2.9, and 4.4 +/- 3.5, P = 0.102). The MetS score is related to CAD severity in non-diabetic patients but the association between the MetS score and angiographic CAD severity may be obscured in the presence of diabetes.