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Prognostic Implication of Metabolic Syndrome in Atrial Fibrillation Patients without CAD

This study examines the long-term prognostic implications of metabolic syndrome (MetS) on non-thromboembolic major adverse cardiovascular events (MACE), including myocardial infarction, coronary revascularization, and cardiac death, in atrial fibrillation (AF) patients without overt coronary artery disease (CAD). The results show that MetS confers an independent and increased risk of MACE in this patient population.

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Prognostic Implication of Metabolic Syndrome in Atrial Fibrillation Patients without CAD

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  1. Chih-Hsin, Yeh 2019.01.23

  2. Introduction • Atrial fibrillation (AF), the most common cardiac arrhythmia worldwide,has become a leading health concern owing to its growingprevalence and a strong association with increased morbidity andmortality. • Indeed, contemporary findings demonstrate that >40% of deaths inAF patients are cardiac-related (i.e. sudden cardiac arrest, fatal MI, orprogressive HF), whereas <10% of mortality is attributable to strokeor bleeding events. • Also, available evidence indicates that AF isassociated with a approximately 50% higher risk of MI, whereaspatients without established coronary artery disease (CAD) have a70% higher risk ofMI compared with individuals without AF.

  3. Introduction • Recently, a novel 2MACE risk score, featuring MetS (assigning twopoints for MetS and prior MI, and one point each for age >_75 years,chronic HF, and embolism), has been introduced as a tool to assessthe risk of future non-thromboembolic MACE in AF patients. • As a modifiable component of the score, MetS has been outlined as a possible target for interventions aiming to reduce cardiovascular risk. • However, the prevalence and long-term risk of MACE related to MetS in AF patients have not been established.

  4. Objective • We have hypothesized that if MetSconfersa higher risk of non-thromboembolic MACE in AF patients, the evidencewould be most convincingly demonstrated in AF subjects withoutevident CAD. • The objective of the present study was toassess the long-term prognostic implication of MetS for incidentMACE, including MI, coronary revascularization, and cardiac death, ina cohort of AF patients free of overt CAD at baseline.

  5. Methods －Study population • The study was designed as an observational, prospective, cohort study,including adult (age ≧ 18 years) patients with non-valvular AF free of overtCAD at baseline. • The study was conducted at the Department ofCardiology, Clinical Center of Serbia, Belgrade, Serbia, which is a tertiaryhealthcare centre receiving referrals from primary and secondary healthcareproviders from Belgrade and Serbia.

  6. Methods

  7. Methods －Assessment of the metabolic syndrome • At inclusion, MetS was defined according to the National CholesterolEducation Program Adult Treatment Panel III (NCEP ATP III) criteria as ≧ 3 of the following: • waist circumference ≧ 88cm in women, and ≧ 102 cm in men • elevated plasma triglycerides (≧ 1.7mmol/L), or treatment for high triglycerides • low-plasma HDL-C (<1.3mmol/L for women and <1.04mmol/L for men) • high fasting plasma glucose(≧ 5.6mmol/L), or diabetes treatment • blood pressure ≧ 130/80mmHg, or treated hypertension.

  8. Methods－Outcomes • MACE:non-fatal/fatalMI, coronary revascularization or cardiac death. • Myocardial infarction • Cardiac revascularizationincluded either percutaneous or surgical revascularization fordocumented CAD (excluding revascularization for an acute MI). • Cardiacdeath was defined as sudden cardiac death, or death due to progressiveHF, cardiovascular procedures, and procedure-related bleeding.

  9. Methods－Statistical Analysis • Student’s t-test,Wilcoxon’srank-sum test, test, Fisher’s exact test • Poisson regression analysis • Cumulative time-to-event Kaplan–Meier curves were estimated according to MetSstatus and comparedwith the log-rank test • Cox proportional hazard models • adjusted for age, sex, smoking status, and the individual MetScomponents • propensity score (PS)-adjusted • The discriminative validity ofthe prediction models was assessed with the C-statistic.

  10. Results

  11. Results

  12. Results

  13. Results

  14. Conclusion • Metabolic syndrome is common in AF patients without overt CAD, and confers an independent, increased risk ofMACE, including MI, coronary revascularization, and cardiac death. • Given its prognostic implications, preventionand treatment of MetS may reduce the burden of non-thromboembolic complications in AF.

  15. Limitations • A major limitation to the present study is the single-centre design andinclusion of a moderate sample size of strictly Caucasian AF patientstreated at a tertiary cardiology centre, which limits generalization todifferent clinical settings and other races. • Another limitation concernsunmeasured confounders and the lack of adjustment for possiblechanges in risk factors and treatment over time that could havebiased the results. • Finally, subgroupanalyses have not been performed due to a lack of adequatestatistical power because of a limited sample size.

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