Abstract 13818: The Prognostic Importance of Metabolic Syndrome in a Large Cardiac Rehabilitation Cohort
Background: The metabolic syndrome (MetSyn) is associated with an increased risk of diabetes and cardiovascular disease. The purpose of the present investigation was to assess the association between MetSyn and outcomes in those who have coronary artery disease (CAD) and whether changes in cardiometabolic profile through cardiac rehabilitation (CR) are associated with improved mortality.
Methods: We conducted a study of 2867 subjects with CAD who attended a comprehensive CR program between 1996 and 2009. Data was obtained from the Cardiac Wellness Institute of Calgary and Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease databases. All subjects had cardiometabolic risk assessment including bloodwork, waist circumference measurement and exercise treadmill testing at program entry and completion (12 weeks). 1696 subjects had the same assessment at one year. Subjects were classified as having MetSyn according to the harmonized definition.
Results: At baseline, 1232 (48.3%) subjects had MetSyn; this number decreased to 1021 (42.5%) by the completion of CR (p<0.0001). By one year, 41.3% of subjects had MetSyn (p<0.0001). Completion of CR was associated with an improvement in fitness of 0.95 METs in those without MetSyn and 1.18 in those with MetSyn (p=0.0002). A diagnosis of MetSyn at baseline, post CR completion or at one year did not predict mortality (HRs: 1.10 (95%CI 0.81, 1.51), 1.31 (95%CI 0.95, 1.80) and 1.47 (95%CI 0.97, 2.22), respectively). Recovery from MetSyn by 12 weeks or 1 yr was also not associated with decreased mortality (HR 0.57 (95%CI 0.28, 1.15) and 0.54 (95%CI 0.22, 1.29)). When components of MetSyn were considered individually, hypertension and elevated glucose at baseline and 12 weeks were predictive of increased mortality (p-values for all HR <0.05); at one year, only elevated glucose was predictive (HR 1.85, 95%CI 1.18, 2.91).
Conclusion: Attending a CR program resulted in a reduction in a prevalence of MetSyn and improvement in fitness. While MetSyn predicts increased long-term risk of mortality in primary prevention, this does not appear to be the case in the short-term in secondary prevention. Potentially, improved aerobic fitness may neutralize the increased risk of MetSyn in patients participating in CR.
- © 2011 by American Heart Association, Inc.